<p> Aspects of heart-failure day-to-day health monitoring include adherence to medication, diet, and physical activity recommendations, and identifying changes in dyspnea, fatigue, or lower-limb edema. Participation in a telehealth program can guide day-to-day health monitoring toward healthy behaviors and symptom recognition. The purpose of this study was to characterize telehealth data, nurse responses to telehealth alerts, and healthcare utilization by participants. A retrospective review was conducted of the initial 90 days of 187 older veterans with heart failure participating in one Care Coordination Home Telehealth program from September 2007&ndash;September 2013. Data were collected from telehealth records and electronic medical records. Descriptive statistics were used to identify differences in call compliance, telehealth alerts, and nurse responses to alerts. Rates of heart-failure-related healthcare utilization were analyzed using logistic regression. Participants were predominantly male and non-Hispanic White, with the comorbidity of hypertension and an average age of 73.9 years. Telehealth call compliance was 75.8%. There was a sharp decline in daily compliance the 1st week of program participation, with a significant nonlinear effect. The mean proportion of submissions measuring within alert range was 23.3% (<i>SD</i> = 24.6) for weight and 1.3% (<i>SD</i> = 3.3) for dyspnea. The mean proportion of timely nurse response to alert range data was 15.1% (<i>SD</i> = 17.7) for weight and 48.5% (<i>SD</i> = 43.0) for dyspnea. Among the sample, 17.6% required an emergency department visit and 18.2% required inpatient hospital care. Hospital length of stay was likely to increase among participants with chronic renal disease (incidence rate ratio [IRR] = 1.78, <i>p</i> &lt; 0.001), advancing age (IRR = 1.01, <i>p</i> &lt; 0.001), presence of telehealth alerts (IRR = 1.006, <i>p</i> &lt; 0.035), and presence of nurse responses to alerts (IRR = 1.013, <i>p</i> &lt; 0.001). The initial rapid drop in daily compliance by older adults highlights the need for equipment training and follow-up support throughout the 1st week of participation. Telehealth alerts and nurse responses to alerts were statistically significant predictors for heart-failure-related hospital length of stay. Future healthcare utilization risk models and clinical trials of telehealth systems should include measures related to telehealth alert-range data and nursing responses to changes in patient status identified by telehealth alerts. </p><p>

<p> <b>Purpose:</b> The purpose of this study is to explore the grief/bereavement process of Alzheimer's Disease and Related Dementias (ADRD) caregivers following death of a family member in long-term care (LTC) and develop a theoretical model of this phenomenon based upon in-depth individual interviews. There is limited evidence examining ADRD caregiver grief and bereavement following family member death in LTC settings. Grounded Theory methodology has not been utilized to explore this phenomenon.</p><p> <b>Background:</b> ADRD is estimated to be the ^6th leading cause of death in the United States. Most individuals with ADRD die in LTC settings, where grief and bereavement support to surviving family members is virtually non-existent. Twenty-percent of these caregivers experience prolonged and/or exaggerated grief reactions that may impair their physical/mental health. </p><p> <b>Method:</b> A Grounded Theory design was used in this study. Participants were caregivers of a family member with ADRD who died in a LTC setting, recruited via Internet-based websites and caregiver forums. The interview guide explored recall of end-of-life grief and bereavement and the impact of LTC placement. Audio-taped individual interviews were conducted via Internet-based video-conferencing or telephone. Interviews were transcribed verbatim and entered into DeDoose^&copy; (qualitative data management software). Grounded theory methods were used to analyze data, formulate theoretical assumptions, and develop a theoretical model. Constant comparative analysis was used to interpret the findings and determine data saturation. Rigor was ensured through peer debriefing, audit trails, and expert reviews of the proposed model.</p><p> <b>Results:</b> Participants included adult children/grandchildren (<i>n</i>=16) and spouse (<i>n</i>=1) ranging in age from 30 to 77 years (M=56.94, SD=5.36). The mean time between death and the interview was 2.98 years (SD=2.22). The emerging model identified is comprised of 3 interdependent components of bereavement (behavioral, cognitive, and emotional). The following factors related to LTC placement were identified as facilitators or barriers to caregiver grief/bereavement: relationships/support with staff, death rituals, end-of-life care (hospice, end-of-life suffering), frequent deaths of other LTC residents, staffing-shortages, and length of time in LTC. </p><p> <b>Conclusions:</b> Findings from this study can be used to develop bereavement interventions for ADRD caregivers whose family members die in LTC.</p><p>

Objective. To examine the feasibility of family participation in a nurse-supported, multicomponent intervention program for delirium prevention in the older hospitalized adult. Background. Delirium is the leading complication of hospitalization for older adults and is associated with important consequences including increased morbidity and mortality, increased use of health care resources, and increased caregiver burden. The potential role that family caregivers could play in delirium prevention and how nurses could facilitate family participation has been largely unexplored. The Calgary Family Intervention Model (CFIM), operating on the assumptions of a family-centered care philosophy, provided a framework for understanding the feasibility of family participation in delirium prevention efforts. Methods. A descriptive exploratory design using a convenience sample of 15 family caregivers of older hospitalized adults at a large teaching hospital was used to address the research questions. For the Family Participation Delirium Prevention Program (FPDPP), family caregivers implemented five intervention protocols targeted toward four baseline risk factors for delirium and self-tracked daily intervention completion. Feasibility was based on rates of intervention completion, and consideration of the barriers and facilitators for participation based on older adults’ and family caregivers’ responses on discharge questionnaires and staff nurses’ responses on a questionnaire. Results. Intervention completion was highest for the orientation protocol (83.5%), followed by the vision protocol (81.5%), therapeutic activities protocol (76.9%), hearing protocol (73.6%), and early mobilization protocol (55.3%). Three themes emerged on the barriers and facilitators for family participation: therapeutic relationships, partnership, and environment. The barriers and facilitators were generally consistent with the concept of family-centered care as described in the CFIM. Conclusion. Based on the rates of intervention completion, it appears that the FPDPP is feasible for implementation in clinical practice. A remarkable level of agreement was found on the concept of the feasibility of family participation among older adult patients, family caregivers, and staff nurses with the common themes that emerged. Key to its successful implementation will be recognition and attention to the barriers and facilitators for participation. In addition, operating from a framework of family-centered care, nurses can advocate for environments that support family caregivers’ participation in a delirium prevention program.

<p> Anxiety and behavior disturbances are a significant problem for geriatric residents living in a facility. Currently treatment for these symptoms is pharmacological. While medications are necessary in some cases, significant uncomfortable side effects can result. The availability of effective treatments that are non-pharmacological allows nurses to offer an alternative option for these symptoms. The purpose of this project was to investigate animal-assisted therapy (AAT) and the effects this therapy has on anxiety and behavioral symptoms for geriatric patients living in a facility. A four week study was conducted with adult subjects age 55-85 who were diagnosed with anxiety or behavior symptoms and live in a facility. A dog was utilized for the therapy. Evidence suggests the effectiveness of AAT for a multitude of disease states and medical conditions. Use of ATT in this study revealed several behavioral changes for individual participants.</p>

<p>Abstract The increased prevalence of cognitive deterioration has increased the challenges of caring for older adults. This study?s project site offers a psychiatric program for older adults with customized care for complex geriatric mental health patients. Clinical assessment and care management are often overlooked in geriatric mental health patients diagnosed with behavioral and psychological symptoms of dementia (BPSD). The purpose of this project was to deliver an education program developed from the Staff Training in Assisted Living Residences-Veterans Administration, P.I.E.C.E.S ? model and the Castle framework to 42 nursing and allied health staff of the project site. The project question explored whether an education program on care of patients with BPSD increased staff members? perceived knowledge and competence in providing care to these patients. This education program focused on comprehensive assessment, individualized care planning, and individualized nonpharmacological interventions to manage older adults with dementia. Descriptive statistics were used to analyze performance outcomes data before and after staff education. In addition, care plans of patients were reviewed. Results included a 100% increase in recognition of core concepts of the education program; a 48% to 86% increase in staff willingness to use interdisciplinary care plans; and a 6.6% to 95% increase in documentation of key interventions in care plans for 6 behaviors of dementia. The results of this project might bring about social change by improving the skills and competence of nursing staff in managing the patients with dementia, thus positively impacting the quality of life of patients with BPSD by benefiting from nonpharmacological interventions.

<p> Over the last half a century, the frequency and intensity of tornados, floods, and other severe weather events have underscored the need for disaster preparedness, particularly for older adults. Functional limitations, cognitive decline, and medical comorbidities such as heart disease and diabetes create additional vulnerabilities, regardless of the type of disaster. Still, elders are capable of self-identifying needs and can be empowered to prepare communication plans, assemble disaster kits, and learn how to respond to threats posed by specific disasters. By increasing the level of disaster preparedness through training, many of the health problems faced by elders during a disaster could be alleviated and their overall response improved. Yet despite their abilities and the known benefits of disaster preparedness, disaster education and planning for elders has not been widely implemented.</p><p> The purpose of the Geriatric Passport Project was to increase the level of disaster preparedness through implementation of a disaster education program among community-dwelling older adults over the age of 55. Recruitment strategies included media, engaging key staff from program sites, and word of mouth. </p><p> The project used a pre-post reflexive control design. Knowledge about the elements to include in a disaster communication plan increased as did knowledge about items to include in a disaster kit. Notably, self-rated level of stress associated with evacuation to a shelter remained unchanged. Most importantly, the perceived level of disaster preparedness increased, suggesting that those who participated in the Geriatric Passport Project felt more prepared to respond to a disaster as a result of having attended the disaster education program.</p><p> The Geriatric Passport Project appears to have beneficial effects and the success of the pilot project supports exploring the feasibility of expanding the program to a wider geographic region and conducting a more rigorous evaluation of program effectiveness, efficacy, and efficiency.</p>

<p> This qualitative descriptive interdisciplinary study, performed in the space between nursing and engineering and within the field of gerontechnology, explored the influence of culture on older adults&rsquo; adoption of smart home monitoring. In-depth email interviews were used with a purposive sample of older adults (n=21) age 65 and older from Washington, Idaho, Alabama, Tennessee, and New York. Participants were asked to prospectively consider the question of adoption of a smart home that is under development at Washington State University&rsquo;s Center for Advanced Studies in Adaptive Systems (CASAS) that combines artificial intelligence software with sensor monitoring for the purpose of maintaining safety and health. This smart home learns the resident&rsquo;s motion patterns and can take an action on behalf of the resident living in the home. Many participants indicated a prospective openness to smart home monitoring. Openness depended on (a) the level and specificity of need and whether the smart home would meet that need, (b) perceived loss of privacy compensated by a feeling of safety and a receipt of health-assistance, (c) functionality, and (d) cost. Low inference themes emerging from rich text and supported with multiple lines of participants&rsquo; own words were <i> privacy, pride and dignity, family, trust, being watched, human touch, features and functionality, cost, and timing.</i> Participants were asked to self-identify their own culture of socially constructed values, which were found to heavily inform perceptions of privacy, independence, and family. Findings from this study explicate and illuminate older adults&rsquo; perceptions and descriptions of smart home monitoring, the relation to their own socially constructed values, and the influence on a decision to adopt or not adopt smart home monitoring. Findings may be used to inform future smart home design using machine learning, marketing, clinical nursing practice, nursing education, health policy, interdisciplinary collaboration, and research.</p>

<p> This narrative research offers an inquiry that intends to inspire thinking about a culturally competent dementia care framework in the United States. The main research question is: How does a culture hold dementia care? A subquestion is: What can we in the United States learn from other cultures about dementia care to enhance this care for all? The inquiry was designed to conduct narrative research focusing on Japanese culture in the context of caregiving to people with dementia; 4 professional and 4 family caregivers from this culture, who have cared or have been caring for persons with dementia, were interviewed. The narratives reflected the caregivers' lived experiences and how they were culturally compelled to give and sustain care. </p><p> This inquiry assumes that a person-centered dementia care model is challenging for the U.S. healthcare system, despite attempts to do so, due to the prevailing values and beliefs in the United States that center around a cure model as opposed to a care model. It also assumes that ideal person-centered dementia care in the United States needs to pay close attention to the cultural competence of caregivers and healthcare professionals, as their clients identify as persons through their cultural ways of being. These assumptions are grounded in the literature review. </p><p> As a result of narrative data analysis, 5 themes emerged from the data among family caregivers, and 2 themes among professional caregivers as the commonality. In addition, 4 themes emerged not as common themes but as unique themes. This dissertation examined Japanese interdependent construal of the self and demonstrated that these themes could be explained through understanding Japanese sense of self. </p><p> It is evident that interdependence between the self and others is deeply embedded in Japanese culture. Without a doubt, interdependence uniquely manifests in the caregivers&rsquo; attitudes, values and worldviews of caregiving in Japanese culture. Although the limited number of participants should be considered, these findings/caregivers&rsquo; insights generated from this study aim to promote and encourage dialogues regarding what culturally competent dementia care looks like among caregivers and beyond in the United States when taking care of people from different cultures.</p><p>

<p> Atypical symptoms, multiple co-morbidities and a lack of public awareness make it difficult for older adults to know when to seek help for sepsis. Diagnosis delays contribute to older adults&rsquo; higher sepsis mortality rates. This research describes patients&rsquo; and caregivers&rsquo; experiences with the symptom appraisal process, self-management strategies, provider-nurse-patient interactions, and barriers when seeking sepsis care. Convenience and purposive stratified sampling were utilized on two data sources. A nurse-patient and nurse-family caregivers were interviewed. Online stories by older adult patient survivors or family members from the Faces of Sepsis&trade; Sepsis Alliance website were analyzed. Emergent themes were identified using qualitative descriptive methods. Listlessness and fatigue were most bothersome symptoms for the nurse-family caregivers. Fever, pain and low blood pressure were most common complaints, followed by breathing difficulty, mental status changes and weakness. Patients expressed &ldquo;excruciating pain&rdquo; with abdominal and soft tissue sources of infection, and with post-operative sepsis. Concern was expressed that self-management strategies and medications create barriers by masking typical sepsis signs. Health care providers&rsquo; interpersonal interactions, lack of awareness of sepsis symptoms and guidelines, complacency towards older adults, and denial by patients were barriers. Further barriers were staff inexperience, delays, care omissions, and tension between health care providers, patients and caregivers&mdash;with emerging advocacy by patients and family. In conclusion, providers should assess previous self-management strategies when evaluating symptoms. At primary care visits or hospital discharge, older patients with risk factors need anticipatory guidance for sepsis symptoms and possible emergent infections&mdash;specifically patients with pre-existing risk factors such as urinary tract infections, pneumonia, or operative events. Public and professional education are needed to overcome a lack of urgency and understanding of symptoms for diagnosis, treatment and guideline adherence for inpatients and outpatient clinics. Further research on subjective sepsis symptoms may improve patient-clinician communications when evaluating sepsis in older adults. </p><p>

<p> Depression among the elderly is a significant concern due to the limited evidence-based treatment options and its overall global burden. Walking activity as a form of physical activity serves as an evidence-based intervention in addressing the issue of depression among the elderly. The depression level among elderly patients was examined (n = 17, Mage = 68.71, SD = 3.04) before walking activity using the Geriatric Depression Scale (GDS) &ndash; 15 questionnaire version. Thirty minutes of a bi-weekly walking activity was implemented for eight weeks followed by the depression level measured using the GDS-15. There were statistically significant differences across the variables before walking activity (Mbefore = 7.71, Sbefore = 1.53) and after walking activity (Mafter = 6.59, Safter = 1.58, P = .00) determined through the utilization of the Statistical Package for Social Sciences (SPSS) version 24. The finding supports the consistent usage of walking activity in reducing the symptoms of depression consequently decreasing mortality and morbidity rate, reducing healthcare expenditure as well as addressing the overall depression related public health concerns. </p><p>