Mary Ersek

Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature.

A meta-analysis was undertaken to determine the effects of surgery for lumbar spinal stenosis on pain and disability. Seventy-four journal articles met inclusion criteria and were independently reviewed by two readers. On average, 64% of patients treated surgically for lumbar spinal stenosis were reported to have good-to-excellent outcomes. However, there was wide variation across studies in the percentage with good outcomes. Few patient characteristics were found to predict outcome. Major deficits in study design, analysis, and reporting were common, and these precluded firm conclusions.

Quality of Life in Women with Ovarian Cancer

Despite growing interest in quality of life (QOL) as an important variable in nursing and health care, little research focuses on QOL in women with ovarian cancer (OVCA). The purpose of this study was to examine QOL in OVCA survivors. The convenience sample consisted of 152 women in all disease stages. Quantitative data were collected using the QOL-Cancer Survivors tool and a demographic sheet. Qualitative data were collected by asking participants to write their definitions and experiences of QOL since their diagnosis. Reliability and validity of all data and findings were established. Findings reveal that QOL is moderately highfor this group of cancer survivors, despite some specific negative facets of the illness and treatment experience. Qualitative analysis elaborates the four domains of Ferrells QOL model: physical, psychological, social, and spiritual well-being. Qualitative data also reflect the complexity of the cancer experience.

Use of pain-behavioral assessment tools in the nursing home expert consensus recommendations for practice

Many tools are available for the assessment of pain in nonverbal older adults; however, guidelines are needed to help clinicians select the proper instrument for use in the nursing home setting. This article describes a project to identify clinically useful pain-behavioral assessment tools that have undergone sufficient psychometric testing. Phase 1 of the project included a comprehensive review and critique of currently available tools. In Phase 2 the National Nursing Home Pain Collaborative developed criteria to evaluate an updated list of tools and then rated 14 tools using these criteria. As a result, two tools were recommended as most representative of current state of the science, most clinically relevant, and practically applicable to integrate into everyday practice and support adherence to regulatory guidelines. Such recommendations for selection of best-available pain assessment tools are a cornerstone for clinicians in regard to managing pain of nursing home residents who, due to dementia, are unable to self-report pain.

Improving Decision-Making for Feeding Options in Advanced Dementia: A Randomized, Controlled Trial

To test whether a decision aid improves quality of decision‐making about feeding options in advanced dementia.

The Challenges and Opportunities in Providing End-of-Life Care in Nursing Homes

Approximately 20% of deaths in the United States occur in nursing homes. That percentage is expected to increase as the population continues to age. As a setting for end-of-life care, nursing homes provide both challenges and opportunities. This article examines factors that impede the delivery of high-quality end-of-life care in nursing homes, such as inadequate staff and physician training, regulatory and reimbursement issues, poor symptom management, and lack of psychosocial support for staff, residents, and families. In addition to discussing hindrances to providing end-of-life care, this article explores characteristics of nursing homes and their staff that support the care of terminally ill residents. Also included is an overview of models for delivering end-of-life care in nursing homes, including provision of hospice services, specialized palliative care units, and consultation services. Finally, this article discusses educational programs and current educational initiatives to enhance end-of-life care in nursing homes.

Advanced Dementia: State of the Art and Priorities for the Next Decade

Dementia is a leading cause of death in the United States. This article outlines the current understanding of advanced dementia and identifies research priorities for the next decade. Research over the past 25 years has largely focused on describing the experience of patients with advanced dementia. This work has delineated abundant opportunities for improvement, including greater recognition of advanced dementia as a terminal illness, better treatment of distressing symptoms, increased access to hospice and palliative care services, and less use of costly and aggressive treatments that may be of limited clinical benefit. Addressing those opportunities must be the overarching objective for the field in the coming decade. Priority areas include designing and testing interventions that promote high-quality, goal-directed care; health policy research to identify strategies that incentivize cost-effective and evidence-based care; implementation studies of promising interventions and policies; and further development of disease-specific outcome measures. There is great need and opportunity to improve outcomes, contain expenditures, reduce disparities, and better coordinate care for the millions of persons in the United States who have advanced dementia.

Investigating the educational needs of licensed nursing staff and certified nursing assistants in nursing homes regarding end-of-life care

Nursing homes care for people at the end of life (EOL). There is evidence to suggest, however, that nursing staff in these settings is often unprepared to provide a high level of EOL care. This article reports the findings from three preliminary studies that investigated the needs of licensed staff and certified nursing assistants in nursing homes regarding EOL care. The studies involved needs assessment surveys, focus group interviews with staff members, and telephone interviews with nursing home administrators. Data show that the major needs included a lack of knowledge and skills in symptom management; communication difficulties; conflicts with families and physicians; and emotional distress in dealing with time constraints and attachment to residents. Implications for nursing home staff education are described.

Efficacy of a self-management group intervention for elderly persons with chronic pain

ObjectivesTo assess the efficacy of a self-management group intervention in improving physical functioning, mood, and pain among elderly persons with chronic pain, and to identify factors that may be associated with improvement. Materials and MethodsForty-five residents of three retirement communities (86% women; mean age, 82.0 years) were assigned randomly to a 7-week pain self-management group or an educational booklet control condition. Participants completed self-report measures of pain, functioning, depression, and pain-related beliefs at baseline, 9 weeks later (after treatment), and 3 months after the post-treatment assessment. ResultsThe self-management group showed significantly greater pre- to post-treatment improvement in physical role function (P = 0.04) and characteristic pain intensity (P = 0.02). No significant differences were found between groups on measures of pain-related activity interference, depression, and pain-related beliefs. Improvement in characteristic pain and physical role function was not associated with baseline depression scores, pretreatment expectations, or changes in pain-related beliefs. DiscussionThis study provides preliminary support for the efficacy of a self-management group intervention for older adults with chronic pain and has implications for future studies of such approaches for this and similar populations.

Oral Feeding Options for People with Dementia: A Systematic Review

To review the benefits of oral feeding options in people with dementia.

Results of a Randomized Controlled Trial to Examine the Efficacy of a Chronic Pain Self-Management Group for Older Adults [ISRCTN11899548]

&NA; Chronic pain is a common, disabling problem in older adults. Pain self‐management training is a multimodal therapy that has been found to be effective in young to middle‐aged adult samples; however, few studies have examined the effectiveness of this therapy in older adults. In this randomized, controlled trial, we evaluated a pain self‐management training group (SMG) intervention as compared with an education‐only (BOOK) control condition. Participants, 65 years of age or older who experienced persistent, noncancer pain that limited their activities, were recruited from 43 retirement communities in the Pacific Northwest of the United States. The primary outcome was physical disability, as measured by the Roland‐Morris Disability Questionnaire. Secondary outcomes were depression (Geriatric Depression Scale), pain intensity (Brief Pain Inventory), and pain‐related interference with activities (Brief Pain Inventory). Randomization occurred by facility to minimize cross‐contamination between groups. Two‐hundred and fifty‐six individuals, mean age = 81.8 (SD: 6.5), enrolled and 218 completed the study. No significant differences in outcomes were found between groups at post‐intervention, 6‐month follow‐up, or 12‐month follow‐up. The SMG group showed a significantly greater increase over time, relative to the BOOK group, in two process measures, as measured by the Chronic Pain Coping Inventory: use of relaxation and use of exercise/stretching. In both cases, the increase was greatest from baseline to the post‐intervention assessment. Study findings indicate that additional research is needed to determine the most effective content and delivery methods for self‐management therapies targeted at older adults with chronic pain.