April 01, 2015

Journal of Gerontological Nursing


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

Guest Editorial
Quality of Nursing Home Environments

There are many concerns about the quality of nursing homes despite legislative-required regulations, quality improvement projects …

Nursing homes decry emphasis on the negatives of their facilities and the little recognition of the positives. Turnover of nurses, certified nursing assistants, and administrative staff make provision of quality of care and innovation in care extremely difficult (Castle, 2001; Maas, Specht, Buckwalter, Gittler, & Bechen, 2008). It has been especially hard to recruit bachelor-prepared nurses to nursing homes, adding to the difficulty of having nurses adequately prepared to care for older individuals with complex needs in addition to managing a large staff of minimally prepared workers. Most believe that nursing home staff want to provide good care but often lack the resources of knowledge or time to do so.

Product News

Fda approves new drug to treat dementia
Actavis and adamas pharmaceuticals, inc., announced that the u.s. Food and drug administration has approved the new drug application for namzaric™ for the treatment of moderate to severe dementia of the alzheimer’s type in patients stabilized on memantine hydrochloride and donepezil hydrochloride.

Insulin nasal spray for treating cognitive impairment
A man-made form of insulin delivered by nasal spray may improve working memory and other mental capabilities in adults with mild cognitive impairment (mci) and alzheimer’s dementia (ad), according to a pilot study published in the journal of alzheimer’s disease.


Mobility Disabilities among Older Adults

Approximately 40% of individuals 65 and older had at least one disability, according to a U.S. Census Bureau report from 2008–2012. Of 15.7 million individuals, two thirds say they had difficulty in walking or climbing. Difficulty with independent living, such as visiting a doctor’s office or shopping, was the second-most cited disability, followed by serious difficulty in hearing, cognitive difficulty, difficulty bathing or dressing, and serious difficulty seeing.

Highlights of the report include:

•More than one third of individuals 85 and older with a disability lived alone, compared with one fourth of those between ages 65 and 74.

•Women 65 and older were more likely than men 65 and older to have five of six types of disability included in the American Community Survey, especially ambulatory difficulty.

•Disability rates were lower for married older adults than for widowers or those in other categories of marital status.

Trusting Nurses for 13 Years

The annual Gallup survey on trust in professions shows the public continues to rate nursing as the most honest and ethical. For the past 13 years, the public has voted nurses as the most honest and ethical profession in America in the Gallup poll. This year, 80% of Americans rated nurses’ honesty and ethical standards as “very high” or “high,” 15 points more than any other profession.

 Funding Alzheimer’s Research

The Alzheimer’s Association commends Congress for addressing Alzheimer’s disease in the fiscal year 2015 funding bill. By incorporating the Alzheimer’s Accountability Act (H.R. 4351/S. 2192), Congress has made a long-term commitment to elevating research funding. This bill will help ensure that future Congressional Alzheimer’s funding decisions will be guided by the professional judgment of National Institutes of Health (NIH) scientists as they strive toward the National Plan to Address Alzheimer’s Disease’s goal to prevent and effectively treat Alzheimer’s by 2025.

Improving Quality of Life for Older Adults with Arthritis and Muscle/Joint Pain

A new study found that older adults experienced less pain, reduced stiffness, and less fatigue after participating in a hospital-based exercise program….

 The Costs of Alzheimer’s Caregiving

Approximately one half (42%) of family members caring for a loved one with Alzheimer’s disease or other dementia spend ≥$20,000 per year on caregiving, according to a new Caring.com report. Caregiving expenses include out-of-pocket costs for assisted living, professional in-home caregivers, medications and medical bills, incontinence and wandering products, transportation, and more.

Of the 42%, 33% spend ≥$30,000 per year on Alzheimer’s caregiving; 8% do not know how much they spend on caregiving.

Twenty-two percent of family caregivers say that caring for a loved one with Alzheimer’s disease or dementia has put them in debt. But Alzheimer’s disease and dementia caregiving has more than monetary effects:

•Ninety-seven percent of family caregivers say their personal relationships have suffered or ended as a result of caring for a loved one with Alzheimer’s disease or dementia.

•Seventy-six percent say their emotional well-being has declined as a result of Alzheimer’s disease or dementia caregiving, and 55% say their physical health has declined.

•Fifty-six percent of caregivers have had to quit their jobs or say their career has been negatively affected by their caregiving duties.

Typically, family caregivers for Alzheimer’s disease and dementia patients spend more money and more time than other family caregivers….

 Clinical Concepts

Trigeminal neuralgia (TN) is one of the most common forms of neuralgia experienced by older adults. Early in the course of the illness, individuals may be misdiagnosed, with associated delays in treatment. The current article uses an individual example to provide a framework for assessment and clinical management p. 8–12.

Public Policy

Physical and cognitive limitations often accompany aging, increasing the importance of a safe and supportive environment to help older adults maintain mobility. Neighborhood design and maintenance must be evaluated to promote physical activity, mobility, and safety. Audit tools, geographic information system data, and resident interviews are used for this purpose, but often fail to provide information that can be translated to practice. The current project is part of a larger Miami-Dade Age-Friendly Initiative to create a metropolitan area that fosters a healthy environment for diverse adults of all ages and abilities. Safe Routes uses a toolkit based on the 5-E model providing practical resources to guide stakeholders in meeting the needs of the community. Findings include the Centers for Disease Control Healthy Aging Research Network Audit Tool assessment for environmental walkability factors. Results from street segment audits along with input from residents can be used to inform sound environmental policies. P.13–21.]

Research Brief

The aim of the current study was to explore why some individuals with dementia and agitated behavior showed limited response to a personalized intervention. Most participants had severe cognitive deficits; however, non-responders were more impaired. Where responders showed large improvements across conditions, agitated behavior remained equally high in non-responders. Responders and non-responders showed increased interest and engagement during the intervention. Increased agitated behavior was associated with severe cognitive impairment. Although studies have shown that psychosocial interventions can reduce agitated behavior, there does seem to be a point where it becomes more difficult to reduce this behavior. However, non-responders still displayed interest, and the authors believe further personalization of the intervention is possible. Therefore, severe dementia and agitated behavior should not exclude individuals from psychosocial interventions; however, a more detailed and timely implementation plan of such treatments may be warranted. [Journal of Gerontological Nursing, 41(3), 22–29.]

CNE Article

Many nursing home residents live a sedentary lifestyle, which can lead to adverse outcomes including declines in physical functioning, lower quality of life, and a higher mortality rate. Providing educational intervention is the first step in helping older adults change their unhealthy lifestyle. The current study examined the effectiveness of an educational program on physical activity of nursing home residents in wuhan, china. p. 30–39.]


Feature Article

Hospitalization can be an isolating and stressful experience for older adults who find themselves cut off from normal routines and social support systems. The Purposeful Visitation Program (PVP) provided structured interactions for hospitalized geriatric patients using volunteers trained to elicit discussion about recreation and leisure. The goal of the program was to improve patients’ orientation, level of calmness, and mood through guided cognitively stimulating interactions. Between January and July 2010, seven volunteers were trained and provided the program to 98 older adults on a geriatric inpatient hospital unit of a large academic medical center. Ninety-nine percent of patients reported enjoying their volunteer visit, and 96% thought other patients would also benefit. Volunteers and staff observed improvements, primarily in patient mood, after visits. PVP represents a cost-effective method of providing structured, individualized, and stimulating social interactions for older adults in a hospital setting.p.42–48.]

Feature Article

Computers offer new activities that are easily accessible, cognitively stimulating, and enjoyable for individuals with dementia. The current descriptive study examined preferred computer activities among nursing home residents with different severity levels of dementia. A secondary data analysis was conducted using activity observation logs from 15 study participants with dementia (severe = 115 logs, moderate = 234 logs, and mild = 124 logs) who participated in a computer activity program. Significant differences existed in preferred computer activities among groups with different severity levels of dementia. Participants with severe dementia spent significantly more time watching slide shows with music than those with both mild and moderate dementia (F [2,12] = 9.72, p = 0.003). Preference in playing games also differed significantly across the three groups. It is critical to consider individuals’ interests and functional abilities when computer activities are provided for individuals with dementia. A practice guideline for tailoring computer activities is detailed. p.50–57.]

Examines a comprehensive, ongoing, patient-centered approach to future health care choice communication that experts warn still is not reaching enough patients and includes codes for discussing ACP directives with patients and their families. “These complex, vitally important conversations support ownership of long-term health care planning, which often begins in dialogue with nurses on the front-lines of patient care,” explains Jennie Chin Hansen, RN, MSN, FAAN, ..


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