AJN’s monthly news section covers timely and important research and policy stories that are relevant to the nursing world. Here are some of the stories you’ll find in our current issue (news articles in AJN are free access):
President Obama signs the Clay Hunt Suicide Prevention for American Veterans Act on Feb. 12, 2015. Photo © Associated Press.
A colleague once remarked, “Isn’t it strange that the universal response to hearing that someone has gone into a nursing home is ‘Ugh’?” As nurses, we might hazard a guess as to what kind of care the new resident may receive. But is there a way to reenvision the care that we provide in nursing homes?
In AJN‘s April Viewpoint essay, NP Heather Walker argues that there is, and that quality improvement (QI) can be an effective tool for change. Walker suggests that QI can do for nursing homes what it has done for acute care: focus attention on the systemic issues that stand in the way of good nursing. As she says in the article,
“QI doesn’t negate personal responsibility, but it broadens the focus so that systemic problems are taken into account.”
The QI process fosters reflection, accountability, and teamwork, which in themselves can improve the work environment and residents’ living experience. For more information about this approach, read the short article, here.—Betsy Todd, AJN clinical editor, MPH, RN, CIC
Signs and Symptoms of Heat Illness
Older adults tend to be more vulnerable than younger adults in a number of ways, one of which is in their reaction to intense heat.
Given the increase in extreme weather events in recent years, an article that we published a few years back, “Heatstroke in Older Adults” (free until September 1), is as timely now as ever. A high percentage of heat-related deaths in the U.S. occur among people who are 65 or older. Here are some of the reasons:
Older adults’ normal temperature-regulating processes may be impaired by illnesses such as diabetes or cardiovascular disease or by medications such as vasoconstrictors or diuretics, leaving them more vulnerable to heat exhaustion, which can progress to heatstroke, a far more dangerous condition. Those who are immobilized or suffer from disorientation secondary to dementia may fail to recognize dangerous symptoms or to drink appropriate types and amounts of fluids or move to a cooler location. Isolation, which is also frequently associated with heat injury, is common among older adults, particularly in cities, which are more susceptible to extreme heat waves because they create ‘heat islands,’ where surface and air temperatures are as much as 10°F higher than those in surrounding areas.
This short article gives nurses essential information on:
By Sylvia Foley, AJN senior editor
‘Mourning Old Man’ by Vincent Van Gogh
“It is a misconception that depression is a normal, inevitable part of aging; it is not,” writes author Cynthia Cahoon in this month’s CE, “Depression in Older Adults.” Depression affects an estimated 15% to 19% of Americans ages 65 and older living in a variety of settings, yet it often goes unrecognized and untreated. Granted, recognition can be challenging, in part because many symptoms of depression are also common to other illnesses seen in older adults. As Cahoon points out, though, there is also “abundant evidence that depression in older adults is treatable, perhaps in as high as 65% to 75% of cases.”
The article provides an overview of depression in older adults and outlines its pathophysiology and disease types. Known risk factors for this population include the following:
According to Cahoon, a majority of adults with depression will present for treatment of physical conditions, rather than for a mood disorder. So it’s important to assess each patient’s mood, regardless of presenting symptoms. Several brief, validated screening tools exist, and busy nurses have several options. One tool, the Whooley Depression Screen, takes less than five minutes to administer and asks just two questions:
1. During the past month, have you often been bothered […]
By Sylvia Foley, AJN senior editor
Frank Jones, age 83, arrives at a local trauma center after falling down a flight of stairs in his home. Initially diagnosed with two fractured ribs, a fractured ulna, and a fractured tibia, he’s admitted to the ICU. At first, things seem to go well—his electrolytes and bloodwork appear to be within normal limits, and his vital signs are stable. But the next day he becomes increasingly unstable. What’s going on?
Trauma is currently the seventh leading cause of death in older adults—and older adults are more likely to suffer complications and die than are younger ones. But as author Christine Cutugno points out in this month’s CE, “The ‘Graying’ of Trauma Care: Addressing Traumatic Injury in Older Adults,” advanced age isn’t a predictor of trauma outcome. Many trauma-related complications are preventable.
What guides current care? While standards of care for geriatric patients and for trauma patients exist, as yet none have been specifically developed for and tested in geriatric trauma patients. Until that happens, Cutugno writes, “nurses will need to be guided by measures known to prevent iatrogenic complications in other patient populations.”
To that end, Cutugno first reviews common mechanisms of traumatic injury in older adults and discusses the effects of aging and comorbidities. She […]