While nursing home residents suffer from pain, anxiety and other distressing symptoms, they are unable to communicate their discomfort due to cognitive impairments.

With electronic health records often lacking structured data on these symptoms, healthcare providers are struggling to deliver timely and appropriate palliative care.

A study from the Utilizing Palliative Leaders in Facilities to Transform care for people with Alzheimer's Disease research team, or UPLIFT-AD, led by Dr. Kathleen Unroe and Dr. John Cagle, seeks to address this gap by revamping an existing symptom assessment tool to improve the detection and management of distress in non-verbal patients.

The UPLIFT-AD study validated an enhanced symptom assessment tool to more accurately capture pain, anxiety and well-being indicators among nursing home residents with moderate to severe dementia.

Originally designed for post-mortem symptom reporting by family members, the adapted tool allows nursing home staff and families to report real-time observations of living residents, making it a valuable resource for guiding palliative care interventions.

Unroe, a research scientist at the Indiana University Center for Aging Research at Regenstrief Institute, told Healthcare IT News there is a critical role of standardized assessments in this process.

"Standardized assessments, relying on observation of clinical staff, do exist for people with cognitive impairment," she said. "This observational data can be captured in standard clinician assessment notes."

However, ensuring that this data is consistently integrated into EHRs remains a challenge.

One of the key issues in symptom tracking for cognitively impaired residents is the lack of structured integration within EHR systems.

While some may assume artificial intelligence or machine learning could help automate symptom detection, Unroe points out that the priority is simply ensuring that symptom assessment data makes it into EHRs in a systematic and accessible way.

"The first step is to get symptom assessment data into EHRs, by integrating assessments, and documentation of assessments, into clinical workflows," she said.

Rather than a technical limitation, integrating these assessments into existing EHRs is largely a matter of workflow optimization and staff training.

Nursing home clinicians must be equipped to document symptoms consistently, and IT systems must support seamless entry and retrieval of this critical data.

Improving palliative care in nursing homes also requires better coordination between different healthcare providers.

Nursing homes often operate in isolation, making it difficult for hospitals and specialists to access symptom records when residents are transferred or require additional care.

Unroe explained participation in health information exchanges could bridge this gap.

"Participation of nursing homes in health information exchanges and direct data exchanges, such as via portals, with hospitals is critical to ensure safer transitions of care," she said.

By linking nursing home EHRs with broader healthcare networks, clinicians can make more informed decisions about symptom management and palliative care interventions.

Looking ahead, healthcare IT solutions could play a crucial role in streamlining palliative care referrals and improving symptom tracking, with automation as a potential game-changer.

By integrating automated screening tools within EHR systems, nursing homes could proactively identify residents in need of specialized palliative care, ensuring that appropriate consultations and interventions are initiated in a timely manner.

"Automated identification of patients likely to benefit from palliative care, and the ability to generate lists of patients appropriate for referral, can take the burden of that process off of nursing home staff," Unroe explained.
 

Nathan Eddy is a healthcare and technology freelancer based in Berlin.
Email the writer: nathaneddy@gmail.com