Geriatric Nursing RSS feed: Current Issue. Geriatric Nursing is a comprehensive source for clinical information and management advice relating to the care of older adults. The journal's peer-reviewed articles report the latest developments in the management of acute and chronic disorders and provide practical advice on care of older adults across the long term continuum. Geriatric Nursing addresses current issues related to drugs, advance directives, staff development and management, legal issues, client and caregiver education, infection control, and other topics. The journal is written specifically for nurses and nurse practitioners who work with older adults in any care setting. Geriatric Nursing is the official journal of the American Assisted Living Nurses Association, National Gerontological Nurses Association, Gerontological Advanced Practice Nurses Association and is indexed in Medline, ISI and CINAHL. http://www.gnjournal.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Geriatric Nursing0197-4572332March 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.gnjournal.com/article/PIIS019745721200081X/abstract?rss=yesTable of Contents10.1016/S0197-4572(12)00081-XGeriatric Nursing 33, 2 (2012)2012-03-01Geriatric Nursing2012-03-01332S0197-4572(11)X0009-57980http://www.gnjournal.com/article/PIIS0197457212000821/abstract?rss=yesEditorial Board10.1016/S0197-4572(12)00082-1Geriatric Nursing 33, 2 (2012)2012-03-01Geriatric Nursing2012-03-01332S0197-4572(11)X0009-58181http://www.gnjournal.com/article/PIIS0197457212000845/abstract?rss=yesInformation for Readers10.1016/S0197-4572(12)00084-5Geriatric Nursing 33, 2 (2012)2012-03-01Geriatric Nursing2012-03-01332S0197-4572(11)X0009-58282http://www.gnjournal.com/article/PIIS0197457212000833/abstract?rss=yesInformation for Authors10.1016/S0197-4572(12)00083-3Geriatric Nursing 33, 2 (2012)2012-03-01Geriatric Nursing2012-03-01332S0197-4572(11)X0009-5e1e2http://www.gnjournal.com/article/PIIS0197457212000766/abstract?rss=yesIn response to the critical need for gerontological nursing faculty in the United States, the John A. Hartford Foundation partnered with the American Academy of Nursing to create a program called Building Academic Geriatric Nursing Capacity (BAGNC). BAGNC's main goal is to increase the number of expert gerontological nursing faculty in schools throughout the country—faculty members well-prepared in the full breadth of the academic role—research, teaching, and leadership.Group Reflections on Building Academic Geriatric Nursing CapacityBarbara Resnick10.1016/j.gerinurse.2012.02.008Geriatric Nursing 33, 2 (2012)2012-03-05Geriatric Nursing2012-03-05332S0197-4572(11)X0009-5From the Editor8385http://www.gnjournal.com/article/PIIS0197457212000699/abstract?rss=yesThe Editor expresses her gratitude to the following individuals who provided their scientific expertise and constructive advice in the review of manuscripts in 2011. Kathleen Abrahamson, PhD, RNGeriatric Nursing’s Acknowledgment to Reviewers10.1016/j.gerinurse.2012.02.001Geriatric Nursing 33, 2 (2012)2012-03-02Geriatric Nursing2012-03-02332S0197-4572(11)X0009-5From the Editor8688http://www.gnjournal.com/article/PIIS0197457212000651/abstract?rss=yesOlder adults with hypertension are dependent on medication to control blood pressure and reduce risk for cardiovascular disease and renal impairment. Unfortunately, adherence to antihypertensive regimens remains low. This pilot study examines the relation among medication beliefs, demographic variables, and antihypertensive medication adherence in a sample of older adults (median age = 74 years). Medication beliefs were measured using the Beliefs About Medicines Questionnaire (BMQ), and medication adherence was measured by electronic monitoring. Among study participants (n = 33), concerns about medications were found to be related to poorer antihypertensive adherence. In particular, older adults with lower medication adherence were concerned about dependency and long-term effects from their medications. When controlling for other factors that may influence antihypertensive adherence, beliefs about medication necessity were related to adherence (odds ratio: 2.027, 95% confidence interval: 1.10-3.75).Medication Beliefs and Antihypertensive Adherence Among Older Adults: A Pilot StudyTodd M. Ruppar, Fabienne Dobbels, Sabina De Geest10.1016/j.gerinurse.2012.01.006Geriatric Nursing 33, 2 (2012)2012-03-05Geriatric Nursing2012-03-05332S0197-4572(11)X0009-5Feature Articles8995http://www.gnjournal.com/article/PIIS019745721200002X/abstract?rss=yesThis study investigates the experiences of unlicensed staff providing care for older adults with behavioral and psychological symptoms of dementia (BPSD). The purpose of this study was to describe the types and frequency of BPSD reported by unlicensed caregivers and to describe reactions and training of the caregivers who provide care to residents with BPSD. Data were derived from 87 staff-resident dyads in twelve assisted living facilities (ALFs). Types and frequency of BPSD and staff reaction to BPSD were collected using standardized measures. Demographic data included amount of staff training related to caring for someone with BPSD. Dementia related behaviors and psychological symptoms were prevalent in the ALF residents, with memory related symptoms being the most frequently reported. Symptoms of depression in the ALF residents were less frequent yet accounted for the highest level of staff reaction. Limited training related to caring for residents with cognitive impairment was reported by staff. Developing ALF staff skills in identifying and managing depression in older adults with dementia may serve a dual purpose of improving quality of life for residents and for ALF staff.Reactions of Assisted Living Staff to Behavioral and Psychological Symptoms of DementiaGlenise McKenzie, Linda Teri, Kenneth Pike, David LaFazia, June van Leynseele10.1016/j.gerinurse.2011.12.004Geriatric Nursing 33, 2 (2012)2012-02-10Geriatric Nursing2012-02-10332S0197-4572(11)X0009-5Feature Articles96104http://www.gnjournal.com/article/PIIS0197457211006070/abstract?rss=yesCognitive impairment limits older adults' abilities to advocate for themselves, thus heightening their risk for abuse. Some older adults with cognitive impairments who seek emergency department (ED) services may present with injuries suspicious of abuse. A portion of these injuries may be erroneously attributed to accidents such as falls. A retrospective analysis of 2 years of ED data using International Classification of Diseases, Ninth Revision (ICD-9) codes was conducted focusing on characteristics of injuries sustained by persons with co-occurring cognitive impairment and fall status. Cognitive impairment was not significantly related to falls (P = .533). Findings suggest that persons with cognitive impairment have unique injury patterns based on fall status, which has implications for elder abuse screening. Injuries for persons with no fall history included injury to the upper limb (P = .004), contusions (P = .012), and open wounds (P = .000). An increased recognition of common injuries in older adults can aid in elder abuse assessment by providing a reference point for uncommon injuries.Raising the Index of Suspicion for Elder Abuse: Cognitive Impairment, Falls, and Injury Patterns in the Emergency DepartmentCarolyn E. Ziminski, Linda R. Phillips, Diana Lynn Woods10.1016/j.gerinurse.2011.12.003Geriatric Nursing 33, 2 (2012)2012-01-19Geriatric Nursing2012-01-19332S0197-4572(11)X0009-5Feature Articles105112http://www.gnjournal.com/article/PIIS0197457212000584/abstract?rss=yesTwo social interaction coding schemas were developed to measure the dementia competent (DSI) and culturally competent (CSI) social interaction of direct-care staff for persons with dementia in a Korean American nursing home. A pilot study was conducted to assess: feasibility, content validity, inter-rater reliability and the ease of use of both schemas. An expert panel evaluated the content validity of the DSI/CSI. Two research assistants (RAs) simultaneously observed and recorded direct-care staff social interaction encounter during care activities. Twenty-three morning care activities were recorded over a 3-day period. The Index of Content Validity score for the DSI and the CSI was .88 and .80, respectively. Cohen's Kappa ranged from 0.73 to 0.83 for the DSI and 0.69 to 0.82 for the CSI, indicating good to very good inter-rater reliability. RA interviews noted that schemas were easy to use and feasible.The Development of Direct-Care Staff Social Interaction Coding Schemas for Nursing Home Residents with DementiaHaesook Kim, Diana Lynn Woods10.1016/j.gerinurse.2012.01.002Geriatric Nursing 33, 2 (2012)2012-02-13Geriatric Nursing2012-02-13332S0197-4572(11)X0009-5Feature Articles113117http://www.gnjournal.com/article/PIIS0197457212000602/abstract?rss=yesAlthough functional status serves as a major predictor of morbidity, researchers and clinicians use different terms and measures, limiting comparisons across studies. To demonstrate how differing measures may generate varied findings, we compared and contrasted data from the SF-12 Health Survey Physical Component Summary Scale (SF-12 PCS) and the Enforced Social Dependency Scale (ESDS). The sample consisted of 49 women aged 65 and older recovering from gynecological cancer surgery with data collection at baseline (postoperative period) and then at 3 and 6 months. Analysis of the relationship between SF-12 PCS and ESDS over time using generalized estimating equations (GEE) demonstrated the relationship was less than 1.0, signaling less than perfect agreement between measures (β = 0.16, P = .002). These findings suggest that that the 2 measures are not interchangeable and may produce conflicting evidence. This highlights the importance of researchers’ and clinicians’ careful conceptualization and operationalization of functional status before measure selection.Functional Status in Older Women Following Gynecological Cancer Surgery: Can Choice of Measure Influence Evidence for Clinical Practice?Janet H. Van Cleave, Brian L. Egleston, Meg Bourbonniere, Lauren Cardone, Ruth McCorkle10.1016/j.gerinurse.2012.01.004Geriatric Nursing 33, 2 (2012)2012-03-05Geriatric Nursing2012-03-05332S0197-4572(11)X0009-5Feature Articles118126http://www.gnjournal.com/article/PIIS0197457212000705/abstract?rss=yesIn the United States, we are fortunate to have generally wide access to new drug products when manufacturers receive Food and Drug Administration (FDA) approval for marketing. With health care coverage of prescription drugs, most Americans, including the elderly, have at least partial financial offset through copayment or coinsurance for prescription drug coverage. Although fewer medications have come to market in the recent years than previously, there has been an increase in the approval of large-molecular-weight biologics, usually designed with specific disease targets in mind. Common to development of drugs and biologics is the general exclusion of older persons from the pivotal clinical trials needed to receive FDA approval. Manufacturers avoid including or include only limited numbers of older persons because of the greater likelihood of underlying disease confounders and the potential for increased morbidity and mortality as we age. Physicians might not refer elderly persons to clinical trials because of concerns that that product may not provide as much benefit to older persons as younger persons. Older persons may have limited ability to participate in clinical trials, which require more frequent visits to the physician. As a result, new products are frequently launched in the United States with inadequate knowledge about the product’s efficacy, safety, and tolerability in this population. summarizes the findings of the Government Accounting Office regarding the number of persons younger than and older than 65 years of age reported in new drug application clinical trials from 2001 through 2004. Even years after drug product availability, little is known about the response of the very old to these products.Therapeutic Experimentation in the ElderlyBarbara J. Zarowitz10.1016/j.gerinurse.2012.02.002Geriatric Nursing 33, 2 (2012)2012-03-01Geriatric Nursing2012-03-01332S0197-4572(11)X0009-5Pharmacy Column127130http://www.gnjournal.com/article/PIIS0197457212000754/abstract?rss=yes With respect to Medicare, the requirement for each enrolled provider or supplier to revalidate its enrollment at least every 5 years has been a regulatory requirement since an overhaul of the enrollment rules in June 2006. However, the Centers for Medicare and Medicaid Services’ (CMS’s) initial focus following these June 2006 regulatory changes was simply to make sure that each enrollee had its enrollment data entered into PECOS, the database developed to maintain Medicare enrollment data, because there were a significant number of providers and suppliers who had enrolled before the July 2002 PECOS implementation.Enrollment Revalidation: Pitfalls and TipsDonna J. Senft10.1016/j.gerinurse.2012.02.007Geriatric Nursing 33, 2 (2012)2012-03-01Geriatric Nursing2012-03-01332S0197-4572(11)X0009-5Legal Column131133http://www.gnjournal.com/article/PIIS0197457212000717/abstract?rss=yes Assisted living, by its very definition, provides assistance in living. One area where this is increasingly needed for AL residents involves fall prevention. Unfortunately, this same concern has also been an increasing focus of malpractice liability to AL communities. As a result of this need and focus, ALs would be well served to develop an aggressive plan of action in managing resident fall risks. This process starts with careful assessment of each residents fall risk, development of a well-thought-out care plan to address these risks, followed by implementation of the plan of care to ensure that residents receive the assistance they require.Stand By Me—Preventing FallsRichard G. Stefanacci, Dan Haimowitz10.1016/j.gerinurse.2012.02.003Geriatric Nursing 33, 2 (2012)2012-03-01Geriatric Nursing2012-03-01332S0197-4572(11)X0009-5Assisted Living Column134136http://www.gnjournal.com/article/PIIS0197457212000729/abstract?rss=yes Hospitalization can be a stressful event for anyone, typically more so for an older adult. Even the robust older person who is admitted for elective, minor surgery is at risk for hospital-acquired complications and will certainly need some support when discharged. In many families, assuming responsibility for an older adult relative with a chronic illness begins gradually and continues over an extended period of time. However, hospitalization of the older adult may mark the beginning of the caregiving role or bring about a precipitous and more intense family involvement in the older adult’s care. Recognizing the critical role that families can play in the hospitalization and postacute care of older people, a group of NICHE (Nurses Improving Care for Healthsystem Elders) members from around the country gathered at American Association of Retired Persons (AARP) headquarters recently to consider the role that nurses can play to support the efforts of family caregivers and to improve their caregiving experience. This work is funded by the grant “Professional Partners Supporting Diverse Family Caregivers across Settings,” funded by the Jacob and Valeria Langeloth Foundation through the AARP Foundation (principal investigator [PI]: Susan Reinhard) who is partnering with NICHE (Co-PI: Liz Capezuti) and the American Journal of Nursing (Co-PI: Shawn Kennedy) to develop and evaluate additional resources to support caregivers of hospitalized older adults.The Family Caregiver: An Untapped ResourceMarie Boltz10.1016/j.gerinurse.2012.02.004Geriatric Nursing 33, 2 (2012)2012-03-01Geriatric Nursing2012-03-01332S0197-4572(11)X0009-5Acute Care of the Elderly Column137139http://www.gnjournal.com/article/PIIS0197457212000614/abstract?rss=yesAdults aged 65 and older comprise the majority of patients in most hospitals. Usual aging changes along with comorbidities place older adults at risk for complications, longer lengths of stay, and hospital readmission. In a 2008 report, “Retooling for an Aging America: Building the Healthcare Workforce,” the Institute of Medicine (IOM) warned that unless health care workers developed competence in the care of older adults, the growing older adult population would face a health care workforce too small and “woefully unprepared” to meet its needs. The current dearth of both gerontologically prepared nursing school faculty and discrete gerontological undergraduate courses reflects the IOM’s stance, as nurses graduate and begin practice without sufficient knowledge and skills to manage the complex care of hospitalized frail older adults.Developing Nurses’ Geriatric Expertise Through the Geriatric Resource Nurse ModelJeanne St. Pierre, Renee Twibell10.1016/j.gerinurse.2012.01.005Geriatric Nursing 33, 2 (2012)2012-03-05Geriatric Nursing2012-03-05332S0197-4572(11)X0009-5NGNA Section140149http://www.gnjournal.com/article/PIIS0197457212000730/abstract?rss=yesThe Health Affairs committee is pleased to announce the selection of Meghan Routt as the 2011–2012 recipient of the Health Affairs Scholarship. Meghan currently works as a nurse practitioner both in an acute care hospital and a skilled nursing facility. She has been a member of GAPNA for 5 years and been active serving on the Practice Committee. As an active member of the Ohio Chapter, Meghan has provided expert testimony to both the House and Senate of Ohio in favor of advanced practice nurses ability to prescribe schedule II narcotics. She has an in-depth understanding of the state legislative process and is now interested in expanding that understanding to the national level. She attended the annual health policy meeting convened by the American College of Nurse Practitioners in February and was an active part of the Health Affairs committee.Health Affairs: A Scholarship Winner and More10.1016/j.gerinurse.2012.02.005Geriatric Nursing 33, 2 (2012)2012-03-01Geriatric Nursing2012-03-01332S0197-4572(11)X0009-5GAPNA Section150155http://www.gnjournal.com/article/PIIS0197457212000778/abstract?rss=yesThe American Assisted Living Nurses Association continues to actively support nurses caring for the nearly 1 million residents who call an assisted living community home. We have recently appointed a new president to help lead our national efforts, our popular preparation course for the assisted living nursing certification examination is moving to an online format, and preparations are underway for the 2012 annual conference.AALNA News and Notes: New President, Preparation Course for Online Certification Examination, National Conference, and MoreJosh Allen10.1016/j.gerinurse.2012.02.009Geriatric Nursing 33, 2 (2012)2012-03-01Geriatric Nursing2012-03-01332S0197-4572(11)X0009-5AALNA Section156157http://www.gnjournal.com/article/PIIS0197457212000742/abstract?rss=yesOlder adults (>65 years) comprise more than 40% of intensive care unit (ICU) admissions and almost 60% of all ICU days. It is estimated that one-third to one-half of older adult patients experience complications that prolong their hospital stay and increase the need for institutionalization after discharge. Implementation of evidenced-base clinical guidelines and protocols to prevent, identify, and treat many common problems (geriatric syndromes) faced by older patients in an acute care setting improves outcomes.New NICHE Course: Critical Care Nursing of Older AdultsBarbara Bricoli10.1016/j.gerinurse.2012.02.006Geriatric Nursing 33, 2 (2012)2012-03-01Geriatric Nursing2012-03-01332S0197-4572(11)X0009-5NICHE Section158159