"It Isn't the Same": Experiences of Informal Caregivers of Older Adults Enrolled in a Home-Based Senior Care Program During COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic placed new strains on informal caregivers, who are already vulnerable to negative psychosocial effects due to demands of the caregiving role. The current study aimed to explore the early impact of COVID-19 on caregivers living with and apart from care recipients. Semi-structured qualitative interviews with seven cohabitating and 10 distanced caregivers of patients in a home-based primary care program were conducted from April to November 2020. A framework matrix was used to identify patterns in caregiver experiences. Cohabitating and distanced caregivers reported shared concerns about COVID-19 and unique concerns dependent on cohabitation status. Cohabitating caregivers reported financial worries, care recipients with dementia being unable to understand restrictions, and concerns about community business changes. Distanced caregivers reported communication challenges with cognitively impaired care recipients and challenges with visitation policies. During pandemics, caregivers' clinical and policy support needs may differ depending on their place of residence relative to care recipients. [Journal of Gerontological Nursing, 49(3), 19-26.].

State Variation in the Utilization of Nurse Practitioner-Provided Home-Based Primary Care: A Medicare Claims Analysis.

Nurse practitioners (NPs) provide an increasing proportion of home-based primary care, despite restrictive scope of practice laws in approximately one half of states. We examined the relationship between scope of practice laws and state volume of NP-provided home-based primary care by performing an analysis of 2018 to 2019 Medicare claims. For each state we calculated the proportion of total home-based primary care visits by NPs and the proportion of all NPs providing home-based primary care. We used the 2018 American Association of Nurse Practitioners classification of state practice environment. We performed chi-square tests to assess the significance between volume and practice environment. We found that 42% of home-based primary care is delivered by NPs nationally, but substantial variation exists across states. We did not find a discernible or statistically significant pattern of uptake of NP-provided home-based primary care across full, reduced, or restricted states. [Journal of Gerontological Nursing, 49(5), 11-17.].

Experiences of a Nursing Team Working in a Residential Care Facility for Older Adults During the COVID-19 Pandemic.

Experiences of staff working in residential long-term care facilities (LTCFs) during the coronavirus disease 2019 (COVID-19) pandemic are likely to differ from that of staff working in acute hospitals. The aim of the current study was to describe the experiences of the nursing team supporting frail older adults with high medical and care needs living in a LTCF. Using a descriptive qualitative design, data were gathered via one-to-one semi-structured interviews and thematically analyzed. Four themes emerged: Providing Care During COVID-19, Impact of COVID-19 on Staff, Organizational Management of COVID-19, and Training and Education. Visitation restrictions and staff shortages impacted all aspects of work life. Staff reported increased stress and exhaustion with COVID-19 infection resulting in long-term health issues. It is important to learn from these experiences to inform and empower staff to manage future outbreaks of infectious diseases. [Journal of Gerontological Nursing, 49(3), 40-46.].

Residential Aged Care Facilities During the COVID-19 Pandemic: A Staff Survey on Impact and Resources.

The current study explored the impact of the coronavirus disease 2019 (COVID-19) pandemic on staff in residential aged care facilities (RACFs). A hardcopy, voluntary, anonymous survey was circulated to local RACFs (June-July 2020), exploring challenges, staffing effects, mood within RACFs, and staff perceptions of supports. Overall, 105 staff members responded, which were mainly nursing personnel (67.6%) and owners/managers (10.5%). Seventy percent believed they were equipped to handle patients with COVID-19. One quarter reported personal protective equipment shortages. Respondents reported pressures to accept patients with COVID-19 from hospitals and/or keep residents in the RACF. One third reported staff "calling in sick" related to COVID-19/quarantine. Common compensatory strategies included increasing part-time workers' hours. Reported mood was largely positive. Most (86.4%) respondents felt supported by general practitioner and local geriatric outreach services. Opportunities to best support RACF staff require further research and dialogue. [Journal of Gerontological Nursing, 49(3), 13-17.].

Adapting Geriatric Day Hospital Care From an In-House to Outreach Process.

Outpatient programs have been challenged to find ways to deliver services while adhering to coronavirus disease protocols. Our Geriatric Day Hospital (GDH) Falls Clinic changed from a 6-week in-house program to an outreach program incorporating telephone assessments and home visits. We evaluated whether the outreach program was effective in improving patient outcomes in 23 serially enrolled clients. Statistically significant gains were achieved with falls, Berg Balance Scale scores, functional reach measurements, and pain management scores. Access to social support from family or friends led to higher implementation of recommendations. There was an inability to predict which clients would improve from an outreach program, but it was evident that the program benefited some clients and provided a viable alternative to an in-person program. [Journal of Gerontological Nursing, 49(4), 33-38.].

Facilitating family-focused Care of Older adults living in Long-Term Care in Canada during Restricted Visiting due to COVID-19.

BACKGROUND: The focus of this paper is exemplary gerontological nursing interventions that effectively supported families and long-term care residents in Canada during visiting restrictions resulting from COVID-19. OBJECTIVE: The aim was to describe exemplary gerontological nursing interventions that families and long-term care residents in Canada found supportive during visiting restrictions resulting from COVID-19. METHODS: An analysis of data artefacts including news reports, blogs and social media postings was completed. RESULTS: Thematic analysis resulted in four themes: dedication amidst challenge, innovation and continuous learning, living their nursing values and purposeful knowledge sharing. These themes are described using a framework that depicts four pillars of exemplary nursing practice: professionalism, scholarly practice, leadership and stewardship (Riley, Beal, & Ponte, 2021). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: A link is made between these pillars of exemplary practice and enactment of family-focused care. Recommendations focused on gerontological nursing approaches that facilitate family-focused care for older adults residing in long-term care are included.

Improving Rates of Pneumococcal Vaccination in a Skilled Nursing Facility.

The pneumonia vaccine is the best way to prevent pneumococcal disease and the high cost of readmission for patients and payors. The readmission rate at a skilled nursing facility (SNF) for a patient with a diagnosis of pneumonia was 24%, whereas the vaccination rate at the SNF was only 28%. This finding is significant because patients aged ≥65 years have a 35% reduction in pneumonia influenzas and all-cause mortality with appropriate pneumococcal vaccination. The current initiative sought to increase the pneumococcal vaccine rate at a SNF through implementation of a structured vaccine initiative. After implementation of a pneumococcal vaccination bundle, vaccine uptake increased from 28% to 66%. The success of the pneumococcal vaccination bundle showed that a focused effort using context-specific, evidence-based interventions can increase vaccine uptake. Adapting an evidence-based bundle to fit the needs of the user's context is an important component to the success of vaccination initiatives. [Journal of Gerontological Nursing, 48(12), 52-56.].

Death Anxiety and Willingness to Work in Geriatric Care: The Role of Contact With Older Adults.

The current study sought to examine the moderating role of contact with older adults in the relationship between medical and nursing students' death anxiety and their willingness to work in geriatric care. A total of 385 Chinese freshman and sophomore medical and nursing students were included in this cross-sectional study. Logistic regression results showed that death anxiety was negatively related to students' willingness to work in geriatric care. The negative association between death anxiety and willingness was moderated by contact with general older adults (i.e., students who had frequent contact with general older adults were more willing to work in geriatric care even with a high level of death anxiety). However, contact with grandparents did not have a significant moderation effect. Interventions to reduce the negative impact of death anxiety on students' willingness to work with older adults should consider increasing medical and nursing students' quality and frequency of contact with older adults. [Journal of Gerontological Nursing, 48(6), 49-56.].

Improving Nursing Student Attitudes Toward Older Adults Through the Use of Mask-Ed™ Simulation.

Older adults are significant consumers of health care, yet studies find many health care students do not want to work with this population. This negative attitude can impact health outcomes. Increased exposure to older adults is linked to increased positive attitudes toward older adult care. Addressing the need for increased opportunities to interact with older adults will likely enhance these attitudes and thus improve health outcomes. In the current study, four varied Mask-Ed™ simulation activities were used in a course with a specific focus on nursing care of older adults. The Mask-Ed™ character, an older adult woman, works with students and provides opportunities for positive interactions/experiences. Students responded positively to simulation activities. Students described the experiences as helpful in increasing their confidence and comfort level with older adults. This unique experience fostered positive attitudes toward older adults among nursing students by giving them the opportunity to practice engaging with this population. [Journal of Gerontological Nursing, 47(12), 43-47.].

Bibliometric Analysis on Geriatric Nursing Research in Web of Science (1900-2020).

OBJECTIVE: Aging is a growing public health concern for people, organizations, and governments. The current study was undertaken to provide insights into the global research output on geriatric nursing. METHODS: A bibliometric study was implemented using the WoS database for the period from 1900 to 2020. Various tools and measures were used to analyze and visualized. RESULTS: The search strategy found 4923 papers. The oldest paper was written by Beverly C. Andre in 1953. As team size increases, so does the number of citations. The USA was the active country and the highest number of coauthors. New York University was an active institution. Stig Karlsson was the most active author in Geriatric Nursing with 28 articles from Sweden, followed by Koen Milisen and Sandman, with 26 articles each from Sweden and Belgium. The most frequent words in this field were depression, malnutrition, education, Alzheimer's disease, and dementia. The latest research themes in this field were COVID-19, interprofessional locomotive syndrome, emergency nursing, and public health. The most influential papers were specified. Journal of the American Geriatrics Society was the most active journal. CONCLUSIONS: Geriatric nursing is a rooted field and has received special attention in the last decade. Policymakers, especially in developing countries, should pay attention to geriatric nursing as a specialty of nursing to solve aging issues they would face considering the increasing elderly population.

The 'loneliness pandemic': implications for gerontological nursing.

The COVID-19 pandemic compelled states to limit free movement, in order to protect at-risk and more vulnerable groups, particularly older adults. Due to old age or debilitating chronic diseases, this group is also more vulnerable to loneliness (perceived discrepancy between actual and desired social relationships) and social isolation (feeling that one does not belong to society). This forced isolation has negative consequences for the health of older people, particularly their mental health. This is an especially challenging time for gerontological nursing, but it is also an opportunity for professionals to combat age stereotypes reinforced with COVID-19, to urge the measurement of loneliness and social isolation, and to rethink how to further adjust interventions in times of crisis, such as considering technology-mediated interventions in these uncertain times.

Oral Care in Hospital Settings: Breaking the Vicious Circle of Older Adult Deconditioning.

Hospitalized older adults frequently develop aspiration pneumonia, swallowing dys-function (dysphagia), and sarcopenia. In the current study, we propose a framework that incorporates these three factors into a vicious circle that leads to deconditioning, a condition frequently experienced by this vulnerable population. Viewing aspiration pneumonia, dysphagia, and sarcopenia, along with their interrelationships through the lens of this vicious circle, illuminates the critical role that oral health plays in deconditioning. Moreover, this framework highlights oral care as a key nursing intervention for reducing deconditioning in hospitalized older adults. Supporting this view, several studies have shown that oral care can improve health outcomes for hospitalized older adults. However, despite oral care being an essential nursing intervention that restores oral function and promotes patient wellness, it is one of the most neglected nursing interventions. Missed oral care occurs due to staff's limited awareness of its significance for care-dependent older adults in hospital settings. We hope that this vicious circle paradigm helps raise awareness of the significance of oral care to prevent deconditioning in hospitalized older adults. [Journal of Gerontological Nursing, 47(6), 7-12.].