《老年护理学》2016年7/8月总第37卷第4期
Geriatric Nursing
July 2016–August 2016Volume 37, Issue 4, p251-332, e1-e2
Table of Contents p251–253
Editorial Board p254
Information for Readers p255
Information for Authors e1–e2
Editorial
From the Editor
Optimizing driving safety: It is a team sport p257–259
优化行车安全：这是一项团队运动
In Spring of 2016 the American Geriatrics Society along with the National Highway Traffic Safety Administration (NHTSA) released the revised Clinician's Guide to Assessing and Counseling Older Drivers (3rd edition). The guide is available on the American Geriatrics Society webpage, Geriatricscareonline.org(http://geriatricscareonline.org/toc/clinicians-guide-to-assessing-and-counseling-older-drivers-3rd-edition/B022). The purpose of this guide is to encourage all health care professionals to assess and counsel older adults about driving safety and to assure that older adults are helped to maintain driving safety for as long as it is appropriate. An interdisciplinary team was involved in the revision process and their focus was to transition from a clinical tendency to take a punitive approach to driving and stop all older adults from driving. Rather it was to optimize driving safety and ability among these individuals.
Feature Articles
Becoming visible – Experiences from families participating in Family Health Conversations at residential homes for older people p260–265
可看得见 – 参与老人居家“家庭健康对话”家人的经验
Having a sick family member living at a residential home for older people can be difficult for families, who as a result often suffer from feelings of forsakenness and powerlessness. In response, the purpose of this study was to illuminate family members' experiences with participating in Family Health Conversations at residential homes for older persons 6 months after concluding the conversation series. Twenty-two family members who participated in the conversations later took part in group interviews, the texts of which were analyzed according to qualitative content analysis. Findings showed that participating in Family Health Conversations mediated consolation, since within such a liberating communicative interaction, family members for the first time felt visible as persons with individual significance. Family members reported a positive experience involving both being open to each other and speaking and listening to each other in a new, structured way. As a result, families were able to discover their family members' problems and suffering, as well as to identify their family's resources and strengths.
Open Access
The impact of resilience among older adults p266–272
老人适应性的影响
The purpose of this literature review was to provide an overview of resilience for the purpose of informing potential intervention designs that may benefit older adults. While numerous reviews have focused on various specific aspects of resilience, none have provided the necessary information required to design an effective resilience intervention. Research examining resilience suggests that older adults are capable of high resilience despite socioeconomic backgrounds, personal experiences, and declining health. Thus opportunities to inform interventions in this area exist. Research studies have identified the common mental, social, and physical characteristics associated with resilience. High resilience has also been significantly associated with positive outcomes, including successful aging, lower depression, and longevity. Interventions to enhance resilience within this population are warranted, but little evidence of success exists. Thus this review provides an overview of resilience that may aid in the design of resilience interventions for the often underserved population of older adults.
The TIME Questionnaire: A tool for eliciting personhood and enhancing dignity in nursing homes p273–277
TIME问卷：引导如何做人及增强养老院尊严的工具
This study aimed at evaluating the effectiveness of the TIME (This Is ME) Questionnaire in eliciting personhood and enhancing dignity; specifically investigating the residents' and health care providers' perspectives in the nursing home setting. Residents (n = 41) from six nursing homes in a Canadian urban center completed both the TIME Questionnaire and a feedback response questionnaire; health care providers (n = 22) offered feedback both through a questionnaire or participation in a focus group. 100% of the residents indicated the summary was accurate. 94% stated that they wanted to receive a copy of the summary, 92% indicated they would recommend the questionnaire to others, 72% wanted a copy of the summary to be placed into their medical chart. Overall HCPs' agreed that they have learned something new from TIME, and that TIME influenced their attitude, care, respect, empathy/compassion, sense of connectedness, as well as personal satisfaction in providing care.
Supporting home health aides through a client's death: The role of supervisors and coworkers p278–283
支持家庭健康助手克服客户死亡经历：督导和同事的作用
This study evaluated home health aides (HHAs) experiences related to the support they received around a client's death. 80 HHAs who had recently experienced a client death participated in semi-structured interviews. They were asked to what extent they felt support was available to them from their supervisor or coworker, whether they sought support, the type of support they sought, and how helpful it was. They were also asked what type of support they would like to receive. Findings showed that just over one third of the HHAs felt they could turn to their supervisors for support and one fifth could turn to their coworkers. Even fewer sought support. However, those who did receive support, found it to be extremely helpful, in particular when the support came from supervisors. Desired types of support were primarily related to having someone to talk to or check in with them, pointing to an important role of nursing supervisors in providing critical support to direct care staff.
Effect of animal-assisted activity on balance and quality of life in home-dwelling persons with dementia p284–291
动物辅助活动对居家老年痴呆症患者平衡及生活质量的影响
Purpose of the study was to examine if animal-assisted activity with a dog (AAA) in home-dwelling persons with dementia (PWDs) attending day-care centers would have an effect on factors related to risk of fall accidents, with balance (Berg balance scale) and quality of life (Quality of Life in Late-stage Dementia) as main outcome. The project was conducted as a prospective and cluster-randomized multicenter trial with a follow-up. 16 adapted day-care centers recruited respectively 42 (intervention group) and 38 (control group with treatment as usual) home-dwelling PWDs. The intervention consisted of 30 min sessions with AAA led by a qualified dog handler twice a week for 12 weeks in groups of 3–7 participants. The significant positive effect on balance indicates that AAA might work as a multifactorial intervention in dementia care and have useful clinical implication by affecting risk of fall.
Fork test: A new simple and reliable consistency measurement for the dysphagia diet p292–295
叉试验：一种新的简便、可靠的难吞咽饮食稠度测量法
The objective of this study was to validate fork test which is a simple tool to assess the consistency of food. The consistencies of 27 water and thickener mixtures were measured with a viscometer. These measures were then compared to those obtained with fork test to evaluate the validity of fork test. The inter-observer and intra-observer reliabilities of the fork test were assessed with an intra-class correlation coefficient. The viscometer was used to obtain reference values for three categories (0–300 cP, 300–10,000 cP, and >10,000 cP) in order to categorize water and thickener mixtures into grade 1, grade 2, or grade 3 according to the results of fork test. Our results revealed that the fork test showed excellent validity (r = −0.889, p < 0.05), intra-observer reliability, and inter-observer reliability. Therefore, fork test may be used as a practical tool to assess food consistency.
Transitional care of older adults in skilled nursing facilities: A systematic review p296–301
技术性护理机构老人的过渡性护理：系统综述
Transitional care may be an effective strategy for preparing older adults for transitions from skilled nursing facilities (SNF) to home. In this systematic review, studies of patients discharged from SNFs to home were reviewed. Study findings were assessed (1) to identify whether transitional care interventions, as compared to usual care, improved clinical outcomes such as mortality, readmission rates, quality of life or functional status; and (2) to describe intervention characteristics, resources needed for implementation, and methodologic challenges. Of 1082 unique studies identified in a systematic search, the full texts of six studies meeting criteria for inclusion were reviewed. Although the risk for bias was high across studies, the findings suggest that there is promising but limited evidence that transitional care improves clinical outcomes for SNF patients. Evidence in the review identifies needs for further study, such as the need for randomized studies of transitional care in SNFs, and methodological challenges to studying transitional care for SNF patients.
Departments
Pharmacy Column
Anticholinergic properties of medications p302–303
药物的抗胆碱能属性
As a person ages they are more susceptible to the adverse effects of medications for a variety of reasons including decreased renal and hepatic function, the presence of multiple health conditions and increasing sensitivity of pharmacologic receptors in the body. In this column I will review the subject of anticholinergic properties of medications and will discuss how they can result in adverse effects.
Legal Column
Understanding the new HHS nondiscrimination rule and how it applies to your facility p304–306
HHS新非歧视性原则的理解及在你机构的应用
The U.S. Department of Health and Human Services (HHS) has issued its much-anticipated “Nondiscrimination in Health Programs and Activities” final rule, which implements § 1557 of the Affordable Care Act (ACA), for the purpose of advancing health equity and reducing health care disparities. Section 1557 provides that an individual shall not be excluded from participation in, denied the benefits of, or be subjected to discrimination on the grounds prohibited under Title VI of the Civil Rights Act of 1964 (race, color, national origin), Title IX of the Education Amendments of 1972 (sex), the Age Discrimination Act of 1975 (age), or Section 504 of the Rehabilitation Act of 1973 (disability).
Assisted Living Column
Preventing medication errors p307–310
预防用药错误
Mrs. Taylor is a 70-year-old female living at home, cooking a meal one day when she has sudden onset of chest pain and shortness of breath. She is hospitalized and diagnosed with having a pulmonary embolism. During her stay in the hospital she is started on enoxaparin and warfarin and remains on both medications as she is transferred to your facility, on a Monday afternoon, for subacute care. Her admission orders include subcutaneous enoxaparin every 12 h and warfarin 3 mg once daily. The hospital sends instructions that she is to continue receiving enoxaparin until her INR, on warfarin, is between 2 and 3.
Acute Care of the Elderly Column
When the falls expert becomes the fall risk patient: Through the looking-glass p311–312
当跌倒专家成为跌倒风险病人：透过镜子看现实
NGNA Section
The association of physical activity, cognitive processes and automobile driving ability in older adults: A review of the literature p313–320
老年人体育活动、认知过程和汽车驾驶能力的相关性：文献综述
As the number of older adults in the United States grows, the number of automobile drivers over the age of 65 will also increase. Several cognitive processes necessary for automobile driving are vulnerable to age-related decline. These include declines in executive function, working memory, attention, and speed of information processing. The benefits of physical activity on physical, psychological and particular cognitive processes are well-documented; however few studies have explored the relationship between physical activity and driving ability in older adults or examined if cognitive processes mediate (or moderate) the effect of physical activity on driving ability. The purpose of this paper is to review the existing literature regarding physical activity, cognition and automobile driving. Recommendations for further research and utility of the findings to nursing and the health care team are provided.
GAPNA Section
GAPNA toolkit available online p321
GAPNA工具包网上有
The Gerontological Advanced Practice Nurses Association (GAPNA) Education Committee created a web-based toolkit to improve access to geriatric and gerontological content for clinical education of advanced practice registered nurse (APRN) students, preceptors, educators, and health care professionals through a single portal of resources. Developed by a group of gerontological APRNs with educator experience, it organizes geriatric knowledge for clinical preceptors. The GAPNA Toolkit content is open access (i.e., open to all – not just GAPNA members) with the goal of improving the health care provided to older adults by APRNs and their students.
Exemplars in advanced practice gerontological nursing: A GAPNA series – GAPNA Consensus Statement proficiencies 3 and 4 p322–325
老年人高级执业护理范例：GAPNA系列—GAPNA共识声明进阶3、4
From now till 2030, 10,000 individuals will be turning 65-years old every day in the United States.1 The aging population is growing older and living longer. This extension in aging means an increased number of individuals developing coexisting disabilities and illnesses, which often results in a more challenging, multifaceted clinical presentation. A layered, seemingly convoluted clinical presentation, calls for the provider to balance additional expertise and skill beyond the competent advanced practice nurse to effectively manage the health needs of the complex older adult.
AALNA Section
Community plan for extreme heat waves p326–328
社区的极端热浪计划
The winter is gone and we are all already enjoying, depending on where you live, the spring or summer weather. Having the joy of living on the New Jersey coast, I have seen both in the same day. While the change is welcome it brings with it a set of precautions we must look at and prepare for to protect ourselves, our families and our residents.
NICHE Section
Annual NICHE Conference promotes best practices for caring for older adults p329–330
年度NICHE会议促进老年人最佳护理实践
NICHE (Nurses Improving Care for Healthsystem Elders) recently concluded its Annual Conference in Chicago. The conference attracted 920 nurses and other health care professionals from 370 organizations whose shared purpose is to improve the quality of care for older adults. An international program was included this year and, facilities from 46 states and seven countries — Austria, Australia, Brazil, Canada, Hong Kong, Singapore and the U.S. — were represented. Meeting and networking with health care professionals from around the world combined with the most robust schedule NICHE has ever offered made for an outstanding conference!
AGS Section
#AGS16: Geriatrics nursing expertise goes west to go global p331–332
#AGS16：老年护理专业知识走出西方走向全球
Several months ago, Steven R. Counsell, MD, AGSF, immediate past President and now Board Chair of the American Geriatrics Society (AGS), used these very pages to describe how there was “something in the mythology of California attuned to seeking and finding,” a “fitting spirit” for the site of the 2016 AGS Annual Scientific Meeting (#AGS16).
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