Detecting Delirium in Older Adults Living at Home

The aim of this study was to determine whether in-home care nurses had the necessary knowledge to detect delirium in older adults. To this end, 87 home care nurses from 2 sites in the greater Quebec City region in Canada answered a questionnaire. The results showed nurses had limited level of knowledge about the diagnostic criteria for delirium, the main signs and symptoms of delirium, and the tools for its detection. Moreover, 54.4% of the in-home care nurses were able to recognize delirium, from structured clinical vignettes.     

The Future Care Plans of Older Adults with Intellectual Disabilities Living at Home with Family Carers

The topic of future care provision for adults with intellectual disability living in the family home is becoming of increasing interest to researchers since epidemiological evidence indicates that this group of people will make increasing demands for residential provision in the future. Deriving information from a previously reported study on the structure and characteristics of the informal support networks, this paper describes the future residential and financial provision planned for a group of people with intellectual disability over the age of 40 years living with relatives in the family home and investigates the factors which influence carers' decisions to plan for the future. A semi-structured interview enabled both quantitative and qualitative data to be collected. Results indicated that plans for the future residential care were minimal. Only 28% of carers had made any concrete plans for future residential care of their relative. In the majority of cases, carers were committed to maintaining long-term home care for their relative with intellectual disability for as long as possible. Attention is drawn to the significant number of elderly parental carers (82% of this sample) who have not made concrete future residential arrangements. Carers were more likely to establish financial plans than residential plans for their family member. No clear differences were found between carers to indicate factors influencing whether they had made preparations for the future. Explanations for the reluctance of carers to plan for the future were, therefore, explored. The overall conclusion to be drawn from the research is that ‘crisis’ resettlement due to ill health or death of the main carer is highly likely. The potential role of service-providers is briefly discussed.     

The Experience of Home Health Care: Perceptions of Older Adults

Abstract Changes in the health care delivery system resulting in increased need for home health services have led to greater involvement of public health nurses in defining practice and developing research in this area. Gaining an understanding of the experience of home health care from the perspective of frail older clients was the purpose of this investigation. An ethnographic study was conducted with nine older adults recently discharged from home health services. Analysis of data generated in home interviews revealed three major themes related to the experience of home health care: nursing care, health problems, and independence. Informants emphasized the reassurance and support given by nurses, yet did not readily identify teaching as part of the nurses' role. Several health problems were mentioned, emphasizing the experience of declining health and loss of independence. Although initially assistive, home health care was perceived to support dependency as the patients became more well and able to undertake self-care.     

Effect of Life Review on Quality of Life For Older Adults Living in Nursing Homes

Aim: To examine the effects of life review on daily activities, social participation, outlook on life, and perceptions of living in a nursing home measured by life satisfaction and quality of life in older adults. Method: The study design was a two-phase quasi-experimental pre-post-tests including development and testing of a life review protocol. Nine residents, age ≥65, participated in a life review group once weekly for 6 weeks. Outcomes were analyzed using the Life Satisfaction Index-Z (LSI-Z) and pre-post surveys. Results: LSI-Z scores improved post-intervention and survey outcomes indicated participation in activities of daily living (ADLs), socialization, outlook on life, and living in a nursing home perceptions improved for all participants. Conclusion: The study demonstrates the effectiveness of a life review protocol to improve ADLs, social participation, and enhancing perceptions of outlook on life and living in a nursing home enhancing QOL and life satisfaction for older adult nursing home residents.     

Optimizing Care for Older Adults With Dementia-Associated Psychosis

Dementia continues to escalate as the aging population increases, and there are no medications available to reverse this disease. Dementia-associated psychosis/behavioral disturbances can be attributed to frontal lobe, vascular, Alzheimer, Parkinson, and Lewy body dementia, but patients must be assessed for other etiologies. Care for these patients can be challenging. Some studies find certain medications to be effective, but they are not without risk. Medications can lead to falls and even demonstrate paradoxical effects, causing significant distress in patients as well as their families. Nonpharmacologic interventions may prove helpful and should be used first if possible.     

Nursing and Home Care in Europe

The demographic trend of a rapidly ageing society becomes increasingly persuasive. More chronically ill patients will be discharged to home care. More people with psychotic problems and debilitating diseases will be living in communities. All require nursing care. This situation is recognized everywhere and no boundaries can change this future.