January 29, 2015

Journal of Gerontological Nursing - December 2014

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


Guest Editorial 

From Dementia Fearful to Dementia Friendly: Be a Champion in Your Community

…This pervasive fear and stigmatization of dementia among the general public begs the question: Is it possible to end fears and stigma associated with dementia? The answer is a resounding “yes.” One emerging but promising solution is to intentionally create communities where members are exposed to and equipped with accurate dementia knowledge and where individuals with dementia and their caregivers are acknowledged as equal community members who are provided with opportunities, resources, and support to remain engaged.
p. 3-5 

Product News p. 7
·                     Circadin® Found to Positively Affect Cognitive Performance in Patients With Alzheimer’s
·                     New Telehealth Applications Provide Real-Time Insights into Patient Metrics 

News p. 8-9
Memory Slips May Signal Increased Risk of Dementia Later in Life
New research published in an online issue of Neurology suggests that individuals without dementia who begin reporting memory issues may be more likely to develop dementia later, even if they have no clinical signs of the disease.
Anxiety, Moodiness, Distress Linked to Higher Risk of Alzheimer’s in Women
Women who are anxious, jealous, or moody and distressed in middle age may be at a higher risk of developing Alzheimer’s disease (AD) later in life, according to a study published in an online issue of Neurology.
Memory Loss Associated With Alzheimer’s May Be Reversed
Memory loss in patients may be reversed, and improvement may be sustained, according to a study published online in the journal Aging.
Insomnia in Older Adults Tied to Sleep Quality, Not Duration
A new study published online in Journals of Gerontology: Medical Sciences has found that sleep problems may stem from the quality of patients’ rest and other health concerns more than the overall amount of sleep they achieve.
Study Finds Increase in Nursing Home Infection Rates
New research presented at IDWeek 2014 shows that nursing home infection rates are on the rise.
Natural Light May Improve Nurses’ Health and Mood
For the health and happiness of nurses—and to ensure the best care of hospital patients—exposure to natural light may be the best medicine, according to research published in Health Environments Research and Design. 

Clinical Concepts 

Depression in Older Women With Metastatic Breast Cancer

Depressive symptoms are common in older women with late-stage breast cancer, and some of these patients meet criteria for major depressive disorder. Significant overlap exists among many of the most prevalent physical signs and symptoms of depression in older adults (e.g., weight loss, fatigue) and the physical signs and symptoms of malignancy or treatment for malignancy, which may contribute to ongoing underdiagnosis and undertreatment of depression in this population. The National Comprehensive Cancer Network and evidence-based geriatric nursing guidelines call for routine screening for depression with valid and reliable screening instruments among high-risk groups at every encounter. Geriatrics, oncology, and palliative care nurses are encouraged to regularly screen older women with metastatic breast cancer for depressive symptoms and maintain a low threshold for initiation of behavioral and/or psychopharmacological interventions.
p. 10–15

Public Policy 

Nursing Home Disaster Planning and Response: A Policy Perspective

Nursing home residents are among the most vulnerable members of a community threatened by disaster. In the past, insufficient planning has resulted in preventable morbidity and mortality for nursing home residents during disasters. State and federal policies have evolved over the past decade to improve oversight of nursing home disaster planning. However, continued political advocacy is critically necessary to promote the safety of nursing home residents during potential emergencies and, especially, naturally occurring disasters. Opportunities exist to improve nursing home disaster response, including better preparation and training and dedicated resources for data management and oversight.
p. 16–24 

CNE Article 

Knowing Versus Doing: Education and Training Needs of Staff in a Chronic Care Hospital Unit for Individuals With Dementia

Hospital clinical staff routinely confront challenging behaviors in patients with dementia with limited training in prevention and management. The authors of the current article conducted a survey of staff on a chronic care hospital unit concerning knowledge about dementia, perceived educational needs, and the care environment. The overall mean score for a 27-item knowledge scale was 24.08 (SD = 2.61), reflecting high level of disease knowledge. However, staff indicated a need for more information and skills, specifically for managing behaviors nonpharmacologically (92.3%), enhancing patient safety (89.7%), coping with care challenges (84.2%), and involving patients in activities (81.6%). Although most staff (i.e., nurses [80%] and therapists [86.4%]) believed their care contributed a great deal to patient well-being, approximately 75% reported frustration and being overwhelmed by dementia care. Most reported being hit, bitten, or physically hurt by patients (66.7%), as well as disrespected by families (53.8%). Findings suggest that staff have foundational knowledge but lack the “how-to” or hands-on skills necessary to implement nonpharmacological behavioral management approaches and communicate with families.
p.  25–34 

Feature Article 

Delusions and Underlying Needs in Older Adults With Alzheimer’s Disease: Influence of Earlier Life Experiences and the Current Environment

Delusions are one of the most severe psychiatric symptoms of individuals with Alzheimer’s disease (AD), which often increase the stress experienced by caregivers. The purpose of this study was to understand the influences of earlier life experiences and the current environment on delusions, as well as the underlying needs of older adults with AD who experience delusions. Using an exploratory research design with a qualitative approach and purposive sampling, 20 family caregivers were interviewed. Two psychosocial types of attributes of delusion were categorized: Type A, the influence of earlier life experiences; and Type B, current environmental influences. The underlying needs of those with delusions include physical comfort, a desire to be secure, and a sense of belonging. The contents of delusions are easily influenced by patients’ earlier negative experiences and responsibilities, whereas the current environment exerts a crucial influence on the occurrence, frequency, and severity of specific delusions. These results can facilitate planning for patient-centered care by enhancing health care providers’ understanding of the psychosocial and environmental attributes and needs behind delusions.  
P. 38–47

Feature Article 

Staffing Levels and the Use of Physical Restraints in Nursing Homes: A Multicenter Study

There is an unclear relation between staffing levels and the use of physical restraints in nursing homes (NHs). A survey design was used in 570 older adults (median age = 86; 77.2% women), living on 23 wards within seven NHs. Restraint use was high (50% of residents, of which 80% were restrained on a daily basis). Multivariate analysis was conducted at the level of the individual wards. Neither staff intensity nor staff mix was a determinant of restraint use. Bathing dependency, transfer difficulties, risk for falls, frequent restlessness/agitation, and depression were independent predictors of restraint use. Patient characteristics have significant greater impact on physical restraint use than staffing levels. Therefore, improving knowledge and skills of NH staff to better deal with restlessness/agitation, mobility problems, and risk for falls is encouraged to decrease the use of physical restraints in NH residents.
p. 48–54

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