This is the current release of the guideline.

Conditions or diseases of the elderly

Frail institutionalized elderly in long-term care settings (nursing homes and assisted-living facilities)

Recognition/Assessment

1. Conduct a comprehensive admission assessment including medical diagnosis, cognitive and psychosocial assessment, estimated life expectancy, history and results of diagnostic and screening tests, identification of risk factors
2. Review the patient's goals of care and advanced directives
3. Clarify the pertinence of potential preventive interventions

Management/Prevention

1. Develop a preliminary, individualized health maintenance plan that may include review of advanced directives, rehabilitative exercise program, medication review, screening tests and immunizations for disease prevention, interventions for lifestyle modification, and psychosocial/spiritual interventions
2. Reach agreement on the health maintenance plan with the patient, family, and primary care practitioner
3. Implement the patient's health maintenance plan

Monitoring

1. Reassess the patient's health maintenance status
2. Monitor the facility performance in implementing health maintenance interventions

Benefits and risks of health maintenance interventions

Not stated

Not stated

Not applicable

Not stated

This guideline was developed by an interdisciplinary workgroup, using a process that combined evidence and consensus-based approaches. Workgroups include practitioners and others involved in patient care in long-term care facilities. Beginning with a general guideline developed by an agency, association, or organization such as the Agency for Healthcare Research and Quality (AHRQ), pertinent articles and information, and a draft outline, each group works to make a concise, usable guideline that is tailored to the long-term care setting. Because scientific research in the long-term care population is limited, many recommendations are based on the expert opinion of practitioners in the field.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Guideline revisions are completed under the direction of the Clinical Practice Guideline Steering Committee. The committee incorporates information published in peer-reviewed journals after the original guidelines appeared, as well as comments and recommendations not only from experts in the field addressed by the guideline but also from "hands-on" long-term care practitioners and staff.

All American Medical Directors Association (AMDA) clinical practice guidelines undergo external review. The draft guideline is sent to approximately 175+ reviewers. These reviewers include AMDA physician members and independent physicians, specialists, nurse practitioners, pharmacists, nurses, consultants in the specified area, and organizations that are knowledgeable of the guideline topic and the long-term care setting.

The algorithm Health Maintenance in the Long-Term Care Setting is to be used in conjunction with the clinical practice guideline. The numbers next to the different components of the algorithm correspond with the steps in the text. Refer to the "Guideline Availability" field for information on obtaining the full text guideline.

A clinical algorithm is provided for Health Maintenance in the Long-Term Care Setting.

The type of evidence supporting the recommendations is not specifically stated.

The guideline was developed by an interdisciplinary work group using a process that combined evidence- and consensus-based thinking.

Early detection and prevention of illness or its complications may reduce morbidity and mortality in the elderly, especially among those who are at the greatest risk of developing and dying from disease. Implementation of appropriate, individualized screening and preventive care measures may represent an opportunity to improve longevity or quality of life for frail elders.

Outcomes that may be expected from the implementation of this guideline include the following:

• More appropriate resource utilization
• A reduction in the number of patients who receive inappropriate procedures or care
• An increase in the number of patients who receive appropriate procedures and care
• Facilitation of patient-centered care goals (i.e., goals that are appropriate to patients' needs and wishes)
• Better-informed patients' families or advocates, with more appropriate expectations about the patient's care goals

Not stated

The implementation of all clinical practice guidelines (CPGs) is outlined in four phases. Each phase presents a series of steps, which should be carried out in the process of implementing the practices presented in this guideline. Each phase is summarized below.

1. Recognition
   • Define the area of improvement and determine if there is a CPG available for the defined area. Then evaluate the pertinence and feasibility of implementing the CPG

2. Assessment
   • Define the functions necessary for implementation and then educate and train staff. Assess and document performance and outcome indicators and then develop a system to measure outcomes

3. Implementation
   • Identify and document how each step of the CPG will be carried out and develop an implementation timetable
   • Identify individual responsible for each step of the CPG
   • Identify support systems that impact the direct care
   • Educate and train appropriate individuals in specific CPG implementation and then implement the CPG

4. Monitoring
   • Evaluate performance based on relevant indicators and identify areas for improvement
   • Evaluate the predefined performance measures and obtain and provide feedback

Not applicable: The guideline was not adapted from another source.

Organizational participants included:

• American Association of Homes and Services for the Aging
• American College of Health Care Administrators
• American Geriatrics Society
• American Health Care Association
• American Society of Consultant Pharmacists
• National Association of Directors of Nursing Administration in Long-Term Care
• National Association of Geriatric Nursing Assistants
• National Conference of Gerontological Nurse Practitioners

Funding was supported by the following: Amgen, Merck & Co., Inc., Ross Products Division of Abbott Laboratories, Sanofi-Aventis

Steering Committee

Committee Members: Marjorie Berleth, MSHA RNC FADONA; Lisa Cantrell, RN, C; Sandra Fitzler, RN; Joseph Gruber, RPh, FASCP, CGP; Hosam Kamel, MD, CMD; Susan M. Levy, MD, CMD; Harlan Martin, R.Ph., CCP, FASCP; Evvie F. Munley; Jonathan Musher, MD, CMD; Barbara Resnick, PhD, CRNP; William Simonson, Pharm.D., FASCP

Not stated

This is the current release of the guideline.

Electronic copies: None available

Print copies: Available from the American Medical Directors Association, 10480 Little Patuxent Pkwy, Suite 760, Columbia, MD 21044. Telephone: (800) 876-2632 or (410) 740-9743; Fax (410) 740-4572. Web site: www.amda.com 

None available

None available

This summary was completed by ECRI Institute on July 9, 2007. The information was verified by the guideline developer on August 23, 2007.

This NGC summary is based on the original guideline, which is copyrighted by the American Medical Directors Association (AMDA). Written permission from AMDA must be obtained to duplicate or disseminate information from the original guideline. For more information, contact AMDA at (410) 740-9743.