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.
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.
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.]
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