Gastrointestinal Disorders in the Long-Term Care Setting (AMDA Clinical Guideline)
Although aging has relatively minimal effects on GI function, age-related changes can cause or contribute to several GI disorders. For example, oral changes (e.g., decreased taste sensation, decreased saliva production) can cause poor appetite, with associated weight loss. Aging can result in impaired function of the gastric mucosal barrier and increased risk of peptic ulcer disease. Patients residing in long term care facilities typically have numerous concurrent conditions and use numerous medications that may complicate the assessment and treatment of GI disorders. GI disorders may also be caused or exacerbated by a variety of medical conditions that are more prevalent with age. Fecal impaction and dehydration are sentinel events that may indicate a patient has or is at high risk for a GI disorder. In addition, the presentation of many GI disorders in older people is atypical. For example, GERD may present as dysphagia, asthma, recurrent aspiration pneumonia, or even cough. It is important for members of the interdisciplinary team in the long term care setting to realize the impact that GI disorders can have on patients' quality of life. These conditions can prevent patients from participating in activities, hinder their mobility, disrupt their sleep, and cause them to become socially isolated.This guideline focuses on the gastrointestinal (GI) disorders most commonly seen in the LTC population. The following outcomes may be expected from implementation of this clinical practice guideline: reduced incidence of some acute GI disorders and greater stability of chronic GI disorders; appropriate use of medications to treat GI disorder; appropriate use of acute care facilities to assess and treat GI disorders if indicated; appropriate use of specialist referrals and invasive testing in the management of GI disorders; reduced morbidity, mortality, and incidence of complications (e.g., fecal impaction, dehydration) of GI conditions and improved palliative care outcomes in residents with poor prognosis.
Anemia in the Long Term Care Setting, (AMDA Clinical Guidelines)