February 23, 2015

Journal of Gerontological Nursing - January 2015

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

Guest Editorial 

Educating Nurses in Gerontology: We Still Have a Way to Go

The end of August marks the beginning of a new semester for nursing students planning to enter the ranks of the nursing profession. Each semester, as I begin my Gerontological Nursing class, I ask these second-semester baccalaureate nursing students to speculate on the area of nursing in which they hope to work. Among many responses, I may receive a pleasant surprise if one or two students express an interest in geriatrics. However, based on current trends, approximately all of my students will be working with the 65 and older population. How do we best prepare these future nurses to meet the needs of the burgeoning older adult population?
p. 3-4 

Product News 
New Mather LifeWays Program Improves Brain Health and Memory
Mather LifeWays Institute on Aging has announced the introduction of Boost Your Brain & Memory, a multifaceted brain health program that focuses on various lifestyle factors that impact brain health and memory strategies that participants can implement in their daily lives.
p. 5 

News p.6-7
  • Study Shows Role of Emergency Contact Often Mistaken for Advance Directive
  • Survey Finds One in Five New Nurses Leaves First Job Within a Year
  • One Half of American Older Adults Need Help With Activities of Daily Living
  • Short Assessment Helps Identify Delirium in Hospitalized Older Adults Older Adult Men Less Likely to Receive Osteoporosis Screening, Treatment Than Women

Aligning Care Initiatives to Reduce Medication Adverse Effects in Nursing Homes

Medication adverse effects in nursing homes continue to be an ongoing issue in long-term care, resulting in adverse events and temporary harm that lead to increased hospitalizations. In 2014, the Office of the Inspector General report noted that among Medicare beneficiaries in Part A stays less than 35 days, 22% experienced an adverse event and 11% experienced temporary harm. Ongoing initiatives and clinical services that can be aligned to address medication adverse events are discussed within the current article.
p. 8–13 

Technology Innovations 

Implementation of a Home-Based Interactive Training System for Fall Prevention: Requirements and Challenges

A critical need exists for rehabilitation for improving older adults’ physical abilities, especially in the field of fall prevention. Although virtual reality and ambient-assistive technology-based approaches are promising, they are cost intensive and frequently face significant obstacles during the developmental process. The authors of the current article developed a motivational interactive training system for fall prevention and stroke rehabilitation and planned a pilot study to measure its usability, user acceptance, and effect on physical abilities and quality of life. Usability results from a field trial are presented. The purpose of the current article is to describe the technological and organizational problems during the development process and field trial. Recommendations for overcoming these barriers are described. These experiences should be taken into account when planning further field trials with assistive technology and older adults.
p. 14–19 

CNE Article

Behavioral and Psychological Symptoms of Dementia: How Long Does Every Behavior Last, and Are Particular Behaviors Associated With PRN Antipsychotic Agent Use?

Behavioral and psychological symptoms of dementia (BPSD) affect approximately all residents in nursing homes at some point; however, the course of BPSD among this group is not well known. The goal of the current study was to describe the course of each measured BPSD over a period of 6 months. A secondary explorative objective was to identify which BPSD are associated with as-needed (PRN) antipsychotic drug use. This secondary analysis study of 146 nursing home residents was drawn from a prospective, observational, multisite (N = 7) cohort study. Results showed that BPSD lasted for an average of 2.3 months, and the BPSD saying things that do not make sense had the longest duration, with 3.6 months. PRN antipsychotic drug administration was associated with nocturnal BPSD and requesting help unnecessarily. Within 3 months, most BPSD were resolved by usual care; use of PRN antipsychotic medication was not associated with behaviors that put the residents or their caregivers at risk.
p. 22–37 

Feature Article 

Comfort Care Rounds: A Staff Capacity-Building Initiative in Long-Term Care Homes

This article reports a pilot evaluation of Comfort Care Rounds (CCRs)—a strategy for addressing long-term care home staff’s palliative and end-of-life care educational and support needs. Using a qualitative descriptive design, semistructured individual and focus group interviews were conducted to understand staff members’ perspectives and feedback on the implementation and application of CCRs. Study participants identified that effective advertising, interest, and assigning staff to attend CCRs facilitated their participation. The key barriers to their attendance included difficulty in balancing heavy workloads and scheduling logistics. Interprofessional team member representation was sought but was not consistent. Study participants recognized the benefits of attending; however, they provided feedback on how the scheduling, content, and focus could be improved. Overall, study participants found CCRs to be beneficial to their palliative and end-of-life care knowledge, practice, and confidence. However, they identified barriers and recommendations, which warrant ongoing evaluation.
p. 42–48 

Feature Article

Somatic Symptoms and Depressive Symptoms Among Older Adult Korean Immigrants

Given the lack of understanding of how Korean immigrants express depressive symptoms, the purpose of this descriptive correlational study was to describe somatic symptoms and depressive symptoms and examine the relationship between them, as reported by older adult Korean immigrants. Purposive sampling was used in this study of 160 older adult (ages 65 to 91) Korean immigrants. Most of these participants immigrated to the United States at an older age. They reported a high level of depressive symptoms, and these symptoms were closely associated with somatic symptoms, a finding that coincides with previous studies differentiating Korean individuals from individuals of other cultures. The findings from this study highlight the need for health care providers to be aware of and recognize cultural differences in how patients express depressive symptoms somatically when assessing and treating depression within the older adult Korean immigrant population.
p. 50–58 

AGS Update

New Guidance on the Prevention and Treatment of Postoperative Delirium in Older Adults

A Clinical Practice Guideline and Best Practice Statement, Clinical Practice Guideline for Postoperative Delirium in Older Adults, was recently developed and released by the American Geriatrics Society’s Geriatrics-for-Specialists Initiative (AGS-GSI) to provide a framework that will enable hospital systems and health care professionals to implement actionable, evidence-based measures to improve delirium prevention and treatment.
p. 59-60

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