Examining pain, function, behavioral symptoms and associations with engagement in meaningful activity for residents with dementia in assisted living.

OBJECTIVES: The purpose of this study was to examine factors associated with engagement in meaningful activity among residents with dementia in assisted living. We hypothesized that greater functional independence, less pain, and lower behavioral and psychological symptom severity would be associated with higher engagement in meaningful activity after controlling for residents' age, gender, comorbidities, and cognition. Understanding factors associated with engagement in meaningful activity can help to inform strategies for optimizing engagement among residents with dementia in assisted living. METHOD: This descriptive study used baseline data from a randomized controlled trial, Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD). Linear regression was used to examine factors associated with engagement in meaningful activity. RESULTS: A total of 71 residents from 5 assisted living settings were included in the sample. Most participants were female (n = 52, 73%), White (n = 62, 87%), and mean age was 85 years old (SD = 8.2). Controlling for age, gender, comorbidities, and cognition, pain was significantly associated with engagement in meaningful activity (b= -2.09, p < 0.05). There were no associations found between function and behavioral symptoms with engagement in meaningful activity. CONCLUSION: Findings from this study show that pain is a significant factor that is negatively associated with residents' engagement in meaningful activity. Ongoing research is needed to help improve pain management for residents with dementia in assisted living and support their engagement in meaningful activity.

Integrating Oral Health Screening Into Primary Care to Promote Dental Referrals in Maryland.

BACKGROUND: Vulnerable populations are more likely to present to non-dental healthcare locations with dental issues. Oral health screening in those settings, such as primary care, is an effective way to identify individuals with unmet oral health needs and facilitate dental referrals. OBJECTIVE: To implement and evaluate the integration of oral health screening at an outpatient transitional primary care clinic in Maryland. METHODS: The quality improvement project occurred over 12 weeks. The project leader obtained support from institutional stakeholders, collaborated with dentistry, provided evidence-based resources, and developed referral strategies. Patients received a pre-screen at registration. Primary care providers used an oral health assessment tool (OHAT) for further screening and/or gave a dental referral. RESULTS: Approximately 108 patients completed pre-screen: 73% had not seen dentist in the past 12 months; 12% had current oral problem or pain; 53% had no established dentist; <5% had a completed OHAT; 20% referred to existing dentist; 56% received dental resource listing. CONCLUSIONS: Oral health disparity continues to exist among vulnerable populations. IMPLICATIONS FOR NURSING: Oral screening by advanced practice nurses is an effective way to identify patients with unmet oral health needs and to promote dental referral.

Anticoagulation clinic versus a traditional warfarin management model.

Warfarin is the most commonly prescribed oral anticoagulant. The management of warfarin is challenging, and current guidelines fail to include a model to assist practitioners in optimizing therapeutic dosing. The traditional model and the anticoagulation clinic (AC) model of warfarin management were compared and results found the AC model optimum.