Billy A. Caceres

Screening for elder mistreatment in dental and medical clinics

OBJECTIVE Elder mistreatment (EM) is a potentially fatal and largely unrecognised problem in the United States. The purpose of this study was to determine the prevalence of EM in busy clinics and specifically, we report on the feasibility of screening for EM as well as the appropriate instrumentation for screening. BACKGROUND Prevalence estimates for elder mistreatment vary, but recent data from a national sample of community-residing adults over 60 years of age indicate that 11.4% of older adults report some form of elder mistreatment. There is a paucity of research related to screening in dental and medical clinics to understand the prevalence in such practice settings. METHODS A cross-sectional study was conducted from January 2008 to March 2009. We enrolled 241 patients at two clinics: a medical clinic (n = 102) and dental clinics (n = 139). A mini-mental status exam was conducted with a minimum of 18 or better for inclusion. An elder mistreatment screen was next used [elder assessment instrument (EAI-R) for medical and Hwalek-Sengstock elder abuse screening test (HS-EAST) for dental]. RESULTS For the 241 patients, we were able to compare data from the EAI-R with the HS-EAST. This pilot work demonstrates the feasibility of screening for EM in busy clinics since we documented patient enrolment of 20% in the medical clinics and 66% in dental clinics. Patients are willing to answer extremely-sensitive questions related to elder mistreatment and are also willing to use computer technology for interviewing. CONCLUSION Dental and medical clinics are important practice venues to screen for elder mistreatment.

A review of the safety and efficacy of bariatric surgery in adults over the age of 60: 2002–2013

Purpose The purpose of this review is to compare outcomes of bariatric surgery in adults over 60 to younger patients. This analysis is important to determine if nurse practitioners (NPs) and other providers should recommend bariatric surgery to obese older adults. Data sources This review included 15 studies published between 2002 and 2013. Conclusions Although older adults seem to experience less weight loss, bariatric surgery has potential benefits for these patients. Significant improvements in hypertension, diabetes, and, to a lesser extent, dyslipidemia are noted. Mortality and surgical complications in older adults are low, while differences in length of hospital stay are inconclusive. Implications for practice The risks of bariatric surgery in older adults need to be carefully evaluated based on individual medical condition. Overall the evidence suggests that bariatric surgery can be safely performed in older adults but more research is needed to determine which older adult patients are the best candidates for bariatric surgery. As bariatric surgery among older adults increases, interdisciplinary teams will continue to serve an important role in the management of bariatric surgery patients. NPs must be aware of trends in this emerging population of bariatric surgery patients.Purpose:The purpose of this review is to compare outcomes of bariatric surgery in adults over 60 to younger patients. This analysis is important to determine if nurse practitioners (NPs) and other providers should recommend bariatric surgery to obese older adults. Data sources:This review included 15 studies published between 2002 and 2013. Conclusions:Although older adults seem to experience less weight loss, bariatric surgery has potential benefits for these patients. Significant improvements in hypertension, diabetes, and, to a lesser extent, dyslipidemia are noted. Mortality and surgical complications in older adults are low, while differences in length of hospital stay are inconclusive. Implications for practice:The risks of bariatric surgery in older adults need to be carefully evaluated based on individual medical condition. Overall the evidence suggests that bariatric surgery can be safely performed in older adults but more research is needed to determine which older adult patients are the best candidates for bariatric surgery. As bariatric surgery among older adults increases, interdisciplinary teams will continue to serve an important role in the management of bariatric surgery patients. NPs must be aware of trends in this emerging population of bariatric surgery patients.

Policy implications of a literature review of bariatric surgery in older adults.

In the past decade, bariatric surgery has garnered attention as a treatment for obesity in older adults. Its increased popularity is a direct response to growing obesity rates in this segment of the population. Bariatric surgery among older adults has emerged as a contentious issue debated by federal and state governments, health care providers, and patients. It is important for geriatric nurses to comprehend the policy and health implications of bariatric surgery for older adults. The purpose of this paper is to (a) discuss the burden of growing obesity rates on the health of older adults, (b) present the results of a literature review of bariatric surgery outcomes in older adults, and (c) evaluate the policy implications of insurance coverage of bariatric procedures.

Recommendations for cardiovascular disease research with lesbian, gay, and bisexual adults

AIMS AND OBJECTIVES The purpose of this paper is to provide recommendations to strengthen cardiovascular disease research with lesbian, gay and bisexual adults, and highlight implications for practice. BACKGROUND Lesbian, gay and bisexual individuals face significant discrimination that negatively impacts their health. Health disparities research in lesbian, gay and bisexual adults have focused on mental health, sexually transmitted infections and substance use. Although cardiovascular disease is the leading cause of death and many lesbian, gay and bisexual adults report increased risk factors for cardiovascular disease, there has been limited research in this area. DESIGN This paper is a critical review. METHODS A literature search was conducted that compared cardiovascular disease risk and/or prevalence between lesbian, gay and bisexual and heterosexual adults. RESULTS Measures to assess cardiovascular disease risk factors and diagnoses varied widely across the 31 included studies. There was a lack of standardisation in definitions used for alcohol consumption, illicit drug use, mental health and self-rated physical health. Most studies that reported body mass index relied on participant self-report. Few studies included measures of physical activity and diet and those that did lacked standardisation. Only seven studies used laboratory data to establish diagnosis of cardiovascular disease. CONCLUSIONS This study is the first comprehensive review on this topic. In cardiovascular disease research with lesbian, gay and bisexual adults, there is a need for: (1) inclusion of stress as a risk factor for cardiovascular disease, (2) standardised measures, (3) objective measures for determining the presence of cardiovascular disease, (4) data from electronic health records to strengthen the study of cardiovascular disease in this population. RELEVANCE TO CLINICAL PRACTICE Strengthening cardiovascular disease research in lesbian, gay and bisexual adults is an important step in addressing health disparities in this population. Nurses and other healthcare professionals should assess sexual orientation in routine health assessments.

King’s Theory of Goal Attainment Exploring Functional Status

Imogene King’s Theory of Goal Attainment provides a schema for nurses interested in functional status. However, the lack of a uniform definition for functional status has hindered development of a concise understanding of this phenomenon. Functional status is particularly important to nurses who are concerned with the safety and wellbeing of clients. With healthcare’s increased focus on client-family-centered care it is important to develop innovative approaches for evaluating functional status that incorporate the client-family perspective. King’s focus on mutual decision-making is an underutilized resource that can provide great insight into the study and understanding of functional status.

Cardiovascular Disease Risk in Sexual Minority Women (18-59 Years Old): Findings from the National Health and Nutrition Examination Survey (2001-2012)

OBJECTIVE Sexual minority women (lesbian and bisexual) experience significant stigma, which may increase their cardiovascular disease (CVD) risk. The purpose of this study was to examine the prevalence of modifiable risk factors for CVD (including mental distress, health behaviors, blood pressure, glycosylated hemoglobin, and total cholesterol) and CVD in sexual minority women compared with their heterosexual peers. MATERIALS AND METHODS A secondary analysis of the National Health and Nutrition Examination Survey (2001-2012) was conducted. Multiple imputation with chained equations was performed. Logistic regression models adjusted for relevant covariates were run. Self-report (medical history and medication use) and biomarkers for hypertension, diabetes, and high total cholesterol were examined. RESULTS The final analytic sample consisted of 7,503 that included 346 sexual minority women (4.6%). Sexual minority women were more likely to be younger, single, have a lower income, and lack health insurance. After covariate adjustment, sexual minority women exhibited excess CVD risk related to higher rates of frequent mental distress (adjusted odds ratio [AOR], 2.05; 95% confidence interval [CI], 1.45-2.88), current tobacco use (AOR, 2.11; 95% CI, 1.53-2.91), and binge drinking (AOR, 1.66; 95% CI, 1.17-2.34). Sexual minority women were more likely to be obese (AOR, 1.61; 95% CI, 1.23-2.33) and have glycosylated hemoglobin consistent with prediabetes (AOR, 1.56; 95% CI, 1.04-2.34). No differences were observed for other outcomes. CONCLUSIONS Sexual minority women demonstrated increased modifiable risk factors for CVD, but no difference in CVD diagnoses. Several emerging areas of research are highlighted, in particular, the need for CVD prevention efforts that target modifiable CVD risk in sexual minority women.

Implications of the CARE Act for Latino Caregivers

The Caregiver Advise, Record, Enable (CARE) Act has the potential to make a positive impact in the lives of Latino older adults and their caregivers. As Latino individuals are the fastest growing older adult population, the number of Latino families and caregivers is also expected to grow, particularly among those providing care for someone with Alzheimers disease or other dementias. Caregiving has been considered a culturally embedded value among Latino individuals. Although few studies have focused on caregiving in this population, those that exist suggest that Latino caregivers struggle to find bilingual and bicultural support and information and show higher levels of distress and health disparities. The purpose of the CARE Act is to help and support family caregivers when older adults are admitted to the hospital and during care transitions. The current article examines the potential implications of this state law, specifically on Latino individuals, including recommendations for policy implementation. [Journal of Gerontological Nursing, 44(3), 9-14.].