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Excerpt: The focus of this paper is 1)to provide an overview and brief analysis of the current status of rural communities, rural elder health, policy, and practice, and further 2)to suggest guidance/recommendations for future policy based on a systems approach which incorporates sustainability, best practice, quality, efficiency, effectiveness, with a conceptual basis for care within the context of people and place which constitutes rural America.

The purpose of this study was to describe the experiences of rural community-dwelling older adults with heart failure who required assistance with activities of daily living (ADLs) and instrumental ADLs (IADLs). The context of the study was a rural area in a southern U.S. state. Twenty older adults with ADL/IADL needs living in the rural area were recruited during hospitalization and interviewed in their homes after discharge. The semi-structured interview focused on ADLs/IADLs and community resources. This qualitative descriptive study used hermeneutic methods for analysis. Four themes were identified: Accepting Limitations, Disappointments and Unmet Expectations, Figure It Out, and Complex Connections. The findings indicate that despite the older adults’ medical conditions, they were able to set up complex arrangements, which allowed them to remain in their homes. Understanding the help older adults require after discharge will assist nurses in developing programs that are available, accessible, and acceptable to older adults who live in rural areas.

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Controlled substance use, particularly among the rising elderly population, places these patients at a much higher risk of falls, injuries, and hospitalization. This study examines the association between preinjury controlled substance prescription and clinical outcomes of older adults after a ground-level fall. A total of 5,930 patients were included. Their home medication list was analyzed to record active opioids, benzodiazepines, narcotics, or other substances defined as controlled according to the Drug Enforcement Agency. Almost half (45%) of the patients were taking controlled substances. Sixty-seven percent of those were females. Total hospital days, Injury Severity Score (ISS), and mortality outcomes were not significantly different between groups. However, intensive care unit (ICU) days, days on mechanical ventilation (MV), and discharge destination were significantly different for patients taking controlled substances versus those not taking controlled substances. Patients taking controlled substances were more likely to be discharged to short- and long-term care facilities versus patients not taking controlled substances (P≤0.001).

Spinal Cord Injury (SCI) is a physically debilitative impairment with a poor prognosis that disrupts the connection between the brain and body. Reduced somatic and autonomic nervous system control over motor and sensory function of muscles and organs causes paralysis and dysregulation of physiological systems. Complications, such as deep vein thromboses, urinary tract infections, and chronic pain, often cause high, life-long economic burdens. Seniors with SCI also have an increased risk of developing cognitive decline. Development of Major Neurocognitive Disorder (Dementia) is characterized by a reduced ability to perform daily activities. In addition to the physical impairments due to SCI, older adults would experience further decreased quality of life. There are various postulations about what contributes to an increased risk of cognitive decline in SCI patients, although the specific mechanism is uncertain. This research project is focused on examining whether blood pressure dysregulation may play a key role in inducing cognitive decline in older adults with SCI. To fulfill this goal, published reviews and clinical and laboratory data from 1997 to 2023 have been analytically reviewed following the presentation of background physiological and pathophysiological information. The outcomes demonstrated that SCI above T6 leads to an increased risk of blood pressure dysregulation and other conditions associated with an increased risk of cognitive decline, including orthostatic hypotension, vascular dementia, and deficient dynamic cerebral autoregulation. Overall, the findings suggest that blood pressure dysregulation that causes cerebral hypoperfusion may be a major contributor to cognitive decline in older adults with SCI.

Abstract Aims: 1) To determine fall risk assessment using subjective and objective measures; 2) To understand older adults' perception on fall risk assessment. Methodology: An explanatory sequential mixed methods design was used and consisted of two phases. Phase 1, the quantitative data was collected from nineteen older adults at an independent living facility in Orlando, Florida. Phase 2, the qualitative data was collected from three participants of Phase 1. After obtaining Institutional Review Board approval, the study was conducted at Lutheran Towers an independent living facility located in the downtown area of Orlando, Florida. Three measurement tools were used: demographic data sheet, an objective tool: BTrackS™ Balance Test (BBT), and Short Falls Efficacy Scale-International (FES-I). Results: In phase 1, 37% of participants had a high risk for falls assessed by the objective measure (BBT), and about 11% had high concern of fall risk assessed by the subjective measure (Short FES-I). Approximately 32% had congruent results between subjective and objective measures and 68 % presented incongruent results between subjective and objective measures. In phase 2, three themes were generated from the qualitative data :1) Perception and experience on fall risk assessment; 2) Perception of the subjective measure (Short FES-I) and 3) Perception of the objective measure (BBT). Conclusion: Those who have incongruent perceptions of their fall risk and physical abilities are most at risk. Performing fall risk assessment using both subjective and objective measures is critical for developing fall prevention plans, to identify those most at risk.

Maintaining a physically active lifestyle has shown to decrease the risks of falling by slowing down the degenerative changes that occur with aging adults. But despite these physical changes, research has recognized the development of the fear of falling (FOF) as also attributing to the aging adults’ risk of falling. Furthermore, increases the risk of falling and subsequently increases the loss of independency. This study aimed to: 1) examine the relationships between the levels of physical activity, degree of FOF, and fall risk using quantitative approach; and 2) explore the changes of FOF and understand its cause using qualitative approach. Data was collected from participants through various assessments including the Rapid Assessment of Physical Activity (RAPA) for measuring physical activity, shortened version of Falls Efficacy Scale-International (FES-I) for measuring FOF, and semi-structured one-on-one interviews. As data is being analyzed, participants who increased their physical activity levels were identified to having lowered their level of FOF and those who had a decrease of physical activity levels showed an increase with their FOF. It was also translated that the notion of being aware played a key role on the individuals FOF from 46% of the 13 participants interviewed and over 80% also stated not having talked to their doctor about their risks of falling and prevention. The importance of maintaining a physical activity level not only continues to prove the benefits it has on the individual’s risk of falling but how it also plays a role on the individuals fear of falling.

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