Journal of Gerontological Nursing

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Keeping Urinary Catheters From Posing a Risk in Long-Term and Post-Acute Care

A new study in JAMA Internal Medicine shows how to keep urinary catheters from posing a risk to the 1.4 million Americans currently in long-term and post-acute care.

The study reported results from the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Long-Term Care, which focused on reducing catheter-associated urinary tract infections (CAUTI) and other health care–associated infections. The project adapted principles and methods from AHRQ's Comprehensive Unit-Based Safety Program, previously found to be effective in hospitals, to the long-term care setting. The project enrolled nursing homes over the course of 2.5 years and provided a toolkit of materials to help their leaders and staff implement and sustain use of evidence-based practices for infection prevention.

Incident of CAUTIs decreased by 54% in 404 nursing homes in 38 states. This decrease happened across the board, with 75% of nursing homes seeing at least a 40% decrease. Rate of infection also dropped approximately 4.5% across all nursing homes. In addition, the number of laboratory tests that clinicians ordered to check patients for infections decreased by 15%, indicating that they were using urine culture tests more appropriately.

Source.“Nursing Homes Cut Urinary Tract Infections in Half Through Focused Effort on Catheter Care.” (2017, May 18). Retrieved June 28, 2017, from http://bit.ly/2un7twE.

Family History and Mitochondrial Gene May Increase Risk for Alzheimer's Disease

A new study in Alzheimer's & Dementia may have identified the link that explains years of conflicting research over a mitochondrial gene and the risk for Alzheimer's disease (AD). The researcher who initially discovered the gene, TOMM40 (Translocase of Outer Mitochondrial Membrane–40kD), found it increased the risk for AD. However, when multiple studies failed to replicate the results, many researchers dismissed the findings. The new study looked at other factors that may contribute to the mixed results.

In the study, late middle-aged individuals with a family history and longer version of the gene encountered twice as much memory loss up to 10 years later as individuals with a family history and a short version of the gene. A similar but stronger finding was seen in a separate group of older adults with and without AD. For this study, family history focused specifically on whether a participant's parents had AD. The study also found an association between the gene, family history, and mitochondrial function. Researchers controlled for gender, age, and education.

Source.“Family History of Alzheimer's May Alter Metabolic Gene That Increases Risk for Disease.” (2017, May 18). Retrieved June 28, 2017, from http://bit.ly/2u2GF5I.

Statins May Not Extend Older Adults' Lifespan

Statins are increasingly prescribed to older adult patients to stave off premature death from heart disease despite a lack of evidence that this practice benefits older populations. A new study in JAMA Internal Medicine found that the cholesterol-lowering drugs may not extend the lifespan in heart-healthy older adults.

Researchers reviewed data from 2,867 adults who participated in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, which concluded in 2002. They found no significant differences in all-cause mortality or cardiovascular outcomes between groups randomized to receive either statins or usual care.

The sample was limited to participants 65 and older with hypertension and without evidence of atherosclerotic cardiovascular disease. One half of participants were treated with pravastatin and one half received usual care to measure pravastatin's effect on all-cause mortality, with a secondary interest in cardiovascular outcomes (e.g., coronary heart disease, nonfatal heart attacks). Researchers noted a nonsignificant direction toward increased mortality in adults 75 and older who received pravastatin.

Source.“Starting Statins in Older Patients Not Effective as Preventive Care.” (2017, May 19). Retrieved June 28, 2017, from http://bit.ly/2slfLsi.

Outdoor Fall Prevention Education Needed for Older Adults

Many older adults have fallen outdoors but lack an understanding of the risks for falling and how to prevent them, warranting efforts for outdoor fall prevention, according to a new study in the Archives of Gerontology and Geriatrics.

The study sought to explore the experiences and fall prevention knowledge of older adults living in the community. Using random digit telephone dialing, researchers surveyed 120 adults 55 and older across the five boroughs of New York City. Most adults surveyed—85 individuals (71%)—had fallen outdoors in their adult years. Of those who had experienced an outdoor fall, 28 had minor injuries, such as scrapes and bruises; 18 had moderate injuries with prolonged pain or soreness; and nine had severe injuries, such as fractures, rotator cuff injuries, or injuries requiring stitches or surgery.

Overall, the survey revealed a number of unmet education and training needs for outdoor fall prevention among community-dwelling older adults. This population should be educated on the importance of wearing single vision glasses and proper footwear, which have been noted as common causes for falls. They should also be educated on the risks associated with recreational areas and parking lots or garages, as these have been shown to be common fall locations. Older adults could also benefit from training on fall prevention strategies, including safety during routine activities, such as carrying items on uneven surfaces, going up and down stairs, and opening or closing doors. Education regarding safe outdoor walking strategies (e.g., avoiding distractions, navigating sloped and uneven surfaces, walking slower) would also be beneficial.

Source.“Study Finds Need for Educating Older Adults on Outdoor Fall Prevention.” (2017, May 19). Retrieved June 28, 2017, from http://bit.ly/2t4Xuwx.

Death Rates from Alzheimer's Disease Increase 55%

Death rates from Alzheimer's disease (AD) increased 55% between 1999 and 2014, according to data from a new study in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report. The number of AD-related deaths at home also increased during the same period, from 14% to 25%, suggesting an increase in the number of caregivers who would benefit from support, including education and case management services.

The study is the first to provide county-level rates for deaths caused by AD. Researchers analyzed state- and county-level death certificate data from the National Vital Statistics System to identify deaths with AD reported as the underlying cause. According to the analysis, possible reasons for the increase include the growing population of older adults in the United Sates, increases in diagnosis of AD at earlier stages, increased reporting by physicians and others who record the cause of death, and fewer deaths from other causes of death for older adults (e.g., heart disease, stroke).

Source.“US Death Rates from Alzheimer's Disease Increased 55 Percent from 1999 to 2014.” (2017, May 25). Retrieved June 28, 2017, from http://prn.to/2sl210B.

Challenges of the Aging Transgender Community

SeniorAdvice.com, one of the nation's top senior housing referral services, released an article on the challenges and progress of the aging transgender community. The three challenges of transgender older adults include:

  • Isolation and a negative social stigma: older adults in this community can face particular challenges in managing longstanding familial roles. There can be difficulties when families and friends have to consider modifying established roles and there may be a period of adjustment for all involved. There is also a lack of availability of social groups, particularly outside large metropolitan areas, and this can worsen isolation.
  • Senior housing issues: There is a lack of availability in LGBT (lesbian, gay, bisexual, and transgender)-friendly senior housing. Because no legal protections exist at the national level for transgender individuals, those seeking nursing home or assisted living care often face discrimination and lack of acceptable living conditions.
  • Health concerns: Transgender individuals frequently lack access to properly trained health care providers who understand their unique medical and psychological challenges. Many within the community report facing harassment, ridicule, and rough treatment by medical professionals, or are refused treatment. Older transgender individuals often face additional complications due to requirements for longer-term and sometimes more intense hormone therapy that require a closer level of attention from health care providers.

Source.SeniorAdvice.com Explores the Challenges of the Aging Transgender Community.” (2017, May 22). Retrieved June 28, 2017, from http://prn.to/2tpYj5j.

Exercises Linked to Activities of Daily Living Beneficial for Older Adults

Exercise is good for older adults. But what kind is best? One researcher from Indiana University–Purdue University Indianapolis believed something more than resistance training was needed to help older adults manage activities of daily living (ADLs). She created a 10-week 3-Step Workout for Life exercise program that turns the homes of older adults into age-appropriate gyms. In the program, older adults perform exercises that are linked to ADLs.

The 3-Step Workout for Life program begins with resistance exercises, such as bicep curls. The second step links those movements with ADLs. The third step increases the challenge of performing those activities (e.g., having the older adult walk farther or at different speeds).

Results at the end of the 10-week program were similar to that of a 10-week resistance-only exercise program. However, older adults retained the benefits of the 3-Step Workout for Life program when they were tested 6 months later, whereas the benefits of the resistance exercise program had significantly decreased.

Source.“There's More to This Exercise Program for Older Adults Than Bicep Curls.” (2017, May 30). Retrieved June 28, 2017, from http://bit.ly/2trOG6z.

Ketamine Does Not Reduce Pain in Older Adults During and Following Surgery

A new study in The Lancet indicates that ketamine does not lower levels of pain or reduce the need for pain-killing opioid drugs after an operation. Further, older adult patients who receive ketamine during surgery are more likely to experience hallucinations and nightmares in the recovery room and for several days following surgery.

Researchers followed 672 surgical patients (60 or older) in four countries: the United States, Canada, India, and South Korea. During surgery, patients either received no ketamine, a very low dose of ketamine, or a slightly higher dose of ketamine. The doses used in the study were ones routinely given to surgical patients.

Patients were evaluated for several days after surgery. Researchers asked about their pain, kept track of the amount of opioid drugs needed to control the pain, and evaluated them twice daily for delirium. They found that 20% of older patients experienced delirium following surgery, and suggest clinicians reconsider the common practice of giving low doses of ketamine during surgery.

Source.“Drug Believed to Reduce Postoperative Pain and Delirium Does Neither.” (2017, May 26). Retrieved June 28, 2017, from http://bit.ly/2t8hM8w.

Authors

10.3928/00989134-20170707-02

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