RESUMO
BACKGROUND: A previous systematic review reporting the contributions of informal, unpaid caregivers to patient heart failure (HF) self-care requires updating to better inform research, practice, and policy. OBJECTIVE: The aim of this study was to provide an updated review answering the questions: (1) What specific activities do informal caregivers of adults with HF take part in related to HF self-care? (2) Have the activities that informal caregivers of adults with HF take part in related to HF self-care changed over time? (3) What are the gaps in the science? METHODS: This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, EMBASE, and Cochrane CENTRAL databases were searched. Eligible studies involved an informal, unpaid caregiver of an adult with HF as a study variable or participant. Caregiving activities were benchmarked using the theory of self-care in chronic illness. RESULTS: Two thousand one hundred fifty-four research reports were identified, of which 64 met criteria. Caregivers' contributions occurred in self-care maintenance (91%), monitoring (54%), and management (46%). Activities performed directly on or to the patient were reported more frequently than activities performed for the patient. Change over time involved the 3 domains differentially. Gaps include ambiguous self-care activity descriptions, inadequate caregiving time quantification, and underrepresented self-care monitoring, supportive, and communication activities. CONCLUSIONS: Newly identified caregiver-reported activities support updating the theory of self-care in chronic illness to include activities currently considered ancillary to HF self-care. Identified gaps highlight the need to define specific caregiving activities, determine task difficulty and burden, and identify caregiver self-care strategy and education needs. Exposing the hidden work of caregiving is essential to inform policy and practice.
Assuntos
Cuidadores , Insuficiência Cardíaca , Autocuidado , Humanos , Insuficiência Cardíaca/enfermagem , Insuficiência Cardíaca/terapia , Cuidadores/psicologiaRESUMO
BACKGROUND: More than 1 million individuals undergo cardiothoracic surgery for coronary artery bypass graft or valve repair/replacement annually in the United States. There is an increased risk of developing serious cognitive impairment post cardiothoracic surgery. Pharmacological interventions and surgical techniques were associated with improvements in cognitive function in previous systematic reviews. However, a gap in the literature exists regarding how nonpharmacological interventions can mitigate cognitive impairment in adults undergoing cardiac surgery. OBJECTIVE: The aim of this study was to explore the effectiveness of nonpharmacological interventions to reduce the detrimental effects of cardiac surgery on cognitive function in patients after cardiothoracic surgery. METHODS: CINAHL, MEDLINE, PubMed, EMBASE, PsycINFO, and Web of Science databases were searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from January 2011 to February 2022. RESULTS: Nineteen studies were included in this review. Researchers defined cognitive impairment differently across studies. Various interventions were used to reduce cognitive impairment post cardiothoracic surgery, with the most common being remote ischemic limb conditioning. The interventions used to reduce cognitive impairment were heterogeneous in outcomes, measurements, and time of assessment, but only 2 interventions were associated with a reduction in cognitive impairment. CONCLUSIONS: This review is a unique synthesis of the quality of interventions that address broader components of cognition. Researchers used various interventions to reduce cognitive impairment; the outcomes, instruments, and time interval for measurements were heterogeneous. Researchers should conduct future studies at multiple time intervals, using a comprehensive measure of cognitive impairment to better understand the impact of cognitive impairment interventions postoperatively.
RESUMO
Many types of items are used to measure self-reported cognition, resulting in heterogeneity across studies. Certain cognitive self-report measure types may be more predictive of future decline. Therefore, the purpose of this systematic review was to compare whether specific types of cognitive self-report measures better predict risk for cognitive decline over time when measures are directly compared within the same study. The PRISMA criteria guided the review. Eligibility criteria included: longitudinal studies, outcome of cognitive decline, at least 2 different cognitive self-report measures, and no cognitive impairment at baseline. Nineteen studies were included in the final review. A narrative synthesis of results was completed, resulting in 3 thematic groups of comparisons across self-reported measure types. Self-reported memory decline with worry and peer perceptions of memory were associated with the highest risk for cognitive decline. Future longitudinal investigations of self-reported cognitive problems should focus on using measures that may be most sensitive to predicting cognitive decline risk.
Assuntos
Disfunção Cognitiva , Idoso , Cognição , Disfunção Cognitiva/diagnóstico , Humanos , Estudos Longitudinais , AutorrelatoRESUMO
COVID-19 has the potential to detrimentally impact HIV self-management in people living with HIV (PLHIV). Effective HIV-self management is critically important in managing symptoms as well as viral suppression. We examined the impact of the COVID-19 pandemic on HIV self-management, social support, social isolation, depressive symptoms, anxiety, and stress in PLHIV. 85 PLHIV were recruited from social media sites and completed an online survey. Data were collected between April 23 and 30, 2020. Participants reported increases in social isolation, depressive symptoms, anxiety, and stress and decreases in social support and overall HIV self-management from pre- to during the pandemic. Additionally, the Social Support domain and Chronic Nature of HIV domain of the HIV Self-Management Scale were also decreased from pre- to during the pandemic. The ability for PLHIV to maintain HIV self-management during this time is essential and HIV care providers should have plans in place to provide support.
Assuntos
COVID-19 , Infecções por HIV , Autogestão , Sintomas Afetivos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Pandemias , SARS-CoV-2 , Estados Unidos/epidemiologiaRESUMO
Many people with epilepsy (PWE) present to the emergency department setting with their first seizure and must wait weeks or months to be seen by a specialized epilepsy provider. The time period between presentation of first seizure and entry into specialized care can be extremely stressful and precarious for PWE and their families. In order to achieve optimal outcomes, epilepsy self-management should be initiated as soon as possible, including in the emergency department setting. The purpose of this study was to review and evaluate existing epilepsy/seizure-related education materials provided to patients in the emergency room setting to determine the degree to which these materials prepare patients and their families for self-management of epilepsy, or potential epilepsy, during the interim between emergency department discharge and entry into specialized care. Twenty emergency department epilepsy/seizure patient discharge education materials were collected and evaluated using a rubric based on the framework of the Epilepsy Self-Management Scale (AESMMI). Materials were rated on a 0-3 scale based on the degree to which self-management education, resources, and skill building were included. The mean score of materials reviewed was quite low at just 10.4, with a score of 33 possible. Also concerning is that the materials scored lowest in the domains of social support, stress management, and coping, all of which are extremely important areas for PWE, especially in the early phases of the disease when patients and families are adjusting. Findings highlight the need for development of robust self-management interventions tailored to PWE in the transition period from presentation of first seizure to entry to specialized care.
Assuntos
Epilepsia , Autogestão , Serviço Hospitalar de Emergência , Epilepsia/terapia , Humanos , Qualidade de Vida , Convulsões/terapia , Apoio SocialRESUMO
Prior research has demonstrated that PWEs view intimate interpersonal relationships as personally important and as a substantive challenge in their lives. This is significant as high-quality intimate relationships have been linked with greater well-being and better healthcare self-management in other disease contexts. For persons with epilepsy (PWEs), self-management is critical for seizure control, lower mortality, and better quality of life. In the current study, we conducted the first known investigation into the quality of PWEs' intimate relationships and their self-management abilities. In a sample of 88 PWEs, using the Adult Epilepsy Self-Management Instrument, results demonstrate links between greater relationship satisfaction and sexual satisfaction with better self-management on seven of the eleven subscales: health communication, coping skills, social support, seizure tracking, seizure response, stress management, and wellness; satisfaction was unrelated to the treatment, safety, medical adherence, and proactivity subscales. Importantly, these results held while controlling for age, gender, social support, and presence of comorbidities. These findings provide some evidence of the importance of intimate relationships in understanding PWEs' healthcare management abilities. Given that intimate relationship dynamics have been shown to be highly amenable to intervention, this is an area of potential interest for improving self-management in PWEs.
Assuntos
Epilepsia , Autogestão , Adulto , Humanos , Orgasmo , Satisfação Pessoal , Qualidade de Vida , ConvulsõesRESUMO
This systematic review synthesizes current evidence to determine how subjective cognitive impairment (SCI) relates to physical, cognitive, and social activity participation in older adults. Nine peer-reviewed articles were reviewed and appraised for evidence quality. Most were cross-sectional and had high methodological quality. Higher levels of SCI were almost universally associated with lower levels of physical and social activity participation. These findings suggest that older adults who report higher SCI engage in fewer activities. Examining these relationships longitudinally is an important next step to determine whether SCI precedes withdrawing from activities in older adults.
RESUMO
OBJECTIVES: Memory complaints are a common concern for older adults and may co-occur with anxiety symptoms. Although both memory complaints and anxiety are associated with heightened cognitive decline risk, little is known about how these symptoms develop over time. The purpose of this study was to examine the differential concurrent and longitudinal relationships among anxiety symptoms and two types of memory complaints in cognitively intact older adults. METHODS/DESIGN: The current study sample was drawn from two longitudinal, nationally representative datasets, the National Health and Aging Trends Study (NHATS) and the Health and Retirement Study (HRS). Cognitively intact older adults aged 65 and over were included, representing six (n = 5069; NHATS) and two (n = 5284; HRS) waves of data, respectively. Using multilevel linear modeling, we tested bidirectional relationships between anxiety and two types of memory complaints: current rating of memory performance and perceived memory decline. RESULTS: Concurrent associations between anxiety symptoms and memory complaints were found in both datasets: At times when current memory performance was rated more poorly or perceived memory decline was reported, anxiety symptoms tended to be higher, and vice versa. A longitudinal relationship was identified in NHATS such that perceived memory decline, and not current memory rating, predicted future anxiety symptoms. CONCLUSION: This study provides a better understanding of the relationships between memory complaints and anxiety symptoms over time. Cognitively intact older adults with perceived memory decline are at greater risk for current as well as future anxiety symptoms.
Assuntos
Transtornos de Ansiedade/complicações , Transtornos da Memória/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Testes NeuropsicológicosRESUMO
The purpose of this article is to explain the strategies used in the "Set-up" phase of developing computer-based education on the care and management of incarcerated people who are older and/or dying. Public health nurses have an opportunity to support efforts in educating corrections staff to enhance health care for older and dying inmates. Such endeavors can promote social justice through inmates receiving evidence-based care that parallels that received by the community at large. "Set-up" is the first of four phases in the Institute for Healthcare Improvement's Framework for Going to Full Scale. Our design approach was threefold and included an environmental scan, a modified Delphi survey, and a usability study. An expert advisory board was consulted throughout the Set-up Phase. Participants for the Delphi Survey had expertise in geriatrics and corrections health care. Usability testing was conducted at two State Correctional Institutions. The Delphi Survey consisted of three Qualtrics surveys. Usability testing examined navigability; detected problems; observed time spent solving problems; identified problem severity; and developed recovery strategies. The Set-up established proof of concept, three prototype modules, and a specifications document to guide future programming. In addition, a Technology Niche Analyses® provided a preliminary commercialization plan (NIH, 2017). The Set-up phase has been instrumental in exposing the available infrastructure for dissemination of an educational product within corrections and may be a first step in addressing public health concerns on issues in aging. Commercial feasibility of the program and the need for continued research for Developing the Scalable Unit were established.
Assuntos
Instrução por Computador/métodos , Geriatria/educação , Educação em Saúde/métodos , Serviços de Saúde para Idosos , Prisioneiros , Assistência Terminal/métodos , Idoso , Idoso de 80 Anos ou mais , Prova Pericial , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The purpose of this study was to examine the infusion of a Toolkit for Enhancing End-of-Life Care in prisons, as well as the outcome and impact on the quality of prison end-of-life care. A total of 74 front-line staff and administrators were in attendance across two post-Toolkit-infusion evaluation visits. Applying qualitative analysis, co-researcher outcome findings were related to activities, community outreach and relations, multidisciplinary team, quality improvement approach, and participatory action research team effects. Organizational outcomes included barriers and challenges, cost, organizational features, sphere of influence, readiness (for change), and sustainability.
RESUMO
Many older adults maintain interest in intimate partner relationships and actively seek dates. Online dating websites are gaining popularity as being a convenient way to link with potential dates, particularly for women and individuals who live in independent dwellings or rural areas. Several online dating websites market exclusively to individuals 50 and older. Although connecting with others via the Internet can decrease social isolation, there are potential risks involved in online dating. Health care providers do not always assess dating and sexual health in the older adult population. Nurses are in a position to assess the dating relationships of older patients and can ask targeted questions to determine if patients are in a potentially risky relationship. A non-judgmental attitude and compassionate approach is essential. Knowledge of safe practices, alerting red flags, and available resources are essential tools for gerontological nurses to possess.
Assuntos
Corte , Internet , Relações Interpessoais , Idoso , Feminino , Enfermagem Geriátrica , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Motivação , Papel do Profissional de Enfermagem , Fatores de RiscoRESUMO
BACKGROUND AND OBJECTIVES: Middle-aged and older adults with human immunodeficiency virus (HIV) are at risk for decreased health-related quality of life (HRQoL), which may be improved by engaging in leisure activities. We examined associations between HRQoL and participation in cognitive, physical, social, and passive leisure activities, and whether depressive symptoms mediated these relationships. Wilson and Cleary's conceptual model of HRQoL guided this study. RESEARCH DESIGN AND METHODS: In this cross-sectional observational study, we enrolled 174 adults living with HIV aged 40 and older (M = 51.3, SD = 7.03). Participants completed assessments of leisure activities, depressive symptoms, and HRQoL. Data were analyzed using Spearman's rho correlations, hierarchal multiple regression, and mediation analyses. RESULTS: Greater engagement in physical activities was associated with higher physical HRQoL (b = 2.02, p < .05). Greater engagement in social activities was associated with both higher physical (b = 1.44, p < .05) and mental HRQoL (b = 1.95, p < .01). However, all associations between leisure activities and HRQoL were fully attenuated by depressive symptoms. Cognitive and passive leisure activities were not significantly correlated with HRQoL. Mediation analyses confirmed that depressive symptoms were the mediator mechanism by which social activities affected mental and physical HRQoL. DISCUSSION AND IMPLICATIONS: More frequent engagement in physical and social leisure activities is associated with better HRQoL, and social leisure activities improve HRQoL via their impact on mood. Interventions to increase leisure activities, especially among people living with HIV who have poorer affective functioning, may be the most effective approach to improving HRQoL.
Assuntos
Infecções por HIV , Qualidade de Vida , Adulto , Idoso , Estudos Transversais , Depressão/psicologia , Humanos , Atividades de Lazer/psicologia , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Associations among psychological health and memory concerns in older adults are well-established, but much of this research is quantitative. OBJECTIVES: This study examined how memory problems influence emotional well-being in older adults without dementia, and whether this differs by cognitive status and current depressive or anxiety symptoms. METHODS: A qualitative descriptive design was used to examine our research questions. Community-dwelling older adults without dementia (n = 49, Mage = 74.5[10.1], 63% women) completed a cognitive assessment, questionnaires and two semi-structured interviews. Content analysis was used to code and categorise the transcribed interview data, then identify themes within and across participant groups. RESULTS: Five themes described the influence of memory problems on emotional well-being: Evoking Emotions, Fearing Future, Undermining Self, Normalising Problems and Adjusting Thinking. Memory problems' impact on emotional well-being varied by current anxiety symptoms, characteristics of the problem and personal experience with dementia. CONCLUSION: The emotional impact of memory problems tended to differ by affective symptoms, not cognitive status. Older adults who report memory concerns without objective evidence of impairment may be at risk for negative impacts to mental health and well-being. IMPLICATIONS FOR PRACTICE: Cognitive screening guidelines should consider best practices for responding to memory concerns when cognitive testing results are normal.
Assuntos
Demência , Transtornos da Memória , Idoso , Demência/psicologia , Depressão/psicologia , Emoções , Feminino , Humanos , Masculino , Testes NeuropsicológicosRESUMO
The growing aged and dying incarcerated population increases demands on corrections health care. People who are incarcerated can assist in care delivery; however, currently, their training is typically face-to-face, home grown, and variable in content and duration. Six focus groups conducted with peer caregivers (PCs) (n = 12) and staff (n = 15) identified priority training topics. Three prototype modules (Standard Precautions; Loss and Grief; and Role of the Inmate Caregiver in the Final Hours) were developed in consultation with an advisory board. Face-to-face usability testing with (n = 20) PCs and staff confirmed contextual relevance and feasibility of the Inmates Care training. The mean system usability score for all participant segments was 86.5. Inmates Care holds promise to complement nurse-led training with a standardized e-training package.
Assuntos
Cuidados Paliativos na Terminalidade da Vida , Prisioneiros , Assistência Terminal , Idoso , Computadores , Atenção à Saúde , Humanos , PrisõesRESUMO
BACKGROUND AND OBJECTIVES: Self-perceptions of memory problems may impact older adults' mood as well as their activity participation, thereby negatively affecting health and well-being. We examined within-person associations among self-reported memory, depressive symptoms, as well as physical, social, and cognitive activity participation in older adults without cognitive impairment. RESEARCH DESIGN AND METHODS: Samples were drawn from the Einstein Aging Study (EAS), National Health and Aging Trends Study (NHATS), Rush Memory and Aging Project (MAP), and Minority Aging Research Study (MARS), with over 8,000 participants (65+ years) included across data sets. In a series of coordinated analyses, multilevel structural equation modeling was used to examine within-person relationships over periods of up to 20 years. RESULTS: Across EAS, NHATS, and MAP/MARS samples, we found that older adults' self-perceptions of memory did not directly covary with activity participation over time. However, we did find an indirect association in NHATS such that within-person changes in depressive symptoms were associated with changes in self-reported memory, and these contributed to lower physical as well as social activity participation. DISCUSSION AND IMPLICATIONS: Older adults' activity participation is important for health, but maximizing engagement requires understanding potentially impeding factors. We found some evidence that as self-perceptions of memory change over time, associated depressive symptoms may contribute to lower activity participation. Inconsistent findings across data sets, however, suggest future research is needed to understand individual characteristics that may influence these relationships.
Assuntos
Disfunção Cognitiva , Depressão , Idoso , Envelhecimento , Depressão/epidemiologia , Humanos , Transtornos da Memória , AutoimagemRESUMO
Participation in leisure activities may be cognitively protective for older adults. However, there is no comprehensive scoring system for analyzing data related to the effectiveness of leisure activity engagement on cognitive decline risk. The authors developed a component scoring system to determine the typical amount of cognitive, physical, and social effort required for participation in common leisure activities. Fifty-nine leisure activities were scored on the three activity effort components in two rounds of expert panel review using a modified Delphi technique. Consensus on the component scores was esta blished. Interrater reliability (IRR) was acceptable across all three components (0.72). IRR was adequate for the cognitive component (0.75) and excellent for the physical (0.94) and social (0.95) components. Component scores can be used to examine how the level of cognitive, physical, or social effort required for engagement in specific leisure activities is associated with risk for cognitive decline and other poor outcomes. [Research in Gerontological Nursing, 13(1), 13-20.].
Assuntos
Cognição/fisiologia , Exercício Físico , Atividades de Lazer/psicologia , Interação Social , Idoso , Idoso de 80 Anos ou mais , Técnica Delphi , Exercício Físico/fisiologia , Exercício Físico/psicologia , Feminino , Humanos , Masculino , Reprodutibilidade dos TestesRESUMO
Conducting research in corrections can contribute to improved individual and public health. Challenges to gaining entry to correctional settings to conduct research can impede research productivity, delay the launch of studies and inhibit researchers from proposing health research in corrections. The purpose of this paper is to share lessons learned from a large-scale corrections research project designed to develop computer-based learning modules to train front-line corrections personnel about geriatric and end-of-life care. Key lessons learned include the importance of building a team of experts, planning and punting, coordinating with institutional review boards and examining denied applications to inform future planning. To be effective in a correctional setting, leaders in nursing research and corrections nursing must work together within the contextual nature of prisons and jails to advance evidence-based practices for this vulnerable population. These lessons serve to establish best practices on how to access correctional settings and to enable more research in corrections.
Assuntos
Acessibilidade aos Serviços de Saúde/normas , Pesquisa em Enfermagem/métodos , Prisões , HumanosRESUMO
The current study investigated whether having a first-degree relative with dementia influenced older adults' self-reported memory, if personality traits moderated these associations, and whether these associations differed by the type of item asked (ie, frequency of memory problems vs perceived memory decline). Data drawn from the Einstein Aging study included 454 older adults (Mage = 76.64, standard deviation = 4.77, 66.96% white, and 63% female). Multilevel modeling analyses showed participants who had a first-degree relative with dementia reported more frequent memory problems and were more likely to report memory decline over the past year. Among participants with a first-degree relative with dementia, higher levels of neuroticism were related to reports of more frequent memory problems at baseline, whereas higher levels of conscientiousness and lower levels of extraversion were related to reports of more frequent memory problems over time. Future research should consider personality traits and family history of dementia as potential contributors to self-reported memory problems.
Assuntos
Demência , Transtornos da Memória/psicologia , Personalidade , Autorrelato , Idoso , Demência/genética , Demência/psicologia , Feminino , Predisposição Genética para Doença , Humanos , Estudos Longitudinais , Masculino , NeuroticismoRESUMO
INTRODUCTION: Corrections agencies are exploring ways to securely and cost-effectively increase access to high-quality, evidence-based educational programs for personnel. Technology-based instructional tools hold strong potential for continuing education. The Institute for Healthcare Improvement's Framework for Going to Full Scale was employed to guide a systematic approach. PURPOSE: The purpose of this article is to outline and describe the design and development of a media-rich interactive computer-based learning product, Enhancing Care for Aged and Dying in Prison, which addresses geriatric and end-of-life care issues in corrections. METHOD: Through an iterative process, the research team developed the computer-based educational program that included program and module-specific objectives in alignment with goals and priorities of the end users, detailed evidence-based content that was engaging and visually appealing, and assessments aimed at testing the user's knowledge. RESULTS: The Enhancing Care for Aged and Dying in Prison contains six modules, created under the careful guidance of the research team and the two advisory boards. Contents, including images and testimonials, were selected purposefully and strategically. Module objectives were developed in alignment with the goals and priorities of each module, and assessments tested user knowledge level pre/post module exposure. Completion of the training product advances the research and development necessary to further the goal of full-scale dissemination of the computer-based education. DISCUSSION/CONCLUSIONS: The goal of this program is to enhance care and improve quality of life for aged and dying inmates. Evidence-based training products are critical in preparing not only forensic nurses who work in corrections but also the broader group of correctional personnel in how to better meet the care needs of incarcerated persons.
Assuntos
Instrução por Computador , Geriatria/educação , Prisioneiros , Design de Software , Assistência Terminal , Idoso , Humanos , Desenvolvimento de Programas , Interface Usuário-ComputadorRESUMO
Self-reported memory problems are often the first indicator of cognitive decline; however, they are inconsistently associated with objective memory performance and are known to be influenced by individual factors, such as personality. The current study examined the relationships between personality traits and self-reported memory problems in cognitively intact older adults, and whether these associations differ across Black and White older adults. Data were collected annually via in-person comprehensive medical and neuropsychological examinations as part of the Einstein Aging Study. Community-dwelling older adults in an urban, multi-ethnic area of New York City were interviewed. The current study included a total of 425 older adults (Mage = 76.68, SD = 4.72, 62.59% female; 72.00% White). Multilevel modeling tested the associations of neuroticism, conscientiousness, extraversion, openness, and agreeableness with self-reported memory problems. Results showed that neuroticism was positively related to frequency of memory problems and perceived ten-year memory decline only when other personality traits were not accounted for. Extraversion was negatively related to frequency of memory problems and perceived ten-year decline for both White and Black participants. However, conscientiousness was negatively related to perceived ten-year decline for Black participants only. Our findings highlight the importance of examining the association of all five personality traits with self-reported memory problems, as well as examining whether these associations differ for participants from different race/ethnicities.