Nursing Older People[JOURNAL]
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200 papers
Type 2 diabetes in older people: pathophysiology, identification and management.
Mayo P
Nurs Older People · 2020 Jun · PMID 32519523 · Publisher ↗
The general population is now living longer, with increasing numbers of older people living with more than one long-term condition. The number of older people diagnosed with type 2 diabetes is also rising because of the...
The general population is now living longer, with increasing numbers of older people living with more than one long-term condition. The number of older people diagnosed with type 2 diabetes is also rising because of the changes resulting from the ageing process and the significant increase in obesity levels, which are affecting the provision of healthcare and individuals' quality of life. This article explores the implications of increased longevity and how this is linked to the development of type 2 diabetes. It explains how the presentation of type 2 diabetes differs in older people compared with younger people, making initial diagnosis increasingly challenging. Frailty and anti-diabetes medicines can affect quality of life and an older person's risk of falls; therefore, linked to these, the article details the effects of declining functional ability and increasing cognitive impairment, and emphasises the need for regular medication reviews. The article also provides an analysis of the care required for older people with type 2 diabetes living in care homes, including the need for flexibility in treatment targets.
Urinary tract infection prevention: evaluating Scotland's national hydration campaign.
McNeish J, Mullings A
Nurs Older People · 2020 May · PMID 32463182 · Publisher ↗
Urinary tract infection (UTI) is a prevalent healthcare-associated infection in adult acute and long-term care facilities in Scotland. To convey the public health benefits of optimal hydration to support UTI prevention,...
Urinary tract infection (UTI) is a prevalent healthcare-associated infection in adult acute and long-term care facilities in Scotland. To convey the public health benefits of optimal hydration to support UTI prevention, the Scottish UTI Network, coordinated by Health Protection Scotland, launched a national hydration campaign in 2018. The benefits of hydration were promoted using a range of materials displayed in a variety of settings, including community pharmacies, inpatient hospital wards, care homes and community settings such as GP surgeries and district nursing hubs. The campaign consisted of three stages, of which the first two stages were aimed at adults. The first two stages were evaluated using online surveys, which were completed by a total of 153 respondents. This article puts the hydration campaign in the context of UTI prevention in Scotland, describes the first two stages of the campaign and provides an overview of the evaluation findings, which suggest that the campaign was received positively.
Changing needs in advanced dementia.
Brown M, Tolson D, Ritchie L
Nurs Older People · 2020 May · PMID 32431132 · Publisher ↗
This is the first article in a six-part series in Nursing Older People exploring the nursing care of people living with advanced dementia. This article discusses the changes that may occur as dementia progresses, from th...
This is the first article in a six-part series in Nursing Older People exploring the nursing care of people living with advanced dementia. This article discusses the changes that may occur as dementia progresses, from the perspective of the individual, their family and other carers. A person living with advanced dementia is likely to experience physical, cognitive and social changes that can be profound and debilitating. Healthcare needs intensify as new and co-existing issues result in increasing dependency on others for support with activities of daily living. These activities can include eating, drinking, mobility and personal care. Consequently, family carers may find their role has to develop and change to provide increasing support in response to these complex needs. These increasing needs can result in care transitions to hospitals or care homes. Careful and collaborative management of care is crucial to maintain quality of life for the person with dementia and family carers.
Supporting family carers via the Admiral Nurse Dementia Helpline: reflection on a case study.
Brown P, Oliver E, Dening KH
Nurs Older People · 2020 Sep · PMID 32400141 · Publisher ↗
In the UK, the quality of post-diagnostic care and support for people with dementia and their family carers is variable and depends on the availability of services in each person's local area. This article considers the...
In the UK, the quality of post-diagnostic care and support for people with dementia and their family carers is variable and depends on the availability of services in each person's local area. This article considers the support services available for families affected by dementia and discusses how telephone helplines can assist those who may have no access to other types of support. It presents a case study describing a call to the Admiral Nurse Dementia Helpline, a service run by nurses with expertise in dementia care and provided by the charity Dementia UK. This is followed by a reflection on the call from the nurse's perspective. The case study-based reflection demonstrates the complexity of providing support through a helpline and the specialist knowledge and skills required to provide the appropriate level of support.
Evaluating a palliative care education programme for domiciliary care workers.
Manson J, Ghasemi L, Westerdale E … +3 more , Taylor P, Kyeremateng S, McTague L
Nurs Older People · 2020 Sep · PMID 32347075 · Publisher ↗
BACKGROUND: Many domiciliary care workers have reported low confidence and isolation when delivering end of life care in patients' homes. Project Extension for Community Healthcare Outcomes (ECHO) is an initiative that h...
BACKGROUND: Many domiciliary care workers have reported low confidence and isolation when delivering end of life care in patients' homes. Project Extension for Community Healthcare Outcomes (ECHO) is an initiative that has demonstrated success in increasing confidence and knowledge of end of life care in UK nursing home and community hospice workers, but it has not been evaluated with domiciliary care workers. AIM: To test the acceptability of Project ECHO to domiciliary care workers as a means of increasing their knowledge of, and confidence in, delivering palliative care, and its effectiveness in reducing their isolation by developing a community of practice. METHOD: A service evaluation, involving one domiciliary care agency delivering care in the community, was conducted from May 2018 to April 2019. The participants were 25 home care workers who were employed by the agency. Participants were invited to attend an event at which gaps in their knowledge were identified, and a curriculum of learning on the Project ECHO programme was developed. The learning involved 12 educational sessions over 12 months, with each session teaching a different component of palliative care. Questionnaires were completed by the participants before and after the educational sessions to assess their effect. In addition, a focus group was conducted with four of the participants. RESULTS: Comparison of the questionnaires completed before and after participating in the education sessions revealed an increase in self-reported knowledge across all 12 topics of the curriculum and an increase in confidence in seven of the 12 topics. However, attendance across the 12 sessions was variable, with no more than nine being attended by any one participant. CONCLUSION: Palliative care education for domiciliary care staff using ECHO methodology was well received, relevant and accessible, and may have the potential to improve self-assessed knowledge and confidence. However, finding an ideal time for as many staff to attend as possible may be challenging.
Introduction to living with advanced dementia series.
Brown M, Tolson D
Nurs Older People · 2020 Jun · PMID 32237550 · Publisher ↗
This is the introductory article in a six-part series in Nursing Older People exploring the nursing care of people living with advanced dementia. It discusses the complex and progressive array of nursing required to meet...
This is the introductory article in a six-part series in Nursing Older People exploring the nursing care of people living with advanced dementia. It discusses the complex and progressive array of nursing required to meet the needs of individuals, the provision of personal care, learning and leadership, meaningful activity, and palliative and end of life care. A main theme of the series is the exceptional nursing skills and knowledge required to deliver evidence-informed care with compassion and respect for people living with advanced dementia. This introductory article provides background information to contextualise advanced dementia and identify the main challenges facing nurses, nurse educators and nurse leaders.
Use of night-time positioning equipment in care home residents with postural asymmetry: a pilot study.
Stephens M, Bartley C
Nurs Older People · 2020 Jun · PMID 32212511 · Publisher ↗
BACKGROUND: Twenty four-hour postural care that includes the use of night-time positioning equipment (NTPE) is being increasingly recommended. However, because most of the published studies focus on children, there is a...
BACKGROUND: Twenty four-hour postural care that includes the use of night-time positioning equipment (NTPE) is being increasingly recommended. However, because most of the published studies focus on children, there is a lack of evidence on the use of NTPE in adults. AIM: The aim of this pilot study was to assess the effect of NTPE use in UK care home residents with complex health conditions and postural asymmetry. METHODS: Ten care home residents trialled NTPE over a 12-week period. Qualitative and quantitative data were collected before and after each trial using standardised assessment tools. Semi-structured interviews were conducted with participants and relatives after each trial. Staff's views were elicited via two focus groups at the end of the study. RESULTS: There were notable benefits of NTPE use in terms of participants' pain levels, sleep quality, risk of pressure ulcers, risk of choking, and weight. There was also evidence of improvements in participants' function, ability to undertake activities of daily living and quality of life. However, some equipment was abandoned during the trials because participants found it too hot or restrictive. CONCLUSION: This pilot study increases the evidence base for a personalised approach to 24-hour postural care that can support older people's health and well-being. Further empirical studies are required to determine how NTPE can be used to improve older people's quality of life.
Extending the Newcastle Model: how therapeutic communication can reduce distress in people with dementia.
Jackman L
Nurs Older People · 2020 Mar · PMID 32207594 · Publisher ↗
This article identifies the importance of effective communication in delivering care to people living with dementia when their understanding of the situation may differ to ours. The Newcastle Model's biopsychosocial fram...
This article identifies the importance of effective communication in delivering care to people living with dementia when their understanding of the situation may differ to ours. The Newcastle Model's biopsychosocial framework is revisited to understand the context in which caregiving takes place, and the article goes on to consider the importance of communication to person-centred care delivery. The special case of lie telling or 'therapeutic untruths' as a communication tool is considered as an often essential way to join with the person's reality, and the practical and ethical dilemmas this poses are considered.
Digital health technology: factors affecting implementation in nursing homes.
Curtis K, Brooks S
Nurs Older People · 2020 Mar · PMID 32159302 · Publisher ↗
BACKGROUND: Digital health technology (DHT), which includes digital algorithms and digital records, is transforming the way healthcare services are delivered. In nursing homes, DHT can enhance communication and improve t...
BACKGROUND: Digital health technology (DHT), which includes digital algorithms and digital records, is transforming the way healthcare services are delivered. In nursing homes, DHT can enhance communication and improve the identification of residents' health risks, but its implementation has so far been inconsistent. Therefore, the LAUNCH (Leadership of digitAl health technology Uptake among Nurses in Care Homes) study was undertaken to identify factors that may affect DHT implementation in these settings. AIM: To identify the factors that enable nurses to implement DHT in nursing homes and to co-design a nurse-led stepped process supporting the effective implementation of DHT innovations in nursing homes. METHOD: An appreciative inquiry methodology was used. A total of 20 interviews with managers, residents and relatives, and nurses from five nursing homes in England were undertaken. The interview questions focused on their understanding of DHT, their experiences of it, and its potential benefits in nursing homes. Data from the interviews were thematically analysed and the emerging themes were used to inform two co-creation workshops, during which participating nurses discussed a practical, evidence-based process for DHT implementation in nursing homes. FINDINGS: Three broad themes emerged from the interviews: improving communication; engaging with DHT and retaining humanised care; and introducing DHT and protecting data security. The co-creation workshop participants formulated the LAUNCH process model, a nurse-led, stepped approach supporting DHT implementation in nursing homes. CONCLUSION: The LAUNCH study identified factors enabling staff in nursing homes to introduce and sustain DHT innovations. Participating nurses co-created a three-step process for the effective implementation of DHT innovations in nursing homes, which have the potential to release staff time, improve quality of care, and have positive effects on staff recruitment and retention.
Sexual health and well-being in later life.
White I
Nurs Older People · 2020 Jun · PMID 32129030 · Publisher ↗
Sexual health in later life is becoming increasingly important as more people are reaching older age and are remaining sexually active well into their seventies and beyond. Alongside this, as more older people seek new r...
Sexual health in later life is becoming increasingly important as more people are reaching older age and are remaining sexually active well into their seventies and beyond. Alongside this, as more older people seek new relationships following partner death or divorce, the rates of newly diagnosed sexually transmitted infections are increasing markedly. This article focuses on sexual health and well-being. It offers a definition of sexual health and explores the changes that people experience in sexual health, well-being and functioning in later life. It discusses common physical, psychosocial and sexual relationship issues, and identifies advice that nurses can offer to older people. Using the PLISSIT model, it then focuses on the role of nurses in promoting sexual health for people in later life.
Defining, monitoring and improving quality in Welsh care homes.
Blunt D
Nurs Older People · 2020 Mar · PMID 32077271 · Publisher ↗
Despite the focus on quality in care homes, and the body of evidence that drives policy and practice, care home residents in Wales experience variations in quality of care. Quality is not easily defined, and care provide...
Despite the focus on quality in care homes, and the body of evidence that drives policy and practice, care home residents in Wales experience variations in quality of care. Quality is not easily defined, and care providers may have differing views on quality and how it is monitored. Health and social care professionals - including nurses - should understand the factors that affect quality in care homes. Quality improvement projects can support the development of a workplace culture that can sustain quality in care homes. This article defines quality, details methods that may be used to monitor quality, and outlines how quality in care homes can be improved.
Exploring the knowledge, attitudes and perceived learning needs of formal carers of people with dementia.
Attard R, Sammut R, Scerri A
Nurs Older People · 2020 Jun · PMID 32020790 · Publisher ↗
BACKGROUND: An appropriate level of knowledge, a positive attitude and awareness of learning needs are essential to provide high-quality care to people living with dementia. AIM: To explore the knowledge, attitudes and p...
BACKGROUND: An appropriate level of knowledge, a positive attitude and awareness of learning needs are essential to provide high-quality care to people living with dementia. AIM: To explore the knowledge, attitudes and perceived learning needs of formal carers of residents living with dementia in one long-term care facility. METHOD: Questionnaires were sent to nurses and nursing assistants working in one long-term care facility in Malta. A total of 207 completed responses were received from these formal carers. The questionnaire comprised scales: the Alzheimer's Disease Knowledge Scale, the Dementia Attitude Scale and the Dementia Learning Needs Assessment tool. RESULTS: Formal carers' knowledge about dementia was satisfactory. Increased knowledge was associated with being a nurse and working on a specialist dementia unit. Overall, formal carers' attitudes towards people with dementia were positive. Nurses identified managing behaviour that challenges as the most important learning need, while for nursing assistants it was how to assist family caregivers in coping with Alzheimer's disease. Nurses and nursing assistants considered learning about the use of technology to be the least important learning need. Being a nurse and working in a specialist dementia unit were predictors of better knowledge. Working in specialist dementia units was also a predictor of positive attitudes towards people with dementia. CONCLUSION: Policymakers should be aware that continued investment in specialist dementia units should be an intermediate and long-term goal because of the projected increase in the number of people living with dementia and the need to ensure these individuals receive optimum care.
Advanced nurse practitioners can lead comprehensive geriatric assessment in acute hospitals.
Mashlan W, Heffey S, Jones L
Nurs Older People · 2020 Jan · PMID 31990162 · Publisher ↗
With an increasingly ageing population comes a greater risk of frailty, a distinct health state in which multiple body systems gradually lose their inbuilt reserves. The ability to recognise important frailty markers and...
With an increasingly ageing population comes a greater risk of frailty, a distinct health state in which multiple body systems gradually lose their inbuilt reserves. The ability to recognise important frailty markers and conduct specialist comprehensive assessments of potentially frail older people admitted to acute hospitals is important to improve their health and well-being. This article explores the role of the advanced nurse practitioner (ANP) in identifying frailty and leading comprehensive geriatric assessment (CGA) for older people admitted to acute hospital settings. A small evaluation of CGA led by an ANP in a district general hospital found that a well-rounded assessment of patients living with frailty could be carried out, and that such assessments reduced unscheduled readmission within 28 days of discharge and overall length of hospital stay by six days. In a challenging climate, in which healthcare services seek to deliver effective and efficient care to the frail older population, ANPs can ensure a timely and specialist approach to CGA.
Role of nursing associates in addressing the needs of people with dementia in hospital.
Smith M, Gill T
Nurs Older People · 2020 Jan · PMID 31984684 · Publisher ↗
It is estimated that people with dementia comprise about one quarter of all inpatients in acute hospital wards, although this could be an underestimate. Healthcare assistants often lack the training and skills, and nurse...
It is estimated that people with dementia comprise about one quarter of all inpatients in acute hospital wards, although this could be an underestimate. Healthcare assistants often lack the training and skills, and nurses often lack the time, to provide optimal care for these patients. As a result, the needs of hospital inpatients with dementia are often unmet, they may have suboptimal outcomes compared with inpatients who do not have dementia, and they may experience significantly reduced well-being and quality of life. Nursing associates have a hands-on role in patient care, and their training should equip them with the skills required to overcome communication barriers and identify patients' needs. This article explores the potential role of nursing associates in addressing the needs of inpatients with dementia.
Osteoporosis and fragility fractures: risk assessment, management and prevention.
Walker J
Nurs Older People · 2020 Jan · PMID 31854161 · Publisher ↗
Osteoporosis is a chronic skeletal condition characterised by low bone mass and microarchitectural deterioration of the bones that disproportionately affects older people. Older people with osteoporosis are at increased...
Osteoporosis is a chronic skeletal condition characterised by low bone mass and microarchitectural deterioration of the bones that disproportionately affects older people. Older people with osteoporosis are at increased risk of sustaining fragility fractures, and this risk is compounded by factors such as falls and frailty. Fragility fractures can have several physical and psychological effects, potentially affecting an older person's quality of life and reducing their life expectancy. Therefore, it is important that nurses can identify individuals at risk of osteoporosis and recognise the factors that may predict fragility fractures. This article outlines the main risk factors for osteoporosis and details the assessment and management of patients with this condition. It also explains the pharmacological interventions and lifestyle changes that can reduce the risk of fragility fractures in older people with osteoporosis.
The role of the community matron: a structured approach to case management.
Tregenza L
Nurs Older People · 2019 Nov · PMID 31778064 · Publisher ↗
The role of the community matron in supporting patients with long-term conditions through holistic case management is well established, as is learning through critical reflection and using case studies for continuing pro...
The role of the community matron in supporting patients with long-term conditions through holistic case management is well established, as is learning through critical reflection and using case studies for continuing professional development. This article draws on a case study to provide a critical analysis of the community matron service, which offers intervention and case management for a patient who had been diagnosed with heart failure.
Strategies to prevent dehydration in older people with dementia: a literature review.
Wilson K, Dewing J
Nurs Older People · 2020 Jan · PMID 31769256 · Publisher ↗
Dehydration is prevalent in hospitalised older people and residents in care homes, and older people with dementia are particularly at risk. A literature review was conducted to determine the evidence-based interventions...
Dehydration is prevalent in hospitalised older people and residents in care homes, and older people with dementia are particularly at risk. A literature review was conducted to determine the evidence-based interventions used to prevent and manage dehydration in older people with dementia. Three databases were searched for relevant literature: Applied Social Sciences Index and Abstracts, Cumulative Index to Nursing and Allied Health Literature, and MEDLINE, alongside hand-searching. In-depth reading of the 12 studies included in this literature review was undertaken. Five themes were identified in relation to the hydration of older people: physical and social environment; staff communication strategies; access to drinks; drinking vessels; and individual preferences. The evidence suggests that dehydration in older people with dementia is an ongoing concern that needs to be addressed. There is evidence supporting the use of essential nursing interventions to improve hydration, such as coloured cups and verbal prompts, but less is known about the barriers preventing nurses from implementing these evidence-based interventions.
What is an older husband's experience of caring for his wife who has dementia?
Nel K, Board M
Nurs Older People · 2019 Nov · PMID 31691551 · Publisher ↗
A significant number of informal carers look after people who have dementia. Women's caring experiences are well documented. However, a substantially smaller amount of research exists specifically investigating the male...
A significant number of informal carers look after people who have dementia. Women's caring experiences are well documented. However, a substantially smaller amount of research exists specifically investigating the male carer perspective. This literature review explores older husbands' experiences of caring for their wives who have dementia. The findings suggest that husbands are committed to their caring role but can feel socially isolated. The caring role of older men has altered the dynamic in the marriage. Husbands continue to show commitment towards their spouses but feel that male-only support groups could offer some respite from their responsibilities. Nurses need to take time to listen to husbands' experiences, offering emotional support and signposting them to other services. Further research on the long-term effects and support needs of older male carers is needed.
Dietary intake of people with dementia on acute hospital wards.
Oldknow H, Williamson K, Williams E … +1 more , Palmer L
Nurs Older People · 2019 Nov · PMID 31663298 · Publisher ↗
The aim of this service evaluation was to understand the factors affecting meal provision on a dementia ward and assess whether meals-based dietary intake met estimated mean energy requirement and reference nutrient inta...
The aim of this service evaluation was to understand the factors affecting meal provision on a dementia ward and assess whether meals-based dietary intake met estimated mean energy requirement and reference nutrient intake (RNI). A mixed-methods approach was adopted: 1. Mapping the dietary intake for a cohort ( n =6) of inpatients with advanced dementia over a period of four consecutive days. 2. Semi-structured interviews to explore the experiences of the professionals ( n =5) involved. Two of the participants' four-day mean intakes did not meet their estimated energy requirement based on meal provision. All participants apart from one met the target of 0.75g of protein per kg body weight per day for the general population. Several of the nutrients consumed were at or exceeded the RNI for adults of this age, although participants' mean dietary vitamin D intake was substantially below the RNI for the general population. The themes included communication, time pressure and the continuity of service provision. The meals provided were nutritionally sound. Individuals' nutritional status was improved through staff supporting them with eating. The contribution of drinks and snacks to nutrient intake warrants further exploration. Effective communication between food providers and ward areas is important. Mealtimes should reflect patient need - for example, having the main meal in the evening and a lighter option at lunch. This does not clash with the benefits of a flexible breakfast time.
Meaningful engagement between secondary school students and older patients in an acute hospital.
Mashlan W, Ralston S, Jones L
Nurs Older People · 2019 Oct · PMID 31617337 · Publisher ↗
This article discusses the development and outcomes of a project involving a shared care acute hospital ward (mental health and medical) and a local secondary school in South Wales. The project enabled meaningful interac...
This article discusses the development and outcomes of a project involving a shared care acute hospital ward (mental health and medical) and a local secondary school in South Wales. The project enabled meaningful interaction between school pupils and patients with dementia, depression and delirium. It also provided secondary school pupils with the opportunity to understand the role of hospital-based healthcare staff and the needs of older patients.
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