Using the Web to improve seniors' awareness of their role in preventing medical errors

The purpose of this project was to assess the value of using the Web to teacholder consumers about their role in preventing medical errors. Consumers were recruited from a metropolitan Detroit senior community center. The majority of the participants had little or no experience with the Internet. After being taught how to use the computer and Internet, seniors completed a Web-based intervention on quality health care and medical errors. Seniors increased their knowledge about quality care and their role in preventing medical errors and highly rated the Websites.     

Medication adherence in older adults with cognitive impairment: a systematic evidence-based review

BackgroundCognitive impairment challenges the ability to adhere to the complex medication regimens needed to treat multiple medical problems in older adults.ObjectiveOur aim was to conduct a systematic evidence-based review to identify barriers to medication adherence in cognitively impaired older adults and interventions aimed at improving medication adherence.MethodsA search of MEDLINE, EMBASE, PsycINFO, GoogleDocs, and CINAHL for articles published between 1966 and February 29, 2012 was performed. Studies included older adults with a diagnosis of cognitive impairment of any degree (mild cognitive impairment or mild, moderate, or severe dementia). To identify barriers to adherence, we reviewed observational studies. To identify relevant interventions, we reviewed clinical trials targeting medication adherence in cognitively impaired older adults. We excluded studies lacking a measure of medication adherence or lacking an assessment of cognitive function, case reports or series, reviews, and those focusing on psychiatric disorders or infectious diseases. Population demographics, baseline cognitive function, medication adherence methods, barriers to adherence, and prospective intervention methodologies were extracted.ResultsThe initial search identified 594 articles. Ten studies met inclusion criteria for barriers to adherence and three met inclusion criteria for interventional studies. Unique barriers to adherence included understanding new directions, living alone, scheduling medication administration into the daily routine, using potentially inappropriate medications, and uncooperative patients. Two studies evaluated reminder systems and showed no benefit in a small group of participants. One study improved adherence through telephone and televideo reminders at each dosing interval. The results of the review are limited by reviewing only published articles, missing barriers or interventions due to lack of subgroup analysis, study selection and extraction completed by 1 reviewer, and articles with at least an abstract published in English.ConclusionsThe few studies identified limit the assessment of barriers to medication adherence in the cognitively impaired population. Successful interventions suggest that frequent human communication as reminder systems are more likely to improve adherence than nonhuman reminders.     

Doctor Recommendations are Related to Patient Interest and Use of Behavioral Treatment for Chronic Pain and Addiction

The opioid crisis has highlighted the importance of improving patients’ access to behavioral treatments for chronic pain and addiction. What is not known is if patients are interested in receiving these treatments. In this cross-sectional study, over 1,000 participants with chronic pain were surveyed using an anonymous online questionnaire on Amazon Mechanical Turk to investigate participants’ use of and interest in pharmacological and behavioral treatments for chronic pain and addiction. Participants also indicated whether their doctor had recommended these treatments. The majority of participants reported using medication for their pain (83.19%) and that their doctor recommended medication (85.05%), whereas fewer participants reported using (67.45%) and being recommended to (62.82%) behavioral treatments. We found 63.67% of participants screened positive for possible opioid misuse; those who screened positive were more interested in receiving behavioral treatments than those who did not screen positive. Participants who received treatment recommendations were more likely to be interested in receiving those treatments as compared to participants who did not. The results suggest that recommendations for behavioral treatments and interest in those treatments are related. Results also suggest that patients endorsing behaviors consistent with opioid misuse are interested in behavioral treatments.PerspectiveThis study provides information around chronic pain patients’ treatment interests, treatment receipt, and recommendation receipt for behavioral pain management and addiction treatment. This study could help facilitate communication between patients and doctors regarding available treatments for chronic pain and pain treatment-related addiction problems.     

Computerized physician order entry system combined with on-ward pharmacist: analysis of pharmacists' interventions

Rationale, aims and objectives To analyse pharmacists' interventions in a setting where a computerized physician order entry system (CPOE) is in use and a pharmacist works on the ward. Method A prospective cohort study was conducted in seven wards of a French teaching hospital using CPOE along with the presence of a full‐time on‐ward pharmacy resident. We documented the characteristics of pharmacists' interventions communicated to physicians during the medication order validation process whenever a drug‐related problem was identified. Independent predictors of the physician's acceptance of the pharmacist's intervention were assessed using multiple logistic regression analysis. Results The 448 pharmacists' interventions concerned: non‐conformity to guidelines or contraindications (22%), too high doses (19%), drug interactions (15%) and improper administration (15%). The interventions consisted of changes in drug choice (41%), dose adjustment (23%), drug monitoring (19%) and optimization of administration (17%). Interventions were communicated via the CPOE in 57% of cases and 43% orally. The rate of physicians' acceptance was 79.2%. In multivariate analysis, acceptance was significantly associated with the physician's status [higher for residents vs. seniors: OR = 7.23, CI 95 (2.37–22.10), P < 0.01], method of communication [higher for oral vs. computer communication: OR = 12.5, CI 95 (4.16–37.57), P < 0.01] and type of recommendation [higher for drug monitoring vs. drug choice recommendations: OR = 10.32, CI 95 (3.20–33.29), P < 0.01]. Conclusions When a clinical pharmacist is present on a ward in which a CPOE is in use, the pharmacists' interventions are well accepted by physicians. Specific predictors of the acceptance by physicians emerge, but further research as to the impact of CPOE on pharmacist–physician communication is needed.     

Age-related changes in working memory during sentence comprehension: an fMRI study.

Sentence comprehension declines with age, but the neural basis for this change is unclear. We monitored regional brain activity in 13 younger subjects and 11 healthy seniors matched for sentence comprehension accuracy while they answered a simple probe about written sentences. The sentences varied in their grammatical features (subject-relative vs object-relative subordinate clause) and their verbal working memory (WM) demands (short vs long antecedent noun-gap linkage). We found that young and senior subjects both recruit a core written sentence processing network, including left posterolateral temporal and bilateral occipital cortex for all sentences, and ventral portions of left inferior frontal cortex for object-relative sentences with a long noun-gap linkage. Differences in activation patterns for seniors compared to younger subjects were due largely to changes in brain regions associated with a verbal WM network. While seniors had less left parietal recruitment than younger subjects, left premotor cortex, and dorsal portions of left inferior frontal cortex showed greater activation in seniors compared to younger subjects. Younger subjects recruited right posterolateral temporal cortex for sentences with a long noun-gap linkage. Seniors additionally recruited right parietal cortex for this sentence-specific form of WM. Our findings are consistent with the hypothesis that the neural basis for sentence comprehension includes dissociable but interactive large-scale neural networks supporting core written sentence processes and related cognitive resources involved in WM. Seniors with good comprehension appear to up-regulate portions of the neural substrate for WM during sentence processing to achieve comprehension accuracy that equals young subjects.     

A qualitative investigation of seniors' and caregivers' views on pain assessment and management.

The literature suggests that pain in the elderly, especially among seniors with dementia, is under-assessed and under-treated.This qualitative study solicited the perspectives of seniors, front-line nursing staff, nursing-home administrators, and informal caregivers of seniors with dementia on the current status of pain assessment and management. The views of these participants complement the research findings reported in the literature. While some of their explanations and potential solutions concerning under-treatment of pain in seniors echo views that have been presented in the literature, the participants also pointed to factors and avenues that have been given less formal consideration (e.g., systemic barriers to effective assessment and treatment of pain).They also highlighted the need for pain-control strategies beyond medication. The implications of these findings are discussed.     

Through seniors' eyes: an exploratory qualitative study to identify environmental barriers to and facilitators of walking.

This qualitative exploratory study examined environmental factors influencing the walking choices of elderly people using the photovoice approach. A total of 13 seniors in Ottawa, Canada, took photographs of barriers to and facilitators of walking in their neighbourhoods. These photos were displayed during 3 focus-group sessions and served as touchstones for discussion. A total of 22 seniors, including 8 of the 13 photographers, participated in the focus-group sessions. The findings show that environmental hazards related to traffic and falls risks can be significant barriers to walking for seniors, and that connectivity can truly exist for the elderly only if convenience, hazard-free routes are available. They also indicate that simple amenities such as benches and washrooms might facilitate walking for seniors. A neighbourhood that is activity-friendly for seniors will also be a good place for everyone else to live, work, and play. The use of photovoice as a method was well received by the participants and provided rich information that may not have been captured through other means.     

上海市徐汇区社区老年人健康教育需求调查及影响因素分析

目的 对上海市徐汇区老年社区进行健康教育项目培训,同时对老年人的健康教育需求进行调查并分析其影响因素,以期为“政府-高校-社区”模式下进行社区老年人健康教育项目选题提供参考并为社区医生和护士对老年人进行健康教育指明方向。方法 于2018年3月～6月对上海市徐汇区14家街道开展了50场老年社区健康教育讲座,应用“老年社区健康教育项目调查问卷”并对他们的健康教育需求进行调查。结果 646名社区老年人对五个方面的健康教育需求由高到低依次为营养,健康问题,身体活动,安全管理,压力管理。婚姻状况、居住状况、患有慢性病、自评健康状况等对老年人健康教育需求有一定影响。结论 上海市徐汇区社区老年人健康教育需求受到婚姻状况、居住状况、患有慢性病、自评健康状况等因素的影响。“政府-高校-社区”模式下开展社区老年人健康教育讲座,应该针对这些影响因素给老年人提供更加专业化、实用性和持续性的健康教育。     

The elderly and their health

Health promotion aims to increase individuals' decision making toward their own health and help them control their quality of life through personal strategies. Seniors benefit from this process, says the author, who describes a collaborative health promotion and information program at the Ottawa-Carleton Regional Health Department--a program that involves seniors, professionals and volunteers. The needs of the seniors were identified, involvement of relevant organizations requested, then the program was tested with the help of pilot groups. After the program was successfully launched, seniors were also involved in its evaluation and revision.     

End-of-life care preferences of Canadian senior citizens with caregiving experience

A grounded theory study of senior citizens' preferences for end-of-life care was conducted in 1998 in Canada. Seniors who had experienced the deaths of others and who had considered their own death and dying were the target population. The sample was 49 seniors who met the study criteria. Participants provided end-of-life care in a variety of settings for 1-8 family members or friends. Two concepts identified were expected dependency while dying and appropriate end-of-life care. Almost all participants preferred to be cared for at home, yet family caregivers who could provide appropriate end-of-life care when dependent were needed for this to occur. The appropriateness of end-of-life care was contingent upon the place where end-of-life care occurred, as well as the type of care provided. Life prolongation was not desired, 53% even endorsed euthanasia as a way of bringing about the inevitable end to life.     

Applying a Vibration Reminder to Ameliorate the Hyperactive Behavior of Students with Attention Deficit Hyperactivity Disorder in Class

The purpose of this study was to investigate the effectiveness of using a vibration reminder with three students with Attention Deficit Hyperactivity Disorder (ADHD) to ameliorate their hyperactive behavior during class. The intervention of using a vibration reminder was based on the concept of providing nonverbal messages to manage students’ behavior. The vibration reminder was placed on one of each participant’s thighs and would be triggered when he/she manifested target behaviors such as hyperactivity. The vibration would cease when the participant stopped the target behaviors, and the duration of the vibration in conjunction with the target behaviors was automatically recorded by the control system. A delayed multiple-baseline across behaviors of a single-subject research design was adopted in this study. The results show that the three participants’ target behaviors significantly decreased after their exposure to the vibration reminder intervention, and they likewise exhibited positive performance during the maintenance phase. The findings demonstrate that the vibration reminder was an effective intervention to ameliorate the participants’ hyperactive behavior during class.     

Medication adherence interventions for older adults: literature review

This literature review explores the range and nature of medication adherence interventions tested with older adults. The unique needs of older adults require specifically designed and tailored interventions. Low medication adherence rates among some elderly contribute to inadequate pharmacological management of illnesses. Searches were conducted to identify randomized controlled trials of medication adherence; computerized databases, journal hand searches, and ancestry searches yielded 63 studies published between 1977 and 2005 where participants' mean age was > 60 years. Interventions were categorized by focus (patient, medication, and administration factors). Most were geared toward promoting knowledge and skills for medication-taking and adherence. Gaps were noted in addressing memory aids and self-monitoring strategies; further development of interventions addressing medication and administration factors influencing adherence are also needed. Identified interventions are geared toward self-medicating patients and fail to address caregivers administering medications. Finally, interventions do little to address variations in patterns of adherence among older adults.     

Ease of Use and Usefulness of Medication Reminder Apps among Rural Aging Adults

ABSTRACT

Older adults manage multiple medications for chronic disease and those living in rural areas are impacted by health care disparities due to health provider shortages and fewer pharmacies. The use of downloadable medication reminder apps on smartphones may serve as a strategy for medication self-management of chronic diseases. In this feasibility study, thirteen rural older adult participants downloaded Medisafe® and used the app to manage their daily medications. The community-dwelling aging adults in this pilot perceived the Medisafe® as not difficult to use, useful for medication tracking and providing reminders for the self-management of multiple medications.     

Pain medication beliefs and medication misuse in chronic pain.

This study assessed the influence of medication beliefs, symptom severity, disability, mood, and psychiatric history on opiate medication misuse behaviors in 288 chronic pain patients. Data were gathered by questionnaires and systematic reviews of electronic medical records. The results demonstrate that patients with a history of substance abuse, compared to those without, showed greater medication misuse despite similar dosages and self-rated opiate effectiveness. Misusers believed more strongly in the potential for opiate addiction and that they required higher doses than others, but also had greater belief in opiate effectiveness and the importance of free access. Although both anxiety and substance abuse history are related to medication misuse, a multivariate analysis indicated that these factors can be seen as mediated by medication beliefs. These data suggest important roles for historical, affective, and cognitive variables in understanding medication misuse. Patients with a history of substance abuse report stronger beliefs in opiate effectiveness while simultaneously showing awareness of their addiction potential. Providers may help patients by addressing these issues prior to prescribing opiates. PERSPECTIVE: History of substance abuse is associated with increased opiate medication misuse independent of differences in reported opiate effectiveness. Self-attributions regarding opiate treatment related to need for higher doses, dose control, and addiction potential, may be important mediators of this relationship and interact with anxiety to produce heightened risk of opiate misuse.     

Faith community nurses: implementing Healthy People standards to promote the health of elderly clients

The face of aging in our society has changed dramatically over the past generation. Many seniors struggle to access needed services, which include health promotion and disease prevention activities. A “Parish Nurse Questionnaire” was developed by the authors using the Healthy People 2010 Critical Health Indicators, the International Parish Nurse Resource Center functions of the parish (faith community) nurse, and the ANA Scope and Standards for Faith Community Nurses to ascertain if, and how frequently, faith community nurses practice interventions that address strategies mandated by theses organizations. Data collected on 102 participants supported that the faith community nurse model of community-based practice guides the development of strategies addressing those established standards. Those who provide health promotion and disease prevention activities in faith communities serve as viable partners with community initiatives, which may help to provide more seamless and efficient services to the elder in the community.     

离退休老年人1000例睡眠卫生调查

目的 调查和分析老年人睡眠状况。方法 对在我院进行体格检查的离退休老年人发出问卷1000份,共收回有效问卷815份,占81．5％。结果 只有21．6％的人认为自己无失眠情况,而78．4％的人自认为有失眠现象,在自认为有失眠现象的人群中,仅有19,6％的人到医院去看医生。结论 老年人对睡眠的认识存在不足,培养良好的睡眠习惯,促进睡眠健康将成为当今每个人关注的问题,尤其应引起医务人员高度的重视。