Journal of Gerontological Nursing

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Decision Maker Surrogates Influenced by Several Factors

Decision making by a surrogate for a family member who is unable to make medical decisions is more complicated than decision making by patients themselves, according to a study published in the Journal of Clinical Ethics.

The researchers found that family decision makers considered the cognitively impaired patient’s wishes and interests, but they also took into account their own needs and preferences.

Factors influencing surrogate decision makers included:

  • Respect for the patient’s input.
  • The patient’s prior wishes.
  • Consideration of the patient’s best interests.
  • The surrogate’s own wishes as a guide.
  • The surrogate’s religious and spiritual beliefs.
  • The surrogate’s own interests.
  • Family consensus.

In the study, the investigators interviewed 35 surrogates with a recent decision-making experience for a hospital patient 65 or older. The group was almost evenly split between Caucasian and African American surrogates. Eighty percent of the respondents were women; 60% were the daughters of the patient with cognitive impairment.

The study noted that “because surrogates also imagine what they would want under the circumstances and consider their own needs and preferences as well as those of the patient for whom they are acting, standard ethical models of surrogate decision-making [in the academic literature] must account for these additional considerations. Surrogates’ desire for more information about patient preferences suggests a need for greater advance care planning.”

Source. “Making Medical Decisions for a Cognitively Impaired Family Member is Complicated.” (2013, August 15). Retrieved September 19, 2013, from http://news.medicine.iu.edu/releases/2013/08/alexia-torke.shtml.

Famous Face Recognition Used to Identify Early-Onset Dementia

A new study suggests that simple tests that measure the ability to recognize and name famous people such as Albert Einstein, Bill Gates, or Oprah Winfrey may help physicians identify early dementia in adults ages 40 to 65. The research appears in Neurology.

For the study, 30 people with primary progressive aphasia, a type of early-onset dementia that mainly affects language, and 27 people without dementia, all with an average age of 62, were given a test. The test included 20 famous faces printed in black and white, including John F. Kennedy; Lucille Ball; Princess Diana; Martin Luther King, Jr.; and Elvis Presley. Participants were given points for each face they could name. If the participant could not name the face, he or she was asked to identify the famous person through description. Participants gained more points by providing at least two relevant details about the person. The two groups also underwent magnetic resonance imaging brain scans.

Researchers found that the people who had early-onset dementia performed significantly worse on the test, scoring an average of 79% in recognition of famous faces and 46% in naming the faces, compared to 97% in recognition and 93% on naming for those free of dementia. The study also found that people who had trouble putting names to the faces were more likely to have a loss of brain tissue in the left temporal lobe of the brain, whereas those with trouble recognizing the faces had tissue loss on both sides of the temporal lobe.

Source. “From Einstein to Oprah: Famous Faces May Help Spot Early Dementia.” (2013, August 6). Retrieved September 19, 2013, from http://www.aan.com/PressRoom/Home/Press-Release/1201.

HRSA Grant Addresses Transitional Care of Frail Older Adults

New York University College of Nursing’s (NYUCN) Dr. Tara A. Cortes, PhD, RN, FAAN, has received a U.S. Department of Health and Human Services Health Resources and Services Administration Advanced Nursing Education Program 3-year, $1.1 million grant for “Interprofessional Care of Older Adults” (IPCOA). This innovative initiative will foster communication and collaboration between physicians and nurse practitioners (NPs) with a focus on transitional care handoffs of patients with multiple chronic conditions.

In partnership with NYU’s School of Medicine, NYUCN is creating a postmaster’s certificate program to address a need for adult advanced practice nurses in primary care to have advanced knowledge and skills in the management of frail, community-dwelling older adults with multiple chronic conditions (MCC). Due to its focus on dual-eligible frail older adults, this project meets the funding preferences for substantially benefiting a practice population categorized as poor and/or medically underserved.

The purposes of the IPCOA proposal are:

  • To implement an innovative, replicable, postmaster’s certificate program for developing adult NPs with competencies to care for older adults with MCCs in an interprofessional model.
  • To increase the number of NPs who have knowledge of the unique needs of older adults with MCCs.
  • To promote interprofessional, team-based learning opportunities applying shared didactic and clinical technology to the management of MCCs in the continuum of care.
  • To disseminate the program nationally to other nursing schools.

The specific objectives of IPCOA are that:

  • Aimed at training an inter-professional workforce to care for patients with MCCs, 100% of the NP and physician learners will demonstrate the ability to use the knowledge and skills endorsed by the Interprofessional Education Collaborative, a national organization focused on better integrating and coordinating the education of nurses, physicians, dentists, pharmacists, public health professionals, and other members of the health care team to provide more collaborative and patient-centered care.
  • At least 45 NPs and 24 physicians will be educated to use an inter-professional model to care for older adults with MCCs.
  • 100% of the NP and physician cohort each year will complete the NYU Teaching, Technology, Team-work (NYU 3T) synchronous and asynchronous curriculum.
  • At least five nursing schools will adapt this postmaster’s certificate program.

The NYU 3T curriculum will be a backbone of IPCOA. NYU 3T provides opportunities for undergraduate nursing and medical students to learn, through online modules, strategies for successful team-based care, including: the roles of different professionals; communication and conflict resolution; interprofessional teamwork; and values and ethics.

Funded by the Macy Foundation, NYU 3T is accessible via http://dei.med.nyu.edu/research/nyu3t.

Source. “NYU College of Nursing’s Dr. Tara Cortes, PhD, RN, FAAN, Receives a $1.1M Advanced Nursing Education (ANE) Grant from HRSA.” (2013, August 8). Retrieved September 19, 2013, from http://bit.ly/18dmuSE.

It May be OK to Encourage Weight Loss in Older Adults

Weight loss has usually been discouraged among older adults, partly because of health concerns over inadvertent reductions in muscle and bone mass, which is known to accompany overall weight loss. However, new research from Wake Forest Baptist Medical Center shows that physical activity and weight loss conducted together for older, overweight and obese adults results in improved body composition, translating into lower cardiovascular disease (CVD) risk and improved mobility.

These new findings are illustrative of an emerging body of research addressing the controversy surrounding the recommendation of weight loss in old age and suggest that intentional weight loss can have positive health benefits for older adults, at least for the short term.

The research team analyzed data from the Cooperative Lifestyle Intervention Program (CLIP), a randomized controlled trial of physical activity and weight loss on mobility in 288 overweight or obese older adults at risk of CVD over a 2.5-year period. CLIP showed that an 18-month physical activity and weight loss intervention was successful in achieving and maintaining clinically significant weight loss for a majority of overweight and obese older adults.

Findings published online in Obesity show that although some of the weight lost by CLIP participants was muscle, a larger amount of lost weight was fat mass, resulting in an increase in the relative proportion of lean body mass.

The average age of participants was 67 with an average body mass index of 32.8 kg/m2. Sixty-seven percent were women and 82% were Caucasian. All participants reported limitations in mobility at the beginning of the study. Dual-energy x-ray absorptiometry-acquired body composition measures (total body fat and lean mass), conventional biomarkers of cardiometabolic risk, and 400-meter walk time were obtained at the study start and 18 months.

Source. “New Research Supports Intentional Weight Loss for Older Adults.” (2013, September 19). Retrieved September 19, 2013, from http://www.newswise.com/articles/view/607847.

10.3928/00989134-20130919-98

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