Formal Caregiver Burden in Nursing Homes: A Concept Analysis.

Caregiver burden is a phrase often used interchangeably with the concepts of stress, strain, and burnout. Distinct differences may be relevant in formal caregiver burden; however, previous concept analyses have not addressed formal caregiver burden in nursing homes, which would be useful as a foundation for theory development and empirical testing. In the current study, based on Walker and Avant's concept analysis guidelines, articles were reviewed to identify the attributes, antecedents, and consequences of formal caregiver burden. Formal caregiver burden was defined as the demands of caring for dependent older adults with a level of competency and responsibility within the context of perceived stress. Antecedents were associated with the organization and environment, such as regulatory restraints, whereas consequences were associated with changes in physical and mental health status. The conceptualization of formal caregiver burden may lead to the development of psychometric instruments and interventions for the well-being of direct care staff in multiple care settings for older adults. [Journal of Gerontological Nursing, 46(9), 19-24.].

Factors Associated With Potentially Inappropriate Medication Use in Rural, Community-Dwelling Older Adults.

Potentially inappropriate medication (PIM) use is a serious public health problem in older adults because it may lead to adverse events. The purpose of the current study was to explore PIM use in rural, community-dwelling older adults. Participants (N = 138) underwent one-on-one medication reviews. Approximately one half (49%) of the sample used prescribed and over-the-counter (OTC) PIM. Prescribed and OTC nonsteroidal anti-inflammatory drugs (33%) and anticholinergic medications (28%) were the most frequently used PIM. Use of PIM was associated with a higher number of medications (r = 0.331, p < 0.01), more medical providers (r = 0.223, p < 0.001), and poor physical health (r = -0.193, p < 0.05). Higher number of medications increased the probability of PIM use by 85% (odds ratio: 1.8; 95% confidence interval [1.19, 2.84]). Findings highlight the importance of re-evaluating the monitoring of medications in rural, community-dwelling older adults and the need for sustainable interventions to reduce prescribing and OTC PIM use. [Journal of Gerontological Nursing, 43(9), 21-30.].

Adverse drug events reported by rural older adults.

Adverse drug events (ADEs) impact the health and safety of older adults. ADEs may lead to unplanned medical visits that influence health and related costs. The purpose of this study was to explore ADEs reported by rural, community-dwelling older adults. Data were collected on 138 participants' demographics, physical and mental health, sleep, medications, and ADEs. One or more ADEs were reported by 48% of participants, including central nervous symptom disturbances (16%), dry mouth (12%), hoarseness, gastrointestinal irritation, and decreased libido (all 8%). Poor sleep and poor physical health were associated with higher reported ADEs (p < 0.05). Older adults (ages 79-99) and those with higher physical health were 60% less likely to report ADEs. Those with poorer sleep quality were 50% more likely to report ADEs. Viable strategies are needed to monitor and reduce ADEs in community-dwelling older adults who use multiple medications to manage poor health and poor sleep.

Understanding Formal Caregiver Burden in Nursing Assistants in Nursing Homes: A Mixed Methods Approach.

The current study aimed to describe formal caregiver burden of nursing assistants in nursing homes. A descriptive, cross-sectional, convergent mixed methods approach identified attributes of formal caregiver burden using phenomenological interviews and established self-report measures. Themes included nursing assistants' experiences of stress, close relationships, extensive assistance of residents, balancing needs and routines, and feeling accomplished. Self-report measures demonstrated moderate stress, moderate caring behaviors, responsibility, and competence. MDS 3.0 results showed moderate cognitive impairment, minimal depressive symptoms, and decreased functional status of residents. The mixed methods synthesis confirmed the presence of five attributes of formal caregiver burden: perceived stress, caring for another, dependency of the older adult, responsibility, and competence. Burnout was not confirmed. Future investigation of attributes among a larger, diverse sample of nursing assistants, residents, and nursing homes will advance knowledge and inform research design and methods of interventions. [Research in Gerontological Nursing, 16(5), 231-240.].

Transitions experienced by older survivors of critical care.

The transition from hospital to home is complicated for older adults who experience a serious or life-threatening illness. The specific aims of this prospective, observational cohort study were to determine the number of older adults who experience a change in their functional ability and residence after an intensive care unit (ICU) stay and to explore risk factors for functional decline and new institutionalization at hospital discharge. We found high rates of unrecognized preexisting cognitive impairment, delirium, complications, functional decline, and new institutionalization in this sample (N = 43). A number of variables were associated with functional decline or new institutionalization, including narcotic agent use (p = 0.03), ICU complications (p = 0.05), comorbidities (p = 0.01), depression (p = 0.05), and severity of illness (p = 0.05). We identified device self-removal, admission type, and ICU delirium as also potentially associated with these outcomes (p ≤ 0.25). There are a number of important and potentially modifiable factors that influence an older adult's ability to recover after a critical illness.

Formal Caregiver Burden in Nursing Homes: An Integrative Review.

Formal caregivers in nursing homes provide care to vulnerable older adults with chronic conditions. Caregiver burden affects formal caregivers. The purpose of this integrative review was to explore formal caregiver burden among nursing staff in nursing homes. Specific aims were to gain an understanding of the attributes, definitions, measures, and primary outcomes. A systematic search of CINAHL, PubMed, PsycINFO, and Embase was completed. The sample included 19 articles, which were published in English between January 1980 and April 2020. Attributes varied; however, perceived stress was frequently identified, consistent with the formal caregiver burden definition. Psychometric measures employed in the studies indicated heterogeneity. Primary outcomes included differences in burden, resident behavior, occupational and personal factors, and resident care. Research is needed to gain an understanding of this recently defined concept. Formal caregiver burden in nursing homes has emerged as a priority for research during the pandemic with new challenges and guidelines.

Sleep disturbance of residents in a continuing care retirement community.

The purpose of this pilot study was to examine the differences in temperature rhythms, rest/activity rhythms, melatonin rhythms, sleep percentages, and daytime sleepiness between two cohort-matched older adult groups in a continuing care retirement residence. Ten nursing home residents experienced disrupted rhythms, slept more, and experienced more daytime sleepiness compared with 10 apartment-dwelling residents. Nighttime light exposure was small in both groups but significantly greater in the nursing home. Gerontological nursing practice implications are to improve older residents' sleep by eliminating nighttime light and sleep-disrupting routines in all care settings for older adults.

Potentially inappropriate medications in community-dwelling older adults.

Potentially inappropriate medication (PIM) use is a significant worldwide public health problem. Community-dwelling older adults are susceptible to the negative outcomes associated with the use of PIMs. A database search (January 1991-June 2013) produced 19 prospective correlational and 10 intervention studies. The current state of the science reveals that conceptual clarity is lacking regarding the use of PIMs. The prevalence of PIM use is well documented in an abundance of descriptive studies. However, researchers have not examined an intervention's effects on health outcomes in community-dwelling older adults. Although independent older adults can acquire PIMs outside of a provider, current interventions aim to change the behavior of the prescribing physician and pharmacist. Nurses need to collaborate with other disciplines in PIM use research. Priority needs are to design interventions that reduce the use of PIMs and negative health outcomes.

Management of delirium in critically ill older adults.

Delirium in older adults in critical care is associated with poor outcomes, including longer stays, higher costs, increased mortality, greater use of continuous sedation and physical restraints, increased unintended removal of catheters and self-extubation, functional decline, new institutionalization, and new onset of cognitive impairment. Diagnosing delirium is complicated because many critically ill older adults cannot communicate their needs effectively. Manifestations include reduced ability to focus attention, disorientation, memory impairment, and perceptual disturbances. Nurses often have primary responsibility for detecting and treating delirium, which can be extraordinarily complicated because patients are often voiceless, extremely ill, and require high levels of sedatives to facilitate mechanical ventilation. An aggressive, appropriate, and compassionate management strategy may reduce the suffering and adverse outcomes associated with delirium and improve relationships between nurses, patients, and patients' family members.

Sleep deprivation impairs 12-hr urine volume excretion in old rats.

Excessive nocturnal urine volumes (UVs) predict almost double the death rate in older adults. Furthermore, sleep-depriving environments may increase nocturnal UVs in old age. Thus, a pilot study was designed to examine the effects of sleep-depriving lighting treatments on the 12-hr UV excretion in young adult rats (6 months, n = 6), middle-aged rats (12 months, n = 12), old rats (16 months, n = 6), and old-old rats (>20 months, n = 5). Each animal was exposed continuously to the treatments beginning with 7 days each of standard laboratory lighting conditions of on 12 hr/off 12 hr, then 7 days continuous dim lighting, and finally 7 days of continuous dim lighting plus sleep deprivation with a noxious noise. Age group and lighting condition treatments influenced 24-hr urine volume excretion (F (2, 29) = 2.41, p = .007, r(2) = .8193). During sleep deprivation, rest-phase 12-hr urine volume excretion increased in both the old and old-old rats (F (2, 5) = 7.79, p < .00001).