Needs assessment of homebound elders in a parish church: implications for parish nursing.

The goals in managing chronic illnesses in the elderly are to maintain the highest possible level of functioning, promote independence in self-care, and enhance quality of life. Parish nursing is one mechanism for providing care for homebound elders with one or more chronic illnesses. However, determining the holistic health needs of older parishioners before developing a parish nursing program is helpful. The holistic needs of elders in two parishes were determined through two multidimensional functional assessment questionnaires and a quality of life scale. Results indicate that this population of elders had relatively high levels of functioning. Quality of life was relatively high and was associated with overall functional abilities.

Functional assessment of the elderly.

Functional levels, Orem's levels of self-care abilities, and need for services of 20 low income elders living in a senior housing project were assessed. The majority of the subjects were at Orem's supportive educative level in the areas of social resources and mental health, and partly compensatory in the areas of economic resources, physical health, and activities of daily living. As expected in a community setting, very few were in the wholly compensatory level. Service needs fell primarily in the partly compensatory level. The results suggest that there is a continuum of needs in this population, and that functional assessment of older adults is an important component of nursing practice in a primary care setting.

Management of problematic behavioral symptoms associated with dementia: a cognitive developmental approach.

The purpose of this 3-year study was to test the efficacy of using a theoretical model based on Piaget's cognitive developmental stages for consistent behavioral and environmental interventions for persons at all stages of Alzheimer's disease and related disorders (ADRD) in nursing home and special care units. The specific aims were to reduce problematic behavioral symptoms and the number, amount and frequency of use of psychotropic medications. After 18 months, problem behaviors and some types of psychotropic medications significantly decreased in the treatment group but not in the control group. Results of the study indicate that using behavioral and environmental interventions based on Piaget levels of cognitive development may be an effective method of managing problematic behavioral symptoms and decreasing the use of psychotropic medications in institutionalized ADRD patients.

The relationship between premorbid life-style and wandering behaviors in institutionalized people with dementia.

Forty-nine ambulatory residents participated in a study conducted to determine the relationship between premorbid life-style, work, and ways of handling stress, and wandering in dementia units. The sample consisted of 23 males and 26 females with a mean age of 79. Family members responded to open-ended questionnaires that asked about premorbid leisure activities, hobbies, exercise, stress management, type of employment and social interactions. Activities were ranked according to energy expended on the Metabolic Cost of Activities (MET) Scale. No activity equaled Inactive (0); 1.5-2 METS equaled Mildly Active (1), 2-3 METS equaled Moderately Active (2), and 3-4 METS equaled Very Active (3). Subjects were observed three times for one-hour intervals on each of three shifts (day, evening, night) at randomly selected times to assess wandering behavior. Behavior was logged every five minutes. The subjects' most frequent conditions were awake (21%), alone (20%), and in their own rooms (17%). Twenty-four (50%) of the subjects were observed pacing, and 16 (33%) were agitated/restless at some point in time. Statistical analyses showed no significant correlations between premorbid life-style variable rankings and the amount of time spent standing, walking and pacing. The findings suggest that wandering behavior is not influenced by premorbid life-styles.

Wandering behaviors in institutionalized persons with dementia.

1. Etiological factors that have been identified in relation to wandering include mental impairment, confusion, darkened or unfamiliar environment, boredom, stress, tension, anxiety, lack of control, lack of exercise, diseases of the central nervous system and cardiac decompensation. 2. The findings of this pilot study indicate that in structured settings such as SCUs, behaviors appear to be related to activities in the environment, e.g., quiet behaviors at night and more active behaviors during the day. 3. Psychotropic medications may not have the desired effect on behaviors in patients with Alzheimer's disease, however, nursing interventions geared toward modifying the environment may be useful in shaping behaviors of patients with dementia.

The relationship between Piaget and cognitive levels in persons with Alzheimer's disease and related disorders.

Clinical observations and research studies have documented that people with Alzheimer's disease and related disorders (ADRD) appear to regress developmentally during the course of the disease. The purpose of this study was to prospectively determine the association between changes in Piaget levels of cognitive development and cognitive decline in nursing home residents in various stages of ADRD. Fifty-seven people were tested three times at yearly intervals, using the Folstein Mini-Mental State Exam to determine cognitive levels and a set of 14 Piaget tasks to determine cognitive developmental levels: 1) Formal Operations; 2) Concrete Operations; 3) Preoperational; and 4) Sensorimotor. Mean MMSE scores declined from 12.7 to 9.4, and there was a downward trend in Piaget levels over the study period. ANOVA showed significant differences (p < 0.0005, Years 1, 2, 3) in MMSE scores among all Piaget levels, and Spearman rho analysis showed significant correlations between Piaget levels and MMSE for each year (p < 0.0005, Years 1, 2, 3). The results suggest that there is a concurrent decline in cognitive developmental levels and cognition in people in various stages of Alzheimer's disease and related disorders.

Cognitive developmental approach to dementia.

Systematic observations of people suffering from dementia of the Alzheimer's type (DAT) reveal they regress in behavior and become childlike. These observations have been used to structure clinical research and therapeutic interventions for dementia patients. However, no concise framework explains successful caregiving. Models for care exist but they lack an adequate framework for the long-term care of a person with DAT. This state of the science review describes what is known about cognitive functioning in people with DAT. It examines studies based on cognitive functioning. It also then relates this information to an emerging theory tentatively identified as a "cognitive developmental approach" which may be useful for understanding people with dementia and for predicting caregiver requirements.

Antepartum cultures for Ureaplasma urealyticum are not useful in predicting pregnancy outcome. The Vaginal Infections and Prematurity Study Group.

To test the hypothesis that genital colonization with Ureaplasma urealyticum would predict adverse pregnancy outcome, 4934 women from five medical centers were evaluated for vaginal colonization with U. urealyticum between 23 and 26 weeks' gestation and followed up to delivery. U. urealyticum colonization was associated with maternal age, parity, racial-ethnic group, martial status, income, education, smoking, number of sexual partners, and colonization with Trichomonas vaginalis, Mycoplasma hominis, and bacterial vaginosis. After adjustment for medical and sociodemographic factors in a multivariate analysis, there was no difference in the mean birth weight or proportion of low-birth-weight infants delivered by women who carried U. urealyticum and those who did not. U. urealyticum colonization at 23 to 26 weeks was not associated with preterm rupture of membranes, preterm labor, or preterm delivery. A positive vaginal culture for U. urealyticum in midgestation does not predict those women at risk for preterm labor, preterm delivery, preterm premature rupture of membranes, or delivery of a low-birth-weight infant.