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 Nursing Practice?

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="">
...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 categories:
  1. ·         basic dementia awareness,
  2. ·         intermediate dementia skills practice training, and
  3. ·         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 While Driving
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 with dementia.
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 Society.
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 events.
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 or warfarin.
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="">
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 and Medicine.
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
High-risk medications (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.]
Wilhelmina Lord-Adem, PharmD; Nicole J. Brandt, PharmD, MBA, CGP, BCPP, FASCP

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

Persistent Pain 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
Resident-to-resident 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

Definition, Determinants, and Outcomes of Social Connectedness for Older Adults: A Scoping Review
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 older adults.
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

Activity Monitoring 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.]
Javad Razjouyan, PhD; Gurtej Singh Grewal, PhD; Cindy Rishel, PhD, RN, OCN; Sairam Parthasarathy, MD; Jane Mohler, PhD, MPH, NP-C; Bijan Najafi, PhD

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, 2017b).

Debra Saliba, MD, MPH, AGSF

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