Aging and Burnout for Nurses in an Acute Care Setting: The First Wave of COVID-19.

We examined the relationship between age, coping, and burnout during the peak of the COVID-19 pandemic with nurses in Texas (N = 376). Nurses were recruited through a professional association and snowball sampling methodology for the cross-sectional survey study. Framed in lifespan development theories, we expected that nurse age and experience would be positively correlated with positive coping strategies (e.g., getting emotional support from others) and negatively correlated with negative coping strategies (e.g., drinking and drug use). We also expected age to be negatively related to the emotional exhaustion and depersonalization facets of burnout and positively related to the personal accomplishment facet of burnout. Findings were largely supported in that age was positively associated with positive coping and personal accomplishment and age and experience were negatively correlated with negative coping and depersonalization. Age was not, however, associated with emotional exhaustion. Mediation models further suggest that coping explains some of the effect of age on burnout. A theoretical extension of lifespan development models into an extreme environment and practical implications for coping in these environments are discussed.

Nurse Adaptability and Post-traumatic Stress Disorder Symptoms During the COVID-19 Pandemic: The Effects of Family and Perceived Organizational Support.

Objective: To examine the effect of family and perceived organizational support on the relationship between nurse adaptability and their experience with COVID-related PTSD (post-traumatic stress disorder) symptoms in frontline nurses working on COVID-19 units. Background: Proximity to and survival of life-threatening events contribute to a diagnosis of PTSD, which is characterized by avoidance of reminders of trauma, intrusive thoughts, flashbacks of events, sleep disturbances, and hypervigilance. Using the job-demands and resource model, we examined the effect of adaptability, family support, and perceived organizational support on PTSD symptoms for nurses during the COVID-19 pandemic. Specifically, we tested whether perceptions of environmental supports-i.e., family and organizational support-moderated the relationship between nurse adaptability and COVID-related PTSD symptoms. Methods: A sample of frontline nurses working on COVID-19 units during the COVID-19 pandemic in Texas (N = 277) participated in this cross-sectional, observational study. Frontline Nurses reported demographic information and completed surveys designed to measure adaptability, perceived organizational support, family support, and COVID-related PTSD symptoms. Results: Adaptability was significantly positively correlated (medium effects) to perceived organizational and family support (r = 0.51 and 0.56, respectively, p < 0.01). Adaptability and perceived organizational support were also negatively correlated with COVID-related PTSD symptoms (medium effects). Adaptability was negatively correlated with COVID-related PTSD symptoms, supporting Hypothesis 1 (r = -0.43, p < 0.01). Perceived organizational support was also significantly negatively correlated with COVID-19-related PTSD symptoms (r = -0.30, p < 0.01). Family support was not significantly correlated with COVID-related PTSD but was positively related to experiencing COVID-related PTSD after other variables were accounted for. Conclusion: Findings suggest that individual adaptability and organizational support may reduce PTSD severity in frontline nurses working during a crisis; however, family support may increase PTSD symptoms. We provide suggestions for strengthening individual adaptability and healthcare leadership including remaining highly engaged to show support by providing rapid communication, remaining calm during difficult circumstances, and maintaining a consistent, physical presence during difficult times. Moreover, our results suggest additional support for nurses with families to adapt to crisis.

Animal-Assisted Activity in Critically Ill Older Adults: A Randomized Pilot and Feasibility Trial.

BACKGROUND: Limited evidence suggests the efficacy of animal-assisted activities (AAA) in improving biobehavioral stress responses in older patients in intensive care units (ICUs). OBJECTIVES: To assess the feasibility of an AAA (dog) intervention for improving biobehavioral stress response, measured by self-reported stress and anxiety and salivary cortisol, C-reactive protein, and interleukin-1ß in older ICU patients, we examined enrollment, attrition, completion, data collection, and biobehavioral stress responses. METHODS: ICU patients ≥60 years old were randomly assigned to a 10-min AAA intervention or control/usual ICU care. Attitudes toward pets were assessed before the intervention. Self-reported stress and anxiety and salivary stress biomarkers were collected before and after the intervention and the usual care condition. RESULTS: The majority of patients were ineligible due to lack of decisional capacity, younger age, inability to provide saliva specimens, or critical illness. Though 15 participants were randomly allocated (AAA = 9; control = 6), only 10 completed the study. All participants completed the questionnaires; however, saliva specimens were significantly limited by volume. AAA was associated with decreases in stress and anxiety. Biomarker results were variable and revealed no specific trends associated with stress responses. Conclusions: Barriers to recruitment included an insufficient number of patients eligible for AAA based on hospital policy, difficulty finding patients who met study eligibility criteria, and illness-related factors. Recommendations for future studies include larger samples, a stronger control intervention such as a visitor without a dog, greater control over the AAA intervention, and use of blood from indwelling catheters for biomarkers.

Loneliness and cognitive function in the older adult: a systematic review.

BACKGROUND: Loneliness is a significant concern among the elderly, particularly in societies with rapid growth in aging populations. Loneliness may influence cognitive function, but the exact nature of the association between loneliness and cognitive function is poorly understood. The purpose of this systematic review was to synthesize current findings on the association between loneliness and cognitive function in older adults. METHOD: A comprehensive, electronic review of the literature was performed. Criteria for inclusion were original quantitative or qualitative research, report written in English, human participants with a mean age ≥ 60 years, and published from January 2000 through July 2013. The total number of studies included in this systematic review was ten. RESULTS: Main findings from the ten studies largely indicate that loneliness is significantly and negatively correlated with cognitive function, specifically in domains of global cognitive function or general cognitive ability, intelligence quotient (IQ), processing speed, immediate recall, and delayed recall. However, some initial correlations were not significant after controlling for a wide range of demographic and psychosocial risk factors thought to influence loneliness. CONCLUSIONS: Greater loneliness is associated with lower cognitive function. Although preliminary evidence is promising, additional studies are necessary to determine the causality and biological mechanisms underlying the relationship between loneliness and cognitive function. Findings should be verified in culturally diverse populations in different ages and settings using biobehavioral approaches.

Spiritual Pain in Meals on Wheels' Clients.

BACKGROUND: Meals on Wheels' clients are at risk for spiritual pain due to advanced age, social isolation, and failing health. They are also prone to stress, depression, and loneliness, placing them at risk for adverse biological disruptions and health outcomes. The purpose of the study was to examine associations of spiritual pain with psychosocial factors (stress, depression, loneliness, religious coping) and salivary biomarkers of stress and inflammation (cortisol, IL-1ß) in Meals on Wheels' clients. METHODS: Data were collected cross-sectionally from 88 elderly (mean age 75.4). Spiritual pain, stress, depression, loneliness, and religious coping were measured with standardized instruments, and salivary biomarkers were assessed with enzyme immunoassays. RESULTS: Spiritual pain was significantly and positively correlated with stress (r = 0.35, p ≤ 0.001), depression (r = 0.27, p = 0.01), and negative religious coping (r = 0.27, p = 0.01). Correlations with loneliness, positive religious coping, and salivary biomarkers were non-significant. CONCLUSION: Spiritual pain is an important concept in this population. Research should be expanded to understand the significance of spiritual pain in conjunction with psychosocial and biological variables and its potential impact on physical, mental, and cognitive health outcomes in the elderly.