Journal of Gerontological Nursing (J GERONTOL NURS)

Publications in this journal

• Article: Moving Beyond Warfarin-Are We Ready?: A Review of the Efficacy and Safety of Novel Anticoagulant Agents Compared to Warfarin for the Management of Atrial Fibrillation in Older Adults.

  Kelechi C Ogbonna, Kalin M Clifford
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  ABSTRACT: Atrial fibrillation (AF) is one of the most common cardiac arrhythmias seen in clinical practice. Stroke risk in patients diagnosed with AF increases from 1.5% in the fifth decade of life to 23.5% in patients older than 80, emphasizing the need for effective and appropriate therapies. Over the past 50 years, vitamin K antagonists-namely warfarin (Coumadin(®))-have been the mainstay for stroke prevention. The introduction of dabigatran (Pradaxa(®)), rivaroxaban (Xarelto(®)), and apixaban (Eliquis(®)) has caused both patients and providers to question whether better alternatives to warfarin therapy exist. These agents have shown to be at least as effective as warfarin in stroke risk reduction with no need for international normalized ratio monitoring. This review will examine these newer anticoagulant agents' safety and efficacy and provide clinical considerations for treating older adults with AF. Clinicians with patients unable to tolerate warfarin or with difficulty managing therapy will need to consider patient characteristics, cost, adherence, lack of a reversal agent, and long-term efficacy before prescribing these agents. [Journal of Gerontological Nursing, xx(x), xx-xx.].
  Journal of Gerontological Nursing 06/2013;
• Article: Symptom Communication During Critical Illness: The Impact of Age, Delirium, and Delirium Presentation.

  Judith A Tate, Susan Sereika, Dana Divirgilio, Marci Nilsen, Jill Demerci, Grace Campbell, Mary Beth Happ
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  ABSTRACT: Symptom communication is integral to quality patient care. Communication between patients and nurses in the intensive care unit (ICU) is complicated by oral or endotracheal intubation and fluctuating neurocognitive status or delirium. We report the (a) prevalence of delirium and its subtypes in non-vocal, mechanically ventilated, critically ill patients; (b) impact of age on delirium; and (c) influence of delirium and age on symptom communication. Videorecorded interactions between patients (N = 89) and nurses (N = 30) were analyzed for evidence of patient symptom communication at four time points across 2 consecutive days. Delirium was measured at enrollment and following sessions. Delirium prevalence was 23.6% at enrollment and 28.7% across sessions. Participants age >60 were more likely to be delirious on enrollment and during observational sessions. Delirium was associated with self-report of pain, drowsiness, and feeling cold. Patients were significantly less likely to initiate symptom communication when delirious. Symptom identification should be carefully undertaken in older adults with or without delirium.
  Journal of Gerontological Nursing 06/2013;
• Article: Improving Care at End of Life in the ICU: A Proposal for Early Discussion of Goals of Care.

  Jennifer B Seaman
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  ABSTRACT: Improving care at end of life (EOL) in the intensive care unit (ICU) remains a challenge, especially for older adults, who face a high likelihood of mortality or profound functional impairment with admission to the ICU and use of life-sustaining treatment (LST) such as mechanical ventilation. Multiple factors pose a barrier to high-quality EOL care that is consistent with patient preferences and values. This article outlines key contributory factors to this problem and offers, as a solution, a proposal for earlier engagement with decisional surrogates to clearly define the surrogate role; outline the risks, benefits, and alternatives to LSTs in use; and clarify patient-specific goals of care. Nurses should play a pivotal role in the development of programs to implement early discussion of goals of care, and they are instrumental in identifying patients at risk and facilitating early engagement with surrogates in facilities where such programs exist. Research that systematically evaluates outcomes of such protocols is needed to guide policy for patient-centered EOL care in the ICU.
  Journal of Gerontological Nursing 06/2013;
• Article: Family-Centered End-of-Life Care in the ICU.

  Debra L Wiegand, Marian S Grant, Jooyoung Cheon, Mary A Gergis
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  ABSTRACT: Families of older adults are intricately involved in the end-of-life decision-making process for a family member with a serious illness in the intensive care unit (ICU) setting. However, families are not always as involved and as informed as they would like to be. Creating a culture that assesses family needs and supports families is an important component of family-centered care. There are several strategies that nurses and other members of the interdisciplinary team can use to promote family-centered end-of-life care in the ICU. Nurses can get to know the family by spending time talking with them, assessing them, seeking to understand their perspectives on their family member's condition, and discussing previously verbalized patient wishes for care. This article offers strategies nurses can use to help guide the family through the end-of-life decision-making process, support families as difficult and complex decisions are made in collaboration with the health care team, and prepare families for the dying process.
  Journal of Gerontological Nursing 06/2013;
• Article: Extending the ABCDE Bundle to the Post-Intensive Care Unit Setting.

  Michele Balas, Rose Buckingham, Tami Braley, Sarah Saldi, Eduard E Vasilevskis
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  ABSTRACT: A recently proposed interprofessional, evidence-based, multicomponent approach to mitigating the effects of intensive care unit (ICU)-acquired delirium and weakness has the potential to radically transform the way care is delivered to older adults requiring sedation, mechanical ventilation, or both. The Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility (ABCDE) bundle empowers members of the interdisciplinary ICU team to implement the best available evidence regarding mechanical ventilation, sedation, weakness, and delirium in a safe, effective, and patient-centered manner. Considering that critically ill older adults are cared for in a number of different settings during the course of hospitalization and recovery, the purpose of this article is to explore the rationale and possible benefits of extending the ABCDE bundle into the post-ICU setting. We provide a case study that illustrates how ABCDE bundle adoption could be the key to improving the quality of care provided to seriously ill older adults in the ICU and beyond.
  Journal of Gerontological Nursing 06/2013;
• Article: The Study of Activity in Older ICU Patients: An Integrative Review.

  Colleen M Casey
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  ABSTRACT: The purpose of this study was to review relevant literature on activity of older critically ill patients, including activity interventions conducted in this population, with a focus on activity measurement and technology. Literature published between 1996 and 2012 was reviewed using keywords older adults, inactivity, mobility, progressive mobility, rehabilitation, ambulation, early mobilization, ICU (intensive care unit), and accelerometry using CINAHL, MEDLINE, and the Cochrane Database of Systematic Reviews. Previous relevant research is discussed and includes intervention and nonintervention studies. Although studies have demonstrated the benefits of early mobilization in the ICU setting, this research has not focused on the high-risk older adult ICU population, nor has it addressed how best to quantify these clinical activities. Current technologies, such as accelerometry, may assist in measuring patient activity and in mobilizing high-risk patients during acute, critical illness.
  Journal of Gerontological Nursing 06/2013;
• Article: Becoming Part of the Plan to Help Conquer Alzheimer's Disease: The National Alzheimer's Project Act.

  Wanda Bonnel
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  ABSTRACT: Alzheimer's disease presents one of the largest challenges facing the aging population. The National Alzheimer's Project Act (NAPA) led to a national plan to engage health care team members in addressing this challenge. As nurse clinicians, educators, and researchers review the NAPA and resultant national plan, they can gain further direction in enhancing or expanding their roles to help stem the devastation of Alzheimer's disease.
  Journal of Gerontological Nursing 06/2013;
• Article: Shifting Institutions: Preparing for Transfers from Prisons to Long-Term Care Facilities.

  Susan J Loeb
  Journal of Gerontological Nursing 06/2013; 39(6):2-3.
• Article: In-Home Fall Risk Assessment and Detection Sensor System.

  Marilyn J Rantz, Marjorie Skubic, Carmen Abbott, Colleen Galambos, Youngju Pak, Dominic K C Ho, Erik E Stone, Liyang Rui, Jessica Back, Steven J Miller
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  ABSTRACT: Falls are a major problem in older adults. A continuous, unobtrusive, environmentally mounted (i.e., embedded into the environment and not worn by the individual), in-home monitoring system that automatically detects when falls have occurred or when the risk of falling is increasing could alert health care providers and family members to intervene to improve physical function or manage illnesses that may precipitate falls. Researchers at the University of Missouri Center for Eldercare and Rehabilitation Technology are testing such sensor systems for fall risk assessment (FRA) and detection in older adults' apartments in a senior living community. Initial results comparing ground truth (validated measures) of FRA data and GAITRite System parameters with data captured from Microsoft(®) Kinect and pulse-Doppler radar are reported.
  Journal of Gerontological Nursing 05/2013;
• Article: Clinical and Transitional Care: Considerations to Optimize Functional Recovery Following Hip Fracture.

  Travis Eckard, Mary P Cadogan
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  ABSTRACT: Between 30% and 40% of community-dwelling older adults in the United States fall at least once each year, and approximately 10% of these falls are associated with a major injury such as a hip fracture. Return to maximum level of functional status following surgery requires individualized rehabilitation programs and may involve multiple care transitions. Using an individual example, this article provides context for meeting rehabilitation goals during transitional care following hip fractures. Understanding recommended clinical management strategies during the acute perioperative period and the rationale for post-surgical rehabilitation decisions based on clinical assessment, program eligibility, and Medicare coverage will allow all health professionals to provide optimal guidance and maximize functional recovery for older adults with hip fractures.
  Journal of Gerontological Nursing 05/2013;
• Article: Pilot testing a couples-focused intervention for mild cognitive impairment.

  Yvonne Yueh-Feng Lu, Joan E Haase, Michael Weaver
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  ABSTRACT: The purpose of this pilot was to evaluate the acceptability, feasibility, and potential benefits of the multicomponent, Daily Enhancement of Meaningful Activity (DEMA) intervention, which was tailored to help couples facing mild cognitive impairment (MCI) work together to meet goals, remain engaged in meaningful activities, and adapt to changes over time. Using a single-group design, 10 individuals with MCI and their family caregivers were recruited to participate in the DEMA intervention over 6 biweekly sessions. Data were collected pre-and at 1 week and 3 months postintervention completion rates indicated the program and study procedures were well accepted. Qualitative and quantitative finding indicated positive trends in meaningful activity performance and maintenance of health-related outcomes, as well as high program satisfaction. The DEMA intervention is potentially promising but needs further testing in a randomized clinical trial.
  Journal of Gerontological Nursing 05/2013; 39(5):16-23.
• Article: Cognitive Health and Older Workers: Policy Implications.

  Karen Devereaux Melillo
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  ABSTRACT: Cognitive health, memory complaints, and cognitive impairment among older workers have begun to receive attention in the research, practice, education, and policy arenas. With the aging population of the United States continuing to increase, projections are that the number of workers 65 and older is also expected to increase. Concerns regarding cognitive impairment and job performance in older workers are being raised. Being familiar with the policies and regulations that protect older workers and offering support and guidance to older adults as they contemplate major life transitions, such as retirement, are important role components for gerontological nurses. Using the five levels of analysis in the social ecology model, selected public policies to support older adults in the workforce are reviewed, and recommendations are presented for fostering positive workplace policies that can promote cognitive health.
  Journal of Gerontological Nursing 04/2013;
• Article: Older Adults' Perceptions of Pictograph-Based Discharge Instructions after Hip Replacement Surgery.

  Jeungok Choi
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  ABSTRACT: Current text-based discharge instructions are unsuitable for low-literate older adults who have difficulty following written action-based instructions. To address this issue, we developed discharge instructions for low-literate older adults after hip replacement surgery using pictographs (i.e., simple line drawings with stick 3 gures showing explicit care actions). The aim of this focus group study was to examine the acceptability and comprehension of these instructions to 15 low-literate older adults. Participants perceived that the pictograph-based discharge instructions helped them understand the intended health care messages, especially for step-by-step procedures of discharge actions. The black-and-white line drawings were well received by all participants of various race/ethnicity. A pictograph-based approach is an effective strategy for developing discharge instructions not only for patients with low-literate skills in acute health care settings, but also for immigrants with significant communication challenges. Future research is suggested to compare the effects of pictograph-based and text-based instructions on adherence to instructions and health outcomes.
  Journal of Gerontological Nursing 04/2013;
• Article: Sexuality in Nursing Homes: Practice and Policy.

  Gayle M Doll
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  ABSTRACT: Older adults' sexuality and sexual expression are often overlooked in nursing home and residential care settings. Despite cultural beliefs that this population is asexual, sexual activity occurs frequently among residents in long-term care. This study, using written survey instrumentation, examines the scope of resident sexuality, staff reactions to sexual behavior, and the policies and guidelines used in 91 nursing homes to address residents' sexual activity. Eighty-five percent of respondents reported that sexual activity had occurred in their homes, and staff reactions to sexual activity were based on general guidelines. Many responses indicated that sexual expression of residents was considered non-normative. Issues of consent, especially concerning residents with dementia, and residents' right to privacy were addressed using existing general policies. Survey results demonstrate a need for specific policies and staff training regarding sexual expression to be developed with the input of nurses, family members, and residents.
  Journal of Gerontological Nursing 04/2013;
• Article: Before Alzheimer's…

  Amanda Lynn Polk
  Journal of Gerontological Nursing 04/2013;
• Article: The Time of Our Lives: Reflections on the Art of Geriatric Nursing.

  Ann L McCracken
  Journal of Gerontological Nursing 04/2013;
• Article: The Work of Spousal Caregiving of Older Adults with End-Stage Heart Failure.

  Lisa A Kitko, Judith E Hupcey
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  ABSTRACT: Heart failure requires complex home management, which is typically performed by a spouse. Yet little is known about the actual "work" of caregiving in individuals with heart failure. The purpose of this study was to describe the types of work manifested in long-term spousal caregiving for older adults across the progression of heart failure. Secondary qualitative analysis was performed of the in-depth serial interview data of 20 spousal caregivers of individuals with heart failure age 62 and older, collected monthly over 12 to 14 months. The work of spousal caregiving impacted all aspects of the lives of spouses and was constant over time and across the course of heart failure. The work of caregiving was always present, even during times of medical stability, but the type of work and intensity varied throughout the course of the illness. Caregivers should be assessed for unmet needs throughout the course of heart failure, not just during the individuals' exacerbations or hospitalizations.
  Journal of Gerontological Nursing 04/2013;
• Article: The Impact of Pain on Physical and Mental Quality of Life in Adults 65 and Older.

  Kevin Hawkins, Shirley Musich, Frank G Bottone, Ronald J Ozminkowski, Yan Cheng, Steven Rush, Joseph Carcione, Richard J Migliori, Charlotte S Yeh
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  ABSTRACT: Pain is a frequent and debilitating problem among older adults, decreasing quality of life (QOL) both physically and mentally. The burden of arthritis, sciatica, and back pain on QOL was estimated using ordinary least squares regression techniques to estimate the impact of each of these types of pain on QOL, controlling for patient demographic, socioeconomic, and health status characteristics. For individuals with arthritis, sciatica, and back pain, the adjusted average physical component scores were 4.19, 1.39, and 6.75 points lower, respectively (all p < 0.0001), than those without pain. Adjusted average mental component scores were 1.33, 0.47, and 2.93 points lower (all p < 0.01) for individuals with arthritis, sciatica, and back pain, respectively. The impact of pain on QOL was greater than that for many other commonly treated medical conditions. Clinicians should discuss pain with their patients to maximize their QOL.
  Journal of Gerontological Nursing 04/2013;
• Article: Physical Activity Preferences for Low-Income Sedentary Urban African American Older Adults.

  Mary A Nies, Meredith Troutman-Jordan, Dominica Branche, Trudy Moore-Harrison, Caroline Hohensee
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  ABSTRACT: The objective of this study was to determine (a) activity preferences for low-income sedentary urban African American older adults and (b) information needed to deliver a lay physical activity intervention in the community for this population. This descriptive qualitative study used six focus groups. Participants were African American, 55 and older, had low incomes, and had sedentary behavior. Physical activity themes included excitement/emotion for physical activity, group physical activity, and location of physical activity. Themes regarding aspects of being a lay community health worker included beneficial service, uncertainty, logistics concerns, and delivery method preferences. The findings from this study will provide the basis for an intervention for low-income sedentary African American older adults. Preferences for physical activity, concerns about and supports needed for individuals to serve as lay community health workers, various types of training materials, and preferred technology for physical activity participation are identified and discussed.
  Journal of Gerontological Nursing 04/2013;
• Article: End-of-Life Caregiving: Challenges Faced by Older Adult Women.

  Gwen McGhan, Susan J Loeb, Brenda Baney, Janice Penrod
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  ABSTRACT: In the United States, the number of people older than 60 is expected to triple over the next 50 years, and as the population ages so do family caregivers. Increased levels of depression and low ratings of subjective well-being in caregivers are consistently associated with older age, the spousal relationship, and female caregiver gender. Less well known is the effect care delivery models have on the older adult as his or her spouse approaches the end of life. The purpose of this study was to explore the challenges faced by older adult spousal caregivers providing end-of-life care across different life-limiting illness trajectories in distinctive care delivery models. An instrumental case study using purposive sampling identified the following themes for older spousal caregivers: balancing multiple morbidities; feeling overwhelmed and exhausted; dealing with personal health issues; feeling isolated; and coordinating care. Implications for health care providers are also examined.
  Journal of Gerontological Nursing 04/2013;