Testing a Model of Sodium Reduction in Hypertensive Older Thai Adults.

Hypertensive older adults will benefit if there is a clear understanding of the factors related to sodium reduction. That would raise awareness of the causes, consequently reducing many health risks, lowering health care costs, and diminishing economic and social burden from high blood pressure. This study explored predictors of urinary sodium excretion. A cross-sectional, correlational study was conducted in 312 hypertensive older Thai adults. Questionnaires related to knowledge, self-care agency, self-care behavior of sodium reduction, and 24-hour urinary sodium analyses were used, followed by the application of structural equation modeling and the Analysis of Moment Structures program. Self-care agency, knowledge, self-care behavior, rural/urban location, and education accounted for 61% of urinary sodium excretion. Self-care agency, knowledge, and self-care behavior were the main predictors in the urinary sodium excretion model. This study suggests establishing supportive educative sodium reduction-related programs that improve knowledge and enhance self-care agency, as well as a comparison of the changes of sodium reduction self-care behavior and urinary sodium excretion over time after the intervention.

Growing Up on an Appalachian Farm: A Centenarian Perspective.

Background Research on centenarians to date has focused on areas with a high population of centenarians. However, there is limited literature on centenarians' perspectives about growing up on farms from the heartland of Appalachia in Eastern Tennessee. Purpose This qualitative descriptive study was designed to characterize the role of a farming childhood by exploring the viewpoints of community-dwelling centenarians who grew up on farms in south central Appalachia. Methods A qualitative descriptive design was used with a convenience sample ( n = 16). Cognitive status was determined with the Short Portable Mental Status Questionnaire. Demographic data were collected. Interviews were transcribed and analyzed with the Neuendorf method of content analysis. Results Main emerging themes were the farm, the family, and the environment. Conclusion The farm was at the center of these centenarians' childhood, influencing their family, community relations, and social interactions, which provided lessons that they utilized throughout their long lives.

Severe sepsis in older adults.

Severe sepsis may be underrecognized in older adults. Therefore, the purpose of this article is to review special considerations related to early detection of severe sepsis in older adults. Normal organ changes attributed to aging may delay early detection of sepsis at the time when interventions have the greatest potential to improve patient outcomes. Systems are reviewed for changes. For example, the cardiovascular system may have a limited or absent compensatory response to inflammation after an infectious insult, and the febrile response and recruitment of white blood cells may be blunted because of immunosenescence in aging. Three of the 4 hallmark responses (temperature, heart rate, and white blood cell count) to systemic inflammation may be diminished in older adults as compared with younger adults. It is important to consider that older adults may not always manifest the typical systemic inflammatory response syndrome. Atypical signs such as confusion, decreased appetite, and unsteady gait may occur before sepsis related organ failure. Systemic inflammatory response syndrome criteria and a comparison of organ failure criteria were reviewed. Mortality rates in sepsis and severe sepsis remain high and are often complicated by multiple organ failures. As the numbers of older adults increase, early identification and prompt treatment is crucial in improving patient outcomes.

Religiousness/Spirituality and anger management in community-dwelling older persons.

Mismanaged anger is associated with adverse health outcomes. This study examined whether dimensions of religiousness/spirituality could predict healthy anger management in a sample of 82 community-dwelling older Americans. A correlational research design was employed using the Deffenbacher Anger Scale and the Brief Multidimensional Measure of Religiousness/Spirituality. Higher scores on Forgiveness, Daily Spiritual Experiences, Religiousness/Spirituality as Coping, and Self-Ranking of Religiousness/Spirituality were correlated with healthier anger management; however forgiveness was the only significant predictor in the regression analysis. Interventions to facilitate forgiveness may promote healthy anger management and minimize the adverse health effects of mismanaged anger.

Health risk factors associated with presenteeism in the workplace.

OBJECTIVE: An emerging concern in the workplace is the productivity of employees who come to work instead of staying home when they are ill, also referred to as presenteeism. This study examined the health risks associated with presenteeism. METHODS: Using a cross-sectional correlational design, we used data from a 2010 self-reported wellness surveys. A negative binomial regression model was used to explore the association between employee health risks and presenteeism. RESULTS: The findings revealed that workplace stress (ß = 0.76; P < 0.001), stress at home (ß = 0.87; P < 0.001), and financial stress (ß = 0.59; P < 0.001) were related to presenteeism. Other health risks were not associated with presenteeism. CONCLUSIONS: We found that only stress was related to presenteeism, and other health risks were unrelated to presenteeism.

Teaching/learning strategies for the essentials of baccalaureate nursing education for entry-level community/public health nursing.

The purpose of this article is to describe teaching/learning strategies for each of the 15 Essentials of Baccalaureate Nursing Education for Entry-Level Community/Public Health Nursing (ACHNE, 2009). Carper's ways of knowing serve as foundations for creating classroom and clinical experiences that focus on clinical action with community as client. Each community/public health essential is defined with relevance to community/public health nursing practice. Five teaching/learning strategies have been delineated for each essential with suggestions of teaching resources and/or target population application. Teaching/learning strategies that focus on community as client, population health, and the essential knowledge and competencies of C/PH nursing will help ensure preparation of baccalaureate prepared nurses with knowledge and skills to improve the health of populations.

A causal model of depression among older adults in Chon Buri Province, Thailand.

The purposes of this study are to develop and empirically test a theoretical model that examines the relationships between a set of predictors and depression among older adults. A biopsychosocial model was tested with 317 community dwelling older adults residing in Chon Buri Province, Thailand. A face-to-face interview was used in a cross-sectional community-based survey. A hypothesized model of depression was tested by using path analysis. It was found that the modified model fitted the data and the predictors accounted for 60% of the variance in depression. Female gender, activities of daily living, loneliness, stressful life events, and emotional-focused coping had a positive direct effect on depression. Social support and problem-focused coping had a negative direct effect on depression. Additionally, perceived stress, stressful life events, loneliness, and income had a negative indirect effect on depression through social support. Female gender, activities of daily living, and perceived stress also had a positive indirect effect on depression through emotional-focused coping. Stressful life events, perceived stress, and income had a negative indirect effect on depression through problem-focused coping. These findings contribute to a better understanding of the variables that predict depression in older adults. Thus, health care providers should consider the effects of these contributing factors on depression in the older adult person and can devise a program to prevent and promote health in older adults alleviating depression.

Becoming an older volunteer: a grounded theory study.

This Grounded Theory study describes the process by which older persons "become" volunteers. Forty interviews of older persons who volunteered for Habitat for Humanity were subjected to secondary content analysis to uncover the process of "becoming" a volunteer. "Helping out" (core category) for older volunteers occurs within the context of "continuity", "commitment" and "connection" which provide motivation for volunteering. When a need arises, older volunteers "help out" physically and financially as health and resources permit. Benefits described as "blessings" of volunteering become motivators for future volunteering. Findings suggest that older volunteering is a developmental process and learned behavior which should be fostered in older persons by personally inviting them to volunteer. Intergenerational volunteering projects will allow older persons to pass on knowledge and skills and provide positive role modeling for younger volunteers.

Nutritional screening in community dwelling older adults.

AIMS AND OBJECTIVES: The purpose of this study was to test whether a combination of validated tools, one for each of five leading nutritional risk factors, could predict unintentional weight loss in community dwelling older adults. BACKGROUND: Non-invasive, easily administered nutritional screening tools for community dwelling older adults are few and those that are available are problematic. METHOD: Convenience samples of 115 adults ≥65 were interviewed. Height, weight and measures of the five nutritional risk factors were collected at interviews 6 months apart. DESIGN: Repeated measures. RESULTS: 91 subjects completing T2 were largely white (95.6%), female (69%), well educated and in good health. Multiple regression was conducted with unintentional weight loss as the dependent variable and depression (the GDS-SF), the Lubben Social Networking Scale, food security, food intake and Independent Activities of Daily Living as the predictor variables. The regression model was statistically significant (F (5, 85) = 0.30852, P = 0.003) with an adjusted r(2) of 0.137. CONCLUSIONS: Five validated tools can be administered by nurses or non-professionals to screen for nutritional risk factors leading to unintentional weight loss. IMPLICATIONS FOR PRACTICE: Early screening has the potential to identify either nutritional risk or nutritional decline in older adults.

Body mass index knowledge of older adults and motivation to change.

Worldwide, 1.6 billion adults are overweight and 400 million are obese. For older adults, being in these categories exacerbates multiple chronic diseases and leads to frailty. The aim of this study was to explore the knowledge of older adults in Ireland and the USA about their body mass index (BMI) category and motivation to change. A quantitative descriptive research design was used in the study. Two convenience samples of community-dwelling older adults, one in Ireland (n=70) and one in the USA (n=70) participated in the study. Data was collected in the form of questionnaires and BMI was calculated. This study found that fewer Irish participants knew their BMI category. In both groups, measured BMI differed greatly from self-perceived BMI. These findings suggest that older adults are unaware of their weight status and therefore do not know that they are in a BMI category with multiple health consequences.

Relationships among stress, infectious illness, and religiousness/spirituality in community-dwelling older adults.

The purpose of this study was to examine the relationships among stress, infectious illness, and religiousness/spirituality in community-dwelling older adults in the southeastern United States. Four assessment tools were completed by 82 older adults (mean age = 74, age range = 65 to 91): the Perceived Stress Scale, the Carr Infection Symptom Checklist (SCL), the Brief Multidimensional Measurement of Religiousness/Spirituality, and a demographic form. A significant correlation was found between stress and SCL scores; however, four dimensions of religiousness/spirituality moderated the relationship between stress and infection. Older adults who were unable to forgive themselves or forgive others, or feel forgiven by God, were more likely to have had an infection in the previous month. Increased infections also occurred when older participants did not feel they had religious support from their congregations. Using these findings, gerontological nurses are well positioned to deliver tailored stress management and forgiveness interventions when older adults report increased stress.

Ready for the World: preparing nursing students for tomorrow.

In 2004, a 5-year plan of international and intercultural education was developed by the University of Tennessee, Knoxville (UTK) to help students become ready for the changing world in which they will live. This program is called "Ready for the World." The University of Tennessee College of Nursing in Knoxville has integrated many of the suggestions from this program into the undergraduate nursing curriculum to prepare students for the world by making the world their classroom. Intercultural learning includes both a solid base of knowledge obtained in the classroom and multiple experiences that involve cultural interaction. Experiences begin on UTK's diverse campus and expand to the surrounding city of Knoxville, including interactions with vulnerable populations such as the homeless or elderly persons, then to nearby Appalachian communities, and on to Central America. Many of these experiences are offered for credit in the Community Health Nursing or the Transcultural Nursing courses. The knowledge nursing students acquire and their varied experiences will help them gain cultural competence for their future nursing practice.

Screening instruments for older adult depressive disorders: updating the evidence-based toolbox.

The prevalence of clinically significant depressive disorders in persons 65 years of age or older in the United States has been estimated to be approximately 15%, increasing the risk for functional decline, morbidity, and mortality. Utilization of a well-chosen screening instrument has been shown to improve the rates of recognition of depressive disorders in older adults. This paper presents a targeted review of the most commonly accepted tools for case-finding of depressive disorders in older adults. After a review of the benefits and shortcomings of screening tools, the strengths, weaknesses, and utility of selected depression scales in geriatric clinical settings are discussed.

Screening for nutritional risk in community-dwelling old-old.

Screening tools for detecting declining nutrition in community-dwelling old-old are few and problematic. The purpose of this study was to identify the leading risk factors associated with noninvasive measures of poor nutritional status among elders aged 80 or older still living independently in the community. This cross-sectional descriptive study included 68 community-dwelling old-old (average age 85.7). Participants were recruited by parish nurses. In-home interviews were conducted. Relationships between five well-established measures of nutritional risk factors and two measures of nutritional status, body mass index (BMI) categories, and unintentional weight loss were examined. Depression and the food pyramid groups with adequate amounts eaten were predictive of unintentional weight loss in the previous 6 months (p = 0.013) but not of high or low BMI. In this sample, 25% were obese. Screening for depression and food intake may be useful in predicting nutritional decline among community-dwelling old-old and point to targeted interventions in a population who are large users of health care dollars.

Frequency of hallway ambulation by hospitalized older adults on medical units of an academic hospital.

Lack of activity during hospitalization may contribute to functional decline. The purpose of this study was to determine the frequency of hallway walking by older adults hospitalized for medical illness. The study was an observational time-sampled study, which was conducted in the hallways of 3 medical units of a 485-bed academic health care center. Each unit was observed weekdays for eight 3-hour intervals covering 8 AM to 8 PM. Before each observation, nursing staff were questioned about walking abilities of patients aged

Admission and discharge mobility of frail hospitalized older adults.

Functional decline during hospitalization is an important clinical problem with potential longlasting undesirable outcomes in frail elders. However, little is known about the change in mobility during hospitalization and the association with discharge status. A Mobility Classification Tool has been developed that categorizes progression of patients' in-hospital mobility using a 5-point scale. The validity and clinical usefulness of this tool was evaluated in a sample of 60 frail older adults hospitalized for medical illness. The tool allows nurses to assess, quantify, and communicate mobility levels and changes in mobility more accurately.

Understanding nutritional health in older adults. A pilot study.

A pilot study of adults ages 65 and older admitted to an acute care setting was conducted to compare nutritional risk as measured by hospital dieticians with two Nutrition Screening Initiative tools, the DETERMINE Your Nutritional Health Checklist and the Level I Screen, and to elicit from patients their own perceptions of nutritional health. Ten community-living older adults were interviewed. Although all 10 were at nutritional risk as measured by both hospital assessment and nutritional risk screening tools, none of these patients believed themselves to be at risk. One conclusion of this pilot is that interventions and education need to be tailored to the perceptions of targeted individuals.

Views of community-dwelling, old-old people on barriers and aids to nutritional health.

PURPOSE: To examine barriers and aids to maintaining the nutritional health of community-dwelling old-old residents from their perspectives. DESIGN: Cross-sectional exploratory study completed in March 2002 of old-old people living independently in one county in the Midwestern United States (US). METHODS: Sixty-eight in-home interviews were conducted with community-dwelling people aged 80 or older. Content analysis was done to examine answers to two open-ended questions about barriers and helps to nutritional health. FINDINGS: These old-old people believed they were doing well nutritionally despite reduced independence and physical limitations. They were positive about their lives and creative in problem solving to remain independent. Social connectedness was the major factor for maintaining independence into old age. The leading barrier to maintaining nutritional health was health problems. Those with more barriers were more likely to be depressed. CONCLUSIONS: Knowledge of aids and barriers to nutritional health, from a personal perspective, gives an understanding of the issues and concerns of old-old people.