Evaluating the Older Patient's Ability to Function

There are over 25 million Americans age 65 years and older, and the majority live independently. Advancing age increases the likelihood that some will require assistance in daily living. Nurse practitioners who serve this population can aid older adults to maintain independence as long as possible. This requires knowledge about physiological age changes as well as changes from pathological conditions and how each can affect function. In an effort to detect functional impairments, vital information can be gathered through a review of functional ability as well as observation of selected measures of function. Incorporation of tools that measure functional status can assist practitioners in determining need for formal health and psychosocial support services.     

Hypertension: How Low to Go When Treating Older Adults

Recent changes to guidelines for diagnosing and managing hypertension (HTN) in adults provide an opportunity for nurse practitioners to reexamine how they treat older adults with elevated blood pressure. This article reviews the revised definition of hypertension based on 2017 treatment guidelines, what age is considered older for adults with hypertension, what the treatment goal is for this population, and recommendations for getting blood pressure to the desired goals.     

Chronic care management for the elderly: an opportunity for gerontological nurse practitioners

PURPOSE: To discuss the role that gerontological nurse practitioners (GNPs) may play in providing chronic care management for the elderly. DATA SOURCES: Review of recent literature on chronic care management, personal experience of the authors in caring for older adults under the chronic care management model, and a case study. CONCLUSIONS: GNPs are the most appropriate practitioners to provide and coordinate chronic care management to the population that needs it most--the elderly. IMPLICATIONS FOR PRACTICE: Demographic shifts in the United States have increased the number of people with chronic illnesses; however, the nation's healthcare delivery system has not significantly evolved to meet the changing needs of its population. As a result, many people, especially older adults, suffer needlessly, and healthcare costs continue to rise. Chronic care management may alleviate older adults' chronic health problems, reduce expenditures for their health care, and promote their satisfaction and quality of life.     

Seeing the person behind the patient: enhancing the care of older people using a biographical approach

Recent policy statements have stressed the need for fundamental changes to the NHS, especially to the hospital care of older people. Person-centred care underpins such changes. If practitioners are to deliver person-centred care, then they need to learn more about the patient as an individual. One way that this might be achieved is through biographical approaches. This paper describes the findings of a developmental study undertaken over a 6-month period to investigate the introduction of a biographical approach to care on a unit in a NHS hospital. It concentrates on the views of the practitioners who used the approach. The study aimed to explore whether a biographical approach - in the form of storytelling - might be used to encourage person-centred practice. Using a practice development approach, the study explored the views of older people, their family carers and practitioners regarding their participation in life story work. Initial data were collected by focus groups with staff from a nursing home who regularly used life stories as a basis for care planning. Further data were collected through focus groups, semistructured interviews and observation - undertaken before and after the introduction of life story work - with older people, family carers and practitioners. Findings revealed that life stories helped practitioners to see patients as people, to understand individuals more fully and to form closer relationships with their families. Support workers also said how much they enjoyed using the approach to inform their care. Further longitudinal research is required to investigate biographical approaches more fully and to work more closely with practitioners to explore how biographical approaches can be undertaken as part of standard practice and be integrated into the culture and management of care.     

Variations in older people’s use of general practitioner consultations and the relationship with mortality rate in Vantaa,Finland in 2003–2014

Abstract

Objective: It is generally expected that the growth of the older population will lead to an increase in the use of health care services. The aim was to examine the changes in the number of visits made to general practitioners (GP) by the older age groups, and whether such changes were associated with changes in mortality rates.

Design and setting: A register-based observational study in a Finnish city where a significant increase in the older population took place from 2003 to 2014. The number of GP visits made by the older population was calculated, the visits per person per year in two-year series, together with respective mortality rates.

Subjects: The study population consisted of inhabitants aged 65?years and older (65+) in Vantaa that visited a GP in primary health care.

Main outcome measures: The number of GP visits per person per year in the whole older population during the study years.

Results: In 2009–2010, there was a sudden drop in GP visits per person in the younger (65–74?years) age groups examined. In the population aged 85+, use of GP visits remained at a fairly constant level. The mortality rate decreased until the year 2008. After that, the positive trend ended and the mortality rate plateaued.

Conclusions: Simultaneously with the decline in GP visits per person in the older population, the mortality rate leveled off from its positive trend in 2009–2010. Factors identified being associated with the number of GP consultations were organizational changes in primary health care, economic recession causing retrenchment, and even vaccinations during the swine flu epidemic.

• Key points

• Along with an increasingly ageing population, concern over the supply of publicly funded health care has become more pronounced.

• The amount of GP visits of 65+ decreased in primary health care, especially in the youngest groups.

• However, in the oldest age groups (85+), the use of GPs remained unchanged regardless of changes in service supply.

• As the rate of GP visits among the population of 65+ declined, the positive trend in the mortality rate ceased.

     

Who wants to work in geriatrics: Findings from a national survey of physicians and nurse practitioners

BackgroundAs the United States population is aging, there is a chronic shortage of geriatrics- and gerontology- trained clinicians despite a variety of incentives. With primary care clinicians also in short supply, health systems are trying to cope with the increasing demand for care for older adultsPurposeThe purpose of this study was to examine respondents' willingness to recommend their career to others and beliefs about changes necessary to enhance the supply of appropriately prepared cliniciansMethodsThis study used a national survey of a stratified sample of 276 physicians and 134 nurse practitioners working in primary care and geriatric practices.FindingsAmong nurse practitioner respondents, 29% would "definitely" recommend a career as a geriatrician vs. seventeen percent of physicians; thirteen percent of physicians would "definitely" recommend a career as a nurse practitioner specializing in adult/gerontology vs. 42% for nurse practitioners. Those trained in geriatrics were more likely to recommend a career in the field.DiscussionNurse practitioners and physicians differ in their willingness to recommend careers in in gerontology and geriatrics, but less than a majority would strongly recommend careers in either specialty. Based on clinical reports, substantial reforms in payment and reimbursement for services may be necessary to bolster the geriatric field's attractiveness, and better prepare the workforce to care for older adults.     

Population-focused care: a new rubric in the role definition for geriatric nurse practitioners in primary care practice?

Traditionally, geriatric nurse practitioners (GNPs) provide care to individual older adults and their families in a primary care practice. Although the goal is to provide high-quality, cost-effective care, GNPs may be providing ineffective care by narrowly focusing on individuals and their families. Given today's health care climate, it is essential that GNPs practice with a wider perspective. This is done by noting health issue trends among the specific older adult population that are targeted for care and planning that care with a population focus delineated by either health issues or characteristics of the older adult population.     

Human immunodeficiency virus and the older person

This article outlines some of the issues which older people who are infected and/or affected by human immunodeficiency virus (HIV) may face. HIV does not discriminate against age, however, clinicians are now seeing an increasing number of HIV positive older people in their everyday practice. This trend is set to continue as HIV becomes more of a chronic health condition as a consequence of more sophisticated treatment regimens. The older population has largely been ignored in the quest to reduce the incidence of HIV infection. This article calls for more research to be conducted taking into account the unique needs of the older population. There is no place in contemporary nursing practice for practitioners to hold erroneous and outdated myths concerning the sexuality and lifestyle choice of the older person.     

Effect of a Virtual Pain Coach on Pain Management Discussions: A Pilot Study

There is a need to enhance patient and practitioner pain communications. A pain communication plus virtual pain coach intervention was tested in the primary care setting for the effect on communication of osteoarthritis pain information by older adults aged ≥60 years, on practitioners’ pain management changes, and on older adults’ reduced pain and depressive symptoms 1 month later. A randomized controlled pilot study design was used. Twenty-three older adults with osteoarthritis pain were randomly assigned to the pain communication plus virtual pain coach group or the pain communication–only group. Pain communication consisted of a video of important osteoarthritis pain information. The coach consisted of practicing out loud with a virtual pain coach via laptop computer. Pain and depressive symptoms were measured with, respectively, the Brief Pain Inventory Short Form and the Beck Depression Inventory II before intervention and 1 month later. Immediately after the intervention, older adults had their primary care visits, which were audiotaped, transcribed, and content analyzed for older adults’ communicated pain information and practitioners’ pain management changes. Older adults in the pain communication plus virtual pain coach group described significantly more pain source information and were prescribed significantly more osteoarthritis pain treatments than older adults in the pain communication–only group. A nonsignificant trend in pain intensity and depressive symptoms reduction resulted for older adults in the pain communication plus virtual pain coach group 1 month later. The virtual pain coach presents a possible strategy for increasing pain management discussions between practitioners and older adults with persistent pain.     

Older Adult Relocation: Considerations for Nurse Practitioners

The projected trends of the senior and baby-boomer population represent a projected demographic change that is nothing short of astounding. The nation's older adult population will continue to swell and, by 2035, will make up approximately 18% to 23% of the total population, nearly doubling this current age segment. With this significant and inevitable shift in demographics, individual, family, and community needs will increase proportionally. Nurse practitioners in primary care settings need to be cognizant of these trends and provide proactive assessments and health promotion advice to older patients and their families.     

Improving healthcare access for older adults with intellectual disability: What are the needs?

This qualitative study was carried out in Spain with the aim of identifying the changes that the health system should make to improve healthcare access for older adults with intellectual disability. Three hundred and sixty‐nine family members and professionals expressed their opinion on how healthcare access could be improved. Participants responded to two open‐ended questions included in a general survey about the health status of older individuals with intellectual disability. Most informants were women and professionals who had known the person with intellectual disability for more than 12 months. A system of categories, which showed good inter‐rater agreement, was developed to analyse participants’ written responses. Both family members and professionals emphasized the need to improve disability training for healthcare practitioners and highlighted the urgent need for flexibility in the structure of a healthcare system that currently overlooks the specific needs of this vulnerable population.     

Care of the elderly as a global nursing issue

The size of the world's elderly population is growing at a rapid rate, with the 60 and older population of Europe and North America outpacing total population growth in recent decades. As life expectancy lengthens, the quality of that life becomes an issue of importance to nursing practitioners and nursing educators. Developed countries and developing countries will be faced with different challenges when determining service delivery models for their aging populations. Innovation in delivery models and comprehensive and longitudinal data are needed if the goal of aging in place is to be achieved.     

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.     

Atrial fibrillation: an epidemic in the elderly

Atrial fibrillation is the most common cardiac arrhythmia that increases in prevalence with age. As the general population grows older, general practitioners will more frequently see this disease in their clinic population. In order to most effectively treat these patients, physicians need to understand key issues, including the use of rhythm control versus ventricular rate control and how to reduce the risk of ischemic stroke. This article will review recent advancements in the understanding of the pathophysiology, management, stroke risk stratification and prevention of thromboembolic complications in atrial fibrillation.     

Atrial fibrillation: an epidemic in the elderly

Atrial fibrillation is the most common cardiac arrhythmia that increases in prevalence with age. As the general population grows older, general practitioners will more frequently see this disease in their clinic population. In order to most effectively treat these patients, physicians need to understand key issues, including the use of rhythm control versus ventricular rate control and how to reduce the risk of ischemic stroke. This article will review recent advancements in the understanding of the pathophysiology, management, stroke risk stratification and prevention of thromboembolic complications in atrial fibrillation.     

Considering the Needs of Older Sexual and Gender Minority People

Sexual and gender minority older adults face unique challenges in health care and are at greater risk for poor health outcomes. The aging population is growing significantly. Nurse practitioners have an opportunity to address the specific challenges associated with family and social support, unique relationships, sexuality and its implications, the lack of community resources, housing including long-term care, end-of-life and palliative care disparities for these populations.     

Warfarin therapy in older adults: managing treatment in the primary care setting

Oral anticoagulant therapy with war farin is commonly used to prevent thromboembolic events in patients at risk. The degree of anticoagulation is variable among individuals and is influenced by many factors; therefore, patients must be monitored frequently to assess for potential adverse effects related to treatment. Individuals older than age 65 are at particular risk for thromboembolic events as well as anticoag ulant-related complications. Because of these factors, elderly individuals pose a unique challenge in maintain ing anticoagulant control. The purpose of this article is to revisit the role of warfarin therapy for elderly individ uals in the primary care setting and to provide nurse practitioners with the information necessary to prescribe and monitor this medication appropriately. This article provides indications for warfarin therapy and also identifies potential barriers to effective management with specific implications for the older population.     

The Management of Depressed Elderly Care Recipients: Family Perspectives on the Skills of Professional Carers

Recent studies have identified high levels of depression among older people, both those in their own homes and those in residential care. With the world's population ageing, it is timely for health service providers to consider how the escalating population of depressed elderly people will be managed. Although treating general practitioners may be the health professionals most expected to detect, treat, and monitor depression among the elderly, professional carers are well placed to assist in the detection and monitoring of the disorder. This study conducted individual interviews with 15 family members of depressed aged-care recipients to determine their perceptions of the skills and knowledge of depression of professional carers. Family members reported that carers are more likely to avoid than engage with their clients about depressive symptomatology and do not communicate their concerns with managers or general practitioners (GPs). Family members believed that, in general, professional carers were undertrained in these areas. The implications of these findings for health service planning and staff training are discussed.