Aldridge Z, Elsegood L, Murray S
… +1 more, Wileman A
Nurs Older People
· 2023 Nov · PMID 37990584
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Urinary and faecal incontinence are more prevalent among older people but, like dementia, incontinence is not a normal or inevitable part of ageing. The number of people living with dementia who experience continence iss...Urinary and faecal incontinence are more prevalent among older people but, like dementia, incontinence is not a normal or inevitable part of ageing. The number of people living with dementia who experience continence issues is likely to be underestimated because many people avoid reporting them as a result of embarrassment and stigma, or because they think incontinence is an inevitable symptom of dementia and that nothing can be done about it. Increased awareness and understanding of the relationship between dementia and incontinence is needed so that nurses can persuade people living with dementia and their family carers to discuss continence issues, assess their needs and provide support. There are several practical strategies that can reduce the incidence of incontinence, counter its negative effects and promote continence in people living with dementia.
Nurs Older People
· 2023 Nov · PMID 37909070
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BACKGROUND: In the UK, people with delirium superimposed on dementia may be cared for by mental health nurses, however there is little in the literature about the experience of caring for people with the condition from t...BACKGROUND: In the UK, people with delirium superimposed on dementia may be cared for by mental health nurses, however there is little in the literature about the experience of caring for people with the condition from the perspective of mental health nurses. AIM: To illuminate the experiences of mental health nurses caring for people with delirium superimposed on dementia and to explore how mental health nurses 'know' the people they care for using 'aesthetic ways of knowing'. METHOD: A mixed-methods design was used guided by the principles of activity theory. Participants were registered mental health nurses with experience of caring for people with delirium superimposed on dementia within a 24-hour care environment, including an NHS mental health foundation trust and care homes. Data were collected in two ways and at two different time points: first via semi-structured interviews (n=7), second via a questionnaire (n=25). Thematic analysis of the qualitative data was paired with simple descriptive statistics of the quantitative data to describe participants' experience. FINDINGS: This article discusses one finding from the larger study, which was undertaken as part of the author's PhD, in relation to the way in which mental health nurses 'know' the people they care for. Overall, participants showed a preference for aesthetic ways of knowing, rather than the use of formal assessment tools or scores. Participants experienced caring for people with delirium superimposed on dementia by valuing the person and concentrating on their behaviours, responses and personality, thus enabling them to anticipate and/or recognise potential triggers, precipitating factors and any changes in behaviours. CONCLUSION: The ways in which mental health nurses know the people they care for influences their care delivery. Mental health nurses' use of aesthetic ways of knowing should be recognised and valued as a way of better understanding and supporting the person with delirium superimposed on dementia.
Nurs Older People
· 2023 Dec · PMID 37850272
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With the rise in the number of older people in the population and new developments in older people's services such as integrated care hubs, there is a need for healthcare professionals working with older people to keep u...With the rise in the number of older people in the population and new developments in older people's services such as integrated care hubs, there is a need for healthcare professionals working with older people to keep up to date with the latest research. This article describes the process of establishing a multidisciplinary journal club in a residential care setting and recognising the potential of such clubs to develop staff members' critical thinking, presentation and communication skills. The authors emphasise the importance of fostering a culture of learning in older people's services and describe how a journal club can support healthcare professionals to maintain their knowledge and improve care.
Nurs Older People
· 2023 Oct · PMID 37789757
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There is a growing evidence base to suggest that music therapy is an effective clinical intervention for people with dementia, having positive effects on mood, emotion, communication and memory, and reducing agitation, a...There is a growing evidence base to suggest that music therapy is an effective clinical intervention for people with dementia, having positive effects on mood, emotion, communication and memory, and reducing agitation, anxiety and apathy. However, the evidence to support this is predominantly from community settings such as residential care homes or people's own homes. This article captures the authors' experiences and reflections regarding their implementation of a music therapy intervention in a dementia inpatient unit. It explores some of the considerations and learning points gained from their experience, including the practicalities around engaging individuals and staff, the use of space, the timing of sessions, available resources and the potential benefits for patients, family members and the unit as a whole. The authors' experiences suggest that the benefits of music therapy appear to be transferable to the dementia inpatient setting.
Polypharmacy is a significant issue for many older people, including those with frailty, and it is associated with a range of adverse effects. Therefore, it is important to address polypharmacy by optimising patients' me...Polypharmacy is a significant issue for many older people, including those with frailty, and it is associated with a range of adverse effects. Therefore, it is important to address polypharmacy by optimising patients' medicines use. Medication reviews are one of the main approaches to medicines optimisation, and various tools are available to support healthcare professionals with conducting these. Another approach is deprescribing, which can improve health outcomes for patients and may have financial benefits for healthcare organisations, but can also present various challenges. This article, the second of two parts, explores the benefits of medicines optimisation in the form of medication reviews and deprescribing for older people with frailty and polypharmacy.
Nurs Older People
· 2023 Oct · PMID 37670533
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The UK population is ageing rapidly, a trend that is likely to continue due to improvements in chronic disease management and increased life expectancy. Comorbidities, including frailty, become increasingly common with a...The UK population is ageing rapidly, a trend that is likely to continue due to improvements in chronic disease management and increased life expectancy. Comorbidities, including frailty, become increasingly common with age and as a result it is likely that multiple medicines will be prescribed for older people, leading to polypharmacy. This is a concern because polypharmacy is associated with various adverse effects and an increased medicine burden in this population, as well as a financial burden for the healthcare system. This article, the first of two parts, explains the physiology of ageing and frailty, and considers the adverse effects of polypharmacy on older people with frailty, using a fictional case study to illustrate this. Part two will use the case study to explore the use of medication reviews and deprescribing benefits as part of medicines optimisation.
Nurs Older People
· 2023 Dec · PMID 37609709
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Foot ulcers in a person with diabetes mellitus can be life-changing and threaten the viability of their lower limb. As many as one in three people with diabetes develops a foot ulcer in their lifetime. These foot ulcers...Foot ulcers in a person with diabetes mellitus can be life-changing and threaten the viability of their lower limb. As many as one in three people with diabetes develops a foot ulcer in their lifetime. These foot ulcers are prone to fast-spreading infection and often precede lower-limb amputation. In older people with diabetes, foot ulcers can have significant negative long-term effects in terms of quality of life, morbidity and mortality. Appropriate care is crucial to prevent the development of foot ulcers and to manage them if they develop despite adequate preventive measures. Multidisciplinary team working and robust care pathways are essential. This article outlines the role of nurses in supporting older people with diabetes to maintain optimal foot health, ensuring that they undergo an annual foot assessment, assessing them for foot ulcers and referring them promptly to specialist care when required to avoid amputation.
Nurs Older People
· 2023 Oct · PMID 37464806
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Identity is a central aspect of our lives. Who we believe ourselves to be has profound implications on how we interact with and interpret the world around us. People with dementia often experience stigma and suboptimal c...Identity is a central aspect of our lives. Who we believe ourselves to be has profound implications on how we interact with and interpret the world around us. People with dementia often experience stigma and suboptimal care because of a perception that they have 'lost their identity' as the cognitive symptoms associated with the condition progress. This notion is challenged by proponents of person-centred care who argue that a person's identity and worth are based on more than cognitive abilities. Person-centred care is a holistic approach that takes account of the entirety of a person's life and provides support that respects the individual and their self-identity. Since identity is vital to well-being, delivery of person-centred care must involve actively seeking a person's concept of self to tailor their care to meet all their needs. This article considers the importance of identity and personhood for people with dementia and their carers in the context of person-centred care. The article includes two case studies to illustrate these concepts in practice.
Nurs Older People
· 2023 Oct · PMID 37403441
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This article reports on a service evaluation of a group-based psychoeducation programme for older people in an inpatient mental healthcare setting. It sought to explore how the programme was experienced by patients and s...This article reports on a service evaluation of a group-based psychoeducation programme for older people in an inpatient mental healthcare setting. It sought to explore how the programme was experienced by patients and staff, as well as its acceptability and the feasibility for implementation in the longer term. Via questionnaires, views were gathered from patients and staff. A focus group interview with staff facilitating the group sessions was also undertaken, and patient attendance records for sessions were collected and compared with demographic data relating to the two wards housed in the unit where the programme took place. The programme was generally viewed as a positive addition to care delivery by staff and patient respondents in offering an adjunct to pharmacological treatment, increasing familiarity with psychology staff, encouraging patients to develop a greater degree of mastery regarding their health and fostering mutual support among the patient community. The role of the ward environment in supporting access to group-based intervention is also considered.
Nurs Older People
· 2023 Jun · PMID 37282748
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BACKGROUND: Intergenerational playgroups are a formalised way of bringing together older people and young children to 'play and interact'. They can facilitate social interaction and reduce loneliness for older people liv...BACKGROUND: Intergenerational playgroups are a formalised way of bringing together older people and young children to 'play and interact'. They can facilitate social interaction and reduce loneliness for older people living in care homes. Although interest in intergenerational playgroups is increasing, there is a lack of research into their implementation. AIM: To explore staff's views on the implementation of intergenerational playgroups in care homes for older people. METHOD: A qualitative method was adopted. Face-to-face semi-structured interviews were undertaken with ten members of staff working in four care homes in a range of roles. FINDINGS: Participants considered intergenerational playgroups to be low-cost interventions with benefits for residents, children, parents or carers and the community. However, there did not appear to be a standardised format or guidance for implementing and delivering the intervention and participants felt that they received little support from colleagues or from executive leadership teams. CONCLUSION: To support the effective implementation and the sustainability of intergenerational playgroups in care homes, there is a need to educate care home staff about their benefits and to develop guidance and national policies.
Aldridge Z, Ponnusamy K, Noble A
… +2 more, Collier P, Smith D
Nurs Older People
· 2023 May · PMID 37221893
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It has been estimated that 70% of care home residents have dementia on admission or develop it after admission, but that many do not have or receive a formal diagnosis of dementia. People with dementia often have signifi...It has been estimated that 70% of care home residents have dementia on admission or develop it after admission, but that many do not have or receive a formal diagnosis of dementia. People with dementia often have significant care needs and it is important that the condition is diagnosed even at an advanced stage. This will enable nurses to predict the person's care needs, develop appropriate care plans and arrange pre-emptive decisions. In 2021-22, a quality improvement project took place in care homes in West Norfolk. This project piloted an abbreviated memory assessment model based on the Diagnosing Advanced Dementia Mandate (DiADeM) tool to increase the rate of diagnoses among residents showing signs and symptoms of cognitive impairment but not formally diagnosed with dementia. Out of 109 residents assessed, 95 were diagnosed with dementia. The pilot is being extended locally and replicated across England.
Nurs Older People
· 2023 May · PMID 37161545
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Antipsychotic medicines are often prescribed 'as required' to manage behavioural and psychological symptoms of dementia, despite evidence that these medicines have little benefit for people with dementia and have numerou...Antipsychotic medicines are often prescribed 'as required' to manage behavioural and psychological symptoms of dementia, despite evidence that these medicines have little benefit for people with dementia and have numerous adverse side effects, including sedation. It is the nurse's role to decide if and when to administer antipsychotic medicines that have been prescribed on an as required basis. This decision-making is underpinned by complex ethical considerations such as mental capacity, chemical restraint, quality of life and autonomy. Adopting a person-centred approach and considering the ethics, guidelines and legislation related to such decisions can support nurses to act in patients' best interests. This article uses two ethical frameworks - the four principles of biomedical ethics and the 'four quadrants' approach - to examine this complex issue and to demonstrate their use in the context of ethical decision-making in nursing practice.
The number of older people in UK prisons has increased significantly in recent years and most of them have at least one health condition. Research has shown that the physical and mental health of older people living in t...The number of older people in UK prisons has increased significantly in recent years and most of them have at least one health condition. Research has shown that the physical and mental health of older people living in the community is positively correlated with resilience, but there is limited research on how to promote resilience in older prisoners. This systematic literature review offers a synthesis of interventions, practices and processes that may improve resilience in older prisoners. The review included eight peer-reviewed studies and identified three elements that support resilience in older prisoners: organised interventions; relational activities; and subjective processes. Healthcare professionals working in prisons can use the findings to identify how to support older prisoners' well-being and develop the conditions that may enable older prisoners to sustain and strengthen their resilience.
Stephens M, Kelly S, O'Connor D
… +1 more, McRae S
Nurs Older People
· 2023 Mar · PMID 36987777
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Interprofessional learning can offer students from different disciplines an opportunity to learn from, with and about each other. Additionally, practice placements in care home settings can offer students a rich learning...Interprofessional learning can offer students from different disciplines an opportunity to learn from, with and about each other. Additionally, practice placements in care home settings can offer students a rich learning experience. In 2021, a pilot interprofessional student placement initiative in care homes took place in the Manchester area, with three care homes and 17 students from a range of health and social care disciplines. In this article, the members of the core operational group that implemented the initiative reflect on their experiences. Using the 'What? So what? Now what?' reflective framework, they describe the context of the initiative, explore the lessons learned and make recommendations for future initiatives. The authors' intention is to inspire other educators to consider offering interprofessional placements to students, recognise the value of care homes as placement settings, and acknowledge the benefits of using reflection-in-action and reflective frameworks in healthcare education and practice.
Nurs Older People
· 2023 Mar · PMID 36883890
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Behavioural and psychological symptoms of dementia (BPSD) affect more than one third of people with dementia at some point during the course of their condition. Agitation is the third most common BPSD but is the least we...Behavioural and psychological symptoms of dementia (BPSD) affect more than one third of people with dementia at some point during the course of their condition. Agitation is the third most common BPSD but is the least well understood in terms of identification and management. Furthermore, agitation as a symptom of dementia is often confused with agitation as a way of expressing an emotion or unmet need. Psychosocial interventions are recommended to support the person with dementia and their family carers to manage agitation as a symptom of dementia, as well as other BPSD, in a person-centred manner. Some psychosocial interventions for managing agitation as a symptom of dementia have shown benefits, but further investigation of the usefulness of a range of interventions is needed. This article discusses the assessment and management of agitation as a symptom of dementia and illustrates their application through a case study.
Delirium, which may present as acute fluctuation in arousal and attention and changes in a person's behaviours, can increase the risk of falls, while a fall can increase the risk of developing delirium. There is, therefo...Delirium, which may present as acute fluctuation in arousal and attention and changes in a person's behaviours, can increase the risk of falls, while a fall can increase the risk of developing delirium. There is, therefore, a fundamental relationship between delirium and falls. This article describes the main types of delirium and the challenges associated with recognition of the condition and discusses the relationship between delirium and falls. The article also describes some of the validated tools used to screen patients for delirium and includes two brief case studies to illustrate this in practice.
Deconditioning is caused by complex physiological changes occurring as a result of immobility, for example during or after a period of acute illness or injury and hospitalisation. It leads to functional decline and compo...Deconditioning is caused by complex physiological changes occurring as a result of immobility, for example during or after a period of acute illness or injury and hospitalisation. It leads to functional decline and compounds or contributes to conditions such as frailty and sarcopenia. In the past, prolonged bed rest was considered therapeutic, but the need to reduce or avoid prolonged immobility is now widely recognised. Hospital-associated deconditioning can be reduced or prevented through mobilisation strategies such as those promoted by the #EndPJparalysis campaign. This article explains the importance of reducing or preventing hospital-associated deconditioning and nurses' role in this.
Nurs Older People
· 2023 Jan · PMID 36694988
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Communication is a two-way process of exchanging or sharing information and is an essential element of the nursing process. Challenges with communication are a feature of all types of dementia, so understanding how demen...Communication is a two-way process of exchanging or sharing information and is an essential element of the nursing process. Challenges with communication are a feature of all types of dementia, so understanding how dementia affects communication and how to support people is important for all nurses. This article provides an overview of communication in dementia care. The authors draw on the literature on communication and dementia to present evidence-based, practical approaches for supporting person-centred communication with people with dementia.
Nurs Older People
· 2023 Jan · PMID 36628551
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Trained mealtime volunteers are ideally situated to provide mealtime assistance to older patients in general hospital settings. Older patients are at risk of becoming undernourished and dehydrated while in hospital as a...Trained mealtime volunteers are ideally situated to provide mealtime assistance to older patients in general hospital settings. Older patients are at risk of becoming undernourished and dehydrated while in hospital as a result of various factors, such as cognitive impairment and lack of mealtime assistance. This article details an extended literature review that was conducted to explore the lived experiences of older patients, staff, relatives and volunteers of mealtime assistance provided by volunteers. The findings suggest that continual use of mealtime volunteers in practice could improve the quality of care. Mealtime volunteers could be educated on the importance of communicating information pertaining to patients' food and fluid intake to enhance patient monitoring. Furthermore, additional training for mealtime volunteers could be streamlined and standardised to improve patient care and safety.
Nurs Older People
· 2023 Jan · PMID 36514871
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Older people on mental health inpatient wards are at high risk of falls due to a combination of physiological, pathophysiological and pharmacological factors. Falls prevention should therefore be a priority for nursing s...Older people on mental health inpatient wards are at high risk of falls due to a combination of physiological, pathophysiological and pharmacological factors. Falls prevention should therefore be a priority for nursing staff caring for this patient group. This article describes a quality improvement project conducted on four older adult mental health inpatient wards in Scotland. The project aimed to reduce the number of falls, increase staff's adherence to person-centred falls prevention care planning, and ensure every fall would prompt a post-fall review. Nursing staff participated in a falls prevention training session and registered nurses received, in addition, one-to-one coaching sessions on person-centred care planning. Despite the challenges faced by mental healthcare professionals at the time of the project, staff responded positively and there was a decrease in the number of falls, including falls resulting in harm.