The assessment of pain in older people

Pain is under-recognised and under-treated in older people. It is a subjective, personal experience, only known to the person who suffers. The assessment of pain is particularly challenging in the presence of severe cognitive impairment, communication difficulties or language and cultural barriers. These guidelines set out the key components of assessing pain in older people, together with a variety of practical scales that may be used with different groups, including those with varying levels of cognitive or communication impairment. The purpose is to provide professionals with a set of practical skills to assess pain as the first step towards its effective management. The guidance has implications for all healthcare and social care staff and can be applied in all settings, including the older person's own home, in care homes, and in hospital.     

Autonomy for older people in residential care: a selective literature review

Autonomy is an important concept because it brings dignity to peoples' lives, regardless of physical circumstances. The United Nations (UN) Madrid International Plan of Action on Ageing emphasises the need to include older adults in autonomous decision-making processes. However, many older people living in residential care find that their autonomy is curtailed. This is largely because autonomy for older people is poorly understood, and hence, nurses working with older people need to become clear about what autonomy is and how it can be facilitated. In this, the first of three papers, the literature is reviewed specifically to establish the meaning of autonomy for older people in residential care as opposed to autonomy in a wider context. This important distinction may help nurses working with older people to begin to facilitate autonomy more effectively.     

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.     

The physical environment,activity and interaction in residential care facilities for older people: a comparative case study

The physical environment is of particular importance for supporting activities and interactions among older people living in residential care facilities (RCFs) who spend most of their time inside the facility. More knowledge is needed regarding the complex relationships between older people and environmental aspects in long‐term care. The present study aimed to explore how the physical environment influences resident activities and interactions at two RCFs by using a mixed‐method approach. Environmental assessments were conducted via the Swedish version of the Sheffield Care Environment Assessment Matrix (S‐SCEAM), and resident activities, interactions and locations were assessed through an adapted version of the Dementia Care Mapping (DCM). The Observed Emotion Rating Scale (OERS) was used to assess residents’ affective states. Field notes and walk‐along interviews were also used. Findings indicate that the design of the physical environment influenced the residents’ activities and interactions. Private apartments and dining areas showed high environmental quality at both RCFs, whereas the overall layout had lower quality. Safety was highly supported. Despite high environmental quality in general, several factors restricted resident activities. To optimise care for older people, the design process must clearly focus on accessible environments that provide options for residents to use the facility independently.     

The holistic assessment of the patient in pain

Holistic pain assessment involves the recognition of pain, an understanding of the context in which it is experienced and knowledge of the resources available to deal with it. Psychosocial and functional approaches to assessment are key to helping the patient cope with pain.     

Agenda for the future: enhancing autonomy for older people in residential care

This is the concluding paper of a three paper publications. Paper 1 focused on specifically understanding what autonomy for older people in residential care means. Paper 2 discussed the various factors that either facilitate or hinder residents autonomy and directed readers to reflect upon their practice. This final paper outlines the findings from the action research phase of a study aimed at enhancing resident autonomy. It describes just one way in which residential care units can work on enhancing residents autonomy and enables the reader to reflect upon nursing practices, which with the right approach can be resident-centred.     

Comprehensive nursing assessment in the care of older people

A comprehensive assessment is the first stage of the nursing process. In rehabilitation nursing, it provides the foundation for care that enables individuals to gain greater control over their lives and enhance their health status. The place of the older person and significant carers/family members in assessment cannot be overestimated, as each should be empowered to fulfill the role of imparting expert knowledge about the person's life experience and views. This article examines some pertinent issues in relation to nursing assessment and emphasises that identification of needs and the use of appropriate assessment tools, in conjunction with the knowledge, skills and clinical judgement of the practitioner, are required in assessment.     

Development of a model of situational leadership in residential care for older people

lynch b.m., McCormack b. & McCance t. (2011) Journal of Nursing Management 19, 1058–1069
Development of a model of situational leadership in residential care for older people Aim The aim of the present study was to present the process used to develop a composite model of situational leadership enacted within a person-centred nursing framework in residential care. Background Transforming the culture of the residential unit from a restrictive institution to a vibrant community of older adults requires transformational leadership. Situational leadership is one form of transformational leadership, which claims that there is not one leadership style that works in all situations. Method A model of situational leadership in residential care was developed through a series of systematic steps that identified direct linkages between situational leadership and the main constructs of the Person-Centred Nursing Framework. The process included reviewing the evidence, undertaking a comparative analysis, identifying key concepts, connecting the concepts and developing a model. Conclusion A conceptual model is presented which integrates person-centredness with leadership thinking in order to effectively impact on the follower’s performance in managing the care environment and delivering person-centred care. Implications for Nursing Management Currently the model is being utilized in an action research study to evaluate the role of leaders in the practice setting of long-term care. While some of the connecting concepts have been identified in the present study, more work needs to be done to unravel these connections in further study of leaders in practice.     

Improving the oral health of older people in long-term residential care: a review of the literature

Background.  Unrefutable evidence now links poor oral health with the development of preventable systemic illnesses and debilitating conditions that threaten quality of life and life itself. This is especially significant for an increasing older population who are dependent on others for care.
Aims and objectives.  The majority of studies analysing the oral health of older dependent people in long-term residential care have been undertaken by dental professionals. This critical literature review examines the issue from a nursing perspective because nursing care providers have a fundamental role in daily oral health provision for dependent residents.
Conclusions.  Multiple barriers were found to negatively impact on daily oral healthcare provision, including lack of care provider education, oral health values, availability of resources, implementation of supportive policies, documentation and oral health assessment tools.
Relevance to clinical practice.  The nursing profession, at all levels, must become pro-active in removing financial, political and workforce barriers that impact negatively on oral health outcomes. A multi-faceted approach is required to address these barriers, including development and implementation of oral health education programmes, assessment screening tools, care plans, documentation, supply of oral hygiene aids and the appointment of oral care 'champions'.     

Falls in older people: the role of assessment in prevention and care

Falls among older people constitute a serious public health problem, which has a substantial impact on both the person and on healthcare services. Falls assessment can be divided into a number of types. Community nurses are well placed to use falls risk checklists to identify older people who may be at risk of falling and then offer these individuals a more in-depth assessment. In addition, community nurses have a role to play in assessing older people who have recently fallen to prevent future falls and potential injury. Falls prevention programmes centre on the identification of risk factors and the planning and delivery of interventions designed to eliminate or ameliorate these risks. A falls assessment should include a review of intrinsic factors such as mobility, lower extremity functioning, vision, medications, footwear and past medical history. It is also important to consider extrinsic factors such as tripping, slipping and other environmental hazards.     

Caring for older people with dementia in residential care: nursing students' experiences

AIM: This paper is a report of selected findings from two projects aimed at improving nursing students' experiences of caring for older people in elder care settings. BACKGROUND: With a growing number of older people the prevalence of dementia is rapidly increasing, such that it is now a primary reason for admission to residential care. This has implications for the preparation and support of nursing students on clinical placements as people with dementia represent a key focus of their nursing activities. METHOD: Two projects were conducted in Tasmania between 2001 and 2005, involving 87 second year Bachelor of Nursing students who participated in 3-week clinical placements in eight residential elder care facilities. During the placements, students and their mentors participated in a series of weekly focus group discussions to explore their experiences of caring for residents with dementia. Thematic analysis of the data was conducted. FINDINGS: Staff in the facilities struggled to support students effectively and often failed to recognize that students found residents' behaviour disturbing. Despite having some theoretical understanding of dementia, students reported being unsure of how to respond to residents and often felt scared and intimidated. CONCLUSION: Better preparation and support are needed for students on placements involving residents with dementia. Feasible strategies for more effective support include increased curriculum content about caring for people with dementia, and improved collaboration between university schools of nursing and settings for care of older people.     

The impact of residential respite care on the behaviour of older people with dementia: literature review

Aim.  The aim of this review was to examine the impact of residential respite care on the behaviour displayed by older people with dementia.
Background.  Relocation of older people with dementia to a different care setting could have a negative impact on their behaviour. If such a response is anticipated, a short-term admission to a residential aged care facility for respite care would appear to be futile for the older person and their home caregiver. Therefore, it is important to know what the outcomes of residential respite care are in relation to behaviour for older people with dementia.
Methods.  A literature search was undertaken and papers emerged from a range of disciplines. The search terms 'respite'; 'respite care'; 'residential respite care'; 'short-stay', 'short-term', 'overnight stays/admissions', 'behav*' and various combinations of these terms were used to find relevant publications in English from Ageline, CINAHL, Medline and, Psychinfo databases dating from 1966. Other key publications were located when searching through the reference lists of retrieved publications. A limited body of literature on residential respite care for older people with dementia was revealed.
Results.  Six studies were identified, which met the criteria of residential respite care as the intervention and behaviour as an outcome.
Conclusions.  The studies had a variety of methodological limitations and produced contradictory findings. The strength of the studies was the reporting of outcomes for respite recipients who are usually overlooked in the outcomes for respite research.
Relevance to clinical practice.  Residential respite care has great anecdotal support but more empirical and evaluative research is needed on outcomes for the respite recipients.     

Staff and home caregiver expectations of residential respite care for older people

It is generally agreed that relieving the burden experienced by home caregivers caring for older people should be one of the main aims for respite services that are provided. Over the past four years the use of residential respite care has quadrupled in Australia but it remains underutilised. To improve the uptake of this valued service, one hundred home caregivers and 25 staff from residential aged care facilities were surveyed about why residential respite care was being used and what their expectations were. This study provided insight into the value that is placed on residential respite care by identifying reasons and expectations for use so that nursing care and service provision can be continually directed at meeting these needs.