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Lin SY, Fick DM. Empowering Certified Nursing Assistants to Screen for Delirium: If Not Now, When? J Gerontol Nurs 2024; 50:3-5. [PMID: 38691118 DOI: 10.3928/00989134-20240416-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Affiliation(s)
- Shih-Yin Lin
- NYU Rory Meyers College of Nursing New York, New York
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Wang J, Shen JY, Conwell Y, Podsiadly EJ, Caprio TV, Nathan K, Yu F, Ramsdale EE, Fick DM, Mixon AS, Simmons SF. Implementation considerations of deprescribing interventions: A scoping review. J Intern Med 2024; 295:436-507. [PMID: 36524602 DOI: 10.1111/joim.13599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Over half of older adults experience polypharmacy, including medications that may be inappropriate or unnecessary. Deprescribing, which is the process of discontinuing or reducing inappropriate and/or unnecessary medications, is an effective way to reduce polypharmacy. This review summarizes (1) the process of deprescribing and conceptual models and tools that have been developed to facilitate deprescribing, (2) barriers, enablers, and factors associated with deprescribing, and (3) characteristics of deprescribing interventions in completed trials, as well as (4) implementation considerations for deprescribing in routine practice. In conceptual models of deprescribing, multilevel factors of the patient, clinician, and health-care system are all related to the efficacy of deprescribing. Numerous tools have been developed for clinicians to facilitate deprescribing, yet most require substantial time and, thus, may be difficult to implement during routine health-care encounters. Multiple deprescribing interventions have been evaluated, which mostly include one or more of the following components: patient education, medication review, identification of deprescribing targets, and patient and/or provider communication about high-risk medications. Yet, there has been limited consideration of implementation factors in prior deprescribing interventions, especially with regard to the personnel and resources in existing health-care systems and the feasibility of incorporating components of deprescribing interventions into the routine care processes of clinicians. Future trials require a more balanced consideration of both effectiveness and implementation when designing deprescribing interventions.
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Affiliation(s)
- Jinjiao Wang
- Elaine, Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester, Rochester, New York, USA
| | - Jenny Y Shen
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Eric J Podsiadly
- Harriet J. Kitzman Center for Research Support, School of Nursing, University of Rochester, Rochester, New York, USA
| | - Thomas V Caprio
- Department of Medicine, Division of Geriatrics & Aging, University of Rochester Medical Center, Rochester, New York, USA
- UR Medicine Home Care, University of Rochester Medical Center, Rochester, New York, USA
- University of Rochester Medical Center, Finger Lakes Geriatric Education Center, Rochester, New York, USA
| | - Kobi Nathan
- Department of Medicine, Division of Geriatrics & Aging, University of Rochester Medical Center, Rochester, New York, USA
- St. John Fisher College, Wegmans School of Pharmacy, Rochester, New York, USA
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Erika E Ramsdale
- Department of Medicine, Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, New York, USA
| | - Donna M Fick
- Ross and Carol Nese College of Nursing, Penn State University, University Park, Pennsylvania, USA
| | - Amanda S Mixon
- Department of Medicine, Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Sandra F Simmons
- Department of Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Fick DM. AGS' Response to the World Falls Guidelines. J Gerontol Nurs 2024; 50:51-52. [PMID: 38417071 DOI: 10.3928/00989134-20240208-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
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Dhliwayo R, Trivedi S, Ngo L, Fick DM, Inouye SK, Boltz M, Leslie D, Husser E, Shrestha P, Marcantonio ER. Factors associated with disagreement between clinician app-based ultra-brief Confusion Assessment Method and reference standard delirium assessments. J Am Geriatr Soc 2024; 72:828-836. [PMID: 38014821 PMCID: PMC10947955 DOI: 10.1111/jgs.18690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 10/16/2023] [Accepted: 10/25/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Recently, the Ultra-Brief Confusion Assessment Method (UB-CAM), designed to help physicians and nurses to recognize delirium, showed high, but imperfect, accuracy compared with Research Reference Standard Delirium Assessments (RRSDAs). The aim of this study is to identify factors associated with disagreement between clinicians' app-based UB-CAM assessments and RRSDAs. METHODS This is a secondary analysis of a prospective diagnostic test study. The study was conducted at two hospitals and included 527 inpatients (≥70 years old) and 289 clinicians (53 physicians, 236 nurses). Trained research associates performed RRSDAs and determined delirium presence using the CAM. Clinicians administered the UB-CAM using an iPad app. Disagreement factors considered were clinician, patient, and delirium characteristics. We report odds ratios and 95% confidence intervals. RESULTS One thousand seven hundred and ninety-five clinician UB-CAM assessments paired with RRSDAs were administered. The prevalence of delirium was 17%. The rate of disagreement between clinician UB-CAM assessments and RRSDAs was 12%. Significant factors associated with disagreement between clinician UB-CAM assessments and RRSDAs (OR [95% CI]) included: presence of dementia (2.7 [1.8-4.1]), patient education high school or less (1.9 [1.3-2.9]), psychomotor retardation (2.5 [1.4-4.2]), and the presence of mild delirium or subsyndromal delirium (5.5 [3.5-8.7]). Significant risk factors for false negatives were patient age less than 80 (2.2 [1.1-4.3]) and mild delirium (3.5 [1.6-7.4]). Significant risk factors for false positives were presence of dementia (4.0 [2.3-7.0]), subsyndromal delirium (5.1 [2.9-9.1]), and patient education high school or less (2.0 [1.2-3.6]). Clinician characteristics were not significantly associated with disagreement. CONCLUSIONS The strongest factors associated with disagreement between clinician UB-CAM screens and RRSDAs were the presence of dementia and subsyndromal delirium as risk factors for false positives, and mild delirium and younger age as a risk factor for false negatives. These disagreement factors contrast with previous studies of risk factors for incorrect clinician delirium screening, and better align screening results with patient outcomes.
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Affiliation(s)
| | - Shrunjal Trivedi
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Long Ngo
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Donna M. Fick
- College of Medicine, The Pennsylvania State University, Hershey Pennsylvania
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania
| | - Sharon K. Inouye
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA
- Hinda and Arthur Marcus Institute of Aging Research, Hebrew SeniorLife, Boston, MA
| | - Marie Boltz
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania
| | - Douglas Leslie
- College of Medicine, The Pennsylvania State University, Hershey Pennsylvania
| | - Erica Husser
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania
| | | | - Edward R. Marcantonio
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA
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Fick DM. #AGS24 to Deliver Cutting-Edge Research & Clinical Practice Advancements on Alzheimer's Disease, Artificial Intelligence, Inclusive Practices, and Much More. J Gerontol Nurs 2024; 50:47-48. [PMID: 38170458 DOI: 10.3928/00989134-20231212-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
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Kwak MJ, Inouye SK, Fick DM, Bonner A, Fulmer T, Carter E, Tabbush V, Maya K, Reed N, Waszynski C, Oh ES. Optimizing delirium care in the era of Age-Friendly Health System. J Am Geriatr Soc 2024; 72:14-23. [PMID: 37909706 PMCID: PMC10843290 DOI: 10.1111/jgs.18631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/30/2023] [Accepted: 09/16/2023] [Indexed: 11/03/2023]
Abstract
Delirium is a significant geriatric condition associated with adverse clinical and economic outcomes. The cause of delirium is usually multifactorial, and person-centered multicomponent approaches for proper delirium management are required. In 2017, the John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) launched a national initiative, Age-Friendly Health System (AFHS), promoting the use of a framework called 4Ms (what matters, medication, mentation, and mobility). The 4Ms framework's primary goal is to provide comprehensive and practical person-centered care for older adults and it aligns with the core concepts of optimal delirium management. In this special article, we demonstrate how a traditional delirium prevention and management model can be assessed from the perspective of AFHS. An example is the crosswalk with the Hospital Elder Life Program (HELP) Core Interventions and the 4MS, which demonstrates alignment in delirium management. We also introduce useful tools to create an AFHS environment in delirium management. Although much has been written about delirium management, there is a need to identify the critical steps in advancing the overall delirium care in the context of the AFHS. In this article, we suggest future directions, including the need for more prospective and comprehensive research to assess the impact of AFHS on delirium care, the need for more innovative and sustainable education platforms, fundamental changes in the healthcare payment system for proper adoption of AFHS in any healthcare setting, and application of AFHS in the community for continuity of care for older adults with delirium.
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Affiliation(s)
- Min Ji Kwak
- Division of Geriatric and Palliative Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Texas, USA
| | - Sharon K. Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Donna M. Fick
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Alice Bonner
- Institute for Healthcare Improvement, Boston, Massachusetts, USA
- Moving Forward Nursing Home Quality Coalition, Washington, District of Columbia, USA
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Terry Fulmer
- The John A. Hartford Foundation, New York, New York, USA
| | - Emily Carter
- Division of Geriatric Medicine, Maine Medical Center, Portland, Maine, SA
| | - Victor Tabbush
- Anderson School of Management, University of California, Los Angeles, California, USA
| | - Kerri Maya
- Department of Continuing Professional Development, Sutter Health System, Sacramento, CA, USA
| | - Nicholas Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christine Waszynski
- Division of Geriatric Medicine, Hartford Hospital, Hartford, Connecticut, USA
| | - Esther S. Oh
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Fick DM. Less Is More With Medication Use, But More Is Better When It Comes to Team Care: Embracing Interdisciplinary Team Care & Welcoming a New Section Editor. J Gerontol Nurs 2023; 49:3-4. [PMID: 38015148 DOI: 10.3928/00989134-20231107-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
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Young HM, Fick DM. Extreme Weather: Implications for Older Adults. Res Gerontol Nurs 2023; 16:270-272. [PMID: 38015159 DOI: 10.3928/19404921-20231018-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
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Fick DM, Young HM. Extreme Weather: Implications for Older Adults. J Gerontol Nurs 2023; 49:3-5. [PMID: 37906047 DOI: 10.3928/00989134-20231010-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
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Fick DM. How Socially Fit Are You? The Importance of Relationships Across the Lifespan. J Gerontol Nurs 2023; 49:3-4. [PMID: 37768585 DOI: 10.3928/00989134-20230907-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
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Fick DM. AGS works to improve vaccination rates. Geriatr Nurs 2023; 53:313. [PMID: 37620187 DOI: 10.1016/j.gerinurse.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
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Fick DM. AGS CoCare ®: HELP Reduces In-Hospital Delirium. J Gerontol Nurs 2023; 49:51-52. [PMID: 37523335 DOI: 10.3928/00989134-20230707-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
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Kuzmik A, Hannan J, Boltz M, Shrestha P, Husser EK, Fick DM, Marcantonio ER. A pilot study testing the iOS UB-CAM delirium app. J Am Geriatr Soc 2023; 71:1999-2002. [PMID: 36722177 PMCID: PMC10258118 DOI: 10.1111/jgs.18252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Ashley Kuzmik
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - John Hannan
- Department of Computer Science & Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Marie Boltz
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Priyanka Shrestha
- School of Nursing, George Washington University, Washington, DC, USA
| | - Erica K. Husser
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Donna M. Fick
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Edward R. Marcantonio
- Divisions of General Medicine and Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Fick DM. Many Older Adults Take Multiple Medications; Updated AGS Beers Criteria ® Will Help Ensure They Are Appropriate. J Gerontol Nurs 2023; 49:51-52. [PMID: 37256754 DOI: 10.3928/00989134-20230512-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Shrestha P, Fick DM, Boltz M, Loeb SJ, High AC. Caregiving for Persons Living With Dementia During the COVID-19 Pandemic: Perspectives of Family Care Partners. J Gerontol Nurs 2023; 49:27-33. [PMID: 36852990 DOI: 10.3928/00989134-20230209-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Persons living with dementia (PLWD) are at increased risk for coronavirus disease 2019 (COVID-19) and poorer outcomes if they contract the disease. COVID-19 may also change and exacerbate usual stresses of family caregiving. The current qualitative descriptive study examined 14 family care partners' (FCPs) experiences and perspectives on how the COVID-19 pandemic impacted them, their care recipients, and their caregiving for their care recipients. Thematic analysis of interviews generated five themes: Cautious of COVID-19 Exposure, Challenges of Balancing COVID-19 Restrictions With Caregiving, Shared Loneliness, Functional Decline, and Communication Challenges With PLWD and Health Care Professionals (HCPs). FCPs are integral to the care of PLWD across care settings. The time is now to plan for changes in policy that will safely maintain FCPs' visitation with their care recipients with dementia and allow for partnering with HCPs to avoid the long-lasting negative effects on older adults' health and function. [Journal of Gerontological Nursing, 49(3), 27-33.].
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Wang J, Shen JY, Conwell Y, Podsiadly EJ, Caprio TV, Nathan K, Yu F, Ramsdale EE, Fick DM, Mixon AS, Simmons SF. How "age-friendly" are deprescribing interventions? A scoping review of deprescribing trials. Health Serv Res 2023; 58 Suppl 1:123-138. [PMID: 36221154 DOI: 10.1111/1475-6773.14083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To assess how age-friendly deprescribing trials are regarding intervention design and outcome assessment. Reduced use of potentially inappropriate medications (PIMs) can be addressed by deprescribing-a systematic process of discontinuing and/or reducing the use of PIMs. The 4Ms-"Medication", "Mentation", "Mobility", and "What Matters Most" to the person-can be used to guide assessment of age-friendliness of deprescribing trials. DATA SOURCE Published literature. STUDY DESIGN Scoping review. DATA EXTRACTION METHODS The literature was identified using keywords related to deprescribing and polypharmacy in PubMed, EMBASE, Web of Science, ProQuest, CINAHL, and Cochrane and snowballing. Study characteristics were extracted and evaluated for consideration of 4Ms. PRINCIPAL FINDINGS Thirty-seven of the 564 trials identified met the review eligibility criteria. Intervention design: "Medication" was considered in the intervention design of all trials; "Mentation" was considered in eight trials; "Mobility" (n = 2) and "What Matters Most" (n = 6) were less often considered in the design of intervention. Most trials targeted providers without specifying how matters important to older adults and their families were aligned with deprescribing decisions. OUTCOME ASSESSMENT "Medication" was the most commonly assessed outcome (n = 33), followed by "Mobility" (n = 13) and "Mentation" (n = 10) outcomes, with no study examining "What Matters Most" outcomes. CONCLUSIONS "Mentation" and "Mobility", and "What Matters Most" have been considered to varying degrees in deprescribing trials, limiting the potential of deprescribing evidence to contribute to improved clinical practice in building an age-friendly health care system.
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Affiliation(s)
- Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester, Rochester, New York, USA
| | - Jenny Y Shen
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Eric J Podsiadly
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester, Rochester, New York, USA
| | - Thomas V Caprio
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Kobi Nathan
- St. John Fisher College, Wegmans School of Pharmacy, Rochester, New York, USA
| | - Fang Yu
- Arizona State University, Edson College of Nursing and Health Innovation, Phoenix, Arizona, USA
| | - Erika E Ramsdale
- University of Rochester Medical Center, Department of Medicine, Division of Hematology/Oncology, Rochester, New York, USA
| | - Donna M Fick
- Penn State University, Ross and Carol Nese College of Nursing, University Park, Pennsylvania, USA
| | - Amanda S Mixon
- Division of General Internal Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sandra F Simmons
- Division of Geriatrics & Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Inloes JB, Brown A, Rettell Z, Fick DM, Bell SA. Home-Based Care Provider Perspectives on Care Refusal During the COVID-19 Pandemic. J Gerontol Nurs 2023; 49:35-41. [PMID: 36594910 DOI: 10.3928/00989134-20221206-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Acute and chronic disease management continues to shift toward a health care in the home model, yet literature discussing continuity of home-based care services during public health emergencies, such as infectious disease pandemics, is scant. In the current study, we used semi-structured telephone interviews with 27 home-based care providers (HBCPs) from Medicare-certified home health care agencies located in eight U.S. counties to explore older adults' decision making around home-based care service continuation during the coronavirus disease 2019 (COVID-19) pandemic. Four themes emerged, including two related to older adults' decision making around refusal of in-home care and two related to HBCPs' responses to care refusals. Fear of COVID-19 infection motivated older adults to make care-related decisions that were incongruent with their health needs, including refusal of care in the home, despite receiving education from HBCPs. These data highlight a need for tools to help HBCPs better support patients through decision-making processes about care continuation during COVID-19 and future infectious disease pandemics. [Journal of Gerontological Nursing, 49(1), 35-41.].
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Sillner AY, Berish D, Mailhot T, Sweeder L, Fick DM, Kolanowski AM. Delirium superimposed on dementia in post-acute care: Nurse documentation of symptoms and interventions. Geriatr Nurs 2023; 49:122-126. [PMID: 36495794 PMCID: PMC9892266 DOI: 10.1016/j.gerinurse.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
Delirium superimposed on dementia (DSD) is common in older adults being discharged to post-acute care settings (PAC). Nurse documentation remains poorly understood. Aims were to describe nurse documentation and to determine associations in a secondary data analysis of a large, single-blinded randomized controlled trial (Recreational Stimulation For Elders As A Vehicle To Resolve DSD (Reserve For DSD). Just under 75% of the sample had at least one symptom of delirium documented by the nursing staff, while 25.9% had none despite being CAM positive by expert adjudication. Only 32% had an intervention documented. Number of documented interventions were significantly associated with number of documented symptoms. There is a need for research and innovation related to nurse documentation and communication of DSD symptoms and interventions in an efficient and accurate manner to impact care for vulnerable older adults in these settings.
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Affiliation(s)
- Andrea Yevchak Sillner
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA.
| | - Diane Berish
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
| | - Tanya Mailhot
- Montreal Heart Institute Research Center, Université de Montréal: Montreal, QC, CA
| | - Logan Sweeder
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
| | - Donna M Fick
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
| | - Ann M Kolanowski
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
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Fick DM, Shrestha P. Delirium in Persons With Dementia: Integrating the 4Ms of Age-Friendly Care as a Set Into the Care of Older People. J Gerontol Nurs 2022; 48:3-6. [PMID: 36169297 DOI: 10.3928/00989134-20220909-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Donna M Fick
- Journal of Gerontological Nursing, Elouise Ross Eberly Endowed Professor, Ross and Carol Nese College of Nursing Pennsylvania State University Director, Tressa Nese and Helen Diskevich Center of Geriatric Nursing Excellence State College, Pennsylvania
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Madrigal C, Mogle J, Abbott K, Mills WL, Fick DM, Scanlon D, Behrens L, Eshraghi K, VanHaitsma K. The Association Between Preference Satisfaction and Satisfaction with Overall Care for Nursing Home Residents. J Aging Soc Policy 2022; 34:707-722. [PMID: 35491885 PMCID: PMC9560912 DOI: 10.1080/08959420.2022.2029265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/22/2021] [Indexed: 10/18/2022]
Abstract
The Centers for Medicare and Medicaid Services mandate the provision of person-centered care (PCC), but there is limited evidence on how PCC impacts nursing home (NH) residents' care experiences. This study examined the relationship between n = 163 NH residents' ratings of satisfaction with care related to their preferences and their satisfaction with overall care. Residents with higher preference satisfaction ratings reported significantly higher levels of satisfaction with overall care. Using preference satisfaction ratings has the potential to improve PCC planning and delivery in nursing homes.
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Affiliation(s)
- Caroline Madrigal
- Center of Innovation in Long-Term Services & Supports, Providence VA Medical Center, 830 Chalkstone Ave, Providence, RI 02908
| | - Jacqueline Mogle
- Eden Bennett Pierce Prevention Research Center, The Pennsylvania State University, 320D Biobehavioral Health Building, University Park, PA 16802
| | - Katherine Abbott
- Department of Sociology and Gerontology, Scripps Gerontology Center, Miami University, 397 Upham Hall, 100 Bishop Circle, Oxford, OH, 45056
| | - Whitney L. Mills
- Investigator, Center of Innovation in Long-Term Services & Supports, Providence VA Medical Center, 830 Chalkstone Ave, Providence, RI 02908 and Assistant Research Professor, Department of Health Services Policy and Practice, Brown University, 121 South Main Street, Providence, RI 02903
| | - Donna M. Fick
- College of Nursing, The Pennsylvania State University, 201 Nursing Sciences Building, University Park, PA 16802
| | - Dennis Scanlon
- Health Policy and Administration, The Pennsylvania State University, 504Q Ford Building, University Park, PA 16802
| | - Liza Behrens
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, 3615 Chestnut Street, Ralston-Penn Center, RM 329, Philadelphia, PA 19104
| | - Karen Eshraghi
- Abramson Center for Jewish Life, 1425 Horsham Rd, North Wales, PA 19454
| | - Kimberly VanHaitsma
- Associate Professor, Director, Program for Person Centered Living Systems of Care, College of Nursing, The Pennsylvania State University, 201 Nursing Sciences Building, University Park, PA 16802 and Adjunct Senior Research Scientist, Polisher Research Institute, Abramson Center for Jewish Life, 1425 Horsham Rd, North Wales, PA 19454
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Fick DM, Kagan SH, Resnick B, Young HM. Making Care for Older People the Choice of Nurses Today, Tomorrow, and Forever. Res Gerontol Nurs 2022; 15:214-216. [DOI: 10.3928/19404921-20220426-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Donna M. Fick
- Journal of Gerontological Nursing Professor, Pennsylvania State University University Park, Pennsylvania
| | | | - Barbara Resnick
- Geriatric Nursing Professor, University of Maryland Baltimore, Maryland
| | - Heather M. Young
- Research in Gerontological Nursing Professor and Dean Emerita, University of California Davis Davis, California
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Baumbusch J, Blakey EP, Carapellotti AM, Dohmen M, Fick DM, Kagan SH, Melendez-Torres GJ, Morgan BE, Munsterman E, Resnick B, Young HM. Nurses and the decade of healthy ageing: An unprecedented opportunity. Geriatr Nurs 2022; 47:A1-A3. [PMID: 35523612 DOI: 10.1016/j.gerinurse.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jennifer Baumbusch
- Associate Professor, University of British Columbia, Vancouver, BC, Canada
| | - Emma P Blakey
- PhD Candidate, Oxford Brookes University, Oxford, England, UK
| | | | - Marleen Dohmen
- PhD Candidate, Leyden Academy on Vitality and Ageing, Leiden, Netherlands
| | - Donna M Fick
- Professor, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Sarah H Kagan
- Professor of Gerontological Nursing, University of Pennsylvania, Pennsylvania, USA
| | | | | | | | | | - Heather M Young
- Professor and Dean Emerita, University of California Davis, Davis, California, USA
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25
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Baumbusch J, Blakey EP, Carapellotti AM, Dohmen M, Fick DM, Kagan SH, Melendez-Torres GJ, Morgan BE, Munsterman E, Resnick B, Young HM. Nurses and the decade of healthy ageing: An unprecedented opportunity. Int J Older People Nurs 2022; 17:e12469. [PMID: 35490355 DOI: 10.1111/opn.12469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Marleen Dohmen
- Leyden Academy on Vitality and Ageing, Leiden, Netherlands
| | - Donna M Fick
- Pennsylvania State University, University Park, Pennsylvania, USA
| | - Sarah H Kagan
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Fick DM, Kagan SH, Resnick B, Young HM. Making Care for Older People the Choice of Nurses Today, Tomorrow, and Forever. J Gerontol Nurs 2022; 48:2-4. [PMID: 35575551 DOI: 10.3928/00989134-20220509-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Donna M Fick
- Journal of Gerontological Nursing Professor, Pennsylvania State University University Park, Pennsylvania
| | - Sarah H Kagan
- Professor of Gerontological Nursing University of Pennsylvania Philadelphia, Pennsylvania
| | - Barbara Resnick
- Geriatric Nursing Professor, University of Maryland Baltimore, Maryland
| | - Heather M Young
- Research in Gerontological Nursing Professor and Dean Emerita, University of California Davis Davis, California
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28
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Baumbusch J, Blakey EP, Carapellotti A, Dohmen M, Fick DM, Kagan SH, Melendez-Torres G, Morgan BE, Munsterman E, Resnick B, Young HM. Nurses and the Decade of Healthy Ageing: An Unprecedented Opportunity. Res Gerontol Nurs 2022; 15:110-113. [DOI: 10.3928/19404921-20220420-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jennifer Baumbusch
- International Journal of Older People Nursing, Associate Professor, University of British Columbia Vancouver, BC,
Canada
| | - Emma P. Blakey
- International Journal of Older People Nursing, PhD Candidate, Oxford Brookes University Oxford,
England
| | - Anna Carapellotti
- International Journal of Older People Nursing, Post-Doctoral Researcher, Queen's University Belfast, Northern
Ireland
| | - Marleen Dohmen
- International Journal of Older People Nursing PhD Candidate, Leyden Academy on Vitality and Ageing Leiden,
Netherlands
| | - Donna M. Fick
- Journal of Gerontological Nursing, Professor, Pennsylvania State University University Park,
Pennsylvania
| | - Sarah H. Kagan
- International Journal of Older People Nursing, Professor of Gerontological Nursing, University of Pennsylvania Philadelphia,
Pennsylvania
| | - G.J. Melendez-Torres
- International Journal of Older People Nursing, Professor, University of Exeter Exeter,
England
| | - Brianna E. Morgan
- International Journal of Older People Nursing, PhD Candidate, University of Pennsylvania Philadelphia,
Pennsylvania
| | - Ellen Munsterman
- International Journal of Older People Nursing, PhD Student, University of Pennsylvania Philadelphia,
Pennsylvania
| | - Barbara Resnick
- Geriatric Nursing, Professor, University of Maryland Baltimore,
Maryland
| | - Heather M. Young
- Research in Gerontological Nursing, Professor and Dean Emerita, University of California Davis Davis, California
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Leslie DL, Fick DM, Moore A, Inouye SK, Jung Y, Ngo LH, Boltz M, Husser E, Shrestha P, Boustani M, Marcantonio ER. Comparative salary-related costs of a brief app-directed delirium identification protocol by hospitalists, nurses, and nursing assistants. J Am Geriatr Soc 2022; 70:2371-2378. [PMID: 35441698 PMCID: PMC9378349 DOI: 10.1111/jgs.17789] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/12/2022] [Accepted: 03/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Systematic screening can improve delirium identification among hospitalized older adults. Prior studies have shown clinicians and health system leaders may believe they do not have the time and resources for assessment. We conducted a comparative salary-related cost analysis of an adaptive delirium identification protocol directed by an iPad app. METHODS We recruited 527 older adult medicine patients from an urban academic medical center (n = 269) and a rural community hospital (n = 258). Physicians and nurses completed the two-step Ultra-brief Confusion Assessment Method (UB-CAM) protocol (with or without a skip pattern), while certified nursing assistants completed only the UB-2 ultra-brief screen. The sample included 527 patients (average age 80, 57% women, 35% with dementia). Time required to administer the protocol was collected automatically by the iPad app. Salary-related costs of screening were determined by multiplying the time required by the hourly wage for the three disciplines, as obtained from national and regional published healthcare salary cost data. Cost estimates for entire hospital implementation were also calculated. RESULTS Participants were screened on 924 hospital days by 399 clinicians (53 physicians, 236 nurses, 110 CNAs). For the UB-2, CNAs cost per screen was lower than the other clinician types ($0.37 per screen vs. $0.73 for nurses and $2.39 for hospitalists). For the UB-CAM with skip (UB-CAM), costs per protocol were $1.10 for nurses vs. $3.61 for physicians. The annual salary-related costs of hospital-wide implementation of a nurse-based UB-CAM protocol in a medium-sized (300-bed) hospital was $63,015 plus $4356 for initial and annual training. CONCLUSIONS CNAs and nurses had the lowest salary-associated costs for app-directed CAM-based delirium screening and identification, respectively. Salary-related annual hospital costs for the most efficient protocols in a medium-sized hospital were less than the annual cost of hiring 1 FTE of the discipline performing the protocols.
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Affiliation(s)
- Douglas L Leslie
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Donna M Fick
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA.,The Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Amber Moore
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Divisions of General Medicine and Gerontology, Harvard Medical School, Boston, Massachusetts, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sharon K Inouye
- Divisions of General Medicine and Gerontology, Harvard Medical School, Boston, Massachusetts, USA.,Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.,Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Yoojin Jung
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Long H Ngo
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Divisions of General Medicine and Gerontology, Harvard Medical School, Boston, Massachusetts, USA
| | - Marie Boltz
- The Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Erica Husser
- The Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Priyanka Shrestha
- The Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Malaz Boustani
- Division of Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Edward R Marcantonio
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Divisions of General Medicine and Gerontology, Harvard Medical School, Boston, Massachusetts, USA.,Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Baumbusch J, Blakey EP, Carapellotti A, Dohmen M, Fick DM, Kagan SH, Melendez-Torres GJ, Morgan BE, Munsterman E, Resnick B, Young HM. Nurses and the Decade of Healthy Ageing: An Unprecedented Opportunity. J Gerontol Nurs 2022; 48:3-6. [PMID: 35499288 DOI: 10.3928/00989134-20220422-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jennifer Baumbusch
- International Journal of Older People Nursing, Associate Professor, University of British Columbia Vancouver, BC, Canada
| | - Emma P Blakey
- International Journal of Older People Nursing, PhD Candidate, Oxford Brookes University Oxford, England
| | - Anna Carapellotti
- International Journal of Older People Nursing, Post-Doctoral Researcher, Queen's University Belfast, Northern Ireland
| | - Marleen Dohmen
- International Journal of Older People Nursing, PhD Candidate, Leyden Academy on Vitality and Ageing Leiden, Netherlands
| | - Donna M Fick
- Journal of Gerontological Nursing, Professor, Pennsylvania State University University Park, Pennsylvania
| | - Sarah H Kagan
- International Journal of Older People Nursing, Professor of Gerontological Nursing, University of Pennsylvania Philadelphia, Pennsylvania
| | - G J Melendez-Torres
- International Journal of Older People Nursing, Professor, University of Exeter Exeter, England
| | - Brianna E Morgan
- International Journal of Older People Nursing, PhD Candidate, University of Pennsylvania Philadelphia, Pennsylvania
| | - Ellen Munsterman
- International Journal of Older People Nursing, PhD Student, University of Pennsylvania Philadelphia, Pennsylvania
| | - Barbara Resnick
- Geriatric Nursing, Professor, University of Maryland Baltimore, Maryland
| | - Heather M Young
- Research in Gerontological Nursing, Professor and Dean Emerita, University of California Davis Davis, California
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Marcantonio ER, Fick DM, Jung Y, Inouye SK, Boltz M, Leslie DL, Husser EK, Shrestha P, Moore A, Sulmonte K, Siuta J, Boustani M, Ngo LH. Comparative Implementation of a Brief App-Directed Protocol for Delirium Identification by Hospitalists, Nurses, and Nursing Assistants : A Cohort Study. Ann Intern Med 2022; 175:65-73. [PMID: 34748377 PMCID: PMC8938856 DOI: 10.7326/m21-1687] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Systematic screening improves delirium identification among hospitalized older adults. Little data exist on how to implement such screening. OBJECTIVE To test implementation of a brief app-directed protocol for delirium identification by physicians, nurses, and certified nursing assistants (CNAs) in real-world practice relative to a research reference standard delirium assessment (RSDA). DESIGN Prospective cohort study. SETTING Large urban academic medical center and small rural community hospital. PARTICIPANTS 527 general medicine inpatients (mean age, 80 years; 35% with preexisting dementia) and 399 clinicians (53 hospitalists, 236 nurses, and 110 CNAs). MEASUREMENTS On 2 study days, enrolled patients had an RSDA. Subsequently, CNAs performed an ultra-brief 2-item screen (UB-2) for delirium, whereas physicians and nurses performed a 2-step protocol consisting of the UB-2 followed in those with a positive screen result by the 3-Minute Diagnostic Assessment for the Confusion Assessment Method. RESULTS Delirium was diagnosed in 154 of 924 RSDAs (17%) and in 114 of 527 patients (22%). The completion rate for clinician protocols exceeded 97%. The CNAs administered the UB-2 in a mean of 62 seconds (SD, 51). The 2-step protocols were administered in means of 104 seconds (SD, 99) by nurses and 106 seconds (SD, 105) by physicians. The UB-2 had sensitivities of 88% (95% CI, 72% to 96%), 87% (CI, 73% to 95%), and 82% (CI, 65% to 91%) when administered by CNAs, nurses, and physicians, respectively, with specificities of 64% to 70%. The 2-step protocol had overall accuracy of 89% (CI, 83% to 93%) and 87% (CI, 81% to 91%), with sensitivities of 65% (CI, 48% to 79%) and 63% (CI, 46% to 77%) and specificities of 93% (CI, 88% to 96%) and 91% (CI, 86% to 95%), for nurses and physicians, respectively. Two-step protocol sensitivity for moderate to severe delirium was 78% (CI, 54% to 91%). LIMITATION Two sites; limited diversity. CONCLUSION An app-directed protocol for delirium identification was feasible, brief, and accurate, and CNAs and nurses performed as well as hospitalists. PRIMARY FUNDING SOURCE National Institute on Aging.
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Affiliation(s)
- Edward R Marcantonio
- Divisions of General Medicine and Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts (E.R.M.)
| | - Donna M Fick
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, and College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania (D.M.F.)
| | - Yoojin Jung
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Y.J.)
| | - Sharon K Inouye
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, and Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts (S.K.I.)
| | - Marie Boltz
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania (M.B., E.K.H., P.S.)
| | - Douglas L Leslie
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania (D.L.L.)
| | - Erica K Husser
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania (M.B., E.K.H., P.S.)
| | - Priyanka Shrestha
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania (M.B., E.K.H., P.S.)
| | - Amber Moore
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, and Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts (A.M.)
| | - Kimberlyann Sulmonte
- Department of Nursing, Beth Israel Deaconess Medical Center, Boston, Massachusetts (K.S.)
| | - Jonathan Siuta
- Department of Medicine, Mount Nittany Medical Center, State College, Pennsylvania (J.S.)
| | - Malaz Boustani
- Center for Health Innovation and Implementation Science, Indiana University School of Medicine, Indianapolis, Indiana (M.B.)
| | - Long H Ngo
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts (L.H.N.)
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Schulman-Green D, Hshieh T, Adamis D, Avidan MS, Blazer DG, Fick DM, Oh E, Morandi A, Price C, Verghese J, Schmitt EM, Jones RN, Inouye SK. Domains of delirium severity in Alzheimer's disease and related dementias. J Am Geriatr Soc 2021; 70:1495-1503. [PMID: 34951704 PMCID: PMC9106827 DOI: 10.1111/jgs.17624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/11/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The ability to rate delirium severity is key to providing optimal care for persons with Alzheimer's Disease and Related Dementias (ADRD). Such ratings would allow clinicians to assess response to treatment, recovery time and prognosis, nursing burden and staffing needs, and to provide nuanced, appropriate patient-centered care. Given the lack of existing tools, we defined content domains for a new delirium severity instrument for use in individuals with mild to moderate ADRD, the DEL-S-AD. METHODS We built upon our previous study in which we created a content domain framework to inform development of a general delirium severity instrument, the DEL-S. We engaged a new expert panel to discuss issues of measurement in delirium and dementia and to determine which content domains from the prior framework were useful in characterizing delirium severity in ADRD. We also asked panelists to identify new domains. Our panel included eight interdisciplinary members with expertise in delirium and dementia. Panelists participated in two rounds of review followed by two surveys over 2 months. RESULTS Panelists endorsed the same content domains as for general delirium severity, including Cognitive, Level of Consciousness, Inattention, Psychiatric-Behavioral, Emotional Dysregulation, Psychomotor Features, and Functional; however, they excluded six of the original subdomains which they considered unhelpful in the context of ADRD: cognitive impairment; anxiety; fear/sense of unease; depression; gait/walking; and incontinence. Debated measurement challenges included assessment at one point in time versus over time, accounting for differences in clinical settings, and accurate assessment of symptoms related to delirium versus dementia. CONCLUSIONS By capturing a range of characteristics of delirium severity potentially present in patients with ADRD, a population that may already have attention, functional, and emotional changes at baseline, the DEL-S-AD provides a novel rating tool that will be useful for clinical and research purposes to improve patient care.
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Affiliation(s)
| | - Tammy Hshieh
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Dimitrios Adamis
- Sligo Mental Health Services, Sligo, Ireland.,Research and Academic Institute of Athens, Athens, Greece
| | - Michael S Avidan
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Dan G Blazer
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Donna M Fick
- Penn State Ross and Carol Nese College of Nursing, University Park, Pennsylvania, USA
| | - Esther Oh
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alessandro Morandi
- Fondazione Teresa Camplani, Cremona, Italy.,Parc Sanitari Pere Virgili and Vall d'Hebrón Institute of Research, Barcelona, Spain
| | - Catherine Price
- University of Florida College of Public Health and Health Professions, Gainesville, Florida, USA
| | - Joe Verghese
- Albert Einstein School of Medicine, Bronx, New York, USA
| | - Eva M Schmitt
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Richard N Jones
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Sharon K Inouye
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Emery-Tiburcio EE, Berg-Weger M, Husser EK, Tumosa N, Golden RL, Newman MH, Morley JE, Knecht-Fredo JM, Hupcey JE, Fick DM. The Geriatrics Education and Care Revolution: Diverse Implementation of Age-Friendly Health Systems. J Am Geriatr Soc 2021; 69:E31-E33. [PMID: 34624931 DOI: 10.1111/jgs.17497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Erin E Emery-Tiburcio
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Marla Berg-Weger
- School of Social Work, Saint Louis University, Saint Louis, Missouri, USA
| | - Erica K Husser
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Nina Tumosa
- Division of Medicine and Dentistry, Bureau of Health Workforce, Health Resources and Services Administration, Fairlee, Vermont, USA
| | - Robyn L Golden
- Department of Social Work and Community Health, Rush University Medical Center, Chicago, Illinois, USA
| | - Michelle H Newman
- Department of Social Work and Community Health, Rush University Medical Center, Chicago, Illinois, USA
| | - John E Morley
- Department of Medicine, Saint Louis University, Saint Louis, Missouri, USA
| | - Jenny M Knecht-Fredo
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Judith E Hupcey
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Donna M Fick
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
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Fick DM. How Will We Spend Our Days and Hours to Improve the Care of Older Adults? J Gerontol Nurs 2021; 47:3-5. [PMID: 34590980 DOI: 10.3928/00989134-20210908-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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36
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Fick DM. Aducanumab and the Medicalization (Still) of Alzheimer's Disease: A Challenge to Measure and Act On What Matters. J Gerontol Nurs 2021; 47:2-4. [PMID: 34432574 DOI: 10.3928/00989134-20210806-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Older adults have unique health risks related to climate change. This commentary addresses the health impacts of climate change for older adults, identifies gaps in gerontological nursing research, and highlights areas for research to address the significant gap in nursing science. Climate risks of extreme weather events, such as heat, rain, flooding, and wildfires, as well as poor air quality, vector-borne diseases, interruptions of services, and treatment plans all place older adults at risk of experiencing greater morbidity and early mortality. Despite these risks, there is a gap in nursing research related to climate change and aging. Nurse scientists can address this gap with an interdisciplinary approach. There are climate resources and theoretical frameworks to support scientific inquiry. Funding sources must be made available to assure rigorous scholarship of climate-related health impacts for older adults. Gerontological nurse researchers must build capacity to address climate change and health. [Research in Gerontological Nursing, 13(1), 6-12.].
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Armstrong B, Habtemariam D, Husser E, Leslie DL, Boltz M, Jung Y, Fick DM, Inouye SK, Marcantonio ER, Ngo LH. A mobile app for delirium screening. JAMIA Open 2021; 4:ooab027. [PMID: 34549169 PMCID: PMC8446432 DOI: 10.1093/jamiaopen/ooab027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 02/17/2021] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The objective of this study is to describe the algorithm and technical implementation of a mobile app that uses adaptive testing to assess an efficient mobile app for the diagnosis of delirium. MATERIALS AND METHODS The app was used as part of a NIH-funded project to assess the feasibility, effectiveness, administration time, and costs of the 2-step delirium identification protocol when performed by physicians and nurses, and certified nursing assistants (CNA). The cohort included 535 hospitalized patients aged 79.7 (SD = 6.6) years enrolled at 2 different sites. Each patient was assessed on 2 consecutive days by the research associate who performed the reference delirium assessment. Thereafter, physicians, nurses, and CNAs performed adaptive delirium assessments using the app. Qualitative data to assess the experience of administering the 2-step protocol, and the app usability were also collected and analyzed from 50 physicians, 189 nurses, and 83 CNAs. We used extensible hypertext markup language (XHTML) and JavaScript to develop the app for the iOS-based iPad. The App was linked to Research Electronic Data Capture (REDCap), a relational database system, via a REDCap application programming interface (API) that sent and received data from/to the app. The data from REDCap were sent to the Statistical Analysis System for statistical analysis. RESULTS The app graphical interface was successfully implemented by XHTML and JavaScript. The API facilitated the instant updating and retrieval of delirium status data between REDCap and the app. Clinicians performed 881 delirium assessments using the app for 535 patients. The transmission of data between the app and the REDCap system showed no errors. Qualitative data indicated that the users were enthusiastic about using the app with no negative comments, 82% positive comments, and 18% suggestions of improvement. Delirium administration time for the 2-step protocol showed similar total time between nurses and physicians (103.9 vs 106.5 seconds). Weekly enrollment reports of the app data were generated for study tracking purposes, and the data are being used for statistical analyses for publications. DISCUSSION The app developed using iOS could be easily converted to other operating systems such as Android and could be linked to other relational databases beside REDCap, such as electronic health records to facilitate better data retrieval and updating of patient's delirium status. CONCLUSION Our app operationalizes an adaptive 2-step delirium screening protocol. Its algorithm and cross-plat formed code of XHTML and JavaScript can be easily exported to other operating systems and hardware platforms, thus enabling wider use of the efficient delirium screening protocol that we have developed. The app is currently implemented as a research tool, but with adaptation could be implemented in the clinical setting to facilitate widespread delirium screening in hospitalized older adults.
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Affiliation(s)
- Brett Armstrong
- University of New England College of Osteopathic Medicine, Biddeford, Maine, USA
| | - Daniel Habtemariam
- The Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Erica Husser
- The Colleges of Nursing and Medicine, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Douglas L Leslie
- The Colleges of Nursing and Medicine, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Marie Boltz
- The Colleges of Nursing and Medicine, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Yoojin Jung
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Donna M Fick
- The Colleges of Nursing and Medicine, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Sharon K Inouye
- The Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Edward R Marcantonio
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Long H Ngo
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Young HM, Kolanowski AM, Fick DM. The Time Is Always Right to Do What Is Right: Revisiting Our Societal Values and Strategies in the Care of Older Adults in 2021. Res Gerontol Nurs 2021; 14:55-58. [PMID: 34038671 DOI: 10.3928/19404921-20210128-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - Ann M Kolanowski
- The Pennsylvania State University, College of Nursing, University Park, Pennsylvania
| | - Donna M Fick
- Journal of Gerontological Nursing, Elouise Ross Eberly Professor, Director of the Center of Geriatric Nursing Excellence, The Pennsylvania State University, College of Nursing, University Park, Pennsylvania
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Affiliation(s)
- Donna M Fick
- Penn State College of Nursing, University Park, Pennsylvania
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Fick DM, Kolanowski AM, Young HM. The Time Is Always Right to Do What Is Right: Revisiting Our Societal Values and Strategies in the Care of Older Adults in 2021. J Gerontol Nurs 2021; 47:3-6. [PMID: 33482008 DOI: 10.3928/00989134-20210121-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Husser EK, Fick DM, Boltz M, Shrestha P, Siuta J, Malloy S, Overstreet A, Leslie DL, Ngo L, Jung Y, Inouye SK, Marcantonio ER. Implementing a Rapid, Two-Step Delirium Screening Protocol in Acute Care: Barriers and Facilitators. J Am Geriatr Soc 2021; 69:1349-1356. [PMID: 33474729 DOI: 10.1111/jgs.17026] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND/OBJECTIVES An effective and efficient protocol for delirium identification is needed to improve health outcomes for older adults and reduce healthcare costs. This study describes the barriers and facilitators related to the implementation of the ultra-brief confusion assessment method (UB-CAM), a rapid two-step delirium identification protocol (ultra-brief screen, followed by CAM in positives), field tested with hospitalized older adults (70+). DESIGN A qualitative descriptive design using observational data collection and brief semi-structured interviews. SETTINGS An urban academic medical center and a community teaching hospital. PARTICIPANTS Participants included 50 physician hospitalists, 189 registered nurses, and 83 nursing assistants (NAs). MEASUREMENTS Field researchers guided by a modified multi-level implementation framework, collected observational data as participants administered the UB-CAM (n = 767). Thematic analysis was conducted on five observational categories: structural, organizational, patient, clinician, and innovation. Field notes and brief semi-structured interviews (n = 231) with clinicians, explored the utility, acceptability, and feasibility of the protocol, and supplemented the observations. RESULTS The UB-CAM was generally positively received by all three clinician types. Six themes describe barriers and/or facilitators to implementing the UB-CAM: (1) physical setting and milieu; (2) practice environment; (3) integrating into role; (4) adaptive techniques; (5) patient responses; and (6) systematic assessment. The composition and interaction of the six themes determined if the theme was expressed as a barrier or facilitator, affirming the importance of context when implementing system-level delirium screening. CONCLUSION This is one of the first studies to test a two-step process for delirium identification, and to involve NAs in screening, and the findings demonstrate overall support from clinicians for delirium identification, and describe the need for a multifaceted, contextualized, and systemic approach to implementation and evaluation of delirium screening.
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Affiliation(s)
- Erica K Husser
- The Pennsylvania State University, College of Nursing, University Park, Pennsylvania, USA
| | - Donna M Fick
- The Pennsylvania State University, College of Nursing, University Park, Pennsylvania, USA
| | - Marie Boltz
- The Pennsylvania State University, College of Nursing, University Park, Pennsylvania, USA
| | - Priyanka Shrestha
- The Pennsylvania State University, College of Nursing, University Park, Pennsylvania, USA
| | - Jonathan Siuta
- Mount Nittany Physician Group, Mount Nittany Medical Center, State College, Pennsylvania, USA
| | - Shannon Malloy
- Beth Israel Deaconess Medical Center, Department of General Medicine, Boston, Massachusetts, USA
| | - Abigail Overstreet
- Beth Israel Deaconess Medical Center, Department of General Medicine, Boston, Massachusetts, USA
| | - Douglas L Leslie
- The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | - Long Ngo
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Yoojin Jung
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Sharon K Inouye
- Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward R Marcantonio
- Divisions of General Medicine and Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Schnitker L, Nović A, Arendts G, Carpenter CR, LoGiudice D, Caplan GA, Fick DM, Beattie E. Prevention of Delirium in Older Adults With Dementia: A Systematic Literature Review. J Gerontol Nurs 2020; 46:43-54. [PMID: 32852044 DOI: 10.3928/00989134-20200820-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/08/2020] [Indexed: 11/20/2022]
Abstract
Although dementia is the largest independent risk factor for delirium and leads to poor health outcomes, we know little about how to prevent delirium in persons with dementia (PWD). The purpose of the current systematic literature review was to identify interventions designed to prevent delirium in older PWD. Seven studies meeting inclusion criteria were extracted. Five studies were in the acute care setting and two were community settings. One study used a randomized controlled trial design. Five of the seven interventions comprised multiple components addressing delirium risk factors, including education. Two studies addressed delirium by administration of medication or vitamin supplementation. Using the GRADE framework for the evaluation of study quality, we scored three studies as moderate and four studies as low. Thus, high-quality research studies to guide how best to prevent delirium in PWD are lacking. Although more research is required, the current review suggests that multicomponent approaches addressing delirium risk factors should be considered by health care professionals when supporting older PWD. [Journal of Gerontological Nursing, 46(10), 43-54.].
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Yevchak Sillner A, Ngo L, Jung Y, Inouye SK, Boltz M, Leslie D, Marcantonio ER, Fick DM. Ultrabrief Screens for Detecting Delirium in Postoperative Cognitively Intact Older Adults. J Hosp Med 2020; 15:544-547. [PMID: 32853147 PMCID: PMC7489801 DOI: 10.12788/jhm.3410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/10/2020] [Indexed: 11/20/2022]
Abstract
The authors' sought to develop an ultrabrief screen for postoperative delirium in cognitively intact patients older than 70 years undergoing major elective surgery. All possible combinations of one-, two- and three-item screens and their sensitivities, specificities, and 95% confidence intervals were calculated and compared with the delirium reference standard Confusion Assessment Method (CAM). Among the 560 participants (mean age, 77 years; 58% women), delirium occurred in 134 (24%). We considered 1,100 delirium assessments from postoperative days 1 and 2. The screen with the best overall performance consisted of three items: (1) Patient reports feeling confused, (2) Months of the year backward, and (3) "Does the patient appear sleepy?" with sensitivity of 92% and specificity of 72%. This brief, three-item screen rules out delirium quickly, identifies a subset of patients who require further testing, and may be an important tool to improve recognition of postoperative delirium.
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Affiliation(s)
- Andrea Yevchak Sillner
- College of Nursing, The Pennsylvania State University, University Park, Pennsylvania
- Corresponding Author: Andrea Yevchak Sillner, PhD; ; Telephone: 814-863-4294; Twitter: @amyevchak
| | - Long Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Yoojin Jung
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sharon K Inouye
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Marie Boltz
- College of Nursing, The Pennsylvania State University, University Park, Pennsylvania
| | - Douglas Leslie
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Edward R Marcantonio
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Donna M Fick
- College of Nursing, The Pennsylvania State University, University Park, Pennsylvania
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Shrestha P, Fick DM. Family caregiver's experience of caring for an older adult with delirium: A systematic review. Int J Older People Nurs 2020; 15:e12321. [PMID: 32374518 DOI: 10.1111/opn.12321] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 01/05/2023]
Abstract
AIM To enhance understanding of how family caregivers perceive the experience of caring for an older adult with delirium across care settings and to identify the challenges in recognising and managing delirium to inform future research and best practices. METHOD A systematic literature review was conducted in five databases per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Primary or secondary peer-reviewed articles published between 1987 and October 2018 describing the experiences of family caregivers caring for older adults with delirium or delirium superimposed on dementia were included in the review. Mixed Method Appraisal Tool (MMAT) was used to evaluate the methodological quality. A thematic synthesis of results was conducted to extract relevant data as per the aims of the study. RESULTS Eighteen articles met the eligibility criteria, which were reviewed and analysed in regard to purpose, sample, research design, variables and results. Seven themes emerged in the process. The current challenges and gaps in our knowledge of this phenomenon have also been highlighted, which should be helpful to inform best practices, and finally, an agenda for future research is proposed. CONCLUSION Family caregivers are an important partner in the detection and management of delirium. The impact of caring for an older adult with delirium on the family caregivers should not be overlooked. This paper highlights the dearth of research on family caregiver's experience of caring for older adults with delirium and even less in the context of delirium superimposed on dementia. More research is required to further understand the family caregiver's experience and their challenges in order to support them in their caregiving role and to determine their needs and preferences of being involved in the plan of care. IMPLICATIONS FOR PRACTICE These findings suggest that family caregivers are a valuable resource in the recognition and management of delirium and should be included as care partners in the health care team, while also catering to their health and well-being in the process.
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Affiliation(s)
| | - Donna M Fick
- Penn State College of Nursing, State College, PA, USA
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Fick DM. Less Really Is More in Inappropriate Medication Use in Older Adults: How Can We Improve Prescribing and Deprescribing in Older Adults? J Am Geriatr Soc 2020; 68:1175-1176. [PMID: 32364621 DOI: 10.1111/jgs.16485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/20/2020] [Accepted: 04/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Donna M Fick
- College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
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Affiliation(s)
- Heather M. Young
- Professor and Founding Dean Emerita Betty Irene Moore School of Nursing National Director
- Betty Irene Moore Nurse Fellows in Leadership and Innovation Program UC Davis Sacramento, California
| | - Donna M. Fick
- Elouise Ross Eberly Endowed Professor Penn State College of Nursing, Director, Center of Geriatric Nursing Excellence University Park, Pennsylvania
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Singu S, Koneru M, Robinson KA, Neufeld KJ, Oh ES, Wilson LM, Needham DM, Balagani A, Aldabain L, Nikooie R, Fick DM. Are Antipsychotics Helpful for Preventing or Treating Delirium? J Gerontol Nurs 2020; 46:3-5. [DOI: 10.3928/00989134-20200303-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Fick DM. Ushering in the New Year With New Research, New Grants, and Age-Friendly Stories to Tell. J Gerontol Nurs 2020; 46:4-6. [PMID: 31895954 DOI: 10.3928/00989134-20191205-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Behrens LL, McGhan G, Abbott KM, Fick DM, Kolanowski AM, Liu Y, Buck HG, Roes M, Heid AR, Spector A, Van Haitsma K. Mapping Core Concepts of Person-Centered Care in Long-Term Services and Supports. J Gerontol Nurs 2019; 45:7-13. [PMID: 30690649 DOI: 10.3928/00989134-20190111-02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Person-centered care (PCC) has a wide range of definitions, most based on expert opinion rather than empirical analysis. The current study used an empirical concept mapping approach to identify core components of PCC used in long-term services and supports (LTSS). The aim is to help providers and researchers develop a unified set of domains that can be used to assess and improve the quality of PCC in real-world settings. Results yielded six domains describing essential elements of PCC in LTSS: Enacting Humanistic Values, Direct Care Worker Values, Engagement Facilitators, Living Environment, Communication, and Supportive Systems; and two underlying dimensions: Intrapersonal Activities and Extrapersonal Services and Social and Physical Environment. Nurses can use the results to enhance clinical knowledge and skills around delivery of PCC. Researchers can use the results to build a comprehensive and unified measure to accelerate adoption of PCC practices shown to benefit older adults, families, and the LTSS workforce. [Journal of Gerontological Nursing, 45(2), 6-13.].
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