Geriatric Nursing Commons^™

A Quality Improvement Initiative Utilizing Help To Reduce Delirium, Improve Patient Outcomes, And Provide Age Friendly Care For Patients 65 Years Of Age Or Older With Modifiable Delirium Risk Factors., Maggie Blake

Doctor of Nursing Practice (DNP) Manuscripts

Background: Delirium, an acute change in cognition, occurs in 21% of hospitalized patients and is linked to increased length of stay, readmissions, and increased mortality (Shen et al., 2024). In older adults, delirium prevalence increases and is linked to poor outcomes that inhibit patients' health care goals (Shen et al., 2024). Despite the well-published harms of delirium and standardized prevention measures, delirium prevention is not prioritized. Methods: HELP, originally the Hospital Elder Life Program, now preferred to be known as HELP, is a standardized delirium prevention model specifically designed to address the unique needs of hospitalized older adult patients. HELP …

Falling Star Program: A Visual Cue Intervention To Reduce Falls In Long-Term Care, Maggie Shanahan

Evidence-Based Practice Project Reports

Falls among older adults in skilled nursing and long-term care settings remain a leading cause of injury, functional decline, and increased healthcare utilization, contributing significantly to morbidity and mortality in this population (Centers for Disease Control and Prevention [CDC], 2023; Agency for Healthcare Research and Quality [AHRQ], 2022). The primary purpose of this project aimed to implement and evaluate a structured visual cue–based fall prevention intervention to reduce fall rates among high-risk residents in a long-term care facility in Northwest Indiana. The project included 23 participants aged 65 years and older who were identified as high risk for falls. Using …

Wellness In Motion: A Quality Improvement Initiative To Support Resident Mobility And Reduce Falls., San N. Pham

Master's Theses and Capstones

Background: Falls are a significant concern in community living centers for older adult veterans. Promoting physical activity and resident engagement is crucial for reducing fall risk among this population.

Local Problem: A specific microsystem within this setting has a fall rate of 3 falls per month. This discrepancy underscores the need for targeted interventions to effectively address this issue.

Methods: This study measured key metrics related to falls and resident engagement in mobility programs both before and after the implementation of an exercise program within the microsystem.

Intervention: The "GIMME 10" exercise program, grounded in evidence-based practices and emphasizing resident-centric …

Improving Nursing Staff Knowledge For Management Of Geriatric Patients With Confusion In The Emergency Department, Kareem G. Carter

Master's Projects and Capstones

Problem: Staff knowledge of effective management of confusion in geriatric patients (>65yo) may be limited and inconsistent with the current goal of establishing a geriatric-friendly Emergency Department (ED) Model of Care. Suboptimal management of this patient population can result in prolonged ED stays, which increases the cost to the hospital and the patient (Han & Wilber, 2013).

Context: An Emergency Department at a large Bay Area urban hospital hopes to obtain Geriatric Emergency Department Accreditation (GEDA) through the American College of Emergency Physicians (ACEP).

Interventions: Create a simplified checklist for nursing staff using mnemonic devices to …

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 …

Mental Health Effects Of The Covid-19 Pandemic On Older Adults, Elizabeth Kerr

Dissertations

Problem: Significant psychological effects such as anxiety, depression, stress, and loneliness are shown to affect the older adult population, aged 65 years and older. The social isolation and disconnectedness related to the COVID-19 pandemic potentially worsens anxious and depressive feelings, increasing the risk for adverse outcomes in the high-risk older adult population. This project aimed to identify older adults at risk for acute, situational mental health issues associated with the pandemic.

Methods: A descriptive study design was used. Telephone interviews were conducted to explore effects of the COVID-19 pandemic on mental health responses in older adults. A convenience sample …

Can Nurses Predict Transitions Of Care In Assisted Living?, Emma M. Blair

Honors Theses and Capstones

The older adult population is rising exponentially due to medical advances and the aging of the Baby Boomer Population (Wister, 2005). Many of these older adults are choosing to live in assisted living facilities due to the increased independence and decreased cost of living compared to nursing homes (Grabowski, Stevenson, & Cornell, 2012). Since nurses are the primary directors of care for those in assisted living, the question was asked if they can predict a resident’s length of stay based on their knowledge and clinical judgement. A prospective study was performed at an assisted living facility in Oakland, California to …

Creating A Quality Improvement Toolkit To Identify & Address Gaps In The Care Of Older Adults With Hip Fracture, Amanda J. Covell

Doctoral Projects

Introduction: Traumatic hip fracture remains a major cause of disability, decline, and mortality for adults over 65. Gaps remain in the consistency of care and services hip fracture patients receive during hospitalization and post-discharge, leading to adverse outcomes, including MI, surgical site infection, poorly managed pain, and increased mortality. To help address these inconsistencies, the AAOS released updated clinical practice guidelines for management of hip fracture care in the elderly in 2014. These guidelines examine the entire hospitalization process for this population and set forth evidence-based standards to assist with improving outcomes for hip fracture patients.

Objectives: Five of the …

Delirium In Long Term Care Rehabilitation Residents: A Correlational Retrospective Study, Rebecca Lerma-Kjonegaard

Dissertations

Abstract Background: Delirium is associated with devastating outcomes, cognitive loss,

decreased function and an increase risk of mortality which affects patients and places a heavy burden on family and the healthcare system. The purpose of this study was to describe the relationship between select demographics, clinical characteristics, CHART- DEL-derived delirium diagnosis and ICD-10 coded discharge delirium diagnoses among Long Term Care (LTC) rehabilitation residents.

Method: A retrospective correlational design from174 LTC rehabilitation residents age 65 years or older using EMR and hard copy charts. The setting was a Southern California community hospital-based 100-bed LTC. Abstracted data included demographic characteristics (age, …

Exercises For Older Adults With Knee And Hip Pain, Neil E. Peterson, Kay D. Osterloh, M. Nichole Graff

Faculty Publications

Half of all older adults report knee and/or hip pain. Obesity and sedentary lifestyle contribute to the incidence and prevalence of painful knee and hip conditions. Weight loss should be a priority in overweight or obese patients. Improving joint function over time requires a balance of rest and usage. Practitioners should assess joint disorders and recommend exercises for reducing knee and hip pain with patients when appropriate. Instruction should include a combination of 1) stretching and flexibility, 2) strength training, and 3) endurance conditioning exercises. Even small improvements in exercise can make meaningful improvements in pain, movement, endurance, and quality …

The Effects Of Post-Discharge Phone Calls On 30-Day Readmission Rates In The Older Adult Population, Amy Salyer

DNP Projects

Abstract

Objective: The purpose of the project is to develop a specialized and evidenced-based transitional care program including post-discharge phone calls for the older adult population within the University of Kentucky Good Samaritan Hospital system.

Background: Problems in the post-discharge period such as failure to communicate/understand discharge instructions appropriately and lack of timely follow-up appointment with primary care physician lead to increased readmission rates. Utilizing post-discharge phone calls will facilitate prompt communication with the patient after discharge ensuring full understanding of the plan of care.

Aim: Assess the readmission rates of those who received post-discharge phone calls compared to those …

Older Adults’ Response To Adverse Opioid Related Events: A Secondary Analysis, Sarah R. Coughlin

Honors Scholar Theses

Background: Many older adults suffer from chronic pain, a disease treated with opioids. Older adults are also highly susceptible to opioid ADEs. Research addressing older adults’ self-management of opioid ADEs is lacking.

Objectives: This study compared the opioid ADE profile found by the present research to those previously reported in the literature for older adults. It also described how older adults respond to opioid ADEs and the resulting outcomes.

Method: The study utilized a secondary analysis design to examine 15 opioid ADE cases from a pilot study that described older adults’ responses to analgesic ADEs.

Results: Neurological ADEs, including dizziness …

Evaluation Of Serum Vitamin D Levels In Older Adults Who Fall And Sustain A Fracture: A Retrospective Chart Review, Suzanne L. Pilon

DNP Projects

Purpose: This practice inquiry project was designed to (i) evaluate serum vitamin D levels in individuals aged 65 years and older who had fallen and sustained a fracture and (ii) identify if the serum vitamin D levels were within therapeutic range.

Background: Older adults are at increased risk of falling and sustaining a fracture as a result of falls. Vitamin D has been shown to be effective in fall prevention yet vitamin D is deficient in the older population worldwide. Evaluating current serum vitamin D levels in older adults who fall and sustain a fracture may provide additional insight in …

The Effects Of 12 Weeks Of Instructor-Led Yoga Classes On Balance In Older Adults, Patricia C. Hart

Evidence-Based Practice Project Reports

Participation in a regular exercise program is an effective way to reduce and/or prevent a number of functional declines associated with aging (Chodzko-Zajo et al., 2009). Older adults are advised to participate in regular aerobic activity and practice muscle strengthening activities and exercise that maintains or improves balance (U.S. Department of Health and Human Service, [USDHHS], 2012). Less than one third of older adults engage in 30 minutes of low to moderate intense physical activity at least five days a week as recommended in current guidelines (USDHHS, 2012), and these guidelines fail to address losses in strength and flexibility seen …