Improving Care at End of Life

This paper from the King's Fund (UK) provides a descriptive analysis of the impact and costs of new services as part of the Marie Curie Delivering Choice Programme, which was launched in 2004.

Delivery of care for patients at the end of their lives is becoming an increasing policy concern. Although the majority of people report that they would choose to die in their home, only a minority of patients achieve this wish. The Delivering Choice Programme aims to develop and help provide the best possible service for patients at the end of their lives.

http://www.kingsfund.org.uk/publications/kings_fund_publications/improving_choice_at.html

WHO Global Report on Falls Prevention in Old Age

Published in 2007, this global report is the product of the conclusions reached and recommendations made at the WHO Technical Meeting on Falls Prevention in Older Age which
took place in Victoria, Canada in February 2007.

The report includes international and regional perspectives on falls prevention issues and strategies and is based on a series of background papers that were prepared by worldwide recognized experts.

http://www.who.int/ageing/publications/Falls_prevention7March.pdf

Long Term Neurological Conditions

The Long Term Neurological Conditions guide is a new resource from the National Worksforce Projects (UK) produced in conjunction with a number of healthcare charitable organisations, including the Multiple Sclerosis Society, Epilepsy Action, the Parkinson's Disease Society, the Royal College of Nursing and the Department of Health.

The aim of the guide is to help commissioners and providers of services to people with long term neurological conditions offer the best possible service. It outlines why services for neurological conditions are important, shows the importance of multidisciplinary healthcare teams plus illustrates and clarifies the contribution of specialist nurses. It also features examples of good practice and feedback from patients.

http://www.changeagentteam.org.uk/index.cfm?pid=34&catalogueContentID=3259

New tools available at the Institute for Healthcare Improvement

New tools available at the Institute for Healthcare Improvement site:
http://www.ihi.org/IHI/Topics/MedicalSurgicalCare/MedicalSurgicalCareGeneral/Tools/

Nursing Assistant Ostomy Competency Tool
A tool used to rate nursing assistants on their performance of critical elements of care for patients with ostomies.

Braden Scale Risk Assessment and Skin Inspection Flow Chart
A flowchart indicating the steps taken to assess a patient’s risk of developing pressure ulcers and steps to identify and treat pressure ulcers which have formed.

Pressure Ulcer Plan of Care Tool
A grid identifying various elements of care for patients with pressure ulcers.

Wound Competency Identifying Pressure Ulcers and Other Wounds
A tool used to identify pressure ulcers, determine their severity (stage), and differentiate from other types of wounds.

Always a Last Resort: reducing antipsychotic use

Up to 105,000 people with dementia are given the drugs inappropriately, according to expert predictions in the new UK All-Party Parliamentary Group (APPG) on Dementia report, 'Always A Last Resort', published today.

Antipsychotics continue to be a first resort for dealing with challenging behaviour in people with dementia, such as aggression or agitation, despite causing devastating side effects, doubling risk of death and costing the UK over £60 million a year.

'Always a Last Resort' identifies 5 vital steps to reduce antipsychotic use and reveals there is currently no audit or regulation of the issue. It urges the Government to use its new National Dementia Strategy to address the problem and the National Institute for Health and Clinical Excellence to conduct a thorough review.

http://www.alzheimers.org.uk/downloads/ALZ_Society_APPG.pdf

Supporting Older People in Care Homes at Night

This report from the Joseph Rowntree Foundation, (University of Edinburgh) 2008 sought to explore night time care in nursing homes at night. A review of the literature revealed that this was an understudied, and less well understood aspect of care in the nursing home.

http://www.jrf.org.uk/bookshop/eBooks/2192-night-care-older-people.pdf

Best Practices Approach to Oral Care in Long-Term Care Homes

The Best Practices Approach to Oral Care in Long-Term Care Homes Resource Kit, March 2008

The Oral Care Resource Kit is a compilation of the many oral care resources created within or in collaboration with the Regional Best Practices Coordinators in LTC Care Initiative (Central South & South West) up to February 2008.

Most of the oral care reference tools, assessment tools, education resources and other items included in the Oral Care Resource Kit are already available for download from http://www.rgpc.ca/ (Long-Term Care>>LTC BP Resource Centre>>Resources>>Oral Care).

Recognition of Pain in Cognitively Impaired Older Adults

The May issue of the University of Iowa Geriatric Center E-News, "Recognition of Pain in Cognitively Impaired Older Adults," is available online.

http://www.healthcare.uiowa.edu/igec/publications/e-news/assets/E-News_05_2008.pdf

Frameworks of Integrated Care for the Elderly: A Systematic Review

Published in April, 2008, this report from the Canadian Policy Research Networks looks at the issue of finding efficient and effective ways to care for the elderly. As the baby boom cohort ages, this issue of of growing importance.

Our health system’s central concern has been acute care, that is, treatment of episodes of illness or injury for a short period of time. However, elderly people often have chronic health issues – problems that are long-term and continuing. They may have more than one chronic condition and may need a variety of health and social support services to help them live well. In many cases, appropriate supports can allow those with chronic health issues to live in their own homes rather than in an institution as well as to avoid unnecessary hospital services. But for care to be matched well to individual circumstances, a range of services may need to be coordinated or even, depending on the complexity of the need, “integrated” by pooling resources from multiple systems.

http://www.cprn.org/documents/49813_FR.pdf

Barriers to research utilization and research use among registered nurses in the care of older people

Bostrom AM, Nilsson Kajermo K, Nordstrom G, Wallin L.. Barriers to research utilization and research use among registered nurses in the care of older people: Does the BARRIERS Scale discriminate between research users and non-research users on perceptions of barriers? Implement Sci. 2008 May 1;3(1):24 [Epub ahead of print]

http://www.implementationscience.com/content/3/1/24

Source: PubMed

ABSTRACT: BACKGROUND: One strategy to enhance research use and change current practice is to identify barriers and then implement tailored interventions to reduce these barriers. In nursing, the BARRIERS scale has been frequently used to identify nurses' perceptions of barriers to research utilization. However, this scale has not been applied to care of older people, and only one study has investigated how identified barriers link to research utilization. Therefore, the purpose of this study was twofold: to describe RNs' perceptions of barriers to and facilitators of research utilization and to examine the validity of the BARRIERS scale in relation to research use. METHODS: A cross-sectional survey design was used and registered nurses (RNs) working in the care of older people participated (response rate 67%, n = 140/210). Two questionnaires, the BARRIERS scale and the Research Utilization Questionnaire (RUQ), were used. Data were analyzed using descriptive and bivariate inferential statistics. RESULTS: Characteristics of the organization and the presentation of research finding swere rated as the most prominent barriers. The three items most frequently reported as barriers were: the nurse is isolated from knowledgeable colleagueswith whom to discuss the research (89%); the facilities are inadequate forimplementation (88%); and, the relevant literature is not compiled in one place(81%). Surveyed RNs suggested more support from unit managers and better availability of user-friendly reports in Swedish to enhance research use. The RNs reported a modest use of research. A weak but significant correlation was found between the Research Use index in RUQ and the Presentation subscale in theBARRIERS scale (r = -0.289, p<0.01), suggesting that the RNs reporting more research use were less likely to perceive presentation of research as a barrier. Dividing the sample into research users (n = 29) and non-research users (n =105), the research users rated significantly lower on the subscales Presentation,Nurse and Research in the BARRIERS scale. CONCLUSIONS: The BARRIERS scale revealed differences in the perception of barriers between research users and non-research users. Thus, methodologically the scale appears useful in identifying some types of barriers to research utilization but not organizational barriers. The identified barriers, however, are general and wide-ranging, making it difficult to design useful specific interventions.

Nurse Competence in Aging Initiative

The November/December 2007 issue of Geriatric Nursing, a journal published by Elsevier, Inc., features a special supplement on the results of the highly successful Nurse Competence in Aging (NCA) Initiative. The project engaged members of 55 specialty nursing organizations to enhance geriatric-related education that is highly targeted to nurses practicing within each specialty.

Begun in 2002, the five-year initiative was funded by the Atlantic Philanthropies (USA) through a grant to the American Nurses Association (ANA) through the American Nurses Foundation (ANF). It represented a strategic alliance between ANA, the American Nurses Credentialing Center (ANCC), and The Hartford Institute for Geriatric Nursing.

Through the support provided by NCA, 80 percent of NCA participating organizations developed a set of geriatric competencies for their members; 80 percent used Web technology to promote issues of care for older adults to their members, many of them appointing one or more "Web Fellow" to implement the geriatric portion of the Web site; and 91 percent promoted geriatrics at their associations' conferences. More than half of the organizations added geriatric language to their scope and standards documents, developed geriatric special interest groups, or developed member awards for geriatric competence.

"Specialty nurses constitute a large component of the nurse workforce in ambulatory-care settings, hospitals, home care, and long-term care, where in most settings the majority of patients are over 65. Yet, most of these nurses have not received education targeted toward geriatric patients," says Mathy Mezey, director of The Hartford Institute for Geriatric Nursing at NYU College of Nursing. "There is much evidence that nurses who have been educated about principles of geriatric care, either in academic programs or through on-the-job training, contribute to improved outcomes for their older patients."

The Geriatric Nursing supplement will be highly useful as a blueprint for associations in the future to undertake the task of improving their approach to care for older adults.

The supplement is available free of charge online at http://www.gnjournal.com/issues/contents?issue_key=S0197-4572(07)X0065-X

To obtain a print copy of the supplement, please contact Elsevier Customer Service at elspcs@elsevier.com.

Let's Talk about Restraints: Rights, Risk, and Responsibility

Released by the Royal College of Nursing (UK) in March 2008, this guidance is applicable to all settings where
nursing care is provided. It replaces the document Restraint revisited – rights, risks and responsibility; guidance for nursing staff.

While again it has been written for all nursing staff, distinctions are made, where appropriate, between the roles and responsibilities of registered nurses, nursing students, and health care assistants. It also sets out what support and guidance nursing staff should expect their employing organisation to provide.

In addition, it may be helpful to regulators and inspectors of health and social care.
This guidance is intended for nurses working with adults, with examples and case studies
particularly geared towards the care of older people.

Although this guidance is directed at nurses, except in emergencies, decisions about restraint
need to be made after discussion, wherever possible, with the older person, their relatives
and friends, as partners in care. It is important to involve the whole care team, including other
professionals and agencies that may be helping to support the older person.

http://www.rcn.org.uk/__data/assets/pdf_file/0010/157762/003208.pdf

Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease

Released in January, 2008, this guideline updates the 2006 release.

Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Bethesda (MD): Global Initiative for Chronic Obstructive Lung Disease, World Health Organization, National Heart, Lung and Blood Institute; 2007.

http://www.goldcopd.com/Guidelineitem.asp?l1=2&l2=1&intId=996

Treating Depression in Older Adults

Snowden M, Steinman L, Frederick J. Treating depression in older adults: challenges to implementing the recommendations of an expert panel. Prev Chronic Dis 2008;5(1).

A special topic in the Preventing Chronic Disease, Public Health Research Practice and Policy series, this article shows the difficulties involved in translating research into practice. The authors describe real-world experiences in implementing evidence-based interventions in various community settings. Because depression among older people is viewed more and more as a public health problem, they suggest that partnerships of providers, patients, and policy makers be forged to overcome challenges related to funding, training, and implementing treatments for this condition.

http://www.cdc.gov/pcd/issues/2008/jan/07_0154.htm

Retooling for an Aging America: Building the Health Care Workforce

The Institute of Medicine has published a report, Retooling for an Aging
America: Building the Health Care Workforce, 2008, in which the health care
needs of Americans over 65 years of age are determined and these needs are
assessed through an analysis of the forces that shape the health care
workforce, including education and training, models of care, and public
and private programs.

The report can be purchased at:
http://www.iom.edu/CMS/3809/40113/53452.aspx

or the complete report can be downloaded from:

http://www.nap.edu/catalog.php?record_id=12089 - toc

A Quick Look at Alzheimers: Four Short Films for Download

Developed in partnership with the Alliance for Aging Research, these four very-short films aim to increase understanding of Alzheimer's disease. The creators of the films call them"pocket" films because of their brevity and portability; they are designed to be viewed anywhere at anytime: a doctor's office, a Congressional hallway, a family living room.

The films are designed to be downloaded to iTunes, or to your desktop.

http://www.aboutalz.org/