Journal of Gerontological Nursing

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JGN Editor Kathleen C. Buckwalter, PhD, RN, FAAN, Accepts the American Psychiatric Nurses Association’s Psychiatric Nurse of the Year Award.© American Psychiatric Nurses Association

Journal of Gerontological Nursing (JGN) Editor Kathleen C. Buckwalter, PhD, RN, FAAN received the American Psychiatric Nurses Association’s (APNA) most distinguished award in October during APNA’s annual conference in Louisville. Dr. Buckwalter was named the APNA Psychiatric Nurse of the Year for demonstrating vision, perseverance, dedication, initiative, and facilitation in the delivery of mental health services to individuals, families, and their communities. According to the nomination guidelines, the recipient of this award must provide creative solutions, exhibit and encourage risk taking, challenge traditional roles and perspectives of psychiatric-mental health nursing, champion the facilitation of mental health services, disseminate psychiatric-mental health nursing knowledge, and be recognized as a leader committed to assisting other psychiatric-mental health nurses. When asked by the APNA panel on which of her projects she feels is most indicative of what she has tried to accomplish throughout her career, Dr. Buckwalter named the Mental Health of the Elderly project, which sought to bring mental health services, via an interdisciplinary team, to homebound older adults living in rural areas and in need of community services and psychosocial support and treatment.

Dr. Buckwalter is currently a Sally Mathis Hartwig Professor of Gerontological Nursing Research and Director of the John A. Hartford Center of Geriatric Nursing Excellence at The University of Iowa College of Nursing in Iowa City. JGN congratulates its Editor on this outstanding honor.

After 7 years in the making, researchers at the University of Texas (UT) Southwestern Medical Center at Dallas have created an experimental vaccine against beta-amyloid, the small protein that forms plaques in the brain and is believed to contribute to the development of Alzheimer’s disease.

Compared with similar so-called DNA vaccines the UT Southwestern researchers tested in an animal study, the new experimental vaccine stimulated more than 10 times as many antibodies that bind to and eliminate beta-amyloid. The results appeared in the journal Vaccine.

A traditional vaccine—an injection of beta-amyloid protein itself into the arm—has been shown in other research to trigger an immune response, including the production of antibodies and other bodily defenses against beta-amyloid. However, the immune response to this type of vaccine sometimes caused significant brain swelling. UT Southwestern’s new DNA vaccine does not contain beta-amyloid itself but instead a piece of the beta-amyloid gene that codes for the protein. In the current study, the researchers coated tiny gold beads with the beta-amyloid DNA and injected them into the skin of the animals’ ears. Once in the body, the DNA stimulated an immune response, including antibodies to beta-amyloid.

Future studies will focus on determining the safety of the vaccine and whether it protects mental function in animals.

Source.“UT Southwestern Researchers Create Experimental Vaccine Against Alzheimer’s.” (2010, October 12). Retrieved October 25, 2010, from http://www.eurekalert.org/pub_releases/2010-10/usmc-usr100810.php.

The results of a groundbreaking long-term study may change the way blood pressure (BP) medication is administered and affect the type of treatment hypertension patients receive. Two articles published in Chronobiology International cover and interpret the newly completed MAPEC study (Ambulatory Blood Pressure Monitoring in the Prediction of Cardiovascular Events and Effects of Chronotherapy), which shows that a shift to taking medication at night instead of in the morning significantly increases efficacy in keeping BP within a healthy range. In addition, taking medication at night offers extra protection against heart attacks, strokes, and other types of cardiovascular diseases.

Over the 5-year study, the group of patients who took at least one of their medications at night experienced just one third of the number…

JGN Editor Named Psychiatric Nurse of the Year

JGN Editor Kathleen C. Buckwalter, PhD, RN, FAAN, Accepts the American Psychiatric Nurses Association’s Psychiatric Nurse of the Year Award.© American Psychiatric Nurses Association

JGN Editor Kathleen C. Buckwalter, PhD, RN, FAAN, Accepts the American Psychiatric Nurses Association’s Psychiatric Nurse of the Year Award.© American Psychiatric Nurses Association

Journal of Gerontological Nursing (JGN) Editor Kathleen C. Buckwalter, PhD, RN, FAAN received the American Psychiatric Nurses Association’s (APNA) most distinguished award in October during APNA’s annual conference in Louisville. Dr. Buckwalter was named the APNA Psychiatric Nurse of the Year for demonstrating vision, perseverance, dedication, initiative, and facilitation in the delivery of mental health services to individuals, families, and their communities. According to the nomination guidelines, the recipient of this award must provide creative solutions, exhibit and encourage risk taking, challenge traditional roles and perspectives of psychiatric-mental health nursing, champion the facilitation of mental health services, disseminate psychiatric-mental health nursing knowledge, and be recognized as a leader committed to assisting other psychiatric-mental health nurses. When asked by the APNA panel on which of her projects she feels is most indicative of what she has tried to accomplish throughout her career, Dr. Buckwalter named the Mental Health of the Elderly project, which sought to bring mental health services, via an interdisciplinary team, to homebound older adults living in rural areas and in need of community services and psychosocial support and treatment.

Dr. Buckwalter is currently a Sally Mathis Hartwig Professor of Gerontological Nursing Research and Director of the John A. Hartford Center of Geriatric Nursing Excellence at The University of Iowa College of Nursing in Iowa City. JGN congratulates its Editor on this outstanding honor.

Alzheimer’s Vaccine Shows Promise in Animal Tests

After 7 years in the making, researchers at the University of Texas (UT) Southwestern Medical Center at Dallas have created an experimental vaccine against beta-amyloid, the small protein that forms plaques in the brain and is believed to contribute to the development of Alzheimer’s disease.

Compared with similar so-called DNA vaccines the UT Southwestern researchers tested in an animal study, the new experimental vaccine stimulated more than 10 times as many antibodies that bind to and eliminate beta-amyloid. The results appeared in the journal Vaccine.

A traditional vaccine—an injection of beta-amyloid protein itself into the arm—has been shown in other research to trigger an immune response, including the production of antibodies and other bodily defenses against beta-amyloid. However, the immune response to this type of vaccine sometimes caused significant brain swelling. UT Southwestern’s new DNA vaccine does not contain beta-amyloid itself but instead a piece of the beta-amyloid gene that codes for the protein. In the current study, the researchers coated tiny gold beads with the beta-amyloid DNA and injected them into the skin of the animals’ ears. Once in the body, the DNA stimulated an immune response, including antibodies to beta-amyloid.

Future studies will focus on determining the safety of the vaccine and whether it protects mental function in animals.

Source.“UT Southwestern Researchers Create Experimental Vaccine Against Alzheimer’s.” (2010, October 12). Retrieved October 25, 2010, from http://www.eurekalert.org/pub_releases/2010-10/usmc-usr100810.php.

Hypertension Meds May Work Better at Night

The results of a groundbreaking long-term study may change the way blood pressure (BP) medication is administered and affect the type of treatment hypertension patients receive. Two articles published in Chronobiology International cover and interpret the newly completed MAPEC study (Ambulatory Blood Pressure Monitoring in the Prediction of Cardiovascular Events and Effects of Chronotherapy), which shows that a shift to taking medication at night instead of in the morning significantly increases efficacy in keeping BP within a healthy range. In addition, taking medication at night offers extra protection against heart attacks, strokes, and other types of cardiovascular diseases.

Over the 5-year study, the group of patients who took at least one of their medications at night experienced just one third of the number of cardiovascular disease (CVD) episodes experienced by the group of patients who took all their medications in the morning.

Taking at least one BP medication at bedtime, as opposed to taking all medications in the morning, was found—based on around-the-clock ambulatory BP monitoring—to best normalize the sleep-time BP, known to be the most sensitive predictor of a patient’s 5-year risk of CVD mortality. In addition, the MAPEC study shows that taking medication at night is the best way to control daytime BP levels. The study also highlighted the importance of knowing a patient’s sleep-time BP readings.

Using their findings, the research team members proposed the following steps:

  • 24-hour ambulatory BP monitoring should be the proper means of differentiating the needs of BP patients and the only means of categorizing patients as non-dippers (i.e., patients whose sleep-time BP levels do not drop 10% to 20% from daytime levels) in the 24-hour pattern. It is also the best means of confirming that treatment goals of BP control are met, which include ensuring that sleep-time BP levels are in the correct range.
  • Elevated sleep-time BP should be made an important new therapeutic clinical target for medications.
  • Prescribing that hypertension medications be taken at night offers an inexpensive and highly efficacious means of controlling BP without the need to increase either the dosage or number of medications.

Source.“Blood Pressure Pills More Effective When Taken at Night.” (2010, October 5). Retrieved October 25, 2010, from http://www.prnewswire.com/news-releases/blood-pressure-pills-more-effective-when-taken-at-night-104335813.html.

Shoulder Surgery OK in Older Adult Population

A new study published in Arthroscopy: The Journal of Arthroscopic and Related Surgery shows that minimally invasive, arthroscopic shoulder surgery can significantly improve pain and function.

Surgeons often recommend against surgery for older adults because circulation and bone quality are poorer. Many older patients also often have other diseases that can compromise the healing process. But the arthroscopic surgery in the cases studied proved remarkably successful.

A total of 39 patients older than 70 underwent surgery to repair full-thickness tears in the rotator cuff after more conservative treatment, such as pain medication and debridement to remove fragments of tissue, had failed. The patients were followed for 2 years after surgery, and their shoulder function was compared with that of similar individuals of the same age who had healthy, normal shoulders.

Range of motion improved significantly. Patients were able to raise their arm in front and rotate it to the side, something that for many was difficult or impossible before the surgery. Muscle strength also improved. Pain was reduced significantly in 96% of the patients, many of whom had undergone the surgery because their pain was so bad they were unable to sleep. Almost all of the patients reported improved function in their shoulder, and 94% said they were satisfied and would undergo the surgery again if they had to make the decision over.

When these postoperative results were viewed in light of the normal aging process, the majority of individuals had a shoulder that functioned nearly as well as a healthy shoulder for that age group and gender.

According to the study authors, the success of the arthroscopic rotator cuff repair surgery—both objectively and subjectively—in older patients was due to newer surgical techniques, as well as the individuals’ commitment to postoperative rehabilitation and realistic expectations. Patients who were deemed to have irreparable rotator cuff tears were not offered arthroscopic rotator cuff repair surgery.

Source.“Surgery to Repair Torn Shoulder Muscles in the Elderly Can Reduce Pain and Improve Function.” (2010, September 1). Retrieved September 30, 2010, from http://www.sciencedaily.com/releases/2010/09/100901121759.htm.

Report Sheds Light on AFib’s Medicare Burden

The results of a new report foreshadow an increasing cost burden to the Medicare system related to atrial fibrillation (AFib), despite its low profile among other chronic diseases. The report, “Health Services Utilization and Medical Costs Among Medicare Atrial Fibrillation Patients,” was written by Avalere Health and funded as an outcome of AF Stat: A Call to Action for Atrial Fibrillation, a collaboration of health care leaders and organizations working to improve the health and well-being of people affected by AFib. AF Stat is an initiative sponsored by sanofi-aventis U.S. LLC.

The report shows that total medical costs of treating AFib averaged almost $24,000 per beneficiary, with 62% of these costs attributable to inpatient care. By way of comparison, this is on par with other cardiovascular conditions recognized as cost drivers, including treatment for acute coronary syndrome, myocardial infarction, and unstable angina, according to separate research cited by the authors.

According to the report, Medicare serves as the primary payer for AFib across all settings of care, including hospital inpatient and outpatient visits, physician office visits, and emergency care. The use of such a broad array of health services leads Medicare to pay an estimated $15.7 billion each year to treat newly-diagnosed AFib patients. This is largely due to the later onset of AFib, which predominantly affects people older than 65, and the number of age-related comorbidities associated with AFib.

The report further describes that Medicare is affected by a particularly high use of health care services among Medicare AFib patients:

  • Patients saw physicians an average of 67 times during the 15-month follow-up period.
  • During this same follow-up period, 61% of patients needed emergency services at least once, averaging three trips per patient.
  • Medicare AFib patients generally experience extended and repeated stays in the hospital: During their initial hospitalization for AFib, on average patients stayed in the hospital for 4 days, costing nearly $5,500 per patient.
  • Among those who were readmitted to the hospital after their initial stay, half experienced one rehospitalization, and 24% were readmitted twice. Nearly half of these readmissions took place within 6 months of the first trip to the hospital.

The full report is available at http://www.AFStat.com.

Source.“New Report Demonstrates Medicare’s Burden from Use of Health Services Among Atrial Fibrillation Patients.” (2010, September 22). Retrieved October 25, 2010, from http://sanofi-aventis.mediaroom.com/index.php?s=43&item=298.

Center for Lewy Body Disease Offers Collaborative Care

The Center of Excellence on Brain Aging at New York University (NYU) Langone Medical Center has established a specialty center for the diagnosis and treatment of Lewy body disease (LBD), widely misdiagnosed because its symptoms closely resemble those of other more commonly known diseases such as Alzheimer’s and Parkinson’s disease. The center is the first of its kind in the New York City tri-state area.

The LBD Center at NYU Langone offers a collaborative, patient-focused approach to diagnosis and treatment. Diagnostic evaluations involve both physical and neurological examinations, as well as patient and family interviews (including a detailed lifestyle and medical history) and neuropsychological and mental status tests. The patient’s functional ability, attention, language, visuospatial skills, memory, and executive functioning are assessed. Patient care teams include neurologists, neuropsychologists, psychiatrists, internists, and geriatric specialists, as well as social workers to provide support and care for caregivers. Innovative programs in cognitive remediation and falls prevention can be tailored to individual patient needs.

The center also offers a wide array of comprehensive and technologically advanced testing including brain imaging such as magnetic resonance imaging and positron emission tomography scans, sleep evaluations, and other laboratory studies. In addition, patients have the opportunity to participate in clinical research projects involving imaging, cerebrospinal fluid, and other biological markers leading to development of new therapeutics not available elsewhere.

Source.“NYU Langone Establishes Specialty Center for Diagnosis and Treatment of Lewy Body Disease.” (2010, September 29). Retrieved October 25, 2010, from http://aging.med.nyu.edu/news/2010/nyu-langone-establishes-specialty-center-diagnosis-and-treatment-lewy-body-disease.

10.3928/00989134-20101201-07

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