Managing cancer‐related fatigue in men with prostate cancer: A systematic review of non‐pharmacological interventions

The aim of this systematic review was to synthesize the best available evidence informing the effectiveness of non‐pharmacological interventions for managing cancer‐related fatigue in men treated for prostate cancer. This review considered experimental studies that included men with prostate cancer (regardless of staging, previous treatment or comorbidities), aged 18 years and over who were undergoing any treatment, or had completed any treatment for prostate cancer within the previous 12 months. Three interventions were identified for the management of cancer‐related fatigue in men with prostate cancer. Evidence from five studies including 447 participants demonstrates the effectiveness of physical activity, both aerobic and resistance exercise, and from three studies including 153 participants suggesting the benefits of psychosocial interventions including education and cognitive behavioural therapy. Health professionals require knowledge of a range of effective interventions aimed at reducing cancer‐related fatigue in men with prostate cancer and should incorporate those interventions into their patient management. Although physical activity appears to show the greatest benefit, other non‐pharmacological interventions such as education and cognitive behavioural therapy have demonstrated benefit and should also be considered as a strategy in treating this debilitating side effect of cancer and its treatment.     

Pain assessment in older people with dementia: literature review

Title.  Pain assessment in older people with dementia: literature review.
Aim.  This paper is a report of a literature review conducted to identify barriers to successful pain assessment in older adults with dementia and possible strategies to overcome such barriers.
Background.  Pain is frequently undetected, misinterpreted, or inaccurately assessed in older adults with cognitive impairment. These people are often unable to articulate or convey how they feel and are often perceived as incapable of experiencing or recalling pain.
Data sources.  Searches were conducted of CINAHL, Medline and other databases for the period 1993–2007 using the search terms pain, dementia, assess*, barrier* and obstacle*.
Methods.  Studies were critically appraised by two independent reviewers. Data were extracted using instruments specifically developed for the review. Studies were categorized according to levels of evidence defined by the Australian National Health and Medical Research Council and Joanna Briggs Institute.
Results.  Perceived barriers to successful pain assessment in people with dementia included lack of recognition of pain, lack of sufficient education and/or training, misdiagnosis or late diagnosis, and non-use of assessment tools. Barriers related to people with dementia included insufficient evidence, the possibility of a 'no pain' subset of people with dementia, type of pain, and stoical attitudes. Strategies proposed as means of overcoming these barriers included knowing the person, knowing by diversity/intuitive perception, education and training, and use of adequate tools.
Conclusion.  More extensive education and training about the relationship between pain and dementia are urgently needed, as is the development and implementation of an effective pain assessment tool specifically designed to detect and measure pain in older adults with all stages of dementia.     

The effect of massage on agitated behaviours in older people with dementia: a literature review

Aims and objectives. To review the literature on massage used to manage agitated behaviours in older people with dementia, assess its efficacy as a non‐pharmacological approach and provide recommendations for future research. Background. Agitation has traditionally been managed with chemical or physical restraint. There has been a growing interest in complementary therapies such as massage. Design. A literature review. Methods. Cooper’s five‐stage model of synthesising research guided the review process. The search terms ‘massage’, ‘agitation’ and ‘dementia’ were defined, and 10 databases were searched in October 2011. No date limitations were applied, although searches were limited to articles written in English. For relevant records, full‐text copies were obtained and assessed in terms of inclusion criteria and methodological quality using the Validity Rating Tool (VRT). Data were extracted using a form constructed with reference to the checklist of items to consider in data extraction, produced by the Cochrane Handbook for Systematic Reviews of Interventions. Results. Thirteen studies met the inclusion criteria and were assessed on the VRT. One study was considered of adequate methodological quality to be included in the review. This prospective study found that massage significantly reduced levels of agitation in 52 cognitively impaired residents in two long‐term care facilities. Conclusions. There is a severe paucity of research that considers the effects of massage on managing agitated behaviours in older people with dementia. Whilst conclusions cannot be drawn from the one study included in this review, it did provide evidence to support the use of massage as a non‐pharmacological approach to managing agitation in older people with dementia. More research, of better methodological quality, is needed. Relevance to clinical practice. There is a need for health practitioners to be aware of the limited evidence for massage as an intervention for agitation and to provide opportunities to validate massage practice.     

Effectiveness of gerontologically informed nursing assessment and referral interventions for older persons attending the emergency department: systematic review

Title. Effectiveness of gerontologically informed nursing assessment and referral interventions for older persons attending the emergency department: systematic review Aim. This paper is a report of a literature review conducted to analyse data from published studies reporting nursing interventions targeted at older attendees of emergency departments (EDs), and to provide a critical appraisal of the evidence concerning their effectiveness. Background. Attendance at hospital EDs by older persons presents opportunities for targeted interventions to address actual and potential problems associated with or in addition to the presenting problem. The evidence concerning the effectiveness of such interventions is mixed. Data sources. Studies were retrieved from a systematic search of published works indexed in CINAHL, MEDLINE (PubMed), Science Direct and the Cochrane Central Register of Controlled Trials (CENTRAL). Methods. A systematic review of effectiveness was conducted using the Cochrane Effective Practice and Organisation of Care guidelines and a narrative synthesis approach for data handling and presentation. The review period was 1992 to 31 August 2008. Results. Nursing assessment and referral interventions have demonstrated effectiveness in reducing service use and improving physical function, but have failed to demonstrate statistically significant effects on predicted patient and/or health systems outcomes. Conclusion. The evidence of the effectiveness of gerontologically informed nursing assessment and referral interventions in EDs must be accepted with caution, as not all studies demonstrated effectiveness in predicted patient and/or health systems outcomes, and the testing of complex social interventions in randomized clinical trials is inherently problematic. Further evidence of the effectiveness of nursing interventions is required, and such evidence might be usefully demonstrated using pragmatic, as opposed to explanatory, trials.