Association of Loneliness With Change in Physical and Emotional Health of Older Adults During the COVID-19 Shutdown.

Objectives: To examine factors influencing loneliness and the effect of loneliness on physical and emotional health, in the context of the COVID-19 pandemic.

Design: Prospective, observational cohort.

Setting: Community-dwelling participants.

Clinicians' Perceptions of a Modified Hospital Elder Life Program for Delirium Prevention During COVID-19.

The Hospital Elder Life Program (HELP) is a multicomponent delirium prevention program targeting delirium risk factors of cognitive impairment, vision and hearing impairment, malnutrition and dehydration, immobility, sleep deprivation, and medications. We created a modified and extended version of the program, HELP-ME, deployable under COVID-19 conditions, for example, patient isolation and restricted staff and volunteer roles. We explored perceptions of interdisciplinary clinicians who implemented HELP-ME to inform its development and testing.

Categorizing national caregiver recommendations to support family caregivers and address unmet needs.

Background: Recognizing family caregivers as vital providers of long-term assistance to loved ones with chronic illness, several national organizations developed recommendations to improve support for family caregivers.

Purpose: This article categorizes these recommendations to advance family-centered nursing practice, develop health policies, and advocate for family caregiver support.

Methods: Six reports of caregiver recommendations published in the United States from 2016 to 2021 were analyzed using thematic analysis.

Identifying Delirium in Persons With Moderate or Severe Dementia: Review of Challenges and an Illustrative Approach.

Delirium and dementia are common causes of cognitive impairment among older adults, which often coexist. Delirium is associated with poor clinical outcomes, and is more frequent and more severe in patients with dementia. Identifying delirium in the presence of dementia, also described as delirium superimposed on dementia (DSD), is particularly challenging, as symptoms of delirium such as inattention, cognitive dysfunction, and altered level of consciousness, are also features of dementia.

Psychometric Properties of a Delirium Severity Score for Older Adults and Association With Hospital and Posthospital Outcomes.

Importance: The ability to rate delirium severity is key to providing optimal care for older adults, and such ratings would allow clinicians to target patients with severe delirium and monitor response to treatment, recovery time, and prognosis; assess nursing burden and staffing needs; and, ultimately, provide more appropriate patient-centered care. Current delirium severity measures have been limited in their content, gradations, and measurement characteristics.

Objective: To examine the internal consistency, reliability, and validity for clinical outcomes of the DEL-S delirium severity score, a measure of delirium severity that was developed using advanced psychometric approaches, analogous to those of the Patient-Reported Outcomes Measurement Information System initiative.

Predictors of Caregiver Burden in Delirium: Patient and Caregiver Factors.

The current study examined the association of patient factors, patient/caregiver relationships, and living arrangements with caregiver burden due to delirium. The sample included a subset ( = 207) of hospitalized medical and surgical patients (aged >70 years) enrolled in the Better Assessment of Illness Study and their care-givers. The majority of caregivers were female (57%) and married (43%), and 47% reported living with the patient.

Development and internal validation of a predictive model of cognitive decline 36 months following elective surgery.

Introduction: Our goal was to determine if features of surgical patients, easily obtained from the medical chart or brief interview, could be used to predict those likely to experience more rapid cognitive decline following surgery.

Methods: We analyzed data from an observational study of 560 older adults (≥70 years) without dementia undergoing major elective non-cardiac surgery. Cognitive decline was measured using change in a global composite over 2 to 36 months following surgery.

A Call to the CMS: Mandate Adequate Professional Nurse Staffing in Nursing Homes.

Editor's note: This article is by 22 nursing gerontology experts who are all advocates of nursing home reform. They are listed at the end of this article.

Detecting Delirium: A Systematic Review of Identification Instruments for Non-ICU Settings.

Background/objectives: Delirium manifests clinically in varying ways across settings. More than 40 instruments currently exist for characterizing the different manifestations of delirium. We evaluated all delirium identification instruments according to their psychometric properties and frequency of citation in published research.

Machine Learning to Develop and Internally Validate a Predictive Model for Post-operative Delirium in a Prospective, Observational Clinical Cohort Study of Older Surgical Patients.

Background: Our objective was to assess the performance of machine learning methods to predict post-operative delirium using a prospective clinical cohort.

Methods: We analyzed data from an observational cohort study of 560 older adults (≥ 70 years) without dementia undergoing major elective non-cardiac surgery. Post-operative delirium was determined by the Confusion Assessment Method supplemented by a medical chart review (N = 134, 24%).

New Delirium Severity Indicators: Generation and Internal Validation in the Better Assessment of Illness (BASIL) Study.

Background: Delirium is a common and preventable geriatric syndrome. Moving beyond the binary classification of delirium present/absent, delirium severity represents a potentially important outcome for evaluating preventive and treatment interventions and tracking the course of patients. Although several delirium severity assessment tools currently exist, most have been developed in the absence of advanced measurement methodology and have not been evaluated with rigorous validation studies.

The Caregiver Burden of Delirium in Older Adults With Alzheimer Disease and Related Disorders.

Objectives: To measure the burden of delirium in older adults with or without Alzheimer disease or related disorders (ADRDs).

Design: Prospective, observational cohort.

Setting: Inpatient hospital and study participants' homes.

Perspectives on the Delirium Experience and Its Burden: Common Themes Among Older Patients, Their Family Caregivers, and Nurses.

Background And Objectives: While there are qualitative studies examining the delirium-related experiences of patients, family caregivers, and nurses separately, little is known about common aspects of delirium burden among all three groups. We describe common delirium burdens from the perspectives of patients, family caregivers, and nurses.

Research Design And Methods: We conducted semistructured qualitative interviews about delirium burden with 18 patients who had recently experienced a delirium episode, with 16 family caregivers, and with 15 nurses who routinely cared for patients with delirium.

Assessment of Instruments for Measurement of Delirium Severity: A Systematic Review.

Importance: Measurement of delirium severity has been recognized as highly important for tracking prognosis, monitoring response to treatment, and estimating burden of care for patients both during and after hospitalization. Rather than simply rating delirium as present or absent, the ability to quantify its severity would enable development and monitoring of more effective treatment approaches for the condition.

Objectives: To present a comprehensive review of delirium severity instruments, conduct a methodologic quality rating of the original validation study of the most commonly used instruments, and select a group of top-rated instruments.

Diversifying the Pipeline Into Doctoral Nursing Programs: Developing the Doctoral Advancement Readiness Self-Assessment.

This article presents the development and psychometric analysis of the Doctoral Readiness Self-Assessment for Doctoral Study. This survey was developed as the first step of a Web-based, on-line mentoring platform for nurses who are considering a doctoral degree program. By identifying and anticipating the predictors and barriers of success in doctoral nursing education, including practical (finances, time, geographical restriction) and personal factors (motivation, attitudes, perceived ability to navigate the application process), students are guided through a self-reflective process to determine readiness.

Setting the Stage for Success: Mentoring and Leadership Development.

The New Careers in Nursing (NCIN) Program funded by The Robert Wood Johnson Foundation has expanded enrollment in schools of nursing with accelerated nursing programs and increased diversity in the nursing workforce. As the demand for highly educated and skilled nurses continues to grow, accelerated nursing programs are thriving and increasing in number. The growing cadre of nontraditional nursing students has challenged nursing faculty to institute innovative teaching methods to develop accelerated students' leadership skills and to provide mentoring resources for newly licensed nurses to guide the successful and complex transition from the student to professional practice.

Effect of Delirium and Other Major Complications on Outcomes After Elective Surgery in Older Adults.

Importance: Major postoperative complications and delirium contribute independently to adverse outcomes and high resource use in patients who undergo major surgery; however, their interrelationship is not well examined.

Objective: To evaluate the association of major postoperative complications and delirium, alone and combined, with adverse outcomes after surgery.

Design, Setting, And Participants: Prospective cohort study in 2 large academic medical centers of 566 patients who were 70 years or older without recognized dementia or a history of delirium and underwent elective major orthopedic, vascular, or abdominal surgical procedures with a minimum 3-day hospitalization between June 18, 2010, and August 8, 2013.

EFFECT OF PREOPERATIVE PAIN AND DEPRESSIVE SYMPTOMS ON THE DEVELOPMENT OF POSTOPERATIVE DELIRIUM.

Background: Preoperative pain and depression predispose patients to delirium. Our goal was to determine whether pain and depressive symptoms interact to increase delirium risk.

Methods: We enrolled 459 persons without dementia aged ≥70 years scheduled for elective orthopedic surgery.

NICE to HELP: operationalizing National Institute for Health and Clinical Excellence guidelines to improve clinical practice.

The National Institute for Health and Clinical Excellence (NICE) in the United Kingdom developed guidelines for the diagnosis, prevention, and management of delirium in July 2010 that included 10 recommendations for delirium prevention. The Hospital Elder Life Program (HELP) is a targeted multicomponent strategy that has proven effective and cost-effective at preventing functional and cognitive decline in hospitalized older persons. HELP provided much of the basis for seven of the NICE recommendations.

Global aging: implications for women and women's health.

The world's older population has been growing for centuries; however, the pace of this growth is accelerating rapidly. According to the U.S.

Screening for dementia in "real world" settings: the cognitive assessment screening test: CAST.

Among elderly people who do not present with complaints of memory impairment, dementia is often missed by physicians, and time-consuming screening tests requiring expertise to administer and interpret are rarely done. Easily administered, reliable and cost effective dementia screening tests are needed for elderly individuals. The "pencil and paper" Cognitive Assessment Screening Test (CAST) takes minimal examiner time/training, and is both sensitive and specific in discriminating demented patients from healthy controls.