PURPOSE: To use machine learning techniques with sensor data to predict fall risk in older adults aging in place. METHOD: We tested the feasibility of using anomaly detection on a dataset comprising 315 days of continuou...PURPOSE: To use machine learning techniques with sensor data to predict fall risk in older adults aging in place. METHOD: We tested the feasibility of using anomaly detection on a dataset comprising 315 days of continuous unobtrusive sensor data obtained from a single participant to predict fall risk within a 10-day window. Predictions were validated with performance metrics, including accuracy, F1 score, and receiver operating characteristic-area under curve (ROC-AUC), using actual falls documented in the electronic health record. RESULTS: The model resulted with accuracy = 0.96 (95% confidence interval [CI] [0.94, 0.99]), F1 = 0.78 (95% CI [0.73, 0.83]), and ROC-AUC = 0.89 (95% CI [0.85, 0.93]). CONCLUSION: The application of anomaly detection on sensor data may provide a timely and valid indication of fall risk in older adults within a 10-day window. Further research and validation are warranted to confirm these findings and expand the scope of application in the domain of older adult care and health care support. [(10), 7-10.].
PURPOSE: To examine the use of the PARO robotic pet seal for hospitalized older adults with dementia and compare the effects of PARO use with visits by a human on various outcomes, including physical restraint use, psych...PURPOSE: To examine the use of the PARO robotic pet seal for hospitalized older adults with dementia and compare the effects of PARO use with visits by a human on various outcomes, including physical restraint use, psychotropic medications, bedside sitters, and delirium. METHOD: Complete data for 38 participants were analyzed using Mann-Whitney U and chi-square tests. RESULTS: Participants interacting with PARO spent less time in their interactions; however, they received fewer psychotropic medications and had fewer instances of delirium than those who interacted with human visitors only. CONCLUSION: Aspects of hospitalization may limit the time an older adult can sustain attention or be free from interruption; however, short, repeated visits with PARO may affect the development of delirium and decrease use of medications to alter behavior in the hospital setting. [(10), 11-16.].
PURPOSE: To explore barriers and facilitators to nurses' provision of sexual and reproductive health (SRH) care to community-dwelling older adults. METHOD: An integrative literature review was performed using Whittemore...PURPOSE: To explore barriers and facilitators to nurses' provision of sexual and reproductive health (SRH) care to community-dwelling older adults. METHOD: An integrative literature review was performed using Whittemore and Knafl's method. Three databases were searched for research conducted between 2012 and 2023, and the Mixed Methods Appraisal Tool was used to determine the quality of included studies. RESULTS: Nine studies were ultimately included for analysis, and themes were and . included: nurses' lack of knowledge about older adults' sexual health, discomfort discussing sexual topics, age-related stereotypes regarding older adults' sexuality, and older adults' lack of knowledge of and reluctance to discuss sexuality and sexual health issues. included: gender of health care provider, nursing education on effective communication strategies, encouraging open dialogue to challenge ageist perceptions, and sexual education for older adults. CONCLUSION: Findings underscore the impact of stigma and negative ageist assumptions on whether discussions about SRH occur between nurses and older adults. There is a need for comprehensive education for nurses and older adults about SRH to recognize sexual health needs and promote open and constructive conversations. Moreover, research about how to best facilitate older adults' SRH is needed. [(10), 17-23.].
PURPOSE: To examine the feasibility and acceptability of progressive whole-body resistance training with social support reinforcement for older adults living alone. METHOD: This mixed methods single-group pilot study exa...PURPOSE: To examine the feasibility and acceptability of progressive whole-body resistance training with social support reinforcement for older adults living alone. METHOD: This mixed methods single-group pilot study examined an intervention provided over 3 nonconsecutive days per week for 12 weeks. We evaluated quantitative data on recruitment, uptake, retention, and adherence, and measured pretest and posttest outcome scores on body composition, physical function, and psychosocial health. We conducted a focus group interview to collect qualitative data on participants' perspectives. RESULTS: Seven participants (five women and two men) completed the program (attendance rate = 88.9%). Physical function and psychosocial health improved, but soft lean and skeletal muscle mass decreased. Five themes emerged from the qualitative data. CONCLUSION: Results support the feasibility and benefits of this intervention program for older adults living alone despite challenges with recruitment and uptake. [(10), 34-41.].
PURPOSE: To ascertain current nutritional knowledge and training needs of community-based nurses caring for older adults in the United Kingdom. METHOD: A descriptive cross-sectional, anonymized, online survey of nurses'...PURPOSE: To ascertain current nutritional knowledge and training needs of community-based nurses caring for older adults in the United Kingdom. METHOD: A descriptive cross-sectional, anonymized, online survey of nurses' knowledge, attitudes, and practices related to older adults' nutrition was developed. Community-based nurses working with older adults in the United Kingdom were recruited via social media and convenience sampling. RESULTS: Responses were received from 194 community-based nurses. Nutritional care was seen as a multidisciplinary responsibility by 62% of participants. Most undertook nutrition screening (93%), were confident in providing nutritional advice (83%), and ease of identifying those in need (88%) was high. However, some aspects of nutritional knowledge were less complete, including recommended daily intakes of protein (60% unsure) and fiber (52% unsure). CONCLUSION: High confidence in delivering nutritional advice contrasted with uncertainty around some aspects of nutritional knowledge, suggesting opportunities to improve training on the nutritional needs of older adults. [(11), 13-19.].
PURPOSE: Older people with HIV (OPWH; aged ≥50 years) have unique vulnerabilities to intersecting risks for marginalization and isolation. The current qualitative study explored perceptions of social connection during th...PURPOSE: Older people with HIV (OPWH; aged ≥50 years) have unique vulnerabilities to intersecting risks for marginalization and isolation. The current qualitative study explored perceptions of social connection during the coronavirus disease 2019 (COVID-19) pandemic. METHOD: Purposive sampling was used to recruit participants from two local community-based organizations (CBOs) in the Greater Boston area. Recruitment occurred through dissemination of flyers by staff of the CBOs. Semi-structured interviews were conducted between October 2021 and March 2022. Data were analyzed using thematic analysis. RESULTS: Of 22 participants, most were women (63.6%) and Hispanic/Latinx or African American/Black (86.4%). Participants viewed social connection as an important aspect of well-being, but acknowledged that COVID-19 induced social isolation. There were gender differences in social connection. Technology was adopted by all participants that allowed connection to others. Pre-existing relationships with support groups and CBOs facilitated improved social connection and well-being. CONCLUSION: Focused attention should be on individuals not linked to CBOs or social services and those who lack access or have barriers to technology use, as they may be at the most significant risk for isolation. [(12), 11-17.].
PURPOSE: Hearing trouble (HT) impairs communication with health care providers (HCPs) and may lead to negative care experiences that impact health outcomes. The current study aimed to examine how HT influences patient pe...PURPOSE: Hearing trouble (HT) impairs communication with health care providers (HCPs) and may lead to negative care experiences that impact health outcomes. The current study aimed to examine how HT influences patient perceptions of provider interactions and whether having an accompanying companion during health care visits modifies perceptions of provider interactions. METHOD: This cross-sectional study analyzed 9,104 responses from the 2016 Medicare Current Beneficiary Survey. RESULTS: Compared to beneficiaries without HT, those with HT had greater odds of negative perceptions of HCP interactions. Beneficiaries with HT had greater odds of disagreeing with positive statements about care, including provider competence, provider cares to check everything, provider response, and provider rarely in a hurry. Having an accompanying companion during health care visits was not found to significantly modify perceptions of interactions. CONCLUSION: Findings suggest HT is a modifiable factor impacting health care communication. Implementing simple accommodation strategies in clinical practice can improve nursing care for older adults with HT. [(11), 29-35.].
PURPOSE: This evidence-based initiative assessed the effect of adding a mobility champion to an existing progressive mobility protocol on functional decline in hospitalized older adults as evidenced by recommended discha...PURPOSE: This evidence-based initiative assessed the effect of adding a mobility champion to an existing progressive mobility protocol on functional decline in hospitalized older adults as evidenced by recommended discharge to home versus an inpatient rehabilitation facility. METHOD: Older adults admitted from home to a 47-bed medical-surgical telemetry unit who were assessed as ambulatory, either independently or with assistance (Level 5), and with a progressive mobility order in the electronic health record were included in the initiative. Patient care associates who volunteered to be mobility champions were trained how to safely ambulate patients. RESULTS: Patients who worked with a mobility champion were less likely to be referred to inpatient rehabilitation post discharge for further care due to functional decline. CONCLUSION: Mobility has a critical role in the maintenance of hospitalized older adults' functional abilities and is a determinate of their post discharge disposition. [(11), 37-43.].
PURPOSE: As the number of older adults increases, the volume of alcohol-related problems among the older adult population also rises. The purpose of the current scoping review was to summarize and disseminate research fi...PURPOSE: As the number of older adults increases, the volume of alcohol-related problems among the older adult population also rises. The purpose of the current scoping review was to summarize and disseminate research findings related to screening for alcohol use disorder (AUD) in older adults (aged ≥60 years) and determine if research gaps exist in the current literature. METHOD: The concepts of older adults, screening tools, AUD, and instrument evaluation were searched in Medline, APA PsycINFO, and CINAHL. After eligibility criteria were established, screening was completed using Covidence software. Data extracted from each study included the instrument used, method of evaluation, and findings. RESULTS: Seven studies remained after screening. None of the studies took place in the United States. The Alcohol Use Disorders Identification Test and related variations were used most often and were found to be adequate for detecting at-risk drinking among older adults. In addition, some studies suggested lower screening limits for older adults. CONCLUSION: As the percentage of older adults engaging in risky or hazardous drinking patterns grows, there is an increased need for AUD screening using a reliable tool. Current research is limited; more research is needed regarding which tools perform best in various settings, as well as how to interpret instrument results for older adults. [(11), 21-28.].
Meyer HA, Kiydal D, Siefert K
… +5 more, Clark E, Dondi AC, Abu-Alhaija DM, Davis KG, Gillespie GL
J Gerontol Nurs
· 2024 Nov · PMID 39312757
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PURPOSE: To investigate the prevalence of workplace violence (WPV) in home health care and long-term care facilities (LTCFs) and explore the relationship between WPV and worker well-being. METHOD: A cross-sectional surve...PURPOSE: To investigate the prevalence of workplace violence (WPV) in home health care and long-term care facilities (LTCFs) and explore the relationship between WPV and worker well-being. METHOD: A cross-sectional survey was conducted with health care workers in an agency that provided care in homes or LTCFs. Six measures of worker well-being were collected: satisfaction with work and life, work-related rumination, work/family conflict, burnout, and turnover intention. Surveys also assessed type and frequency of WPV. RESULTS: Seventeen participants completed surveys. Verbal abuse by patients was the most often experienced type of WPV. Employees who reported experiencing WPV had higher burnout and lower satisfaction with work and life. CONCLUSION: WPV routinely occurs in home health care and LTCFs and appears to be related to worker well-being. Facility managers who can control WPV will likely impact the well-being of employees. [(11), 44-52.].
PURPOSE: To define prescribing cascades (PCs) and provide tools to identify PCs, including the most common PCs described in the literature. PCs lead to the accumulation of medications prescribed to older adults, dispropo...PURPOSE: To define prescribing cascades (PCs) and provide tools to identify PCs, including the most common PCs described in the literature. PCs lead to the accumulation of medications prescribed to older adults, disproportionately affecting those who often have additional health care complexities, such as multiple chronic conditions and multiple transitions of care. METHOD: Review of recent research efforts to identify and describe evolving clinical practice interventions to detect and reverse PCs. RESULTS: Clinicians can contribute to mitigating PCs through better understanding of how PCs occur in practice. Armed with this knowledge, clinical team members can implement proposed strategies and techniques to engage in primary and secondary prevention of PCs. CONCLUSION: Ultimately, PCs are a culprit of preventable medication harm. Several tools are presented, which are initiated through maintaining a high index of suspicion for PCs in the evaluation of a new symptom presentation by older patients. [(9), 7-11.].
PURPOSE: To understand perceived facilitators and barriers older adults experienced in accessing coronavirus disease 2019 (COVID-19) vaccines. METHOD: An electronic survey was distributed to older adults and those famili...PURPOSE: To understand perceived facilitators and barriers older adults experienced in accessing coronavirus disease 2019 (COVID-19) vaccines. METHOD: An electronic survey was distributed to older adults and those familiar with experiences of older adults accessing COVID-19 vaccines. Analysis included descriptive statistics and directed content analysis of open-ended responses, guided by the National Institute on Aging Health Disparities Research Framework. RESULTS: Most participants ( = 294) identified as White (79.5%), 33.8% identified as Hispanic, 8.1% identified as Black, and 12.4% identified as Other. Two thirds of respondents were male (68.6%), and the median age was 67 years. Five key themes emerged: , , , , and . CONCLUSION: Barriers and facilitators to accessing COVID-19 vaccines for older populations paralleled those seen in other demographics. Similar needs likely exist for access to other vaccines and health care in general. Vaccine rollouts, particularly in public health emergencies, must be carried out with care and an awareness of the barriers faced by vulnerable groups. [(9), 12-17.].
J Gerontol Nurs
· 2024 Sep · PMID 39194324
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PURPOSE: To describe successful strategies for the recruitment of diverse community-dwelling older adults for a technology-based fall risk assessment research study during the global coronavirus disease 2019 pandemic. ME...PURPOSE: To describe successful strategies for the recruitment of diverse community-dwelling older adults for a technology-based fall risk assessment research study during the global coronavirus disease 2019 pandemic. METHOD: In this cross-sectional study, 124 adults aged ≥60 years agreed to participate. We used several recruitment strategies, including social media platforms, local community centers, flyers, contacting key persons, word of mouth, and contacting participants from previous research projects. RESULTS: Targeted and personalized strategies for recruitment, including contacting a key community leader (52.4%, = 65) and communication with friends and family members (46.7%, = 58), were the most successful. One (0.8%) participant was recruited from a prior research project. In contrast, individuals were not recruited from posted flyers and social media. CONCLUSION: Recruitment can be improved with word of mouth and contacting key persons, such as community leaders, which can be achieved by building a trusted relationship between researchers and community leaders. [(9), 18-23.].
Hshieh T, Schulman-Green D, Fong TG
… +8 more, Metzger E, Arias F, Helfand B, Marcantonio E, Schmitt E, Tabloski P, Jones RN, Inouye SK
J Gerontol Nurs
· 2024 Sep · PMID 39194323
·
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PURPOSE: Despite the importance of measuring delirium severity in patients with Alzheimer's disease and related dementias (ADRD), no validated instrument currently exists. Our goal was to generate items for use in such a...PURPOSE: Despite the importance of measuring delirium severity in patients with Alzheimer's disease and related dementias (ADRD), no validated instrument currently exists. Our goal was to generate items for use in such an instrument. METHOD: An interdisciplinary expert panel developed items to assess seven domains and 21 subdomains of delirium severity. Nursing experts provided input on items. RESULTS: Experts achieved consensus on 21 items, including best respondents for each item, and appropriate look-back periods. Nursing experts emphasized the need for educating nursing staff and obtaining information from caregivers. CONCLUSION: Careful, nuanced identification of distinguishing features is key for generating items for measuring delirium severity in persons with ADRD. Once developed, engaging nurses will be essential to facilitate adoption and relevance of the tool. [(9), 24-30.].
PURPOSE: To analyze cardiorespiratory fitness (CRF) levels using the gold-standard, laboratory-based cardiopulmonary exercise test (CPET) in community-dwelling older adults ( = 145) with amnestic mild cognitive impairmen...PURPOSE: To analyze cardiorespiratory fitness (CRF) levels using the gold-standard, laboratory-based cardiopulmonary exercise test (CPET) in community-dwelling older adults ( = 145) with amnestic mild cognitive impairment (aMCI), specifically CPET feasibility, CRF prediction, and CRF status in comparison to published sedentary, cognitively normal, age- and sex-adjusted normative data. METHOD: Peak oxygen consumption (VO [mL/kg/min]) was assessed by CPET, which was categorized as submaximal, near-maximal, or maximal tests. VO predicted was compared to VO measured to assess its utility. Data were analyzed with tests. RESULTS: Participants' mean age was 73.77 years ( = 5.74 years), with 51.7% males, 91.7% Caucasian, 68.3% married, and 16.9 years ( = 2.88 years) of education. Mean VO measured was 17.07 ( = 4.92) for the total sample (18.29 [ = 4.64] for males, 15.78 [ = 4.91] for females). Sixteen (11.03%) CPETs were submaximal, 53 (36.55%) were near-maximal, and 76 (52.41%) were maximal. Mean VO predicted was 28.59 ( = 21.94) for the total sample (29.36 [ = 22.3] for males, 27.76 [ = 21.68] for females) and was significantly higher than VO measured ( < 0.0001). Among participants with maximal CPETs, VO measured was significantly lower than sedentary normative data ( < 0.0001). CONCLUSION: CPET was feasible for older adults with aMCI. VO predicted overly inflates CRF estimates. Low levels of CRF in older adults with aMCI suggest aerobic exercise as an important intervention. [(9), 31-36.].
PURPOSE: To systematically identify knowledge patterns and gaps in the appropriateness of nursing home (NH) to emergency department (ED) transitional care for older adults with dementia. METHOD: A systematic search of mu...PURPOSE: To systematically identify knowledge patterns and gaps in the appropriateness of nursing home (NH) to emergency department (ED) transitional care for older adults with dementia. METHOD: A systematic search of multiple information sources was performed from July to August 2023 using predesigned search strategies. RESULTS: From 13 articles, 54 identified pieces of specific care evidence were grouped into six major care domains: (1) ; (2) ; (3) ; (4) ; (5) ; and (6) . CONCLUSION: A comprehensive, consensus-based body of evidence is lacking. Despite person-centered, standardized, and professional resources supporting transitional care, reorienting NH cultural models remains unclear. Gaps include evidence tailored to diverse participants and contexts. Thus, a focus on policies, education, and research is required. [(9), 37-45.].
PURPOSE: To understand direct care workers' perceptions of the impact of implementing a person-centered communication tool, Preference for Activity and Leisure (PAL) Cards, into care. METHOD: PAL Cards provide at-a-glanc...PURPOSE: To understand direct care workers' perceptions of the impact of implementing a person-centered communication tool, Preference for Activity and Leisure (PAL) Cards, into care. METHOD: PAL Cards provide at-a-glance information about a nursing home (NH) resident's background and important preferences for activities and leisure. As a quality improvement project, 11 NHs implemented use of PAL Cards in their communities and provided feedback ( = 91 feedback forms received) on their perceptions of impact of PAL Cards on care communication and delivery. RESULTS: A variety of NH staff members, across disciplines, were a part of PAL Card implementation. The majority of staff (84%) perceived that PAL Cards helped them start a conversation with a resident and 64% indicated that PAL Cards helped them provide care for a resident. CONCLUSION: PAL Cards are an effective tool for communicating information about NH residents' preferences to staff. [(8), 5-10.].
PURPOSE: To examine the effect of walking interventions on sleep quality of persons with dementia (PWD) and their caregivers (dyads), and how different companions affect results. METHOD: Forty-five dyads were divided int...PURPOSE: To examine the effect of walking interventions on sleep quality of persons with dementia (PWD) and their caregivers (dyads), and how different companions affect results. METHOD: Forty-five dyads were divided into three groups: a control group and two experimental groups (one with a care attendant, one with a family caregiver). The two experimental groups engaged in 120 minutes of walking per week for 24 weeks. RESULTS: A significant improvement in sleep quality was observed among PWD in the family caregiver group (Wald χ = 4.55, = 0.033), whereas there was no improvement in the care attendant group. A slight improvement in sleep quality of family caregivers was also found. CONCLUSION: Findings suggest the importance of creating individualized walking activity plans for dyads, incorporating trust and rapport-building strategies to improve sleep quality. [(8), 46-56.].