The assessment and management of pain among older people in care homes: current status and future directions

Pain is highlighted as a significant, yet neglected problem among older people, particularly in long-term care settings. The effects of inadequate assessment and treatment of pain among older people may lead to multiple problems.Problems arise due to cognitive impairment of clients and inadequate assessment by healthcare professionals. Analgesics are under-used and there is a need for improved education of both healthcare professionals and older people regarding attitudes to pain and ageing. Research is needed into the prevalence of pain among older people in United Kingdom (UK) care homes, how best to further educate healthcare professionals regarding pain management and how to enable older people to be facilitative partners in this process.     

社区老年视觉障碍人群保健服务体系的建立与实施

目的 了解社区老年视觉障碍人群就医行为与影响因素,为社区建立健全老年眼保健服务提供实际依据.方法 对视力普查中检出有不同程度视觉障碍的老年人,进行眼保健服务体系实施前后的问卷调查,调查内容主要有就医行为、影响因素、眼保健知识认知程度等.结果 与建立并实施眼保健服务体系前比较,视觉障碍老年人选择"及时就医"者由36.54%提高到72.95%,对眼保健知识"完全不了解"者由62.69%降低为4.11%.结论 随着我国人口老龄化,老年性眼病也愈来愈多,青光眼、白内障、老年性黄斑退化及糖尿病视网膜病变等是引起视力衰退或丧失的四大原因.因此,将老年人视力障碍的初级眼保健纳入社区服务内容,加强眼科专业人士、社区保健工作者的工作联系,建立起老年视觉障碍保健服务及转诊体系,在社区积极开展初级眼保健知识的教育,对提高老年人的眼保健意识、减缓视力衰退、积极防治视觉障碍、提高老年生活质量等有着重要的意义.     

The impact of ageing simulation education on healthcare professionals to promote person-centred care towards older people: A literature review

AimThis review aimed to explore the impact of ageing simulation for healthcare professional education to promote person-centred care towards older people.BackgroundAgeing simulation is an emerging educational approach to facilitate the learning of healthcare professionals on ageing and older people. However, there is limited evidence available exploring its use and impact on the person-centred care of older people.DesignAn integrative review approach was used.MethodsFour databases were searched from January 2010 to April 2020 including CINAHL, MEDLINE, Web of Science and PsychINFO, 21 papers were identified and analysed.ResultsThree interrelating themes were identified to outline the findings across the reviewed studies: ageing simulation use (theme 1), characteristics (theme 2) and impact (theme 3). Results showed literature available on ageing simulation is varied, ranged in study quality and applied several ageing simulation iterations making comparisons across the studies difficult.ConclusionsDespite these challenges it was clear ageing simulation is a promising educational approach currently being used to promote person-centred care for older people in healthcare professionals. Ageing simulation successfully improved the ageing knowledge, empathy levels and attitudes towards older people of healthcare professionals.     

The effect of reminiscence therapy on quality of life,attitudes to ageing,and depressive symptoms in institutionalized elderly adults with cognitive impairment: A quasi‐experimental study

The aim of this study was to analyse the effect of group narrative reminiscence therapy on cognition, quality of life, attitudes towards ageing, and depressive symptoms in a group of older adults with cognitive impairment in institutional care. A quasi‐experimental pretest/post‐test control group design was employed. Interventions involving reminiscence therapy with a narrative approach were included in the care plan and implemented in groups of between five and ten respondents once a week for 8 weeks (total 59 participants). The members of the control group (n = 57) received standard care. A study questionnaire was designed to measure demographic characteristics, quality of life (WOHQOL‐BREF, WHOQOL‐OLD), depressive symptoms (GDS), cognition (MMSE), and attitudes towards ageing (AAQ). Reminiscence therapy positively affected older adults’ quality of life (mostly the areas of mental health and social participation), and also their attitudes to ageing and old age. It reduced symptoms of depression, but had no discernible effect on cognitive function. Reminiscence therapy can positively affect selected aspects of quality of life, attitudes towards old age, and symptoms of depression in the elderly in long‐term healthcare facilities. Group reminiscence therapy can be used as a nursing intervention.     

Viewing oneself as a capable person – experiences of professionals working with older Finnish immigrants

The proportion of older immigrants in the population is expected to increase in Sweden. Research indicates that older immigrants face the double burden of frailty, caused by a weaker health status, and the immigration process. Health promotion interventions can be used to prevent frailty and support healthy ageing in this population. Healthcare professionals are a crucial part of health promotion and the present study aimed to explore healthcare professionals’ experiences of health in context of daily life among older immigrants to and provide a basis for the development of a health promotion intervention targeted at older immigrants. Four focus group discussions were conducted with professionals who worked with home‐dwelling older people from Finland, currently living in Sweden. Participants represented a variety of healthcare professions. Data were analysed using qualitative content analysis. The healthcare professionals perceived that health in daily life was (i) connected to the view of oneself as a capable person and (ii) participants strove to maintain their own origin. The findings highlighted that when planning for health promotion interventions for older immigrants, the point of departure should be to recognise the person as a person and the background of immigration is not the first issue to address. Therefore, a person‐centred health promotion intervention is recommended to open a dialogue between healthcare professionals and older immigrants, so that a common view of the intervention can be reached.     

Exploring the use of emollient therapy in dermatological nursing

This article explores how nurse prescribing has enabled patients with dry itchy skin to choose the product most suitable for the severity of their dry skin with the nurse. This is done through education, negotiation and trial of emollients. Health practitioners should ensure that patients understand how the environment challenges the skin, the processes of inflammation and ageing and how emollients used on a regular basis can support the epidermal barrier. Practical advice on technique of application is as essential to the concordance of the treatment as is the choice of product to be prescribed.     

Exploring the use of emollient therapy in dermatological nursing

This article explores how nurse prescribing has enabled patients with dry itchy skin to choose the product most suitable for the severity of their dry skin with the nurse. This is done through education, negotiation and trial of emollients. Health practitioners should ensure that patients understand how the environment challenges the skin, the processes of inflammation and ageing and how emollients used on a regular basis can support the epidermal barrier. Practical advice on technique of application is as essential to the concordance of the treatment as is the choice of product to be prescribed.     

The role of aggressions suffered by healthcare workers as predictors of burnout

Aims and objectives. To examine the prevalence of aggression against healthcare professionals and to determine the possible impact that violent episodes have on healthcare professionals in terms of loss of enthusiasm and involvement towards work. The objective was to analyse the percentage of occupational assault against professionals’ aggression in different types of healthcare services, differentiating between physical and verbal aggression as a possible variable in detecting burnout in doctors and nursing professionals. Background. Leiter and Maslach have explored a double process model of burnout not only based on exhaustion by overload, but also based on personal and organisational value conflicts (community, rewards or values). Moreover, Whittington has obtained conclusive results about the possible relationship between violence and burnout in mental health nurses. Design. A retrospective study was performed in three hospitals and 22 primary care centres in Spain (n = 1·826). Methods. Through different questionnaires, we have explored the relationship between aggression suffered by healthcare workers and burnout. Results. Eleven percent of respondents had been physically assaulted on at least one occasion, whilst 34·4% had suffered threats and intimidation on at least one occasion and 36·6% had been subjected to insults. Both forms of violence, physical and non‐physical aggression, showed significant correlations with symptoms of burnout (emotional exhaustion, depersonalisation and inefficacy). Conclusions. The survey showed evidence of a double process: (1) by which excess workload helps predict burnout, and (2) by which a mismatch in the congruence of values, or interpersonal conflict, contributes in a meaningful way to each of the dimensions of burnout, adding overhead to the process of exhaustion–cynicism–lack of realisation. Relevance to clinical practice. Studies indicate that health professionals are some of the most exposed to disorders steaming from psychosocial risks and a high comorbidity: anxiety, depression, etc. There is a clear need for accurate instruments of evaluation to detect not only the burnout but also the areas that cause it. Professional exhaustion caused by aggression or other factors can reflect a deterioration in the healthcare relationship.     

The role of emollients in the care of patients with dry skin

Dry skin (xerosis) is a common problem, and ranges from mild dryness through to severe dryness and skin breakdown. The use of emollients continues to be the main therapeutic approach to this problem. However, patients and healthcare professionals do not always appreciate the importance of emollient therapy, and are faced with an overwhelming choice of products. This article aims to review skin barrier function and hydration, the factors causing dry skin and some of the issues that surround the use of emollients.     

Influence of prior cognitive impairment on the severity of delirium symptoms among older patients.

Delirium is common among hospitalized elderly patients with prior cognitive impairment. Detecting delirium superimposed on dementia is a challenge for nurses and doctors. As a result, delirium among demented elderly patients is of increasing interest to healthcare professionals. So far, studies have failed to describe how symptoms of delirium are altered by severity of dementia. This would be valuable information to improve the rate of detection by nurses of delirium among demented patients. However, until now no research has examined the effect of severity of prior cognitive impairment on the severity of delirium symptoms among institutionalized older patients. This study describes the effect of severity of prior cognitive impairment on the severity of delirium symptoms among institutionalized older patients with delirium at the time of their admission to an acute care hospital. One hundred four institutionalized elderly people were included in this study and screened for delirium using the confusion assessment method. Patients with delirium (n = 71) were evaluated with the delirium index to determine the severity of the symptoms of delirium. The results showed that the severity of prior cognitive impairment influences the severity of most of the symptoms of delirium, particularly disordered attention, orientation, thought organization, and memory. Thus, taking into account the severity of prior cognitive impairment could help nurses to detect delirium among older patients.     

Evidence-based use of emollients in neonates

Skin is a unique organ that provides protection, thermoregulation, sensation, and metabolic functions. From birth to adulthood, it serves as a barrier to the environment, protecting the body against infection, injury, and fluid loss. If skin barrier function is compromised at any time, clinically significant deleterious systemic effects could result. Many skin care products have therefore been marketed specifically for “babies.” However, even though advances in dermatology and neonatology have led to a better understanding of the development, structure, and function of neonatal and premature neonatal skin, there is limited evidence-based literature promoting the use of topical emollients for optimizing the skin health of newborns. This review discusses the uniqueness of neonatal skin and the purpose and potential side effects of topical emollients, and it briefly overviews the available evidence-based literature that focuses on the use of emollients in neonates. Copyright © 2001 by W.B. Saunders Company     

Understanding dementia amongst people in minority ethnic and cultural groups

AIM: This paper is a report of a study to explore perceptions of ageing, dementia and ageing-associated mental health difficulties amongst British people of Punjabi Indian origin. BACKGROUND: People from ethnic minorities are often under-represented in mental health services. Contributing factors may include lack of knowledge of dementia in these communities, lack of detection in primary care, expectations of family care and lack of appropriate services. For this to change, greater knowledge is needed about awareness and conceptualization of dementia in minority ethnic communities. METHOD: A focus-group study was conducted between 2001 and 2003 with 49 English-, Hindi- and Punjabi-speaking British South Asians, aged 17-61 years. Views of ageing and ageing-associated difficulties were explored in initial groups. In a second set of groups, vignettes were used for more specific exploration of awareness and understanding of dementia. Data were subjected to thematic analysis. FINDINGS: Ageing was seen as a time of withdrawal and isolation, and problems as physical or emotional; cognitive impairment was seldom mentioned. There was an implication that symptoms of dementia partly resulted from lack of effort by the person themselves and possibly from lack of family care. Therefore people should overcome their own problems and family action might be part of the solution. There was a sense of stigma and a lack of knowledge about mental illness and services, alongside disillusionment with doctors and exclusion from services. CONCLUSION: Health promotion and health interventions delivered with respect for the cultural context are needed, as well as education of healthcare professionals about South Asian conceptualizations of dementia.     

An informed approach may prevent loss. New perspectives on cot death.

Cot death can be devastating for both parents and healthcare professionals, causing feelings of helplessness and loss. Recent research, however, has identified some contributory factors, which nurses and midwives can bring to parents' attention.     

The vital role of emollients in the treatment of eczema

Eczema is one of the most common dermatological diseases, with the number of cases in the UK rising. The use of emollients to maintain skin hydration and help restore barrier function, remains the principal treatment. Unfortunately, many health professionals, and patients themselves, fail to consider emollients an active treatment and may overlook the vital role they play in the maintenance of intact, healthy skin. Despite the overwhelming acceptance of the importance of emollient therapy, there remains a lack of good quality evidence on their effectiveness or whether one is better than another. Even when appropriate emollients are supplied, they are often used incorrectly or accompanied by conflicting/limited advice from health professionals. This article aims to explore normal skin barrier function, the disruption caused by eczema, and some of the contemporary issues surrounding emollient therapy.     

Eczema and dry skin in older people: identification and management

Skin conditions affect up to 70% of older people. Among the commonest are those which are caused by or present as dry, itchy skin. This article discusses the three most common of these--asteatotic, gravitational and discoid eczemas--and offers straightforward advice that nurses can pass on to their patients for how to mitigate and manage these conditions. Central to this is avoidance of soaps and the use of emollients.     

Reducing inequalities in healthcare provision for older adults

The UK has a rapidly ageing population with increasing healthcare needs. Yet social isolation and exclusion, resulting from stigma and age discrimination, means that many older people are faced with unequal access to health care, referral and treatment. Inequalities in health care are particularly prevalent among older people with mental health issues and those from black and minority ethnic backgrounds. Healthcare professionals need to encourage greater involvement of older people in health promotion and community-based healthcare services. Nurses are exemplars for health service delivery and are ideally placed to promote health care that is free from age-related discrimination.     

Surgical Smoke and Biological Symptoms in Healthcare Professionals and Patients: A Systematic Review

PurposeThis study aimed to identify the evidence in the scientific literature between exposure to surgical smoke and biological symptoms in healthcare professionals and patients.DesignA systematic review.MethodsElectronic databases were searched, including vivo observational and experimental studies published until August 2020 in Portuguese, English, Spanish and French.FindingsWe identified 13 studies, with a predominance of cross-sectional (6; 46.15%), experimental laboratory (4; 30.76%) and cohort (3; 23.07%) studies. The main manifestations identified were related to respiratory tract and headache. There was identification of histopathological changes in the nasal mucosa of healthcare professionals and the presence of toxic substances from smoke identified in the urine of patients and healthcare professionals.ConclusionThe scientific literature on the biological symptoms of surgical smoke is mainly composed of observational studies with a reduced sample size, thus constituting aspects which limit a broader and long-term understanding of the biological effects of surgical smoke exposure in healthcare professionals and patients.     

Safe and effective pain management in elders

The elderly are often either untreated or undertreated for pain. The consequences of undertreatment for pain can have a devastating impact on health and quality of life, resulting in depression, anxiety, social isolation, cognitive impairment, immobility, and sleep disturbances. Reasons cited by healthcare professionals for inadequate pain control include lack of training, inappropriate pain assessment, and reluctance to prescribe opioids, however, the undertreatment of pain can be legally considered to constitute neglect, abuse, or negligence. The appropriate treatment of pain is humane and with good diagnostic efforts, proper consideration of appropriate medications and monitoring for adverse effects, healthcare providers can help to successfully control pain.     

Obsessive-compulsive disorder. What to do if you recognize baffling behavior

The prognosis for patients with obsessive-compulsive disorder has improved dramatically in recent years. Primary care physicians, who may be the first healthcare professionals to consult with these patients, can often provide appropriate treatment or therapeutic guidance. Psychiatric consultations and the implementation of a long-term management plan may be needed for complicated cases with comorbid psychiatric conditions and for patients with refractory symptoms of obsessive-compulsive disorder.