Geriatric Nursing Commons^™

Enhancing A Pressure Injury Prevention Bundle In A Skilled Nursing Facility, Lorillie Soleta

Doctor of Nursing Practice (DNP) Scholarly Project

Problem: The purpose of the project was to address the increase in pressure injuries in a skilled nursing facility, which had risen from 6% to 10% despite the implementation of a prevention bundle. The project aimed to evaluate and enhance the effectiveness of existing interventions.

Aim of the Project: The aim was to add evidence-based interventions to the existing pressure injury prevention bundle. The desired outcome was to decrease the number of acquired pressure injuries.

Review of the Evidence: Research indicated that pressure injury prevention bundles were more successful when incorporating offloading interventions. These offloading measures, including frequent turning and …

Early Identification Of Barriers To Medication Adherence In The Elderly Population Through The Use Of A Modified Screening Tool, Miranda Joyner, Blake Meranto

Doctoral Projects

Medication nonadherence (MNA) is a major contributor to hospitalizations and accounts for billions of dollars spent every year on health care. Despite medications being prescribed in nearly 75% of healthcare interactions, it is estimated that 33 to 50% of Americans do not take their medications as prescribed, if at all (Bartlett Ellis et al., 2020; Kleinsinger, 2018). The COM-B (Capability, Opportunity, Motivation, Behavior) Model used in this DNP project suggests that an individual must have the capability, opportunity, and motivation to enact a certain behavior, and should any of these areas be lacking, the behavior is unlikely to occur. This …

Chronic Diseases And Inpatient Care Among The Middle-Aged And Elderly People In Indonesia, Ema Madyaningrum

Journal of Health Research

Background: The prevalence of chronic diseases contributes to an increase in healthcare utilization that results in increased vulnerability in middle and old age. This study aims to determine the factors that influence in-patient care among the middle-aged and elderly.

Methods: We conducted a repeated cross-sectional study using the Indonesia Family Life Survey 4 (IFLS 4) in 2007 (10,754 participants) and IFLS 5 in 2014 (12,058 participants). Chronic diseases include hypertension, diabetes mellitus, tuberculosis, asthma, coronary heart diseases, liver diseases, cancer, arthritis, gout, high cholesterol, prostate illness, kidney diseases, and digestive diseases. We used the frequency distribution, and logistic regression to …

Assessing Preinjury Frailty In The Elderly Hip Fracture Patient To Promote Palliative Care Referral In Those At Risk For High Morbidity And Mortality, Alicia N. Walker, Jewyl Gibson, Sara Dunham

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

The objective of this project is to assess preinjury frailty in hip fracture patients aged 65 and older as a predictor for postsurgical morbidity and mortality, prompting early referral to palliative care services in patients deemed high-risk for postoperative complications. Including palliative care in the multidisciplinary care of the high-risk patient has been shown to improve quality of life, increase patient and caregiver satisfaction, and reduce healthcare costs. The design is a quality improvement initiative. The setting is an academic medical center, serving as the region’s Level 1 Trauma Center. There is no current process for measuring frailty as a …

The Use Of Paxlovid Amongst The Elderly & Reduced Hospital Stays, Maria M. Gichana, Kate Ames, Nicole Chandler, Madeline Gill

Non-Thesis Student Work

Coronaviruses are a large family of viruses infecting many species and cause a variety of illnesses. COVID-19 is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS- CoV-2). Understanding that COVID-19 can cause severe disease in vulnerable populations has launched the development of viral treatments. Nirmatrelvir-ritonavir (Paxlovid) is an oral antiviral treatment authorized for adults with mild to moderate symptoms who are at an increased risk for severe disease. These authors pose the question: For older adults over the age of 65 who have had COVID-19, does the use of Paxlovid reduce hospitalizations, compared to those not treated with Paxlovid? …

Nursing Considerations For Elderly Adults With Urinary Tract Infections In Nursing Homes, Mary Marlett

D.U.Quark

No abstract provided.

Pressure Injury Prevention: A Quality Improvement Project Utilizing Incontinence Care Education, Laura Renner

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

Objective: Evaluate whether the initiation of incontinence care education can improve pressure injury knowledge by an average of 5% in post-test scores over 1 month. Design: Theoretical Framework: Lewin’s Three-Step Model for Planned Change and Evidence-Based Practice Improvement Model. Setting/Local Problem: A 20-bed acute care geriatric unit in a large metropolitan hospital in middle Tennessee with inappropriate use of incontinence management products. Participants: Nurses and nursing assistants employed at the project site. Intervention/Measurements: An educational tool was developed to improve knowledge on pressure injury prevention through incontinence management. A pre-test and post-test were conducted immediately before and after educational tool …

Delirium Screening To Prevent Falls In The Long-Term Care Setting, Jonathan David White, Bsn, Rn, Samereh Abdoli, Phd, Rn

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

Abstract

Background

Nearly 30 million people fall in the United States (U.S.) every year with 20% resulting in serious injury. These incidents disproportionately occur in the elderly population. Of the 1.6 million people living in long-term care (LTC) settings in the U.S., between 50-75% experience a fall annually with many experiencing multiple falls. This population is 2 times as likely to experience such an event – and due to increased age, they are least likely to recover. Delirium, a main contributing factor to fall, has been found to go undetected in as many as 66% of individuals in the clinical …

Improving The Process Of Pain Management By Implementing Best Practices In A Nursing Home, Sukhjit Dhillon

Doctoral Projects

Pain is often untreated or undertreated among older adults living in nursing homes. The lack of standardized pain management protocols makes it difficult to address pain in this population. Deficiencies in pain management and documentation were identified in a nursing home and a performance improvement project was implemented with the aim to improve pain management, pain documentation, and staff knowledge of pain management. A pre-and post-intervention study design was used, and data analysis included descriptive statistics and a paired samples t-test. Participants (n=12) included seven registered nurses and five licensed vocational nurses who provide direct care to the residents in …

Improving Telehealth Knowledge And Comfort In An Older Adult Population, Carolyn J. Jones

Doctor of Nursing Practice (DNP) Projects

Background: Telehealth usage is increasing a means of providing healthcare in a more efficient and cost-effective way. Older adults have been left behind from the telehealth movement and this can negatively impact their access to the healthcare system.

Purpose: An educational workshop was offered in a local older adult community with the goal of increasing their knowledge, literacy, motivation, and usage of telehealth.

Methods: The participants completed a pre-assessment survey to determine their baseline knowledge, experience, and perceptions about telehealth. They then participated in an educational workshop, which consisted of a 45-minute presentation given via Zoom with a 15-minute …

Identifying And Evaluating Pain Management In Hospitalized Older Adults With Hip Fractures: An Integrative Review, Monique Guinocor

Master of Science in Nursing Final Projects

Hip fractures are known to have the highest health morbidity and mortality, especially in the aging population. Having a hip fracture comes with insurmountable pain. Older adults experiences pain differently from other populations due to physiological changes, but this population experiences an undertreatment and mistreatment for pain, resulting in negative outcomes. Current methods for pain control include pharmacologic and nonpharmacologic interventions. Exploring different interventions for pain management is necessary so providers can implement methods that are effective in pain relief without inducing complications. The aim of this integrative review is to identify current pain management interventions and determine their effectiveness …

Intraoperative Dexmedetomidine For Reduction Of Postoperative Delirium In The Elderly: A Scoping Review, Gregory B. Harris Bsn, Rn, Srna, Brooke N. Hatchell Bsn, Rn, Srna, Davelin D. Woodard Bsn, Rn, Srna, Dwayne Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Background/Purpose: Post-operative delirium leads to significant morbidity in elderly patients, yet there is no regimen to prevent POD. Opioid use in the elderly surgical population is of the most significant risk factors for developing POD. The purpose of this scoping review is to recognize that Dexmedetomidine mitigates cognitive dysfunction secondary to acute pain and the use of narcotic analgesia by decreasing the amount of norepinephrine (an excitatory neurotransmitter) released during times of stress. This mechanism of action also provides analgesia through decreased perception and modulation of pain.

Methods: The authors developed eligibility criteria for inclusion of articles and performed a …

Efficacy Of Telehealth Modalities In Medication Adherence For Older Adults, Mitchell Adrian C. Siy

Doctor of Nursing Practice Final Manuscripts

About half of the geriatric population who take at least one medication find medication adherence challenging. Average adherence of an elderly patient taking one medication a day is about 80%. This adherence decreases to about 50% for patients taking medications four times a day. Nonadherence can lead to a myriad of preventable adverse effects that can reduce the quality of life and even result in death. In the United States, $100-300 billion could be saved in health care costs due to adverse effects of poor medication adherence. The purpose of this evidence-based project (EBP) is to improve medication adherence in …

Factors Influencing Health Service Utilization Among The Elderly In Insein Township, Yangon Region, Sandar Min Min Hlaing, Naw Clara, Aye Nanda Han

Makara Journal of Health Research

Background: With the increasing needs of the aging population and the increasing prevalence of non-communicable diseases, assessment of the equity and accessibility of health care among the elderly has become important.

Methods: A cross-sectional descriptive study was conducted from December 2018 to December 2019 among 225 elderly to describe the factors influencing health service utilization. Multistage sampling was applied, and structured questionnaire was used to interview the elderly. Chi-squared test and multiple logistic regression were performed in data analysis.

Results: The average age of the respondents was 71.7 ± 8.17 years old, and 68.4% of the respondents …

Pilot Project: Developing A Standardized Evidence-Based Education Process For Nurses To Enhance New Medication Eduction Of Hospitalized Patients With Heart Failure, Michele Ann Crotteau

Doctor of Nursing Practice Projects

Problem Description: Research has shown that health information is difficult for the average adult to understand while clear communication helps patients feel involved and increases adherence to treatment. The Joint Commission recommends Health Literacy (HL) assessment and the use of the Teach Back Method (TBM). Medication errors that occur between the RN and elderly patient are preventable when the RN communicates effectively about the patient’s medications. A paucity of research exists evaluating TBM for nurse-patient communications. This Quality Improvement (QI) Pilot Project (PP) took place over 3-months, aimed to improve new medication education to elderly patients with Heart Failure (HF). …

Caregiver Burden From Caring For Dependent Elderly In Yangon, The Republic Of The Union Of Myanmar, May Zun Naing, Sein Yaw May, Min Htike Aung

Makara Journal of Health Research

Background: Elderly population and well-being of those are emerging as major challenges for families and communities. This study aimed to identify caregiving burden among caregivers who care for dependent elderly.

Methods: A cross sectional descriptive study was conducted in Tharkayta Township, Yangon, Myanmar. Total 200 caregivers were selected applying multi-stage sampling method and structured questionnaires were used to collect data. Dependent score of elderly was assessed by using Barthel Index of activities of daily living (ADL) and assessment of caregiver burden through Zarit Burden Interview.

Results: The results showed that over one fifth of caregivers 21.5% had …

Chronic Constipation Among Community-Dwelling Older People In The East Coast Region Of Peninsular Malaysia, Patimah Abdul Wahab, Azidah Abdul Kadir, Yeong Yeh Lee, Siti Hawa Ali, Dariah Mohd Yusoff

Makara Journal of Health Research

Background: This study aimed to investigate the prevalence, symptoms, and factors associated with chronic constipation among community-dwelling older people in the East Coast region of Peninsular Malaysia. Methods: A cross-sectional study was conducted in four selected health clinics using stratified cluster sampling. A face-to-face interview was carried out among the elderly outpatients, in order to complete a structured questionnaire. Results: A total of 400 participants were included in the study. The mean age was 68.7 ± 6.4 years, and 55% of the cohort were women. The prevalence of chronic constipation was 32.3% among the sample population. The …

A Retrospective Chart Review Pilot Study Of Fall Prevention Through A New And Innovative Care Model, Lydia Smith

Doctoral Projects

According to the Centers for Disease Control and Prevention (CDC), falls are the leading cause of injury-related mortality in the geriatric population, and they are the most common cause of brain injury and hip fracture. The prevalence for falls is 30% in patients over 65 in the United States who experience a fall annually, and the prevalence in dementia patients can be up to 80% annually; the consequences of falls can include injury, reduction in mobility, depression and decreased socialization with peers (CDC, 2015). The purpose of this retrospective chart review pilot study is to examine the number of falls …

Implementation Of An Evidence Based Screening Protocol To Improve The Diagnosis Of Dementia In A Home-Based Primary Care Setting, Lauren Liesbeth Sutton

Doctoral Projects

Dementia is a major public health concern that is both debilitating and deleterious to those afflicted with its various forms. The number of those living with dementia is increasing exponentially as the population continues to rise, with 46.8 million people worldwide currently afflicted with dementia (Chow et al., 2018). Dementia causes cognitive impairment that is severe enough to affect everyday function (Chow et al., 2018). The impairment and disability resulting from dementia indicates a significant health problem in primary care. Findings from research studies indicate that prophylactic and periodic screening for dementia can heighten provider suspicion and translate into earlier …

Nutrition Education To Improve Health Outcomes In Community Dwelling Older Adults, Sara Giessinger

Master's Projects and Capstones

Abstract

The proportion of people age 60 and over is growing faster than other age group, and will double by 2050 from approximately 605 million to 2 billion worldwide, in addition to the 80 and over population quadrupling by the same time. Non-communicable diseases such as obesity, cancer, coronary heart and lung disease, diabetes, hypertension, insulin resistance, and hyperlipidemia,represent 63% of deaths annually worldwide. Due to the immense contact nurses have with clients, they play a key role in screening, referrals and education to guide this demographic to improved health outcomes through nutrition and physical activity interventions (Xiaoyue, Parker, Ferguson, …

Identification Of Potentially Inappropriate Medication Utilizing The Beers Criteria Among Elderly Patients, Christine B. Mitchell

Doctor of Nursing Practice

Background: The normal process of aging causes numerous physiological changes that affect pharmacodynamics and pharmacokinetics. Therefore, the geriatric population is more vulnerable to the effects of potentially inappropriate medication. The American Geriatric Society’s Beers Criteria identifies potentially inappropriate medication to be avoided for this population and can be implemented in efforts to avoid risks associated for this population.

Aim and Methods: The purpose of this project was to implement the Beers Criteria to identify potentially inappropriate medications among patients 65 years and older. The objectives were to increase the percentage of charts reviewed for inappropriate medications and to increase the …

Enhancing Elderly Advance Care Planning Experience At A Primary Care Clinic, Oi Shan Wong

Doctoral Projects

The purpose of the project was to examine if the identification of readiness for an advance care planning (ACP) discussion of elderly participants would enhance the outcomes of participants' satisfaction, improve the likelihood of having an ACP discussion and increase the completion rates of an advance directive (AD) document after an office visit.

Forty-four elderly participants, who met the selection criteria, were recruited from a primary clinic in Northern California from October 1, 2017 to December 31, 2017 (Female, n =28). All participants were randomly assigned to either an intervention group (n= 22) or a control group ( …

Direct Care Nursing Aide Turnover In Long-Term Care Facility, Qilian Luo

Muskie School Capstones and Dissertations

This capstone project, Direct Care Nursing Aide Retention in a Long-Term Care Facility, will uses both qualitative and quantitative analyses to identify the possible contributors to high nursing aide turnover rates in Maine. The quantitative analyses of this project are based on the staffing payroll data of one Maine assisted living facility. The final product of this capstone project will be shared with the study facility, in the hope that they may find uses for its content.

Physical Activity And Fall Prevention In Older Adults, An Educational Intervention, Caleb Daniel Knight

Family Medicine Clerkship Student Projects

Falls in adults over 65 years of age constitute a significant health burden in our country, and this age group is growing rapidly. Falls are addressed with a multifactorial approach, addressing comorbidities, medications, and the physical environment, however, an effective point of intervention accessible by most older adults is physical activity. A brief educational presentation about the morbidity and mortality associated with falls, and the protective effects of physical activity, was provided to Meadowbrook Healthcare subacute nursing home residents in Plattsburgh, NY. Questions were encouraged and answered afterwards, and copies of the presentation were left for the residents to review …

“I Feel Like I’M Drawing Strength From It”: Lived Experiences Of Filipino Elderly Participating In Craft-Making, Sharon B. Cajayon, Romeo Luis A. Macabasag, Norilyn Limchanco, Vanessa O. Umali, Ellayza N. Blas, Michelle S. Angulo, Cristine Joy A. Breguera, Nikka Angela A. De Guzman, Sheila N. Malapi, Emmalyn E. Quibote

The Qualitative Report

In this phenomenological study, we offer an insightful understanding of the lived experiences of seven (7) Filipino elderly participating in craft-making. We purposively selected the key informants from a municipality in the province of Bulacan, Philippines. The transcribed data gathered through a semi-structured in-depth interview was analyzed using Colaizzi’s approach. Six themes describing the lived experiences emerged: “Fostering friendship,” “Flourishing health,” “Furthering service,” “Facing aging with acceptance,” “Finding felicity and self-fulfillment,” “Feelings of belongingness and security.” Just like the sun, the elderly’s participation in craft-making serves as a nourishment for them. This exploration speaks to understanding the potential of craft-making …

Active Ageing In Pakistan: Challenges And Opportunities, Samina Vertejee, Noureen Nasruddin Karamali

Samina Vertejee

Abstract

The increasing number of ageing population is a signpost for re-directing the resources to ensure quality of life for elderly thus promoting active ageing. However, the challenges to achieve the goal outweigh the opportunities due to scarcity of resources. Several factors including, brain drain, poverty, lack of knowledge of elderly to protect their rights in association with poor state laws determines the poor quality of life for elderly in Pakistan. Although, the apparent scenario is quite unpleasant yet there are several opportunities such as improved crude birth and death rates, increased awareness about gerontology as a specialty care area …

A Descriptive Study Of The Elderly In California Substance Abuse Treatment Programs, David Berenschot

Electronic Theses, Projects, and Dissertations

As gerontologists may know, there are a great deal of studies and a variety of academic literature on the misuse of alcohol and prescription medication amongst the elderly population. While there is a plethora of information on alcohol and prescription misuse, there is little reported data about the prevalence of other substance misuse experienced by this population. This study aims to help to fill that gap in the data by using quantitative methods to describe the scope of substance abuse of individuals 55-years or older. This study utilizes data from the Treatment Data Set Admission (TEDS-A). The TEDS-A is a …

Evaluating The Likelihood Of Use Of Bispectral Index Guided Anesthesia As A Strategy To Reduce Postoperative Delirium In Surgical Patients 65 Years Of Age Or Older, Simon Jack Gibson

Doctoral Projects

Postoperative delirium (POD) is the most common postoperative complication in the elderly, accounting for approximately $164 billion in costs per year in the United States (Inouye, Westendorp, & Saczynski, 2014, p. 911). This complication occurs in as many as 50% of elderly patients, but can be prevented as much as 40% of the time (Inouye et al., 2014). The use of processed encephalographic monitoring, such as Bispectral Index (BIS) monitoring, to guide anesthetic dosage is the single intraoperative intervention with enough evidence to support it as a recommendation for use to reduce POD (American Geriatrics Society, 2015). There were two …

A Systematic Review Of Recruitment For Older Chinese Immigrants Into Clinical Trials, Wen-Wen Li, Yuaner Wu, Angela Chia-Chen Chen

Asian/Pacific Island Nursing Journal

Purpose: To identify barriers and discuss strategies for recruitment of older Chinese immigrants into clinical research studies.

Methods: A systematic review was conducted using Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). PubMed, WEB of Science, CINAHL Plus, and the Cochrane Central Register of Controlled Trials were searched from 2001 to 2014. Empirical studies with Chinese immigrants aged 60 or older were identified and analyzed. Numerical analysis, such as calculation of response rates as indexes for recruitment outcomes, was conducted. Content analyses for recruitment barriers were abstracted.

Results: Thirteen studies of 4753 subjects were analyzed. Response rates ranged from …

A Structured Telephonic Transition Program For Heart Failure Patients, Julia E. Robinson

Doctor of Nursing Practice Final Manuscripts

HF is a fatal condition affecting more than 5 million Americans leading to frequent hospitalizations, poor quality of life and death. The annual cost to the healthcare system is approximately $38 billion, ranking HF as one of the costliest conditions to manage. Significant evidence exists that HF self-care management programs improve patient self-care and decrease HF-related readmissions. Current guidelines recommend health professionals provide comprehensive HF education focused on knowledge, skills of management, and self-care behaviors.

The Iowa Model of Evidence Based Practice provided the foundation for the practice change. Structured telephonic support (STS) was based on Bandura’s Self- Efficacy behavior …