Strategies used to facilitate the discussion of advance care planning with older adults in primary care settings: A literature review.

BACKGROUND AND PURPOSE: The purpose of this literature review was to evaluate strategies used in primary care settings to initiate advance care planning (ACP) conversations leading to the completion of an advance directive (AD). Approximately 50% of older adults have an AD; few talk to their primary care provider (PCP) about end-of-life wishes. The Institute of Medicine report and recent changes in Medicare reimbursement policies create opportunities for PCPs to address ACP in primary care settings. METHODS: We used a systematic review approach. The search included seven Elton B. Stephens Company databases, limited to English language and peer-reviewed publications from 1991 to 2017 using 10 key words. CONCLUSIONS: Effective interventions were educational materials using various methods of delivery, computer-generated triggers for PCPs, inclusion of multidisciplinary professionals for content delivery, and patient preparation for PCP visit. IMPLICATIONS FOR PRACTICE: The identified strategies provide a starting point for PCPs to consider increasing the ACP discussion with their patients. Primary care providers must create opportunities to meet the needs of their patients and their families. Established guidelines and reimbursement for ACP challenge PCPs to identify and contribute to the formulation of best practices to facilitate AD completion in primary care settings.

Examining Fall Recurrence Risk of Homebound Hispanic Older Adults Receiving Home Care Services.

INTRODUCTION: Unintentional falls and injuries is a major problem among older adults and the fourth cause of death in the United States. A previous fall event doubles the risk of recurrence and lessens the person's quality of life. Hispanic older adults have higher rates of disability and lower independent functioning due to poor medical health and risk for fall recurrence. Most fall studies focus on fall risk with few studies on fall recurrence in older adults receiving home health care services unrelated to fall incident. METHOD: A descriptive pilot study of 30 homebound Hispanic older adults receiving home care services who reported a fall within 3 months was conducted by a multidisciplinary team to evaluate risk of fall recurrence. RESULTS: A heightened risk for fall recurrence was identified with high number of chronic illnesses, high intake of medications, vision problems, and prevalence of urinary incontinence. CONCLUSION: Findings highlight significant number of intrinsic factors for fall risk recurrence and injuries in a Hispanic older adults population that is homebound and receiving home care services. A multidisciplinary evaluation and culturally appropriate interventions to lessen the risk of fall recurrence are recommended.

To Give and To Get: How Nurse Faculty Scholars Contribute and Benefit From Participating in Interdisciplinary Research Teams.

BACKGROUND: Meeting the demands for career advancement in the faculty tenure track of a university becomes a challenge for new researchers when active nursing research is limited or nonexistent. Nurse faculty transitioning from clinical practice settings may face greater difficulty climbing the ladder of promotion because of the limited opportunity for nursing research. A way to create a research thread that will allow an opportunity to ease into the new role and build an effective research team is to participate in an interdisciplinary research (IDR) team. PURPOSE: This article is written to encourage academic nurse faculty who may find themselves in a nursing research "desert" to collaborate with other disciplines and consider joining an IDR team to get started in career advancement. DESCRIPTION: Three "Gs"-get, give, and generate-have been created to illustrate the benefits and contribution of IDR. Practical ways to help get started and make the best use of the IDR team are suggested. CONCLUSION: The participation in an IDR team offers new nurse faculty a way to jump-start a scholarly career. Collaboration with like-minded colleagues from various disciplines offers an opportunity to expand knowledge, gain professional growth, and contribute to scientific development.

Vision and falls: a multidisciplinary review of the contributions of visual impairment to falls among older adults.

Falls are a leading cause of mortality among older adults worldwide. With the increasing aging population, falls are rapidly becoming a public health concern. Numerous internal and external factors have been associated with an older adult's increased risk of falling. Most notably visual impairments are gaining recognition for their critical role in fall events, particularly related to trips, slips and falls due to environmental hazards. This review presents the issue of vision and falls from a multidisciplinary health professional perspective. Discussions include the influence of visual impairment on mobility and activities of daily living, the effects of medications on vision, visual cognitive factors on falls risk and visual training interventions. Finally, implications for multidisciplinary health professional practice and suggestions for future research are offered.