Inpatient Pulmonary Rehabilitation Program in a Long-Term Care Facility: Short-Term Outcomes and Patient Satisfaction.

The purpose of the current study was to evaluate short-term outcomes of inpatient pulmonary rehabilitation (IPR) programs for older patients with chronic obstructive pulmonary disease (COPD). IPR comprises medical management, exercise, nutrition counseling, and coping skills education programs, among other interventions. The current study used a pretest-posttest design with 21 participants evenly split by gender between the ages of 46 and 95. Effects of IPR on functional tolerance exercise capacity and perceived dyspnea on exertion level had a statistically significant difference by the end of the program. Scores for health-related quality of life and subscales of symptoms, impact, and activity in participants younger than 65 were not statistically significant, whereas St. George's Respiratory Questionnaire scores for participants older than 65 showed a statistically significant improvement. Results showed that early IPR is an effective intervention for the management of symptoms of COPD in older adults recovering from a COPD exacerbation.

The patient-centered medical home.

The patient-centered medical home (PCMH) is a comprehensive model of care that has the potential for improving primary health care for older adults. Nurse practitioners (NPs) have the potential to make a significant impact in PCMHs and to positively affect patient care outcomes. In particular, NPs with practice doctorates have the leadership skills to effectively lead PCMHs. Policies need further refinement to facilitate the leadership role of NPs within PCMHs.

Social interactions and depressive symptoms among community dwelling older adults in Nepal: a synergic effect model.

In Asian families, where patriarchal family systems are common, living arrangements of older adults are characterized by residing with a married son. This study examines the synergic effects of intergenerational solidarity (emotional and instrumental support exchange and anticipated support) on depression of older adults from a developing country, Nepal. Gender differences are also explored in the study. This was a cross-sectional face-to-face interview study of 489 community dwelling older adults living in an urban area of Nepal. The data were analyzed using multiple regression models with each dimension of intergenerational solidarity and conflict variables entered one-by-one with the confounding variables. The results illustrate that older women receiving lower emotional and instrumental support were significantly more likely to be depressed compared to older men receiving less support from their son. Also, women reporting lower anticipated support and higher conflict with their son were more likely to be depressed than men. Regarding synergic effects, emotional support exchange buffered against the deleterious effects of conflict with depression in older adults. The results highlight a need for further research on late life intergenerational relationships (IR) and mental health of older adults in developing countries so that it can be useful for health care practitioners.

Translating evidence from systematic reviews for policy makers.

Gerontological nurses who have received education and have experience in conducting systematic reviews may assume a key role in interpreting systematic reviews for policy makers. Systematic reviews offer evidence to determine the best policy and program solutions to a problem. To be successful in translating evidence from systematic reviews, gerontological nurses need to (a) understand the steps of the policy making process and where different kinds of reviews may be used, (b) assess the "technical" literacy and level of interest in gerontological issues of the intended policy maker, and (c) develop and practice skills in policy writing that distill information in policy briefs as well as shorter formats. Gerontological nurses can be powerful advocates for older adults using the systematic review of the literature as an instrument to educate policy makers.

Caring for an aging population: review of policy initiatives.

Due to the aging population in the United States, there will be a need for a larger workforce that is prepared to provide care to an older adult population. The Institute of Medicine has noted challenges related to the preparation of a geriatric workforce due to lack of faculty, inconsistent curricula, and few training opportunities, and has made recommendations to increase the geriatric workforce. In this article, several policy initiatives are discussed that address the shortage of health professionals prepared to care for older adults. Initiatives by professional nursing organizations to improve the gerontological nursing workforce are also reviewed.

The systematic review of the literature: a tool for evidence-based policy.

The systematic review of the literature is a valuable tool for gerontological nurses to influence policy decisions. There are several organizations that provide helpful guidelines for the conduct of systematic reviews of the literature, including the Cochrane Collaboration, the Joanna Briggs Institute, and the Evidence for Policy and Practice Information Co-Ordinating Centre at the Institute of Education, University of London. Gerontological nurses who have a strong foundation in research methodology and the skills to synthesize scientific evidence for the purpose of promoting evidence-based policy have the potential to positively influence health care outcomes for older adults. For nurses to assume a leadership role in synthesizing scientific evidence for evidence-based policy development and refinement, nursing education will need to assume a more active role in teaching systematic review methodology. This article presents an overview of resources for con-ducting systematic reviews of the literature and discusses the use of the systematic review as a tool for evidence-based policy.

Long-term care insurance in Japan: implications for U.S. long-term care policy.

The purpose of this article is to review the long-term care insurance program in Japan and the present system of payment of long-term care services in the United States. The long-term care insurance system in Japan was implemented in 2001 for the purpose of promoting independence in older adults with functional disability. It reimburses for both home and institutional care. Several concerns expressed about the Japanese system include increasing applications for nursing home placement, lower use of home care services than anticipated, limited coverage for disabilities for those under 65, regional variations in service, educational preparation for case managers, and access to care for older adults. Revisions to the Japanese system and implications for U.S. long-term care policy are discussed.

Consumption of one egg per day increases serum lutein and zeaxanthin concentrations in older adults without altering serum lipid and lipoprotein cholesterol concentrations.

Lutein and zeaxanthin accumulate in the macular pigment of the retina, and are reported to be associated with a reduced incidence of age-related macular degeneration. A rich source of lutein and zeaxanthin in the American diet is the yolk of chicken eggs. Thus, the objective of the study was to investigate the effect of consuming 1 egg/d for 5 wk on the serum concentrations of lutein, zeaxanthin, lipids, and lipoprotein cholesterol in individuals >60 y of age. In a randomized cross-over design, 33 men and women participated in the 18-wk study, which included one run-in and one washout period of no eggs prior to and between two 5-wk interventions of either consuming 1 egg or egg substitute/d. Serum lutein 26% (P < 0.001) and zeaxanthin 38% (P < 0.001) concentrations increased after 5-wk of 1 egg/d compared with the phase prior to consuming eggs. Serum concentrations of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides were not affected. These findings indicate that in older adults, 5 wk of consuming 1 egg/d significantly increases serum lutein and zeaxanthin concentrations without elevating serum lipids and lipoprotein cholesterol concentrations.

Methodological issues in male caregiver research: an integrative review of the literature.

UNLABELLED: PURPOSE OF THE PAPER: The purpose of this integrative review of the literature is to identify sampling and analysis issues related to gender in caregiver research in the nursing and health literature. BACKGROUND: Men provide approximately 28% of the care in the home to functionally impaired elders in the United States of America (USA), and because of demographic predictions are expected to provide more in the future. Social science research related to male caregivers has been criticized as having many limitations. A critical review of the nursing and health literature would be helpful to nursing researchers and clinicians by identifying limitations in caregiving research related to gender and providing direction for future research. METHODS: A literature search using the CINAHL database and the terms 'family caregiver', 'dementia', and 'male' was conducted. Thirty-six articles were retrieved, reviewed, and abstracted. FINDINGS: Thirteen articles were qualitative studies, 22 were quantitative, and one had both qualitative and quantitative components. Many of the studies used small samples, and no analysis was included by gender. Most of the samples were convenience samples, with many being self-selected. There was also a lack of analysis of data by family relationship. No qualitative studies and only nine of the quantitative studies included analysis of the data by gender. Studies that reported by gender were all cross-sectional. CONCLUSIONS: There is a need for caregiver research that has larger samples of males, and includes analysis by gender and family relationship. There is also a need for more intervention studies that are well controlled, and evaluate the effect of the intervention on both male and female caregivers.

Cardiovascular health and physical activity in older adults: an integrative review of research methodology and results.

UNLABELLED: PURPOSE OF THE PAPER: The purpose of this article is to review the literature on physical activity and its relationship to cardiovascular risk factors and mortality in older adults, in an effort to clarify the specific benefits and optimal level of physical activity for cardiovascular health in the older adult population. BACKGROUND/RATIONALE: Despite physical activity being recognized as an important factor in the quality of life of older adults, there is a lack of clarity about the optimal level of physical activity that results in positive cardiovascular health benefits. DESIGN/METHODS: An integrative review of the literature using the MEDLINE and CINAHL databases from 1990 through August 2000 was conducted identifying articles related to physical activity and cardiac risk factors, cardiovascular health, or mortality in the older adult. RESULTS/FINDINGS: Forty-four research articles were reviewed. The intervention studies generally provided support for positive cardiovascular changes with exercise, but the results were inconsistent, sample sizes were small, and the outcomes, interventions, and measures of physical activity differed between studies. There was wide variation in the method of measurement of physical activity in the studies. Studies showed an increase in mortality in those who had a sedentary lifestyle compared to those who were more physically active. Results were mixed related to plasma lipids levels. Three studies showed a positive effect of physical activity on blood pressure (BP), while three studies showed no relationship. Each of the studies that evaluated the relationship between physical activity and pulse rate showed a decreased rate with increased physical activity. CONCLUSIONS: The quantity and type of physical activity that should be recommended to bring about positive effects on cardiovascular health and mortality is unclear. There is support, however, that an active lifestyle decreases mortality. There is conflicting evidence to support positive effects of physical activity on cardiac risk factors. Further research is needed with larger sample sizes, better control of extraneous variables, and using measurements of physical activity that have undergone adequate psychometric testing.