Recruiting ethnically diverse nurses to graduate education in gerontological nursing. Lessons from a successful program.
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Aged↗
Biomedical subjects
Jill A Bennett
Publications and source records attributed to Jill A Bennett.
Issues affecting the health of older citizens: meeting the challenge.
The health of older Americans will become a critical national policy issue during this century. As the population of older adults increases dramatically, there are few signs that adequate resources are available to meet the challenge of providing health care and good quality of life for older adults and their families. A fundamental change in the values emphasized in the American culture, and in other cultures, will be required to change the present health care system from one which focuses on diagnosis and treatment of disease to a system that attends to the major issues that affect quality of life of older adults and their families. This article discusses four critical areas influencing the quality of life of older Americans: providing resources to individuals to help manage chronic medical conditions, assuring a sufficient number of primary health care providers educated in geriatrics and gerontology, removing financial barriers to accessing health care and medications, and changing the American cultural value system that emphasizes disease treatment over providing emotional, educational, and support resources. To make these profound changes in the formal health care system, health care providers, health care organizations, and policy makers must commit to embracing the importance of quality of life as an integral component of health care for older citizens.
Aged↗
Maintaining and improving physical function in elders.
This chapter reviews 60 published research reports about maintaining and improving physical function in elders. Reports were identified through searches of MEDLINE and CINAHL using the following search terms: Activities of Daily Living, aged, nursing care, nurse-patient relations, geriatric nursing, nursing assessment, geriatric assessment, behavior therapy, disability evaluation, exercise, and physical. Reports were included if published in English between 1985 and 2000, if conducted in adults over age 60, and if the first author was a nurse or the reported intervention was implemented by nurses. Descriptive and experimental studies of physical function in elders were included. The results of this synthesis showed that nurse scientists have developed new instruments to measure physical function, including scales sensitive to changes in physical function caused by dementia. Nursing studies have described many of the physical and psychological factors associated with poor physical function in elders, though environmental factors and ethnic differences in physical function merit further study. Many nurse scientists are currently investigating behavioral interventions, exercise interventions, and changes in nursing care that could improve the physical function of both community-dwelling elders and those who live in residential facilities.
Activities of Daily Living↗
Cognitive impairment in heart failure: issues of measurement and etiology.
BACKGROUND: Clinicians need easy methods of screening for cognitive impairment in patients with heart failure. If correlates of cognitive impairment could be identified, more patients with early cognitive impairment could be treated before the problem interfered with adherence to treatment. OBJECTIVES: To describe cognitive impairment in patients with heart failure, to explore the usefulness of 4 measures of cognitive impairment, and to assess correlates of cognitive impairment. METHODS: A descriptive, correlational design was used. Four screening measures of cognition were assessed in 42 patients with heart failure: Commands subtest and Complex Ideational Material subtest of the Boston Diagnostic Aphasia Examination, Mini-Mental State Examination, and Draw-a-Clock Test. Cognitive impairment was defined as performance less than the standardized (T-score) cutoff point on at least 1 of the 4 measures. Possible correlates of cognitive impairment included age, education, hypotension, fluid overload (serum osmolality < 269 mOsm/kg), and dehydration (serum osmolality > or = 295 mOsm/kg). RESULTS: Cognitive impairment was detected in 12 (28.6%) of 42 participants. The 4 screening tests varied in effectiveness, but the Draw-a-Clock Test indicated impairment in 50% of the 12 impaired patients. A summed standardized score for the 4 measures was not significantly associated with age, education, hypotension, fluid overload, or dehydration in this sample. CONCLUSIONS: Cognitive impairment is relatively common in patients with heart failure. The Draw-a-Clock Test was most useful in detecting cognitive impairment, although it cannot be used to detect problems with verbal learning or delayed recall and should not be used as the sole screening method for patients with heart failure. Correlates of cognitive impairment require further study.
Adult↗
Validity and reliability of the NYHA classes for measuring research outcomes in patients with cardiac disease.
The New York Heart Association (NYHA) functional classification system was developed to help physicians in clinical practice evaluate the effect of cardiac symptoms on a patient's daily activities. Over time, the role of the NYHA classification system has expanded, and it is now frequently used in clinical research. This review of the literature was undertaken to explore whether the NYHA classes have sufficient validity and reliability to serve as a functional outcome measure in research studies. After exploring its strengths and limitations, we conclude that the NYHA classes are a valid measure of functional status, a concept that is distinct from functional capacity and functional performance. The reproducibility of the NYHA functional classification system has not been established in the literature. Researchers are urged to report the methods for determining NYHA class, the training of raters, and the intra-rater or inter-rater reliability in studies that have multiple raters or measurements. Until the reliability of the NYHA functional classification system is determined, it is prudent to refrain from using the NYHA classes as the sole outcome measure of change in function in research studies of cardiac patients.
Clinical Trials as Topic↗
The complex challenge of helping older adults manage cardiovascular disease.
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Aged↗
The mediating effect of pain and fatigue on level of functioning in older adults.
BACKGROUND: Medical conditions and symptoms have been shown to predict level of functioning in older adults, but medical conditions and symptoms have rarely been investigated together in a comprehensive model that included both medical conditions and symptoms as predictors of functioning in older adults. OBJECTIVE: The purpose of this study was to determine whether the adverse effect of medical conditions on different aspects of functioning in older adults is mediated by the level of symptoms (pain and fatigue). If so, level of functioning may improve if pain or fatigue can be mitigated, even when underlying medical conditions cannot be cured. METHOD: Data from 225 adults aged 65-90 were used to test whether medical conditions, symptoms (pain and fatigue), and six covariates predicted lower body performance, self-reported physical functioning, and self-reported role and social functioning. The fit of a series of models to the data was analyzed using structural equation modeling. RESULTS: Medical conditions affected self-reported physical functioning and self-reported role and social functioning by increasing the level of symptoms, rather than by direct association. Further descriptive studies are needed to identify other symptoms and modifiable mechanisms by which medical conditions affect functioning. Researchers who investigate the causes of poor functioning in older adults are encouraged to include symptoms in models that hypothesize medical conditions as predictors of functioning outcomes.
Activities of Daily Living↗
United States Spanish short-form-36 health survey: scaling assumptions and reliability in elderly community-dwelling Mexican Americans.
BACKGROUND: Measuring health status is challenging in Mexican Americans and other diverse groups, because most health measurement instruments were developed and tested in English. Thus, it is difficult to determine whether measured health disparities are the result of actual differences or due to measurement error resulting from translation or conceptual differences. OBJECTIVES: The purpose of this study was to test the metric equivalence of the United States (US) Spanish Short-Form-36 Health Survey (SF-36) in a group of elderly Mexican Americans. In addition, the SF-36 scores of elderly Mexican American women in our sample were compared with normed scores for the SF-36 scales in the general population of elderly US women. METHOD: Health status was measured by the US Spanish SF-36 in telephone surveys conducted entirely in Spanish. The sample (N = 65) was elderly (mean age 75.3) and primarily female (78%). Most had less than 7 years of education and an annual income below $10,000. RESULTS: Missing data were negligible, and did not indicate difficulty with particular items. The item response values were well distributed and item response means were generally similar within a scale. Most item correlations were higher with the item's hypothesized scale than with other scales, though some items in the Mental Health, Vitality, and Social Functioning scales were highly correlated with other scales. Internal consistency reliability (Cronbach alpha) was.80 or above on all scales except Social Functioning (.69). SF-36 scale scores were lower in elderly Mexican American women than in elderly women in the general US population. DISCUSSION: The US Spanish SF-36 was a generally satisfactory measure of health status in a sample of elderly Mexican Americans with little formal education. The performance of some items in the Mental Health, Vitality, and Social Functioning scales warrants further research.
Acculturation↗