Use of hypodermoclysis to manage dehydration

Older people, particularly those who are frail, are vulnerable to dehydration. Management of dehydration in older people can be more complex than in younger adults because of the physical effects of ageing. As the population ages, nurses will increasingly care for older patients in every setting. This article provides an overview of the physiological changes that affect the ability of older people to maintain a normal fluid balance. Risk factors for dehydration are reviewed and strategies for the prevention, detection and management of dehydration are discussed. The article focuses on subcutaneous fluid replacement for the management of dehydration in older adults.     

Student nurse-older person communication

There is an increasing ageing population in western countries. Most nurses will be involved in caring for older people in the future. Over the last number of years much has been written about the benefits of effective nurse-patient communication. However, research findings indicate that the quality of nurse-older person communication has been and continues to be poor. The purpose of this mini ethnography was to ascertain how student nurses communicate with older people. This is relevant as today's students are tomorrow's registered nurses and the manner in which they currently communicate with older person may indicate how they will interact with this population in the future. Data were collected using both participant observation and semi-structured interviews. Data were analysed using latent thematic analysis. Four major themes were identified from the findings. These were: Types of communication, modes of communication, factors that either hinder or enhance effective communication and student nurses' approach to communicating with older people. There are a number of recommendations from this study. These include, promoting a person-centred approach to care of the older person, ensuring appropriate clinical supervision of student nurse-older person communication by preceptors, increasing theoretical input in relation to interpersonal skills and communication theory, facilitating reflective practice whilst students are on clinical placement and regular auditing of clinical placements as suitable learning environments.     

An exploratory study: assessing the meaning in life among older adult clients.

Meaning in life has been intimately linked to health, but it has not been explored in an elderly population. The factors that elderly people perceive as being meaningful must be identified, as well as the extent to which they experience fulfillment of meaning in their lives. The majority of study participants indicated that relationships give meaning to their lives; however, nurses must individually assess clients regarding what is most meaningful to them. Clients without meaning or low levels of meaning need to be identified. As nurses become more aware of what is meaningful to older people, they can plan and carry out interventions based on interaction to support or improve areas meaningful to the older person.     

Older people's expectations regarding ageing, health-promoting behaviour and health status

Title.  Older people's expectations regarding ageing, health-promoting behaviour and health status.
Aim.  This paper is a study to explore the influence of expectations regarding ageing on physical and mental health status, and to examine the mediating effects of health-promoting behaviour on the relationship between these expectations and physical and mental health.
Background.  To achieve healthy ageing, it is necessary for older people to play an active role in maintaining good health. Without any expectations for healthy ageing among older people themselves, encouraging them to participate in health-promoting behaviour and thereby to maintain good health would be unsuccessful.
Method.  A convenience sample of 99 community-residing Korean older people was surveyed in 2007 via questionnaire using a short version of the Expectations Regarding Aging questionnaire, Health Promoting Lifestyle Profile II, and Medical Outcomes Study 12-item short form.
Findings.  Having a higher expectation about ageing was associated with better physical and mental health, after adjusting for age, gender and education. Expectations about ageing were partially mediated through the health-promoting behaviour that influenced physical and mental health.
Conclusion.  It may be necessary for nurses to make an effort to improve older people's expectations about ageing to help them achieve good health. Nursing interventions to improve these expectations need to be used in conjunction with an emphasis on older people's active involvement in health-promoting behaviour.     

Student attitudes and educational support in caring for older people--a review of literature

The ageing population is currently one of the main issues facing UK healthcare systems. Nurses of the future will be faced with the task of caring for this elderly population. Meanwhile, care standards and government policies have emphasized the need for preparing students to care for the older people. Preparing nursing students to meet the care needs of an expanding ageing population is a challenge for nursing education. Moreover, caring for older people are often not seen by students as an attractive option, a perception that exerts a considerable influence on the values that inform their future professional practice. This paper examines the literature related to the students’ perceptions of caring for older people and suggests the need for specific curricular content, teaching and a structured approach to the educational preparation and support of students for their practice experience. If students are provided with the relevant preparation and support, they can engage in enriched learning experiences, deliver quality care and develop positive attitudes in caring for older people in their professional practice.     

Promoting healthy ageing: the importance of lifestyle

The UK has a rapidly ageing population with increased healthcare needs. While the population can, on the whole, look forward to longer years of good health, many people will be living with one or more chronic conditions. However, modifiable lifestyle, such as a healthy diet and physical activity, can encourage healthy ageing and improve the quality of life of older people. Nurses are ideally placed to provide advice on nutrition and physical activity to older people in an effort to reduce the burden of age-related disease. This is likely to require new ways of working, with nurses being trained to recognise opportunities for health promotion with older patients, as well as how to plan for and conduct health promotion so that it becomes integral to practice.     

The context, measures and outcomes of psychosocial care interventions in long-term health care for older people

This paper examines the psychosocial dimensions of long-term care with reference to the new International Classification of Functioning, Disability and Handicap (ICIDH 2) and to research conducted in Hong Kong. It also draws on selected international literature about older people. It discusses the different ways in which information can be gained about the personal, social and emotional processes of rehabilitation that influence outcomes and raises methodological questions about the study of interventions. Outcomes that are sensitive to psychosocial interventions and that take account of the elderly person's own perspective are identified as important challenges for nurses and other professionals in the multidisciplinary team, in order to respond to an individualized approach to long-term care. It is concluded that gaining a better understanding of the psychosocial dimensions of long-term care will enhance professional practice and benefit older people and their carers.     

Classifying and managing pretibial lacerations in older people

As the population of older people increases it is likely there will be an associated increase in the numbers of patients presenting with pretibial lacerations to GP surgeries, accident and emergency departments and referred to community nurses. This will be due, in part, to the increasing frailty of the skin of the older person, as well as comorbidities, the number of which are also likely to increase with ageing. It is important that the older person with a pretibial laceration is treated promptly and appropriately to prevent complications and optimize healthcare resources.     

Approaches to long‐term conditions management and care for older people: similarities or differences?

AIM: In the past few years, there has been an increased emphasis both on the care for older people and the management of long-term conditions within the United Kingdom. Currently, the Department of Health and the Scottish Executive identify and manage these two areas as separate entities. The aim of this article is to examine the current approaches to both of these areas of care and identify commonalities and articulate differences. BACKGROUND: The population across the world and particularly within the United Kingdom is ageing at an unprecedented rate. The numbers suffering long-term illness conditions has also risen sharply in recent years. As such, nurses need to be engaged at a strategic level in the design of robust and appropriate services for this increasing population group. EVALUATION: A comprehensive literature review on long-term conditions and the care of older people was undertaken in an attempt to identify commonalities and differences in strategic and organizational approaches. A policy analysis was conducted to support the paper and establish links that may inform local service development. KEY ISSUES: Proposing service development based on identified needs rather than organizational boundaries after the establishment of clear links between health and social care for those with long-term conditions and the ageing population. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse Managers need to be aware of the similarities and differences in political and theoretical approaches to the care for older people and the management of long-term conditions. By adopting this view, creativity in the service redesign and service provision can be fostered and nurtured as well as achieving a renewed focus on partnership working across organizational boundaries. CONCLUSIONS: With the current renewed political focus on health and social care, there is an opportunity in the UK to redefine the structure of care. This paper proposes similarities between caring for older people and for those with long-term conditions, and it is proposed these encapsulate the wider issues that need to be debated to achieve a truly joint approach to care.     

Giving patients a choice of what to wear in hospital

The number of older people in hospital is increasing in line with an ageing population. In response, specialist teams have been established to review and enhance the provision of all aspects of care for older patients. This article explores how providing a choice of what to wear in hospital can influence the overall well-being of older patients.     

Research into ageing and older people

AIM: The aim of this paper is to consider the process of ageing, the effects of ageing and research related to ageing. BACKGROUND: In most countries of the world, the UK being no exception, the population is ageing in terms of the absolute numbers of and relative proportion of older people. This has resulted from economic, scientific and medical progress. However, it poses challenges for health and social services. METHOD: Selective review of the literature. CONCLUSION: Ageing is an inevitable part of life and, while not in itself debilitating, can be accompanied by a range of debilitating physical and mental conditions which lead to frailty and dependency. There is limited evidence that the ageing process can be alleviated, as such, but there is some evidence that choices and circumstances in early life can influence the extent to which we age successfully. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers have two responsibilities with regard to age: they are increasingly engaged in organizing care for older people in acute and long-term settings and in nursing homes and the more they need to understand the process of ageing. They also have responsibilities towards their workforce and can facilitate lifestyle choices which may help their workforce to age successfully.     

"The food here is tasteless!" Food taste or tasteless food? Chemosensory loss and the politics of under-nutrition

A common complaint voiced by older people living in residential care is that the food lacks taste. When older people find food tasteless, the pleasure gained from eating and therefore, their appetite may be compromised, as will their food choices, nutrition, immune systems, functional status and well-being. However, often nurses overlook these symptoms as 'inevitable and irreversible' aspects of ageing, which they are not. In fact, many older people experience chemosensory (taste and smell) disorders or loss which means they lose the ability to taste the flavour of food. Commonly overlooked is the fact that chemosensory loss may well be a significant contributing factor to the high level of under-nutrition reported in residential care in Australia. Our purpose in this article is to explore important issues related to taste and smell dysfunction; the physiology of these sensations; several causes distinct from ageing; and interventions to help older people again enjoy their food with the concomitant advantages to their health and well-being. We also consider the way in which legislation related to Government funding has influenced gerontological nurses' assessment skills and values, particularly concerning nutrition assessment to the detriment of not only older people living in residential care but also the profession of gerontological nursing. Attention is drawn to the need for nurses to up-date their clinical knowledge, assessment skills and practice including enhancing the flavour of food and the social occasion of dining for older people living in residential care.     

Do nurses promote urinary continence in hospitalized older people?: an exploratory study

Aim. The aim of this paper is to explore whether nurses working in elderly medicine and in acute medical settings promote urinary continence in older people or in reality use containment strategies. Background. Untreated urinary incontinence in older adults can result in prolonged hospital admission and increased risk of admission to long‐term care. Urinary incontinence can also have severe psychosocial effects on older people. Most studies relating to this topic have relied on quantitative approaches to data collection with a seeming lack of qualitative investigation into how nursing staff promote urinary continence in hospitalized older people. Method. Focus groups and one‐to‐one semi‐structured interviews were carried out in two NHS regions in Scotland. Registered and non‐Registered Nurses were invited to participate. Five focus groups (n = 17) and four single interviews (n = 4) were conducted. Data generated were analysed thematically using QSR N‐VIVO 2. Findings. Some nurses believe that older people accept urinary incontinence as a consequence of ageing. Lack of assessment results in older people being labelled as incontinent of urine. Assessment strategies in medicine for the elderly tend to focus on product identification and management of incontinence. Although nurses from all clinical areas identify the importance of promoting continence, the problem continues to be contained rather than treated. Conflicting clinical priorities, varying staff approaches to urinary continence and deficits in education are cited among the barriers to promoting continence. Conclusions. The results suggest that nurses continue to contain urinary incontinence rather than promoting continence in older people. Relevance to clinical practice. Nursing staff need to be aware of the impact of untreated urinary incontinence on older people. Practitioners should promote continence rather than employing containment strategies. A validated assessment tool for older people needs to be developed. Views of older people should be sought regarding their attitudes towards urinary incontinence.     

Postoperative pain in older people: a review of the literature

Aims and objectives. The literature review was conducted to explore those factors which complicate pain management in older people to inform future research, education and nursing practice in this area. Background. Acute pain management in hospitalized older people is complex because of the physiological changes of ageing, pharmacological factors and under‐representation of this patient group in reported research about assessing acute pain. Methods. A review of the literature was undertaken using electronic databases and specified search terms, some hand searching was also used and included the grey literature, textbooks and conference proceedings. A computerized literature search was carried out using CINAHL, Bandolier, Cochrane, Medline, the British Nursing Index and the International Association for the Study of Pain website for the period 1992–2004. The search terms were acute pain, older people, elder care, pain assessment and acute pain services. Thirty‐seven research‐based reviews and published studies and 17 policy documents were included. Conclusions. Managing acute pain well in older adults involves understanding the influence of a series of integrated factors: attitudes and beliefs, physiological ageing processes, pharmacological factors and the social construction of the older person in healthcare contexts. Relevance to clinical practice. This review offers new insight into those factors which, taken together, add complexity to managing acute pain in older people well. Moreover, nurses are the professional group mainly responsible for assessing pain, administering and now prescribing analgesia and evaluating the quality of pain relief in older people. On this basis, they are also the group most likely to effect improved patient outcomes.     

Older people's views on rural life: a study of three villages

In the context of increasing interest in how rurality affects health services and nursing practice in the UK, this paper reports and discusses data from a survey of older people living in three English villages. The survey found that village populations differed widely, that there were changes in the proportions of older people in the villages over time, and that close social networks existed for some but not all. The paper concludes that health care practitioners should avoid stereotypes of village life. In their increasing emphasis on health promotion and active ageing among older people, nurses may find data collected by the voluntary sector to be a useful resource. Working in partnership with groups to achieve a deep understanding of local contexts may assist nursing practitioners when building up pictures of older patients' health‐related needs and views.     

Gambling behaviors in Black older adults: perceived effects on health

Gambling is a popular activity among older adults of multiple ethnic and cultural backgrounds, but gambling research has not focused on elderly individuals or on minority groups. Although most gambling is a social activity, it also could have health implications for older adults. Sixty-seven Black individuals, ages 50 to 88, completed the Massachusetts Gambling Screen and 20 Black older adults were interviewed about gambling behaviors and beliefs about gambling and health. Although participants in this study were low income, they were as active in gambling as the general population. One pathological gambler and two problem gamblers were identified. The correlation between reported overall health and beliefs about the effects of gambling on health was not significant. Researchers, educators, and nurses working with older adults can help define the health implications of gambling on this population.     

Promoting mental health in older people admitted to hospitals

Mental health problems are common in older people admitted to general hospitals. With an increasing ageing population, admissions will rise and nurses will be expected to manage patients' co-existing mental health problems as well as physical problems. This article explores potential strategies for the management of patients with depression, delirium and dementia. The emphasis is on improving quality of care for this group of vulnerable patients.     

Meeting the health needs of older people with learning disabilities

The increasing population of older people with learning disabilities may lead to higher demand for contact with registered nurses. To date, little research has been undertaken regarding the role of registered nurses in meeting the health and care needs of this client group. In this article, the author reports on the second stage of a three-stage research study that used six case studies to explore this issue. Implications for nursing were identified in areas such as health needs, record keeping, medication, advocacy, social aspects, ageing in place, percutaneous endoscopic gastrostomy (PEG) feeding, spirituality and end-of-life care. The author concludes that registered nurses will need to continue to remain up to date to meet the complex needs of older individuals with learning disabilities.     

Hyperhomocysteinemia in advanced age.

Nutritional deficiency does not fit the view of life in an affluent society and in fact typical diseases resulting from a deficiency of vitamins are actually a rarity. On the other hand, elderly people must be regarded as an essential risk group for vitamin deficiency because of various influence factors. The frequency of lowered vitamin concentrations in the blood increases with age. However, knowledge on the consequences for this population is insufficient, especially for hyperhomocysteinemia. Investigations have yielded the following results: 1. Hyperhomocysteinemia often occurs with advanced age; 2. Impairment of physical condition or social situation seems to increase the risk of hyperhomocysteinemia; 3. Administration of the vitamins B6, B12 and folate causes a significant decrease of elevated serum homocysteine concentrations in older persons. Homocysteine-lowering treatment should improve the prevention of chronic diseases. The question is which effects can be expected from such treatment in the elderly. Because of its great importance for both the persons concerned and society in general hyperhomocysteinemia in advanced age requires further systematic examination.