July 03, 2014

Journal of Gerontological Nursing June 2014








Full text articles are available to fee paying members of Alzheimer’s Australia NSW by emailing NSW.Library@alzheimers.org.au
Editorial
What I Know For Sure: The Value of Interprofessional Education and Practice in Geriatrics and an Exciting New Collaboration for Our Journal
Sometimes it can be difficult and frustrating to work with other disciplines, and some days it may seem easier to “do it alone,” but fortunately or not for gerontology, the nature of our work and complexity of patient care and presentation of problems and needs demand we work together well in real life. I believe this early experience of learning outside of my discipline has allowed me to embrace and respect the value that other health professionals add and know that they want the same things for the patient as I do—quality care, appropriate care, and care that respects the older adults’ preferences and values. It may not always be a quicker process, but I strongly believe it is better.
p. 3-4

 News HIGHLIGHTS P. 7-9
Family Photos Transferred to Removable Wallpaper Assist in Comforting LTC Residents
In response to the fact that many long-term care facilities discourage picture frames and placing nails in walls, WeMontage recently launched the world’s first online-to-offline photo sharing website ( http://www.wemontage.com) that transforms memorable photos into removable wallpaper, providing a unique solution for families and their loved ones who have been placed in assisted living facilities.
Drug Candidate Does Not Meet Primary Endpoint in Alzheimer’s Study
Prana Biotechnology has released topline results of the 12-month Phase II Imaging trial in Alzheimer’s Disease (“IMAGINE” Trial), based on draft results
New Delirium Severity Measure Developed, Tested
A new method for measuring delirium severity in older adults has been developed by researchers from Harvard University, Brown University, and the University of Massachusetts. The new scoring system, CAM-S, is based on the Confusion Assessment Method (CAM) and standardizes the measurement of delirium severity for both clinical and research uses. Details are published in the Annals of Internal Medicine.
Researcher Uses Grant Money to Teach Adults How to Avoid Falling
Clive Pai, a professor of physical therapy at the University of Illinois at Chicago will use a 5-year, $1-million grant from the National Institute of Aging (NIA) to develop a computerized treadmill program that could be used in physical therapy offices to prevent falls and fall-related injuries in older adults.
New Trial Discloses Alzheimer’s Risk, Tests Early Interventions
A new clinical trial will soon begin testing whether early medical intervention in people at risk for Alzheimer’s disease (AD) can slow progression of disease pathology before symptoms emerge, as outlined in Science Translational Medicine. For the first time, people with no AD symptoms will be told of their risk status before being asked to join the randomized controlled trial. As part of the overall prevention trial, Penn Medicine neurodegenerative ethics experts will monitor how learning about their risk of developing AD affects trial participants.
Animal-Assisted Activities Boost Older Adults’ Esteem
Given the proven ability of animal interaction to improve self-esteem and quality of life, research recently published in Activities, Adaption & Aging set out to examine how animal-assisted activities (AAAs) can positively affect older adults’ self-esteem, feelings of empowerment, and communication with others.
Surrogate Decision Makers Needed for Community-Dwelling Adults with Dementia
More than 70% of older Medi-care beneficiaries experience cognitive impairment or severe dementia near the end of life and may need surrogate decision makers for health care decisions. Advance care planning for older adults with dementia may be particularly important for individuals who do not reside in a nursing home or a long-term care facility, according to an article published in Health Affairs. 

Clinical Concepts 

Pain Assessment in Hospitalized Older Adults With Dementia and Deliriumstract


Pain can have negative effects leading to prolonged hospital stays. Determining the presence of uncontrolled and untreated pain in patients with cognitive impairments such as delirium, dementia, and delirium superimposed on dementia (DSD) is challenging. One tool commonly suggested for use in assessment of pain in older adults with cognitive impairment is the Pain Assessment In Advanced Dementia (PAINAD) scale. Proper use of the PAINAD scale as part of a comprehensive pain management plan can help reduce the likelihood of a patient experiencing unrecognized and untreated pain. Using an individual example, this article illustrates best practices in pain assessment and management for a woman experiencing DSD during an acute hospitalization.
p. 10–15 

Public Policy 

When Nurses Leadstract


In Fall 2011, the Centers for Medicare and Medicaid Services (CMS) began a major initiative to improve dementia care in nursing homes. The initial goal was to reduce the prevalence of antipsychotic medication use in long-stay nursing home residents with dementia by 15%. Through a new, public-private collaboration, the National Partnership to Improve Dementia Care established coalitions in every state. After 18 months, a 15.1% reduction was achieved nationally. Throughout the initiative, many nurses played key roles in leading the process for change. This article describes the roles of nurse leaders in this national policy work.
p.  17–21 

CNE Article 

Orthostatic Hypotension in Older Adults with Dementia

Orthostatic hypotension (oh) in older adults with dementia is associated with increased confusion, dizziness, syncope, and falls. These problems may result in a negative, downward spiral accompanied by high morbidity and mortality. The literature supports that nonpharmacological interventions are effective in the reduction of symptoms and prevention of orthostasis. The purpose of this quality improvement project was to increase staff knowledge and skill in the assessment, documentation, and care of residents with oh in dementia care units within a continuing care retirement community. An in-service program using a protocol based on clinical practice guidelines was presented to rns, licensed practical nurses, therapists, and unlicensed caregivers. Assessments, documentation of assessments, and interventions for residents with oh increased following the in-service program. As staff continue to apply their knowledge in care routines, it is expected that this evidence-based practice will reduce symptoms of oh and increase safety and quality of life within this specific population.
p. 22–29. 

Feature Article 

Prostate Cancer and Quality of Life: Analysis of Response Shift Using Triangulation Between Methods

ract

Quality of life (QoL) after prostate cancer treatment is uncertain. Patient responses to QoL questions shift for a number of reasons: measurement intervals no longer have the same psychological anchors (recalibration), the importance attributed to different QoL domains changes over time (reprioritization), and the definition of QoL differs throughout the disease continuum (reconceptualization). Therefore, the aim of this study was to describe QoL response shift in a cohort of 66 men with prostate cancer. The method involved carrying out a sequential triangulation between quantitative and qualitative methods. Patients were assessed at baseline (P1), followed by a posttest (P2) and a then-test measurement (P3). The difference between P3 and P1 was used to determine the response shift effect (recalibration). From baseline to posttest, QoL significantly decreased. The recalibration then-test confirmed a low QoL in all periods evaluated. Coping mechanisms were found to differ by age group, with older men less concerned about side effects than younger men. Health professionals should be alert to QoL changes over time and possible side effects, should coping skills fail.
p.  32–41 

Feature Article 

Medication Management Roles in Assisted Livingbstract


Residents in assisted living (AL) frequently need assistance with medication management. Rooted in a social model, AL serves people facing increasing health management challenges as they “age in place.” This study explored roles in AL medication management and satisfaction with unlicensed assistive personnel (UAP) as medication aides, a cost-effective staffing approach that is used frequently. The sample included 112 participants representing all parties involved in medication administration (residents, medication aides, administrators, RNs and licensed practical nurses, pharmacists, and primary care providers) in 15 AL settings in four states. Results include description of medication management roles; empirical validation of existing AL nursing professional standards; and satisfaction with the role of UAP as medication aide from all perspectives. Clinical implications include creating a supportive environment for medication aides (i.e., UAPs); the importance of the RN role as facilitator of AL medication management; and the need for collaboration and interprofessional team development across disparate settings.
p. 42–53 

Endnotes 

Two Days

Mary was a resident whose memory loss was so significant that she was not able to participate in the activities offered as part of the memory care program. She loved holding a doll (her “baby,” we were informed) and loved everything we did for her. Rather than sitting on the outside of an activity sleeping, Mary’s life changed on Day One when she joined other residents in the Namaste Care room. She was not isolated; she napped occasionally, but when she was awake she smiled, hugged us, and kissed our faces or our hands. She was a delight and clearly pleased to be in Namaste Care. Before she left the room for dinner on the first day, I kneeled beside her chair and told her how happy I was that she had spent the day with us. Mary took my hand and kissed it and said, “This is the best day ever; it should be in the paper.”
Joyce. Simard is Adjunct Associate Professor, School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia, and a private geriatric consultant, Land O’ Lakes, Florida.The author is the developer of the Namaste Care program for people with advanced dementia and received consulting fees from Epoch Senior Living.
p. 54-56
 
 

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