Journal of gerontological nursing最新文献

Purpose: Falls are a significant financial burden and health hazard for residents in assisted living facilities (ALFs). However, limited capacity to observe residents has hindered understanding of resident-staff interactions within rooms. The current study aimed to describe nurse-resident interactions using data from a remote technology combining computer vision and staff location tracking.

Method: Eighty-three staff working at an urban ALF with 215 residents were trained at the initiation of the study. Remote surveillance devices were installed in 32 residences and staff and resident interactions were tracked over 170 days.

Results: Staff visited residents an average of 20.7 times per day for short durations (mean = 1.08 minutes). Urgent alert response times averaged 3.0 minutes, with faster response times through the mobile application (mean = 2.7 minutes) compared to in-person (mean = 3.3 minutes) response.

Conclusion: By better understanding staff activity patterns in ALFs, this study has the potential to improve fall prevention and care for residents in ALFs. [Journal of Gerontological Nursing, 50(7), 7-11.].

Purpose: Nursing homes were at the epicenter of the coronavirus disease 2019 (COVID-19) pandemic and continue to experience its effects, including staffing shortages. Although various studies have described the experiences of frontline staff, less has been published about the experiences of those in administrative positions. The current study explored factors impacting nursing home administrators' (NHAs) perceived preparedness, day-to-day operational challenges and needs, and career outlook in the context of the COVID-19 pandemic.

Method: A cross-sectional online survey was administered via Qualtrics^®, comprising demographic and facility-level questions and eight open-ended questions. Qualitative content and thematic analysis were used to code the text for themes describing administrator perceptions.

Results: NHAs (N = 60) described feeling unprepared, experiencing disruptions of day-to-day operations, and witnessing a decrease in resident well-being. NHAs also expressed a decrease in their own well-being due to COVID-19. Many NHAs expressed wanting to, planning to, or actively working toward leaving their role due to the consequences of COVID-19.

Conclusion: As nursing homes continue to face staffing shortages, supporting those in the role of administrator becomes of urgent importance, as this role directly impacts staff and resident well-being. [Journal of Gerontological Nursing, 50(6), 17-24.].

Purpose: To implement the Age-Friendly Health Systems (AFHS) 4Ms framework, focusing on Medication and its impact on Mobility, Mentation, and What Matters, within Hamad Medical Corporation in Qatar.

Method: A quality improvement approach was used to implement, extend, and sustain the AFHS 4Ms framework at Hamad Medical Corporation. The Medication "M" was described as the use case to illustrate the impact of high-risk medications on Mobility, Mentation, and What Matters, using an evidence-based, interdisciplinary approach.

Results: Implementation of the AFHS 4Ms framework revealed success in aligning multidisciplinary teams to prioritize patient-centered care and caregiver engagement. Through this collaboration, a process map, modified medication screening tool, documentation templates, and educational efforts were developed.

Conclusion: Applying the AFHS 4Ms framework into health care settings is crucial to improve the care of older adults. Medication management is a cornerstone, involving interdisciplinary team input during screening and act phases to ensure proper medication prescribing and use in older adults. [Journal of Gerontological Nursing, 50(6), 6-9.].

Purpose: Medication adherence in adults with H-type hypertension plays a crucial role in lowering blood pressure and treating complications. Cognitive function has been identified as a significant influencing factor for medication adherence, whereas excessive levels of homocysteine can impair cognitive function. Metamemory, which is influenced by cognitive function, also affects medication adherence. However, the complex relationship among these factors remains poorly understood among adults with H-type hypertension. Therefore, we hypothesize that metamemory serves as a mediator for the impact of cognitive function on medication adherence.

Method: A total of 232 adults with H-type hypertension were enrolled to provide cognitive function scores, metamemory scores, and medication adherence rates.

Results: A pairwise correlation exists among cognitive function, metamemory, and medication adherence. Metamemory partially mediates (57.5%) the relationship between cognitive function and medication adherence.

Conclusion: Our findings suggest that interventions targeting improvements in metamemory may enhance medication adherence among individuals with H-type hypertension. [Journal of Gerontological Nursing, 50(6), 44-52.].

Purpose: The coronavirus disease 2019 (COVID-19) pandemic impacted life for older adults living in residential settings, affecting their psychosocial well-being. Risk for COVID-19 is associated with increasing age and pre-existing health conditions. The current study aimed to describe the challenges of COVID-19 and post-traumatic growth (PTG) for residents of a continuing care retirement community (CCRC) in South Florida.

Method: A parallel mixed methods approach was used to explore the experience of older adults with PTG. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using content analysis to identify emergent themes.

Results: Ninety-eight older adults living in a single CCRC completed a survey. Age ranged from 67 to 99 years (mean age = 86 years), with >90% identifying as non-Hispanic White and female (78%). Using the PTG theoretical framework, experiences were categorized into five dimensions: new possibilities, relating to others, personal strength, spiritual growth, and appreciation for life.

Conclusion: The current study focused on the challenges and growth experienced by older adults, as framed by PTG theory. Findings shed light on the capacity of this demographic, with an average age of 86 years, to overcome obstacles and achieve PTG. [Journal of Gerontological Nursing, 50(6), 25-33.].

Purpose: To examine state Area Agencies on Aging (AAAs) in Pennsylvania for services they provide to older adults regarding extreme events and how readiness can be captured through social networks and policies at the local, state, and federal levels.

Method: Using an online survey, 79% of AAA directors answered questions describing perceptions and actions related to social capital and its influence on policy.

Results: AAAs acknowledged weather/temperature changes impact the need to prepare for common scenarios of extreme weather, temperature, and flooding. AAAs reported major social connections with county government and one state agency, with limited connections with federal agencies.

Conclusion: Multiple opportunities exist for AAAs to consider climate change in expansion efforts, specifically regarding health care. Geriatric nurses can play a key role in expansion, advocacy, and policy development for AAAs that serve older adults in the context of climate change. [Journal of Gerontological Nursing, 50(6), 11-15.].

Purpose: To examine the knowledge, stress levels, and attitudes of clinical nurses regarding care for individuals considered the oldest-old (i.e., aged ≥80 years) and to identify related factors.

Method: In this descriptive cross-sectional study, data were collected via an online structured questionnaire survey administered to 128 clinical nurses.

Results: Participants had low levels of knowledge about the oldest-old with hearing impairments or mental health problems (e.g., depression, anxiety, delirium), and high levels of stress. Factors influencing attitudes toward the oldest-old were graduate or higher educational level (p = 0.002), ≥10 years of work experience (p = 0.049), and lower stress (p = 0.033). The explanatory power of the regression model was 18.1%.

Conclusion: Further research and development programs should aim to promote positive attitudes toward care for older adults among nurses and develop methods to reduce and better manage stress when caring for these individuals. [Journal of Gerontological Nursing, 50(6), 35-43.].

Introduction

I am #AGSProud of the advocacy work that the American Geriatrics Society (AGS) does on behalf of older adults and the geriatrics health professionals who serve them. One reason why our advocacy is so impactful is that AGS is able to draw on the expertise of its members to inform our comment letters. AGS remains steadfast in its commitment to advocating for the rights and well-being of older adults, emphasizing equal protection and treatment for all. In this column, I have summarized several of our AGS comment letters with the goal of providing a glimpse into our ongoing efforts to shape public policy with the goal of improving the lives of all older adults. From addressing staffing standards in long-term care facilities to recommending the reconsideration of using revised criteria for the diagnosis and staging of Alzheimer's disease to inform clinical care, each letter reflects our commitment to advocating for policies that support all of us as we age.

Comment Letter on Minimum Staffing Standards for Long-Term Care Facilities

In November 2023, AGS submitted comments to the Centers for Medicare and Medicaid Services (CMS) in response to its proposal to revise minimum staffing standards for long-term care facilities (AGS, 2023c). In our letter, we noted our appreciation for CMS' proposal to set minimum staffing standards, which we believe are an important, incremental first step to ensure safe, reliable, and quality nursing home care. Our letter offers comments and recommendations on several CMS proposals, including proposed minimum nursing staffing standards, hardship exemptions, RN onsite requirement, facility assessment requirements, and implementation deadlines.

Comment Letter on Ways and Means Committee Request Around Rural Health Care

In October 2023, AGS submitted recommendations in response to a request from the House Committee on Ways and Means on a legislative framework for improving access to health care in rural and underserved areas (Smith, 2023). In our letter (AGS, 2023b), AGS offered support and feedback as the Committee looks to identify solutions to reshape our nation's health care system and improve our nation's health for future generations. We asked the Committee to consider several potential solutions to increasing access to primary care clinicians, including geriatricians. These solutions include restoration of the primary care bonus payment that was included in the Affordable Care Act, opportunities for loan repayment and forgiveness for those entering geriatrics, support for legislation focused on enhancing the health care workforce, and other improvements, such as access to telehealth services and Medicare payment system reform.

Comments on the 2024 Medicare Physician Fee Schedule

In September 2023, AGS submitted extensive comments in response to the CMS Calendar Year 2024 proposed rule updating the Medicare Physician Fee Schedule (PFS) and Quality Payment P