Epidemiology of horse trauma: a literature review.

PURPOSE: Horses are used for many recreational and occupational activities. They are large, strong, temperamental, and unpredictable animals and people involved with them are at risk for injuries, from minor abrasions to severe injuries that may lead to death. This review reports on horse trauma in relation to the characteristics of injured equestrians, characteristics of horse trauma, and clinical outcomes. METHODS: A literature search was conducted from health-related electronic databases to identify studies from 2018 to 2023. The search returned 115 relevant full-text articles but after screening and assessment for eligibility, 39 were included in this review for a detailed examination of horse trauma epidemiology. Most studies were undertaken in the USA and the most used method was a retrospective review of hospital or trauma registry data. RESULTS: There have only been very slight changes in horse trauma numbers and outcomes over the past 5 years. Most injuries often follow falls and kicks. Females in their late-20 s to mid-30 s who are recreational equestrians are the group most represented in the data. The commonest injuries include fractures, and head, thoracic, and abdominal trauma. Most individuals with horse trauma were treated in the Emergency Department and discharged. For the equestrians who were admitted to hospital, around one-third required surgery. Mortality rates are very low. CONCLUSION: The popularity of occupational and recreational horse activities does not seem to wane and horse trauma continues to represent a significant concern for the health system. Health care workers need to be cognizant of the scope of trauma presentations as the mechanisms of injury can be complicated putting the equestrian at a high risk of associated injuries that may be life-threatening.

Pain Management in the Postoperative Period for People With Dementia: An Integrative Review.

Objective: With the increased global prevalence of older people with dementia, more will present for surgery over the coming decades. Therefore, the objective of this study was to synthesize the existing research about how pain in managed for people with dementia in the postoperative period and discuss the implications for clinical practice. Methods: For this integrative review, the Cumulative Index to Nursing and Allied Health literature, Medline/Pubmed, ProQuest, ERIC, and Health Source Nursing were searched to identify original empirical research published between 2000 and 2021. Tasks were divided between reviewers to ensure independent study selection, data extraction, and risk of bias assessment. Results: Eleven articles were eligible. The evidence is incompletely developed therefore the review focused on pain assessment, the types and amount of pain relief, that people with dementia receive less analgesia than people without dementia and the challenges for effective pain management. Most studies were surgery for hip fracture so there is scope to look at outcomes for other types of surgery. Analgesia was administered but it was noted that even over a 20-year period, people with dementia received less than cognitively intact people. Pain management could have a stronger evidence-base with more psychometric development of pain assessment tools. Challenges are due to the impaired ability of the person with dementia to communicate pain and that clinicians have difficulty understanding pain behavior in people with dementia. Conclusion: Adequate pain management for people with dementia in the postoperative period is important for a faster and better recovery.

Nonpharmacological Interventions for Anxiety and Dementia in Nursing Homes: A Systematic Review.

Anxiety is a major mental disorder in later life that impacts on activities of daily living and quality of life for adults living with dementia in nursing homes. The aim of this article was to systematically review nonpharmacological interventions for older adults living in nursing homes who experience comorbid anxiety and dementia. METHOD: A systematic literature search was conducted across key databases (Cinahl, ASSIA, Cochrane reviews and trials, psycARTICLES, psycINFO, and PubMed) to identify studies measuring anxiety as an outcome for an intervention for older adults living with dementia in nursing homes, up to December 31, 2017. RESULTS: The search yielded a total of 1,925 articles with 45 articles accessed for full article review. A total of 13 articles were included in this review following quality appraisal based on Cochrane methodology with six different anxiety measures used. The studies included were moderate to high-quality randomized control trials although heterogeneity precluded a combined meta-analysis. CLINICAL IMPLICATIONS: The most common interventions used to address anxiety in this population were music therapy and activity-based interventions although there was limited evidence for the efficacy of either intervention. Little is known about effective nonpharmacological treatment for anxiety for people living with dementia in nursing homes. Further research using consistent measurement tools and time points is required to identify effective interventions to improve the quality of life for people living with both dementia and anxiety in nursing homes.

Team decision making: design, implementation and evaluation of an interprofessional education activity for undergraduate health science students.

An undergraduate health science student curriculum activity in interprofessional education (IPE) focused on team decision making was piloted. The IPE activity included a lecture, small group learning activity and an onsite observation of an interprofessional health care team (IPHCT) meeting. Measures included the Readiness for Interprofessional Learning scale, Interdisciplinary Education Perception scale and the Role Perception Questionnaires. The students completed a workbook to assess decision making capacity in IPHCTs. The results indicated that students (n = 61) were willing to share their knowledge and skills as a way of understanding clinical problems in the workplace and had professionally oriented perceptions and related affective domains. They also showed a positive role perception of their own role and that of other professions. Analysis of the workbooks revealed that students were able to identify positive and negative impacts on effective team decision making and its effects on a patient centred approach to health care.

Effect of a residential respite admission for older people on regional Queensland family carers.

OBJECTIVE: This study undertaken in regional Queensland aimed to determine the effect of a residential respite care (RRC) admission for older people on family carers. METHOD: The study used a repeated measures, prospective design. The participants were 100 family carers and their older dependants who were studied before and after the RRC admission. RESULTS: Family carer psychological distress increased after a period of RRC [F(1, 57) = 250.9, p < .001] as did the level of caregiver burden [F(1, 57) = 189.8, p < .001]. The presence of dementia and hearing problems in the RRC recipients, the psychological distress of the family carer, being younger and a spouse of the RRC recipient all predicted carer burden. CONCLUSIONS: It is not surprising that RRC, once over, does not necessarily reduce psychological distress and carer burden if this is associated with ongoing caring responsibilities that are resumed after RRC. Nurses need to discuss these issues with family carers and inform them of the likely outcomes of RRC and how they may better utilise the 'break' provided by RRC to counteract some of this response.

Staff and home caregiver expectations of residential respite care for older people.

It is generally agreed that relieving the burden experienced by home caregivers caring for older people should be one of the main aims for respite services that are provided. Over the past four years the use of residential respite care has quadrupled in Australia but it remains underutilised. To improve the uptake of this valued service, one hundred home caregivers and 25 staff from residential aged care facilities were surveyed about why residential respite care was being used and what their expectations were. This study provided insight into the value that is placed on residential respite care by identifying reasons and expectations for use so that nursing care and service provision can be continually directed at meeting these needs.

Prevalence of disruptive behaviour displayed by older people in community and residential respite care settings.

The aim of this study was to determine the prevalence of disruptive behaviour displayed by older people in community and residential respite care settings. The specific objectives were to (i) obtain an estimate of the frequency of disruptive behaviour displayed by older people in the community setting before residential respite care; (ii) characterize older people being admitted for residential respite care; and (iii) obtain an estimate of the frequency of disruptive behaviour displayed by older people in residential respite care. A quantitative approach using a cross-sectional survey was employed in the community and in the residential aged care facilities. The older people (n = 100) had a mean age of 81.8 years (range 66-96 years). The older people were being admitted from their homes for booked respite care at residential aged care facilities in a regional Australian city. Home caregivers and nurses rated disruptive behaviour using the Dementia Behaviour Disturbance Scale (DBDS). Reliability data for the DBDS are provided. As expected, in both community and residential respite settings, older people with dementia (29%) scored significantly higher on the DBDS than people without dementia. In addition, DBDS scores were unexpectedly higher in the community setting than in the respite setting. These findings should be taken into consideration by primary health-care professionals when offering treatment options to the home caregivers and by staff in the residential aged care facilities that offer respite.

The impact of residential respite care on the behaviour of older people with dementia: literature review.

Aim. The aim of this review was to examine the impact of residential respite care on the behaviour displayed by older people with dementia. Background. Relocation of older people with dementia to a different care setting could have a negative impact on their behaviour. If such a response is anticipated, a short-term admission to a residential aged care facility for respite care would appear to be futile for the older person and their home caregiver. Therefore, it is important to know what the outcomes of residential respite care are in relation to behaviour for older people with dementia. Methods. A literature search was undertaken and papers emerged from a range of disciplines. The search terms 'respite'; 'respite care'; 'residential respite care'; 'short-stay', 'short-term', 'overnight stays/admissions', 'behav*' and various combinations of these terms were used to find relevant publications in English from Ageline, CINAHL, Medline and, Psychinfo databases dating from 1966. Other key publications were located when searching through the reference lists of retrieved publications. A limited body of literature on residential respite care for older people with dementia was revealed. Results. Six studies were identified, which met the criteria of residential respite care as the intervention and behaviour as an outcome. Conclusions. The studies had a variety of methodological limitations and produced contradictory findings. The strength of the studies was the reporting of outcomes for respite recipients who are usually overlooked in the outcomes for respite research. Relevance to clinical practice. Residential respite care has great anecdotal support but more empirical and evaluative research is needed on outcomes for the respite recipients.

Implementing the wandering evidence for older people with dementia: key issues for nurses and carers.

This paper explores and discusses key issues for nurses and carers in implementing the evidence from the recent assessment of wandering studies conducted by Algase. Wandering is one of the most burdensome of all the behavioural symptoms and is increasing as the prevalence rates of dementia rise with the aging of the population. Wandering describes a diverse pattern of behaviour from aimless walking and pacing through to elopement. Until recently, the empirical evidence in relation to wandering and its implications for caring for older people has seriously lagged behind other research. However, several studies have led to important advances in the management of wandering and despite there being in some instances methodological deficiencies and modest efficacy, nurses, carers and older people who wander will benefit from the findings.

The impact of residential respite care on the behavior of older people.

BACKGROUND: The aim of this study was to examine the impact of residential respite care on disruptive behavior displayed by older people, particularly those with dementia. METHODS: A quasi-experimental, repeated-measures, single-group design was used. The participants were a consecutive series of 100 older people with a mean age of 81.8 years (range 66-96 years) who had been booked for a respite admission to one of several residential aged care facilities in a provincial Australian city. A diagnosis of dementia was reported for 29% of the sample. Disruptive behaviors were rated before and after the period of respite by home caregivers (N = 100) and during the period of respite by nurses (N = 25) using the Dementia Behavior Disturbance Scale (DBDS). RESULTS: Age, male gender and the presence of dementia were all significantly related to the frequency of reported disruptive behaviors. Residential respite care was associated with a significant reduction in the frequency of reported disruptive behaviors in older people (Wald chi2 = 28.28, p < 0.0001). However, this improvement in behavior did not persist into the post-respite period. The deteriorating behavioral trajectory that was evident prior to respite care continued following the period of respite care. CONCLUSIONS: Residential respite care was associated with a temporary diminution in the frequency of reported disruptive behaviors in older people. This finding should be reassuring both for family carers considering placing a relative in residential respite care and for health workers considering whether to recommend such a course of action.

Behaviour of older people admitted for residential respite care.

The aim of this pilot study was to determine whether residential respite care is used because of disruptive behaviour displayed by older people. The specific objectives were to 1) characterise older people being admitted for residential respite care, 2) obtain a preliminary estimate of the proportion of older people in residential respite care because of disruptive behaviour, and, 3) examine the relationship between residential respite care and disruptive behaviour. A quantitative approach using a cross-sectional survey was employed. The respite recipients were 35 older people with a mean age of 81.5 years (range 67-96 years). The respite recipients had been admitted for residential respite care to aged care hostels and nursing homes in a provincial city and its surrounding rural area. Nurses rated disruptive behaviour using the Dementia Behavior Disturbance Scale (DBDS). Additional reliability data for the DBDS are provided. The study found that the largest specific group of residential respite care users were widows (31.4%) who lived alone in their own home. The reason for over half (51.4%) of the residential respite admissions was to give a carer a 'break' from the older person. Although a large proportion (80%) of respite recipients were rated as having disruptive behaviour, the proportion of admissions because of disruptive behaviour was much less (28.6%). People with dementia (37.1%) scored significantly higher than people without dementia on the DBDS [F (1,33)=15.57, p<0.001]. Older people with dementia were prescribed a greater number of psychotropic medications. It is concluded that despite residential respite care being offered primarily to assist with carer burden it is not being used mainly for older people whose behaviour is problematic for the carers.