Katherine Marshall

Hospital Admissions for Malnutrition and Dehydration in Patients With Dementia.

Dehydration and malnutrition are commonly experienced by patients with dementia and can result in hospitalizations and decreased quality of life. The purpose of this study was to explore and describe retrospectively, the incidence and correlations of variables that may precede hospitalizations for dehydration/malnutrition in the community-dwelling patient with dementia. Data from the Outcome and Assessment Information Set (OASIS) Start of Care (SOC) on 44 patients served by a Michigan home care agency were retrieved for analysis. This study did not reveal any single or collection of variables that would predict risk for hospitalization for dehydration/malnutrition. With the lack of specific predictors of hospitalization related to dehydration and malnutrition, clinicians need to place high priority on risk-lowering strategies and preventive education for patients, family, and caregivers.

The Benefits of Immunizations for Older Adults.

Immunizations are one of the most effective ways to combat morbidity and mortality associated with infectious disease (Pilkinton & Talbot, 2015). However, even though it is possible for diseases to be prevented via immunization, vaccination rates in the United States rarely meet their targets (Greenberg, 2012). Education on the benefits of timely immunization in preventing disease in older adult home care patients should be a priority intervention for the home healthcare clinician. Home healthcare clinicians can promote and administer routine immunizations that can assist in keeping their patients healthy and promote a good quality of life. Unfortunately, because older adults are often being treated for serious comorbidities, routine immunizations are sometimes overlooked. For those over 65 years of age, recommended vaccines include influenza (flu), herpes zoster (shingles), diphtheria, tetanus, pertussis (whooping cough), and pneumococcal disease (Centers for Disease Control and Prevention [CDC], 2016). These vaccines are relatively safe, with few contraindications and have a low rate of adverse reactions (Greenberg, 2012). Vaccines for influenza, pneumococcal pneumonia, and tetanus have preventative efficacy rates of about 90% (Greenberg, 2012). Influenza causes 23,000 deaths each year, with older adults accounting for 90% of these deaths (Pilkinton & Talbot, 2015). The influenza vaccine is given yearly, starting in October and ending in February of the following year (Greenberg, 2012). For older adults, the flu vaccine is given as an inactivated virus or the standard high-dose vaccine. The intranasal (live vaccine) is contraindicated in those over 49 years old (Greenberg, 2012). Home care clinicians will need to consult with the patient’s primary care provider or allergist if an egg allergy is present (CDC, 2016). Streptococcus pneumoniae is the most common bacterial cause of community-acquired pneumonia, and causes significant morbidity and mortality (Pilkinton & Talbot, 2015). The pneumococcal vaccination is typically given only once after the age of 65, but revaccination can occur after 5 years if diseases such as chronic renal failure, chronic immunosuppression, malignancies, and asplenia are present (Greenberg, 2012). There are two pneumococcal vaccines currently recommended: PCV-13 and PPSV-23. PCV-13 is recommended for all vaccinenaïve adults when they turn 65, followed by the PPSV-23 6 to 12 months later (Pilkinton & Talbot, 2015). If a patient has received PPSV-23 before turning 65, there should be a 1-year interval before PCV-13 is given, and the follow-up PPSV-23 should not be administered less than 5 years after the previous PPSV-23 dose (Pilkinton & Talbot, 2015). No further PPSV-23 doses after age 65 are recommended (Pilkinton & Talbot, 2015). The influenza and pneumococcal vaccines may be administered at the same time (by separate injection in opposite arms) without an increase in side effects or decrease in antibody response to either vaccine (Greenberg, 2012). Tetanus-diphtheria booster is needed every 10 years for those who received the series in childhood or teen years and have not received a booster in the last 10 years (Greenberg, 2012). A one-time dose of the tetanus, diphtheria, pertussis (Tdap) is recommended at the soonest opportunity for those over 65 who have not yet been vaccinated, regardless of when their last Td vaccine was (Pilkinton & Talbot, 2015). It should be noted that this vaccine is different than the childhood tetanus, diphtheria, and pertussis vaccine, as the one given to adults has less diphtheria and pertussis immunogen (as denoted by the lowercase letters) (Pilkinton & Talbot, 2015). If the patient has never been vaccinated for tetanus-diphtheria, the vaccine should be given twice within a 1to 2-month interval and an additional dose 6 to 12 months later (Greenberg, 2012). After this time, it is recommended that Td vaccine be administered every 10 years (Pilkinton & Talbot, 2015). The tetanus-diphtheria toxoid (Td) or Tetanus, diphtheria, pertussis (Tdap) booster may also be given with other vaccines (Greenberg, 2012). Varicella zoster virus resides in the nerve roots of people who have had varicella (chicken pox) and manifests as shingles with increasing incidence with age (Pilkinton & Talbot, 2015). In some patients over 60 years

Dementia and the home healthcare clinician.

As record number of individuals move into their retirement years, home healthcare clinicians are witnessing an increase in the number of patients and families struggling to cope with the complex symptoms of dementia. Unlike other terminal conditions such as cancer, the course of this terminal and debilitating disease can span several decades. Home healthcare clinicians will be caring for greater numbers of these patients and their families in the community.