Abstract
As life expectancy increases the number of older adults requiring long-term care of some kind increases. These adults have varying needs, but most adults have problems with skin integrity, muscle weakness, and emotional issues in long-term care facilities. Interventions to meet these needs focus on preventing skin break down, improving muscle strength to prevent falls, and settings that promote usefulness and a feeling of not being alone. Current options available to older adults may not meet all of their needs, and creativity is needed in devising interventions to meet these needs. Structuring long-term care settings to encourage activity in older adults and connecting with other generations can help prevent feelings of loneliness and uselessness, and help older adults live meaningful and productive lives in long-term care settings.

Long-Term Healthcare Needs of the Elderly
As adults age many will require long-term health care. The evolving needs of the older adult population will require creative and new ways to meet their health care needs. This paper will look at the needs older adults have, and options that are currently available to meet these long-term care needs. This paper will also present new options that have been proposed for long-term health care settings, how these options compare with current interventions, and what outcomes can be expected if these new options are implemented.
The Problem
As life expectancies increase the older adult population will also increase. According to the 2000 Census there was a 12% increase in the population of United States citizens 65 years of age or older from 1990 to 2000 (U.S. Census Bureau, 2001). Caring for this aging population is a multifaceted problem as needs vary depending on the individual. The needs of an older individual also change over time as alterations in their physical condition and level of functioning occur (Joy & Fong, 2000). These needs not only include the type of long-term care setting to choose, but also encompass the special needs adults have as they age. These special needs include problems with skin breakdown, injuries that occur due to muscle weakness, and emotional issues such as feelings of loneliness or uselessness and even depression. All of these problems must be addressed if older adults are to function at the most independent level possible and have satisfaction in living (Joy & Fong, 2000).
Interventions and Expected Outcomes Current options available for older adults needing long-term healthcare include adult day care programs, homecare services, retirement communities, residential care facilities, and skilled care facilities. Not all of these options are available in all areas. Adult day care programs provide supervised supportive care services for the elderly for a portion of the day. Homecare services allow the elderly to remain in their homes and have healthcare services come to them. Retirement communities offer independent living for elderly who may or may not need medical services. Residential Care facilities allow the elderly to have their healthcare needs met in a home like setting, and usually have 15 or fewer residents. Skilled nursing facilities provide healthcare care to elderly that require 24 hour nursing care (Joy & Fong, 2000). While these options meet many needs of older adults there are some needs that frequently are not met. Three areas where needs are often not met are skin integrity, muscle weakness, and emotional support.
As adults age their skin integrity deteriorates over time. This change results in a decreased ability of the skin to act as a barrier to pathogens. The skin of an older adult is also easier to irritate, and can break down easily. One study by the Joanna Briggs Institute (2007) offered evidence based practices that can be utilized in the care of older adults in long-term care settings. From the research that is available the study found one way that skin deterioration can be prevented is by using disposable absorbent underpants rather than reusable underpants. Many older adults have trouble with incontinence, and disposable absorbent underpants help to keep urine away from the skin of an older adult. This helps to prevent skin breakdown that can be caused from direct contact of the older adult’s skin with urine. Older adults also have trouble with pressure sores due to decreased mobility, and the Joanna Briggs Institute (2007) study offered evidence based practice interventions that can be used to help prevent pressure sores. The study found that using no-rinse cleansers instead of soap and water could reduce pressure sores. Soap and water can dry the skin and cause increased breakdown, leading to unhealthy skin and a greater risk of pressure sores (Joanna Briggs Institute, 2007).
Aging adults often have problems with muscle weakness due to decreased activity. One study by Kato, Izumi, Hiramatsu, and Shogenji (2006) found that exercise programs in long-term health care facilities can help increase muscle strength in older adults and prevent weakness that can lead to the more serious problem of falls. The exercise program developed and used by the intervention group included warming up exercises, stretching in place, toe exercises, exercises to strengthen muscles in the lower extremities, exercises to facilitate neuromuscular function, and a cool down period. The study found that the intervention group maintained their mobility, had increased balance and a decreased number of fallers and falls when compared to the control group. Using this exercise plan can help improve muscle strength in older adults, and prevent falls occurring in long-term care facilities. This would increase the quality of life for these older adults, and prevent injuries that can severely decrease their quality of life (Kato, Izumi, Hiramatsu, and Shogenji, 2006). Older adults living in long-term care settings sometimes feel feelings of loneliness and uselessness. These feelings are sometimes caused because the older person has no regular visitors, or simply feels they have nothing to offer to the current generation. A study by Joy & Fong (2000) discussed housing options currently available to older adults, and proposed options that can help with the feelings of loneliness and disconnection with other generations. One such option is called intergenerational sharing. Intergenerational sharing is a housing community that unlike a retirement community has not only elderly residents, but residents of all ages. These communities would allow generations to learn from each other, and allow family members to better plan for the future healthcare needs of its elderly members since everyone learns and gains from the experience. Another option presented in the Joy & Fong (2000) study is The Eden Alternative. This option involves nursing homes that transform from mini-institutions to places where elderly can live meaningful and interactive lives. Current nursing homes often have strict schedules and are detached from the community. This can cause residents to become lonely, bored and sometimes depressed. Nursing homes participating in The Eden Alternative would have activities that add meaning to residents’ lives. Activities would include nurturing pets of all kinds, caring for and growing their own flowers and vegetables, and after school programs where students interact with the elderly residents. Many nursing homes currently have some of these type programs and have had positive feedback from residents. The Eden Alternative would provide a long-term care setting where older adults could be productive decreasing feelings of uselessness, and have interaction with people outside the long-term care setting helping reduce feelings of loneliness (Joy & Fong, 2000).
Practice Guidelines Guidelines for health maintenance in the long-term care setting were written and updated by the American Medical Directors Association (2007). The goals of the guidelines are “to improve the quality of care delivered to patients in long-term care settings,” and “to provide guidelines on primary prevention of the long-term care resident, to the extent that it is feasible and beneficial in the frail elderly long-term care population” (American Medical Directors Association, 2007). The guidelines use early detection and prevention as interventions to prevent illnesses, or complications from illnesses, that can decrease morbidity and mortality in the older adult population. The guidelines also state that execution of screening and preventive care measures that are tailored to individual residents of long-term heath care settings can help improve the quality and length of life for those residents (American Medical Directors Association, 2007).

Evidence Grading Using the Methodology Checklist (Scottish Intercollegiate Guidelines Network, 2004) the evidence used to compile this paper was graded. The articles entitled “Topical Skin Care in Aged Care Facilities” (Joanna Briggs Institute, 2007), “Development of an Exercise Program for Fall Prevention for Elderly Persons in a Long-Term Care Facility” (Kato, Izumi, Hiramatsu, and Shogenji, 2006), and “The Older Adult: A Comparison of Long-Term Care in Glasgow and San Francisco” (Joy & Fong, 2000) were all graded positively as having internal validity since the question focused in each study was appropriately addressed and clearly focused, the methodology description is included in all of the studies, literature searched in compiling the studies is sufficient and identifies all studies that were relevant, the quality of the studies was assessed, and enough similarities exist among the studies chosen to make combining the studies rational. The overall assessment of the “Topical Skin Care in Aged Care Facilities” (Joanna Briggs Institute, 2007) study did show there is a potential for bias since some of studies in the review had no control group. “Development of an Exercise Program for Fall Prevention for Elderly Persons in a Long-Term Care Facility” (Kato, Izumi, Hiramatsu, and Shogenji, 2006), and “The Older Adult: A Comparison of Long-Term Care in Glasgow and San Francisco” (Joy & Fong, 2000) studies did not show a potential for bias. Types of studies utilized in researching these articles include randomized control trials, cohort studies, and case-controlled studies.
Summary
Meeting the long-term healthcare needs of older adults can be challenging since these needs can vary depending on individuals. These needs not only include the type of long-term setting the older adult will live in, but problems they physically face as they age. Interventions to help promote skin integrity and muscle weakness can help prevent infection and injury in older adults. Living arrangements that encourage activity and involvement with other generations can help prevent loneliness and uselessness older adults may feel as they age. Putting the interventions listed in this paper to use in the clinical setting can help older adults be as functional as possible and live as independently as possible. The interventions will also help provide the highest possible quality care to older adults in long-term care settings, and prevent events such as falls and impaired skin integrity that can lead to a reduction in their quality of life.

References
American Medical Directors Association. (2007). Health maintenance in the long-term care setting. Retrieved July 17, 2009, from http://www.guideline.gov/summary/ summary.aspx?doc_id=10829&nbr=005654&string=elderly
Joanna Briggs Institute. (2007). Topical skin care in aged care facilities. Australian Nursing Journal, 15(6), 27-30. Retrieved July 12, 2009, from CINAHL Plus with Full Text database.
Joy, J., & Fong, C. (2000). The older adult: a comparison of long-term care in Glasgow and San Francisco. International Nursing Review, 47(3), 157-166. Retrieved July 17, 2009, from CINAHL Plus with Full Text database.
Kato, M., Izumi, K., Hiramatsu, T., & Shogenji, M. (2006). Development of an exercise program for fall prevention for elderly persons in a long-term care facility. Japan Journal of Nursing Science, 3(2), 107-117. Retrieved July 12, 2009, from CINAHL Plus with Full Text database.
Scottish Intercollegiate Guidelines Network. (2004). Methodology checklist. Retrieved July 12, 2009, from http://www.sign.ac.uk/methodology/checklists.html
U.S. Census Bureau. (2001). The 65 years and over population: 2000. Census 2000 Brief. Retrieved July 17, 2009, from http://www.census.gov/prod/2001pubs/c2kbr01-10.pdf