Bonnie Callen

Screening Instruments for Older Adult Depressive Disorders: Updating the Evidence-Based Toolbox

The prevalence of clinically significant depressive disorders in persons 65 years of age or older in the United States has been estimated to be approximately 15%, increasing the risk for functional decline, morbidity, and mortality. Utilization of a well-chosen screening instrument has been shown to improve the rates of recognition of depressive disorders in older adults. This paper presents a targeted review of the most commonly accepted tools for case-finding of depressive disorders in older adults. After a review of the benefits and shortcomings of screening tools, the strengths, weaknesses, and utility of selected depression scales in geriatric clinical settings are discussed.

Teaching/Learning Strategies for the Essentials of Baccalaureate Nursing Education for Entry-Level Community/Public Health Nursing

The purpose of this article is to describe teaching/learning strategies for each of the 15 Essentials of Baccalaureate Nursing Education for Entry-Level Community/Public Health Nursing (ACHNE, 2009). Carpers ways of knowing serve as foundations for creating classroom and clinical experiences that focus on clinical action with community as client. Each community/public health essential is defined with relevance to community/public health nursing practice. Five teaching/learning strategies have been delineated for each essential with suggestions of teaching resources and/or target population application. Teaching/learning strategies that focus on community as client, population health, and the essential knowledge and competencies of C/PH nursing will help ensure preparation of baccalaureate prepared nurses with knowledge and skills to improve the health of populations.

Becoming an older volunteer: A grounded theory study.

This Grounded Theory study describes the process by which older persons “become” volunteers. Forty interviews of older persons who volunteered for Habitat for Humanity were subjected to secondary content analysis to uncover the process of “becoming” a volunteer. “Helping out” (core category) for older volunteers occurs within the context of “continuity”, “commitment” and “connection” which provide motivation for volunteering. When a need arises, older volunteers “help out” physically and financially as health and resources permit. Benefits described as “blessings” of volunteering become motivators for future volunteering. Findings suggest that older volunteering is a developmental process and learned behavior which should be fostered in older persons by personally inviting them to volunteer. Intergenerational volunteering projects will allow older persons to pass on knowledge and skills and provide positive role modeling for younger volunteers.

Severe sepsis in older adults.

Severe sepsis may be underrecognized in older adults. Therefore, the purpose of this article is to review special considerations related to early detection of severe sepsis in older adults. Normal organ changes attributed to aging may delay early detection of sepsis at the time when interventions have the greatest potential to improve patient outcomes. Systems are reviewed for changes. For example, the cardiovascular system may have a limited or absent compensatory response to inflammation after an infectious insult, and the febrile response and recruitment of white blood cells may be blunted because of immunosenescence in aging. Three of the 4 hallmark responses (temperature, heart rate, and white blood cell count) to systemic inflammation may be diminished in older adults as compared with younger adults. It is important to consider that older adults may not always manifest the typical systemic inflammatory response syndrome. Atypical signs such as confusion, decreased appetite, and unsteady gait may occur before sepsis related organ failure. Systemic inflammatory response syndrome criteria and a comparison of organ failure criteria were reviewed. Mortality rates in sepsis and severe sepsis remain high and are often complicated by multiple organ failures. As the numbers of older adults increase, early identification and prompt treatment is crucial in improving patient outcomes.

Relationships Among Stress, Infectious Illness, and Religiousness/Spirituality in Community-Dwelling Older Adults

The purpose of this study was to examine the relationships among stress, infectious illness, and religiousness/spirituality in community-dwelling older adults in the southeastern United States. Four assessment tools were completed by 82 older adults (mean age = 74, age range = 65 to 91): the Perceived Stress Scale, the Carr Infection Symptom Checklist (SCL), the Brief Multidimensional Measurement of Religiousness/Spirituality, and a demographic form. A significant correlation was found between stress and SCL scores; however, four dimensions of religiousness/spirituality moderated the relationship between stress and infection. Older adults who were unable to forgive themselves or forgive others, or feel forgiven by God, were more likely to have had an infection in the previous month. Increased infections also occurred when older participants did not feel they had religious support from their congregations. Using these findings, gerontological nurses are well positioned to deliver tailored stress management and forgiveness interventions when older adults report increased stress.

Nutritional screening in community dwelling older adults

AIMS AND OBJECTIVES The purpose of this study was to test whether a combination of validated tools, one for each of five leading nutritional risk factors, could predict unintentional weight loss in community dwelling older adults. BACKGROUND Non-invasive, easily administered nutritional screening tools for community dwelling older adults are few and those that are available are problematic. METHOD Convenience samples of 115 adults ≥65 were interviewed. Height, weight and measures of the five nutritional risk factors were collected at interviews 6 months apart. DESIGN Repeated measures. RESULTS 91 subjects completing T2 were largely white (95.6%), female (69%), well educated and in good health. Multiple regression was conducted with unintentional weight loss as the dependent variable and depression (the GDS-SF), the Lubben Social Networking Scale, food security, food intake and Independent Activities of Daily Living as the predictor variables. The regression model was statistically significant (F (5, 85) = 0.30852, P = 0.003) with an adjusted r(2) of 0.137. CONCLUSIONS Five validated tools can be administered by nurses or non-professionals to screen for nutritional risk factors leading to unintentional weight loss. IMPLICATIONS FOR PRACTICE Early screening has the potential to identify either nutritional risk or nutritional decline in older adults.

ICD and End-of-Life Discussions Why Communication Matters

An implanted cardiac defibrillator (ICD) is a unique indwelling device for the treatment of cardiac dysrhythmia and the prevention of sudden cardiac death. On February 4, 1980, the first ICD was implanted into a human subject. Thousands of Americans have been saved as a result of this device. Near the end of life, an active ICD may no longer be consistent with a patient’s needs and/or current health status. The very benefit of the device becomes the risk. Research has shown a deficit in recipient understanding of the role and function of the ICD. Likewise, there is a deficit in physician-led discussions and education of ICD deactivation in end-of-life care.

WEIGHT GAIN IN OVERWEIGHT AND OBESE COMMUNITY DWELLING OLD-OLD

Objectives: The purpose of this study was to 1) investigate lifetime weight changes in community dwelling old-old, those age 80 or older; 2) explore reasons for weight changes from their personal perspective and 3) examine ways the old-old feel they can successfully lose weight. A cross sectional design was used for this qualitative study.Setting: One county of a southeastern U.S. state.Participants: Nine community dwelling old-old.Measurement: Content analysis of transcripts was used to examine the interviews.Results: All of the old-old interviewed had reached their maximum weight after the age of 65. Average lifetime weight gain was 73 pounds. All wanted to lose weight and found ways to incorporate small changes in their everyday lives.Conclusion: With increasing life expectancy among older adults, health promotion targeting weight control needs to include the old-old.

Testing a Model of Sodium Reduction in Hypertensive Older Thai Adults

ABSTRACT Hypertensive older adults will benefit if there is a clear understanding of the factors related to sodium reduction. That would raise awareness of the causes, consequently reducing many health risks, lowering health care costs, and diminishing economic and social burden from high blood pressure. This study explored predictors of urinary sodium excretion. A cross-sectional, correlational study was conducted in 312 hypertensive older Thai adults. Questionnaires related to knowledge, self-care agency, self-care behavior of sodium reduction, and 24-hour urinary sodium analyses were used, followed by the application of structural equation modeling and the Analysis of Moment Structures program. Self-care agency, knowledge, self-care behavior, rural/urban location, and education accounted for 61% of urinary sodium excretion. Self-care agency, knowledge, and self-care behavior were the main predictors in the urinary sodium excretion model. This study suggests establishing supportive educative sodium reduction-related programs that improve knowledge and enhance self-care agency, as well as a comparison of the changes of sodium reduction self-care behavior and urinary sodium excretion over time after the intervention.

Religiousness/Spirituality and Anger Management in Community-Dwelling Older Persons

Mismanaged anger is associated with adverse health outcomes. This study examined whether dimensions of religiousness/spirituality could predict healthy anger management in a sample of 82 community-dwelling older Americans. A correlational research design was employed using the Deffenbacher Anger Scale and the Brief Multidimensional Measure of Religiousness/Spirituality. Higher scores on Forgiveness, Daily Spiritual Experiences, Religiousness/Spirituality as Coping, and Self-Ranking of Religiousness/Spirituality were correlated with healthier anger management; however forgiveness was the only significant predictor in the regression analysis. Interventions to facilitate forgiveness may promote healthy anger management and minimize the adverse health effects of mismanaged anger.