A Community-Based Collaborative Care Model to Improve Functional Health in Underserved Community-Dwelling Older Adults.

OBJECTIVE: Examine the effects of a 6-month health multidimensional intervention on physical function, bone density, and mood in a diverse sample of community-dwelling older adults at risk for frailty and excess disability. METHOD: A quasi-experimental, pre- post-program design was implemented. Adults aged 55 years and older ( n = 337, 60% African American) participated in the intervention and received assessments at baseline, 6 months, and 12 months. RESULTS: Physical function was maintained during the intervention for both African American and White elders but declined at 12 months for both groups ( p < .0001). Symptoms of depression improved during the intervention ( M = 0.65 ± 0.07, M = 0.15 ± 0.04, M = 0.68 ± 0.07, p < .001, respectively) but worsened at 12 months ( M = 0.68 ± 0.07, p < .001). Bone density scores remained stable from baseline (distal: -1.62 ± 1.17, proximal: -2.73 ± 1.85) to 12 months (distal: -1.72 ± 1.21, proximal: -3.11 ± 1.85, ps > .05) for both groups. DISCUSSION: Program findings may serve as a basis for the development of a randomized, controlled study to provide empirical evidence of intervention efficacy. Such findings may help inform the development of community-based programs to identify vulnerable older adults and provide vital preventative care to decrease frailty and excess disability.

The Relationship Among Multiple Sclerosis-Related Symptoms, Sleep Quality, and Sleep Hygiene Behaviors.

AIMS AND OBJECTIVES: The aim of this study was to examine the relationships among multiple sclerosis (MS)-related symptoms, sleep hygiene behaviors, and sleep quality in adults with MS who self-report fatigue. BACKGROUND: Fatigue is a frequent, prevalent symptom among adults with MS. Few studies have examined the relationship among fatigue and other symptoms with sleep quality and sleep behaviors. DESIGN: This is a descriptive correlational study. METHODS: A convenience sample of 39 adults with MS were recruited for the study. Instruments used included the revised MS Related Symptom Scale and the Pittsburgh Sleep Quality Index. Correlations examined the relationships among fatigue and other MS symptoms with sleep quality and sleep hygiene behaviors. RESULTS: The frequency of several symptoms correlated with poor sleep quality, and fatigue frequency was higher in those who used electronic devices and practiced poor sleep hygiene behaviors. NURSING IMPLICATIONS: Nurses should incorporate interventions for symptoms that impact sleep quality. These findings suggest that sleep hygiene education should be a part of routine clinical care. CONCLUSION: Adults with MS experience the burden of many symptoms that impact sleep quality. Interventions that include education to improve symptoms, sleep hygiene behaviors, and sleep quality are needed.

Recommendations and Extraction of Clinical Variables of Pediatric Multiple Sclerosis Using Common Data Elements.

PURPOSE: The purpose of this article was to demonstrate the feasibility of using common data elements (CDEs) to search for information on the pediatric patient with multiple sclerosis (MS) and provide recommendations for future quality improvement and research in the use of CDEs for pediatric MS symptom management strategies Methods: The St. Louis Children's Hospital (SLCH), Washington University (WU) pediatrics data network was evaluated for use of CDEs identified from a database to identify variables in pediatric MS, including the key clinical features from the disease course of MS. The algorithms used were based on International Classification of Diseases, Ninth/Tenth Revision, codes and text keywords to identify pediatric patients with MS from a de-identified database. Data from a coordinating center of SLCH/WU pediatrics data network, which houses inpatient and outpatient records consisting of patients (N = 498 000), were identified, and detailed information regarding the clinical course of MS were located from the text of the medical records, including medications, presence of oligoclonal bands, year of diagnosis, and diagnosis code. RESULTS: There were 466 pediatric patients with MS, with a few also having the comorbid diagnosis of anxiety and depression. CONCLUSIONS: St. Louis Children's Hospital/WU pediatrics data network is one of the largest databases in the United States of detailed data, with the ability to query and validate clinical data for research on MS. Nurses and other healthcare professionals working with pediatric MS patients will benefit from having common disease identifiers for quality improvement, research, and practice. The increased knowledge of big data from SLCH/WU pediatrics data network has the potential to provide information for intervention and decision-making that can be personalized to the pediatric MS patient.

Assessment of Delirium in Intensive Care Unit Patients: Educational Strategies.

BACKGROUND: Delirium is an acute brain dysfunction associated with poor outcomes in intensive care unit (ICU) patients. Critical care nurses play an important role in the prevention, detection, and management of delirium, but they must be able to accurately assess for it. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) instrument is a reliable and valid method to assess for delirium, but research reveals most nurses need practice to use it proficiently. METHOD: A pretest-posttest design was used to evaluate the success of a multimodal educational strategy (i.e., online learning module coupled with standardized patient simulation experience) on critical care nurses' knowledge and confidence to assess and manage delirium using the CAM-ICU. RESULTS: Participants (N = 34) showed a significant increase (p < .001) in confidence in their ability to assess and manage delirium following the multimodal education. No statistical change in knowledge of delirium existed following the education. CONCLUSION: A multimodal educational strategy, which included simulation, significantly added confidence in critical care nurses' performance using the CAM-ICU. J Contin Nurs Educ. 2017;48(5):239-244.

Loss and Loneliness: Audrey's Story.

Loneliness is a concept recently capturing the attention of nursing and other healthcare professionals due to its unfavorable effects on health outcomes. The purpose of this article is to convey the story of one widow named Audrey (pseudonym) and to describe her experiences of profound loneliness. Narratives from this single case study are reported as part of a larger qualitative, phenomenological study on loneliness in community-dwelling older adults. Findings from Audrey's story reveal intense periods of loneliness, longing and loss primarily resulting from the death of her spouse. Excerpts from these narratives uncover Audrey's coping strategies for loneliness, which included watching television, telephoning her children, reading the paper, and finding comfort in her faith. Audrey's story is essential for all home healthcare professionals to understand, as it illustrates the powerful impact of loneliness on the quality of life and health of an older adult.

A model of risk reduction for older adults vulnerable to nursing home placement.

Because of the cost of nursing home care and desire of older adults to stay in their homes, it is important for health care providers to understand the factors that place older adults at risk for nursing home placement. This integrative review of 12 years of research, as published in 148 articles, explores the risk factors for nursing home placement of older adults. Using the framework of the vulnerable populations conceptual model developed by Flaskerud and Winslow (1998), we explored factors related to resource availability, relative risks, and health status. Important factors include socioeconomic status, having a caregiver, the availability and use of home- and community-based support services, race, acute illness particularly if hospitalization is required, medications, dementia, multiple chronic conditions, functional disability, and falls. Few intervention studies were identified. Development of evidence-based interventions and creation of policies to address modifiable risk factors are important next steps.

Loneliness in older adults: an embodied experience.

Loneliness is of significant concern in the older adult population. Loneliness has been associated with old age because of multiple losses that may occur. These include loss of health, social status, friends, and/or spouse. There is a gap in the literature with regard to understanding the meaning of loneliness in older adults. Interpretive phenomenology was used for this study, involving multiple interviews with older adults to explore the meaning of loneliness. Findings revealed that many participants experienced loneliness as a result of disrupted meaningful engagement with others due to different age-related changes. Loneliness was embodied as it was expressed through the participants' bodies in several ways, including fatigue, tension, withdrawal, and emptiness. Conclusions from this study reveal the need for nurses to become more aware of loneliness in older adults as a significant health issue.

Toward a better understanding of loneliness in community-dwelling older adults.

The purpose of this interpretive phenomenological study was to explore the meaning of loneliness in community-dwelling older adults and to understand their daily practices in coping with loneliness. The sample consisted of 8 women and 4 men. Interviews were conducted with the 12 participants utilizing several tools, including 3 separate interview guides and the UCLA Loneliness Scale, Version 3 (Russell, 1996). A critical finding was that many participants experienced loneliness as a result of disrupted meaningful engagement, due to age-related changes, as well as other losses, including death of spouse, retirement, and giving up the car. Two paradigm cases and themes representing the loneliness and coping experience emerged. Participant coping practices with loneliness included reaching out to others, helping those in need, and seeking companionship with pets. Many older adults are at risk for loneliness because of declining health and other age-related losses that prevent them from remaining engaged in meaningful relationships. Health care professionals can screen for loneliness to identify those at risk and can intervene to help older adults maintain connections. Recommendations for those caring for lonely older adults include active listening, vision and hearing screenings, transportation needs, pet therapy, volunteering, and engagement in social activities.

Portraits of loneliness: emerging themes among community-dwelling older adults.

With aging comes a multitude of possible losses, including loss of health, spouse, friends, or independence. These losses can place older adults at risk for isolation and loneliness. Loneliness is of significant concern in older adults, as it can negatively affect their quality of life. An interpretive phenomenological study was conducted to explore the meaning of loneliness in 12 older adults living in the community. Selected excerpts from the participants reveal several themes, as well as the importance of maintaining meaningful connections and relationships with others to alleviate feelings of loneliness. Nurses can become more attuned to the problem of loneliness in older adults and the importance of helping their older clients maintain meaningful connections with others to reduce loneliness.

Clinical implications of treating depressed older adults with SSRIs: possible risk of hyponatremia.

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.