Geriatric nursing
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Each year, over 300,000 individuals aged 65 and older are hospitalized for hip fractures in the United States.1 Traditional pain management in the elderly population is difficult because of physiologic changes and comorbidities.2 Peripheral nerve blocks are often placed by anesthesia professionals following hip surgery as part of a multi modal pain management program. Recently, the placement of fascia iliacal blocks has been successfully utilized in the emergency department for geriatric patients suffering from hip fractures. This technique can be easily mastered with proper training for use in the emergency department and pre-hospital environments reducing the pain of hip fracture and its associated risks of morbidity. This article provides a detailed review of anatomy and an ultrasound-guided technique for placement of the fascia iliaca block.
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Geriatric nurses have a responsibility to promote the health of all older adults. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults are particularly vulnerable to poor health outcomes and are less likely to seek healthcare due to fear of discrimination. ⋯ Caring for this population may be challenging, as it will require geriatric nurses to expand their knowledge of LGBTQ health, explore their own biases, and challenge institutional norms. However, through coordinated efforts geriatric nurses can work toward improving care for LGBTQ older adults.
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Advance care planning (ACP) conversations help individuals exercise autonomy and make informed decisions about their care. There are many ACP resources available to support the process of advance care planning, yet available resources not universally accepted and under-utilized in clinical practice. ⋯ We present a comprehensive evaluation of resources to support ACP. Using the Transtheoretical Model, we provide a guide for the use of these educational resources based on patient readiness. This review allows clinicians to identify aspects of each resource that may be helpful in preparing older adults for future healthcare decsions. Our analysis has identified the need to continue to refine these educational resources so that they can reach a broad population with varying needs. Advance care planning (ACP) conversations help individuals exercise autonomy and make informed decisions about their care. There are many ACP educational resources available to support the process of advance care planning, yet available resources are not universally accepted and under-utilized in clinical practice. We present a comprehensive evaluation of 20 educational resources to support ACP. Educational resources were identified and evaluated for: Patient Education Materials Assessment Tool (PEMAT) score, Flesch-Kincaid reading ease and grade level, cost, languages available, and categories of content. Using the Transtheoretical Model, we provide a guide for the use of these educational resources based on patient readiness. This review allows clinicians to identify aspects of each resource that may be helpful in preparing older adults for future healthcare decisions. Our analysis has identified the need to continue to refine these educational resources so that they can reach a broad population with varying needs.
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Our primary objective was to determine the prevalence and characteristics of high dose opioid users among older adults. Study populations included adults ≥65 years with: 1) 12-month continuous medical plan enrollment; and 2) at least 2 opioid prescriptions with a cumulative day supply ≥15 days. Opioid users were categorized as high dose >120 milligram morphine equivalents (MME) per day or lower dose ≤120 MMEs per day. ⋯ Compared to lower dose users, high dose opioid users were male, younger, depressed, in poorer health, had back pain, used benzodiazepines and/or sleep medications, and used 4 or more pharmacies. The prevalence of high dose opioid users was relatively small but users were characterized by a complex mix of physical and mental health issues. Interventions to reduce reliance on opioids may need mental health management to promote more effective pain management.
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Personalized music listening (PML) has been touted as a safe and inexpensive means of improving the quality of life, mood, and behavior of persons with dementia. A PML program was implemented in an assisted living facility and evaluated across the five dimensions of the RE-AIM framework: reach, effectiveness, adoption, implementation, and maintenance. The first 17 residents invited to participate were enrolled and followed over eight months. ⋯ Implementation was facilitated by low costs, engagement of external volunteers, highlighting outcomes that are relevant to staff, and attention to playlists over time. Maintenance required continued engagement of volunteers, ongoing fundraising, attention to facility staff engagement, and iterative adjustments to the program framework as staffing changes occurred. PML was found to be a meaningful intervention that is possible at a reasonable cost.