May 19, 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 

·         May 2015  Volume 41 · Issue 5



Contents

Guest Editorial

Why Should Hospitals Fund Delirium Research? p3

Hospitals funding delirium research enjoy special benefits. Their research teams may work with the unique demographics they serve and thus are able to make research translatable on a local level. With the information gathered, researchers can reduce delirium rates while enhancing health care quality and value and offer interventions tailored to the local context. Implementation of outside research advancements often occurs many years after discovery. An in-house research team should shorten that process. Several resources exist for hospitals to plan agendas for enhancing delirium care and research (Table).


Table:
Delirium Practice and Research Resources for Hospitals


New Minivelle® Dose for Treating Postmenopausal Osteoporosis
Noven’s transdermal delivery of estrogens by Minivelle allows for efficient delivery of estradiol, bypassing first-pass metabolism….

New Advance Care Planning Application The MyDirectives® mobile application (app) allows consumers to digitize their voice and thoughts in a legal advance care plan that is secure and available anywhere in the world. In addition, the app makes it easy for consumers to populate their medical identification with their MyDirectives advance care plan information, which gives physicians access to vital information from a patient’s iPhone® lock screen.

First and Only Orexin Receptor Antagonist for Insomnia Now Available Merck announced that Belsomra® is now available at pharmacies in the United States for the treatment of insomnia in adults who have difficulty falling and/or staying asleep. Belsomra is the only orexin receptor antagonist approved for the treatment of insomnia in the United States. Orexin is one of the many neurotransmitters in the brain involved in promoting wakefulness and Belsomra selectively blocks orexin receptors.


Obesity Linked to Hospital and Emergency Department Admission Rates p6

…Statistical analyses found that the most severely obese group had 3.4 times the odds of having an inpatient admission during the year and 1.4 times the odds of visiting the ED compared with the healthy weight group. In addition, this severely obese group (class III obesity, according to the World Health Organization) had a 10% higher rate of using outpatient services.

 

New Skin Test Offers Insight to Alzheimer’s and Parkinson’s Diseases

Scientists have discovered a skin test that may shed new light on Alzheimer’s and Parkinson’s diseases. The new study showed that skin biopsies can be used to detect elevated levels of abnormal proteins found in the two diseases….

Experts Say “No” to Behavior-Calming Drugs for Patients With Dementia

A new study published in the British Medical Journal says non-drug approaches should be the first choice for treating common symptoms (e.g., irritability, agitation, depression, anxiety, sleep problems, aggression, apathy, delusions) of patients with dementia.

Five nonpharmacological categories have been shown to help reduce behavioral issues:

·    Providing education for the caregiver.

·    Enhancing effective communication between the caregiver and patient with dementia.

·    Creating meaningful activities for the patient with dementia.

·    Simplifying tasks and establishing structured routines.

·    Ensuring safety and simplifying and enhancing the environment around the patient, whether in the home or nursing/assisted living setting.

Antipsychotic Agents May Lead to Increased Risk of Death for Patients With Dementia

..study also examined other psychiatric medications. The risk of death seen with a mood stabilizer (i.e., valproic acid) was similar to that of antipsychotic agents. Antidepressant drugs had less risk compared with antipsychotic agents and valproic acid, but the risk was still higher than that of patients not taking any psychiatric medications to treat behavioral issues in dementia.

The study showed that the mortality risk of antipsychotic agents is higher. The DICE (Describe, Investigate, Evaluate, and Create) approach to assess and manage behavioral symptoms in dementia could help; it emphasizes putting nonpharmacological strategies first.

New Policies Needed to Prevent Violence to Homecare Workers

The study interviewed female homecare workers (defined as those who support older adults with activities of daily living, such as bathing, dressing, grooming, eating, and mobility) and showed that 61.3% experienced physical, verbal, or sexual harassment; aggression; and/or violence.

The researchers recommend preventive safety policies and training sessions for patients and care providers that outline procedures for leaving a home (if necessary), documenting situations, and establishing work boundaries and expectations. Knowing warning signs of violence, how to communicate assertively, and de-escalation techniques will help homecare workers confidently address potentially violent situations.

Does Having a Purpose In Life Improve Brain Health?

A new study published in Stroke reports having a strong sense of purpose in life and direction may make developing brain damage caused by blockages in blood flow less likely. Participants who reported a stronger purpose in life were 44% less likely to have macroscopic infarcts (i.e., visible to the naked eye). No significant relationship was found between purpose in life and microinfarcts (i.e., visible with a microscope).

New Scoring System to Determine Dementia Risk

Researchers from the Mayo Clinic developed a new scoring system to help determine which elderly individuals may be at a higher risk of developing memory and thinking problems that can lead to dementia. Factors easily obtained from medical records, such as years of education, number of medications, history of stroke or diabetes, and smoking, were taken into account. Researchers also factored in information obtained at the clinic visit, such as results of a thinking ability test, symptoms of depression and anxiety, and slow gait. Factors were assigned a score based on how much they contributed to the risk of developing thinking problems.

Although the risk of MCI increases with age, younger men have a higher risk of developing MCI than younger women. Conversely, older women have a higher risk of developing MCI than older men. Variables, such as age, diabetes, heart health risk factors, slow gait, depression, and anxiety disorders, contribute most to the risk score. The apolipoprotein E gene, which has been linked to a higher risk of dementia, was determined to be only a moderate risk factor.

Tobacco Myths: The Older Adult Perspective

Twenty adults ages 50 and older who had ceased using tobacco for 1 year or longer were interviewed. Participants provided personal insights into three myths found in the literature surrounding tobacco use and cessation in older adults and were asked to describe any perceived benefits of tobacco use. The findings indicate older adult tobacco users may need additional education on tobacco risks and cessation benefits provided by health care providers during routine office visits. [Journal of Gerontological Nursing, 41(5), 9–13.]


The numbers of Hispanic and African American older adults in the united states are expected to increase by 86% and more than 31%, respectively. African American and Hispanic American individuals are more likely than Caucasian individuals to have chronic health conditions, and researchers have argued that these health disparities may contribute to their higher rates of dementia-related illnesses. The current article explores strategies to improve participation in cognitive aging research by older adults, particularly minority older adults. The cultural aspects of cognitive aging are examined, especially the role of stigma and stereotype threat. The perceptions of cognitive aging of African American and Hispanic older adults are also described. Specific strategies are presented that have been successfully implemented to improve recruitment and retention in research targeting minority older adults. Strategies that yielded retention of minority older adults included advertising and marketing a randomized clinical trial, media relations, intervention tailoring, and adaptation of psychometric instruments. [journal of gerontological nursing, 41(5), 14–23.]


Feature Article


The current article describes the authors’ efforts to use the approach of reflective adaptive process to implement a new model of care (i.e., the Skilled Heart Unit Program) for effective heart failure (HF) care in one SNF. A team of stakeholders from the local hospital system and a local SNF was convened to design and implement this new model. Evaluation of the implementation processes confirmed the value of the implementation approach, which centered on team-based approaches, staff engagement, and flexibility of processes to respect the SNF’s needs and culture. p26


The purpose of the current study was to assess perceptions of CircleRides, a paper prototype of a service website designed to meet older adult transportation needs.

Three themes emerged from the data: (a) trust and concern, (b) socialization, and (c) flexibility and options….


In its latest update for the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely® initiative, the American Geriatrics Society (AGS) unveiled a revised list of treatments and tests to question and discuss when working with older adults. The list adds to the series of Choosing Wisely resources that encourage health care workers, such as advanced practice nurses and other nursing professionals, to empower older patients when discussing safe, high-quality, and actionable care decisions that are important but sometimes overlooked.

These and other updates add to long-standing recommendations from the AGS, which remain unchanged following the recent expert review. For example, the AGS Choosing Wisely list still advises avoiding:

·    Percutaneous feeding tubes in patients with advanced dementia. Research suggests that hand-feeding these older adults is at least as good as tube-feeding, which often is associated with agitation, the need for physical/chemical restraints, a worsening of pressure ulcers, and other medical complications.

·    Prescribing medication without first conducting a thorough treatment regimen review. Older patients use more prescription and non-prescription drugs than other individuals, and polypharmacy can increase the risk for side effects and other complications. Medication reviews can help identify risks, potential interactions, and unnecessary or underused therapeutic options. According to AGS experts, treatment regimen reviews should be conducted at least annually as an indicator of quality prescribing in older adults …

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