November 13, 2014

Journal of Gerontological Nursing - October 2014

Full text articles are available to fee paying members of Alzheimer’s Australia NSW by emailing
Guest Editorial
Keeping the Older Adult’s Voice Central in Research and Practice
Over the past several years, the notion of person-centeredness has gained increased momentum across the entire continuum of care and is now guiding health care research. The work being conducted by Planetree (access to transform organizational cultures and deliver health care that puts the needs and preferences of individuals first is an excellent example of a provider partnership that aims to make person-centered care a hallmark of care in every setting. From a research perspective, the U.S. Congress, through the Patient Protection and Affordable Care Act (2010), created the Patient-Centered Outcomes Research Institute (PCORI) with the sole mission of helping individuals make informed health care decisions and improving health care delivery and outcomes by answering questions that matter most to them, their families and care partners, and those who advocate on their behalf (access
p. 3-4

Traumatic Brain Injury in Veterans May Increase Risk of Dementia
Older adult Veterans who have experienced a traumatic brain injury (TBI) are more likely to develop dementia than Veterans without TBI according to a study published in Neurology.
U.S. Senate Allocates Additional $100 Million for Alzheimer’s Research
The U.S. Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies allocated an additional $100 million in its fiscal year 2015 funding bill for Alzheimer’s disease (AD) research.
p. 6 


Evaluating the Impact of Palliative or Hospice Care Provided in Nursing Homes

Palliative and hospice care are increasingly being provided in nursing home settings. The current article reviews the existing evidence relevant to nursing homes to provide practitioners with a greater understanding of the impact of palliative and hospice care on clinical care outcomes (e.g., pain, symptom management), processes of care outcomes (e.g., hospitalizations, cost of care), and family member or health care proxy perceptions of care. Overall, the provision of hospice or palliative care in nursing facilities can improve the clinical care residents receive, reduce hospitalizations, and improve family members’ perception of care.
 p. 10–14 

Technology Innovations 

Testing Telehealth Using Technology-Enhanced Nurse Monitoring

Technology-enhanced nurse monitoring is a telehealth solution that helps nurses with assessment, diagnosis, and triage of older adults living in community-based settings. This technology links biometric and nonbiometric sensors to a data management system that is monitored remotely by RNs and unlicensed support staff. Nurses faced a number of challenges related to data interpretation, including making clinical inferences from nonbiometric data, integrating data generated by three different telehealth applications into a clinically meaningful cognitive framework, and figuring out how best to use nursing judgment to make valid inferences from online reporting systems. Nurses developed expertise over the course of the current study. The sponsoring organization achieved a high degree of organizational knowledge about how to use these systems more effectively. Nurses saw tremendous value in the telehealth applications. The challenges, learning curve, and organizational improvements are described.  
p. 15–23

CNE Article
Hydrate for Health: Listening to Older Adults’ Need for Information
An interdisciplinary team of faculty and students developed the Hydrate for Health project to provide relevant and evidence-based information to community-dwelling older adults. Evidence-based factsheets on bladder health, nighttime urination, medication safety, and physical activity/exercise, as well as a fluid intake self-monitoring tool, were developed. Four focus groups were conducted and included older adults (N = 21) who participated in activities at two local senior centers to obtain their feedback about the relevance of the factsheets. Extensive revisions were required based on the feedback received. Older adults expressed a desire for pragmatic information (i.e., how to determine fluid sources from food, how to measure water, how to determine their own fluid needs). They also wanted information that could be easily incorporated into daily life. Nurses play a central role in listening to and incorporating older adults’ voices into consumer education materials.
p.  24–30
Feature Article 

The Consistency of Self-Reported Preferences for Everyday Living: Implications for Person-Centered Care Delivery

Preferences are the expression of an individual’s basic psychosocial needs and are related to care outcomes. The current study tested the consistency of 87 individuals’ everyday preferences over 1 week, comparing responses of nursing home residents (n = 37; mean age = 82) and university students (n = 50; mean age = 20). Participants completed the Preferences for Everyday Living Inventory at baseline and 5 to 7 days later. Preference consistency was calculated three ways: (a) correlations (range = 0.11 to 0.90); (b) overall percent of exact agreement (e.g., response was “very important” at both time points) (66.1%); and (c) responses collapsed as “important” or “not important” (increase in percent agreement to 86.6%). Personal care preferences were more stable, whereas leisure activities were less stable. The groups did not have significant differences in consistency. Some preferences are more consistent than others; age and frailty do not appear to be related to preference instability.
p. 34–46 

Feature Article 

Remaining in the Nursing Home Versus Transfer to Acute Care: Resident, Family, and Staff Preferences

Resident and family insistence on transfer is a major factor in the occurrence of potentially avoidable transfers from nursing homes (NHs) to acute care. The purpose of this study was to explore resident, family, and staff preferences regarding transfer to acute care. A sample of 271 NH residents, family members, staff, and medical providers were interviewed. Seventy-seven percent of residents reported that they had not given any thought to the question of whether they would want to be transferred to acute care. Family members wanted more information than residents, but more residents (39%) thought they should be fully involved in the transfer decision than their family members (12%) or staff (12%). Staff preferred keeping residents in the NH. Families were divided between transferring residents and having them remain in the NH. More residents indicated that their desire to transfer would depend on the severity of their condition and their prognosis. Ethnic group differences were noted. Results suggest that discussion of this issue should occur soon after admission and that differences in perspectives may be expected from those involved.
p. 48–57 

Feature Article 

Differentiating Subtypes of Apathy to Improve Person-Centered Care in Frontotemporal Degeneration

Apathy, a reduction in goal-directed behavior (GDB), affects 90% of individuals with behavioral variant frontotemporal degeneration, which is a common cause of early onset neurodegenerative disease. The cognitive and neural impairments associated with apathy make it difficult to initiate, plan, and self-motivate activities toward a specific goal, such as dressing or bathing. These impairments are associated with significant decline in functional ability, caregiver burden, and increased cost of care due to early institutionalization. The current article reviews the evidence suggesting that apathy arises from the interruption of one or any combination of three GDB processes: initiation, planning, and motivation. From this perspective, three subtypes of apathy related to dysfunction at the level of GDB and the corresponding neuroanatomy are explored. Further research is required to confirm and measure these subtypes of apathy for use in clinical and research settings. A more precise classification of apathy by subtype will allow implementation of the most appropriate person-centered, individualized therapy.
p.  58–65 

Feature Article

Merging Person-Centered Care With Translational Research to Improve the Lives of Older Adults: Creating Community-Based Nursing Research Networks

Translational research is a leading trend in science with the aim of bridging the research–practice gap to significantly speed the implementation of effective interventions in clinical practice. Integrating the values and preferences of older adults and their families into this process is critical to the success of translational research. Engaging communities in meaningful research is an important part of advancing translational science in which older adults are partners in developing solutions to the health needs of individuals within communities. The current article describes one approach to developing an infrastructure (i.e., community-based nursing research network) to support patient-centered care within translational research. Nurses are uniquely poised and prepared to assume leadership roles in community-based research networks to support a true collaboration among stakeholders that prizes the voices of older adults and integrates them into practice efforts.
p. 66–74


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