Nursing older people最新文献

Urinary and faecal incontinence are more prevalent among older people but, like dementia, incontinence is not a normal or inevitable part of ageing. The number of people living with dementia who experience continence issues is likely to be underestimated because many people avoid reporting them as a result of embarrassment and stigma, or because they think incontinence is an inevitable symptom of dementia and that nothing can be done about it. Increased awareness and understanding of the relationship between dementia and incontinence is needed so that nurses can persuade people living with dementia and their family carers to discuss continence issues, assess their needs and provide support. There are several practical strategies that can reduce the incidence of incontinence, counter its negative effects and promote continence in people living with dementia.

Background: In the UK, people with delirium superimposed on dementia may be cared for by mental health nurses, however there is little in the literature about the experience of caring for people with the condition from the perspective of mental health nurses.

Aim: To illuminate the experiences of mental health nurses caring for people with delirium superimposed on dementia and to explore how mental health nurses 'know' the people they care for using 'aesthetic ways of knowing'.

Method: A mixed-methods design was used guided by the principles of activity theory. Participants were registered mental health nurses with experience of caring for people with delirium superimposed on dementia within a 24-hour care environment, including an NHS mental health foundation trust and care homes. Data were collected in two ways and at two different time points: first via semi-structured interviews (n=7), second via a questionnaire (n=25). Thematic analysis of the qualitative data was paired with simple descriptive statistics of the quantitative data to describe participants' experience.

Findings: This article discusses one finding from the larger study, which was undertaken as part of the author's PhD, in relation to the way in which mental health nurses 'know' the people they care for. Overall, participants showed a preference for aesthetic ways of knowing, rather than the use of formal assessment tools or scores. Participants experienced caring for people with delirium superimposed on dementia by valuing the person and concentrating on their behaviours, responses and personality, thus enabling them to anticipate and/or recognise potential triggers, precipitating factors and any changes in behaviours.

Conclusion: The ways in which mental health nurses know the people they care for influences their care delivery. Mental health nurses' use of aesthetic ways of knowing should be recognised and valued as a way of better understanding and supporting the person with delirium superimposed on dementia.

There is a growing evidence base to suggest that music therapy is an effective clinical intervention for people with dementia, having positive effects on mood, emotion, communication and memory, and reducing agitation, anxiety and apathy. However, the evidence to support this is predominantly from community settings such as residential care homes or people's own homes. This article captures the authors' experiences and reflections regarding their implementation of a music therapy intervention in a dementia inpatient unit. It explores some of the considerations and learning points gained from their experience, including the practicalities around engaging individuals and staff, the use of space, the timing of sessions, available resources and the potential benefits for patients, family members and the unit as a whole. The authors' experiences suggest that the benefits of music therapy appear to be transferable to the dementia inpatient setting.

Polypharmacy is a significant issue for many older people, including those with frailty, and it is associated with a range of adverse effects. Therefore, it is important to address polypharmacy by optimising patients' medicines use. Medication reviews are one of the main approaches to medicines optimisation, and various tools are available to support healthcare professionals with conducting these. Another approach is deprescribing, which can improve health outcomes for patients and may have financial benefits for healthcare organisations, but can also present various challenges. This article, the second of two parts, explores the benefits of medicines optimisation in the form of medication reviews and deprescribing for older people with frailty and polypharmacy.