Nursing Older People

The number of older people in UK prisons has increased significantly in recent years and most of them have at least one health condition. Research has shown that the physical and mental health of older people living in the community is positively correlated with resilience, but there is limited research on how to promote resilience in older prisoners. This systematic literature review offers a synthesis of interventions, practices and processes that may improve resilience in older prisoners. The review included eight peer-reviewed studies and identified three elements that support resilience in older prisoners: organised interventions; relational activities; and subjective processes...

Interprofessional learning can offer students from different disciplines an opportunity to learn from, with and about each other. Additionally, practice placements in care home settings can offer students a rich learning experience. In 2021, a pilot interprofessional student placement initiative in care homes took place in the Manchester area, with three care homes and 17 students from a range of health and social care disciplines. In this article, the members of the core operational group that implemented the initiative reflect on their experiences...

Behavioural and psychological symptoms of dementia (BPSD) affect more than one third of people with dementia at some point during the course of their condition. Agitation is the third most common BPSD but is the least well understood in terms of identification and management. Furthermore, agitation as a symptom of dementia is often confused with agitation as a way of expressing an emotion or unmet need. Psychosocial interventions are recommended to support the person with dementia and their family carers to manage agitation as a symptom of dementia, as well as other BPSD, in a person-centred manner...

Delirium, which may present as acute fluctuation in arousal and attention and changes in a person's behaviours, can increase the risk of falls, while a fall can increase the risk of developing delirium. There is, therefore, a fundamental relationship between delirium and falls. This article describes the main types of delirium and the challenges associated with recognition of the condition and discusses the relationship between delirium and falls. The article also describes some of the validated tools used to screen patients for delirium and includes two brief case studies to illustrate this in practice...

Deconditioning is caused by complex physiological changes occurring as a result of immobility, for example during or after a period of acute illness or injury and hospitalisation. It leads to functional decline and compounds or contributes to conditions such as frailty and sarcopenia. In the past, prolonged bed rest was considered therapeutic, but the need to reduce or avoid prolonged immobility is now widely recognised. Hospital-associated deconditioning can be reduced or prevented through mobilisation strategies such as those promoted by the #EndPJparalysis campaign...

Communication is a two-way process of exchanging or sharing information and is an essential element of the nursing process. Challenges with communication are a feature of all types of dementia, so understanding how dementia affects communication and how to support people is important for all nurses. This article provides an overview of communication in dementia care. The authors draw on the literature on communication and dementia to present evidence-based, practical approaches for supporting person-centred communication with people with dementia...

Trained mealtime volunteers are ideally situated to provide mealtime assistance to older patients in general hospital settings. Older patients are at risk of becoming undernourished and dehydrated while in hospital as a result of various factors, such as cognitive impairment and lack of mealtime assistance. This article details an extended literature review that was conducted to explore the lived experiences of older patients, staff, relatives and volunteers of mealtime assistance provided by volunteers. The findings suggest that continual use of mealtime volunteers in practice could improve the quality of care...

Older people on mental health inpatient wards are at high risk of falls due to a combination of physiological, pathophysiological and pharmacological factors. Falls prevention should therefore be a priority for nursing staff caring for this patient group. This article describes a quality improvement project conducted on four older adult mental health inpatient wards in Scotland. The project aimed to reduce the number of falls, increase staff's adherence to person-centred falls prevention care planning, and ensure every fall would prompt a post-fall review...

Appropriate physical activity has more benefits than risks for older people. Increased physical activity enhances older people's mental and physical well-being and can contribute to reduced morbidity and early mortality. Nurses have an important role in advising older people on the level of physical activity that is right for them. Based on the national requirements for physical activity in older people, nurses can tailor their advice to each individual, address the person's concerns about potential risks and emphasise the likely benefits of them becoming more physically active...

There is increasing recognition that adverse childhood experiences are linked to suboptimal mental and physical health in later life. Despite this, there has been little research into the effects of adverse childhood experiences on older people. This article gives an overview of the long-term mental and physical effects of adverse childhood experiences and discusses how childhood trauma may manifest in older people. The author also discusses how nurses and unpaid family carers may themselves have been exposed to adverse childhood experiences and how this may affect their caring role...

Changes in eating behaviours, weight and mental health in older people may be related to psychological distress and indicate the presence of a diagnosable eating disorder, rather than 'anorexia of ageing'. Eating disorders in older people may be overlooked because signs and symptoms are assumed to be part of normal ageing. The role of nurses in the care of older people with eating disorders is likely to be detection, referral and support in accessing specialist intervention. This article offers an overview of eating disorders in older people and discusses why they may arise, why they may not be detected and how to recognise them...

Elder abuse is a growing concern for nurses who work with older people, and safeguarding incidents can be challenging and complex to manage. In the Republic of Ireland, safeguarding agencies claim there is a lack of reporting of abuse to the authorities, raising questions as to whether nurses know how, when and where to report safeguarding concerns. Despite varying strategies and laws concerning the reporting of elder abuse worldwide, the principles of recognising and responding to abuse are similar. However, to date, there is no specific legislation governing safeguarding for adults in Ireland...

BACKGROUND: As the number of people with a diagnosis of dementia continues to increase, it is essential that nurses have the skills required to provide high-quality care. However, there may be gaps in dementia teaching in undergraduate nurse education programmes in the UK. AIM: To assess knowledge of Alzheimer's disease among one cohort of third-year nursing students to improve the education content of the dementia module at Oxford Brookes University, England. METHOD: A total of 35 participants completed the Alzheimer's Disease Knowledge Scale, a validated tool that measures knowledge about risk factors, assessment and diagnosis, symptoms, course (disease progression), life impact, caregiving, and treatment and management...

Dementia can have significant adverse effects on people's ability to eat and drink sufficiently. People with dementia can experience malnutrition and unintentional weight loss at any stage of the condition, but these occur more often in the middle and late stages. It is important that nurses and care staff working in care homes have the appropriate knowledge and skills to provide optimal nutritional care to residents, thereby improving their health, well-being and quality of life. This article provides an overview of nutrition and hydration issues commonly experienced by people with dementia...

Procalcitonin (PCT), a precursor of the hormone calcitonin, has emerged as a marker of bacterial infection that appears to be particularly useful in respiratory conditions. PCT testing has been shown to be beneficial in supporting healthcare professionals with their decision-making about treatment. It also has particular advantages in relation to the care of older people, notably in terms of assessment, recognising sepsis, reducing polypharmacy and informing antibiotic prescribing. This article discusses PCT testing in care homes and how its use can support nurses working in such settings to provide optimal care to residents...

Spending time with a person with dementia to develop a rapport is vitally important for nurses who are attempting to deliver high-quality care. However, finding opportunities to spend meaningful time with a person with dementia can be challenging due to the nature of busy clinical environments. Further, spending time with people may be considered a non-essential use of a nurse's time by some colleagues. These factors can result in inadequate outcomes for both the person with dementia and the nurse providing the care...

Frailty is a distinctive health state and a life-limiting syndrome seen in older people and in those living with multiple long-term conditions. It is likely that every nurse will encounter patients living with frailty in their clinical practice, even more so if they work in older people's nursing. People living with frailty are more vulnerable than others to stressors and insults due to a decline in their physiological reserve and function. There are tools that can be used to assess people's frailty or risk of frailty and interventions that can be used to prevent or reduce frailty...

The incidence of pressure ulcers is highest among older people with frailty. The development of pressure ulcers is a common and challenging issue in this population, which can reduce people's quality of life and increase mortality risk. Multifactorial processes contribute to the development of pressure ulcers in older people with frailty, including age-related skin changes, comorbidities, polypharmacy, reduced mobility, inadequate nutrition and hydration, and continence issues. This article discusses the development and management of pressure ulcers in older people with frailty...

This article details a narrative review that explored the barriers to and facilitators of integration of oral care into nursing practice in care homes to enhance nurses' delivery of oral care. Three themes were identified: gaps in oral care protocols and the complexity of nursing oral care; how interprofessional collaboration and education can improve oral care; and limitations and unresolved issues in nurses' oral care training. The review found that interprofessional collaboration and education were important in normalising oral care practice and nurse leadership in care homes...

BACKGROUND: Individualised music listening has been shown to reduce agitation and improve mood in people with dementia. However, there is a paucity of research describing the cost of implementing such interventions in residential care settings for older people. AIM: To determine the cost of implementing an individualised music intervention for older people with dementia in residential aged care in Australia. METHOD: A simple cost analysis was undertaken to determine the cost of delivering the individualised music intervention to 32 older people with dementia at two residential aged care facilities in New South Wales...