March 03, 2015

Journal of Gerontological Nursing - February 2015

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

Guest Editorial 

A Function-Focused Approach to Long-Term Facility Care

More than 20 years ago, Atchinson (1992) described restorative care as care that maximized a resident’s ability; it focused on what an individual is able to do, and it sought to create independence for the older adult. More recently, Galik, Resnick, Hammersla, and Brightwater (2014) have described this concept as function-focused care.
p. 3-4

Product News 
Olysio® Approved for Treating Chronic Hepatitis C
Janssen Therapeutics announced the U.S. Food and Drug Administration has approved Olysio® (simeprevir), a hepatitis C virus NS3/4A protease inhibitor, in combination with sofosbuvir as an all-oral, interferon- and ribavirin-free treatment option for genotype 1 chronic hepatitis C (CHC) infection in adult patients. Sofosbuvir is an HCV nucleotide analog NS5B polymerase inhibitor developed by Gilead Sciences, Inc.
Patient Support Program Helps Bring OFEV® to the United States
OFEV was approved by the U.S. Food and Drug Administration for the treatment of idiopathic pulmonary fibrosis (IPF), a rare and fatal lung disease that affects as many as 132,000 Americans who are typically men older than 65. It is the only kinase inhibitor approved to treat IPF. 

News 
Discussing End-of-Life Care
In a study published in the Canadian Medical Association Journal, seriously ill hospitalized patients and their families say the most important aspects to discuss are:
·         preferences for care in the event of life-threatening illness,
·         patient values,
·         prognosis of illness,
·         fears or concerns, and
·         additional questions regarding care.
Training to Assess Elderly Drivers
To help keep roadways safe and preserve the freedom of mobility of older drivers, researchers are training law enforcement officers to recognize warning signs of impaired driving skills and take appropriate action. They are also training doctors to think more about their patients’ ability to drive safely with age.
Women and Sleep-Disordered Breathing
Older women with sleep-disordered breathing were found to be at greater risk of decline in the ability to perform daily activities, according to a study in the Journal of the American Geriatrics Society. Sleep-disordered breathing involves repeated interruptions or decreases in breathing during sleep, which often leads to fragmented sleep and hypoxemia or low blood oxygen levels. Physicians rate the severity of sleep-disordered breathing with the apnea-hypopnea index (AHI), which reflects the number of breathing interruptions (apneas) and significant decreases in breathing (hypopneas) per hour of sleep.
Primary Age-Related Tauopathy Closely Resembles Alzheimer’s Disease
A multi-institutional study published in Acta Neuoropathologica has defined and established criteria for a new neurological disease closely resembling Alzheimer’s disease: primary age-related tauopathy (PART). Patients with PART develop cognitive impairment that can be indistinguishable from Alzheimer’s disease, but they lack amyloid plaques.
Low Health Literacy
When it comes to the benefits of electronic health records, older Americans may be left behind. Less than one third of Americans ages 65 and older use the Internet for health information and only 10% of those with low health literacy go online for health-related matters, according to a study in the Journal of General Internal Medicine.
AARP Warns Rise in Brand Name Drug Prices
Retail prices for brand name prescription drugs widely used by older Americans increased by an average of nearly 13% in 2013—more than eight times faster than the 1.5% general inflation rate, according to a new AARP Public Policy Institute report. Increased prices for brand name medications lead to higher out-of-pocket costs for consumers who pay coinsurance, or a percentage of their drug costs, instead of a fixed dollar amount.
 
Diagnosis: Dementia 

Diversional and Physical Nonpharmacological Interventions for Behavioral and Psychological Symptoms of Dementia

This article is the last of a four-part series addressing the use of non-pharmacological interventions for older adults with behavioral and psychological symptoms of dementia (BPSD). These types of interventions are used to prevent, lessen, or eliminate BPSD, thereby reducing patient reliance on psychoactive medications. These interventions are easy to use, cost-effective, and simple to implement. The Centers for Medicare & Medicaid Services’ psychoactive medication reduction initiative encourages all staff to use nonpharmacological interventions to manage BPSD. As with any attempt to handle BPSD, health care professionals and staff need a tool-box of interventions, as what works one day may not work the next and what works with one older adult may not work with another. This article describes the categories of diversional and physical nonpharmalogical interventions, presents the evidence supporting their use, and provides information on effective implementation.
p. 8–17 

Evidence-Based Practice Guideline 
Late-Life Depression Detection
Nurses and allied health providers who provide care to older adults are uniquely positioned to recognize changes in behavior and function that signal the onset of a clinically significant depressive episode. Daily providers often observe a range of depressive syndromes that are associated with greater functional impairment, disability, and reduced quality of life, including subthreshold forms that do not meet full criteria for major depressive disorder (MDD). The purpose of the current guideline is to improve detection of depression symptoms in cognitively intact older adults who may be a higher risk because of social and health-related changes that cluster in late life.
p. 18-25

Research Brief 

Risk of Aspiration in Care Home Residents and Associated Factors

Pneumonia is a prevalent cause of death in care home residents. Dysphagia is a significant risk factor of aspiration pneumonia. The purpose of the current study was to screen for risk of aspiration in care home residents in the Netherlands and assess potential risk factors of aspiration. Five experienced speech-language therapists assessed 203 care home residents (115 primarily physically disabled, 88 primarily cognitively impaired) 60 and older in the first week after admission to a care home. In 43 (21.2%) residents, speech-language therapists assessed risk of aspiration and found no significant difference between physically disabled (26.1%) and cognitively impaired (14.8%) residents. After multivariate logistic regression analysis, the final prediction model for risk of aspiration showed Parkinson’s disease as a significant factor (odds ratio = 5.11; 95% confidence interval [1.49, 17.52]) . The authors therefore conclude that risk of aspiration is a relevant care problem among Dutch care home residents and requires further assessment.  
p. 26–31

CNE Article 

The Prevalence of Uncontrolled Pain in Long-Term Care: A Pilot Study Examining Outcomes of Pain Management Processes

Pain in long-term care (ltc) is common among older residents despite the vast options available for optimal pain management. Inadequate pain management affects individual health care outcomes. Researcher evidence has shown that nurse practitioners (nps) improve the quality of care in ltc but are challenged by multiple barriers that inhibit optimal pain control. The purpose of the current pilot study was to explore both the pain management processes used by nurses in ltc and the documented patient outcomes that come from these processes. In addition, factors were identified that may impact the np role in providing adequate pain control in ltc. This descriptive study used a retrospective, case-controlled research design that incorporated reviewing 55 ltc resident medical records. Results show how the process of pain management in ltc can be improved by expanding the professional role of the np.
p. 33–41

Feature Article 
Staff Compliance With Protocols to Improve the Management of Behavioral and Psychological Symptoms of Dementia
Using data from a larger study investigating the effectiveness of a structured clinical protocol to manage individuals in residential facilities who experience behavioral and psychological symptoms of dementia (BPSD), the current study investigated whether external clinical support in using the protocol with specific residents increased compliance in its use, over and above only providing a generic workshop about the protocol and management of BPSD. Results indicated that provision of the workshop, in addition to clinical support, was associated with significantly higher compliance. However, compliance was only found to be related to positive outcomes when staff received the generic workshop and not clinical support. When clinical support was provided, compliance was not related to outcomes or worse outcomes. These findings, when considered in the context of the results of the larger trial, suggest that the relationship among clinical support, compliance with BPSD protocols, and clinical outcomes for residents and staff is complex and needs further investigation.
p. 44–52 

Feature Article 

Nonpharmacological Therapeutic Techniques to Decrease Agitation in Geriatric Psychiatric Patients With Dementia

Agitation is not only a frequent and disturbing behavior for many patients with dementia, but it also troubles their caregivers and families. Many serious problems and side effects are associated with the use of medications to treat agitation; therefore, alternative approaches to treating agitation must be assessed. The current article presents results from a quality improvement pilot project that examined the usefulness of a specially designed, multisensory room intervention for geriatric psychiatric inpatients with mild to moderate agitation. Thirty-two visits to the sensory room were made by 13 inpatients with dementia. A significant decrease occurred in the Pittsburgh Agitation Scale (PAS) total scores over time from pre-room to post-room intervention, as well as 1-hour post-room intervention (F = 95.3, p < 0.001). Significant effects were found for all PAS subscales (i.e., aberrant vocalizations, motor agitation, and resistance to care), with the exception of the aggression subscale. The multisensory room intervention was effective in decreasing some symptoms of agitation in the geriatric psychiatric patient, thus contributing to positive patient, family, and nursing outcomes.
p. 53–59

 

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