Nursing Commons^™

The Effectiveness Of Dexmedetomidine In The Reduction Of Postoperative Delirium In Patients Over 65: A Scoping Review, Jacqueline Renee Breuer, Michael G. Callonas, Kathleen Chmelicek, Laura Elizabeth Denman, Dwayne Accardo Dnp, Crna, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Postoperative delirium impacts as many as 51% of surgical patients, resulting in increased mortality and morbidity, longer hospital stays, and increased healthcare costs. Adults ≥ 65 have a high risk for developing delirium. This scoping review examines the use of dexmedetomidine in the perioperative period in adults ≥ 65 years old to prevent and treat postoperative delirium.

Methods

Using relevant inclusion criteria, an extensive review of the literature was performed from September through November 2022, utilizing the Cochrane, CINAHL, ClinicalKey, PubMed, and Embase databases. Search phrases included: dexmedetomidine infusion, dexmedetomidine, intraoperative dexmedetomidine, postoperative delirium, older adults, and elderly delirium. …

Initiating A Skin-Care Bundle In The Emergency Department To Decrease Hospital-Acquired Pressure Injuries In Geriatric Patients, Suzanne Babcock, Pamela Hardesty

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Adults 65+ comprise 15.2% of the United States (U.S.) population and 17.9% of Emergency Department (ED) visits. Aging causes changes to skin, including thinning and loss of elasticity. Annually, in the U.S., 2.5 million individuals develop Pressure Injuries (PI), causing 60,000 deaths. Hospital acquired PIs in the U.S. cost $26.8 billion annually, over $10,000/patient and increase the length of stay by greater than four days.

LOCAL PROBLEM: This project occurred in a 27-bed Geriatric Accredited Emergency Department in a southeastern U.S. city where patients 65+ comprise 40% of the patient volume annually. PIs can begin developing within two hours. …

Association Between Chronic Disease And Substance Use Among Older Adults In Tennessee, Manik Ahuja, Jessica Stamey, Johanna Cimilluca, Kawther Al Skir, Mary K. Herndon, Kathleen Baggett, Thiveya Sathiyasaleen, Praveen Fernandopulle

ETSU Faculty Works

Background:

Design and methods:

A Structured Life Review Intervention To Improve Life Satisfaction In Home Health Service Patients: A Feasibility Study, Leah Graf

University Scholar Projects

Two million older adults in the U.S. suffer with depression. Adults who live with the difficulties of depression concurrently experience dissatisfaction with life. Life review is a systematic recollection of past events. Dr. Robert Butler postulated that, as the elderly and those with terminal illness approach the end of their lives, there is a resurgence of life experiences in the conscience (1963). A successful life review conducted by an active listener assists the individual to process unresolved conflicts and attain ego-integrity in the final stage of life. Home health services have become an increasingly accepted option for managing chronic illnesses …

Comparing The Effectiveness Of Cannabis Use And Opioid Use In Palliative Care Patients, Olivia Grace Finley, Brooke Chalmers, Caroline Spencer, Katherine Lewis

Non-Thesis Student Work

This project aims to study the efficacy of the use of marijuana versus opioids for pain management in patients over 65 years old on palliative care. Palliative care is defined as an approach that focuses on improving the quality of care of seriously ill people and their families (Wallerstedt et. al., 2019). Opioids have been a reliable form of chronic pain relief in the past, but since the legalization of marijuana in some states, it has been presented as an alternative. A search was conducted using key words including marijuana, opioids, palliative care, and pain management. …

Physical Restraint In Older People: A Statement From The Early Career Network Of The International Psychogeriatric Association, Mustafa Atee, Claire V. Burley, Victor A. Ojo, Agboola J. Adigun, Hayoung Lee, Daniel J. Hoyle, Olufisayo Elugbadebo, Tomas Leon

Research outputs 2022 to 2026

The International Psychogeriatric Association (IPA) has expressed significant concerns over the use of physical restraints in older people across diverse aged care settings. Following an extensive analysis of the available literature, the IPA's Early Career Network (ECN) has formulated a collection of evidence-based recommendations aimed at guiding the use of physical restraints within various care contexts and demographic groups. Physical restraints not only infringe upon human rights but also raise significant safety concerns that adversely impact the physical, psychological, social, and functional well-being of older adults. Furthermore, their effectiveness in geriatric settings remains inadequate. Given these considerations, the IPA and …

Investigating The Perspectives Of Older Adults In Residential Aged Care On Oral Health-Related Quality Of Life, Parisa Malekpour, Amanda Devine, Julie Dare, Leesa Costello

Research outputs 2022 to 2026

Objective

The objective of the study was to explore how older people living in a residential aged care facility perceived that their oral health influenced their food preferences and attitudes towards food, their social interactions and their self-esteem.

Background

Poor oral health can have biological, behavioural and social impacts on quality of life among older adults (aged 65+ years). In terms of biological impacts, oral health impairments may cause older adults to avoid many types of foods. This shift in dietary pattern can lead to malnutrition among older people, undermine general health and negatively impact quality of life (QOL).

Materials …

Mental Health Benefits Of Physical Activity In Older Adults, Adrian Kurt Zitzmann

Master of Science in Nursing Family Nurse Practitioner

Physical activity is the fountain of youth, strengthening both the physical body as well as the mind, leading to better emotional stability and a general sense of well-being. The population over age 65 is nearing retirement age and are transitioning from a high paced work and family life to a slower and less active “empty nest” lifestyle. Among adults over age 65, will implementing an exercise program for 30 minutes per day increase mental well-being? The benefits of physical activity will be supported by gathering a group of older adults ages 65 and up from a local retirement community to …

Results Of A Multi-Site Pragmatic Hybrid Type 3 Cluster Randomized Trial Comparing Level Of Facilitation While Implementing An Intervention In Community-Dwelling Disabled And Older Adults In A Medicaid Waiver, Sandra Spoelstra, Monica Schueller, Viktoria Basso, Alla Sikorskii

Peer Reviewed Articles

Background: Evidence-based interventions that optimize physical function for disabled and older adults living in the community who have difficulty with daily living tasks are available. However, uptake has been limited, particularly in resource-constrained (Medicaid) settings. Facilitation may be an effective implementation strategy. This study’s aim was to compare internal facilitation (IF) versus IF and external facilitation (EF) on adoption and sustainability of an intervention in a Medicaid home and community-based waiver.

Methods: In a hybrid type 3 trial, waiver sites (N = 18) were randomly assigned to implement the intervention using a bundle of strategies with either IF or IF …

Nurses’ Attitudes Towards Hospitalized Older Adults In A Tertiary Care Setting In Ghana, Yakubu H. Yakubu, Abdul-Ganiyu Fuseini, Eleanor Holroyd

School of Nursing & Midwifery, East Africa

Introduction: The increasing population of older adults and rapid increases in co- morbidities globally has necessitated the need for a healthcare delivery system that meets the multifaceted needs of the growing population of older adults. Concurrent with these rising complex health needs is the importance of positive, non-judgmental attitudes of health services providers towards older adults. Moreover, this is particu-larly important in the nursing profession, given nurses' significant and crucial roles in healthcare settings.

Aim: The study aimed to evaluate nurses’ attitudes towards older adults in a tertiary hospital in Ghana.

Design: It employed a descriptive cross-sectional …

Reducing Medication Non-Adherence With Improved Health Literacy Interventions: An Evidence-Based Practice Quality Improvement Project, Unity Wiles

DNP Projects

Introduction

Health literacy is the ability to obtain, process, and understand basic health information and services needed to make appropriate healthcare decisions and follow instructions for treatment. Patients with low health literacy have been predicted to have poor health outcomes. The inclusion of the single-item literacy tool into the admission process of this project involved the patient-centered-care characteristics of improved patient experience, lower health cost, improved clinical experience, and better outcomes.

Purpose

The National Action Plan to improve Health Literacy seeks to engage organizations, professionals, policymakers, communities, individuals, and families in a linked multi-sector effort to improve health literacy. Low …

Implementation Of A Polypharmacy Deprescribing Protocol Among Older Adults In A Community-Based Care Organization, Johanne Cazeau

Doctor of Nursing Practice Scholarly Projects

Background: Polypharmacy, defined as the use of five or more medications, has the potential to increase morbidity, mortality and decrease quality of life. Older adults are disproportionately affected by polypharmacy. Decreasing polypharmacy could prevent morbidity and mortality while saving millions of dollars annually. The use of the ARMOR tool has been shown to decrease polypharmacy and the prescribing of inappropriate medications among the elderly.

Local problem: There is a high prevalence of polypharmacy among older adult patients at the managed care organization where this quality improvement project was implemented. Among a panel of 30 members, almost all (n=29) were taking …

Improving Pain Management Of Cognitively Intact Older Adults In Long-Term Care Facilities, Lorraine Howlett

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Pain among residents in long-term care facilities (LTCF) is underrecognized and undertreated. Older adults present a pain management challenge due to their altered pharmacokinetics, pharmacodynamics, multiple morbidities, and polypharmacy. Long-term care facility nurses must be knowledgeable of treatment options, assessment of pain before and after treatment interventions, and how to implement any changes needed as indicated by post-treatment assessment. Barriers such as negative staff attitudes and biases, time constraints, and degree of organizational support may need to be overcome.

Purpose: With increased education, resources, and support, LTCF nurses will be better prepared to provide optimal pain management care …

Nurse-Led Volunteer Support Care Plan, Rosemary Saunders, Kate Crookes, Karen Gullick, Olivia Gallagher, Karla Seaman, Debra Scaini, Seng Giap Marcus Ang, Caroline Bulsara, Bev Ewens, Jeff Hughes, Bev O'Connell, Christopher Etherton-Beer

Research outputs 2022 to 2026

The Nurse-Led Volunteer Support Care Plan described in “Nurses leading volunteer support for older adults in hospital: A discussion paper” is made available. This care plan is designed for nurses to develop a plan to direct volunteer support to better meet the individual needs of patients.

Health Service Experiences And Preferences Of Frail Home Care Clients And Their Family And Friend Caregivers During The Covid-19 Pandemic, Lori E. Weeks, Sue Nesto, Bradley Hiebert, Grace Warner, Wendy Luciano, Kathleen Ledoux, Lorie Donelle

Nursing Publications

Objective: The COVID-19 pandemic has brought about a major upheaval in the lives of older adults and their family/friend caregivers, including those utilizing home care services. In this article, we focus on results from a qualitative component added to a pragmatic randomized controlled trial that focuses on the experiences of our study participants during COVID-19. A total of 29 participants responded to the COVID-19 related questions focused on their health services experiences and preferences from March-June 2020 including 10 home care clients and 19 family/friend caregivers in the provinces of Ontario and Nova Scotia, Canada. Results: Many participants were affected …

Voice-Activated Virtual Home Assistant Use And Social Isolation And Loneliness Among Older Adults: Mini Review, Cynthia F. Corbett, Pamela J. Wright Phd, Ms, Med, Rn, Cen, Kate Jones, Michael Parmer

Faculty Publications

A lack of social connectedness is common among older adults due to living alone, loss of loved ones, reduced mobility, and, more recently, social distancing created by the global Covid-19 pandemic. Older adults are vulnerable to social isolation and loneliness, which pose significant health risks comparable to those of smoking, obesity, physical inactivity, and high blood pressure. A lack of social connectedness is also correlated with higher mortality rates even when controlling for other factors such as age and comorbid conditions. The purpose of this mini review was to explore the emerging concepts of older adults' use of commercially available …

Racial Disparities In Post-Acute Home Health Care Referral And Utilization Among Older Adults With Diabetes, Jamie Smith, Olga Jarrín, Haiqun Lin, Tina Dharamdasani, Jennifer Tsui, Charlotte Thomas-Hawkins

College of Nursing Faculty Papers & Presentations

Racial and ethnic disparities exist in diabetes prevalence, health services utilization, and outcomes including disabling and life-threatening complications among patients with diabetes. Home health care may especially benefit older adults with diabetes through individualized education, advocacy, care coordination, and psychosocial support for patients and their caregivers. The purpose of this study was to examine the association between race/ethnicity and hospital discharge to home health care and subsequent utilization of home health care among a cohort of adults (age 50 and older) who experienced a diabetes-related hospitalization. The study was limited to patients who were continuously enrolled in Medicare for at …

Dnp Final Report: Pressure Injury Prevention Patient Initiative (Pippi), Melissa A. De Los Santos

DNP Final Reports

Background: Pressure injuries have been known to affect approximately 2.5 million patients each year, with roughly 60,000 patients dying as a direct result of a pressure injury. Associate healthcare costs are between $9.1-$11.6 billion per year in the United States. The cost of individual patient care was estimated between $20,900 and $151,700 per pressure injury. During the last three years, pressure injury prevalence has risen within the local long-term care organization. Pressure injury prevention interventions have been developed to improve healthcare outcomes, cut costs, and increase revenue for long-term care organizations.

Purpose: Deliver evidence-based educational intervention that incorporates strategies for …

Exploring The Experiences Of The Older Adults Who Are Brought To Live In Shelter Homes In Karachi, Pakistan: A Qualitative Study, Laila Akber Cassum, Keith Cash, Waris Qidwai Dr, Samina Vertejee

School of Nursing & Midwifery

Background: The traditional joint family system in a culturally diverse Pakistani society shows great respect and care for older population by the families and their generations. However, in the recent years the phenomenon of population ageing in Pakistan is rapidly increasing due to demographic shift influencing life expectancy, along with changes in socio-cultural values. This transition has resulted in institutionalization of the elderly as an emerging shelter alternative. The aim of this study was to explore the experiences of the elderly people and to identify the reason which compelled them to reside in these shelter homes.
Method: A …

Caring Near And Far By Connecting Community-Based Clients And Family Member/Friend Caregivers Using Passive Remote Monitoring: Protocol For A Pragmatic Randomized Controlled Trial, Lorie Donelle, Sandra Regan, Michael Kerr, Merrick Zwarenstein, Michael Bauer, Grace Warner, Wanrudee Isaranuwatchai, Aleksandra Zecevic, Elizabeth Borycki, Dorothy Forbes, Lori Weeks, Bev Leipert, Emily Read

Nursing Publications

Background: Significant chronic disease challenges exist among older adults. However, most older adults want to remain at home even if their health conditions challenge their ability to live independently. Yet publicly funded home care resources are scarce, private home care is expensive, and family/friend caregivers have limited capacity. Many older adults with chronic illness would require institutional care without the support from family member/friend caregivers. This role raises the risk of physical health problems, stress, burnout, and depression. Passive remote monitoring (RM), the use of sensors that do not require any action by the individual for the system to work, …

In Beers We Trust: Using Deprescribing Tools To Reduce Inappropriate Polypharmacy In Adults Age ≥ 65, Angelica Ferrazzi

Doctor of Nursing Practice (DNP) Projects

Background: Adverse drug events (ADEs) are a significant cause of morbidity and mortality in older adults (age ≥ 65). Polypharmacy and potentially inappropriate medications (PIMs) are especially prevalent in this population and are a notable contributing risk factor for ADEs. Research demonstrates that comprehensive medication reconciliation that includes evaluation of both the risks and benefits of medications, in conjunction with deprescribing practices, can reduce PIMs; therefore, reducing ADEs.

Purpose: The aim of this quality improvement project was to empower clinicians to deprescribe current medications that are inappropriate, as well as reduce the rate of newly prescribed PIMs among patients age …

Risk Factors For Falls In Homebound Community-Dwelling Older Adults, Yunchuan (Lucy) Zhao, Jenny Alderden, Bonnie Lind, Jennifer Stibrany

Nursing Faculty Publications and Presentations

Objective: To examine risk factors associated with falls among homebound community-dwelling older adults, a vulnerable population often possessing functional disabilities and chronic conditions.

Design and Sample: The study was a cross-sectional study utilizing round 6 data of the National Health and Aging Trend Study (NHATS). Descriptive statistics and multiple logistic regression analyses were conducted. A total of 1,356 homebound community-dwelling older adults aged 65 and above participated in the NHATS.

Measures: The outcome variable was falls within the last month reported in NHATS. Independent variables were selected based on the NHATS disability conceptual model and literature review, including personal conditions, …

Semi-Recumbent Vibration Exercise In Older Adults: A Pilot Study Of Methodology, Feasibility, And Safety, Murad Taani, Ellen Siglinsky, Jessie Libber, Diane Krueger, Neil Binkley, Christine R. Kovach, Bjoern Buehring

Nursing Faculty Articles

Objectives: Older adults with impaired physical function are at risk for further functional decline in part due to limited ability to engage in regular exercise. Effective approaches to exercise in this vulnerable population are needed to improve functional capacity and optimize independence.

Methods: Thirty-two residential care apartment complex (RCAC) residents, age ≥70, with low short physical performance battery (SPPB) scores were recruited and randomly assigned to a crossover-design study exploring feasibility and safety of semi-recumbent vibration exercise in older adults living in one RCAC. The primary outcomes were retention and adherence rates and adverse events.

Results: The retention rate was …

An Interdisciplinary Framework For Impacting Older Adults Health And Physical Activity, Christopher J. Dondzila, Elaine Vandoren

Funded Articles

The exploration of feasible and cost-effective strategies is warranted to mitigate rising healthcare costs and lessen the impact of chronic diseases, functional decline, and disability in older adults. The overwhelming sedentariness of older adults is accompanied by a lack of expertise by healthcare professionals in exercise programming that acknowledge factors influencing physical activity (PA) patterns. We present a framework for a nursing/exercise science interdisciplinary effort to increase PA and improve health in older adults via the delivery of individually tailored exercise programming for an 8-week intervention. Results from this study will be integral in translating effective interdisciplinary efforts across diverse …

Nursing Students' Willingness To Care For Older Adults, Insun Jang, Younglee Kim, Phoebe (Yeon) S. Kim

Nursing Faculty Publications

The older adult population has increased and is projected to grow. This population usually has chronic disorders that need continuous care. However, it has been reported nurses and nursing students have negative attitude towards older adults. This descriptive study aimed at investigating factors influencing nursing students’ willingness to care for older adults. This study was conducted among 270 nursing students at the university in the United States from February 1 to February 28, 2017. Study participants answered the survey about quality and frequency of contact with older adults, anxiety about aging, empathy, attitude, and willingness to care for older adults. …

Improving Mental Healthcare For Older Adults: Community Based Screening For Social And Emotional Loneliness And Major Depressive Disorder, Eunice Kowalczyk

Doctor of Nursing Practice (DNP) Projects

Abstract

Purpose: Major depressive disorder (MDD) is a devastating mental health disorder affecting older adults that is often misdiagnosed or untreated due to a lack of screening and the stigma that MDD symptoms are a normal and expected part of aging. The goal of this quality improvement (QI) project was to implement a community-based screening intervention to identify community-dwelling older adults at risk for or suffering from MDD, and facilitate further evaluation and care.

Methods: Participants were community dwelling older adults, age 56 and older, in Massachusetts. Two screening tools were administered in two sites that screened for social and …

The Effect Of Volunteers’ Care And Support On The Health Outcomes Of Older Adults In Acute Care: A Systematic Scoping Review, Rosemary Saunders, Karla Seaman, Renée Graham, Angela Christiansen

Research outputs 2014 to 2021

Aim: To examine the available evidence on the effects of care and support provided by volunteers on the health outcomes of older adults in acute care services.

Background: Acute hospital inpatient populations are becoming older, and this presents the potential for poorer health outcomes. Factors such as chronic health conditions, polypharmacy and cognitive and functional decline are associated with increased risk of health care‐related harm, such as falls, delirium and poor nutrition. To minimise the risk of health care‐related harm, volunteer programmes to support patient care have been established in many hospitals worldwide.

Design: A systematic scoping review.

Methods: The …

Treatment-Related Decisional Conflict, Quality Of Life, And Comorbidity In Older Adults With Cancer., Jeannette M. Kates

College of Nursing Faculty Papers & Presentations

Objective: The present study aims to examine the relationships between and among cancer treatment-related decisional conflict, quality of life, and comorbidity in older adults with cancer.

Methods: A convenience sample of 200 older adults was recruited from outpatient medical oncology and radiation oncology practices in the northeastern United States. A cross-sectional, descriptive, correlational study design was used employing a survey method. Survey instruments included the Decisional Conflict scale (DCS) (with five subscales, including informed, values clarity, support, uncertainty, and effective decision); Self-administered comorbidity questionnaire (SCQ); European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (including five function …

Aerobic Physical Exercise Increases The Health-Related Quality Of Life In Older Adults, Patricia L. Parker

Doctor of Nursing Practice Projects

Abstract

Problem Description: Globally, the older adult population is expected to substantially increase in number throughout the next few decades. The aging process causes the body and mind to undergo many detrimental changes. Typically, older adults succumb to a more sedentary lifestyle due to factors such as decreased musculature and skeletal changes, chronic pain, socioeconomic and psychological stressors, and memory changes. Inevitably, health-related quality of life and overall independence dwindles in this population negating their perception of happiness and life satisfaction. There is significant research on preventing and/or managing cognitive disabilities in the older adult; however, Western medicine approaches, such …

Barriers To Promoting Mobility In Hospitalized Older Adults, Gordana Dermody, Christine R. Kovach

Research outputs 2014 to 2021

Hospitalized older adults who do not receive sufficient mobility are more likely to sustain negative health outcomes, including higher rates of mortality and institutionalization. Accordingly, the purpose of the current secondary data analysis was to examine the nurse-promoted mobility of hospitalized older adults and the association between nurses’ barriers and nurse-promoted mobility. In addition, the relationship among patient severity of illness, proxy levels for function, and nurse-promoted mobility was examined. The final study sample included 61 nurses working in medical units caring for a total of 77 older adults. Findings suggest nurse knowledge gaps and attitude barriers could potentially influence …