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August 29, 2017
Journal of Gerontological Nursing July 2017 Volume 43 · Issue 7
Geriatric nursing’s most trusted clinical journal for over 40 years - The Journal of Gerontological Nursing is a monthly, peer-reviewed journal publishing clinically relevant original articles on the practice of gerontological nursing across the continuum of care in a variety of health care settings, for more than 40 years.
July 2017 Volume 43 · Issue 7
Dementia Education: Does It Change
Although gerontological nurses are well positioned to care for older
adults with dementia, barriers to implementing quality client care remain,
including: limited knowledge, poor
morale among care staff, lack of professional development opportunities and
unsuitability of acute care hospitals for this client group.
The solution most commonly offered is education. Many academic
institutions, health care facilities, and even professional associations offer
educational activities. The literature is rich with descriptions of activity
formats, from workshops of <1 12="" a="" activities="" applied="" as="" be="" can="" courses="" degree="" described="" duration="" easily="" educational="" exceptional="" face-to-face="" format="" gerontological="" having="" high="" hour="" in="" information="" learned="" learning.="" longer="" meaning="" might="" months="" nursing="" o:p="" of="" offered="" online="" or="" over="" practice.="" print="" provided="" that="" the="" these="" to="" transference="" via="">1>
...However, the value of educational activities in determining clinical
interventions and subsequently evaluating the direct effects of these
interventions on outcomes for older adults with dementia has been limited....
·Design an education framework for the nursing workforce using three
·basic dementia awareness,
·intermediate dementia skills practice training, and
·advanced dementia skills practice training.
·How: develop a model similar to the one designed by the National Health
Service in the United Kingdom or
the Dementia Training Study Centre initiative of the Australian government.
·Work settings where nurses are employed specifically to work with older
adults with dementia be classified as those where staff require basic dementia
awareness training prior to employment. This training should extend beyond
dementia education that is provided within a generic nursing program. How:
develop a “dementia-friendly stamp of approval” for facilities in which
pre-employment dementia training is required.
·Management staff of a facility in which dementia care is provided assess
the environment to identify if it is one in which education flourishes.
·How: conduct an assessment of the organizational culture of the
facility. Does the management support exceptional educational activities? In
addition, the management of the organizational culture is a necessary part of
educational reform. How: nursing leaders directly work with staff on long-term
care units to provide care to older adults with dementia for two full shifts.
·Education activities provided for gerontological nurses should encourage
reflective practice. How: initiate a journal club to provide opportunities for
self-awareness of one's actions and the potential outcomes of these actions....
Sandra P. Hirst, PhD, RN, GNC(C)
More Older Adults Using Cell Phones
The distracted driving habits of young drivers have received a lot of
media attention. However, there has been a lack of data on whether older adults
also engage in these behaviors.
Eighty-two percent of participants owned a smartphone.
The survey found 75% of older adults believed they are capable of using
a hands-free device while driving.
Twenty-seven percent drove children younger than 11 in the past month,
and of those drivers, 42% talked on the phone while driving. Findings also
showed 3% of older adult drivers received a ticket for cell phone use, saying
the penalty changed their driving behavior.
New Intervention Improves Communication
Between Spouse Caregivers and Individuals With Dementia
For individuals with dementia, communicating needs and emotions and
interacting with others become increasingly difficult as communication
deteriorates as dementia progresses. Problems in communicating lead to
misinterpretations and misunderstandings, which often cause considerable stress
for family members, especially spouse caregivers. However, all is not lost
according to a new study in Issues in Mental Health Nursing that
examined and measured communication outcomes in spouse caregivers and patients
For the study, researchers videotaped and later analyzed and measured
118 conversations between 15 patients with varying degrees of dementia and
their spouses to evaluate the effects of a 10-week communication-enhancement
intervention on participants' communication and mental health.
Caregivers were taught to communicate
in a manner that was clear, succinct, and respectful, and avoid testing memory
and arguing. Spouses with dementia were given the opportunity to practice their
conversation skills with a member of the research team who was trained in
communication deficits associated with dementia as well as the intervention.
Conversations were recorded at couples' homes. After setting up the video
camera, researchers left the room and couples were instructed to converse about
a topic of their choice for 10 minutes.
The Verbal and Nonverbal Interaction Scale-CR (VNIS-CR) tool was used to
take into account nonverbal and verbal behaviors. The VNIS-CR delineates social
and unsociable behaviors, characterizes patient behaviors (not through the lens
of a caregiver), and is targeted to spousal relationships in the home.
Non-verbal, non-sociable items in the tool included aloofness, staring into space
and being nonresponsive; nonverbal, sociable items included looking or gazing
at the spouse, being affectionate, and joking. Social verbal behaviors included
using coherent conversation, responding to questions, and addressing their
partner by name or endearment. Unsociable verbal behaviors included shouting,
cursing and unintelligible communication. The 13-item scores were summed to
obtain the final score.
Female Older Adults More Likely to
Experience Recurrent Abuse
Older adults who have been hospitalized for injuries from an assault are
more likely to experience subsequent physical abuse if they are female,
widowed, diagnosed with dementia, or return home to live with the perpetrator,
according to a new study in the Journal of the American Geriatrics
Researchers examined the medical records of adults older than 60 who had
been admitted to five of the largest hospitals in the Chicago metropolitan area
for physical or sexual abuse from 2000–2011 and found 111 cases. More than one
half had documented histories of being abused again after leaving the hospital,
and approximately 80% of those who were re-victimized lived in private
residences at the time of abuse. Repeat victims were most often abused by a
relative—usually a husband, boyfriend, son, or son-in-law. Fifty-seven percent
of victims had their abuse reported to Adult Protective Services or police.
However, when researchers compared hospital records to the Adult Protective
Services files, they found that only 26.6% had investigations on record,
indicating that hospital reporting may have been overstated.
Addressing Language Gaps Between
Patients and Care Providers in Home Health Care Settings
In the United States, one in five households speaks a language other
than English at home. Research has shown that as English language proficiency
decreases, positive health care outcomes also decrease. Patients with limited
English proficiency (LEP) are at higher risk of 30-day readmissions, longer
length of stay in inpatient and emergency department settings, and adverse
Adverse effects of language gaps may be most pervasive in home health
care settings where the implementation of interpreter services is difficult and
highly inconsistent, making effective communication between health care
professionals and patients challenging. There is a paucity of research in this
area. A new study in Home Health Care Management and Practice aimed
to fill this knowledge gap.
These findings point to a lack of understanding of the language capacity
of the U.S. health care workforce, and calls for more research on this subject,
as it is an integral piece to determining the impact—and how to increase the
percentage of—language-concordant health care visits.
Dementia Rates Increase When Treatment
Is Delayed for Patients With Atrial Fibrillation
A new study found that dementia rates increase when anticoagulation
treatment is delayed for patients with atrial fibrillation. The
first-of-its-kind, large-scale study included >76,000 patients with atrial
fibrillation with no history of dementia who were treated with an anti-platelet
Using a measurement scale known as the CHADS2 Vasc score to predict
stroke risks and identify those at highest risk of cognitive decline with a
delay in therapy, researchers found the risk of dementia in low-risk patients
was 30% higher for those who received delayed treatment, and a significant 136%
higher for high-risk patients. Researchers also found that when the time period
of delays were analyzed as a spectrum from <30 1="" 31="" 3="" a="" and="" as="" days="" delays="" dementia="" in="" increased.="" initiation="" linear="" longer="" o:p="" of="" risk="" than="" the="" there="" to="" warfarin="" was="" year="" years="">30>
Adjusting Doses of Older Adults'
Psychiatric Medications May Reduce Fall Risk
Simply adjusting the dose of older adults' psychiatric medication could
reduce their risk of falling, suggests a new study in Social Science
Researchers evaluated the risk of falls from 2006–2010 among older
adults surveyed for the National Health and Retirement Study. When they
examined medication use, the strength of the relationship between depressive
symptoms and falls decreased. Specifically, the study found that a moderate
increase in depressive symptoms among older adults was associated with a 30%
increase in experiencing a fall over the next 2 years.
Clinical Alerts to
Decrease High-Risk Medication Use in Older Adults
(HRMs) account for 14.6% to 54.6% of all medications used in older adults, and
have been linked to >50% of adverse drug events (ADEs). HRM-related ADEs
lead to increased morbidity and mortality, increased hospital length of stay,
and financial costs for patients and health care systems. It has been well
documented that incorporating information technology in patient care in the
form of clinical alert systems can effectively decrease HRM use and improve
patient safety. The current article seeks to identify and discuss clinical
alert systems focusing on HRMs, their impact on prescribing for older adults,
and challenges to the implementation of electronic decision systems. [Journal of Gerontological Nursing, 43(7), 7–12.]
Assessment of Fall
Characteristics from Depth Sensor Videos
Falls are a major source
of death and disability in older adults; little data, however, are available
about the etiology of falls in community-dwelling older adults. Sensor systems
installed in independent and assisted living residences of 105 older adults
participating in an ongoing technology study were programmed to record live
videos of probable fall events. Sixty-four fall video segments from 19
individuals were viewed and rated using the Falls Video Assessment Questionnaire.
Raters identified that 56% (n = 36) of falls were due to an incorrect shift of body
weight and 27% (n = 17) from losing support of an external object, such
as an unlocked wheelchair or rolling walker. In 60% of falls, mobility aids
were in the room or in use at the time of the fall. Use of environmentally
embedded sensors provides a mechanism for real-time fall detection and,
ultimately, may supply information to clinicians for fall prevention
interventions. [Journal of Gerontological Nursing, 43(7), 13–19.]
Jennifer J. O'Connor, MS, RN, CFCN, CNE; Lorraine J.
Phillips, PhD, RN, FAAN; Bunmi Folarinde, MSN, RN; Gregory L. Alexander, PhD,
RN, FAAN; Marilyn Rantz, PhD, RN, FAAN
EVIDENCE-BASED PRACTICE GUIDELINE
Management in Older Adults
More individuals develop
and endure constant or recurring pain in older adulthood. Although 40% of these
individuals receive no treatment, many evidence-based treatments are available.
Accurate assessment of pain, its impact on functioning, and preventing
treatment-related harms lay the foundation of safe, effective pain control.
Analgesic agents are often necessary, but require a delicate balance to prevent
under-treatment, the unnecessary abandonment of therapy, or exposure to
potentially serious adverse effects. Nondrug therapies must be better
integrated into the treatment plan to ensure overall safety. Evidence-based
approaches help older adults thrive and survive longer despite living with
persistent pain. [Journal of Gerontological Nursing, 43(7), 20–31.]
Paul Arnstein, RN, PhD, FAAN; Keela A. Herr, PhD, RN, FAAN
Bullying in Senior
Living Facilities: Perspectives of Long-Term Care Staff
bullying has attracted attention in the media, but little empirical literature
exists related to the topic of senior bullying. The aim of the current study
was to better understand resident-to-resident bullying from the perspective of
staff who work with older adults. Forty-five long-term care staff members were
interviewed regarding their observations of bullying. Results indicate that
most staff members have observed bullying. Verbal bullying was the most
observed type of bullying, but social bullying was also prevalent. Victims and
perpetrators were reported to commonly have cognitive and physical
disabilities. More than one half of participants had not received formal
training and only 21% reported their facility had a formal policy to address
bullying. The implications of these results support the need for detailed
policies and training programs for staff to effectively intervene when bullying
occurs. [Journal of Gerontological Nursing, 43(7), 34–41.]
Felicia J. Andresen, MA; Jeffrey A. Buchanan, PhD
Determinants, and Outcomes of Social Connectedness for Older Adults: A Scoping
Social connectedness is
critical to older adults' well-being, but is defined inconsistently and its
determinants and outcomes have not been comprehensively described.
The current scoping review
mapped the definitions, determinants, and outcomes of social connectedness for
By identifying the
conceptual features described in most articles, social connectedness was defined as: the opposite of loneliness, a
subjective evaluation of the extent to which one has meaningful, close, and
constructive relationships with others (i.e., individuals, groups, and
society). Social connectedness is operationalized into: (a) caring about others
and feeling cared about by others, and (b) feeling of belonging to a group or
community. One's social network and life satisfaction were the most frequently
proposed determinant and outcome, respectively. This review resulted in a clear
definition of social connectedness and comprehensive description of its
possible determinants and outcomes. This clarity will support the development
of interventions to enhance social connectedness for older adults. [Journal of Gerontological Nursing, 43(7), 43–52.]
Hannah M. O'Rourke, PhD, RN; Souraya Sidani, PhD
and Heart Rate Variability as Indicators of Fall Risk: Proof-of-Concept for
Application of Wearable Sensors in the Acute Care Setting
Growing concern for falls
in acute care settings could be addressed with objective evaluation of fall
risk. The current proof-of-concept study evaluated the feasibility of using a
chest-worn sensor during hospitalization to determine fall risk. Physical
activity and heart rate variability (HRV) of 31 volunteers admitted to a 29-bed
adult inpatient unit were recorded using a single chest-worn sensor. Sensor
data during the first 24-hour recording were analyzed. Participants were
stratified using the Hendrich II fall risk assessment into high and low fall
risk groups. Univariate analysis revealed age, daytime activity, nighttime side
lying posture, and HRV were significantly different between groups. Results
suggest feasibility of wearable technology to consciously monitor physical
activity, sleep postures, and HRV as potential markers of fall risk in the
acute care setting. Further study is warranted to confirm the results and
examine the efficacy of the proposed wearable technology to manage falls in
hospitals. [Journal of Gerontological Nursing, 43(7), 53–62.]
AGS and NHTSA Partner
to Plot Course Toward Safe Driving for Older Adults and Caregivers
Sometimes it's a
little better to travel than to arrive.” —Robert M. Pirsig, Zen and the
Art of Motorcycle Maintenance: An Inquiry into Values
Navigation is a recurrent theme at the American Geriatrics Society
(AGS). Our explicit mission is to help fellow health care professionals,
policymakers, and the public navigate high-quality, person-centered care for
older adults across clinical practice, geriatrics research, professional and
public education, and public policy (AGS,
2017a). In keeping with this mission, one of our newest campaigns
focuses on navigating change for older adults and health care professionals.
With support from the National Highway Traffic Safety Administration (NHTSA),
the AGS has leveraged the public education expertise of our Health in Aging
Foundation to develop a new public education program to help older adults
safely navigate the open road (AGS,