Newsview
Article Outline
- Annual NICHE conference largest ever
- Nominations sought for heroes of the depression community
- Depression may predict heart rhythm abnormalities in heart attack patients
- Supplement appears effective in treatment of depression
- Individuals with depression and diabetes do worse than individuals with either illness alone
- Strong association found between depression and risk of death for chronic heart failure patients
- Experimental study shows potential of dietary DHA in Alzheimer's
- Three new trials for caregivers and Alzheimer patients
- Attention NCGNP members—potential publishing opportunity
- Resources
Annual NICHE conference largest ever
Representatives of both new and experienced NICHE (Nurses Improving Care for Health System Elders) hospitals gathered recently in New York City for the annual NICHE conference. The NICHE program, founded more than a decade ago by The John A. Hartford Foundation Institute for Geriatric Nursing, has been adopted nationwide by more than 125 hospitals, and is designed to address the health care needs of an aging population amid a national nurse shortage. Leaders from the 35 new NICHE sites learned about the basic NICHE “toolkit” which includes evidence based, best-practice nursing protocols for nursing care to hospitalized older adults. Also discussed during the conference were other issues in geriatric nursing—including oral care, dementia, elder mistreatment and urinary incontinence. Several hospitals that have done research on the outcomes of their NICHE programs, particularly the acute-care for the elderly (ACE) units, have reported reduced lengths of stay, decreased costs, and improved patient satisfaction.
Nominations sought for heroes of the depression community
Do you know someone who has made great strides in battling depression, or has improved the lives of those struggling with this devastating illness? If so, you can honor that individual by nominating them for the prestigious Lilly Welcome Back Award, which includes a donation of up to $15,000 to the not-for-profit organization of the honoree's choice. The Welcome Back Awards, established in 1998 to help fight the stigma associated with depression, each year celebrate advances made in the depression community. Five individuals are recognized annually for their outstanding contributions to the areas of lifetime achievement, community service, de-stigmatization, primary care, and psychiatry. For more information on the nomination process, please visit the Web site www.WelcomeBackAwards.com.
Depression may predict heart rhythm abnormalities in heart attack patients
The results of a study recently conducted at Duke University Hospital showed that there was a strong association between depression and ventricular tachycardia in patients recently hospitalized for heart attack. Ventricular tachycardia—the incidence of irregular and rapid beating of the heart's main pumping chambers, occurs whenever ventricles beat more than 100 times in a minute. In some cases, it may last for only a few beats—in others, sustained periods of tachycardia can cause severe ventricular damage. The research results, presented at the American Psychosomatic Society held in Vancouver this past March, showed that depression in patients hospitalized for a heart attack can be a significant predictor of ventricular tachycardia. While the researchers cannot determine whether there is a cause and effect relationship, depression has been linked to activation of the immune system, as well as alteration of the aggregation properties of blood platelets. Depression has been linked to depletion of the immune system.
Supplement appears effective in treatment of depression
An article appearing in a recent issue of the Archives of General Psychiatry (2005;62:154-162) shows that DHEA (dehydroepiandrosterone)—an adrenal androgen and neurosteroid available as an over-the-counter supplement in the United States—might possibly have a useful role in the treatment of mild to moderately severe midlife-onset major and minor depression. The study was conducted by Peter J. Schmidt, MD and colleagues from the Behavioral Endocrinology Branch of the National Institute of Mental Health in Rockville, Maryland, and found significant improvements in measures of depression and sexual function after 6 weeks of DHEA treatment. Further controlled evaluations of potential therapeutic agents such as DHEA are needed as the study suggests, but in patients who do not respond to first-line antidepressant treatment, or in those unwilling to take traditional antidepressants, DHEA may play a useful role in the treatment of depression.
Individuals with depression and diabetes do worse than individuals with either illness alone
According to a recent study in Diabetes Care [2004;27(2):421-428] and funded by the AHRQ (Agency for Healthcare Research and Quality), individuals who suffer from a combination of major depression and diabetes, are less likely to be able to carry out their routine daily living and social activities than someone with either illness alone. Since approximately 10% of the diabetic population suffers from major depression, this study finding is significant. In the study population, the researchers found that even after controlling for other factors affecting functioning, individuals suffering from major depression were 3 times as likely to be functionally disabled as those without depression or diabetes. Those with diabetes alone were 2.5 times as likely, and those with diabetes and major depression were 6.15 times as likely to be functionally disabled.
Strong association found between depression and risk of death for chronic heart failure patients
In a Duke University Medical Center study presented at the recent American College of Cardiology annual meetings by Wei Jiang, MD, findings indicate that depression can have a major impact on how patients fare. Researchers found that even mild depression increases long-term mortality in patients with chronic heart failure. Approximately half of all patients with congestive heart failure die within 5 years of diagnosis and this study appears to identify a patient group that is at higher risk for death. While this and other studies have demonstrated links between depression and poor cardiovascular patient outcomes, the mechanisms behind the correlation are not well understood at this time. While it is known that depressed patients may have altered blood platelet aggregation properties, elevated immune-inflammatory responses and a decrease in the heart's ability to react appropriately to the stresses of life, it is also known that depressed patients tend not to comply with their treatments, are not as motivated to stick with exercise programs and diets, and often miss doctor appointments. Dr. Jiang suggests the use of depression screening tools in practice to aid in the early diagnosis and treatment of depression.
Experimental study shows potential of dietary DHA in Alzheimer's
An experimental study published in the March 30, 2005 issue of the Journal of Neuroscience shows that DHA (docosahexaenoic acid), an omega-3 fatty acid, may protect against the accumulation of a protein believed to be linked to Alzheimer's disease. The study used aged mice bred with genetic mutations that caused brain pathology linked to Alzheimer's (total Beta-Amyloid and plaque burden). The pathogens linked to Alzheimer's disease were significantly reduced in mice fed a diet enriched with DHA. The results are significant in that these beneficial results were observed even when the diets were changed late in life, says study investigator, Dr. Greg Cole, Associate Director for Geriatric Research at the VA Greater Los Angeles, and Professor of Medicine and Neurology at UCLA. The results add to the growing body of evidence for the possible role of DHA in the treatment of Alzheimer's.
Three new trials for caregivers and Alzheimer patients
Primary caregivers often experience stress, depression, and other emotional problems as a result of the continuing and demanding levels of care required by patients with Alzheimer's. Three studies are now underway at the New York University School of Medicine to determine if short-term counseling can ease the psychological stress and depression of Alzheimer's patients and their family members. These studies—part of the NYU Silberstein Institute's Psychosocial Research Program—continue the Institute's longstanding endeavor to test interventions to improve the well being of families dealing with Alzheimer's. NYU School of Medicine is actively recruiting caregivers for these studies. People interested in participating should contact Olanta Barton at 212-263-5710 for more information.
Attention NCGNP members—potential publishing opportunity
Barbara Resnick, PhD, CRNP, FAAN, FAANP, NCGNP section co-editor, has forwarded this request from Deborah Truax and Barbara White, who are looking for contributors for their book project. The book will be specifically for nursing practitioners who are managing patients in the skilled nursing facility setting. It will be published in 2006 by Jones and Bartlett. They are in need of NPs to write the following clinical management sections: Cardiology; Neurology; Infectious Disease; Respiratory; Gastrointestinal; Anemias; Dermatology; Genitourinary Disorders; Psychological. If you or a colleague are interested in contributing to the book, please contact Deborah Truax at 562-494-1062 or datruax@earthlink.net.
Resources
Free assisted living resource guides
Several free resource guides are available for assisted living residents, staff and families to create environments that offer independence, choice and control for residents. Developed by the Long Term Care Community Coalition (LTCC) and Coalition of Institutionalized Aged and Disabled (CIAD) and funded by the Robert Wood Johnson Foundation, these free guides are available at www.assisted-living411.org. The guides are based on research performed by the LTCCC and the CIAD. All guides were reviewed by a professional advisory board and were pilot-tested in diverse communities across the nation.
Epilepsy more prevalent in older Americans than other age groups
According to the National Council on Aging and the American Society on Aging, people over 65 constitute the fastest growing population with epilepsy. It is twice as likely to occur in seniors and can be caused by common health problems associated with aging such as stroke, cancer and heart disease. It may also develop following a blow to the head. Elderly patients may not necessarily display the more overt symptoms of major seizures that are most often associated with younger individuals. Instead, the symptoms the elderly exhibit may be more subtle and often overlooked or dismissed as typical symptoms of aging, such as brief gaps in conversation, periods of confusion, blank stares, or being unresponsive. A free discussion guide entitled Controlling Epilepsy Later in Life, is available at the Web site www.ncoa.org. Click on the SeniorsCorner. The guide covers the signs and symptoms of epilepsy along with questions to ask a doctor about treatment options.
And YOU—THE READER—continue to be the best resource. Find ways to assist those in your practice who may need the extra bit of help to get them through a rough time. Be cognizant of the signs and symptoms of depression, not only in your patients, but in yourselves and your co-workers. Guard your own health and energy, knowing that you cannot continually deplete a resource without that resource eventually drying up. As summer nears, remember to take time to smell the roses. Sometimes something as simple as a quiet walk in pleasant surroundings such as a garden, can do wonders to bring someone out of a depressive slump.
PII: S0197-4572(05)00092-3
doi:10.1016/j.gerinurse.2005.03.019
