Life stress, mood disturbance, and elevated interleukin-6 in healthy older women.

BACKGROUND: Although adverse effects of severe chronic stress on immunocompetence and physical well-being in older adults have been reported, the immune response to less severe life stress among healthy older adults, particularly among women, is not well understood. Interleukin-6 (IL-6) has been considered a good overall indicator of immune functioning in older adults because of its contribution to the pathogenesis of several age-related conditions such as osteoporosis. Regulation of IL-6 is impaired in elderly adults, and levels of IL-6 increase with stress and depression. This research cross-sectionally examined levels of IL-6 in three groups of healthy older women with varying levels of life stress and mood disturbance and a healthy group of young women. METHODS: Subjects included 18 caregivers of Alzheimer's patients, 17 older women assessed one month before relocation of their residence, 15 nonmoving and noncaregiving older women, and 20 younger women. Subjects completed the Profile of Mood States (POMS) and had early morning blood draws. RESULTS: Alzheimer's caregivers reported significantly greater distress than women of all other groups. IL-6 levels in caregivers were significantly higher than those of all other women. The older women had significantly higher IL-6 than young controls, but there were no significant differences in IL-6 between movers and older controls. Among all women, greater depression and distress were related to higher levels of IL-6. CONCLUSIONS: These findings suggest that in older women, chronic stressors are associated with significant elevations in IL-6 over and above the elevations associated with normal aging, but that moderate stressors may not be related to appreciable elevations in IL-6.

Mental health services of the rural elderly outreach program.

This paper describes an elderly outreach program (EOP) designed to identify and provide mental health services to the rural elderly. The project integrates a variety of health, mental health, and human service agencies in the planning and delivery of services. Five referral sources are identified and described as well as the assessment, treatment, and referral process. Outcomes are discussed in terms of: characteristics of persons served, ability of the project to identify and deliver mental health services, treatment effectiveness, and cost effectiveness of the project. The EOP seems to have prevented an increase in need for mental health care among Iowans that might have occurred in the program's absence.

Refinement of the Iowa Self-Assessment Inventory.

Two samples of older respondents (N = 1,153 and N = 420) were used in the refinement of the Iowa Self-Assessment Inventory (ISAI). Factor analyses based on data obtained from these samples resulted in modification of the original six-scale inventory to an inventory of seven scales: economic resources, anxiety/depression, physical health, alienation, mobility, cognitive status, and social support. The original ISAI was shortened from 120 to 56 items.

Beyond the Role of ExtenderIndependent and Interdependent Contributions of Nursing to Geriatric Rehabilitation.

Too often, the role of nursing in geriatric neurorehabilitation is defined in terms of extending the care of other disciplines and assuring continuity of selected aspects of care over 24 hours. This article argues that nursing has made significant clinical and scientific progress in contributing, independently and interdependently, to quality rehabilitation care for older adults; and that the role of nursing clearly exceeds the realm of mere extension and continuity of care. Reviewed are nursing's innovations in the areas of promoting comprehensive assessment; fostering functional independence, self-care, and self-care agency; enhancing communication; encouraging family involvement; improving cognitive status; and assuring quality physical care. We conclude with a discussion of the relationship of nursing to other disciplines, and how nursing's contributions can be optimized within the broader context of multidisciplinary geriatric rehabilitation.

Caregiving appraisal and interventions based on the progressively lowered stress threshold model.

The purpose of this article is to describe the impact of a theoretically driven, psychoeducational intervention based on the Progressively Lowered Stress Threshold (PLST) model on caregiving appraisal among community-based caregivers of persons with Alzheimer's disease and related disorders. A total of 241 subjects completed the year-long study in four sites in Iowa, Minnesota, Indiana, and Arizona. Caregiving appraisal was measured using the four factors of the Philadelphia Geriatric Center Caregiving Appraisal Scale: mastery, burden, satisfaction, and impact. Analysis of trends over time showed that the intervention positively affected impact, burden, and satisfaction but had no effect on mastery when measured against the comparison group. The PLST model was influential in increasing positive appraisal and decreasing negative appraisal of the caregiving situation.

Alzheimer's residents' cognitive and functional measures: special and traditional care unit comparison.

The aim of this field experiment was to compare the effects of a special care unit (SCU) on residents with Alzheimer's disease (AD) who lived on the SCU and on traditional (integrated) nursing home units. Twenty-two subjects, 13 on the SCU and 9 on traditional integrated units were compared. Repeated measures ANOVA was used to assess differences between the two groups and within the groups over two bimonthly pretests and two bimonthly posttests. No significant differences on cognitive or functional abilities scores were evident for the groups and no significant differences were found over time. However, consistent with the prediction of the Progressively Lower Stress Threshold Model, the SCU subjects' function was better than subjects on traditional units when measured by socially accessible behaviors.

The experience of caring for a family member with Alzheimer's disease.

The purpose of this phenomenological study was to describe the experience of caring for a family member with Alzheimer's disease or related disorder (ADRD) living at home among a diverse sample of 103 family caregivers. The study involved secondary analysis of in-depth transcribed interview data using van Kaam's rigorous four phase, 12-step psychophenomenological method. A total of 2,115 descriptive expressions were categorized into 38 preliminary structural elements. Eight essential structural elements emerged from an analysis of the preliminary structural elements. The eight elements were then synthesized to form the following synthetic structural definition: Caring for a family member living at home with ADRD was experienced as "being immersed in caregiving; enduring stress and frustration; suffering through the losses; integrating ADRD into our lives and preserving integrity; gathering support; moving with continuous change; and finding meaning and joy."

Alzheimer's disease.

This chapter has included a review of nursing research in Alzheimer's disease. Much of what is in the literature regarding nursing of Alzheimer's disease patients and their families is anecdotal and has not been validated by systematic research and is atheoretical. The majority of nursing research on Alzheimer's disease has been focused on patient characteristics and problem behaviors or on the needs and experiences of family caregivers. Research should continue in these areas along with testing nursing interventions to maintain optimal cognitive, physical, social, and emotional function of Alzheimer's disease patients. Explanatory theories should be devised and tested to advance the development of nursing knowledge in the care of Alzheimer's disease patients and family caregivers. Finally, more evaluation research is needed to test the cost effectiveness of home-based and institutional programs, including effects on Alzheimer's disease patients, family members, and staff caregivers.

What's hot, what's not, in dementia drugs. Part II.

Research is dramatically increasing our understanding of what goes awry in the brains of persons with AD. Three compounds approved for use in other conditions, estrogen, anti-inflammatory drugs, and antioxidants, are currently under study based on their ability to promote cell metabolism and survival, counteract inflammatory responses, and protect neurons from oxidative damage. All three show promise in terms of treating and possibly preventing Alzheimer's disease.

Whole disease care planning: fitting the program to the client with Alzheimer's disease.

Care of the person with a chronic dementing illness is best approached from a conceptual perspective. As the "whole disease care planning" model demonstrates, care is logically derived from knowledge of the client's premorbid characteristics, and intervention strategies develop from following the individual's daily routine and simplifying it as the disease progresses. Although it is impossible to discuss the entire scope of care planning for demented adults in a brief article, this information can help nurses determine which intervention strategies to pursue based on the sociocultural background of clients and their level of functional loss. The desired outcomes at all levels of care include maximizing the potential for safe function by controlling for excess disability and providing appropriate levels of assistance; participation in activities as desired by the client; and minimizing discomfort and maximizing expressions of comfort.

Iatrogenesis in the elderly. Nosocomial infections.

The elderly are increasingly susceptible to nosocomial infection because of age-related changes and the presence of multiple chronic illness. Epidemics frequently occur in long-term care facilities with upper respiratory infections, diarrhea, conjunctivitis, and antibiotic-resistant bacteria the most common. Other common nosocomial infections are those of the respiratory tract, gastrointestinal tract, genitourinary system, and integumentary system. Infection control programs, systematic surveillance, regular inservice programs on infection control (especially handwashing), and employee and resident health programs can be instituted to decrease the incidence of nosocomial infections.

A nursing challenge: Assessment and management of agitation in Alzheimer's patients.

1. Agitation in patients with Alzheimer's disease is a pervasive problem. The behaviors associated with agitation may have detrimental effects on the patient, health care providers, and other patients. 2. Management of these behaviors is particularly challenging and, at times, frustrating for nursing personnel. 3. Attempts to identify the causative factors are essential to the development of an individualized plan of care.

Use of multidimensional assessment to provide testimony on behalf of residents in a life-care home.

City administrators challenged a life-care home's tax-exempt status. A successful, empirically-based case was made based on data collected by gerontological nurses using the Iowa Self-Assessment Inventory (ISAI) and related instruments (Mini-Mental State Examination [MMSE], Instrumental Activities of Daily Living Scale [IADLS], and Physical Self-Maintenance Scale [PSMS]) to describe the life-care population. Testimony by gerontological nurses included comparisons between these life-care residents and statewide data on elderly individuals currently residing in nursing homes and in the community. The data they presented showed not only that this life-care home provided a high quality of life, but also saved society substantial amounts of money in government-funded services that would otherwise be provided to residents of this home. The judge ruled in favor of continuing tax-exempt status for this life-care home because credible evidence clearly demonstrated that taxpayer savings from the services provided to life-care home residents and the life-care commitment dramatically outweighed the taxpayer costs associated with lost tax revenues.

Nurses helping nurses: development of internal specialists in long-term care.

1. Too often, expert assistance provided by psychiatrists and psychiatric nurse specialists to long-term care (LTC) providers of geriatric patients is short-lived and not effective in helping LTC staff deal with their patient's behavioral and psychological problems. 2. One of the main objectives of the study--and one that was found to have positive results--was to provide a mechanism by which LTC staff could develop their own expertise in the management of behaviorally difficult residents. 3. More collaborative efforts among nursing specialists, subspecialists, and generalists are needed to empower those who work in LTC to utilize the abilities and strengths inherent in their positions.

A comparative study: guardianship petitions for adults and elder adults.

1. The appointment of a guardian is the result of a court proceeding that transfers to another an individual's authority to make personal decisions. 2. Gerontological nurses may be asked to assist clients and families in the resolution of problems concerning personal and health care treatment decisions. 3. This study showed that adults younger than 65 years old needed a guardian due to mental retardation, mental illness, or accidental injury. Adults over 65 years old needed a guardian because they had mental retardation, alcoholism, dementia, or other physical disabilities. 4. Immediate family members were most often the individuals to serve as guardians.

Iowa nurses' knowledge of living wills and perceptions of patient autonomy.

The principle of patient autonomy is well recognized in the nursing profession. This study extends the exploration of patient autonomy by examining nurses' knowledge about living wills. The questions addressed in this study included the following: (1) Were Iowa nurses aware of the living will statute? (2) What sources of information did nurses use to learn about this legislation? (3) What were nurses' perceptions of patients' rights? (4) What were nurses' perceptions of nurses' role involving living wills? (5) Were living wills followed? (6) If not followed, which factors contributed to the failure to honor a living will? and (7) Which communication mechanisms were used to alert nurses to a living will? A questionnaire was mailed to 10,000 actively licensed nurses in Iowa. Approximately 3,000 Iowa nurses responded to the questionnaire regarding Iowa living wills. Seventy per cent of the nurses knew that Iowa had living will legislation. No single educational source was a predominate choice for targeted information about the living will statute. Nurses were reluctant to suggest to patients that they should consider writing a living will. Nurses were also more willing to assume a passive role of suggesting that patients talk with relatives about the need for a living will but were less likely to be suggest that a patient write a living will for future health care treatment decisions. The majority of the nurses favored the patient having some control in health care treatment decisions. Three major factors were pertinent to the failure to follow a living will: family request, treating physician's refusal, and lack of information that the living will existed. The medical record was the primary means of communication regarding a living will. To enhance patient efforts at self-determination, nurses must recognize the advance directive legislation is available in their state and the potential impact that their nursing care may have on the implementation of the document.

Unity in diversity: geropsychiatric nursing survey outcomes.

1. Most nurse respondents stated that increased education is of crucial importance in the care of geropsychiatric patients. This need for increased education covers a wide range of areas and includes the problems unique to elderly patients, medications in use, and ensuring that caregiving staff are adequately prepared to deal with geropsychiatric problems. 2. Of the 264 respondents to the survey, their degrees of education and certification and their employment settings represent a diversity of preparation and experience in their fields. This diversity allows them to incorporate a variety of skills in the care of geropsychiatric patients. 3. It is hoped that the survey information can aid in forming sound standards in geropsychiatric education and in the future, gaining certification in geropsychiatric nursing as a subspecialty.

Caring for patients with Alzheimer's disease. Recommendations for nursing education.

1. Most educational programs for healthcare professionals stress acute rather than chronic care and provide little education or training related to caregiving of persons with dementia. 2. Long-term care facilities employ a minimum of licensed staff with the bulk of direct caregiving done by nursing assistants. 3. Licensed nurses and nursing assistants who work with the cognitively impaired should have specialized training and education in caring for persons with AD or other dementias. 4. Annual ongoing training and education should be provided for all caregivers of persons with a dementing illness.

Iatrogenesis in the elderly. Drug-related problems.

Drug reactions are generally related to the influence of age, toxicity, side effects, immunologic reactions, idiosyncratic reactions, drug-drug interactions, and drug-disease interactions. In addition to age-related changes, the elderly are susceptible to the incidence of adverse drug reactions because of polypharmacy, incorrect self-administration of drugs, omission of drugs, taking another's prescriptions, use of over-the-counter drugs, and medication errors by health-care personnel. To prevent or predict adverse drug reactions, the gerontologic nurse can obtain thorough drug histories, educate clients and health-care providers, use nursing measures to alleviate symptoms, and be astute for the potential for problems through drug review.

Shining through: the humor and individuality of persons with Alzheimer's disease.

1. Elders with diminished levels of cognitive functioning are capable of providing meaningful, consistent responses that illustrate individual expressions of self. 2. The demented elder's history and experiences may provide important clues to understanding his or her current behaviors, verbalizations, and perceptions. 3. Humor may be used as a therapeutic intervention for persons with dementia and as a coping strategy for caregivers.