Geriatric Nursing - Articles in Press

A Meta-Analysis on the Impact of Disease-Specific Education Programs on Health Outcomes for Patients with Chronic Obstructive Pulmonary Disease - Corrected Proof

2012-05-18

Disease-specific education programs have become an important factor in the treatment and care of chronic conditions, such as heart failure and diabetes mellitus. However, the effectiveness of these educational methods on chronic obstructive pulmonary disease (COPD) remains unclear. The objective of this meta-analysis was to evaluate whether disease-specific education programs were beneficial to health-related quality of life (HRQoL) variables and other long-term health outcomes in patients with COPD. Using electronic databases (PubMed, Cochrane Library, Science Direct, Chinese Biomedical Data System, China National Knowledge Infrastructure, and Wanfang Database) and individual searches (published and unpublished Chinese studies), we identified 12 randomized controlled trials (RCTs; English and/or Chinese) from 1991 to 2011. A meta-analysis on these studies revealed a positive relationship between disease-specific education programs and HRQoL scores (as measured by the St. George’s Respiratory Questionnaire). Moreover, educational programs were associated with increased knowledge about COPD, improved disease management skills, inhaler adherence, and decreased COPD-related emergency department visits and hospital admissions, as well as long-term effects on improving COPD patients’ health outcomes. Although significant effects were not detected across all HRQoL variables and health measures, our findings suggest that education programs have the potential to be a valuable intervention for COPD patients. Our results provide a foundation for future research in this area, which we recommend as including more rigorously designed, large, randomized studies.

Physical Activity and Psychosocial and Mental Health of Older Caregivers and Non-Caregivers - Corrected Proof

2012-05-17

Few studies have been conducted on physical activity (PA) in older caregivers, a population at risk for mental and physical decline. To assess and compare PA, PA preferences, psychosocial determinants of PA, and mental health indicators between older non-exercising caregivers and non-caregivers. Caregivers (N = 24) and non-caregivers (N = 48) completed questionnaires and wore an accelerometer for 7 consecutive days. Few significant differences were noted in objectively measured or subjectively reported PA between caregivers and non-caregivers. Non-caregivers reported greater social support to exercise from family members. Caregivers reported significantly greater anxiety, depression, stress, and negative health symptoms. Caregivers were significantly more likely to prefer exercise in 10-min bouts. Caregivers are in need of interventions to increase PA and health. Efforts to help caregivers participate in multiple shorter bouts of exercise during the day could be more effective than recommending one continuous 30-minute bout.

The Role of Caregiver Burden in Understanding African American Custodial Grandmothers - Corrected Proof

Gloria F. Carr, Bert Hayslip, Jennifer Gray — 2012-05-17

African American grandmothers who parent their grandchildren often experience burden and altered health related to these responsibilities. However, little is known about how such burden reliably predicts physical and mental health, needs for information about services, needs for service and service use. Recruited from churches and community centers, 93 African American grandmothers who provided care for their grandchildren participated in this study. Hierarchical multiple regression was used to ascertain relationships between variables. Findings suggested that burden predicted needs for information about services, needs for service, service use, and physical health, but not mental health. In order to better understand grandmother caregivers’ well-being and orientation to services, the present study suggests that the role of burden be centralized as a predictor of many parameters pertinent to grandparents raising their grandchildren.

Factors Affecting Caregivers' Perceptions of Residents' Oral Health in Long-Term Care Facilities in Taiwan - Corrected Proof

2012-04-12

The purpose of this study was to investigate the differences between resident oral care policies provided by 2 types of long-term care (LTC) institutions. The study also investigated factors affecting LTC institutional caregivers' perceptions of the residents' oral health. Overall, 103 completed questionnaires were returned. Of these, 44 were from senior citizen welfare institutions, and 59 were from nursing homes. The variables affecting these perceptions included institution type and whether the residents attended hospital dental clinics or consulted a hospital doctor regarding oral health problems. The research results showed that institution type and whether an oral care–related professional was available in an institution were correlated with an increase in institutional caregivers' perceptions of oral care.

Attitudes Toward Life-Sustaining Treatment: The Role of Race/Ethnicity - Corrected Proof

Eunjeong Ko, Sunhee Cho, Monica Bonilla — 2012-03-12

This study explores attitudes regarding life-sustaining treatments between Korean American and Mexican American older adults. A cross sectional design was employed to survey 122 older adults residing in an urban area on the West Coast (64 Korean Americans and 58 Mexican Americans). Face to face interviews were conducted using a structured questionnaire. Results show that Mexican Americans as compared to Korean American older adults hold more favorable attitudes toward life-sustaining treatments. Participants who were male were more likely to have positive attitudes toward life-sustaining treatments than female. Findings emphasize the importance of culturally sensitive end-of-life care practices which consider cultural variations in life-sustaining treatment preferences.

Impact of Soft and Hard Insole Density on Postural Stability in Older Adults - Corrected Proof

2012-03-09

A significant predictor of falls in the elderly population is attributed to postural instability. Thus, it is important to identify and implement practical clinical interventions to enhance postural stability in older adults. Shoe insoles have been identified as a mechanism to enhance postural control, and our study aimed to evaluate the impact of 2 shoe insoles on static standing balance in healthy, older adults compared with standing posture while barefoot. We hypothesized that both hard and soft shoe insoles would decrease postural sway compared with the barefoot condition. Indeed, excursion distances and sway areas were reduced, and sway velocity was decreased when wearing insoles. The hard insole was also effective when visual feedback was removed, suggesting that the more rigid an insole, the greater potential reduction in fall risk. Thus, shoe insoles may be a cost-effective, clinical intervention that is easy to implement to reduce the risk of falling in the elderly population.

Functional Decline in Hospitalized Older Adults: Can Nursing Make a Difference? - Corrected Proof

Marie Boltz, Barbara Resnick, Elizabeth Capezuti, Joseph Shuluk, Michelle Secic — 2012-03-09

Function-focused care (FFC) is an approach to care in which nurses help patients engage in activities of daily living (ADL) and physical activity, with the goal of preventing avoidable functional decline. This prospective, observational study, conducted with hospitalized older adults (N = 93) examined: 1) the demographic and clinical characteristics of patients who were provided FFC activity, and 2) the relationship between change in physical activity and FFC activities. Patients who received FFC were more likely: to be younger (P = .028); had one or more falls during the hospitalization (P = .048); had demonstrated better functional performance at admission (P = .004) and better physical capability, measured by the Tinetti gait and balance scale (P = .004). FFC was associated with less decrement in ADL function, admission to discharge, while considering patient characteristics (t = 7.6; P < .008). Results suggest that hospitalized older persons can benefit from FFC.

Dementia-Specific Quality of Life Instruments and Their Appropriateness in Shared-Housing Arrangements—A Literature Study - Corrected Proof

Johannes Gräske, Thomas Fischer, Adelheid Kuhlmey, Karin Wolf-Ostermann — 2012-02-20

Shared-housing arrangements (SHA) in Germany are a specific type of housing arrangement that belongs to the global concept of small-scale living arrangements. This caring approach comprises characteristics of both home and institutional care for persons with dementia. To evaluate the impact of SHA on the quality of life (QoL) of residents, an appropriate setting- and dementia-specific QoL instrument is needed. This article aims to identify QoL instruments that relate to the core domains of SHA. After a comprehensive literature review, existing dementia-specific QoL instruments were evaluated to determine whether any have been specifically designed for or applied in SHA. Additionally, each domain of the instruments was matched with the core domains of SHA. None of the existing instruments was identified as having been developed for SHA. Matching of the instrument domains with the SHA core domains leads to the conclusion that Quality of Life-Alzheimer’s Disease, Dementia Quality of Life, Alzheimer Disease-Related Quality of Life, and QUALIDEM are adequate instruments for measuring the dementia-specific QoL of persons living in SHA. For the first time, a basis has been created for valid QoL evaluations of residents with dementia living in SHA. The 4 identified instruments are considered applicable in SHA. Conducting a performance test and evaluating further attributes according to the Scientific Advisory Committee of the Medical Outcomes Trust (e.g., reliability and validity) will further elucidation of the appropriateness of the instruments for SHA.

Observing How RNS Use Clinical Time in a Nursing Home: A Pilot Study - Corrected Proof

Mary Ellen Dellefield, Charlene Harrington, Ann Kelly — 2012-02-20

Registered nurses (RNs) working in nursing homes (NHs) are a scarce professional resource. Their responsibilities include direct (e.g., assessment, physical care, and medication administration) and indirect care (e.g., documentation, supervision, and other activities performed away from the resident to manage their care environment). The purpose of the study was to describe the direct and indirect care distribution of RNs working day shift in an NH. All RN care was observed, although RN care associated with pressure ulcer prevention as a clinical outcome was highlighted. Work sampling was conducted using a personal data assistant–based RN Observation Measure. RNs spent 59% of their time on indirect care. Little direct care could be linked with specific clinical categories relevant to pressure ulcer prevention. RNs are challenged to use RN clinical time more strategically.

Pet Ownership and Older Women: The Relationships Among Loneliness, Pet Attachment Support, Human Social Support, and Depressed Mood - Corrected Proof

Cheryl A. Krause-Parello — 2012-02-10

Pets can play a positive role in the both the physical and psychological health of older adults. This cross sectional study investigated the relationships among loneliness, pet attachment support, human social support, and depressed mood in a convenience sample of 159 pet-owning older women residing in the community. Participants completed loneliness, pet attachment support, human social support, and depressed mood scales. The results supported significant relationships between loneliness, pet attachment support, human social support, and depressed mood. No relationship was found between human social support and depressed mood. Pet attachment support, but not human social support, influenced the relationship between loneliness and depressed mood indicating the importance of pet attachment as a greater form of support in this sample. Clinical and social implications for nurses working with the geriatric population were identified and discussed.

Associations Between Chewing and Swallowing Problems and Physical and Psychosocial Health Status of Long-Term Care Residents in Taiwan: A Pilot Study - Corrected Proof

Tze-Fang Wang, I-Ju Chen, I-Chuan Li — 2012-01-19

Oral health is often overlooked in institutional elder care but may have an impact on general health and ability to communicate. We aimed to determine the factor associated with chewing and swallowing problems among long-term care residents in Taiwan. Staff nurses trained to evaluate oral health assessed 781 residents using relevant sections of the Minimum Data Set 2.1 for nursing homes (Chinese version), including the Cognitive Performance Scale, Index of Social Engagement, and Activities of Daily Living Scale. Individuals with chewing and swallowing problems (n = 345) tended to be women (odds ratio [OR] = 1.51, P = .019) in smaller facilities (OR = 4.18, P < .001) with fewer natural teeth (OR = 0.54, P = .011); more broken, loose, or carious teeth (OR = 1.74, P = .042); and with more frequently inflamed gums (OR = 2.72, P = .025) than residents without chewing and swallowing problems (n = 436). Residents' chewing and swallowing problems were significantly associated with parenteral/enteral intake, oral health status, nutritional status, concomitant disease and infection, cognitive function, and social engagement.

Inner Strength in Relation to Functional Status, Disease, Living Arrangements, and Social Relationships Among People Aged 85 Years and Older - Corrected Proof

2012-01-03

Inner strength is described as an important resource that promotes well-being. We used data from a sample of 185 people in the Umeå 85+ cohort study to relate inner strength and its attributes to objective health variables. The Resilience, Sense of Coherence, Purpose in Life, and Self-Transcendence scales were used to assess aspects of inner strength, and strong correlations between the scales were found. Prevalence of heart failure, chronic obstructive pulmonary disorder, osteoporosis, or diagnosed depression was associated with low inner strength. Significant relationships were also found between high inner strength and various measures of social relationships. Participants with a higher degree of inner strength had better physical health and more satisfying social relationships. The promotion of inner strength should be a major aim of geriatric nursing.

Clinical Feasibility Trial of a Motion Detection System for Fall Prevention in Hospitalized Older Adult Patients - Corrected Proof

2012-01-03

The purpose of this pilot study was to test the feasibility of a wireless 5-sensor, motion detection system (5S-MDS) with hospitalized older adults. Interventions to prevent hospital-based falls in older adults are important to reduce morbidity, mortality, and health care costs. Wearable motion sensors, which track and wirelessly transmit body movements, may identify human movement patterns that immediately precede falls, thus allowing early prevention. Descriptive feasibility study in which 5 hospitalized older adults were recruited to wear the 5S-MDS for 4 hours. Measurement included assessment of participant acceptance, skin integrity, and sensor accuracy. All 5 participants (mean age, 90.2 years) agreed that sensors were acceptable and skin integrity was maintained. The sensor data accurately reflected the patient movements. The 5S-MDS was feasible for 4 hours’ use with hospitalized older adults. It has potential as an early warning system for falls.