Laurie Kennedy-Malone

Self-medication with over the counter drugs among elderly adults.

Self-medication with over-the-counter (OTC) drugs is an economical choice of treatment for common self-limiting illnesses. As more medications are made available as OTC drugs, and as the population of older adults continues to increase, a need arises to monitor how elderly individuals use these agents. The purpose of this study was to assess the self-medication practices with OTC drugs among older adults. The study took place in a city in North Carolina in apartments managed by the citys Housing Authority and a private physicians office. Participants included 39 adults ages 59 to 91. Respondents lived independently, used OTC drugs, and were responsible for their health care decisions. Conns Self-Medication Practice Tool was used to assess symptoms the older adults were treating with OTC drugs; therapeutic categories of OTC drugs used; frequency of OTC drugs used; and the use of alcohol, prescription drugs, and caffeine. The respondents reported pain as the symptom most frequently self-treated with OTC drugs. Ninety percent of the respondents used pain medicine, and approximately two thirds (67%) of the respondents used at least one high blood pressure medicine. More than half of the respondents (59%) used caffeine daily, and 10% used alcohol. The researchers concluded that older adults might be unaware of the adverse risks associated with concurrent use of pain medicines, alcohol, high blood pressure drugs, and regular caffeine use. This makes it necessary for all nurses and other clinicians providing health care to older adults to intensify efforts to educate and guard these patients and ensure appropriate use of OTC drugs.

Teaching while learning while practicing: reframing faculty development for the patient-centered medical home.

Soaring costs of health care, patients living longer with chronic illnesses, and continued attrition of interest in primary care contribute to the urgency of developing an improved model of health care delivery. Out of this need, the concept of the team-based, patient-centered medical home (PCMH) has developed. Amidst implementation in academic settings, clinical teachers face complex challenges not previously encountered: teaching while simultaneously learning about the PCMH model, redesigning clinical delivery systems while simultaneously delivering care within them, and working more closely in expanded interprofessional teams.To address these challenges, the authors reviewed three existing faculty development models and recommended four important adaptations for preparing clinical teachers for their roles as system change agents and facilitators of learning in these new settings. First, many faculty find themselves in the awkward position of teaching concepts they have yet to master themselves. Professional development programs must recognize that, at least initially, health professions learners and faculty will be learning system redesign content and skills together while practicing in the evolving workplace. Second, all care delivery team members influence learning in the workplace. Thus, the definition of faculty must expand to include nurses, pharmacists, social workers, medical assistants, patients, and others. These team members will need to accept their roles as educators. Third, learning to deliver health care in teams will require support of both interprofessional collaboration and intraprofessional identity development. Fourth, learning to manage change and uncertainty should be part of the core content of any faculty development program within the PCMH.

Clinical practice characteristics of gerontological nurse practitioners: A national study

Purpose: To determine the clinical practice characteristics of gerontological nurse practitioners (GNPs) in the United States and ascertain whether length of employment, geographic region of practice, work setting, and educational preparation influence GNPs’ delivery of advanced clinical services and clinical procedures. Data sources: The Gerontological Nurse Practitioner Practice Profile was mailed to a stratified random sample of 1000 GNPs certified by the American Nurses Credentialing Center. Conclusions: Despite the growing demands for GNPs, of the 472 GNPs who responded to the survey, only half were working full‐time as a GNP. Although the role was established over 30 years ago, 56% of the respondents indicated that they were the first GNP in the position. There was a statistically significant positive relationship between being the first GNP in his or her practice and the percent of primarily medical advanced clinical services performed. GNPs who worked in multiple clinical setting performed more advanced clinical services and medical procedures than GNPs who only worked in one setting. Implications for practice: This study provides insight into the complex practice characteristics of GNPs. GNPs are combining the nursing skills so necessary to care for older adults with advanced clinical services and clinical procedures deemed medical acts. Various factors influence how GNPs practice, including geographic location, type of practice, and whether the GNP was the first person to be employed as a nurse practitioner at the practice.

Prescribing patterns of gerontological nurse practitioners in the United States

Purpose: To identify the prescribing patterns of gerontological nurse practitioners (GNPs) as reported on the Gerontological Nurse Practitioner Practice Profile. Specifically, the study examined (a) GNPs’ frequency of prescribing certain categories of medications for older adults; (b) the influence of practice, education, and experience variables on prescribing practices of GNPs; and (c) the rate of prescribing inappropriate medications for older adults based on the list of medications on the modified Beers Criteria. Data sources: The study was part of a larger descriptive survey that examined the practice characteristics of GNPs using the Gerontological Nurse Practitioner Practice Profile. A stratified random sample of 1000 GNPs certified by American Nurses Credentialing Center was sent surveys; 472 usable surveys were returned. Only the 234 GNPs who indicated that they were currently practicing full time as a GNP were included in this analysis. Conclusions: Ninety‐three percent of the respondents indicated that they had prescriptive privileges. The most commonly prescribed types of medications were analgesics, antihypertensives, cardiovascular drugs, and diabetic medications. The prescribing patterns of these GNPs were not influenced by education, years of practice, or selected practice characteristics. There was a significant difference in the prescribing of inappropriate medication among office‐based GNPs and those who worked in long‐term care settings. The GNPs in the ambulatory care setting had a tendency to prescribe inappropriate medications more frequently than those in long‐term care facilities. Overall, self‐reported prescribing of inappropriate medications among the GNPs participating in this study, however, was low. Implications for practice: The findings of this study indicate that GNPs are prescribing medications for complex medical conditions.

Beta-blocker medication usage in older women after myocardial infarction.

Purpose: The purpose of this study was to assess demographic characteristics of women prescribed beta‐blocker (&bgr;‐blocker) medication and compare to those not using &bgr;‐blocker medication, and to determine if there are differences in depression and fatigue among women who used &bgr;‐blockers compared to nonusers 6–12 months after myocardial infarction (MI). Data sources: This was a descriptive cross‐sectional study of 84 women (61 using &bgr;‐blockers and 23 not using &bgr;‐blockers) aged 65 and older who were 6–12 months post‐MI. Women had their height and weight measured and completed a Demographic Health Form, the Geriatric Depression Scale, and the Revised Piper Fatigue Scale (RPFS). Conclusions: While most of the women were taking &bgr;‐blockers after MI (74%), significantly fewer Black women were taking &bgr;‐blockers (χ2= 5.086, p= 0.032). Most of the &bgr;‐blocker users were overweight or obese. There were no significant differences in age, t(82) = 0.7, p= 0.486; body mass index, t(82) = 0.76, p= 0.445; income, χ2(df = 2) = 3.219, p= 0.075; mean depression, t(82) = 1.648, p= 0.103; or fatigue scores, t(82) = 0.993, p= 0.324, between &bgr;‐blocker users and nonusers. More of those not taking &bgr;‐blockers reported fatigue with significantly higher fatigue in the affective meaning dimension of the RPFS, t(82) = 2.272, p= 0.03. Implications for practice: &bgr;‐Blocker medication continues to be underutilized in older women. Because no difference was noted in fatigue and depression in the two groups, these may mean that these side effects are not barriers in prescribing this medication post‐MI. Nurse practitioners are in pivotal positions to monitor the ongoing physiological and psychological sequelae post‐MI and implement interventions to improve their outcomes.

Older Adults with Bipolar Disorder: Guidelines for Primary Care Providers

The purpose of this article is to present evidence-based guidelines to facilitate early diagnosis and appropriate treatment of older adults with symptoms of bipolar disorder. Assessment criteria, diagnostic tools, and interventions to optimize care of older adults with bipolar disorder--with a focus on implications for primary care providers--are described.

GAPNA Consensus Statement on Proficiencies for the APRN Gerontological Specialist Proficiency Statement 5

Critical to designing effective informed patient self-care management strategies for older adults, the APRN Gerontological Specialist (APRN-GS) first needs to be highly cognizant of the impact of normal aging on presenting multimorbidity and then the patient’s ability to learn how to safely manage his acute and chronic illness.1,2 Compounding the determination of readiness for self-care management is the need for the clinician to be aware of the patient’s health literacy level, social support status, functional and cognitive ability and financial resources to include type of insurance coverage.1,3,4 An individualized approach that includes disease-specific information along with strategies to enhance the patient’s activities of daily living and quality of life has proven to be effective with older adults.3 For older males as is the case described below, studies have shown that providing the male patient with a practical, action-oriented approach to integrating self-care management into their daily routine are more readily accepted than those that do not design interventions with these strategies in mind.5 Consider the case of an older male who is struggling with managing a new chronic disease.