Rebecca Lorenz

Strength Training, Walking, and Social Activity Improve Sleep in Nursing Home and Assisted Living Residents: Randomized Controlled Trial

OBJECTIVES: To compare the effects of physical resistance strength training and walking (E), individualized social activity (SA), and E and SA (ESA) with a usual care control group on total nocturnal sleep time in nursing home and assisted living residents.

Sleep disturbances in dementia.

Approximately one quarter of adults with dementia experience sleep disturbances. The purpose of this article is to (a) describe and define sleep disturbances in individuals with dementia, (b) describe techniques to assess for sleep disturbances in individuals with dementia, and (c) provide nursing interventions to improve sleep in this patient population. Typical presentations of sleep disturbances in individuals with dementia are described, along with medications that may interfere with sleep. Suggestions for nursing measures that can be implemented to enhance sleep are also presented. Nurses have numerous nonpharmacological options to assist with the regulation of sleep-wake rhythms in individuals with dementia.

Exercise and Social Activity Improve Everyday Function in Long-Term Care Residents

OBJECTIVES This study examined the effects of high-intensity resistance strength training and walking (E), individualized social activity (SA), and resistance training and walking combined with social activity (ESA) on everyday function in long-term care (LTC) residents and explored the relationship between change in everyday function and change in sleep. DESIGN The study used data from The Effect of Activities and Exercise on Sleep, a randomized controlled trial. SETTING Residential LTC facilities. PARTICIPANTS A total of 119 participants who had measures of everyday function and sleep at baseline and postintervention. INTERVENTIONS The E group exercised 5 days a week. The SA group was involved in social activities 5 days a week. The ESA group received both E and SA interventions. The usual care (UC) control group participated in usual activities. MEASUREMENTS Everyday function was measured by the Nursing Home Physical Performance Test. Nighttime sleep was measured by attended polysomnography. RESULTS The UC and SA groups showed a decline in everyday function, whereas the E and ESA groups showed improvement. There were statistically significant differences between the groups, with pairwise comparisons showing significant improvements in the ESA group over the SA group (95% confidence interval, -3.94 to -0.97) and the UC group (95% confidence interval, -3.69 to -0.64). No relationship was found between change in everyday function and change in sleep. CONCLUSION Seven weeks of high-intensity resistance strength training and walking, combined with individualized social activities (ESA), improved everyday function among LTC residents, independent of change in sleep.

Perioperative blood glucose control during adult coronary artery bypass surgery

Coronary artery bypass graft (CABG) procedures are among the most frequently performed surgical procedures in the United States. People with cardiovascular disease who also have diabetes have a greater risk of poor outcomes after CABG procedures than patients who do not have diabetes. This literature review examines current information regarding perioperative blood glucose (BG) control. It emphasizes BG control in adults during the hypothermic period of cardiopulmonary bypass. Hyperglycemia, not the diagnosis of diabetes, significantly increases the risk of adverse clinical outcomes, longer hospitalizations, and increased health care costs.

Coping with preclinical disability: older women's experiences of everyday activities.

PURPOSE The purpose of this paper is to describe coping practices used by older women during preclinical disability. DESIGN This paper was derived from qualitative data gathered during a larger multimethod longitudinal study. Twelve women (60 to 80 years of age) participated in baseline functional performance measures and then repeated in-depth interviews and participant observations over 18 months. METHODS A hermeneutic approach was used to interpret the in-depth interviews, participant observations, and field notes using three interrelated processes of thematic, exemplar, and identification of paradigm cases to identify coping practices. FINDINGS Women coped with functional decline, such as difficulty getting up from the floor, in many different ways. Coping practices were grouped into five themes: resist, adapt, substitute, endure, and eliminate. CLINICAL RELEVANCE These findings suggest that nurses need to realize outward appearances may mask the level of effort required for older women to complete daily activities.

Does dance-based therapy increase gait speed in older adults with chronic lower extremity pain: A feasibility study

A decreased gait speed in older adults can lead to dependency when the individuals are no longer able to participate in activities or do things for themselves. Thirty-seven senior apartment residents (31 females; Mean age=80.6 years; SD=8.9) with lower extremity pain/stiffness participated in a feasibility and preliminary efficacy study of 12 weeks (24 sessions). Healthy-Steps dance therapy compared to a wait-list control group. Small improvements in gait speed ([ES]=0.33) were noted for participants completing 19-24 dance sessions. Improvements in gait speed measured by a 10 Meter Walk Test (0.0517 m/s) exceeded 0.05 m/s, a value deemed to be meaningful in community dwelling older adults. These feasibility study findings support the need for additional research using dance-based therapy for older adults with lower extremity pain.

Medication Reconciliation: Reducing Risk for Medication Misadventure During Transition from Hospital to Assisted Living

The discharge of older adults from hospital to home has been associated with poor outcomes. It is well documented that performing medication reconciliation at every transition point is critical to ensuring patient safety, preventing unnecessary rehospitalizations, and reducing the risk for medication misadventures. However, the medication reconciliation process is not well executed in numerous institutions and possibly not at all in many assisted living facilities (ALFs). Thus, the purpose of this study was to examine medication discrepancies that occur as a result of transitioning from hospitals to ALFs and to explore the role of nurses regarding medication reconciliation in ALFs. A comparison of medication records for 80 residents ages 65 and older revealed that 86.2% of resident records had at least one medication discrepancy. These results represent an opportunity for nurses to be involved with post-acute care communication and medication reconciliation to improve safe transitions for residents in ALFs.

The Presence of Symptoms With Comorbid Conditions in Individuals With Multiple Sclerosis (MS)

Individuals with multiple sclerosis (MS) may experience symptoms that impact comorbid conditions and quality of life (QOL). There is some evidence that symptom severity may vary in certain common health conditions in this population. We aimed to examine symptom severity in light of comorbid conditions commonly seen in individuals with MS (N = 339). Using a cross-sectional Internet survey, we found there was a significant increase in symptom severity of common symptoms of fatigue, imbalance, and weakness, specifically with presence or absence of certain comorbid conditions (depression, arthritis, migraine headaches, coronary artery disease [CAD]). These findings endorse the presence of more severe symptoms with certain comorbid conditions compared with individuals with MS who do not report having comorbid conditions. The findings support the importance of symptom management in individuals with MS who also have comorbid conditions.

Secondary health conditions in individuals with multiple sclerosis: A cross-sectional Web-based survey analysis

ABSTRACT Purpose: The purpose of this study was to compare the rates of secondary health conditions in individuals with multiple sclerosis (MS) with age-matched U.S. general population norms. Method: This was a cross-sectional study in which data were collected using a Web-based survey from members of the greater Midwest MS society chapter. Questions were modeled from the National Health Interview Survey to assess the presence of six health conditions. Self-reported health conditions among the sample were compared to U.S. general population norms from the National Health Interview Survey. Results: Individuals with MS reported higher rates of depression, arthritis, diabetes, coronary artery disease, migraine headaches, and cancer than the normative population. Although the rates of health conditions increased with age in the normative sample, the MS sample showed a curvilinear (bimodal) pattern as a function of age for some secondary health conditions.

Comorbidities in the context of care transitions.

The growing number of individuals with comorbidities experiencing care transitions represents a challenge to the current health care system. A qualitative study of empirical literature, using the Dimensional Analysis approach, was conducted to elucidate the theoretical underpinnings of the phenomenon of individuals with comorbidities undergoing care transitions. The findings were arranged in a novel schematic demonstrating that the relationship among individual attributes, comorbidities, and care processes informed the individuals risk for adverse outcomes. This schematic is useful for future nursing research studies evaluating innovative programs implemented to improve health outcomes among vulnerable populations undergoing care transitions.