Elders at risk during disasters

Recent natural and manmade disasters such as the September 11, 2001 terrorist attacks, the hurricanes of 2005, and Chicago heat waves demonstrate the vulnerability of older adults to such events. In this article, the specific physical, psychosocial, and cultural characteristics of older adults that place them at greater risk during disasters and emergencies are discussed. Unique concerns of older adults and their families in disasters and emergencies are addressed. In addition, the impact that these characteristics have on the ability of older adults to respond to such events and recover from them is discussed. Finally, strategies that home health providers can use in working with vulnerable older adults are explored.     

Supporting evidence for geropsychiatric nursing as a subspecialty of gerontological advanced practice nursing

Advanced practice nurses (APRNs) make significant contributions to the mental health of older adults. Despite the surge in the number of older adults, the number of APRNs choosing educational preparation for geropsychiatric nursing (GPN) is limited. The purpose of the GAPNA GPN Position Statement is to sustain a new vision for the nursing profession that will improve the care of older adults with psychiatric and mental health disorders. This position paper was written by a diverse group of APRNs with the collective intent to reflect respect, decrease stigma, remove controversy, and uphold a positive, person-centered approach to mental disorders among older adults and their families. The GAPNA GPN Position Statement was written to advance excellence in the GPN subspecialty, provide holistic care for older adults and make recommendations for practice. Blending gerontological and psychiatric nursing results in a subspecialty at the top of the APRN Consensus Model pyramid.     

Growth and specialization of gerontological nursing

The development and growth of advanced practice registered nurses (APRNs), specifically those with specialization in geriatrics, has had significant impact on the care of older adults. The purpose of this article is to address the historical growth of gerontological nursing, the advanced practice roles created, and the impact that they have had in meeting the health-care needs of the older adult.     

Motivational interviewing for older adults in primary care: A systematic review

Chronic disease is now the leading cause of death and disability in United States. Many chronic illnesses experienced by older adults can be prevented or managed through behavior change, making patient counseling an essential component of disease prevention and management. Motivational Interviewing (MI), a type of conversational method, has been effective in eliciting health behavior changes in people in a variety of settings and may also be a useful tool to help older adults change. This review of the literature analyzes current research and describes potential biases of MI interventions that have been conducted in primary care settings with older adults. MI shows promise as a technique to elicit health behavior change among older adults. However, further study with this population is needed to evaluate efficacy of MI interventions in primary care settings.     

Review article: Environmental heatstroke and long-term clinical neurological outcomes: A literature review of case reports and case series 2000–2016

Global temperatures are rising; extreme environmental heat can result in adverse health effects including heatstroke. Acute effects of heat are well recognised, but there is less understanding of potential long-term adverse outcomes. Our aim was to review recent medical literature for clinical cases of environmental heatstroke with a focus on neurological outcome. Structured search strategies were designed to retrieve publications of heatstroke case reports using Ovid Medline and Embase (2000–2016). One thousand and forty-nine abstracts were identified, and after application of exclusion criteria 71 articles deemed relevant. Ninety cases were identified from 71 articles. 100% presented with acute neurological symptoms; 87.8% presented with non-neurological symptoms. 44.4% patients recovered fully, 23.3% died, 23.3% suffered convalescent or long-term neurological sequelae, and in 8.9% no long-term follow up was available. 57.1% of the patients who died or had a neurological deficit had no documented co-morbidity. Patterns of neurological deficits included 66.7% patients with motor dysfunction, 9.5% cognitive impairment, 19% both motor and cognitive impairment and 4.7% other. In total 71.4% of the impaired patients had long-term cerebellar dysfunction. Adverse long-term neurological outcomes were common in surviving patients presenting with environmental heatstroke. Permanent neurological deficits were present in 34.4% of survivors where outcome was known; many were young, healthy individuals. Cerebellar injury was common suggesting cerebellar structures are vulnerable to heat. These findings highlight that people of all ages and pre-morbid states are at risk of severe heat-related illness. In the face of climate change, effective interventions for heat-related illness, including both treatment and prevention are necessary.     

Species for changing climates – Australian dryland forestry opportunities

Climate change during the next century is projected to result in increased mean annual temperatures and changes in rainfall amounts and seasonality. It will also cause often challenging effects such as droughts, storms, heatwaves and changes in pest and disease occurrence throughout Australia’s current plantation estate. The direct effects of climate change are not the only foreseeable impacts on Australian plantations; competition for the current medium–high-rainfall plantation land base from agriculture and urban development, driven by both climate change and Australian and global societal trends, is also likely. Climatic conditions within most of the existing plantation estate in southern Australia are likely to become hotter, drier and more variable, and available alternative sites will most likely have dry climates. In order to sustain plantation productivity into the future, the forest industry will need to use new breeds of currently planted species or alternative species that are adapted to hotter and drier environments. In this review, we examine opportunities for establishing plantations of tree species adapted to dryland conditions, as well as trade-offs between productivity and survival in unpredictable environments. We discuss two strategies, adapting existing breeds to changing climates and identifying and domesticating novel species. Traditional timber and fibre products are considered, as well as emerging products such as sandalwood oil and services such as carbon sequestration. The need for development of policies that encourage effective and sustainable plantation expansion into dryland areas is discussed.     

Joint self-care by older adults

Self-care actions used for joint symptoms were studied among independently living older adults. Fifty-three of 100 older adults interviewed reported 65 joint problems. Medication use was the most common self-care action reported (56%), followed by heat application (23%), exercise (13%), and rest (10%). Several self-care actions suggested in the professional literature were notably absent or infrequently used in this sample. Twenty percent of the reported joint problems were not treated with self-care actions. The need for joint rehabilitation education in this sample of older adults is well documented.     

The health impacts of climate change: getting started on a new theme

Climate change is widely acknowledged as a key global challenge for the 21st century, and is projected to significantly affect population health and human well-being. All of the climate change-related changes in weather patterns will affect human health, from boosting mental well-being to mortality from large-scale disasters. Human health can be affected both directly and indirectly. For various reasons, the health sector has been slow in responding to the projected health impacts of climate change. To effectively prepare for and cope with climate change impacts, public health must move from a focus on surveillance and response to a greater emphasis on prediction and prevention. The targeted agenda program dialogue identified three priorities for climate change related health actions: heat waves, vector-borne diseases; and malnutrition.     

National survey of psychiatric mental health advanced practice nursing: development, process, and finding

A survey was sent to all Psychiatric Mental Health (PMH) Advanced Practice Registered Nurses (APRNs) who had a registered e-mail address with the American Nurses Credentialing Center, resulting in 1,899 usable surveys. The practice of two groups of APRNs was examined and contrasted: those certified to treat children and adolescents and PMH-APRNs certified only to treat adults. Our findings raise concerns about the numbers of PMH-APRNs treating children. Considering the national demand for mental health professionals prepared to treat children, the specialty must move to increase the number of qualified APRN child providers.     

Age Differences in the Time Course and Magnitude of Changes in Circulating Neuropeptides After Pain Evocation in Humans

This study tested the hypothesis that older adults would have a stronger response for substance P (facilitatory) but weaker response to β-endorphin (inhibitory), in magnitude as well as time course. Eight younger and 9 older adults underwent 3 experimental sessions using well validated laboratory pain models: cold pressor task, contact heat pain, and a nonpainful control. Blood was collected through an indwelling catheter at baseline and 3, 15, 30, 45, and 60 minutes after stimuli administration. Older adults had higher baseline levels of both neuropeptides suggesting increased peripheral activity compared with younger adults. After the cold pressor task, older adults demonstrated a quick and strong release of substance P with dramatic recovery, whereas young adults maintained a constant low-grade response. Unlike substance P, β-endorphin increased between 3 and 15 minutes for both groups with the upsurge substantially higher for older adults. After heat pain, younger adults had an immediate surge in circulating substance P and β-endorphin that was more pronounced than among older adults. However, levels of substance P for younger adults slowly tapered whereas they continued to climb for the older adults through 30 minutes. β-endorphin peaked at 30 minutes for both groups and returned to baseline. No changes were observed during the nonpainful control session.

Social transformation and social isolation of older adults: Digital technologies,nursing, healthcare

BackgroundThe incidence of social isolation among older adults is on the rise in today's health care climate. Consequently, preventing or ameliorating social isolation through technology in this age group is now being discussed as a significant social and health issue.AimThe purpose of the opinion paper is to clarify social transformation through technology and shed light on a new reality for older adults in situations of social isolation. Our goal is to persuade the reader that our position on this topic is a valid one. We support our claims with practice-based evidence and published research studies.MethodsTo do so, we checked the most recent literature, most of which came from the last decade. Our literature survey focused primarily on what is known about technology and how technology can affect social transformation and perceptions of social isolation.FindingsTwo dominant transformative realities became the focal points: the precarious implications of loneliness for older adults and the emerging reality of social change through digital technology central to eHealth and mHealth.DiscussionTo benefit from new technologies and reduce the detrimental effects of social isolation, we must engage older adults in a meaningful way and adapt the system of smart devices to reflect the specific physiological and psychological characteristics of the ageing population.ConclusionOlder adults need to comprehend the meanings of their social experiences to preserve their active lifestyle. Human interactions may be desirable, but technological dominance may also minimize the adverse effects of social isolation.     

The impact of interprofessional collaboration on the effectiveness, significance, and future of advanced practice registered nurses

Interprofessional collaboration was essential for the conduct of research that demonstrated the effectiveness and significance of advanced practice registered nurses (APRNs) in providing care, in reducing health care costs, and in developing innovative models of care for the nation's citizens. If the 2010 Affordable Care Act is to be implemented, APRNs, with their expertise and numbers, are essential to its implementation. Continued interdisciplinary collaboration is needed to expand the scope of APRN state practice regulations, to change reimbursement for APRN services, and to mute opposition to these changes by medical organizations.     

Assessing the Needs of Oncology APRN Preceptors

Due to limited oncology education in many graduate nursing programs, oncology advanced practice registered nurses (APRNs) often serve as preceptors for APRNs new to oncology. A needs assessment surveying familiarity, perceived importance, and perceived confidence with preceptor competencies among APRNs at a comprehensive cancer center found that 75.23% had been preceptors, whereas only 36% reported training. Findings indicate that the educational needs of APRNs new to oncology may be addressed through development of preceptor programs providing knowledge and skills for effective clinical teaching strategies. Preceptor preparation, role support, and development are essential for successful learning experiences.     

Pain control

1. There is a need for more data about the epidemiological nature of pain in older adults. Some evidence suggests that pain is a prevalent but under-reported symptom in this age group. 2. Some experimental studies have suggested that older adults have a different criteria for labeling a stimulus as painful. It is also likely that older adults attribute certain symptoms to aging, and this influences the coping responses to the symptoms. 3. The clinical presentation of pain in older adults may be modified by the presence of multiple diseases super-imposed on the aging process. 4. Effective pharmacological management of pain should consider the older adult's increased susceptibility to troublesome side effects, medication interactions, and low dose toxicity. 5. Nonpharmacological approaches such as an exercise program help improve functional ability as well as assist the individual to cope and live with the pain.     

COVID-19 and Advanced Practice Registered Nurses: Frontline Update

Coronavirus disease 2019 (COVID-19) emerged in 2019 and rapidly became a global pandemic, infecting millions and killing hundreds of thousands. The disease altered the practices of hospitals, clinics, and patients. These changes have implications for advanced practice registered nurses (APRNs). APRNs must remain current on best practices for treatment and diagnosis of COVID-19 while being cognizant of changes to their scope of practice. As the pandemic continues, APRNs will remain on the front lines treating patients with COVID-19 while also caring for vulnerable populations within the community. To provide high-quality care, APRNs must use a multifaceted approach that heeds ongoing updates to evidence-based practice.     

Developing an advanced practice nursing credentialing model for acute care facilities

Credentialing of advanced practice registered nurses (APRNs) in acute care settings is an essential practice, but care must be taken to ensure that full utilization of the scope of practice and capacity of APRNs is attained. The process of credentialing and privileging involves the verification of required education, licensure, and certification to practice as an APRN along with the recognition of the scope of the individual APRN's practice based on training, education, and practice setting. Nursing administrators are challenged with ensuring that APRNs are credentialed and privileged and that appropriate mechanisms exist within the institution for promoting recognition of the scope of practice of APRNs. This article reviews concepts related to the process of credentialing and privileging for APRNs, with special considerations to acute care settings. Important considerations are highlighted to ensure that the credentialing process for APRNs promotes practice within their scope of practice.     

Roles of Nurse Practitioners: Health Consequences of Climate Change in Vulnerable Older Adults

Nurse practitioners (NPs) have key roles in addressing health consequences of climate change across the lifespan for patients, families, communities, and populations. The role of the NP in the health and well-being of vulnerable populations is critical in understanding the deleterious consequences of climate change. Older adults are considered a vulnerable population for health challenges in our climate-changing world. The link between climate and health via a systems approach includes engaging in health assessment, physical examination, differential diagnoses, and plans for interventions. Social determinants of health, community health, and population health are discussed, with recommendations for the roles of NPs.