Nurs Older People
· 2023 Jan · PMID 36475401
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There is increasing recognition that adverse childhood experiences are linked to suboptimal mental and physical health in later life. Despite this, there has been little research into the effects of adverse childhood exp...There is increasing recognition that adverse childhood experiences are linked to suboptimal mental and physical health in later life. Despite this, there has been little research into the effects of adverse childhood experiences on older people. This article gives an overview of the long-term mental and physical effects of adverse childhood experiences and discusses how childhood trauma may manifest in older people. The author also discusses how nurses and unpaid family carers may themselves have been exposed to adverse childhood experiences and how this may affect their caring role. It is crucial that nurses adopt a trauma-informed approach to the care of older people to take account of possible adverse childhood experiences and prevent re-traumatisation.
Nurs Older People
· 2023 Jan · PMID 36416270
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Appropriate physical activity has more benefits than risks for older people. Increased physical activity enhances older people's mental and physical well-being and can contribute to reduced morbidity and early mortality....Appropriate physical activity has more benefits than risks for older people. Increased physical activity enhances older people's mental and physical well-being and can contribute to reduced morbidity and early mortality. Nurses have an important role in advising older people on the level of physical activity that is right for them. Based on the national requirements for physical activity in older people, nurses can tailor their advice to each individual, address the person's concerns about potential risks and emphasise the likely benefits of them becoming more physically active. This article explains the role of nurses in promoting and encouraging physical activity in older people. It describes the historical background of this area of health promotion, considers the challenges nurses experience and discusses the strategies they can use when advising older people on physical activity.
Nurs Older People
· 2022 Oct · PMID 36286010
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Changes in eating behaviours, weight and mental health in older people may be related to psychological distress and indicate the presence of a diagnosable eating disorder, rather than 'anorexia of ageing'. Eating disorde...Changes in eating behaviours, weight and mental health in older people may be related to psychological distress and indicate the presence of a diagnosable eating disorder, rather than 'anorexia of ageing'. Eating disorders in older people may be overlooked because signs and symptoms are assumed to be part of normal ageing. The role of nurses in the care of older people with eating disorders is likely to be detection, referral and support in accessing specialist intervention. This article offers an overview of eating disorders in older people and discusses why they may arise, why they may not be detected and how to recognise them. The authors describe a framework that nurses can use when assessing older people to determine whether they may have an eating disorder.
Nurs Older People
· 2022 Oct · PMID 36222236
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Elder abuse is a growing concern for nurses who work with older people, and safeguarding incidents can be challenging and complex to manage. In the Republic of Ireland, safeguarding agencies claim there is a lack of repo...Elder abuse is a growing concern for nurses who work with older people, and safeguarding incidents can be challenging and complex to manage. In the Republic of Ireland, safeguarding agencies claim there is a lack of reporting of abuse to the authorities, raising questions as to whether nurses know how, when and where to report safeguarding concerns. Despite varying strategies and laws concerning the reporting of elder abuse worldwide, the principles of recognising and responding to abuse are similar. However, to date, there is no specific legislation governing safeguarding for adults in Ireland. This article discusses elder abuse and safeguarding nursing home residents from an Irish perspective, explaining the process of managing concerns in practice using an analysis of a case study.
BACKGROUND: As the number of people with a diagnosis of dementia continues to increase, it is essential that nurses have the skills required to provide high-quality care. However, there may be gaps in dementia teaching i...BACKGROUND: As the number of people with a diagnosis of dementia continues to increase, it is essential that nurses have the skills required to provide high-quality care. However, there may be gaps in dementia teaching in undergraduate nurse education programmes in the UK. AIM: To assess knowledge of Alzheimer's disease among one cohort of third-year nursing students to improve the education content of the dementia module at Oxford Brookes University, England. METHOD: A total of 35 participants completed the Alzheimer's Disease Knowledge Scale, a validated tool that measures knowledge about risk factors, assessment and diagnosis, symptoms, course (disease progression), life impact, caregiving, and treatment and management. Data were analysed using quantitative methods. RESULTS: Participating students appeared to have greater knowledge about dementia in relation to treatment and management, life impact, caregiving, and assessment and diagnosis, and less knowledge about risk factors, course and symptoms. This may be because the focus of teaching is on caregiving and medical treatment. CONCLUSION: This study identified strengths and gaps in nursing students' knowledge of Alzheimer's disease. The results have informed recommendations for ways to improve the education content of the dementia module for future cohorts and to enhance dementia education in nursing, health and social care undergraduate programmes in general.
Dementia can have significant adverse effects on people's ability to eat and drink sufficiently. People with dementia can experience malnutrition and unintentional weight loss at any stage of the condition, but these occ...Dementia can have significant adverse effects on people's ability to eat and drink sufficiently. People with dementia can experience malnutrition and unintentional weight loss at any stage of the condition, but these occur more often in the middle and late stages. It is important that nurses and care staff working in care homes have the appropriate knowledge and skills to provide optimal nutritional care to residents, thereby improving their health, well-being and quality of life. This article provides an overview of nutrition and hydration issues commonly experienced by people with dementia. It explores common causes of suboptimal nutrition and hydration, outlines tools for nutritional screening and assessment and discusses interventions to improve the nutritional care of care home residents with dementia.
Nurs Older People
· 2022 Aug · PMID 36000255
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Procalcitonin (PCT), a precursor of the hormone calcitonin, has emerged as a marker of bacterial infection that appears to be particularly useful in respiratory conditions. PCT testing has been shown to be beneficial in...Procalcitonin (PCT), a precursor of the hormone calcitonin, has emerged as a marker of bacterial infection that appears to be particularly useful in respiratory conditions. PCT testing has been shown to be beneficial in supporting healthcare professionals with their decision-making about treatment. It also has particular advantages in relation to the care of older people, notably in terms of assessment, recognising sepsis, reducing polypharmacy and informing antibiotic prescribing. This article discusses PCT testing in care homes and how its use can support nurses working in such settings to provide optimal care to residents. The article is underpinned by the latest evidence on PCT testing and the author's clinical experience as an advanced nurse practitioner working in a care home.
Nurs Older People
· 2022 Aug · PMID 35946385
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Spending time with a person with dementia to develop a rapport is vitally important for nurses who are attempting to deliver high-quality care. However, finding opportunities to spend meaningful time with a person with d...Spending time with a person with dementia to develop a rapport is vitally important for nurses who are attempting to deliver high-quality care. However, finding opportunities to spend meaningful time with a person with dementia can be challenging due to the nature of busy clinical environments. Further, spending time with people may be considered a non-essential use of a nurse's time by some colleagues. These factors can result in inadequate outcomes for both the person with dementia and the nurse providing the care. This article outlines a rationale for reframing the time nurses have available to spend with people with dementia. The author explains the concepts of 'ways of being' and 'mentalising' and how these can assist nurses to provide a more authentic presence during their interactions with people with dementia.
The incidence of pressure ulcers is highest among older people with frailty. The development of pressure ulcers is a common and challenging issue in this population, which can reduce people's quality of life and increase...The incidence of pressure ulcers is highest among older people with frailty. The development of pressure ulcers is a common and challenging issue in this population, which can reduce people's quality of life and increase mortality risk. Multifactorial processes contribute to the development of pressure ulcers in older people with frailty, including age-related skin changes, comorbidities, polypharmacy, reduced mobility, inadequate nutrition and hydration, and continence issues. This article discusses the development and management of pressure ulcers in older people with frailty. It also outlines some of the measures that can be taken by nurses and other healthcare professionals to reduce the risk of pressure ulcers developing in this population.
Nurs Older People
· 2022 Aug · PMID 35791827
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Frailty is a distinctive health state and a life-limiting syndrome seen in older people and in those living with multiple long-term conditions. It is likely that every nurse will encounter patients living with frailty in...Frailty is a distinctive health state and a life-limiting syndrome seen in older people and in those living with multiple long-term conditions. It is likely that every nurse will encounter patients living with frailty in their clinical practice, even more so if they work in older people's nursing. People living with frailty are more vulnerable than others to stressors and insults due to a decline in their physiological reserve and function. There are tools that can be used to assess people's frailty or risk of frailty and interventions that can be used to prevent or reduce frailty. This article describes frailty and explains how to assess, prevent and reduce it. The article also outlines the relationship between frailty and coronavirus disease 2019 and the frailty trajectory at the end of life.
Nurs Older People
· 2022 Aug · PMID 35730481
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This article details a narrative review that explored the barriers to and facilitators of integration of oral care into nursing practice in care homes to enhance nurses' delivery of oral care. Three themes were identifie...This article details a narrative review that explored the barriers to and facilitators of integration of oral care into nursing practice in care homes to enhance nurses' delivery of oral care. Three themes were identified: gaps in oral care protocols and the complexity of nursing oral care; how interprofessional collaboration and education can improve oral care; and limitations and unresolved issues in nurses' oral care training. The review found that interprofessional collaboration and education were important in normalising oral care practice and nurse leadership in care homes. Nurse-led interprofessional oral care could enhance the quality of care in care homes by advancing interprofessional collaboration and education, coordinating care and improving organisational support.
Amor Gaviola M, Searles A, Dilworth S
… +3 more, Higgins I, Holliday E, Jill Inder K
Nurs Older People
· 2022 Aug · PMID 35673896
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BACKGROUND: Individualised music listening has been shown to reduce agitation and improve mood in people with dementia. However, there is a paucity of research describing the cost of implementing such interventions in re...BACKGROUND: Individualised music listening has been shown to reduce agitation and improve mood in people with dementia. However, there is a paucity of research describing the cost of implementing such interventions in residential care settings for older people. AIM: To determine the cost of implementing an individualised music intervention for older people with dementia in residential aged care in Australia. METHOD: A simple cost analysis was undertaken to determine the cost of delivering the individualised music intervention to 32 older people with dementia at two residential aged care facilities in New South Wales. The analysis took into consideration the operating, training and delivery costs, as well as the costs of purchasing the music equipment and downloads. RESULTS: The cost of delivering the individualised music intervention was found to be AU$6,623.76 per year - or AU$3.98 per resident per week, at 2017 values. At 2022 values, this equates to an annual cost of AU$7,130.07 (£4,031.85) for 32 residents and a weekly cost of AU$4.28 (£2.42) per resident per week. CONCLUSION: The cost of implementing the individualised music intervention was relatively low compared with the overall cost of residential aged care for older people with dementia.
Nurs Older People
· 2022 Aug · PMID 35582820
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BACKGROUND: Older people's health is vulnerable to the effects of long-term changes to everyday life and their recovery from ill health can be delayed by the deconditioning effects of isolation. Social isolation can incr...BACKGROUND: Older people's health is vulnerable to the effects of long-term changes to everyday life and their recovery from ill health can be delayed by the deconditioning effects of isolation. Social isolation can increase the likelihood of loneliness in older people, which has negative implications for their mental and physical health. AIM: To explore the effects of social isolation and social distancing on older people in the Republic of Ireland during and following the government-enforced lockdown in the first wave of the coronavirus disease 2019 (COVID-19) pandemic. METHOD: This study involved a convenience sample of four participants from the Republic of Ireland. Semi-structured interviews were conducted and audio-recorded with each participant over six sessions, two weeks apart, between 6 April 2020 and 7 July 2020. Transcripts were analysed using content analysis of longitudinal data to identify themes. FINDINGS: Three themes were identified: the effect on health and mental well-being; commitment to restrictions; and concern about the non-adherence of others. CONCLUSION: Participants committed fully to 'cocooning' and other government restrictions, sometimes to the detriment of their health. Healthcare professionals need to be mindful of potential post-pandemic deconditioning in older people resulting from adherence to government restrictions and lingering anxieties about returning to normality after prolonged isolation.
Webster J, Sanders K, Cardiff S
… +1 more, Manley K
Nurs Older People
· 2022 May · PMID 35506341
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While much attention has been given to organisational culture, there has been less focus on workplace culture. Yet workplace culture strongly influences the way care is delivered, received and experienced. An effective w...While much attention has been given to organisational culture, there has been less focus on workplace culture. Yet workplace culture strongly influences the way care is delivered, received and experienced. An effective workplace culture is crucial for the well-being of individual staff members and teams as well as for patients' experiences and outcomes of care. This article describes the 'Guiding Lights for effective workplace cultures' which were developed by the authors and provide a framework to assist in understanding and promoting effective workplace cultures and creating environments where staff and patients feel safe and valued. There are four Guiding Lights: 'collective leadership', 'living shared values', 'safe, critical, creative learning environments' and 'change for good that makes a difference'. Each one articulates what good workplace cultures are through descriptors and intermediate outcomes and together produce a set of ultimate outcomes. The Guiding Lights provide nurses working in older people's care settings with an opportunity to learn from, and celebrate, what is going well in their workplaces and to consider areas that require further development.
Nurs Older People
· 2022 May · PMID 35441502
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Urinary tract infections (UTIs) are common in older people and are frequently more complicated to diagnose than in younger adults. There are often challenges associated with distinguishing symptomatic UTIs from asymptoma...Urinary tract infections (UTIs) are common in older people and are frequently more complicated to diagnose than in younger adults. There are often challenges associated with distinguishing symptomatic UTIs from asymptomatic bacteriuria, particularly in people with cognitive impairment. Older people with dementia are at increased risk of developing a UTI because dementia can lead to voiding issues, impede personal hygiene and increase the need for urinary catheterisation. Furthermore, while a UTI is usually diagnosed based on an individual's physical signs and symptoms, people with dementia may only exhibit signs of sudden altered mental status such as increased confusion, agitation or withdrawal, making diagnosis challenging. This article discusses the main considerations regarding UTIs in people with dementia in hospital and outlines prevention strategies that nurses can implement in their practice.
BACKGROUND: Views in the care home community are divided regarding whether or not staff should wear a uniform. There is little research on the topic and the views of care home residents and their relatives are rarely sou...BACKGROUND: Views in the care home community are divided regarding whether or not staff should wear a uniform. There is little research on the topic and the views of care home residents and their relatives are rarely sought. AIM: To capture the views of staff, residents, relatives and visiting professionals in two care homes on the use of uniforms. METHODS: This small-scale exploratory study used photographs showing three clothing options: a formal option, a polo shirt option and an 'own clothes' option. Each option was modelled in two different poses, one 'approachable' and the other 'unapproachable'. Staff, relatives, the wider care home team and visiting professionals expressed their preferences by replying to a short survey. Residents, all of whom had dementia, expressed their preferences through a table-top activity. FINDINGS: Overall, the formal clothing option was preferred for formal care activities and the 'own clothes' option was preferred for social activities. The polo shirt option often obtained the second-highest number of preferences. The photographs featuring the 'unapproachable' pose were rarely selected. CONCLUSION: The approachability of staff is just as important as the clothes they wear. An alternative to formal uniforms could be for staff to wear polo shirts, possibly as an interim measure to explore the effects of changing the care home's staff uniform policy.
The coronavirus disease 2019 (COVID-19) pandemic has had far-reaching and significant effects worldwide. Many of those identified as most vulnerable to the disease reside in long-term care settings such as nursing and re...The coronavirus disease 2019 (COVID-19) pandemic has had far-reaching and significant effects worldwide. Many of those identified as most vulnerable to the disease reside in long-term care settings such as nursing and residential homes, so infection prevention and control is an essential area of practice. This article describes how COVID-19 is transmitted and discusses various measures that can be taken to reduce the spread of infection to protect residents, staff and visitors. Such measures include social distancing, routine screening, the use of personal protective equipment and cleaning.
Nurs Older People
· 2022 May · PMID 35195375
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BACKGROUND: Within gerontological nursing as a postgraduate nursing specialty, there is a lack of consensus regarding the standardised competencies and education development required, particularly in the UK. AIM: To deve...BACKGROUND: Within gerontological nursing as a postgraduate nursing specialty, there is a lack of consensus regarding the standardised competencies and education development required, particularly in the UK. AIM: To develop and evaluate a competency framework for early career nurses undertaking post-registration education in a UK university in care for older people living with frailty. METHOD: The competency framework was developed as part of a broader gerontological education-career pathway intervention to improve competence and retention among early career nurses. A four-step process was used to develop the framework guided by a consensus building approach. A mixed-methods approach to the evaluation was adopted, with an online survey, one-to-one interviews and focus group interviews with students and organisational stakeholders. FINDINGS: A total of 33 students completed the competency framework as part of an academic module, 30 of whom took part in the evaluation. There was consensus among interviewees that the competencies confirmed 'what they knew already' and identified areas they needed to develop. Survey respondents reported that the competency framework was a useful part of the education-career pathway. CONCLUSION: The competency framework was acceptable to students and feasible to complete. It also enabled students to appreciate the unique knowledge and skills that underpin gerontological nursing and to evidence their expertise using a structured approach.
A comprehensive geriatric assessment (CGA) is a holistic multidimensional review of older people living with frailty or at risk of frailty. In emergency surgical settings, CGAs can be used to identify medical issues and...A comprehensive geriatric assessment (CGA) is a holistic multidimensional review of older people living with frailty or at risk of frailty. In emergency surgical settings, CGAs can be used to identify medical issues and geriatric syndromes among older patients and consequently try to improve their post-operative outcomes. However, there is a lack of geriatrician input in hospitals beyond medical wards, which means that older people who need emergency surgery do not always undergo a CGA, with potential negative repercussions for their post-operative outcomes. One solution to this issue is to employ advanced nurse practitioners (ANPs) to deliver equivalent services. This article presents and discusses the results of an audit of an ANP-led CGA service for older people admitted to hospital for emergency surgery. The ANP reviewed 147 patients during the audit period and identified frailty in 37% and new medical issues in 89% of patients. Interventions initiated by the ANP based on the CGA included requests for additional investigations, referral to allied health professionals and discharge planning. The audit results suggest that ANPs can conduct CGAs in emergency surgical settings effectively.
Nurs Older People
· 2022 Jan · PMID 35080169
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Falls are common in older people and are a cause of preventable morbidity and mortality. As well as causing injury, falls can result in pain, distress, loss of confidence, loss of independence and increased mortality. Ol...Falls are common in older people and are a cause of preventable morbidity and mortality. As well as causing injury, falls can result in pain, distress, loss of confidence, loss of independence and increased mortality. Older people are more likely to visit an emergency department following a fall, therefore these incidents place a high burden on these patients and their carers, as well as on healthcare systems. Appropriate risk assessment accompanied by multifactorial falls prevention interventions can reduce the risk of falls. Assessments should include a medication review because various medicines, sometimes referred to as 'falls risk increasing drugs', can precipitate or contribute to falls. This article examines some of the medicines in this group that can contribute to falls, serious injuries and fractures in older people. It also discusses the importance of medicines management as part of falls risk assessment and prevention interventions.