Technology has expanded genomic research and the complexity of extracted gene-related information. Health-related genomic incidental findings pose new dilemmas for nurse researchers regarding the ethical application of disclosure to participants. Consequently, informed consent specific to incidental findings is recommended. Critical Social Theory is used as a guide in recognition of the changing meaning of informed consent and to serve as a framework to inform nursing of the ethical application of disclosure consent in genomic nursing research practices.
A secondary data analysis of 25,560 minutes of structured clinical observations from a longitudinal study examined the impact of time-varying background factors, social environment, and psychotropic medication use on behavioral symptoms of nursing home residents with Alzheimer's disease (AD). Data were collected at baseline (N = 177), 12 months (N = 138), and 24 months (N = 111). Mixed-effects regression modeling showed that at 24 months: (a) higher cognitive and physical function and having a private bedroom/bathroom had the most positive influence on resident positive behaviors; (b) use of antipsychotic medications and solitary activities had the most negative influence on resident positive behaviors; (c) higher cognitive function significantly decreased negative behaviors; and (d) care-related activities and total number of psychotropic medications significantly increased negative behaviors. The current study describes risk factors for behavioral disturbances and the impact of activities, social environment, and psychotropic medications on behavioral outcomes in nursing home residents with AD. [Journal of Psychosocial Nursing and Mental Health Services, 56(11), 18-26.].
At an advanced age, serious medical and psychiatric illnesses frequently coalesce. Often, the need for admission to inpatient geriatric psychiatric care arises from coexisting medical problems. While cognitive and behavioral interventions are important, the complexity of physical comorbidities usually becomes the focus of hospitalization and requires intensive medical treatments. This paper describes adaptations made in one metropolitan geriatric psychiatry unit in order to better treat complex patients who experience both medical and psychiatric illness. The need for all members of the interdisciplinary team to expand their practice and the importance of complementary approaches of psychiatry and medicine are emphasized.
Family caregiving is a growing public health concern and caregivers of persons with Alzheimer's disease or other related dementias (ADRD) need appropriate, timely, and ongoing education and support to successfully meet their caregiving responsibilities. Well-designed interventions can significantly reduce risk concerning caregiver mental and physical health, and improve care recipient outcomes. Few interventions are translated into everyday practice; and most rely on in-person, professionally-led delivery methods, making them inaccessible to many family caregivers.The product developed and tested in this pilot study included six evidence-based Caregiver Skill Building Intervention (CSBI) modules, available via a web-based online format for ADRD caregivers. On-demand interactive training modules made up an integrated web-based product that taught family caregiver skills concerning how to care for their impaired family member. Product strengths include: a) an evidence-based intervention, developed from a prior group-based randomized clinical trial (RCT); b) a focus on caregiver management skill, rather than merely teaching facts; c) an interactive approach, enabling caregivers to apply information to realistic scenarios and receive immediate feedback to their responses; d) content which addresses key caregiving topics; and e) a convenient approach, available 24 hours/day/7 days/week from any location with internet access.The project enrolled 100 family caregivers and established feasibility of translating an RCT group intervention to an individualized web-based format. Caregivers positively evaluated this eLearning process (n=53); significantly increased caregiving skill at 6-and 12-weeks, (p=0.01 and 0.05, respectively); and improved caregiver depressive symptoms (p=0.01) and positive affect (p=0.05) at six weeks.
More than 54 million people in the United States are aged ≥65 years, including an estimated 2.4 million people who identify as lesbian, gay, bi-sexual, transgender, or queer (LGBTQ). As a group, LGBTQ older adults experienced criminalization, discrimination, and social stigma the majority of their lives, with rates of victimization and stigma increasing with age. LGBTQ older adults continue to experience social and health disparities compared to heterosexual individuals. To meet the needs of LGBTQ older adults, it is necessary to understand the impact of politics, culture, and social norms as they came of age. Unique mental health needs, such as social isolation, loneliness, disenfranchised grief, and long-term social support, are discussed through the lens of the minority stress model. Implications and recommendations for health care, research, and policy, such as creating a safe and welcoming environment and providing culturally competent care for LGBTQ older adults, are discussed. [ Journal of Psychosocial Nursing and Mental Health Services, 60 (4), 7–10.]
Through pharmacogenomics testing, identifying genetic variants that influence how individuals respond to medications could potentially decrease the “trial and error” approach to prescribing medications, maximize beneficial effects, and reduce risks of adverse drug events. Yet, pharmacogenomics testing is still subject to an ongoing debate over its clinical validity and utility. The purpose of the current integrative review was to examine and synthesize evidence on the clinical application of pharmacogenomics in medication management among older adults. Gaps were found, such as lack of studies investigating the prospective use of pharmacogenomics testing to improve clinical outcomes and lack of strong evidence on the clinical validity and utility of pharmacogenomics testing in the medication management of older adults. However, the review identified evidence for the potential benefits of pharmacogenomics testing to improve older adults' clinical outcomes that warrant further investigation. [ Research in Gerontological Nursing, 14 (4), 211–220.]
Recruitment of dementia caregivers whose family members reside in long-term care facilities (LTCFs) poses unique challenges as it traditionally relies on the assistance of facility administrators. The purpose of this presentation is to examine and evaluate new recruitment strategies to determine their effectiveness in an ongoing Stage I randomized clinical trial testing the effects of a Chronic Grief Management Intervention, Video-streamed (CGMI-V) on caregivers’ mental health (grief, depression, anxiety) and facility-related outcomes (conflict with staff, satisfaction with care). A total of 144 caregivers will be randomly assigned to the CGMI-V or to the minimal treatment conditions. The initial recruitment plan was to build on already-established relationships with more than 35 LTCFs that helped recruit in a previous study. The usual approach was to offer written materials and onsite presentations about the study to facility staff and to dementia family caregivers of facility residents. Within the first six months, recruitment efforts yielded less than a dozen participants, thus we had to refine our approach. Revised recruitment strategies included the adoption of resources from the National Institute on Aging’s ADORE (Alzheimer’s and Dementia Outreach, Recruitment, and Engagement) and ROAR (Recruiting Older Adults into Research) platforms. This new approach included online study advertising on NIH and Alzheimer’s Association research study repositories and advertising on parent institution’s on-hold messaging system. Adoption of these new strategies is yielding an increase in participant screening and enrollment. Results are pending.
situation of interaction between staff and elderly people with moderate Alzheimer-type dementia was as follows: (1) staff member suggests, "Shall we go to a nice place?" (proposal), (2) elderly person shows interest in staff member, (3) staff member takes seated elderly person's hand (invitation), (4) elderly person stands up (consent), (5) staff member opens toilet door and says "Please go ahead" (invitation), (8) elderly person enters toilet alone and empties bladder (maintaining toileting behavior). Inherent in this interaction are rules of daily conversation involving established chains of utterances that lead up to the invitation and the elderly people responding to the proposals and invitations of staff in a response prioritization system (prioritizing consent and avoiding rejection as responses to proposals and invitations). Also, in other situations, elderly people did not reject the proposals or invitations of staff members. Conclusions: The study suggests that the use of response prioritization systems and established chains are effective as communication skills to elicit the maintenance of daily life behaviors among elderly people with moderate Alzheimertype dementia.Background: Up to 90% of persons with dementia experience negative/disruptive behavioral symptoms such as agitation and aggression at some point during the course of the illness. These symptoms could result from many factors; and misinterpreting these factors could lead to ineffective interventions. It is imperative to understand what factors greatly influence behavioral symptoms. This study described the associations between background factors (demographics, cognitive function, physical function) and proximal factors (activities, social environment, psychotropic medication) with positive/functional behaviors and negative/disruptive behaviors in nursing home residents with dementia. Methods: The Need-driven Dementia-compromised Behavior Model guided secondary analyses of clinical and observational baseline data of a 3-year longitudinal study. Participants included 177 residents with dementia living in two nursing homes. Measures included: MMSE (cognitive function), Performance of ADLs (physical function) and number of psychotropic medications used. Trained observers completed 60 5-minute direct observation sessions on each resident over 12 consecutive weekdays between 9:00 a.m. to 9:00 p.m. using a structured time-sampling technique. A total of 10,620 observation sessions were completed for 177 participants. Observations included behaviors (positive/functional, negative/disruptive) and context of behavior (type of activity engaged in, social environment [location, type of individuals, proximity of others]). Frequency of behaviors were summed and grouped into positive/ functional and negative/disruptive behaviors. Results: Regression analyses with stepwise modeling showed that: 1) Better cognitive
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