July 17, 2014

Journal of Gerontological Nursing July 2014

Full text articles are available to fee paying members of Alzheimer’s Australia NSW by emailing NSW.Library@alzheimers.org.au 

Guest Editorial 
Barbara J. Edlund, PhD, ANP, BC
The concept of healthy or successful aging has largely focused on physical health and the absence of disease or illness (Blazer, 2006; Reichstadt, Sengupta, Depp, Palinkas, & Jeste, 2010; Rowe & Kahn, 1997). In an extensive review of quantitative studies on successful aging, Depp and Jeste (2006) noted 29 different definitions of this concept, with most focusing on physical health. The emphasis on physical health is attributed to early studies on aging conducted by the MacArthur Foundation (Berkman et al., 1993) and the subsequent work of Rowe and Kahn (1997). The outcome of these efforts characterized successful aging as staying engaged in life, maximizing physical and cognitive abilities, and minimizing risk and disability (Rowe & Kahn, 1997).
p. 4-5

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p. 8-9

 

Geropharmacology 

Anticoagulation in Long-Term Care: How Can We Improve Medication Monitoring?

Thromboembolic diseases affect a significant proportion of older adults; however, due to the risks and associated adverse events with anticoagulation therapy, this population may be less likely to receive the best care. Among anticoagulant-related events within the nursing home, most involve oral anticoagulant agents and occur due to deficiencies in monitoring. With the recent approvals of new oral anticoagulant agents dabigatran, rivaroxaban, and apixaban, more options are now available for treating thrombotic disorders. Ensuring that all members of the health care team are aware of the risks and benefits of these agents is paramount to improving the monitoring as well as safety in older adults who are at greatest risk for adverse events.
P. 10–15 

Technology Innovations 

Managing Dementia Symptoms and Needs Using Technology

Dementia is a difficult and costly disease to manage. Although caregivers and patients have indicated they need support for activities of daily living and debilitating neuropsychological symptoms, most technology innovations focus on safety and social contact. This feasibility study tested a care technology designed to manage dementia symptoms and everyday routines using common, nonpharmacological interventions. It was implemented in two formal care environments (memory care, assisted living). In Sample 1, independent observers decided which symptoms were present or absent in individual residents pre-intervention and 1 and 2 months during the intervention. In Sample 2, independent observers determined the desired status (goals) for individual residents prior to intervention and evaluated resident status 1 and 2 months into the intervention. The intervention was associated with a reduction in symptoms and progression toward wellness goals, suggesting that nondrug interventions for managing symptoms and daily routines in dementia can be delivered effectively using advanced technology.
p. 16–20

Evidence-Based Practice Guideline 

Quality Improvement in Nursing Homes

Quality may be defined as an attribute of a product or service (Spath, 2013). Several features of quality include: (a) achieving or surpassing customer expectations; (b) changing definitions of the expectations over time; and (c) improving the product or service as expectations change (Spath, 2013). Quality measurement is needed by researchers to measure costs and outcomes, and consumers need a guide to help them choose a nursing home. Clinical data are often used to measure nursing home quality. An example of a data source is the Minimum Data Set (MDS) (Gruneir & Mor, 2008). Many agree that nursing home quality is multidimensional, which makes identification and measurement more complex (Dellefield, 2007; Dosa, Bowers, & Gifford, 2006; Gruneir & Mor, 2008; Rantz et al., 1999).
p. 21-31 

CNE Article 

Return Visits to the Emergency Department: What Can We Learn From Older Adults’ Experiences?

Unscheduled return visits to the emergency department (ed) represent a considerable segment of older adults’ total visits to the ed. This study explores the factors that led to early return visits to the ed by older adults. Using a qualitative descriptive design, semi-structured interviews were conducted in a large teaching hospital with 15 older adults who returned to the ed within 2 weeks after an initial visit. From the interviews, three major themes emerged as precipitants that led older adults to return to the ed. These were managing the symptoms, care curing the initial ed visit, and who i am. The findings suggest that the main reason for older adults’ return to the ed is the severity of the symptoms they experienced. Ensuring the timeliness of follow-up appointments and the provision of resources to support the transition home are identified as interventions that would improve the care provided in EDs.
P. 32–40 

Feature Article 

Prevalence, Views, and Impact of Advance Directives Among Older Adults

This article reviews the literature on advance directives among U.S. older adults published from 2008 through 2013, with a focus on advance directive prevalence, implications of advance directives on patient care, and impact of interventions to increase advance directive completion. Advance directive completion varies by demographic characteristics and is affected by patient attitudes toward advance directives and end-of-life care. Patients with advance directives are less likely to receive feeding tubes, experience burdensome transitions between nursing homes and hospitals, and die in the hospital. Advance directive completion increases when health care providers ask culturally sensitive questions and educate patients about advance directives, but better documentation and communication of advance directives are needed to ensure adherence to these measures. Despite increasing advance directive completion as patients move from community to nursing homes to hospice, advance directives are often insufficiently detailed and current for health care professionals to be confident they are acting in accordance with what patients would choose for themselves.
p. 44–50 

Feature Article 

A Mixed-Methods Approach to Investigating the Adoption of Evidence-Based Pain Practices in Nursing Homes

This mixed methods study examined perceived facilitators and obstacles to adopting evidence-based pain management protocols vis-a-vis documented practice changes that were measured using a chart audit tool. This analysis used data from a subgroup of four nursing homes that participated in a clinical trial. Focus group interviews with staff yielded qualitative data about perceived factors that affected their willingness and ability to use the protocols. Chart audits determined whether pain assessment and management practices changed over time in light of these reported facilitators and barriers. Reported facilitators included administrative support, staff consistency, and policy and procedure changes. Barriers were staff attitudes, regulatory issues, and provider mistrust of nurses’ judgment. Overall, staff reported improvements in pain practices. These reports were corroborated by modest but significant increases in adherence to recommended practices. Change in clinical practice is complex and requires attention to both structural and process aspects of care.
p. 52–60

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