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Online Advanced Release
Articles appearing in this "Online Advanced Release" section have been peer-reviewed and accepted for publication in the Journal of Gerontological Nursing and posted online before print publication. Articles appear on this site after copyediting and author corrections, but before final proofing. The content of the article will usually remain unchanged, and possible further corrections are fairly minor. The final published article will specify the issue and page numbers. Once the final version is available in print, the version posted here will be removed from this site.
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Table of Contents
Advocacy: It Is Time to Be the Change
Ann L. McCracken, PhD, RNPosted: February 22, 2010
Nursing is well positioned to be a major force in informing and influencing health policy. Gerontological nurses, as essential stakeholders in health care policy, must be sensitive to policy windows, seek out resources, design systematic approaches, and take action that will shape more effective and efficient care for the older people they serve.
doi:10.3928/00989134-20100202-05 [get full text]
Prospects for Introducing the Eden Alternative to Japan
Shizuka Otsuka, MSN, RN; Akiko Hamahata, PhD, RN; Misa Komatsu, PhD, RN; Chizuko Suishu, MAED, RN; Keiko Osuka, PhD, PHN, RNReceived: April 24, 2009; Accepted: October 29, 2009; Posted: February 22, 2010
To date, no elder care facilities in Japan have formally introduced the Eden Alternative® philosophy of care. The purpose of this cross-sectional descriptive study was to identify the perceptions of care workers and nurses regarding the lives of older adults in care facilities to consider the prospects for introducing the Eden Alternative to Japan. The participants included 139 care workers and 41 nurses who responded to a survey questionnaire based on Eden Alternative principles developed by the researchers for this study. More than half of the participants indicated that they sometimes thought the older adults experienced feelings of helplessness, loneliness, and boredom and hoped for changes in the manner of care to improve the lives of residents. Participants were also in favor of the residents having plants and visits from children, but opinions about having animals on site were split. The fact that the survey respondents noticed the problems indicated by the Eden Alternative suggests there is great potential for introducing the Eden Alternative to Japan.
doi:10.3928/00989134-20100202-03 [get full text]
Factors Influencing Life Satisfaction of Korean Older Adults Living with Family
Sohyune R. Sok, PhD, RNReceived: April 7, 2009; Accepted: October 29, 2009; Posted: February 22, 2010
The purpose of this study was to identify the factors influencing life satisfaction of Korean older adults living with family. Participants included 267 adults age 65 and older who met eligibility criteria. Analyses showed that the prediction model of the life satisfaction of older adults who are living with their family was significant (F = 24.429, p < 0.001). The value of the adjusted R2 was 0.306, which corresponds to the explanatory power of 30.6%. The factor found to have the greatest influence on these adults’ life satisfaction was depression (β = 0.329), followed by perceived health status (&beta = 0.206), self-esteem (&beta = 0.090), monthly pocket money (&beta = 0.060), and age (&beta = 0.040). It is possible that older adults’ life satisfaction increases when they are provided with nursing interventions and are able to effectively manage their health. Nursing interventions must strive to improve their self-esteem and address their depression.
doi:10.3928/00989134-20100202-01 [get full text]
The 2009 Doris Schwartz Gerontological Nursing Research Award: Mathy Mezey, EdD, RN, FAAN
Helen W. Lach, PhD, RN, GCNS-BCPosted: February 22, 2010
Dr. Mathy Mezey’s contributions to the field of gerontological nursing were celebrated in November at the Gerontological Society of America’s Nursing Care of Older Adults Interest Group meeting where she received the 2009 Doris Schwartz Gerontological Nursing Research Award. Dr. Mezey talked about her mentors, experiences, and care of older adults in the presentation “50 Years: Older Adults and Geriatric Nursing.” In a large room full of enthusiastic geriatric nurses, many of whom she has mentored, Dr. Mezey provided insight into how geriatric nursing and this group developed. The following are some highlights of her career and encouragement for future geriatric nurses.
doi:10.3928/00989134-20100202-07 [get full text]
Lessons from Nursing Home Dysphagia Malpractice Litigation
Dennis C. Tanner, PhDReceived: May 25, 2009; Accepted: October 29, 2009; Posted: February 22, 2010
The purpose of this article is to review the management of swallowing disorders in nursing home patients. The goal is to provide readers with five areas of contentious dysphagia management issues that have surfaced in several malpractice litigation cases. A detailed examination of what went wrong in the management of these patients’ dysphagia from the perspective of the plaintiffs’ dysphagia expert witness, as well as a discussion of what nursing home staff could have done to prevent these tragedies, is presented.
doi:10.3928/00989134-20100202-06 [get full text]
Regulatory Components for Treating Persistent Pain in Long-Term Care
Jonathan Planton, PharmD, BS; Barbara J. Edlund, PhD, RN, ANP, BCReceived: June 16, 2009; Accepted: December 9, 2009; Posted: February 22, 2010
Persistent or chronic pain is frequently reported by older adults and has the potential to dramatically influence quality of life. Estimates indicate that 25% to 50% of community-dwelling older adults experience this kind of pain. This rate is even higher in long-term care facilities, where 50% to 75% of residents have chronic pain syndromes that are untreated or undertreated. To promote optimal pain management and enumerate the responsibilities of skilled nursing facilities to effectively treat and prevent pain, the Centers for Medicare & Medicaid Services released a new pain management surveyor guidance, F-Tag 309, which endorses the presence of an interdisciplinary team approach to pain management that involves the resident. The guidance delineates pain management principles, the need for ongoing professional education in all components of pain management, and emphasizes the important role of appropriate pharmacological treatment in conjunction with nonpharmacological interventions to aggressively manage pain. This directive will help skilled nursing facilities achieve optimal pain management for their residents.
doi:10.3928/00989134-20100202-02 [get full text]
Older Adults with Bipolar Disorder: Guidelines for Primary Care Providers
Tracey Sherrod, MSN, RN, ANP-C, GNP-BC; Ann Quinlan-Colwell, MS, RNC, AHN-BC, FAAPM; Theresa B. Lattimore, MSN, NP-C; Mona M. Shattell, PhD, RN; Laurie Kennedy-Malone, PhD, GNP-BCReceived: May 12, 2009; Accepted: September 23, 2009; Posted: February 22, 2010
The purpose of this article is to present evidence-based guidelines to facilitate early diagnosis and appropriate treatment of older adults with symptoms of bipolar disorder. Assessment criteria, diagnostic tools, and interventions to optimize care of older adults with bipolar disorder—with a focus on implications for primary care providers—are described.
doi:10.3928/00989134-20100108-05 [get full text]
Clinical Implications of Treating Depressed Older Adults with SSRIs: Possible Risk of Hyponatremia
Judith M. Smith, MSN, RN, GCNS-BCReceived: May 4, 2009; Accepted: September 3, 2009; Posted: February 22, 2010
Depression is a serious mental health problem in older adults. Some of the symptoms of depression include depressed mood, significant change in weight or appetite, changes in sleep patterns, a decrease in concentration and energy, and possible suicide. However, depression is a treatable illness, especially with the newer class of antidepressant agents, the selective serotonin reuptake inhibitors (SSRIs). One side effect of SSRI use includes hyponatremia, which is becoming an increasingly serious complication that may have harmful clinical ramifications. Older adults are especially at risk for hyponatremia and could experience serious consequences if left untreated. The purpose of this article is to use an individual example to demonstrate the clinical importance of detecting hyponatremia in older adults receiving SSRI treatment.
doi:10.3928/00989134-20100202-04 [get full text]
Keela Herr, PhD, RN, FAAN, AGSF; Heide Bursch, MS, RN; Mary Ersek, PhD, RN, FAAN; Lois L. Miller, PhD, RN, FGSA, FAAN; Kristen Swafford, MS, RN, CNSReceived: April 7, 2009; Accepted: October 5, 2009; Posted: January 22, 2010
Many tools are available for the assessment of pain in nonverbal older adults; however, guidelines are needed to help clinicians select the proper instrument for use in the nursing home setting. This article describes a project to identify clinically useful pain-behavioral assessment tools that have undergone sufficient psychometric testing. Phase 1 of the project included a comprehensive review and critique of currently available tools. In Phase 2, the National Nursing Home Pain Collaborative developed criteria to evaluate an updated list of tools and then rated 14 tools using these criteria. As a result, two tools were recommended as most representative of current state of the science, most clinically relevant, and practically applicable to integrate into everyday practice and support adherence to regulatory guidelines. Such recommendations for selection of best-available pain assessment tools are a cornerstone for clinicians in regard to managing pain of nursing home residents who, due to dementia, are unable to self-report pain.
doi:10.3928/00989134-20100108-04 [get full text]
Prevention and Clinical Outcomes in Older Inpatients with Suspected Venous Thromboembolism
Jung-Ah Lee, PhD, RN; Brenda K. Zierler, PhD, RNReceived: May 26, 2009; Accepted: September 16, 2009; Posted: January 22, 2010
Venous thromboembolism (VTE) is one of the most common preventable disorders among hospital inpatients. Advancing age is a major risk factor for VTE. The purpose of this study was to describe and compare prevention practices and clinical outcomes in older (age 65 and older) versus younger (ages 18 to 64) hospitalized patients at risk for or diagnosed with VTE. Medical charts of 210 older and 450 younger inpatients undergoing diagnostic tests to rule out VTE were reviewed at an academic medical center. Acute VTE was diagnosed in 17.1% of older and 22.7% of younger inpatients. Pharmacological prophylaxis was used in 70% of eligible older and 57% of eligible younger inpatients. Nearly one quarter of eligible older inpatients did not receive any VTE prevention measures. The 3-month mortality was higher in older inpatients (13.9%) compared with younger inpatients (9.8%) with VTE, despite the lower rate of VTE in older inpatients. Prevention measures for VTE were underused in both older and younger inpatients.
doi:10.3928/00989134-20100108-06 [get full text]
Understanding Physical Health of Older Adults with Schizophrenia: Building and Eroding Trust
Heather C. Leutwyler, PhD, FNP, CNS; Margaret I. Wallhagen, PhD, GNP-BC, AGSF, FAANReceived: May 11, 2009; Accepted: August 4, 2009; Posted: November 23, 2009
Adults with schizophrenia are living longer, and data suggest they face health care disparities contributing to poor physical health. This article presents findings from a study that explored the understanding of physical health among older adults with schizophrenia. One goal was to understand factors that influence experienced health care disparities. This grounded theory study used semi-structured interviews and participant observation and was conducted among 28 older adults with schizophrenia living in a variety of settings. Trust evolved as a dynamic process that was built with factors of respect, caring, advocacy, and consistency and eroded through factors of disrespect, not being heard, lack of time and provider inaction, and stigmatization. When trust is given and received between providers, the health care system, and the older adult with schizophrenia, the adult’s physical health outcomes may improve and health care disparities may decline. These findings provide insights to promote optimal physical health outcomes.
doi:10.3928/00989134-20091103-99 [get full text]
Health Practices of Older Adults in Good Health: Engagement Is the Key
Karen A. Van Leuven, PhD, FNPReceived: September 4, 2008; Accepted: August 26, 2009; Posted: November 23, 2009
Using an interpretive, descriptive method, this study investigated the beliefs, values, lifestyles, and health status of adults age 75 and older who identified themselves as healthy, as well as the interactions with and observations of health care personnel who work with them. Staff participants were drawn from medical offices, a skilled nursing facility, and an assisted living site. Older adults who self-identified themselves as healthy (n = 14), as well as those who self-identified themselves as being in fair or poor health but were included per staff recommendation (n = 4), were recruited from the sites in which these staff worked. They were interviewed about health, health promotion, health care, and lifestyle. Social engagement appeared to be a strong mediating factor against chronic illness.
doi:10.3928/00989134-20091110-99 [get full text]
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