Elder care staff may fail on eye, ear, mouth care
Anyone who has had a loved one in a nursing home well knows the anxiety and worry about whether the facility is a good fit for the illness and other needs of the patient. The focus usually is on the condition or conditions that triggered the move from home or hospital care, but recent research suggests that families also need to make sure nursing homes don't forget health-care basics for the eyes, the ears and the mouth.
The studies all show that routine screening of vision, hearing and dental care likely is to lapse in nursing homes, leaving staff unaware of problems that may make it difficult for patients to communicate.
The most recent study, involving 380 patients 55 years of age and older at 17 nursing homes in the Birmingham, Ala., area, was published in the July issue of the Archives of Ophthalmology.
The researchers, led by Cynthia Owsley of the University of Alabama-Birmingham, interviewed each patient, as well as a family member or guardian, about the use of eyeglasses and recent eye care.
Fifty-seven percent of the patients were visually impaired - no better than 20/40 vision in their better eye - and three-quarters had abnormal ability to detect boundaries between objects and changes in brightness, which is important for both mobility and reading.
Yet 66 percent of the patients had no reference to eye exams in their medical records, even though all 17 facilities had licensed optometrists on retainer for eye-care services. Asked about their most recent eye exam, 28 percent said they had one in the previous year, 20 percent said it was more than two years past or used words indicating that their last exam had been a long time ago.
Oral health also may suffer, experts say, particularly among baby boomers. While dental care for earlier generations of senior nursing-home patients generally meant making sure dentures got cleaned and periodically checked for fit, boomers mostly have grown old with their own teeth.
A 2005 survey of nursing-home executives in Ohio found that half rated the oral health of their residents as "poor" or "fair," yet 60 percent said they were satisfied with the dental care their residents got.
The survey, led by Marsha Pyle, associate dean of the Case Western Reserve University School of Dental Medicine, found that although 88 percent of the nursing homes have a staff dentist, most patients have to go off-site to see them, and daily dental care is left to nursing assistants. When time or other needs were a problem, most of the administrators said dental care could slide, even though most were aware that poor oral hygiene can lead to other health problems.
The research was published in the journal Special Care Dentistry.
Finally, a 2004 report from Dr. Jiska Cohen-Mansfield at the research institute of the Jewish Home for the Aging of Greater Washington found that more than half of 279 nursing-home residents in several institutions suffered from serious hearing loss, but staffers were aware of the hearing problem in fewer than half of them.
Only 30 of the nursing-home residents had been screened for hearing problems in the past year.
The researchers note that symptoms such as confusion, withdrawal and disorientation may be caused by untreated hearing loss, yet nursing-home caregivers are likely to assume that the problem is dementia related to old age unless the hearing problems are identified.
Other researchers have noted that nursing-home residents are particularly likely to have problems with the design and function of hearing aids. Many patients fret over batteries, earwax buildup and other difficulties, and some researchers suggest that simple external sound amplifiers are more useful than devices fitted to the ears for residents more concerned about function than style.
