Barriers to primary care: perceptions of older adults utilizing the ED for nonurgent visits.

This purpose of this mixed methods study was to understand access to primary care among older adults who present to an inner city emergency department (ED) for nonurgent care. Questionnaires (N = 62) included demographic, illness characteristics, and health care utilization. Qualitative interviews (N = 20) were conducted.

The impact of informal caregivers on depressive symptoms among older adults receiving formal home health care.

This study evaluated the association between presence and types of informal caregivers and the presence of depressive symptoms among older adults receiving formal home health care (HHC). A secondary analysis of data was conducted using a computerized patient care database, the Outcome and Assessment Information Set. Logistic regression analyses were used to examine the data of 8448 patients aged 65 years or older who had been admitted to an HHC agency from acute care hospitals between January 1, 2002 and June 30, 2002.

Living with cancer: perspectives on a five year journey.

This is a personal story of the lived experience of the authors, both nurses, who as partners face ovarian cancer. We describe the initial impact of such a diagnosis and its immediate life-changing consequences, treatment decisions and sequelae, remission and recurrence, and choices about living with a chronic illness and the ever-present specter of death. We recognize that our experience is uniquely ours, yet we believe it has meaning for all patients and caregivers, as well as the many health professionals who treat, care for, guide and comfort those who bear the burden of cancer.

Nurses' perspectives on feeding decisions for nursing home residents with advanced dementia.

Aim: To develop a broad understanding of nursing beliefs, knowledge and roles in feeding decisions for nursing home residents with advanced dementia.

Background: Concern is growing about the common use of feeding tubes in nursing home residents with advanced dementia. Nurses can play an important role in providing information and guiding family members through difficult feeding decisions.

The influence of nursing home culture on the use of feeding tubes.

Background: Nationwide, many nursing home (NH) residents with advanced cognitive impairment are tube fed, despite no demonstrable benefits of this intervention in this population. Studies suggest that organizational features of NHs are associated with this practice, but underlying reasons for these associations are poorly understood.

Methods: We conducted a focused ethnographic study of 2 NHs in South Carolina, 1 with a high tube-feeding rate (41.

A place called LIFE: exploring the advance care planning of African-American PACE enrollees.

The goals of this exploratory study were (a) to describe, among African-American PACE (Program of All-Inclusive Care for the Elderly) enrollees, verbalized preferences for end-of-life care as compared to preferences for care as documented in their medical record and (b) to explore the personal values that inform end-of-life decision making among these frail elders. Medical record review and semi-structured interviews generated descriptive and qualitative data for 18 African-American enrollees in a PACE program located in a large eastern city of the United States. Review of verbalized and documented preferences for end-of-life care among participants indicated that most preferred life-sustaining treatments.

Enhancing geriatric nursing competencies for RNs in nursing homes.

The purpose of this review was to determine the best method to deliver education that strengthens geriatric nursing competencies in RNs working in nursing homes to achieve excellent outcomes for a complex population. On the basis of the evidence reviewed, recommendations are made related to the kind of learning activities, structure of educational sessions, and instructor qualifications and consultation activities.

Symptoms of restless legs syndrome in older adults: outcomes on sleep quality, sleepiness, fatigue, depression, and quality of life.

Objectives: To compare differences in sleep quality, sleepiness, fatigue, depression, and quality of life according to severity of symptoms of restless legs syndrome (RLS) in older adults.

Design: Descriptive, comparative study; cross-sectional design.

Setting: Penn Sleep Center at the University of Pennsylvania and RLS support groups in Philadelphia.

Delirium in older patients in surgical intensive care units.

Purpose: To examine the frequency and course of delirium in older adults admitted to a surgical intensive care unit (SICU).

Design And Methods: Prospective, observational cohort study of 114 English-speaking participants and their surrogates, aged 65 and older, admitted to an SICU, and managed by a surgical critical care service. Chart reviews and surrogate interviews were conducted within 24 hours of SICU admission to collect information regarding evidence of dementia using the short form of the Informant Questionnaire on Cognitive Decline in the Elderly.

Advance directives at end-of-life: nursing home resident preferences for artificial nutrition.

Objective: Nursing homes are increasingly the place where many Americans die. Thus, advance directives are critical to the preservation of the autonomous wishes at end-of-life. The purpose of this paper is to determine if preferences for artificial nutrition, as stated in the advance directives of nursing home residents, are honored in the last 2 months of life.

Improving cognition and function through exercise intervention in Alzheimer's disease.

Purpose: To analyze the effects of cognition on function and to explore the potential of aerobic exercise for promoting cognitive and functional capacities.

Design: Integrative review of literature.

Methods: Studies were selected based on an extensive search of electronic databases and manual cross-referencing for 1980 to 2006, using the combination of key words: Alzheimer's disease (AD), dementia, or cognitive impairment with function or activities of daily living.

Psychometric properties of the Post-Fall Index.

Evaluation and prevention of falls begin with a thorough understanding of their occurrence. Post-fall assessment (PFA) tools should be available to sufficiently guide nursing staff in identification of all possible causes. Absence of empirically tested PFA tools led to the development of the Post-Fall Index (PFI).

A feasibility study of methodological issues and short-term outcomes in seriously injured older adults.

Background: For any given traumatic injury, older adults experience a longer hospitalization, more complications, and higher mortality than do younger patients.

Objectives: To prospectively identify problems in designing follow-up studies in seriously injured older adults without head injury and to examine outcomes after serious trauma in older adults who were sent to a level I trauma center.

Methods: A short-term descriptive follow-up design was used in which each patient served as his or her baseline.

The cancer pain experience of Israeli adults 65 years and older: the influence of pain interference, symptom severity, and knowledge and attitudes on pain and pain control.

Goals: Little is known about Israeli elders' cancer pain experience. The purpose of this study was to explore the cancer pain experience, including pain intensity, pain management index, pain interference, symptom severity, and knowledge and attitudes toward pain and pain control.

Patients And Methods: Descriptive cross-sectional methods were used to obtain data with four instruments.

Current approaches to postfall assessment in nursing homes.

Objective: Falls in nursing homes occur among a large percentage of residents. Their onset necessitates a postfall assessment (PFA) be performed by clinical staff to determine likely etiology. The absence of an empirically validated comprehensive postfall assessment tool has led to considerable variability in the types of PFAs performed.

Organizational characteristics and restraint use for hospitalized nursing home residents.

Objectives: To examine the effect of organizational characteristics on physical restraint use for hospitalized nursing home residents.

Design: Secondary analysis of data obtained between 1994 to 1997 in a prospective phase lag design experiment using an advanced practice nurse (APN) intervention aimed at reducing physical restraint for a group of hospitalized nursing home residents.

Setting: Eleven medical and surgical units in one 600-bed teaching hospital.

A psychometric evaluation of the Cornell Scale for Depression in Dementia in a frail, nursing home population.

Objective: The authors conducted a psychometric evaluation of the Cornell Scale for Depression in Dementia (CSDD) through factor analysis and assessment of criterion validity in an older, frail nursing home population, with a secondary analysis of pre-intervention data from a longitudinal clinical trial aimed at reducing restraints in nursing homes.

Methods: The sample for the present study was 642 nursing home residents (mean [SD] age 84.3 [7.

Advance care planning and end-of-life care for hospitalized nursing home residents.

Objectives: To describe advance care planning (ACP) and end-of-life care for nursing home residents who are hospitalized in the last 6 weeks of life.

Design: Constant comparative analysis of deceased nursing home resident cases.

Setting: A not-for-profit Jewish nursing home.

Mental health correlates of aggression in nursing home residents with dementia.

Purpose: Aggression continues to challenge caregivers of persons with dementia, and identification of foci for effective interventions is needed. The purpose of this study was to examine the influence of (a) the resident characteristics of depression, communication, and cognition and (b) behavior management strategies on aggression in a group of older nursing home residents (N = 405) with evidence of dementia.

Design And Methods: This cross-sectional correlational study examined the association of resident characteristics and behavior management strategies with bivariate aggression, physical aggression, and verbal aggression, using hierarchical regression.