J Gerontol Nurs
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The purpose of this narrative literature review was to describe the state of the science on the effectiveness of opioid medications to palliate dyspnea in older adults with advanced disease. A three-stage critical appraisal process was used to evaluate articles published between 2000-2011 that were retrieved from the CINAHL, Ovid MEDLINE, and PsycINFO databases. ⋯ Many recent articles on this topic shed light on the importance but underuse of opioid agents to palliate dyspnea, particularly in older adults with advanced chronic illnesses, such as heart failure and chronic obstructive pulmonary disease. ADRA (Assess, Document, Re-assess, Advocate) is a proposed framework that gerontological nurses can use to ensure patients receive adequate symptom management for refractory dyspnea.
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Delirium is an acute, fluctuating confusional state that results in poor outcomes for older adults. Dementia causes a more convoluted course when coexisting with delirium. This study examined 128 days of documentation to describe what nurses document when caring for patients with dementia who experience delirium. ⋯ Common descriptive terms included words and phrases indicating fluctuating mental status, lethargy, confusion, negative behavior, delusions, and restlessness. Delirium is a medical emergency. Nurses are in need of education coupled with clinical and decisional support to facilitate recognition and treatment of underlying causes of delirium in individuals with dementia.
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Older adults have a legally recognized right to determine and control the health care they receive and are legally presumed to possess the capacity necessary to make health care decisions. However, older adults are at major risk for life-threatening and serious health problems leading to a loss of their capacity to make end-of-life and other health care decisions. Advance care planning is a process that enables older adults to specify who they want to act as a surrogate decision maker and what decisions they want made for them in the event of incapacitation. Geriatric nurses can play a significant role in promoting advance care planning and the use of legal tools for such planning.
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Delirium is common, deadly, and costly in people with dementia. The purpose of this pilot study was to test the feasibility of the computerized decision support component of an intervention strategy-Early Nurse Detection of Delirium Superimposed on Dementia-designed to improve nurse assessment and detection of delirium superimposed on dementia. ⋯ Despite the prevalence and severity of delirium in people with dementia, there are currently no published reports of the use of the electronic medical record in delirium detection and management. Success of this effort may encourage similar use of information technology in other settings.