How often have you heard “less is better” in our world of geriatrics? Yet the care we are providing continues to reflect more and more options and interventions. Recently there was a wonderful paper in the New Yorker¹ in which Atul Gawande discussed overkill and the way in which we over test and over treat in health care. In the paper, he referred to a study showing that 25–42% of Medicare patients were exposed to at least one of twenty-six tests or treatments that scientific and professional organizations have consistently determined to have no benefit or to be harmful.

The objective of this study was to evaluate a new way for applying bed baths and reducing the risk for dry skin by comparing the effect of two washing methods on skin hydration. A cluster randomized trial was conducted. Skin hydration was measured before and after implementation of disposable wash gloves, using a MoistureMeter SC at three skin sites. Total skin hydration did not differ between residents at the start of the study in both groups. After implementation, the post minus pre hydration scores were higher for the intervention group than the control group at all skin sites. However, the difference was only significant at cheek site. The use of disposable wash gloves does not increase the risk for dry skin in comparison with traditional washing methods. These results may encourage the introduction of disposable wash gloves as an innovation in daily skin care practice.

The purpose of this study was to determine the effect of range of motion exercises on preventing delirium and shortening the duration of delirium among patients in the intensive care unit who are aged 65 and over. The study was conducted in the intensive care unit on patients with non-invasive mechanical ventilation. The sample size included 47 patients from the intervention group and 47 from the control group. The incidence of delirium was 8.5% in the intervention group and 21.3% in the control group. The duration of delirium was 15 h for patients in the intervention group and 38 h for those in the control group. Although delirium incidence and duration decreased by 2.5-fold in the intervention group compared to the control group; there was no significant relationship between the intervention and control groups. In conclusion, as the decreases in delirium occurrence and duration were not statistically significant, the effect of range of motion exercises was limited.

Overseeing medication-taking is a critical aspect of dementia caregiving. This trial examined a tailored, problem-solving intervention designed to maximize medication management practices among caregivers of persons with memory loss. Eighty-three community-dwelling dyads (patient + informal caregiver) with a baseline average of 3 medication deficiencies participated. Home- and telephone-based sessions were delivered by nurse or social worker interventionists and addressed basics of managing medications, plus tailored problem solving for specific challenges. The outcome of medication management practices was assessed using the Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE) and an investigator-developed Medication Deficiency Checklist (MDC). Linear mixed modeling showed both the intervention and usual care groups had fewer medication management problems as measured by the MedMaIDE (F = 6.91, p < .01) and MDC (F = 9.72, p < .01) at 2 months post-intervention. Reduced medication deficiencies in both groups suggests that when nurses or social workers merely raise awareness of the importance of medication adherence, there may be benefit.

Describing the trajectories of hospital-associated functional decline in older patients admitted to acute medical units and identifying predictors at the individual, nursing, and hospital levels, were the aims of the study. A longitudinal survey among 12 acute medical units in which 1464 patients were consecutively enrolled and evaluated using the Barthel Index (BI), was performed. Functional decline was defined as a decrease in the BI of at least 5 points from admission to discharge. In all, 17.1% participants (n = 251) demonstrated functional decline. In accordance with multiple logistic regression analysis, 28.8% (R²) of the variance in the functional decline was explained by: confusion/disorientation (RR = 4.684; 95% CI = 3.144–6.978), admission from nursing homes (RR = 2.464; 95% CI = 1.642–3.697), daily care expressed in minutes offered by nursing aides (RR = 1.535; 95% CI = 1.275–1.849), higher workforce skill-mix (RR = 2.221; 95% CI = 1.763–2.797), bladder catheter insertion (RR = 1.599; 95% CI = 1.128–2.268), and higher BI score at admission (RR = 1.019; 95% CI = 1.014–1.024). Increasing the amount of care delivered by competent nurses—having a bachelors degree—providing and supervising direct-care activities, may reduce the occurrence of functional decline in older patients admitted to medical units.

Home health care agencies are increasingly taking care of sicker, older patients with greater comorbidities. However, they are unequipped to appropriately manage these older adults, particular persons living with dementia (PLWD). We therefore developed the Dementia Symptom Management at Home (DSM-H) Program, a bundled interprofessional intervention, to improve the care confidence of providers, and quality of care delivered to PLWD and their caregivers. We implemented the DSM-H with 83 registered nurses, physical therapists, and occupational therapists. Overall, there was significant improvement in pain knowledge (5.9%) and confidence (26.5%), depression knowledge (14.8%) and confidence (36.1%), and neuropsychiatric symptom general knowledge (16.8%), intervention knowledge (20.9%), attitudes (3.4%) and confidence (27.1%) at a statistical significance of (P < .0001). We also found significant differences between disciplines. Overall, this disseminable program proved to be implementable and improve clinician's knowledge and confidence in caring for PLWD, with the potential to improve quality of care and quality of life, and decrease costs.

This study aims to explore and compare nursing home residents', family members', and nursing staff's needs and expectations regarding a fall prevention brochure. Focus groups were carried out with 25 residents, 12 family members and 14 nursing staff separately, from three randomly selected nursing homes. Qualitative content analysis was used to analyze the data using a concept-driven coding frame. Results showed that residents want to be informed about dealing with extrinsic fall risks and coping strategies after a fall event. In addition, family members wanted to have detailed information on intrinsic fall risks as well as specific fall prevention strategies, such as body exercises. Of special importance for nursing staff was that not all falls are preventable even when preventive measures were taken. As the need and expectations of users differ substantially, one brochure could not comprise all postulated criteria and different brochures are necessary for residents and for family members.

This pilot study attempted to reduce resistance-to-care (RTC) and combative behaviors in nursing home residents with dementia by eliciting their positive affect. Four female residents with dementia were recruited from a nursing facility. Each resident was involved in one intervention trial and one control trial. The response of the residents was assessed by the Agitated Behavior Scale and the Observational Measurement of Engagement Tool. The distress level of the certified nursing assistants (CNAs) delivering the care was reported through the Distress Thermometer. Results showed that the residents displayed fewer behavioral symptoms in the intervention trial than in the control trial. The CNAs reported less distress in the intervention trial than in the control trial. These preliminary findings suggest that it might be feasible to use positive images to reduce residents' behavioral symptoms and decrease the distress of CNAs.

The Volunteering-in-Place (VIP) Program was developed to provide individualized meaningful volunteer activities matched to interests and capabilities for older adults with MCI in assisted living. The purposes of this single-site pre-test/post-test pilot study were to (1) establish feasibility of the VIP Program based on treatment fidelity (design, treatment, delivery, enactment); and (2) evaluate preliminary efficacy via improvement in psychological health (depressive symptoms, usefulness, purpose, resilience, and life satisfaction) and decreased sedentary activity (survey and Fitbit) at 3 and 6 months. Ten residents participated. The majority was white, female and educated, and on average 88 years old. The VIP Program was feasible and most participants continued to volunteer at 6 months. There were non-significant improvements in depressive symptoms, usefulness, purpose, resilience and recreational physical activity. The results of this study provide support for the feasibility of the VIP Program. Further study is necessary to examine efficacy.

A great deal of media attention has been given to a recently-published study that concluded that the prevalence of dementia was significantly greater in patients who had been regularly taking a proton pump inhibitor (PPI) including omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), pantoprazole (Protonix) or rabeprazole (Aciphex). The article was reported by many media outlets in stories with titles ranging from “Can Common Heartburn Drugs Raise Risk for Dementia?” and “Proton Pump Inhibitors Linked to Dementia” the former being a title that perhaps distorts the actual study findings misleading the reader to believe that a clear link exists between PPIs and dementia.

“Contradiction is not a sign of falsity, nor the lack of contradiction the sign of truth.” This quote from the philosopher, Pascal, is how a federal district court judge began her decision, finding in favor of a national hospice provider charged by the United States Department of Justice (DOJ) with submitting false certifications of hospice eligibility. This case strikes a deadly blow to the government's longstanding theories and tactics in prosecuting providers under the federal False Claims Act.

Even if you are not directly involved in LTC the CMS quality measures are important. More important is knowing what it takes to deliver on CMS LTC requirements and soon likely to be expanded to all providers such as those in ALCs. As CMS drives toward value based purchasing nurses and all providers will need to develop the skills and process to produce quality results – results that are being measured. These CMS LTC quality measures are becoming more significant as Medicare move to a value based system.

I've recently returned from attending the European Sociological Association's “Ageing in Europe” workshop held at the University of Chester, United Kingdom (U.K.) in synch with the University of Chester College of Nursing's Global Healthcare Conference: “Reframing Healthcare for an Ageing Population.” I had the good fortune to provide keynote addresses at both conferences and thought to share some transatlantic insights in this column. Engaging with gerontology colleagues in the U.K. reinforced that the challenges we face in the United States in providing consistently high quality, individualized, late life and end-of-life care are very similar in the U.K., although our systems of care differ.

Mrs. Jones is an 86-year-old widowed female who has been living alone at home for the past 10-years. She fell and broke her hip three days ago. She has undergone a right hip replacement and it is time to plan for her discharge from the hospital. Her daughter lives an hour away, and is at the hospital this morning with her mother as the discharge planning begins. The case worker has given the daughter a list of skilled nursing homes (NH) with an available bed close to the daughter's home and in the local area.

In 2015, the document GAPNA's APRN Consensus Statement on Proficiencies for the APRN Gerontological Specialist¹ was published and then widely distributed to schools of nursing and professional organizations that provided validation to this document. The document which can be found on the Gerontological Advanced Practice Nurses Association (GAPNA) organizational website, highlights 12 proficiency statements that this organization believes represents the specialty of advanced practice gerontological nursing.

Tommy was the high school bully from my hometown of Pittsburgh, Pennsylvania. Frankly, the first bully I ever knew was the kind of loathsome character who, on one warm and sunny bus ride home from school, showed off to “get the girls' attention” by whaling on, Charlie, an incredibly kind French horn player, until he drew blood. Even in the swirl of my own teen trepidations, I inherently knew Tommy had morphed from a dark place (probably under a rock) where self-control and love for oneself was extinct.

NICHE Hospitals Reports identify the positive outcomes and innovative initiatives experienced at NICHE Designated healthcare organizations in their care of older adult patients. This second entry details success stories at NICHE sites involving length of stay (LOS) reductions. These initiatives demonstrate the successful application of evidence based best practices implemented at our NICHE healthcare organizations.

“When you think about your work, what first comes to mind?” There are many ways we could answer that question, but I know advanced practice nurses and other geriatrics health professionals would begin by noting that the question itself is all wrong. For us, it isn't “what” but “who” comes to mind that makes all the difference. Geriatrics has always been about people: individual men and women who helped shape the society we share, and who deserve to shape their own care and well-being by extension.