Pamela Z. Cacchione

Clinical profile of acute confusion in the long-term care setting

Aspects of acute confusion (AC) including risk factors, behavior patterns, and outcomes are not well documented in long-term care (LTC) residents. The purpose of this prospective study was to describe the clinical profile of AC in LTC including risk factors, behavior patterns, etiologies, and 3-month outcomes. Seventy-four elderly LTC residents were assessed for AC, depression, and global cognitive impairment. Risk factors associated with AC included hearing deficits, depression, pulmonary disorders, and abnormal serum sodium or potassium levels. Behavior patterns of acutely confused residents included hyperactive (n = 9, 31%), hypoactive (n = 8, 28%), and mixed (n = 7, 24%). In the majority of the AC cases, the etiology was multifactorial: Infections and dehydration were the most common causes. Residents with AC had very poor 3-month outcomes. Thirty-four percent (n = 10) of the residents with AC died within 3 months of the evaluation. This study highlights the complexity and serious nature of AC in this frail population.

Four acute confusion assessment instruments: reliability and validity for use in long-term care facilities.

Frail older adults in long-term care (LTC) facilities are at high risk for acute confusion. This study evaluated the reliability and validity of four acute confusion instruments for use in LTC: the Clinical Assessment of Confusion-A (CAC-A), the Clinical Assessment of Confusion-B (CAC-B), the NEECHAM Confusion Scale (NEECHAM), and the Visual Analog Scale for Acute Confusion (VASAC). Seventy-four residents from two LTC facilities were evaluated for acute confusion using the four instruments as well as the Mini-Mental Status Examination (MMSE), the Geriatric Depression Scale (GDS), and Diagnostic and Statistical Manual for Mental Disorders (DSM IV) criteria for delirium. Coefficient alphas were .82 for the CAC-A, .86 for the CAC-B, and .80 for the NEECHAM. Interrater reliability on 30 paired evaluations was .90 for the CAC-B, .87 for the NEECHAM, and .80 for the VAS-AC. All instruments were correlated with the MMSE and the DSM IV criteria for delirium at the p < .001 level. Predictive validity was supported for the CAC-B, the NEECHAM, and the VAS-AC. Discriminant validity using the GDS was supported for the VAS-AC. Construct validity using confirmatory factor analysis was supported for the NEECHAM, with a two-factor structure. Based on this study, the VAS-AC is recommended for use as a general screening instrument and when it is positive for acute confusion, the NEECHAM should be used for a more indepth assessment.

Risk for Acute Confusion in Sensory-Impaired, Rural, Long-Term-Care Elders

Acute confusion is a common geriatric syndrome in long-term care (LTC) elders with prevalence rates of 10% to 39%. Sensory impairment, specifically vision and hearing impairment, is even more common in LTC, with prevalence rates of 40% to 90%. The purpose of this study was to investigate the risk relationship between sensory impairment and the development of acute confusion in LTC elders. Each resident (N = 114) underwent sensory screening and then was followed for 28 days to monitor for the onset of acute confusion. Twenty residents (17.5%) developed acute confusion, 60 residents (52.6%) were found to be visually impaired, 49 (44.1%) were hearing impaired, and 28 (24.6%) were found to be dually impaired. Significant relationships between vision impairment, odds ratio (OR) = 3.67, confidence interval (CI) (1.13, 11.92), and dual sensory impairment, OR = 2.88, CI (1.04, 8.26), with the development of acute confusion were identified.

Nutritional status and delirium in long-term care elderly individuals

Delirium is physiologically plausible in elderly individuals with a poor nutritional status. We explored body composition, serum protein levels, and delirium in a multicenter long-term care study using bioelectrical impedance analysis (BIA). Estimates from the BIA procedure included the body cell mass and fat-free mass (FFM) of nursing home elderly residents (N = 312). Increased delirium was identified in men and women who were leaner and had lower FFM. Clinical surveillance for delirium in frail elderly individuals with low serum albumin levels and polypharmacy is recommended because of their increased likelihood of having drug toxicities for medications with protein-binding properties.

Afternoon Napping and Cognition in Chinese Older Adults: Findings from the China Health and Retirement Longitudinal Study Baseline Assessment

To examine the cross‐sectional associations between self‐reported postlunch napping and structured cognitive assessments in Chinese older adults.

The Evolving Methodology of Scoping Reviews

Scoping reviews have now been around for approximately 18 years with the growing use of this methodology. In a recent scoping review of scoping reviews, from 1999 to 2012, almost 70% of the scoping reviews were found from 2009 to 2012 (Pham et al., 2014). This scoping review pointed out that there are a variety of terms used to describe scoping reviews in the literature including but not limited to scoping study, scoping project, literature mapping, scoping exercise, scoping report, evidence mapping, systematic mapping, and rapid review (Pham et al., 2014). This variety of terms may stem from the lack of a universal definition of scoping review methodology. Examples of these varied definitions include (a) the Arksey and O’Malley (2005) definition that scoping reviews aim to map rapidly the key concepts underpinning a research area and the main sources and types of evidence available; (b) scoping reviews involve the synthesis and analysis of a wide range of research and non-research material to provide a greater conceptual clarity about a specific topic or field of evidence (Davis, Drey, & Gould, 2009); and (c) scoping reviews aim to provide a map of what evidence has been produced from disparate or heterogeneous sources as opposed to seeking only the best evidence to answer a particular question related to policy or practice (Joanna Briggs Institute [JBI], 2015). The purpose of scoping reviews is evolving as well. The most cited protocol for scoping reviews is the protocol put forth by Arksey and O’Malley (2005). They described the purpose of a scoping review is to examine the extent range and nature of research activity around a particular topic, to

People With Dementia: Capacity to Consent to Research Participation:

Embarking on research with older adults whether in the community, in assisted living, or in the long-term care setting can be challenging from the very beginning. Depending on the purpose and specific aims of a study, the sample may include older adults who have some level of dementia. If so, the question of the older adult with dementia’s capacity to give informed consent may be in question. This challenge to the ability to provide informed consent could preclude researchers from even pursing research with this population. However, the negative public health impact of dementia is so severe that this population needs further study. The challenge for us as nurse researchers is to recognize and protect the rights and interests of individuals with dementia who are asked to provide informed consent to participate in research (Slaughter, Cole, Jennings, & Reimer, 2007). Informed consent is defined as the provision of voluntary authorization given by an individual who has the capacity to understand the research protocol and decide whether to participate in the research (Black et al., 2008). Key elements of informed consent process include the verbal and written description of the expectations of participation in the research protocol including the purpose, risks, and benefits. Also included in the expectations of informed consent is that individual’s participation is voluntary and that a participant can withdraw at any time without penalty (Black et al., 2008; Karlawish, 2008). Editorial

Stakeholders’ Perceptions Sought to Inform the Development of a Low-Cost Mobile Robot for Older Adults: A Qualitative Descriptive Study:

Creative solutions are needed to support community-dwelling older adults residing in a variety of settings including their house, apartment, or Supportive Apartment Living (SAL) to promote independence and reduce the risk of nursing home replacement. The objective of this study was to gain an understanding of older adults’ needs for physical, mental, and social activities to support the design and functionality of a low-cost mobile assistive robot. A qualitative descriptive study was designed which included three stakeholder focus groups (caregivers, clinicians, and older adults). We held three focus groups with a total of 19 participants: one with paid caregivers (n = 6), one with interdisciplinary clinicians (n = 8), and one with older adults residing in SAL (n = 5). Conventional content analysis was the analytical technique. Four themes emerged: (a) Accomplishing Everyday Tasks: activities of daily living (ADLs) and instrumental activities of daily living (IADLs) were important from the perspectives of all three groups for the older adults to accomplish daily, as well as the “use it or lose it” attitude of the older adults; (b) Personal Connections and Meaningful Activities: for the older adults, it was important for them to engage in socialization and leisure activities, and for the caregivers and clinicians, they work to build personal relationships with the older adults; (c) Cognitive Interventions: the clinicians provided cognitive tools (including reminders, routine and designing interventions) to older adults so they can remain as safe and independent as possible in the SAL; and (d) Safety Measures: encompassed clinicians addressing safety and injury prevention and the caregivers checking in on the older adults in their SAL apartments. This work contributed to the design and functionality specifications for an autonomous low-cost mobile robot for deployment to increase the independence of older adults.

The Science of Caregiving—2014 National Nursing Research Roundtable: A Research Imperative

The National Institute of Nursing Research (NINR; 2014) partnered with the Oncology Nursing Society to host an esteemed group of nursing leaders to discuss and share nursing research findings to strengthen nursing practice and improve health outcomes for caregivers. Nursing leaders were brought together in early March of 2014 to share information regarding the state of the science of caregiving across the lifespan. I was lucky enough to have been invited to this exceptional experience. I was invited due to my leadership role as one of the co-conveners of the Nursing Care of Older Adults Special Interest Group of the Gerontological Society of America. The other participants included a who’s who list of nursing leaders from nursing organizations across the United States including American Association of Colleges of Nursing, American Association of Critical Care Nurses, American Nurses Association, American Organization of Nurse Executives Foundation, American Society for Pain Management Nursing, Eastern Nursing Research Society, Emergency Nurses Association, Gerontological Society of American, National Association of Pediatric Nurse Practitioners, National League of Nursing, Rehabilitation Nursing Foundation, Sigma Theta Tau International, Southern Nursing Research Society, Western Institute of Nursing, and Wound Ostomy and Continence Nurses Society. In addition to these illustrious

What is clinical nursing research

I am honored to be joining Dr. Marilynn Woods as Co-Editor of Clinical Nursing Research. While pondering my first opportunity to write an editorial in this new role, I was lucky enough to participate in an editors’ forum at the Midwest Nursing Research Society (MNRS) meeting. I have to admit, the whole conference was stimulating. Prior to MNRS, I had considered writing about mentorship; about how, as mentors, we can influence nursing— first, by listening to our own mentors, and second, by being good mentors to others. Another issue I considered relates to the importance of nurses doing nursing research and the disasters that can occur when physicians fail to collaborate early in the process of designing studies beyond their scope of practice. I look forward to future exploration of these ideas. For this issue, I’d like to respond to the question I was asked during the MNRS conference. “What is clinical nursing research?” I have to personally thank Dr. Vicki Conn, the Editor of Western Journal of Nursing Research, our sister journal, for persisting with this question throughout the conference. I’d like to address this question, partly to clarify my own thoughts on the issue, but also in an effort to encourage nurses to pursue this important endeavor. I was able to find a definition of clinical research on the National Institute of Health’s Center for Scientific Review Web site: