Geriatric Nursing最新文献

Aim: Ecchymosis occurs when blood leaks into subcutaneous tissue or capillaries rupture. In older patients, adequate pressure after venipuncture may prevent it, but the optimal duration is unclear. This study evaluated the effect of applying 20 N of direct pressure for 1, 3, or 5 minutes after blood collection on ecchymosis at 24, 48, and 72 hours in older patients using oral or subcutaneous anticoagulants.

Methods: The study used a parallel-group, prospective, single-blind randomized controlled design. The study sample consisted of 164 patients hospitalized at the geriatric clinic of a city hospital. Ecchymosis development was assessed by making and recording observations at 24, 48 and 72 h after routine blood sampling. Opsite Flexigrid was used to measure the size of the ecchymosis.

Results: The mean age of the patients was 76.26±8.01 years, 50 % were women, and 56.1 % used subcutaneous anticoagulants. A statistically significant difference was found between the groups in terms of the frequency and size of ecchymoses at 24, 48, and 72 h after blood collection (24th hour: χ²=30.792, p < 0.001; 48th hour: χ²=28.698, p = 0.001; 72nd hour: χ²=26.429, p = 0.002). The incidence of ecchymoses ≥1 cm² in the control group was 14 % at all time points, and this rate was significantly higher than in all other groups (p < 0.05).

Conclusion: In geriatric patients receiving oral or subcutaneous anticoagulants but without coagulopathy, applying pressure to the venipuncture site for 5 min after blood collection reduced the development of ecchymosis.

Osteoporosis (OPR) screening has declined in the United States, highlighting the need for improved practices. This QI Study addresses the undertreatment of OPR in primary care. çwas used to collect data related to fractures and osteoporosis. Thirty-nine volunteers were evaluated for osteoporosis and fracture risk using chi-square and t-tests against a comparison control group. The analysis revealed statistically significant differences (p<0.001) in the provider ordering of DEXA scans, diagnosis of osteoporosis, and vitamin supplementation compared to the control group. These findings suggest that implementing the FRAX tool as a standard screening practice can enhance osteoporosis treatment.

Objective: To investigate individual and joint associations of unhealthful Plant-based Diet Index (uPDI) and social isolation with multi-trajectories of frailty in surviving Chinese older adults over a 10-year follow-up.

Methods: We analyzed data of 2,440 surviving older adults from 2008 to 2018 in the Chinese Longitudinal Healthy Longevity Survey. Group-Based Multi-Trajectory Modeling (GBMTM) and Logistic regression analyses were conducted to analyses data.

Results: The GBMTM identified four distinct frailty trajectories: "No Frailty STable Group," "Mild Frailty Group," "Incident IADL-Dominant Deterioration Group," and "Global Frailty Deterioration Group." The analysis revealed that both higher uPDI and social isolation quartiles were associated with the higher risk of adverse frailty trajectories. Notably, the combined higher quartiles of uPDI and social isolation further increasing the risk.

Conclusion: uPDI and social isolation were both individually and jointly associated with multi-trajectories of frailty in surviving Chinese older adults over a 10-year follow-up.

We aimed to determine the effects of baseline (T0) satisfaction with work and leisure time activities on the onset of depressive symptoms at follow-up (T1). In this prospective study in Japan, we included 1841 older adults aged ≥ 60 years. Participants were categorized into both dissatisfied, work dissatisfied, leisure time dissatisfied, and both satisfied groups based on baseline assessement (T0). Compared with the both satisfied group, the leisure time dissatisfied, work dissatisfied, and both dissatisfied groups had higher odds ratios for the onset of depressive symptoms at follow-up (T1). In the subgroup analysis, the both dissatisfied group showed associations with depressive symptoms, regardless of sex. The work dissatisfied and leisure time dissatisfied groups showed associations with the onset of depressive symptoms in only men and women, respectively. The risk for the onset of depressive symptoms was the highest when dissatisfaction with work and leisure time activities coexisted.

Purpose: This study aimed to explore the professional quality of life among nursing assistants and identify latent profiling, and examine their relationships with perceived organizational support and self-efficacy.

Design: A cross - sectional survey study was conducted.

Methods: Nursing assistants from two hospitals in Shenzhen, China, were recruited through convenience sampling. Demographic characteristics, perceived organizational support, self-efficacy, and professional quality of life were measured using validated scales. Latent profile analysis (LPA) identified subgroups of professional quality of life, and logistic regression examined the associations of demographic factors, organizational support, and self-efficacy with profile membership.

Results: A total of 354 nursing assistants were included in this study. The professional quality of life was classified into three profiles: "adaptive group", "stress group", and "high burden group" comprising 216, 102, and 36 nursing assistants, respectively. Statistical differences were observed among the three groups in terms of demographic characteristics such as gender, ethnicity, certification, and professional title (P < 0.05). Additionally, instrumental support, emotional support, and self - efficacy differed significantly among the groups (P < 0.05). Gender (female), licensure, professional title (primary and mid - level), emotional support, and self - efficacy were predictors of nursing assistants' professional quality of life.

Conclusion: These findings may facilitate the identification of different profiles of nursing assistants for targeted training programs aimed at improving their professional quality of life. Furthermore, intervention strategies emphasizing emotional support, and self - efficacy may offer valuable approaches for enhancing professional quality of life.

We aimed to assess whether childhood hunger experiences are associated with adverse health outcomes in old age. A cross-sectional study was conducted using data from the second wave of the ELSI-Brazil (2019-2021). Childhood hunger was assessed by the following question: "From birth until you were 15 years old, have you ever had a lack of food in your home and ended up going to bed feeling hungry?". Outcomes were obesity, multimorbidity, limitation in basic activities of daily living (BADLs), frailty, cognitive impairment, and depressive symptoms. Logistic regression was used in data analysis. The prevalence of childhood hunger experiences was 23.6%. After adjustments, having experienced hunger in childhood was significantly associated with higher odds of multimorbidity (OR=1.17; 95%CI=1.01-1.35), limitation in BADLs (OR=1.39; 95%CI=1.03-1.87), frailty (OR=1.35; 95%CI=1.03-1.77), and depressive symptoms (OR=1.42; 95%CI=1.15-1.76). These findings suggest the necessity for public policies to ensure adequate childhood nutrition to promote healthy aging in future generations.

Strategies to ensure appropriate prescribing of antipsychotics in behavioral and psychological symptoms of dementia (BPSD) are limited in the primary care setting. In a metropolitan primary care setting, antipsychotic medications were found to be inappropriately prescribed in 45 % of patients with BPSD as defined by American Psychiatric Association (APA) clinical guidelines. A quality improvement project (QIP) was implemented to educate providers on appropriate prescribing for BPSD using the Neuropsychiatric Inventory Questionnaire (NPI-Q) tool. Outcome measures were to reduce inappropriate prescribing from 45 % to 30 % and reduce adverse events from 9 % to 4 %. At the completion of the project, results exceeded the goal with a reduction of inappropriate prescribing to 19 % and, achieved a 3 % reduction of adverse events. This project demonstrates the benefit of using the NPI-Q tool as a guideline for other primary care providers to safely establish prescribing practices for patients with BPSD.

Background: Osteosarcopenia is a geriatric syndrome characterized by the coexistence of sarcopenia and osteopenia/osteoporosis, which can lead to frailty and mortality. The effectiveness of physical exercise on osteosarcopenia, particularly on muscular and skeletal parameters, remains unclear. This systematic review aimed to analyze the impact of exercise interventions on osteosarcopenia in older adults and to describe the diagnostic methods used in different clinical trials.

Methods: Randomized clinical trials conducted in older adults (≥65 years) diagnosed with osteosarcopenia were included, sourced from PubMed, Embase, Cochrane, and Scopus databases without language or publication year restrictions, up to July 2024. Osteosarcopenia was defined as the coexistence of sarcopenia and osteopenia/osteoporosis based on dual-energy X-ray absorptiometry (DXA) criteria. Exercise interventions of at least four weeks were considered, with comparisons to non-exercise control groups. This systematic review followed the PRISMA guidelines and was registered in PROSPERO (CRD42016043310).

Results: A total of 250 articles were identified, but only four studies met the eligibility criteria, involving 195 participants. All included studies utilized resistance training (RT) as the exercise intervention. The most common diagnostic criteria for osteosarcopenia were based on the T-score of the lumbar spine and/or femur, measured via DXA, using World Health Organization cut-off points for bone mineral density (BMD) and the criteria from the European Working Group on Sarcopenia in Older People for sarcopenia. RT was found to be effective in increasing strength and muscle mass in older adults diagnosed with osteosarcopenia, though it did not significantly improve physical performance.

Conclusion: There are few studies on this topic, making it difficult to draw definitive conclusions regarding the effectiveness of physical exercise in older adults with osteosarcopenia. Resistance training showed positive results, particularly in improving strength and muscle mass. PROSPERO REGISTRATION NUMBER: https://www.crd.york.ac.uk/PROSPERO/view/CRD42020215659.

Aims: The aims of this study were to investigate if chronic pain presence is significantly increased in older adults with heart failure (HF) compared to those without HF, and if a combination of pain and HF reduced quality of life and physical function.

Methods: Retrospective cross-sectional survey and medical record data from 41,395 participants age ≥65 in the All of Us Research Program were analyzed using linear and logistic regression.

Results: Participants with HF had a higher prevalence of chronic pain than those without HF but was not statistically significant. Having pain only, HF only, and both pain and HF were associated with reduced quality of life and physical function when compared to having no HF or pain. However, these associations were the strongest in those with both chronic pain and HF.

Conclusions: A combination of HF and chronic pain markedly worsened outcomes, underscoring the need for improved pain management.