May 14, 2014

Journal of Gerontological Nursing - March 2014

Full text articles are available to fee paying members of Alzheimer’s Australia NSW by emailing NSW.Library@alzheimers.org.au
Guest Editorial
Recruitment efforts for clinical trials within the African American community, especially those targeting older African American adults, has traditionally been difficult. Ford et al. (2013) found that minority group members welcomed the opportunity to participate in intervention research. The African American participants in their focus groups revealed that barriers to recruitment included costs, lack of diversity on the recruitment team, and general mistrust of medical research. In this editorial, we would like to describe our experience in recruitment to expand on the last concern: mistrust.
p. 3-4 

News highlights
  • Good News about Alzheimer’s Emerging The fiscal year 2014 budget recently signed by President Obama contained an unprecedented $122 million increase for Alzheimer’s disease (AD) research, education, outreach, and caregiver support.
  • Don’t Just Sit There—Take a Stand! A new study of 93,000 postmenopausal women in the United States found that those with the highest amounts of sedentary time, defined as sitting and resting but excluding sleeping, died earlier than their most active peers. In addition, researchers found that even habitual exercisers are at risk if they have high amounts of idle time. The study was one of the largest and most ethnically diverse of its kind, and its findings were published in the American Journal of Preventive Medicine.
  • Incontinence in Older Women Virtual reality, dance, and fun may help improve urinary incontinence in older women, according to a feasibility study published in Neurourology and Urodynamics. This is the first time virtual reality has been used to treat urinary incontinence.
  • Researchers to Test Video Game in People at Risk of Alzheimer’s Akili Interactive Labs Inc. (Akili) has announced that it has entered into an agreement with Pfizer Inc. to test the ability of Akili’s mobile video game platform, Project EVO, to detect cognitive differences in healthy older adults at risk of developing Alzheimer’s disease (AD). The platform technology was featured in the journal Nature, and to Akili’s knowledge, this is the first time that a large pharmaceutical company will test the use of a mobile video game as a clinical tool to determine early signs of neurodegenerative disease pathology.
  • Company Expands Clinical Trials for Alzheimer’s TauRx Therapeutics Ltd., a clinical-stage biopharmaceutical company that has developed a tau aggregation inhibitor treatment for Alzheimer’s disease (AD), has expanded its international clinical trials by adding 35 new research centers across the United States.
  • B-Shoe Footwear Helps Seniors Maintain Balance, Avoid Falls B-Shoe is a standard-looking walking shoe that detects when older adults are losing their balance and are about to fall. It then automatically drives one leg slightly backwards to prevent the fall.
  • Adjustable Corner Shower Seat Helps Reduce Fear of Falling For many older adults, the fear of falling makes them reluctant to perform certain daily living activities, including showering. A solution for overcoming this fear of falling in the shower is the new Ableware® Adjustable Corner Shower Seat, which provides a safe, stable seat while showering.
Clinical Concepts
Osteoporosis is a common but often silent condition among older adults. The characteristic pathological changes associated with osteoporosis may go unnoticed until a fracture occurs or a bone density test is performed. Although osteoporosis occurs in men and among premenopausal women, it is most prevalent among postmenopausal women who are the focus of this article. Within the subpopulation of postmenopausal women, there are major differences in risk status, disease severity, and response to treatment. Two individual examples are presented to highlight these differences and to illustrate appropriate assessment and treatment strategies in each scenario. In addition, general nonpharmacological recommendations for postmenopausal women across risk status and disease severity are presented.
p. 10–14 
 
Public Policy
Although hearing loss is common in old age and associated with a variety of negative outcomes, hearing aids and related services are not covered by Medicare or many other forms of insurance. Out-of-pocket costs are expensive and thus serve as a barrier for many individuals. Efforts at the national level to broaden coverage can confront surprising or unexpected opposition from a variety of groups. This article discusses how an experience as an Atlantic Philanthropies Health and Aging Policy Fellow helped inform how gaining an understanding of the positions held by such stakeholder groups is critical to developing strategies to promote a more effective payment structure that would improve access to hearing care. The implications for nurses desiring to influence policy are also highlighted.
p.  15–19
Research Brief
Little is known about the prevalence of pressure ulcers (PUs) among racial and ethnic groups of older individuals admitted to nursing homes (NHs). NHs admitting higher percentages of minority individuals may face resource challenges for groups with more PUs or ones of greater severity. This study examined the prevalence of PUs (Stages 2 to 4) among older adults admitted to NHs by race and ethnicity at the individual, NH, and regional levels. Results show that the prevalence of PUs in Black older adults admitted to NHs was greater than that in Hispanic older adults, which were both greater than in White older adults. The PU rate among admissions of Black individuals was 1.7 times higher than White individuals. A higher prevalence of PUs was observed among NHs with a lower percentage of admissions of White individuals.
p.  20–26
CNE Article
This article describes the development and implementation of a wandering screening and intervention program based on identifying hospitalized patients with impaired cognition and mobility. A wandering screening tool developed by a multidisciplinary team was linked to appropriate levels of interventions available in the electronic health record. Advanced practice nurses (apns) confirmed the accuracy of screening and interventions by bedside nurses for all patients who screened positive. Of 1,528 patients hospitalized during a 3-week period, 48 (3.1%) screened positive for wandering. At-risk patients were older (age ≥65) (66.7%), those admitted to surgical units (41.7%), caucasian (89.6%), and men (58.3%). Thirteen (27.1%) had dementia and 45 (93.8%) had impaired cognition. Of those patients who screened positive for wandering, the apns agreed with the bedside nurses’ assessment in 79.2% of cases (38/48) about wandering risk and 89.5% (34/38 true positives) for the interventions. A two-item wandering screening tool and intervention was feasible for use by bedside nurses. Further studies are needed to determine whether this tool is effective in preventing wandering.
p. 28–33 

Sleep pattern changes are considered normal as individuals age. However, changes in sleep patterns can ultimately affect the quality of life of many older adults. In addition, many sleep conditions are associated with an increase in morbidity and mortality. It is essential for clinicians to recognize sleep changes to lead to appropriate treatment. This article will focus on the assessment and interventions of sleep disorders in older adults
p. 38-45 

Poor sleep in later life is a global issue that reduces many individuals’ quality of life (QOL). The purpose of this pilot study was to test the feasibility and effects of a simplified tai chi exercise intervention on sleep quality and QOL among Chinese community-dwelling older adults with poor sleep quality. This single-group, descriptive feasibility study included 34 individuals with poor sleep quality who agreed to participate in a 12-week tai chi intervention. Twenty-six individuals completed the program (23.5% dropout rate). Older adults with poor sleep quality who completed the intervention showed significant improvement in the Medical Outcomes Study Short Form-36 mental component and the Pittsburgh Sleep Quality Index global and component scores. The low recruitment and attendance and high dropout rates might be associated with participants’ age, gender, and sleep quality. Further long-term studies are required to examine the potential effects of the tai chi intervention.
p.  46–52

 

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