Assessment and measurement of pain in older adults.

Although the empiric base is still limited when providing clear directions for pain assessment and management in older adults, it is possible to identify recommendations for guiding practice based on consensus and a developing scientific base to support best practice activities. A brief overview of the epidemiology and consequences of pain is offered, followed by a summary of issues and approaches relevant to pain assessment in older adults. Cohort-specific recommendations for comprehensive pain assessment and measurement based on current evidence are then addressed, including strategies for assessment of pain in cognitively impaired older adults.

The biological basis of behavioral symptoms in dementia.

This article describes the pathophysiology of dementia and differentiates between cognitive and noncognitive symptoms that characterize this devastating illness. Relationships between brain anatomic and neurochemical systems and behavioral symptoms of dementia are discussed. An overview of the etiologies and neuro-pathologies of dementia are presented as they relate to impairments in memory and intellectual abilities, personality changes, and behavioral symptoms. Recent genetic and molecular discoveries that have advanced our understanding of this complex spectrum of disorders and their treatment(s) are also highlighted.

Life stress, mood disturbance, and elevated interleukin-6 in healthy older women.

BACKGROUND: Although adverse effects of severe chronic stress on immunocompetence and physical well-being in older adults have been reported, the immune response to less severe life stress among healthy older adults, particularly among women, is not well understood. Interleukin-6 (IL-6) has been considered a good overall indicator of immune functioning in older adults because of its contribution to the pathogenesis of several age-related conditions such as osteoporosis. Regulation of IL-6 is impaired in elderly adults, and levels of IL-6 increase with stress and depression. This research cross-sectionally examined levels of IL-6 in three groups of healthy older women with varying levels of life stress and mood disturbance and a healthy group of young women. METHODS: Subjects included 18 caregivers of Alzheimer's patients, 17 older women assessed one month before relocation of their residence, 15 nonmoving and noncaregiving older women, and 20 younger women. Subjects completed the Profile of Mood States (POMS) and had early morning blood draws. RESULTS: Alzheimer's caregivers reported significantly greater distress than women of all other groups. IL-6 levels in caregivers were significantly higher than those of all other women. The older women had significantly higher IL-6 than young controls, but there were no significant differences in IL-6 between movers and older controls. Among all women, greater depression and distress were related to higher levels of IL-6. CONCLUSIONS: These findings suggest that in older women, chronic stressors are associated with significant elevations in IL-6 over and above the elevations associated with normal aging, but that moderate stressors may not be related to appreciable elevations in IL-6.

The effects of attrition on implementing and evaluating a mental health continuing education program for nursing personnel in long-term care facilities.

BACKGROUND: The effects of attrition on a continuing education program for nursing personnel within long-term care facilities are described. METHODS: Allowing flexible participation can enhance the impact of a continuing education program designed for paraprofessional staff. Increasing the number of nursing staff who experience only a portion of the training has implications for the instructional design and the evaluation. Recommendations to improve accommodation of staff and enhance dissemination of training are offered as well as appropriate evaluation techniques. CONCLUSION: Self-contained short units of instruction allow those with minimal time to benefit from the training. Effective evaluation requires special sampling and measurement strategies. Cross-sectional methods make good use of training resources but usually yield measurable changes only in lower-level program objectives.

Geropsychiatric nursing consultation as an adjunct to training in long-term care facilities: the indirect approach.

Creative, collaborative approaches between sub-specialties in nursing are needed to improve the quality of care and, hence, the quality of life for mentally ill and behaviorally impaired older adults living in long-term care (LTC) facilities. Results of a consultation survey collected as part of a larger geriatric mental health training project, and described in this article, support the position that consultee-centered geropsychiatric nursing consultation services are an important adjunct to training. However, this indirect approach to service enhancement may not be well understood and, as a result, not well utilized by LTC nurses. Methods to facilitate understanding and utilization of "indirect" mental health assistance to LTC residents and staff are explored within the context of building productive liaisons among nurses.

Standardized care plan. Managing Alzheimer's patients at home.

1. Family-provided care of members with Alzheimer's disease and related disorders (ADRD) is complicated by the presence of secondary behavioral symptoms, such as agitation, that lead to caregiver depression, burden, and breakdown. 2. Caregiver education to manage secondary symptoms in ADRD can be simplified by using a theoretical framework of person-environment fit, providing a selection of interventions to modify the environment to reduce demand on the dwindling resources of the demented person. 3. The Progressively Lowered Stress Threshold (PLST) model identifies six areas of stress for persons with ADRD fatigue, change of caregiver, environment or routine, demands to achieve beyond capability, multiple and competing stimuli, affective response to perceived losses, and physical stressors.

Geropsychiatric nursing consultation: a valuable resource in rural long-term care.

Psychiatric and geropsychiatric nurse specialists have the potential to positively influence the day-to-day care provided in rural nursing homes by acting as teachers, resource persons, facilitators, and role models to long-term care (LTC) personnel. The combined approach of training LTC nurses to train their own staff while supporting the application of learning with consultee-focused nursing consultation proved to be an effective and time-efficient method of improving the geropsychiatric nursing care provided in rural nursing homes.

Essential clinical experience for subspecialty development in geropsychiatric nursing.

1. Subspecialization in geropsychiatric nursing builds on the specialist preparation obtained in graduate level psychiatric/mental health or gerontologic nursing education. 2. Development of a subspecialty requires a base of substantive knowledge gained in the classroom, supplemented by a series of supervised clinical experiences. 3. Clinical practicum experiences with specific role options for the geropsychiatric clinical nurse specialist and experiences with special populations are essential to the further development of geropsychiatric nursing as a subspecialty.

Evaluation of a geriatric mental health training program for nursing personnel in rural long-term care facilities.

Although mental illness among elderly living in nursing homes is a substantial and growing concern, the behavioral problems associated with mental illness or threats to mental health are not well understood, tolerated, or effectively managed by nursing home staff. As a result, resident care and quality of life, and staff morale often suffer. The need for geriatric mental health training in long-term care settings has become increasingly apparent. Psychiatric/mental health nurses are in an advantageous position to address this current need and future challenge through the development, implementation, and evaluation of geriatric mental health education and training programs in long-term care settings. This article describes one such innovative training effort, designed to improve the quality of psychosocial care provided by nursing personnel in rural long-term care settings, and highlights evaluation outcomes related to participant satisfaction, staff knowledge, and attitudes.

An administrator's dilemma: keeping the innovative mental health and aging programs alive after the grant funds end.

Too often innovative and successful mental health and aging programs terminate when external funding sources end. This article describes one such project that has survived and even flourished well beyond the grant period. The original program is set forth, and changes in both the type of services offered and in the clientele are reviewed. The rationale for deviations from the original model are highlighted. Expansion, contraction and reexpansion of the range of services offered, as well as factors that impeded and enhanced program survival, are noted. The critical role of administrative leadership, vision and support for geropsychiatric services and staff is emphasized.