bluuebunny/crossref_metadata_2025 huggingface dataset:
Tai Chi Chih: An Exercise Option for Older Adults
Authors: Schaller Kevin J
Published: May 2014

ABSTRACT

The purpose of this study was to determine the effects of Tai Chi Chih on balance, flexibility, mood, health status, and blood pressure in a sample of community-dwelling elders. A quasi-experimental pretest-posttest design was used in the study. Participants were recruited from a senior center located in the suburbs of a large metropolitan area. The experimental group consisted of 24 volunteers over trie age of 55 who performed 60 minutes of Tai Chi Chih once a week for 10 weeks and practiced at home. The control group consisted of 22 volunteers who continued with their current level of activity. Analysis of covariance revealed a significant difference between the two groups on balance (F=4.3, p<.05). This study suggests that Tai Chi Chih is a safe and enjoyable form of exercise that might improve balance in community-dwelling elders.
THE EFFECT OF DIETARY FIBER IN TUBE-FED ELDERLY PATIENTS
Authors: Bass D Jamie , Forman Lawrence P , Abrams Sarah E , Hsueh Andie M
Published: May 2014

ABSTRACT

Diarrhea is a common problem with potentially serious consequences for elderly tube-fed patients. A review of the literature indicates that diarrhea has been associated with the use of antibiotics, low blood albumin concentration, and a lack of fiber in the diet. This study documents the observed effect or dietary fiber on the incidence of diarrhea in 50 tube-fed patients. Over a 3week period, patients who received fiber-containing formula had fewer liquid/loose stools than patients who received fiber-free formula. Nurses who care for elderly, tubefed patients can help to improve outcomes by advocacy and interdisciplinary collaboration with registered dietitians and primary providers and by teaching assistive staff the importance of accurate recording of bowel function.
FORMAL LONG-TERM CARE NETWORKS: Forming a Partnership with Gerontological Nurses
Authors: Travis Shirley S
Published: May 2014

ABSTRACT

Faced with overwhelming demands on their time, physical reserves, and emotional energy, contemporary families are depending more and more on formal networks to help them with their elder care responsibilities. In the past, these interactions worked in a somewhat complimentary fashion with each caregiver having identifiable roles and responsibilities. Now, reforms in health and human services are pushing and pulling families into complex caregiving partnerships. These situations have the very real potential for creating stress, strain, tension and conflict among caregivers, as well as opportunities for thriving partnerships in care.
UNDERSTANDING THE WANDERING PATIENT: A Continuity of Personality Perspective
Authors: Thomas David W
Published: May 2014

ABSTRACT

The purpose of this article is to study the relationship between personality and wandering behavior among individuals with dementia. Surrogates of 20 wanderers and 20 non-wanderers were administered a demographic and personality questionnaire. The findings, which also included a qualitative follow-up, revealed that wanderers scored significantly higher than non-wanderers on the personality factors of extroversion (p≤.01) and agreeableness (p≤.05). A strong implication of the study, for nurses and other care providers, is that for many people wandering is an expression of one's personality-ingrained over a lifetime of development-rather than solely an expression of dementia.
Strategies for: PROMOTING ETHICAL DECISION-MAKING
Authors: Mysak Sonia
Published: May 2014

The use of structured controversy as a strategy for helping the non-licensed caregiver make ethical decisions as well as develop critical thinking skills was an innovative teaching technique. Students in the Homecare/Special care aide program are essential providers of care to residents or clients in a special care facility or in a homecare setting. Theory and practice of ethical decision-making is not usually dealt with in the curriculum of the non-licensed caregiver. Implementation of this approach helped students learn theory and skills necessary when dealing with controversial issues in making ethical decisions. Thompson and Thompson's (1985) ten steps of bioethical decision-making were implemented to assist in the process. Structured controversy was defined and the process of implementing structured controversy outlined. A variety of ethical issues were presented based on the ethical principles of beneficence, justice, autonomy, truthfulness, confidentiality, and integrity (Yeo, 1991). Several definitions of critical thinking are presented.
The Eating Behavior Scale: A SIMPLE METHOD OF ASSESSING FUNCTIONAL ABILITY IN PATIENTS WITH ALZHEIMER'S DISEASE
Authors: Tully Mary W , Matrakas Katherine Lambros , Muir Joanne , Musallam Kathleen
Published: May 2014

ABSTRACT

Health care providers and family members need practical methods of assessing functional skills of individuals with Alzheimer's Disease (AD). There are neuropsychological tests that identify areas of function and dysfunction in the brain, but discrepancies have been noted between test scores and functional behaviors in activities of daily living (ADLs). The Eating Behavior Scale (EBS) was developed to measure functional ability during meals. A sample of 30 patients with probable AD were observed using the EBS during two meals on two different days. There was a strong negative correlation between meal duration and the EBS score. That is, the lower the EBS score, the longer the time required to complete the meal. Mini-Mental Status Exam (MMSE) scores were positively correlated with EBS scores. Patients with higher MMSE scores and less time since diagnosis tended to have higher EBS scores, indicating greater independence in eating.
POWER TO THE PATIENT
Authors: Tolley Mattie
Published: May 2014

I bandaged the arm of an elderly woman in a long-term care facility, using my best professional technique. She was immediately unhappy with the bandage, stating she wanted it done differently. Knowing my technique was best, I tried to put her off by saying, "Well, let it stay that way until we change it again, OKi" Finally she said with obvious anger, "It's my arm isn't itf" At last realizing the sense of powerlessness my action was causing, !promptly made the minor alteration she wanted. Therapeutically, it made little difference to her orthopedic problem but to the client it was the difference between self-control and powerlessness.
Caregiver Hardiness Explored Within Watson's Theory of Human Caring in Nursing
Authors: Piccinato Jacqueline M , Rosenbaum Janet N
Published: May 2014

Older family caregivers are often responsible for aged parents or spouses. The purpose of this theoretical article is to review the literature regarding the concept of hardiness, present a summary of Jean Watson's Theory of Human Caring in Nursing, explore older caregiver hardiness within Watson's theory, and discuss implications for gerontological nursing. An understanding of older caregiver hardiness within Watson's theory will guide gerontological practice, research, and theory development in nursing.
EVALUATION OF AN INSERVICE TRAINING PROGRAM ON DEMENTIA AND WANDERING
Authors: Cohen-Mansfield Jiska , Werner Perla , Culpepper William J , Barkley Denyse
Published: May 2014

Abstract This study assessed the impact of an inservice training program in four nursing homes on nursing staff's knowledge of dementia, pacing/wandering behavior and management strategies, staff satisfaction, and their perceptions of work difficulty and quality of care. Additionally, unit-level behavioral observations of agitated behavior and the nature of resident interactions with staff members and other residents were also performed to assess whether changes in nursing staff's knowledge impacted the residents or interactions with the residents. Analyses revealed that quiz scores were significantly improved immediately following the inservice program as compared to pretest but returned to near pretest levels at the 1 -month follow-up. Additionally, nursing staff reported that residents were allowed to pace/wander to a greater extent at follow-up compared to pretest. Methods for improving the effectiveness of inservice training are discussed.
HOSPITALIZED ELDERLY
Authors: Ryan Maura C
Published: May 2014

The Relationship Between Loneliness, Social Support, and Decline in Cognitive Function in the

Abstract: To determine the effects of preexisting levels of loneliness and social support on cognitive decline during hospitalization, 145 elderly subjects 65 to 92 years old without impaired cognition were tested for levels of loneliness, social support, and cognitive status on admission to an acute care hospital. Five days later, cognitive status was again measured in the remaining 86 patients. Loneliness was found to be inversely related to cognitive status on admission. In those with high loneliness scores on admission, cognitive status had improved significantly 5 days later. High social support was correlated with high cognitive status on admission and significant cognitive decline during hospitalization.
Assessment and Managment of SLEEP DISORDERS IN THE ELDERLY
Authors: Beck-Little Rebecca , Weinrich Sally P
Published: May 2014

ABSTRACT

Sleep disorders are major syndromes that can interfere with falling to sleep or maintaining sleep, or produce excessive daytime sleepiness. Sleep disorders are rarely diagnosed in the elderly due to age-related changes in sleep patterns. Gerontological nurses can assist the elderly client to achieve improved sleep through increased awareness of sleep disorders, related assessment tools, and interventions.
GRANDMOTHERS WHO RAISE GRANDCHILDREN
Authors: Dowdell Elizabeth B , Sherwen Laurie N
Published: May 2014

A Cross-Generational Challenge to Caregivers
DISCHARGE PLANNING FOR Elderly Patients
Authors: Rosswurm Mary Ann , Lanham Debra M
Published: May 2014

ABSTRACT

The complex chronic health problems and functional limitations common in the elderly population place them at risk for complicated hospitalizations and discharge planning. The purpose of this study was to investigate the effectiveness of a discharge planning protocol in identifying elderly patients' home care needs. The sample in this quasiexperimental study consisted of 507 hospitalized patients age 65 years or older. The control group received the usual hospital discharge planning protocol. In the experimental group, nurse/social worker teams coordinated the discharge planning process, using an adapted form of the Discharge Planning Questionnaire (DPQ) to identify the home care needs of elderly patients. Thirty days after hospital discharge, both patient groups participated in a telephone survey to obtain information about health care problems they experienced during home recovery and their use of health care resources.

The findings indicated that the majority of the elderly patients had functional dependencies, which required the help of another person to carry out daily household duties and provide assistance with basic needs, especially ambulation. These functionally dependent patients only received home care referrals about 50% of the time. These findings raise questions about current reimbursable services. Logistic regression analysis indicated that patients with increased functional dependency and patient problems during home recovery had a greater likelihood of rehospitalization and emergency department usage. This information about the home care of elderly patients after hospitalization supports the need for comprehensive functional assessment as part of discharge planning. This study also suggests that the nurse/social worker team can provide effective screening and discharge planning coordination of home care. Physician involvement and effective communication networks must be in place.
Testing the Uniform Needs Assessment Instrument for Hospital Discharge Planning With Older Adults
Authors: Westra Bonnie L , Holland Diane E , Aufenthie Judy , Cullen Laura , Finley Janet , Griebenow Linda , Hess Gale , Jacobson Theresa , Kennebek Sue , McHale Janyce , McMyler Eileen , Ohland Jill , Ryan Sheila , Wollan Peter
Published: May 2014

ABSTRACT

The Uniform Needs Assessment Instrument (UNAI) was developed to systematically assess the continuing care needs of high-risk older adults in response to the 1986 Omnibus Budget Reconciliation Act. Based on previous studies, a revised UNAI was tested with 103 hospitalized older adults, comparing usual discharge planning with the UNAI. High interrater reliability was obtained. The UNAI had high (≥ 85%) sensitivity and specificity when comparing needs identification on the UNAI with subjects' reported needs at 10 to 14 days after discharge. Overall, the UNAI was more effective (sensitive and specific).
GERONTOLOGICAL NURSING IN THE 21ST CENTURY
Authors: Burggraf Virginia , Barry Richard
Published: May 2014

ABSTRACT

The approaching millennium brings not only a muted but also a challenging vision for the future of gerontological nursing. This vision is muted by the rhetoric of the 90s dictating the elimination of costly programs with the potential to diminish quality. It is a vision of challenge to advocate for, protect, demand, and create a new framework that will guarantee high-quality health care for older patients.

In an attempt to clarify that vision, this article outlines three areas of gerontological nursing: education, practice, and research. The future direction in these areas will dictate how collective thinking can support health care for older people in the next century and beyond. These components of nursing must be integrated to develop quality care needed by older patients.
BALANCE AND MUSCLE STRENGTH as Predictors of Frailty Among Older Adults
Authors: Dayhoff Nancy E , Suhrheinrich Joy , Wigglesworth Janet , Topp Robert , Moore Susan
Published: May 2014

ABSTRACT

The term frailty is increasingly used in gerontological literature and in practice. However, indicators differentiating frail from nonfrail are not well delineated. Identifying factors discriminating between frail and nonfrail older community-residing adults may lead to more comprehensive clinical assessments and targeted interventions to minimize or prevent frailty. Eighty-four adults, ages 60 to 88 (mean = 74) living independently in the community completed a functional performance questionnaire and a perceived health questionnaire that were combined as measures of frailty. Predictor variables of frailty included four measures of balance and three measures of lower leg strength. Discriminant analysis revealed that one balance score and dorsiflexion correctly classified 65% of group membership, with better prediction of the nonfrail than frail group. This study clarifies that the predictors of frailty include the combination of dorsiflexion strength and balance, specifically the contribution of vision to balance when the support surface is compliant. Recommendations are proposed for conceptualizing and operationalizing frailty and adding variables to enhance discrimination between frailty and nonfrailty. Nursing implications include adding clinical assessments of specific components of balance and ankle strength to develop a more comprehensive evaluation of frailty.
Family Caregiving of Hospitalized Patients
Authors: Bowman Karen F , Rose Julia H , Kresevic Denise
Published: May 2014

CAREGIVER AND NURSE PERCEPTIONS AT ADMISSION AND DISCHARGE
Wandering and Technology Devices
Authors: Melillo Karen Devereaux , Futrell May
Published: May 2014

Helping caregivers ensure the safety of contused older adults
A Procedure for WITHDRAWAL OF SLEEP MEDICATION in Elderly Women Who Have Been Long-Term Users
Authors: Tabloski Patricia A , Cooke Kristin M , Thoman Evelyn B
Published: May 2014

ABSTRACT

A program for withdrawal of sedative/hypnotic medication was investigated in elderly women, ages 64 to 91. The sleep cycles of 10 drug withdrawal (DVV) and 10 non-drug withdrawal (N-DW) subjects were monitored for a 24-hour period for 5 successive weeks, using a nonintrusive recording procedure. The first 2 baseline weeks were followed by 1 week of half-dose, then 2 weeks of full withdrawal for the DW group. The results indicated no demonstrable effect on sleep, sleep complaints, levels of depression, or daytime sleepiness on the DW group. The conclusion is that the procedure of withdrawal from sleep medication over a 2-week period, combined with the use of a substitute pill to maintain the ritual of nightly pill-taking, is appropriate and effective for long-term elderly users.
SENIOR CENTERS Shifting Student Paradigms
Authors: Schneiderman Janet U , Jordan-Marsh Maryalice , Bates-Jensen Barbara
Published: May 2014

ABSTRACT

The purpose of this study was to evaluate an innovative service learning experience for new nursing students involving senior citizen centers. Junior nursing students (n - 128) were assigned in cohorts to one of five centers for a 5-week rotation. A questionnaire was administered post hoc to the students, teaching assistants, center directors, and a sample of senior citizens at each site. The majority of students believed the experience was a valuable part of the curriculum and saw prospects for community health nursing roles. However, they had concerns regarding losing time in acute care and relevance and number of assignments, and reported some difficulty in applying classroom content in the setting. Directors and senior citizens were universally positive about the experience. Student and teaching assistant reports were key in revising the curriculum. Revisions include logistics of the placement of the experience and assignments as well as incorporation of this experience within the community context.
Are Older Women Offered Adequate Health Care?
Authors: Blair Kathryn A , White Nancy
Published: May 2014

ABSTRACT

The "graying of America" will have profound effects on the health care delivery system. With shrinking amounts of health care dollars, nurses and primary care providers need to promote health maintenance and disease prevention strategies that will foster healthier aging. This study was designed to examine the health promotion strategies of family practice physicians and residents. The target population was a sample of 201 women age 60 and older. The health maintenance issues were counseling about hormone replacement therapy (HRT), urinary incontinence (Ul), and immunizations. The results clearly demonstrated that older women were not adequately immunized or counseled about HRT or Ul. Nurses can play a pivotal role in changing these practices. Nurses can serve as advocates for older woman by encouraging them to request these services, or advanced practice nurses can provide these services.
HIV and the Older Adult
Authors: Bachus Michelle A
Published: May 2014

Nurses must overlook ageism and educate older adults about HIV risk behaviors, treatment, challenges, and prevention methods.
Respite For CAREGIVERS: A Community-Based Model in a Rural Setting
Authors: Hayes Jill M
Published: May 2014

ABSTRACT

Currently in the United States, 4 million Americans suffer from Alzheimer's disease (AD), and projections are that this population will increase to 7 million by the year 2040. Traditionally, care for these clients is provided by family, relatives, and friends - an informal caregiver network (ICN). Changing demographics in the United States are threatening this caring network. When these factors are coupled with the recent emphasis on cost containment in health care, caring for this client population has become a significant political, economic, and societal issue. Strategies must be developed to meet the needs of both the clients and their caregivers. Respite services have been identified as an effective strategy in the ongoing management of clients with AD. A model is proposed to provide community-based respite services in a rural setting in northeast Georgia. The need for respite services, along with barriers to the use of such services by clients and their caregivers, is described. Strategies to overcome barriers and provide needed services in a cost effective and sensitive manner are presented. Implications for nursing and related disciplines are discussed.
Meal Management Strategies of Older Adult Women
Authors: Bonnel Wanda Blaser
Published: May 2014

Identifying transitions and interventions can help older women maintain independence and proper nutrition
Comparison of Caregivers', Residents', and Community-Dwelling Spouses' Opinions About: Expressing Sexuality in an Institutional Setting
Authors: Gibson Margaret C , Bol Nancy , Woodbury M Gail , Beaton Catherine , Janke Corey
Published: May 2014

ABSTRACT

Opinions regarding the appropriateness of elderly residents' sexual behaviors in a chronic care hospital and how to respond to inappropriate behaviors were surveyed. Study participation was open to all staff (N = 1,205), eligible residents (N = 182) and community-dwelling spouses (N = 103). Participation rates were 40% (residents), 42% (spouses), 34% (nursing staff), 50% (allied health staff), and 22% (support staff). Staff completed the questionnaire independently, while residents and spouses were offered self-completion or a structured interview. Almost all selected the interview. Residents and spouses were less tolerant than staff of residents' masturbating, engaging in sexual relationships, viewing sexual materials, and making sexual approaches to staff. Privacy was the primary determinant of appropriateness for behaviors for all groups. Staff and spouses were more likely to endorse counseling when behaviors were perceived as inappropriate than residents. Nurses endorsed counseling less frequently than allied health professionals and support staff. Nurses were more likely to have been approached sexually by a resident. Differences of opinion are interpreted in terms of cohort influences on values and contextual influences on behavior.
Minimum Data Set and Resident Assessment Instrument
Authors: Rantz Marilyn J , Popejoy Lori , Zwygart-Stauffacher Mary , Wipke-Tevis Deidre , Grando Victoria T
Published: May 2014

Can Using Standardized Assessment Improve Clinical Practice and Outcomes of Care?

ABSTRACT

Regulating and standardizing the assessment of residents was envisioned by the 1986 Committee on Nursing Home Reform to have many advantages for facility management, government regulatory agencies, and clinical staff to evaluate changes in resident status and adjust the care plans accordingly. Standardized assessment data was viewed as a source of management information to be used to track case mix (i.e., acuity) of residents, allocate resources such as staff, and evaluate care quality. The Resident Assessment Instrument is a clinically relevant assessment process that can facilitate effective care planning, interventions, and quality improvement. It is a clinically complex process requiring care delivery systems developed by RNs to support the implementation of individualized care.
Implementing an Incontinence Program in Long-Term Care Settings
Authors: Maloney Cindy , Cafiero Madeline
Published: May 2014

A Multidisdplinary Approach

A comprehensive bladder and bowel continence program addresses quality of life, medical and nursing evaluations, and behavioral management
Their Only Privacy Is Between Their Sheets
Authors: Bauer Michael
Published: May 2014

Privacy and the Sexuality of Elderly Nursing Home Residents

Sexual needs are not seen as basic body care and caregivers tend to believe unlimited access to a resident's personal space is acceptable.
Development and Implementation of a Case Management Model for Long-Term Care
Authors: Allen Norine E , Meduna Edward
Published: May 2014

Interdisciplinary team members identify the benefits of quality of care and cost efficiency created by greater collaboration among staff and family.
The Meaning of Leisure
Authors: Roelofs Lois Hoitenga
Published: May 2014

Actively creating leisure experiences, or authoring leisure, allows older adults to achieve satisfaction and improve their quality of life.
Individualized Interventions to Prevent Bed-Related Falls and Reduce Siderail Use
Authors: Capezuti Elizabeth , Talerico Karen A , Cochran Ina , Becker Honore , Strumpf Neville , Evans Lois
Published: May 2014

ABSTRACT

Five categories of problems that often result in siderali use: memory disorder, impaired mobility, injury risk, nocturia/incontinence, and sleep disturbance. As nursing homes work toward meeting the Health Care Financing Administration's mandate to examine siderali use, administrators and staff need to implement interventions that support safety and individualize care for residents. While no one intervention represents a singular solution to siderali use, a range of interventions, tailored to individual needs, exist. This article describes the process of selecting individualized interventions to reduce bed-related falls.
OBSERVED BEHAVIORS of Patients With Probable Alzheimer's Disease Who Are Hospitalized for Diagnostic Tests
Authors: Day Nancy , Musallam Kathleen , Wells Mary
Published: May 2014

ABSTRACT

This study examines observed behaviors of hospitalized patients with probable Alzheimer's disease (AD) undergoing invasive diagnostic procedures. Data was obtained from nursing documentation in the medical records of 30 patients, 10 in each stage of AD (i.e., mild, moderate, severe). In general, analysis of the data revealed that changes in behavior occurred immediately prior to, during, and following these procedures. Specifically, the moderately impaired patients showed the most significant curve over the 5-day observation period, while patients in the mildly impaired group showed a high peak of behavioral change on the test day. The severely impaired group of patients had a higher sustained level of activity throughout the 5-day period. Routine assessment of the patients' usual behaviors, caregivers' knowledge of the stage of disease, and awareness of the potential impact that diagnostics may have on cognitively impaired patients could help care providers decide what interventions most likely would lead to successful outcomes.
Use of the Iowa Self-Assessment Inventory With Older Hospitalized Patients
Authors: Hegamin-Younger Cecilia , Piven Mary Lynn Scotton , Buckwalter Kathleen C , Schacht Elizabeth , Brems Colleen S , Hradek Elizabeth , Keen Patricia , Morris Woodrow , Crowe Joan E
Published: May 2014

This screening tool helps determine the needs of older patients who are depressed; however, refinement of psychosocial assessment tools is necessary to improve health care outcomes.
The Changing Role of Grandparenthood
Authors: Davidhizar Ruth , Bechtel Gregory A , Woodring Barbara C
Published: May 2014

ABSTRACT

For many grandparents in America, caring for grandchildren has become a full-time responsibility that has led to multiple stresses. Raising grandchildren may cause financial stress, cramped living quarters, role restriction, and social isolation among this group. However, advantages to this role among grandparents can include greater life satisfaction and a positive influence on the other generations within the family. Nurses and other health providers can play an essential role in assisting grandparents caring for grandchildren by strategically building family strengths and cohesiveness.
Practical Uses of Peripheral Intravenous Nutrition: Three Case Studies
Authors: Gilmore LuAnn R , Escobeo Jan , Elliot Linda , Spiller Kim , Strikland Jerry , Jones Jeannie , Allen Pat
Published: May 2014

The nurse, dietitian, physician, pharmacist, and physical therapist must work as a team in the delivery of proper nutrition interventions.
MAMMOGRAPHY SCREENING for Older Women With and Without Cognitive Impairment
Authors: Messecar Deborah C
Published: May 2014

ABSTRACT

No upper age limit exists for Medicare benefits for mammography screening, but benefits for women older than age 75 remain unclear. From a clinical perspective, it would be useful to know if there is an upper age limit for women beyond which screening for breast cancer will not extend life. Using a decision-analysis model, the author examined the utility of screening using cohorts of women age 75 to 79, 80 to 84, and 85 and older, with and without cognitive impairment. The analysis evaluated different scenarios of the benefit of biennial screening versus no screening for women who had no prior screening and women who had participated in a regular screening program. Screening increased Quality Adjusted Life Years (QALYs) at all ages. Marginal savings in life expectancy adjusted for quality of life for women with no prior screening ranged from 43.5 days for healthy 75 to 79-year-old women to 25.9 days for women older than age 85. Among cognitively impaired women who were never screened, savings ranged from 20 to 5.5 days for the three age cohorts. Biennial screening among women who had been screened continuously resulted in substantially smaller life expectancy savings, from 3.3 days for healthy individuals age 75 to 79 to less than 1 day for women older than age 85. Cost effectiveness analysis indicated the reduction in costs associated with managing recurrent disease gained by early diagnosis with mammography was greatest among the population with no prior screening. Although the increase in QALYs was consistently lower for cognitively impaired women than for their healthy counterparts, the presence of cognitive impairment did not alter the finding that screening increased QALYs.
Documenting Productive Behaviors: Using the Functional Behavior Profile to Plan Discharge Following Stroke
Authors: Baum M Carolyn , Edwards Dorothy F
Published: May 2014

A dementia assessment tool is used following stroke to identify caregiver problems, treatment planning, and placement decisions.
Cardiovascular Risk Assessment in Elderly Individuals
Authors: Fleury Julie , Keller Coffeen
Published: May 2014

Health promotion and heart disease prevention for older adults require health care workers to consider modifiable, psychosocial, and nonmodifiable risk factors, especially because incidence of the disease increases with advancing age.
Maintaining Health in Well Older Adults: Initiatives for Schools of Nursing and The John A. Hartford Foundation for the 21st century
Authors: Belza Basia , Baker Margaret Wooding
Published: May 2014

ABSTRACT

In the past century, there has been a substantial increase in the number of older Americans and an increase in their life expectancy at birth. These trends will continue over the next century, marked by further increases in active life expectancy and marked changes in the racial and ethnic composition of the older population. While nursing has traditionally focused on the care of frail older individuals, most older adults-well older adults-enjoy a relatively high level of health and function. In this article, well older adults are defined as those with the physical, mental, social, and spiritual function or resources to meet the needs of everyday living. Recommendations for improving care of well older adults are provided, including reconceptualizing ways of thinking, expanding practice initiatives, building the science of nursing research in geriatrics and gerontology, developing education and training opportunities, and rethinking individual safety within the context of autonomy.
Nursing and Gerontology
Authors: McBride Angela Barron
Published: May 2014

ABSTRACT

This article, originally prepared as a think piece for The John A. Hartford Foundation, explores the interrelationship between nursing and gerontology: strengths nursing brings to the area of aging; challenges that must be addressed both at the societal level and within the profession for nursing to achieve its full potential in gerontology; and strategies that might be adopted to maximize strengths and address identified gaps. These strategies include highlighting the heroic behaviors of the gerontologic nurse, increasing support for gerontologic advanced practice nursing, promoting collaborative gerontologic research, encouraging dissemination of nursing's knowledge base, and collaborating with foundations to promote self-care. It is proposed that nursing's research-practice agenda in the third millennium must be: preventing disease where possible; minimizing morbidity and maximizing quality of life when disease cannot be prevented, and having the wisdom to reconcile the two.
Enhancing Geriatric Nursing Scholarship: Specialization Versus Generalization
Authors: Mezey Mathy , Fulmer Terry , Fairchild Susan
Published: May 2014

ABSTRACT

This article explores the relative merits of encouraging preparation of more nurses with specialization in geriatrics as compared to encouraging geriatric preparation among nurses whose major field of study is outside geriatrics. The article explores two approaches to examining capacity for geriatric nursing scholarship among nurse scholars not involved in geriatrics, and in schools of nursing with strength in research but with little geriatric research. The findings show an ongoing need to strengthen geriatric nursing as an area of specialization. Faculty prepared in geriatric nursing are underrepresented in schools of nursing, and only a small number of doctoral students specialize in geriatric nursing. Academic nursing programs with strength in geriatric nursing need ongoing support to maintain and expand current geriatric programs. Data support that encouraging individual non-geriatric nurse faculty and doctoral candidates to focus their work on areas of concern to geriatric nursing, and strengthening geriatrics in research-intensive schools of nursing that have not heavily invested in geriatric scholarship are viable options for strengthening academic geriatric nursing. Establishing mechanisms to attract nurse scholars working outside the scope of geriatric nursing to address clinical issues of concern to older adults offers promise in rapidly attracting new scholars to geriatric nursing.
What Is Your Life Like Now?: Loneliness and Elderly Individuals Residing in Nursing Homes
Authors: Hicks T J
Published: May 2014

ABSTRACT

Loneliness has been associated with cognitive deterioration, social isolation, hopelessness, and the inability to perform independent activities of daily living. Three factors have been found to increase levels of loneliness among elderly individuals residing in a nursing home: lack of intimate relationships, increased dependency, and loss. Nurses in long-term care facilities are in a position to directly intervene with elderly residents. Individualized interventions will allow the resident to have greater well being and greater quality of life.
Theft In Nursing Homes
Authors: Harris Diana K , Benson Michael L
Published: May 2014

Strategies must be developed to prevent theft in nursing homes so residents do not have to spend the end of their lives without their cherished possessions.
Dysphagia Among Nursing Home Residents: An Assessment and Management Protocol
Authors: Shanley Chris , O'Loughlin Grainne
Published: May 2014

Nurses need training to recognize early signs of dysphagia so they may manage older adults with difficulty in swallowing before it leads to other health problems.
Facilitating End-of-Life Decision-Making: Strategies for Communicating and Assessing
Authors: Norton Sally A , Talerico Karen A
Published: May 2014

ABSTRACT

End-of-life decision-making is often a difficult process and one that many elderly patients and their families will undergo. The grounded theory study of nurses, physicians, and family members (n = 20) reported in this article examined provider behaviors that facilitated the process of decision-making near the end of patients' lives. According to participants, providers who are experienced and comfortable are more likely to engage in communication and assessment strategies that facilitate end-of-life decision-making. Communication strategies included: being clear, avoiding euphemisms, spelling out the goals and expectations of treatment, using words such as "death" and "dying," and being specific when using such words as "hope" and "better." Assessment strategies included: assessing patients' physical conditions and end-of-life wishes, patients' and family members' understandings of the disease and prognosis, and their expectations and goals. An important first step for improved care is making explicit the provider's communicating and assessing strategies that facilitate end-of-life decision-making.
Community Needs Assessment for Nursing Homes: A Taiwan Study
Authors: Chen Shu-li
Published: May 2014

Rapid social change in Taiwan inspired research to determined community perceptions of needed services for the elderly population.
Effects of the Quality of Dyadic Relationships on the Psychological Well-Being of Elderly Care-Recipients
Authors: Nunley Barbara L , Hall Lynne A , Rowles Graham D
Published: May 2014

ABSTRACT

The purpose of this study was to examine the association of the quality of caregiver relationships with the psychological well-being of elderly care- recipients. Sociodemographic variables and characteristics of the care- recipient situation (e.g., self-rated physical health, amount of instrumental support needed) were explored as potential predictors of the psychological well-being of elderly individuals. A secondary analysis of data collected during inhome interviews with 37 community-dwelling older adults revealed no significant correlations between the quality of the primary intimate relationship and any dimension of psychological well-being. However, better self-rated health was associated with fewer depressive symptoms, higher morale, greater life satisfaction, and better quality of life. The more instrumental support needed by an individual, the greater their depressive symptoms and the lower their morale. The findings also revealed that the older the individual was, the greater the depressive symptoms were and the lower life satisfaction became. Self- rated physical health predicted each dimension of psychological well-being. The findings suggest that age, the amount of instrumental support needed, and perceptions of physical health are important indicators of the psychological well-being of elderly care- recipients.
How Accurate Are Chronic Wound Assessments Using Interactive Video Technology?
Authors: Gardner Sue E , Frantz Rita A , Specht Janet K Pringle , Johnson-Mekota Judy L , Buresh Kelli A , Wakefield Bonnie , Flanagan James
Published: May 2014

ABSTRACT

This project examined the accuracy of chronic wound assessments made using an interactive, video telecommunications system (Teledoc™ 5000, NEC America, Inc., Irving, TX) by comparing a nurse expert's in-person wound assessments with wound assessments made from taped Tefedoc sessions. Wound assessments determined the absence or presence of nine wound characteristics instrumental in guiding treatment (e.g., tunneling, undermining, granulation tissue, necrotic tissue, epithelial tissue, purulent exudate, erythema, edema, induration). A sample of 13 paired wound observations was analyzed. The accuracy of the Teledoc technology was examined by calculating the amount of agreement between the inperson assessments and the taped Teledoc assessments for each of the nine characteristics. Agreement for eight of the nine wound characteristic exceeded 75%, suggesting this telehealth medium does not alter wound assessment data, which are essential in guiding treatment decisions. In addition to connecting the remotely based nurse with nursing expertise to improve patient care, telehealth technology seemed to increase the remotely-based nurses' knowledge of wound assessment and treatment as well.
EVALUATING THE COST of One Telehealth Application Connecting an Acute and Long-Term Care Setting
Authors: Specht Janet K Pringle , Wakefield Bonnie , Flanagan James
Published: May 2014

ABSTRACT

This article describes a study of the costs of a pilot telemedicine chronic wound consultation clinic. Cost minimization analysis is the technique used to examine the costs of the clinic. The components of cost analysis include the fixed costs of personnel and equipment and the indirect costs of circuit and line charges. Cost avoidance is also examined. Cost avoidance evaluates what costs were avoided by the use of the telemedicine clinic. Additionally, the cost perspectives of the consulting agency, the referring agency, and the patient are examined. The average cost of a chronic wound consultation was $136.16 (acute care perspective). Costs of a traditional face-to-face consultation, if the residents were transported to the acute care facility would be $246.28. Fifteen telehealth consultations per month were used to determine per consultation costs for line charges and depreciation/maintenance costs. In this pilot study, a cost savings was realized and patients benefited. Increased volume will help to offset the cost of the equipment depreciation and maintenance and make telehealth chronic wound consultations more cost effective.
Determinants of Preventive Services Utilization in Rural Older Women
Authors: Pullen Carol , Fiandt Kathryn , Walker Susan Noble
Published: May 2014

A telephone questionnaire was administered to older women to assess what personal and contextual influences determined use of preventive services.
Nursing Home Placement: Factors Affecting Caregivers' Decisions to Place Family Members with Dementia
Authors: Hagen Brad
Published: May 2014

ABSTRACT

Nurses who work with older adults with dementia in the community are aware of how difficult it can be for family _ members to make p lacement- related decisions, and need research -based information to help families make these decisions. This article presents the results of a qualitative research study intended to explore the factors influencing caregivers' decision-making process related to placi%Ji- ing an elderly family member with dementia in a nursing home. Using the study findings, the author suggests a theory which helps to explain some of the decision -making factors which appear to influence caregivers' abilities to make placement-related decisions. The nursing implications of this theory, and recommendations for future research, are > presented.
Measuring QUALITY OF CARE with an Inpatient Elderly Population: THE GERIATRIC RESOURCE NURSE MODEL
Authors: Turner Jean T , Lee Virginia , Fletcher Kathy , Hudson Kathy , Barton Dave
Published: May 2014

ABSTRACT

Nurses provide health services to an increasing number of older adults in acute care settings. Acute care nurses are committed to giving patients the highest quality care while recognizing the importance of delivering care in a cost-effective manner. In this study, a unitbased, nurse-centered geriatric program is evaluated. The program is designed to enhance the knowledge and skill of staff nurses in providing care to elderfy patients.

Both quantitative and qualitative methods are used to assess geriatric resource nurses' (GRNs) influence on quality and cost outcomes of the elderly participants. Patients age 65 years and older were randomly selected from two general medical units of a major academic tertiary care center in the southeastern United States. Data were collected during an 18-month period in 1996 and 1997, A total of 129 participants provided data for quantitative analysis. A subset of 34 participants (17 from the unit where GRNs were on staff and 17 from a control unit) was interviewed about their experience during hospitalization. This information was analyzed for common themes and trends using appropriate qualitative techniques.

Demographic variables and common measures of illness severity and complexity showed comparable patient populations on the two units. However, results of quantitative analyses indicated significant differences between groups on admission for several of the health status measures. Participants on the unit without GRNs were found to have more problems with pain, incontinence, and mobility. Administrative measures showed the number of patients readmitted to the hospital within 31 days of discharge and the length of stay associated with this initiai readmission were significantly lower on the unit with GRNs. The use of vest-type physical restraints was also less frequent on this unit.

Elderly patients in both groups indicated they have special needs related to normal aging changes and chronic illnesses, resulting in higher levels of fragility and decreased energy reserves. They identified specific functional areas for which help was needed. These include assistance with bathing, eating, sleeping, mobility, and elimination. Fewer participants on the intervention unit reported decline in activities of daily living (ADL) function during hospitalization than did control participants. Participants in both groups stressed the importance of nurses' demonstrating understanding and caring when working with older individuals.
Subjective Responses to Caregiving for a Spouse with Dementia
Authors: Narayan Suzanne , Lewis Marsha , Tornatore Jane , Hepburn Kenneth , Corcoran-Perry Sheila
Published: May 2014

ABSTRACT

Family members, typically spouses, serve as the primary caregivers for individuals with dementia. While it is recognized that caregivers experience both positive and negative subjective responses to caregiving, relatively little research has been done on the relationship between these types of responses. The objectives of the study were to examine the relationships between and among spouse caregivers' positive and negative subjective responses to caregiving, and increase understanding of the experience of being a spouse caregiver for a person with dementia. Fifty spouse caregivers completed quantitative measures of positive subjective responses (Positive Aspects of Caregiving and Caregiver Competence) and negative subjective responses (Relational Deprivation, Role Captivity, and Loss of Self). Additionally, participants were interviewed concerning their caregiving experiences. Positive Aspects of Caregiving and Caregiving Competence were significantly related to each other (p < .01 ), as were the three measures of negative subjective responses (p< .01). No significant correlations were found between any measures of a positive and a negative subjective response, suggesting the two types of responses are independent. Duration of caregiving was significantly related to Positive Aspects of Caregiving (p < .05), Caregiver Competence (p < .05), and Relational Deprivation (p < .01). Qualitative interview data revealed that participants simultaneously experienced caregiving as self-affirming, while also enduring losses and difficulties resulting from their caregiving role. Integrating the positive and negative aspects of the whole of caregiving is important to understand the caregiving experience and to design interventions to support caregivers.
Pain in Nursing Home Residents: Comparison of Residents' Self-Report and Nursing Assistants' Perceptions
Authors: Horgas Ann L , Dunn Karen
Published: May 2014

Incongruencias exist in resident and caregiver reports of pain; therefore, pain management education is needed to prevent suffering.
Delirium in Elderly Patients: An Overview of the State of the Science
Authors: Foreman Marquis D , Wakefield Bonnie , Culp Kennith , Milisen Koen
Published: May 2014

ABSTRACT

Delirium is a common and potentially preventable and reversible cause of functional disability, morbidity, mortality, and increased health care use among elderly individuals. Much has been learned about delirium in the past decade. Highlighted in this article are recent advances in the diagnosis of delirium, delirium in long-term care, use of health care resources, outcomes of delirium, etiologies, and interventions to prevent and treat delirium. Suggestions for future research also are proposed.