Journal of gerontological nursing最新文献

Purpose: To explore care requirements of older adults with urinary incontinence (UI) and contributing factors.

Method: This cross-sectional study used the Older Adults Urinary Incontinence Care Needs Inventory to survey participants with UI in three large-scale tertiary hospitals located in Guangzhou City, China, from January 2023 to November 2023. Statistical analyses, including analysis of variance, t tests, correlation analyses, and linear regression models, were conducted to assess factors influencing participants' care needs.

Results: A total of 530 older adults with UI participated in the survey and mean standardized score for overall care needs was 78.65 (SD = 5.01), with mean scores for each dimension ranging from 70.88 (SD = 10.55) for social participation needs to 82.45 (SD = 7.11) for health education needs. Factors that were found to influence incontinence care needs in older adults included age, literacy level, number of leaks, and type of disease (F = 37.07, adjusted R² = 0.290, p < 0.001).

Conclusion: Comprehensive care for older adults with UI, encompassing physiological, psychological, and social aspects, is crucial. It is essential to tailor care to individual needs and characteristics, taking into account factors, such as age and education, to ensure effective care. [Journal of Gerontological Nursing, 50(5), 43-49.].

Introduction

Mrs. Frank was an 84-year-old nursing home resident who was diagnosed with dementia 2 years before entering the facility. She was active in the nursing home, participating in recreational therapy activities, and had a good rapport with staff. One morning the certified nursing assistant (CNA) noticed she had developed a cough, was sleeping more, and not eating as much. She also did not want to go to her usual exercise class. The CNA let the RN know that Mrs. Frank was not herself and that she was worried she might be developing delirium from an acute illness. The nursing home did not have a process in place for delirium assessment and 2 days later Mrs. Frank had a fall in the nursing home and was admitted to the hospital for pneumonia.

How age-friendly care can optimize delirium management for older adults, including those living with dementia, has been discussed previously (Fick & Shrestha, 2022; Kwak et al., 2024). We seek to expand on this important dialogue and discuss the empowerment of CNAs as nursing homes integrate age-friendly delirium care.

Age-Friendly Delirium Care

Age-Friendly Health Systems (AFHS; https://www.ihi.org/initiatives/age-friendly-health-systems) is a national initiative that aims to ensure all older adults in all care settings consistently receive equitable, person-centered, and evidence-based care. The four pillars of AFHS are What Matters, Medication, Mentation (dementia, depression, delirium), and Mobility, collectively known as the 4Ms Framework. Although most nursing homes are already addressing one or more of the 4Ms, the key to truly becoming age-friendly is the reliable application and integration of all 4Ms as a set during every encounter with every older adult in every setting.

CNAs are responsible for most direct patient care and spend the most time with residents among nursing home staff. CNAs are uniquely positioned to facilitate the implementation of the 4Ms to promote age-friendly delirium care for residents with and without dementia: “What Matters” or goals and preferences of older adults and care partners should be incorporated into all direct care activities, whereas “Mobility” should be encouraged during transferring. Engagement in meaningful activities to keep the mind active and mobility are protective factors for delirium, whereas malnutrition and medication are risk factors. Typical duties of CNAs include assisting residents with bathing, toileting, dressing, turning, repositioning, transferring (What Matters and Mobility); listening to and reporting health concerns of residents to nurses (What Matters); measuring and reporting vital signs (of which mental status should also be included [Fick, 2018]); and serv- ing meals and assistance with eating (What Matters, e.g., food preferences [U.S. Bureau of Labor Statistics, U.S. Department of Labor, 2023]). Regarding Medication, some states allow CNAs to have an expanded role to dispense medicat

Purpose: The current randomized controlled trial aimed to bolster the physical fitness of prefrail older adults, potentially delaying their need for admission to care facilities and enhancing their overall well-being.

Method: The experimental group received a physical fitness intervention comprising resistance band use and tai chi three times per week for 12 weeks, whereas the control group received frailty-related health education. Thirty-four male participants completed the study.

Results: A total of seven items had statistically significant differences at 12- and 16-week posttest, respectively: frailty index (p = 0.03; p = 0.03); Instrumental Activities of Daily Living Scale (p < 0.001; p < 0.001); and physical fitness, back (p < 0.001; p < 0.001); physical fitness, arm curl (p = 0.02; p < 0.001); physical activity (p < 0.001; p = 0.009); quality of life, physiological (p = 0.04; p < 0.001); and heart rate variability (p < 0.001; p < 0.001).

Conclusion: Results revealed substantial improvements in physical fitness, frailty conditions, self-care abilities, and quality of life, but not balance or lower limb flexibility, for the experimental group. Therefore, exercise interventions may effectively improve prefrail older adults' quality of life. [Journal of Gerontological Nursing, 50(5), 19-26.].

Introduction

One thing I have learned about revision is that sometimes I need to go back in order to move forward. Sometimes I need to return to those earlier versions—one, two, three—to find the spark that drove me to the page in the first place. What can I excavate from those earlier versions? What necessary fire can I restore to the present iteration?

As an editor, this quote speaks to me about writing and life, and recently came to my thoughts while attending a conference on resilience. It reminds me that our earlier lives and iterations of who we were and what we experience impact us as we age.

Are there individualized paths to resilience? What is common about resilience versus other concepts and what is unique? How do childhood risk factors, including victimization and trauma, impact aging? What about those individuals who show extreme resilience to early life adversity? How does that impact resilience as we age? How do we support resilience across the lifespan? How do we address diversity and equity in resilience? How do we integrate genetics into resilience and what is the clinical utility of current tools? Can caregiving be a positive factor for resilience?

These are just a few of the questions that were pondered at the recent Bench-to-Bedside Conference Series: Stress Tests and Biomarkers of Resilience held on March 3–5, 2024, supported by the National Institute on Aging and the American Geriatrics Society (AGS). I was honored to attend as part of my role as AGS President and as a National Institutes of Health–funded nurse scientist investigating delirium and delirium in persons with dementia. My own work in persons with delirium and dementia focuses on knowing the person to understand the disease and wellness and emphasizes looking for resilience and observing and documenting the strengths of older adults and persons with disabilities (Fick, 2022).

This was the second conference in a series of three led by resilience researchers across disciplines from pediatrics to geriatrics, psychology, genetics, sociology, epidemiology, neurology, nursing, and others. The first conference in 2022 explored commonalities and differences among the frameworks of resilience most commonly used in aging research in the three domains of resilience: physical, cognitive, and psychosocial. A meeting summary was published in the August issue of the Journal of the American Geriatrics Society (Abadir et al., 2023). Themes of the first conference included underlying contributors to resilience, the dynamic nature of resilience throughout the life span, and the role of resilience in health equity. Although participants did not agree on a single definition of “resilience(s),” they identified common and unique features of resilience to add to a definition. The first conference led to multiple recommendations, including new longitudinal studies of the impact of exposures to stres