Trajectories of Purpose in Life Across Diagnosis of Alzheimer's Disease or Related Dementias in Older Adulthood.

Objectives: Sense of purpose serves as a psychological resource for late-life health. Limited research has examined how purpose changes across chronic illness diagnoses, including a diagnosis of Alzheimer's disease and related dementias (ADRD).Method: This study leverages data from the National Health and Aging Trends Study (NHATS; N = 831) to establish trajectories of purpose across ADRD diagnosis using three-year (pre-diagnosis, year of diagnosis, post-diagnosis) timespans and two comparison groups (heart disease diagnosis, no diagnosis). Results: We observed a longitudinal decrease in purpose in the ADRD diagnosis group, t = 3.85, p = .003, d = -0.258. This contrasts with heart disease diagnosis and no diagnosis groups, where purpose did not change over time. Discussion: Older adults who receive an ADRD diagnosis may be vulnerable to a decreasing sense of purpose across their diagnosis experience. We consider social, psychological, and clinical antecedents for this trend.

Implementation of Enhanced Recovery After Surgery in a Community Hospital: An Evidence-Based Approach.

PURPOSE: Enhanced recovery after surgery (ERAS) is an evidence-based practice protocol that has been shown to reduce cost, decrease length of stay (LOS), and improve surgical outcomes. DESIGN: An evidence-based practice improvement project with a multidisciplinary team translated the ERAS protocol into practice at a community hospital. The evidence-based practice improvement design allows integration of evidence into projects to improve clinical outcomes for patients. METHODS: Small tests of change using the Plan-Act-Study-Do methodology were used to evaluate the process of implementing one surgical service at a time to ensure effective outcomes. After the process was determined to be effective, patient outcomes (eg, LOS) were measured. FINDINGS: On average, LOS was decreased from 3.2 to 1.7 days. Surgical readmission rate decreased from 3% to 1%. There has been positive feedback and nursing workload has decreased with consistent processes. CONCLUSIONS: The ERAS order set continues to be modified based on the evidence and feedback from anesthesia and registered nurses. Monthly reports ensure consistency.