Effectiveness of fracture liaison service in reducing the risk of secondary fragility fractures in adults aged 50 and older: a systematic review and meta-analysis.

To determine and appraise the certainty of fracture liaison service (FLS) in reducing the risk of secondary fragility fractures in older adults aged ≥ 50 years and to examine the nature of the FLS and the roles of various disciplines involved in the delivery of the FLS. Medline, EMBASE, PubMed, CINAHL, SCOPUS, and The Cochrane Library were searched from January 1st, 2010, to May 31st, 2022. Two reviewers independently extracted data. The risk of bias was evaluated using the Newcastle-Ottawa Scale for cohort studies and the PEDro scale for randomized trials, while the GRADE approach established the certainty of the evidence. Thirty-seven studies were identified of which 34 (91.9%) were rated as having a low risk of bias and 22 (59.5%) were meta-analyzed. Clinically important low certainty evidence at 1 year (RR 0.26, CI 0.13 to 0.52, 6 pooled studies) and moderate certainty evidence at ≥ 2 years (RR 0.68, CI 0.55 to 0.83, 13 pooled studies) indicate that the risk of secondary fragility fracture was lower in the FLS intervention compared to the non-FLS intervention. Sensitivity analyses with no observed heterogeneity confirmed these findings. This review found clinically important moderate certainty evidence showing that the risk of secondary fragility fracture was lower in the FLS intervention at ≥ 2 years. More high-quality studies in this field could improve the certainty of the evidence. Review registration: PROSPERO-CRD42021266408.

Family caregiver readiness to adopt smart home technology to monitor care-Dependent older adults: A qualitative exploratory study.

AIMS: The aim of this study was to explore factors that influence family caregiver readiness to adopt health smart home technology for their care-dependent older adult family member. Health smart homes are designed to remotely monitor the health and wellness of community-dwelling older adults supporting independent living for as long as possible. Accordingly, if the health smart home is deployed into the home of a care-depended older adult, it can potentially support family caregivers by facilitating workforce participation and give piece of mind to the family caregiver who may not live close to the older adult. However, wider adoption of health smart home technologies into the homes of community-older adults is low, and little is known about the factors that influence the readiness of family caregivers to adopt smart home technologies for their care-dependent older adults. DESIGN: A qualitative Descriptive study design was utilized. METHODS: Qualitative data were collected between 2019 and 2020 via semi-structured interviews. Thematic analysis of interviews was completed, and data were organized into themes. RESULTS: Study findings show that caregiver readiness (N = 10) to adopt smart home technology to monitor older adult family members were influenced by five primary themes including a 'big brother effect', 'framing for acceptance', 'data privacy', 'burden' and 'cost.' CONCLUSION: Family caregivers were open to adopting smart home technology to support the independent living of their older adult family members. However, the readiness of family caregivers was inextricably linked to the older adults' readiness for smart home adoption. The family caregiver's primary concern was on how they could frame the idea of the smart home to overcome what they viewed as hesitancy to adopt in the older adult. The findings suggest that family caregivers endeavour to balance the hesitancy in their older adult family members with the potential benefits of smart home technology. IMPACT: Family caregivers could benefit if their care-dependent older adults adopt smart home technology. Recognizing the role of caregivers and their perspectives on using smart home technologies with their care-dependents is critical to the meaningful design, use and adoption.

Prevalence of psychological symptoms and their correlates among physiotherapy clinical students: A cross-sectional study.

Background: Mental health in medical students is well researched, with physiotherapy students receiving less attention even though psychiatry is a recognised specialty within physiotherapy. Objectives: To assess the prevalence and correlates of depression, anxiety and stress among physiotherapy clinical students. Methods: A descriptive cross-sectional study design was employed on 402 physiotherapy clinical students aged 17-40 years using a convenience sampling method. The data were collected using the self-administered 42-items Depression, Anxiety and Stress scale (DASS) and the data were analysed using a Chi-square test and binary logistic regression analysis. Results: The prevalence of depression, anxiety and stress among these students was 79.9%, 85.6% and 81.6%, respectively. The results indicate that financial status and social life influenced depression by 20.6% (odds ratio [OR] [95%] = 1.206 [1.110, 1.311]) and 36% (OR [95%] = 1.360 [1.050, 1.764]), respectively. Fear of repeating a class influenced anxiety by eight times (OR [95%] = 8.330 [6.643, 10.422]). Fear of repeating a class, financial status and academic performance influenced stress by eight times (OR [95%] = 8.360 [6.677, 10.470]), 17.5% (OR [95%] = 1.175 [1.083, 1.275]) and 18.1% (OR [95%] = 1.181 [1.083, 1.276]), respectively. Conclusion: Our study concluded that there was a high prevalence of depression, anxiety and stress among physiotherapy clinical students. These outcomes suggest that more attention needs to be given to improving physiotherapy clinical students' mental health, which will ultimately improve learning outcomes. Clinical implications: The long-term effects of psychological distress could potentially impact students' academic performance. It may also have long-lasting effects after graduation. Therefore, students who are at risk of developing psychological symptoms are needed to be thoroughly examined and then receive early required interventions.

Nurse-in-the-loop smart home detection of health events associated with diagnosed chronic conditions: A case-event series.

Background: Telehealth and home-based care options significantly expanded during the SARS-CoV2 pandemic. Sophisticated, remote monitoring technologies now exist that support at-home care. Advances in the research of smart homes for health monitoring have shown these technologies are capable of recognizing and predicting health changes in near-real time. However, few nurses are familiar enough with this technology to use smart homes for optimizing patient care or expanding their reach into the home between healthcare touch points. Objective: The objective of this work is to explore a partnership between nurses and smart homes for automated remote monitoring and assessing of patient health. We present a series of health event cases to demonstrate how this partnership may be harnessed to effectively detect and report on clinically relevant health events that can be automatically detected by smart homes. Participants: 25 participants with multiple chronic health conditions. Methods: Ambient sensors were installed in the homes of 25 participants with multiple chronic health conditions. Motion, light, temperature, and door usage data were continuously collected from participants' homes. Descriptions of health events and participants' associated behaviors were captured via weekly nursing telehealth visits with study participants and used to analyze sensor data representing health events. Two cases of participants with congestive heart failure exacerbations, one case of urinary tract infection, two cases of bowel inflammation flares, and four cases of participants with sleep interruption were explored. Results: For each case, clinically relevant health events aligned with changes from baseline in behavior data patterns derived from sensors installed in the participant's home. In some cases, the detected event was precipitated by additional behavior patterns that could be used to predict the event. Conclusions: We found evidence in this case series that continuous sensor-based monitoring of patient behavior in home settings may be used to provide automated detection of health events. Nursing insights into smart home sensor data could be used to initiate preventive strategies and provide timely intervention. Tweetable abstract: Nurses partnered with smart homes could detect exacerbations of health conditions at home leading to early intervention.

Systematic review of perception of barriers and facilitators to chronic disease self-management among older adults: Implications for evidence-based practice.

BACKGROUND: An aging population has contributed to an increased prevalence in chronic disease. To empower patients, healthcare systems are shifting toward chronic disease self-management. However, no review on how older adults self-manage chronic disease and the barriers and facilitators they experience has been published. AIMS: To explore barriers and facilitators perceived by older adults during the process of self-managing chronic disease. METHODS: A systematic review of qualitative literature was performed using the Joanna Briggs Institute methodology. The literature search was conducted using Ovid databases (MEDLINE, CINAHL with full text, and PsycINFO) for the period of 1988-2020. All records were screened using predetermined eligibility criteria. The critical appraisal instrument QARI (Qualitative Assessment and Review Instrument) was employed to assess the quality of the included studies. Data from the included papers were extracted using the QARI data extraction tool. Extracted data were then synthesized to produce final sets of themes and sub-themes relating to the review question. RESULTS: A total of 267 abstracts were screened, and 13 studies reporting barriers and facilitators perceived by older adults during the process of managing chronic diseases were included in the review. Physical and cognitive decline, low-health literacy, culture, and relationships with healthcare professionals were described as barriers. Facilitators were described as resources that supported disease self-management and included family, social networks, healthcare professionals, and religious beliefs. LINKING EVIDENCE TO ACTION: This study highlights the importance of understanding the patients' perspectives of the barriers and enablers of self-management of chronic illness for health professionals across settings. Understanding barriers and facilitators to chronic disease self-management will support health professionals to identify strength-based approaches to self-management that meet the needs of individual older adults.

Knowledge and current practices of Nigerian physiotherapists on the physical activity and exercise training in the rehabilitation of patients with asthma.

OBJECTIVES: The study aimed to determine the knowledge and current practices of Nigerian physiotherapists on the physical activity and exercise training in the rehabilitation of patients with asthma and to determine if any difference exists between novice and expert professionals. METHODS: This was designed as a cross-sectional study. A total of 311 practicing physiotherapists in Nigeria participated in the study. An electronic questionnaire comprising 34 semi-structured questions with three domains; personal information, knowledge, and current practices, was used to collect data throughout 4-months. Data were analyzed using a pragmatist paradigm. RESULTS: Out of the physiotherapists, 51.8% (n = 161) had postgraduate degrees, 46.9% (n = 146) had bachelor's degrees, and 1.3% (n = 4) had a doctor of physiotherapy degrees. The result also indicates that 45.3% (n = 141) of the physiotherapists had insufficient knowledge about asthma, and 39.5% (n = 123) were not using current clinical practice in the rehabilitation of patients with asthma. The results also indicate that expert physiotherapist has more knowledge and also uses current practices when compared to novice physiotherapist. CONCLUSIONS: Even though expert physiotherapists have better knowledge and current practices when compared to the novice physiotherapists, the overall outcomes indicate that Nigerian physiotherapists had insufficient knowledge about asthma and were not using current clinical practice in the rehabilitation of patients with asthma.

The use of theory in qualitative research: Challenges, development of a framework and exemplar.

BACKGROUND: Whilst theoretical grounding is considered important for sound research methodology, consensus on the application of theory in qualitative research remains elusive. Novice researchers may experience challenges in applying theory in qualitative research and these may contribute to the under-use, over-reliance or inappropriate application of theory. Practical guidance on how theory can inform and guide the conduct of qualitative research is needed. PURPOSE: The purpose of this paper was to propose a framework for the application of theory in qualitative research and provide an exemplar. METHODS: The Theoretical Application Framework for Qualitative Studies (TAF-QS) was developed from the synthesis of existing literature and the authors' own experience of the application of theory. RESULTS: The TAF-QS encourages researchers to articulate which theoretical framework or conceptional framework they are drawing on and how this will be applied by reflecting on the purpose and the context of the study. CONCLUSION: The TAF-QS provides support for researchers to explore how theory can be applied and how to achieve this in qualitative research. TWEETABLE ABSTRACT: The use of theory in qualitative research.

Factors influencing community-dwelling older adults' readiness to adopt smart home technology: A qualitative exploratory study.

AIMS: Ageing-in-place for older people could be more feasible with the support of smart home technology. Ageing in-place may maximize the independence of older adults and enhance their well-being and quality of life, while decreasing the financial burden of residential care costs, and addressing workforce shortages. However, the uptake of smart home technology is very low among older adults. Accordingly, the aim of this study was to explore factors influencing community-dwelling older adults' readiness to adopt smart home technology. DESIGN: A qualitative exploratory study design was utilized. METHODS: Descriptive data were collected between 2019 and 2020 to provide context of sample characteristics for community-dwelling older adults aged ≥65 years. Qualitative data were collected via semi-structured interviews and focus groups, to generate an understanding of older adult's perspectives. Thematic analysis of interviews and focus group transcripts was completed. The Elderadopt model was the conceptual framework used in the analysis of the findings. RESULTS: Several factors influenced community-dwelling older adults' (N = 19) readiness to adopt smart home technology. Five qualitative themes were identified: knowledge, health and safety, independence, security and cost. CONCLUSION: Community-dwelling older adults were open to adopting smart home technology to support independence despite some concerns about security and loss of privacy. Opportunities to share information about smart home technology need to be increased to promote awareness and discussion. IMPACT: Wider adoption of smart home technology globally into the model of aged care can have positive impacts on caregiver burden, clinical workforce, health care utilization and health care economics. Nurses, as the main providers of healthcare in this sector need to be knowledgeable about the options available and be able to provide information and respond to questions know about ageing-in-place technologies to best support older adults and their families.

A Comparison Between the Effect of Combined Chain Exercises Plus Kinesio Taping With Combined Chain Exercises Alone in Knee Osteoarthritis: A Randomized Clinical Trial.

OBJECTIVE: This study aimed to examine the effect of Kinesio taping as an adjunct to combined chain exercises compared with combined chain exercises alone in the management of individuals with knee osteoarthritis. METHODS: A total of 60 (27 male, 33 female) individuals (age range = 50-71 yrs and mean age = 54.26 ± 8.83 yrs) diagnosed as having mild to moderate knee osteoarthritis (based on the Kellgren and Lawrence grade I-III classification) were randomly allocated into two groups with 30 participants each in the Kinesio taping + combined chain exercises and combined chain exercises groups. Participants in the Kinesio taping + combined chain exercises group received Kinesio taping plus combined chain exercises and those in the combined chain exercises group received only combined chain exercises. Each participant was assessed for pain, range of motion, functional mobility, and quality of life at baseline and after 8 wks of intervention. A mixed-design multivariate analysis of variance was used to analyze the treatment effect. RESULTS: No significant differences were observed in the baseline characteristics of participants in both groups. The result indicated that there was a significant time effect for all outcomes, with a significant interaction between time and intervention (P < 0.001). The Bonferroni post hoc analyses of time and intervention effects indicated that the Kinesio taping + combined chain exercises group improved significantly better than the combined chain exercises group in all outcomes, pain (mean = 2.01 [0.64] vs. 3.94 [1.12], F[df] = 5.466[1,58], P = 0.011), flexion range of motion (mean = 121.15 [2.07] vs. 104.28 [3.24], F[df] = 26.722[1,58], P < 0.001), functional mobility (mean = 19.47 [1.95] vs. 31.01 [2.39], F[df] = 29.436[1,58], P < 0.001), and quality of life (mean = 68.76 [3.19] vs. 45.62 [2.87], F[df] = 71.984[1,58], P < 0.001), after 8 wks of intervention. CONCLUSIONS: The findings of this study concluded that Kinesio taping + combined chain exercises and combined chain exercises were both effective but Kinesio taping plus combined chain exercises was more effective in the management of individuals with knee osteoarthritis. TRIAL REGISTRATION: Pan African Clinical Trial Registry: PACTR201810603949411.

Automated Smart Home Assessment to Support Pain Management: Multiple Methods Analysis.

BACKGROUND: Poorly managed pain can lead to substance use disorders, depression, suicide, worsening health, and increased use of health services. Most pain assessments occur in clinical settings away from patients' natural environments. Advances in smart home technology may allow observation of pain in the home setting. Smart homes recognizing human behaviors may be useful for quantifying functional pain interference, thereby creating new ways of assessing pain and supporting people living with pain. OBJECTIVE: This study aimed to determine if a smart home can detect pain-related behaviors to perform automated assessment and support intervention for persons with chronic pain. METHODS: A multiple methods, secondary data analysis was conducted using historic ambient sensor data and weekly nursing assessment data from 11 independent older adults reporting pain across 1-2 years of smart home monitoring. A qualitative approach was used to interpret sensor-based data of 27 unique pain events to support clinician-guided training of a machine learning model. A periodogram was used to calculate circadian rhythm strength, and a random forest containing 100 trees was employed to train a machine learning model to recognize pain-related behaviors. The model extracted 550 behavioral markers for each sensor-based data segment. These were treated as both a binary classification problem (event, control) and a regression problem. RESULTS: We found 13 clinically relevant behaviors, revealing 6 pain-related behavioral qualitative themes. Quantitative results were classified using a clinician-guided random forest technique that yielded a classification accuracy of 0.70, sensitivity of 0.72, specificity of 0.69, area under the receiver operating characteristic curve of 0.756, and area under the precision-recall curve of 0.777 in comparison to using standard anomaly detection techniques without clinician guidance (0.16 accuracy achieved; P<.001). The regression formulation achieved moderate correlation, with r=0.42. CONCLUSIONS: Findings of this secondary data analysis reveal that a pain-assessing smart home may recognize pain-related behaviors. Utilizing clinicians' real-world knowledge when developing pain-assessing machine learning models improves the model's performance. A larger study focusing on pain-related behaviors is warranted to improve and test model performance.

The Role of Virtual Reality in Improving Health Outcomes for Community-Dwelling Older Adults: Systematic Review.

BACKGROUND: Virtual reality (VR) delivered through immersive headsets creates an opportunity to deliver interventions to improve physical, mental, and psychosocial health outcomes. VR app studies with older adults have primarily focused on rehabilitation and physical function including gait, balance, fall prevention, pain management, and cognition. Several systematic reviews have previously been conducted, but much of the extant literature is focused on rehabilitation or other institutional settings, and little is known about the effectiveness of VR apps using immersive headsets to target health outcomes among community-dwelling older adults. OBJECTIVE: The objective of this review was to evaluate the effectiveness of VR apps delivered using commercially available immersive headsets to improve physical, mental, or psychosocial health outcomes in community-dwelling older adults. METHODS: Peer-reviewed publications that included community-dwelling older adults aged ≥60 years residing in residential aged care settings and nursing homes were included. This systematic review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness evidence. The title of this review was registered with JBI, and the systematic review protocol was registered with the International Prospective Register of Systematic Reviews. RESULTS: In total, 7 studies that specifically included community-dwelling older adults were included in this review. VR apps using a head-mounted display led to improvements in a number of health outcomes, including pain management, posture, cognitive functioning specifically related to Alzheimer disease, and a decreased risk of falls. A total of 6 studies reported a statistically significant difference post VR intervention, and 1 study reported an improvement in cognitive function to reduce navigational errors. Only one study reported on the usability and acceptability of the interventions delivered through VR. While one study used a distraction mechanism for pain management, none of the studies used gaming technology to promote enjoyment. CONCLUSIONS: Interventions to improve health outcomes through VR have demonstrated potential; however, the ability to synthesize findings by primary outcome for the older adult population is not possible. A number of factors, especially related to frailty, usability, and acceptability, also need to be explored before more substantial recommendations on the effectiveness of VR interventions for older adults can be made. TRIAL REGISTRATION: PROSPERO CRD42019143504; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=143504.

Hospitalized Adult Patient Characteristics Associated With Participation in a Volunteer-Assisted Mobility Program: A Feasibility Study.

BACKGROUND: Physical inactivity during hospitalization commonly results in functional decline. Structured multidisciplinary programs/approaches may be useful to promote mobility in hospitalized adults. PURPOSE: The purpose was to determine whether a volunteer-assisted mobility program was feasible to improve the ambulation of hospitalized patients, and examine the characteristics of patients associated with willingness to participate in the program. METHODS: A prospective descriptive correlation study was conducted in 2 acute care units. A volunteer-staffed program was implemented with the aim of improving the ambulation of hospitalized patients. RESULTS: Hospitalized patients (N = 490) were approached, with 39.2% (n = 192) agreeing to ambulate an average of 109.7 m (interquartile range = 51.45-172.2 m). Patients with a low clinical frailty score, high body mass index, or physical therapy order were more likely to participate in the volunteer-assisted mobility program. CONCLUSIONS: The findings suggest that a volunteer-assisted interdisciplinary program is a feasible way to promote the ambulation of some patients.

Interpreting Health Events in Big Data Using Qualitative Traditions.

The training of artificial intelligence requires integrating real-world context and mathematical computations. To achieve efficacious smart health artificial intelligence, contextual clinical knowledge serving as ground truth is required. Qualitative methods are well-suited to lend consistent and valid ground truth. In this methods article, we illustrate the use of qualitative descriptive methods for providing ground truth when training an intelligent agent to detect Restless Leg Syndrome. We show how one interdisciplinary, inter-methodological research team used both sensor-based data and the participant's description of their experience with an episode of Restless Leg Syndrome for training the intelligent agent. We make the case for clinicians with qualitative research expertise to be included at the design table to ensure optimal efficacy of smart health artificial intelligence and a positive end-user experience.

A conceptual framework for clinicians working with artificial intelligence and health-assistive Smart Homes.

The Smart Home designed to extend older adults independence is emerging as a clinical solution to the growing ageing population. Nurses will and should play a key role in the development and application of Smart Home technology. Accordingly, conceptual frameworks are needed for nurse scientists who are collaborating with multidisciplinary research teams in developing an intelligent Smart Home that assists with managing older adults' health. We present a conceptual framework that is grounded in critical realism and pragmatism, informing a unique mixed methodological approach to generating, analyzing, and contextualizing sensor data for clinician-based machine learning. This framework can guide nurse scientists in knowledge construction as they participate in multidisciplinary health-assistive Smart Home and artificial intelligence research. In this paper, we review philosophical underpinnings and explicate how this framework can guide nurse scientists collaborating with engineers to develop intelligent health-assistive Smart Homes. It is critical that clinical nursing knowledge is integrated into Smart Home and artificial intelligence features. A conceptual framework and practical method will provide needed structure for knowledge construction by nurse scientists.

Enhancing Post-Baccalaureate Doctor of Nursing Practice students' analytic skills.

Programs with several paths to the Doctor of Nursing Practice (DNP) face significant difficulties in preparing clinical scholars who can transform healthcare. While Post-Baccalaureate to DNP (BSN-DNP) programs are fulfilling the Institute of Medicine's mandate for seamless academic progression, several factors need to be considered for students' successful program completion. These factors include: (1) the students' stage of cognitive development for strategic thinking (metacognition); (2) students' tendency to underestimate the rigors of doctoral educational requirements; and (3) faculty challenges in helping students to acquire skills needed to complete the DNP project. The purpose of this paper is to describe learner-centered approaches to enhance analytic preparation of BSN-DNP students.

A nurse-driven method for developing artificial intelligence in "smart" homes for aging-in-place.

OBJECTIVES: To offer practical guidance to nurse investigators interested in multidisciplinary research that includes assisting in the development of artificial intelligence (AI) algorithms for "smart" health management and aging-in-place. METHODS: Ten health-assistive Smart Homes were deployed to chronically ill older adults from 2015 to 2018. Data were collected using five sensor types (infrared motion, contact, light, temperature, and humidity). Nurses used telehealth and home visitation to collect health data and provide ground truth annotation for training intelligent algorithms using raw sensor data containing health events. FINDINGS: Nurses assisting with the development of health-assistive AI may encounter unique challenges and opportunities. We recommend: (a) using a practical and consistent method for collecting field data, (b) using nurse-driven measures for data analytics, (c) multidisciplinary communication occur on an engineering-preferred platform. CONCLUSIONS: Practical frameworks to guide nurse investigators integrating clinical data with sensor data for training machine learning algorithms may build capacity for nurses to make significant contributions to developing AI for health-assistive Smart Homes.

Mobility Programs for the Hospitalized Older Adult: A Scoping Review.

Objectives: This scoping review (a) describes programs to improve mobility in hospitalized adults and (b) determines the methods used to measure mobility. Method: The Joanna Briggs Institute Methodology for Scoping Reviews was used to conduct this review. Results: Our findings suggest that using a multidisciplinary approach may be the most effective way to promote mobility in hospitalized older adults. Most studies did not articulate how physical activity was measured, indicating that more research is needed. Discussion: The literature shows that implementation of protocols designed to improve the early and regular implementation of physical mobility activities improves the health outcomes of hospitalized older people. Costs associated with healthcare utilization are also reduced, including hospital length of stay. Mobility programs that quantified mobility through validated measurement tools or accelerometers are the most promising as they provide feedback that reinforces progress of the patient and the expected benefits of early mobility.

Barriers to Promoting Mobility in Hospitalized Older Adults.

Hospitalized older adults who do not receive sufficient mobility are more likely to sustain negative health outcomes, including higher rates of mortality and institutionalization. Accordingly, the purpose of the current secondary data analysis was to examine the nurse-promoted mobility of hospitalized older adults and the association between nurses' barriers and nurse-promoted mobility. In addition, the relationship among patient severity of illness, proxy levels for function, and nurse-promoted mobility was examined. The final study sample included 61 nurses working in medical units caring for a total of 77 older adults. Findings suggest nurse knowledge gaps and attitude barriers could potentially influence the type and frequency of mobility they promote in older patients. A relationship was found between older patients with impaired mobility using assistive devices for mobility at home, and those at high risk for falls and nurses promoting more sedentary activity (e.g., chair sitting, walking in the room). Interestingly, nurses promoted significantly more sedentary mobility for patients with physical therapy orders. [Res Gerontol Nurs. 2018; 11(1):17-27.].

Nurses' Experience With and Perception of Barriers to Promoting Mobility in Hospitalized Older Adults: A Descriptive Study.

The purpose of the current study was to examine nurses' barriers, including knowledge, attitude, and external barriers, to promoting physical activity in hospitalized older adults. Differences between the perceptions of barriers based on nurses' experience were also examined. A behavioral framework classifying nurse knowledge, nurse attitude, and external barriers was used for the study. Eighty-five nurses were recruited from two community-based hospitals in the Pacific Northwest. The findings suggest that nurses with varying levels of experience perceive a variety of barriers to promoting mobility in hospitalized older adults. Nurses with ≤5 years of experience perceived that they may lack knowledge and training to safely mobilize hospitalized patients and make appropriate referrals to therapists. Nurses' attitudes revealed that they collectively viewed the promotion of mobility as a priority, but novice nurses did not. Further, some nurses deferred the responsibility to promote mobility to other disciplines. [Journal of Gerontological Nursing, 43(11), 22-29.].

ED Utilization and Self-Reported Symptoms in Community-Dwelling Older Adults.

The rise in ED utilization among older adults is a nursing concern, because emergency nurses are uniquely positioned to have a positive impact on the care of older adults. Symptoms have been associated with ED utilization; however, it remains unclear whether symptoms are the primary reason for ED utilization. The purpose of this study was to describe the self-reported symptoms of community-dwelling older adults prior to accessing the emergency department and to examine the differences in self-reported symptoms among those who did and did not utilize the emergency department. METHODS: A prospective longitudinal design was used. The sample included 403 community-dwelling older adults aged 75 years and older. Baseline in-home interviews were conducted followed by monthly telephone interviews over 15 months. RESULTS: Commonly reported symptoms at baseline included pain, feeling tired, and having shortness of breath. In univariate analysis, pain, shortness of breath, fair/poor well-being, and feeling tired were significantly correlated with ED utilization. In multivariable models, problems with balance and fair/poor well-being were significantly associated with ED utilization. DISCUSSION: Several symptoms were common among this cohort of older adults. However, no significant differences were found in the types of symptoms reported by older adults who utilized the emergency department compared with those who did not utilize the emergency department. Based on these findings, it appears that symptoms among community-dwelling older adults may not be the primary reason for ED utilization.