September 02, 2014

Journal of Gerontological Nursing - August 2014 , Volume 40 · Issue 8



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

Henry M. Plawecki, PhD, EdS, RN, MSN

Aging is often accompanied by a progressive recognition of one’s fear of loss of independence. In many cases, the loss of independence begins with benign symptoms associated with normal aging. One of the more subtle interruptions to an older adult’s lifestyle is the adjustment to low levels of generalized transitory pain. Untreated pain, even at low intensity levels, can have a significant, persistent, and magnifying effect on other nondramatic lifestyle changes. Pain can initiate sleep disturbances, impair and decrease ambulation, enhance the risk of falling, foster feelings of isolation and depression, and contribute to cognitive impairment.

Adjusting to low levels of pain is a learned behavior. Older patients learn that many individuals in their age group experience generalized pain. Eventually, they become convinced that pain is the result of old sports/work injuries, some low level of arthritis, or normal aging. For most older adults, pain is an accepted part of the normal aging process. One of the greater challenges for nurses is to initiate conversations with patients about the challenges affecting their daily lives. Nurses will need to identify the changes and/or factors, such as pain, that impact older adults’ level of life satisfaction. For example, nurses can ask, “Has pain interfered with performing any of your desired physical activities?” Once patients understand that they can openly respond to nurses’ questions about pain and its effects, a greater opportunity develops to plan change programs….


Computerized Testing Solution Promotes Brain Wellness After Stroke and TBI

NeuroTrax has announced the global availability of BrainCare™, a cognitive assessment and report solution that helps clinicians advance brain wellness of stroke and traumatic brain injury (TBI) patients.
BrainCare standardizes brain wellness assessment and tracking and measures progress toward regaining lost function. The assessment is user-friendly and includes a standardized set of computerized tests to identify cognitive and psychosocial factors. These tests cover the following six major areas of memory and thinking, as well as mood and nervousness:

·         memory, ·         executive function, ·         attention, ·         visual spatial,
·         verbal function, and ·         problem solving….

 
Mobile App Alerts Family Caregivers About Older Adults’ Activities and Routines

SafeinHome is a mobile device application, or app, for family caregivers that uses discrete sensors placed unobtrusively in older adults’ homes to let caregivers know if anything is out of the ordinary.
The sensors wirelessly transmit activity data through a built-in cellular connection to the caregiver’s smart-phone or tablet. They track the older adult’s movements and activity in any room in the house and securely send alerts to the caregiver’s smartphone if something is wrong, without invading the older adult’s privacy….

     FDA Approves New Biosensor With Fall Detection Feature

Vital Connect has announced that its HealthPatch™ MD biosensor, which is capable of capturing clinical-grade biometric measurements and includes a fall detection feature, has received clearance from the U.S. Food and Drug Administration….

Suicidal Thoughts in Older Adults Driven By Physical, Economic Factors

The majority of thoughts of death and suicide among older adults may be a result of physical, economic, and family factors—not depression, according to study findings presented at the American Association for Geriatric Psychiatry Annual Meeting.
To elucidate motivations behind suicidality, the psychiatrist asked participants why they responded “yes” to question nine, as well as what reasons they had to live. According to researchers, the majority of participants said that factors other than depression, including illness, disability, pain, financial concerns, family problems, and bereavement were driving their thoughts…

AAD Launches Public Service Announcement to Urge Older Men To Check Skin for Signs of Cancer

The American Academy of Dermatology (AAD) has launched Lawn, a public service advertisement (PSA) that encourages men 50 and older to examine their skin for suspicious or changing spots.
Using humorous scenarios, Lawn points out that if men will do anything to take care of a spot on their lawn, they should do the same for a spot on their skin. Distributed to television and cable stations nationwide, the television PSA encourages men to check their skin and have someone they trust check the areas they cannot see. The PSA can be viewed on the AAD YouTube channel and at www.aad.org/psa....

Researchers Say Surgery Decisions for Frail Older Adults Should Be Patient-Centered and Team-Based

The article suggests that the decision to have surgery must balance the advantages and disadvantages of surgical and non-surgical treatment, as well as the patient’s values and goals. In addition, the decision should be made among the patient, his or her family, and a team of medical experts (i.e., surgeon, primary care physician, physician anesthesiologist), who can explain each surgical and non-surgical option, as well as each option’s benefits and risks.
The article also suggests that high-risk older adult patients should be given the choice among treatments, including no treatment…

Short Daily Walks May Reduce the Risk of Mobility Disability in Older Adults

A daily 20-minute walk may reduce the risk of major disability in older adults and enhance the quality of their later years, according to study results published in the Journal of the American Medical Association.
After more than 2 years of follow up, researchers found that the risk of major mobility disability was reduced by 18% among participants in the physical activity group, meaning they were more capable of walking without assistance for approximately one quarter of a mile.

Study Finds Higher Risk of Early Death in Patients With Mild Cognitive Impairment

Study findings presented at the American Academy of Neurology’s 66th Annual Meeting indicated that individuals who have thinking problems, although their memory is still intact, may have a higher death rate in a 6-year period, compared with those who have no thinking or memory problems. The same was suggested in the study for those who are experiencing mild cognitive impairment (MCI) with memory decline; however, the first group had the highest death rate.
Individuals with MCI with no memory loss had more than twice the death rate during the study than those without MCI, whereas participants with MCI with memory loss had a 68% higher death rate during the study than those without MCI…

Vitamin D Deficiency May Cause Cognitive Decline Over Time in Older Adults

Vitamin D deficiency and cognitive impairment are common in older adults, and a new study published in the Journal of the American Geriatrics Society suggests that an association exists between low vitamin D levels and cognitive decline over time.
4 years later, they found that low vitamin D was associated with worse cognitive performance on one of the two cognitive tests used in the study…

Diagnosis: Dementia
 
The Role of Therapeutic Use of Self in the Application of Nonpharmacological Interventions
Beth Barba, PhD, RN, FAGHE, FAAN; Maria Stump, RN, MSN; Suzanne Fitzsimmons, MSN, GNP, ARNP-BC

The Centers for Medicare and Medicaid Services launched a new initiative aimed at improving behavioral health and safeguarding older adults residing in nursing homes from unnecessary antipsychotic drug use. This article is part two of a four-part series on how caregivers working with older adults can implement nonpharmacological interventions. Many different types of nonpharmacological interventions exist, including staff techniques, communication skills, the identification of basic and medical needs, and actual activities, which may be performed alone, one-on-one, or in small groups. To implement nonpharmacological interventions, a trusting relationship must be established. What is done, what is not done, and how one behaves can all precipitate or prevent agitation, anxiety, depression, and apathy in older adults. This article will address the trusting relationship concept that must be actualized for nonpharmacological interventions to be successful…

Elaine Wittenberg-Lyles, PhD; George Demiris, PhD, FACMI; Debra Parker Oliver, PhD, MSW; Molly Burchett, MA

The goal of this study was to explore aging-related stress among older spousal caregivers providing hospice care for an older adult with cancer. Cases were selected from an ongoing randomized controlled trial that involved audiorecorded visits with caregivers over four different time points. Recordings consisted of caregivers discussing caregiving problems and ways they attempted to cope. Four caregiver cases comprising 16 audiorecordings were qualitatively analyzed for aging-related stress during caregiving. Caregiving stress primarily involved the patients’ cognitive deficits. The caregiving experience also made older caregivers aware of their own aging and physical limitations, heightened self-imposed expectations to fulfill their role as spouse, and led them to consider their own mortality. This study informs development of caregiver interventions aimed at addressing the reciprocal challenge of caregiving and aging…

Jennifer Klein, PhD, OT(C); Sandra Holowaty, RN, BScN, GNC(C)

“Managing Constipation: Implementing a Protocol in a Geriatric Rehabilitation Setting” found on pages 18–27, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz.CNE Quiz

Feature Article

Meriam Caboral-Stevens, MS, NP-C; Mark Medetsky, RN

In the United States, older adults hold approximately 34% of the nation’s wealth. The combination of wealth, cognitive decline, and impaired financial capacity is a growing challenge to our society. As America ages, one of the most pressing challenges facing older adults is living an independent and autonomous life. Financial capacity (FC) is one of the instrumental activities of daily living considered the single best predictor of capacity for independent living in older adults. FC issues arise when an older adult experiences cognitive loss or dementia. Therefore, the purposes of this article are to: (a) review the construct of FC focusing on older adults, (b) discuss the different models of FC, (c) describe ways to assess FC in older adults, (d) identify indicators of FC impairment in older adults, and (e) discuss implications for practice. [Journal of Gerontological Nursing, 40(8), 30–37.]

Feature Article

Kazuko Mitoku, PhD, RN; Setsu Shimanouchi, PhD, RN

The aim of this study was to determine whether home modification was associated with subsequent progression of frailty and mortality in older adults. We conducted a prospective cohort study in 574 adults 65 and older who required a low or moderate level of care. Of these, 34% modified their homes—most frequently a corridor—and the most common type of modification was the installation of handrails. The mortality was significantly lower among older adults with home modifications than in those without home modifications at 2 years (adjusted hazard ratio [HR] = 0.52; 95% confidence interval [CI] [0.32, 0.87]), 3 years (HR = 0.57, 95% CI [0.54, 0.81]), and 4.7 years (HR = 0.65, 95% CI [0.65, 0.91]). These findings suggest that home modification may prevent the progression of frailty (i.e., need for low/moderate level of care increasing to the need for high level of care) in older adults…

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