Combating Social Isolation in Older Adults: An Intergenerational Nursing Communication Project.

The importance of social connection to health and well-being has long been recognized. Social isolation is prevalent and impactful in the lives of older adults across care settings. A semester-long communication-focused clinical project was developed and piloted with sophomore Bachelor of Nursing Science students during Fall 2020 and replicated in Fall 2021 and 2022. Students were paired with older adult volunteers/mentors from a senior living organization and contacted mentors every 2 weeks over the 15-week semester. Older adult volunteers served as mentors, sharing their wisdom and life experiences. Students practiced their communication skills and learned about their mentor's life. Pre- and post-activity surveys of student attitudes toward older adults/aging suggested a dramatic and positive shift in perspective, and mentors rated the experience highly favorably. Intergenerational communication and relationship building has the potential to combat social isolation, promote healing and growth, and enable mutually beneficial engagement. [Journal of Psychosocial Nursing and Mental Health Services, 61(10), 7-11.].

Appreciation of the Research-Practice Link: Authentic Learning Environments for Writing-Intensive Nursing Courses.

Undergraduate students often perceive a disconnect between research and nursing practice. To support student understanding of this relationship, an innovative, authentic learning environment was created in a writing-intensive, capstone-level nursing course. Authentic learning environments couple real-life situations/simulations with personal, experiential learner engagement. Students completed pre- and postsurveys assessing their beliefs about and confidence in using research to inform practice. Quantitative and open-ended qualitative responses were analyzed with inferential statistics and conventional content analysis techniques, respectively. Findings suggested the learning environment increased student confidence and facilitated connections between research and practice, supporting continued use and further evaluation of this approach.

Measurement of peripheral blood flow in patients with peripheral artery disease: Methods and considerations.

Peripheral artery disease (PAD) is a manifestation of generalized atherosclerosis which results in hemodynamic compromise of oxygen and substrate delivery to the lower extremity skeletal muscles. Hemodynamic assessments are vital in PAD diagnosis and in the evaluation of strategies aimed at treating claudication (i.e. exercise training, revascularization, and pharmacological agents). Venous occlusion plethysmography (VOP) is a century-old, non-invasive technique used to quantify limb blood flow and has been used to evaluate hemodynamic compromise in patients with PAD. However, the literature suggests a wide array of methodological variability in the measurement and analysis of limb blood flow using VOP. In this manuscript, we overview the clinical application of VOP measurement, and secondly we review the methodological variation that occurs during the measurement and analysis of VOP in healthy individuals and in patients with claudication.

Development and Testing of a Neuropsychiatric Symptoms Model in Mild Cognitive Impairment.

Neuropsychiatric symptoms are prevalent in individuals with mild cognitive impairment (MCI) and have a significant detrimental effect on health and quality of life. Identifying factors that contribute to their occurrence may enable prompt treatment and intervention. The current study entails the development and testing of a biopsychosocially based model to assist nurses in the identification of individuals with MCI who are most likely to experience symptoms of depression, apathy, and/or anxiety. Factors within the biological and sociodemographic domains of the Neuropsychiatric Symptoms in MCI (NPSMCI) model were tested using multivariate logistic regression analyses. Findings suggest that age, presence of an e4 allele of the apolipoprotein E gene, living situation, and degree of comorbid illness were associated with the occurrence of symptoms of depression and apathy. Further testing and refinement are necessary, but the findings provide guidance to nurses and alert them to assess individuals most likely to experience these symptoms. [Journal of Gerontological Nursing, 44(1), 21-30.].

The PADQOL: development and validation of a PAD-specific quality of life questionnaire.

Understanding the impact of peripheral artery disease (PAD) requires broad evaluation of how functional limitations of PAD affect patients' perceptions of health-related quality of life (HRQL). The objective of this study was to describe the development, testing, and psychometric properties of the PAD Quality of Life Questionnaire (PADQOL). The PADQOL was developed in three steps: (1) interviews of symptomatic PAD patients provided content of the initial questionnaire; (2) co-administration with the SF-36 (a 36-item short-form health survey), Walking Impairment Questionnaire, and Profile of Mood States examined construct validity; and (3) a three-phased factor analysis identified factors and shortened the questionnaire. Data analyses from 297 symptomatic PAD patients resulted in a 38-item questionnaire of five factors: Social relationships and interactions, Self-concept and feelings, Symptoms and limitations in physical functioning, Fear and uncertainty, and Positive adaptation (α = 0.92-0.73) and items related to sexual function, intimate relationships and employment. Between-instrument correlations established construct validity. In conclusion, PADQOL is a validated measure to assess the disease-specific physical, psychosocial and emotional effects of PAD for research and practice.

Understanding Dizzy Patients a Cross-Sectional Analysis of Attitudes toward Diagnosis, Providers, and Treatment.

OBJECTIVE: To evaluate patients' attitudes regarding their dizziness, provider capabilities, and receptiveness toward treatment. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary care vestibular clinic. PATIENTS: Ages 18 years or older, fluent in English, and who presented with a chief complaint of dizziness or vertigo. INTERVENTION(S): N/A. MAIN OUTCOMES MEASURE(S): Non-validated questionnaire surveying patients' beliefs regarding the cause of their dizziness, likelihood of successful treatment, and openness to various treatment modalities. RESULTS: Patients were asked to complete an online non-validated survey regarding their dizziness prior to being evaluated in neurotology clinic. About 67 surveys were completed between January 2017 and September 2018. A majority of patients attributed their dizziness to their ears (n = 47, 70%), followed by the brain (n = 29, 43%). Most subjects chose "neither agree nor disagree" about whether their provider could identify the cause of their dizziness (27%). Most subjects also chose "neither agree nor disagree" that their dizziness would resolve with treatment (31%). These attitudes were not influenced by demographics, dizziness severity, anxiety, depression, or quality of life on multivariate ordinal regression modeling. CONCLUSIONS: Patients who experience dizziness have neutral attitudes with regards to believing that their provider will be able to identify the cause of their dizziness and whether their dizziness will resolve with treatment. These neutral attitudes are experienced by a plurality of patients and do not differ by demographic information, dizziness handicap, quality of life, depression, or anxiety.

Antibody Response to SARS-CoV-2 Infection and Vaccination in COVID-19-naïve and Experienced Individuals.

Understanding the magnitude of responses to vaccination during the ongoing SARS-CoV-2 pandemic is essential for ultimate mitigation of the disease. Here, we describe a cohort of 102 subjects (70 COVID-19-naïve, 32 COVID-19-experienced) who received two doses of one of the mRNA vaccines (BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna)). We document that a single exposure to antigen via infection or vaccination induces a variable antibody response which is affected by age, gender, race, and co-morbidities. In response to a second antigen dose, both COVID-19-naïve and experienced subjects exhibited elevated levels of anti-spike and SARS-CoV-2 neutralizing activity; however, COVID-19-experienced individuals achieved higher antibody levels and neutralization activity as a group. The COVID-19-experienced subjects exhibited no significant increase in antibody or neutralization titer in response to the second vaccine dose (i.e., third antigen exposure). Finally, we found that COVID-19-naïve individuals who received the Moderna vaccine exhibited a more robust boost response to the second vaccine dose (p = 0.004) as compared to the response to Pfizer-BioNTech. Ongoing studies with this cohort will continue to contribute to our understanding of the range and durability of responses to SARS-CoV-2 mRNA vaccines.

Can a Nursing Home Psychotropic Reduction Project be Successfully Implemented in Assisted Living?

The objective of this study was to compare implementation of a psychotropic medication reduction project across two types of residential long-term care settings: nursing homes (NH) and assisted living (AL) facilities. Fifteen NHs and 14 AL facilities from within a single corporate chain participated in the psychotropic medication reduction project. Using a comparative case study approach, we conducted in-person and telephone interviews with 62 staff members from participating NH and AL facilities to investigate the experience of project implementation. Project implementation within the more institutional NH model produced dramatic changes in residents' lives and medication use. Conversely, changes made in the AL environment appeared to have less impact on resident medication use and resident-centric narratives, and AL staff identified numerous barriers to implementation. Identifying methods to monitor processes and outcomes of care without increasing the regulatory burden of AL facilities may increase transferability of quality improvement efforts across settings.

Mapping a Strength-Oriented Approach to a Standardized Terminology: A Case Study.

As a new era of healthcare advocates a more valuable and intelligent approach to care management and delivery based on values and outcomes, shifts toward risk management to boost performance should be considered that encompass the capitalization of health assets or health strengths. To make full use of individuals' or populations' health assets, data capture and representation are needed. This paper uses a strengths-oriented case study mapped to an inter-disciplinary standardized terminology, the Omaha System, to illustrate and compare the conventional problem-based approach to care management with the strengths-oriented approach to care that demonstrates whole-person data capture of an individual's health and health assets leveraged to promote health values and performance. The Omaha system provides a standardized framework to organize the concepts of all of health from a whole-person perspective for documentation to enable data analysis, interoperability, and health information exchange.

Development and Validation of VM-PATHI: Vestibular Migraine Patient Assessment Tool and Handicap Inventory.

OBJECTIVE: The aim of this article is to develop and validate a disease-specific, patient-reported outcome measure for vestibular migraine. SETTING: Tertiary care vestibular center. PATIENTS: Adult patients with definite or probable vestibular migraine per Barany Society Criteria. STUDY DESIGN: This was a prospective cohort study. VM-PATHI (Vestibular Migraine Patient Assessment Tool and Handicap Inventory) was developed with expert input, literature review, and patient feedback. VM-PATHI scores were compared between those with vestibular migraine and controls, across several time points, and to other dizziness and quality of life (QoL) measures. RESULTS: A 25-item questionnaire was developed. Cronbach's α was high at 0.92. Test-retest reliability was excellent (r = 0.90, p < 0.001). Scores were much higher in patients with vestibular migraine (mean 42.5, SD = 16.1) than control patients (mean = 9.6, SD = 8.5). VM-PATHI scores were responsive to treatment (p = 0.01). Scores were well correlated with general QoL, depression, and anxiety scores. Scores were also correlated with the Dizziness Handicap Inventory (r = 0.69). An exploratory factor analysis was performed, which revealed 6 distinct factors that corresponded well to different aspects of disease-related symptomatology. CONCLUSION: VM-PATHI is a valid, reliable, and responsive measure of disease severity in vestibular migraine.

Understanding the Dizziness Handicap Inventory (DHI): A Cross Sectional Analysis of Symptom Factors That Contribute to DHI Variance.

OBJECTIVE: The Dizziness Handicap Inventory (DHI) is the most commonly used quality of life measure for vestibular disorders. However, there is wide variability in scores, and little is known about which variables contribute to dizziness-related quality of life. Our goal was to investigate the key demographic and symptom-related factors to that account for DHI variance. STUDY DESIGN: Cross-sectional survey. SETTING: Tertiary referral center. PATIENTS: Adult patients presenting to a dizziness clinic. MAIN OUTCOME MEASURE: DHI variance explained by multiple linear regression. RESULTS: Seventy subjects were included in our study. We performed univariate analyses on numerous demographic and dizziness-related factors, and constructed a multivariate model based on explaining the highest variance in the data with the least number of independent variables. Several validated quality of life and mental health survey scores (SF-36-quality of life; PHQ-9-depression; and GAD-7-anxiety) were significantly correlated with higher DHI scores. Additional factors, including the number of dizzy days per month, the number of dizziness descriptors (spinning, lightheadedness, disequilibrium, etc.), and the number of dizziness triggers (loud sounds, stress, riding in a car, etc.), were all significantly associated with higher DHI scores; a multiple linear regression model showed that these three aforementioned factors combined accounted for 56% of the variability in the DHI scores (p < 0.0001). Adding an index of depression, as measured by the PHQ-9, increased the adjusted R to 64% (p < 0.0001). CONCLUSIONS: DHI score variability is explained by mental health and quality-of-life measures in addition to the daily burden of dizziness.

Adherence and exercise mode in supervised exercise therapy for peripheral artery disease.

Supervised exercise therapy (SET) is a first-line treatment for people with peripheral artery disease (PAD). However, data on patient adherence to SET are limited. In addition, while intermittent treadmill exercise has been widely tested, no studies have investigated recumbent total body stepping (step-ex). We examined whether exercise mode (treadmill walking [n = 17], step-ex [n = 18], or a multimodal approach [n = 18]) affected adherence to a 12-week SET program. We also investigated the potential safety and viability of step-ex for people with PAD by looking at change in exercise training capacity (highest metabolic equivalent of tasks [METs] achieved and highest total MET-minutes achieved per session). The 53 participants comprised 50% female candidates (n = 26) and were (mean [SD]) 74.2 (8.3) years old, with an ankle-brachial index of 0.70 (0.19). Overall adherence to SET was 62%. There was a difference in adherence between groups (P = .022), with the multimodal group (73.6% [21.5%]) higher than the treadmill group (50.2% [28.8%], P = .010). Treadmill participants (n [%]) (8 [47.1%]) dropped out at a higher rate than the multimodal group (3 [16.7%], P = .053). All groups increased the exercise training capacity. The multimodal group achieved greater improvement in total MET-minutes achieved per session (61.5 [45.1]) than the treadmill group (14.7 [44.3]) (P = .008).A multimodal approach to PAD exercise therapy resulted in higher adherence and greater change in exercise training capacity. Step-ex was safe for people with PAD. While further study is warranted, it is appropriate for SET programs to consider a multimodal approach using step-ex, especially given the varied health and physical ability of the PAD population.

Changes in vitamin E prescribing for Alzheimer patients.

OBJECTIVE: At the end of 2006, a survey was sent to members of the American Association of Geriatric Psychiatry (AAGP) to assess possible changes in prescribing Vitamin E to patients with Alzheimer disease that followed two published reports in early 2005 suggesting increased mortality and an increased incidence of heart failure with Vitamin E supplements. METHOD: A three-item questionnaire was mailed to all AAGP members who had prescription privileges to assess changes in prescribing Vitamin E after January, 2005. RESULTS: A total of 572 completed surveys were returned for a response rate of 35%. Nearly 60% of respondents reported a change over the 2 years that followed the 2005 reports. The greatest change was in the group not prescribing Vitamin E, which increased from 6.6% before 2005 to 60.6% afterward. CONCLUSIONS: AAGP members significantly reduced prescribing Vitamin E to patients with Alzheimer disease after 2005. The two reports are discussed with an emphasis on their methodological limitations and the potential for additional information on Vitamin E side effects from ongoing research.

Long-term outcomes of supervised exercise in peripheral artery disease: Impact of differing modes of exercise 1-4 years after intervention.

The prevalence and debilitating nature of peripheral artery disease (PAD) mandate the development and aggressive implementation of the most efficacious treatment strategies available. Research has clearly demonstrated that supervised exercise in individuals with PAD and lifestyle-limiting claudication leads to improved outcomes in the short term. An important factor in determining the relative value of exercise training in PAD rehabilitation is the extent to which the benefits are sustained over time. The aim of this study was to examine the long-term outcome status of participants in the EXercise Training to Reduce Claudication: Arm ERgometry versus Treadmill Walking (EXERT) trial. Twenty-two participants agreed to attend a single data collection visit 1-4 years after their completion of the EXERT study. Objective and subjective measures of health status and physical function and a measure of quality of life were obtained and compared to performance at the end of the EXERT trial. Although analyses indicate that changes in health status and objective measures of physical function occurred in the long-term follow-up period, between-group differences were minimal and were limited to a statistically significant difference in the distance covered during the 6-minute walk test. Subjects' perceptions on change in physical function and quality of life were similarly stable over time although a statistically significant decrease in participant's confidence in managing their disease/symptoms was evident, suggesting the importance of ongoing support and symptom management strategies. This has significant implications for vascular nurses.

Relationship matters in dementia caregiving.

This study examined the relationship between four framing categories of caregiving (Relational, Instrumental, Reactive, Role Acquiring), derived from interviews with spouse caregivers, and scores on standardized measures of responses to and outcomes of caregiving. Participants were 132 spouses recruited into a larger intervention study of family caregivers of community-dwelling persons with dementia. Qualitative data were analyzed using constant comparative method; quantitative data were analyzed using one-way analysis of variance (ANOVA). Findings demonstrated that relational spouses scored better than spouses in the other three categories, indicating greater positive well-being. Relational spouses also scored significantly lower than instrumental and reactive spouses on a composite caregiver distress measure (p = 0. 003). These results suggest that interventions may need to be tailored to spouses with different caregiving perspectives.