Journal: Nursing older people
CHIEF MEDICAL officer Dame Sally Davies has called for an investigation into the possible link between deafness, blindness and dementia, after the publication of her annual report on the state of the public’s health.
Joint contractures, or limitations in the full range of movement of joints, are common in older people living in long-term care settings. They result in physical discomfort, social isolation, loss of independence and increased staffing demands. Studies conclude that the prevention of contractures should be the first line of treatment. This article aims to raise awareness of contractures in older people living in nursing homes and individualised preventive strategies that can be used by nursing staff such as maintaining functional ability, risk identification, stretching and correct bed and seating position.
Dehydration is prevalent in hospitalised older people and residents in care homes, and older people with dementia are particularly at risk. A literature review was conducted to determine the evidence-based interventions used to prevent and manage dehydration in older people with dementia. Three databases were searched for relevant literature: Applied Social Sciences Index and Abstracts, Cumulative Index to Nursing and Allied Health Literature, and MEDLINE, alongside hand-searching. In-depth reading of the 12 studies included in this literature review was undertaken. Five themes were identified in relation to the hydration of older people: physical and social environment; staff communication strategies; access to drinks; drinking vessels; and individual preferences. The evidence suggests that dehydration in older people with dementia is an ongoing concern that needs to be addressed. There is evidence supporting the use of essential nursing interventions to improve hydration, such as coloured cups and verbal prompts, but less is known about the barriers preventing nurses from implementing these evidence-based interventions.
Advanced clinical practitioners (ACPs) are master’s-level educated, experienced and competent nurses or allied healthcare professionals who practise a high degree of autonomy and undertake complex decision-making. This article offers a reflective account of advanced clinical practice in an older person’s unit specialising in rehabilitation and complex discharge planning. It illustrates how ACPs work autonomously with medical colleagues to provide patient-focused care, enhance the multidisciplinary team and provide safe, high-quality care. The article also describes various aspects of the role for nurses or allied healthcare professionals who might consider this career path.
The general population is now living longer, with increasing numbers of older people living with more than one long-term condition. The number of older people diagnosed with type 2 diabetes is also rising because of the changes resulting from the ageing process and the significant increase in obesity levels, which are affecting the provision of healthcare and individuals' quality of life. This article explores the implications of increased longevity and how this is linked to the development of type 2 diabetes. It explains how the presentation of type 2 diabetes differs in older people compared with younger people, making initial diagnosis increasingly challenging. Frailty and anti-diabetes medicines can affect quality of life and an older person’s risk of falls; therefore, linked to these, the article details the effects of declining functional ability and increasing cognitive impairment, and emphasises the need for regular medication reviews. The article also provides an analysis of the care required for older people with type 2 diabetes living in care homes, including the need for flexibility in treatment targets.
This is the first article in a six-part series in Nursing Older People exploring the nursing care of people living with advanced dementia. This article discusses the changes that may occur as dementia progresses, from the perspective of the individual, their family and other carers. A person living with advanced dementia is likely to experience physical, cognitive and social changes that can be profound and debilitating. Healthcare needs intensify as new and co-existing issues result in increasing dependency on others for support with activities of daily living. These activities can include eating, drinking, mobility and personal care. Consequently, family carers may find their role has to develop and change to provide increasing support in response to these complex needs. These increasing needs can result in care transitions to hospitals or care homes. Careful and collaborative management of care is crucial to maintain quality of life for the person with dementia and family carers.
Twenty four-hour postural care that includes the use of night-time positioning equipment (NTPE) is being increasingly recommended. However, because most of the published studies focus on children, there is a lack of evidence on the use of NTPE in adults.
With an increasingly ageing population comes a greater risk of frailty, a distinct health state in which multiple body systems gradually lose their inbuilt reserves. The ability to recognise important frailty markers and conduct specialist comprehensive assessments of potentially frail older people admitted to acute hospitals is important to improve their health and well-being. This article explores the role of the advanced nurse practitioner (ANP) in identifying frailty and leading comprehensive geriatric assessment (CGA) for older people admitted to acute hospital settings. A small evaluation of CGA led by an ANP in a district general hospital found that a well-rounded assessment of patients living with frailty could be carried out, and that such assessments reduced unscheduled readmission within 28 days of discharge and overall length of hospital stay by six days. In a challenging climate, in which healthcare services seek to deliver effective and efficient care to the frail older population, ANPs can ensure a timely and specialist approach to CGA.
Delirium is a common neuropsychiatric disorder that all those working with older people will have encountered at some stage. Delirium is often poorly identified in hospital settings and therefore not optimally managed. After data collection on the acute medical unit in an acute hospital trust in the UK it was evident that patients with signs of delirium were not being formally assessed and therefore not appropriately managed in many cases. A quality improvement project introduced the 4AT delirium assessment tool to try to ensure that patients with delirium were being identified. The project team carried out several plan-do-study-act cycles to bring about our changes, which included a 4AT assessment sticker for nursing staff to complete and teaching for all healthcare staff. Through involvement of all members of the multidisciplinary team and ongoing feedback and changes we were able to increase assessment of delirium from 0% to 64%. There is ongoing work to be done to continue to improve delirium management, but by initially improving the assessment and identification of delirium we will make a difference to these patients' outcomes.
Early identification of frailty at the front door of the acute hospital is vital to allow rapid comprehensive geriatric assessment and care pathway development in the most appropriate location. This article discusses the importance of developing robust processes to enable early identification and management of frailty in the acute hospital. It also highlights the benefits of developing a dynamic team of professionals at the front door of the acute hospital who are effectively trained to undertake comprehensive assessment. Effective care planning for older people with frailty requires meticulous coordination through collaboration across health and social care and this is demonstrated using an effective model which has been developed in a district general hospital in Scotland.