Evaluation of the Morse Fall Scale in hospitalised patients.
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Accidental Falls↗
Biomedical subjects
K Milisen
Publications and source records attributed to K Milisen.
Use of physical restraint in nursing homes: clinical-ethical considerations.
This article gives a brief overview of the state of the art concerning physical restraint use among older persons in nursing homes. Within this context we identify some essential values and norms that must be observed in an ethical evaluation of physical restraint. These values and norms provide the ethical foundation for a number of concrete recommendations that could give clinical and ethical support to caregivers when they make decisions about physical restraint. Respect for the autonomy and overall wellbeing of older persons, a proportional assessment of the advantages and disadvantages, a priority focus on the alternatives to physical restraint, individualised care, interdisciplinary decision making, and an institutional policy are the central points that make it possible to deal responsibly with the use of physical restraint for older persons in nursing homes.
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[Geriatric and gerontologic nursing: investing in quantity or quality?].
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[A systematic review of multifactorial interventions for primary prevention of delirium in the elderly].
Delirium is a severe psychiatric syndrome that is highly prevalent in elderly patients in a general hospital. Primary prevention is important to prevent delirium. This article reviews recent developments with regard to multifactorial intervention trials for primary prevention of delirium. The review process involved a systematic search in MEDLINE, The Cochrane Database and CINAHL Database and subsequent examination of reference lists. Six studies were selected. Four studies showed that systemic interventions regarding medical-, nurse-led, environmental-, and educational items, were effective in preventing delirium. In one study a reduction was found in duration and severity of duration only. One study showed no effect on delirium at all. Despite the methodological weaknesses of the studies, conclusions are that different kinds of non-pharmacological interventions can be effective in preventing delirium.
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Early detection and prevention of delirium in older patients with cancer.
Delirium poses a common and multifactorial complication in older patients with cancer. Delirium independently contributes to poorer clinical outcomes and impedes communication between patients with cancer, their family and health care providers. Because of its clinical impact and potential reversibility, efforts for prevention, early recognition or prompt treatment are critical. However, nurses and other health care providers often fail to recognize delirium or misattribute its symptoms to dementia, depression or old age. Yet, failure to determine an individual's risk for delirium can initiate the cascade of negative events causing additional distress for patients, family and health care providers alike. Therefore, parameters for determining an individual's risk for delirium and guidelines for the routine and systematic assessment of cognitive functioning are provided to form a basis for the prompt and accurate diagnosis of delirium. Guidelines for the prevention and treatment of delirium are also discussed.
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Meeting the challenges for gerontological nursing in Europe: The European Nursing Academy for Care of Older persons (ENACO).
In order to support the urgent need for proactive and targeted investments in care for older persons a group of geriatric nurse specialists from different European countries convened in Leuven (Belgium) in November 2002 to launch the European Nursing Academy for Care of Older persons (ENACO). The mission of ENACO is to enhance outcomes of older persons and their caregivers through strengthening gerontological clinical nursing care, education, research and health policy within an interdisciplinary context. Specific objectives of ENACO are: 1) providing up-to-date education and training by "teaching the teachers". More specifically, the target groups are master's prepared nurses specialized in gerontology who can contribute and guide the development of gerontological/geriatric nursing care in their own country; 2) developing a core curriculum for basic gerontological nursing education in Europe and; 3) developing an European network of gerontological nursing expertise. More specifically, a web page providing opportunities for interactive communication as well as a mentoring program will be developed for nurses interested in the deepening and fine-tuning of their professional experience in care for older persons. The fact that care for older persons is high on the European agenda, the collaboration with the European Academy for Medicine of Ageing (EAMA), and other professional organizations in Europe and other parts of the world, are promising elements in the development of ENACO.
Academies and Institutes↗
A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients.
OBJECTIVES: To develop and test the effect of a nurse-led interdisciplinary intervention program for delirium on the incidence and course (severity and duration) of delirium, cognitive functioning, functional rehabilitation, mortality, and length of stay in older hip-fracture patients. DESIGN: Longitudinal prospective before/after design (sequential design). SETTING: The emergency room and two traumatological units of an academic medical center located in an urban area in Belgium. PARTICIPANTS: 60 patients in an intervention cohort (81.7% females, median age = 82, interquartile range (IQR) = 13) and another 60 patients in a usual care/nonintervention cohort (80% females, median age = 80, IQR = 12). INTERVENTION: (1) Education of nursing staff, (2) systematic cognitive screening, (3) consultative services by a delirium resource nurse, a geriatric nurse specialist, or a psychogeriatrician, and (4) use of a scheduled pain protocol. MEASUREMENTS: All patients were monitored for signs of delirium, as measured by the Confusion Assessment Method (CAM). Severity of delirium was assessed using a variant of the CAM. Cognitive and functional status were measured by the Mini-Mental State Examination (MMSE) (including subscales of memory, linguistic ability, concentration, and psychomotor executive skills) and the Katz Index of activities of daily living (ADLs), respectively. RESULTS: Although there was no significant effect on the incidence of delirium (23.3% in the control vs 20.0% in the intervention cohort; P =.82), duration of delirium was shorter (P =.03) and severity of delirium was less (P =.0049) in the intervention cohort. Further, clinically higher cognitive functioning was observed for the delirious patients in the intervention cohort compared with the nonintervention cohort. Additionally, a trend toward decreased length of stay postoperatively was noted for the delirious patients in the intervention cohort. Despite these positive intervention effects, no effect on ADL rehabilitation was found. Results for risk of mortality were inconclusive. CONCLUSIONS: This study demonstrated the beneficial effects of an intervention program focusing on early recognition and treatment of delirium in older hip-fracture patients and confirms the reversibility of the syndrome in view of the delirium's duration and severity.
Activities of Daily Living↗
Delirium in elderly patients: an overview of the state of the science.
Delirium is a common and potentially preventable and reversible cause of functional disability, morbidity, mortality, and increased health care use among elderly individuals. Much has been learned about delirium in the past decade. Highlighted in this article are recent advances in the diagnosis of delirium, delirium in long-term care, use of health care resources, outcomes of delirium, etiologies, and interventions to prevent and treat delirium. Suggestions for future research also are proposed.
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Postoperative variation in neurocognitive and functional status in elderly hip fracture patients.
Regaining independence in the performance of activities of daily living (ADL) is a nursing priority in the postoperative care of hip fracture patients, though often impeded by a temporary yet reversible decrease in cognitive status postoperatively. This study investigated the incidence and evolution of decreased cognitive status in geriatric hip fracture patients from admission through to the fifth postoperative day, and the relationship between cognitive abilities and functional (ADL) status. Twenty-six elderly hip fracture patients (f: 21, m: 5) with a mean age of 79.5 years (SD = 8.2) admitted to the emergency room of an academic medical centre were monitored longitudinally from admission until the fifth postoperative day regarding neurocognitive status and ADL status, as measured by the mini-mental state exam (MMSE; including subscales of memory, linguistic ability, concentration and psychomotor executive skills) and an adapted version of the Katz ADL-scale, respectively. Patients were categorized on the basis of cognitive status as follows: no cognitive impairment (MMSE > or = 24), moderate (MMSE < or = 23 but > or = 18) and severe impairment (MMSE < or = 17). Nineteen of the 26 patients (73.1%) showed cognitive impairment (MMSE < or = 23) at some point in time before and/or after surgery. Some improvement in cognitive status was observed yet only selectively across patient cohorts and neurocognitive dimensions. Cognitive status, especially memorial ability and psychomotor executive skills, seemed to be most vulnerable to becoming impaired after hip fracture surgery. A relationship was found between cognitive and functional status, specifically, strong associations between memory and psychomotor skills relative to ADL and modest associations between linguistic ability and concentration relative to ADL. Further, patients with decreased cognitive status postoperatively remained more ADL-dependent than non-impaired patients. This study underscores the importance of a systematic assessment of the cognitive status of elderly hip fracture patients and linking these observations to functional ability in order to enhance the postoperative rehabilitation of this patient group.
Activities of Daily Living↗
Delirium in the hospitalized elderly: nursing assessment and management.
Delirium is a serious health problem with significant negative consequences which is experienced by many hospitalized elderly patients. Because of its clinical impact and potential reversibility, prompt treatment of delirium is essential. Therefore an understanding of delirium, its manifestations, methods of detection, prevention, and treatment in hospitalized elderly patients is needed. This article provides an overview of the diagnostic and therapeutic dilemmas of delirium.
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Nursing case management for psychogeriatric patients and their families: description of a clinical model.
A theoretical model of clinical case management for psychogeriatric patients and their families is described. Psychogeriatric patients often have complex health care needs, requiring specific nursing interventions. The increasing frailty of these patients over time, together with the risk for institutionalization, make professional nursing contribution to their care even more desirable. Nursing case management is described by means of a conceptual-operational continuum. On the conceptual site, the continuum includes a geriatric definition and core principles of case management. On the operational site, case management is described as a clinical system, a process, a technology, and a role. The process of case management is a deliberate, intellectual activity whereby the practice of nursing is approached in an orderly, systematic manner. It includes components of assessment, diagnosis, planning, implementation, and evaluation. The case management approach requires nurses to assume an active role in designing care maps and to work collaboratively with members of a multidisciplinary team.
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Process evaluation of a nurse-led multifactorial intervention protocol for risk screening and assessment of fall problems among community-dwelling older persons: a pilot-study.
This pilot study investigated the feasibility of a nurse-led fall prevention strategy in community-dwelling older persons. The sample included 126 subjects (mean age = 76 years) who could rise from a chair and transfer independently. During a home visit, a research nurse identified individuals at risk: a history of >or= 2 falls in the previous year or difficulties in gait and/or balance. Patients not at risk received an educational leaflet. Older persons at risk received an evaluation of risk factors for falling. Whenever problems were identified, the nurses gave specific advice and subjects were referred to their general practitioner (GP). After one month, adherence to these recommendations was evaluated. Twenty-seven individuals showed an increased risk of falling (21.4%). The mean number of risk factors per person was 3.4 (SD=1.2). Noncompliance with one or more of the fall prevention recommendations was 58.3%. Differentiated by type of recommendations, a high degree of compliance was observed for recommendations related to gait and balance, use of medication, orthostatic hypotension, urge-incontinence, environment and behavior (81.8%-100%). While most individuals followed the recommendation to consult their GP (66.7%-80%), most of the GP's failed to propose any further measures to prevent falls. Screening, evaluation of risk factors, giving advice and follow-up required on average 3.1 (SD=0.8), 29.4 (SD=15.1), 15.8 (SD=11.0) and 13.1 (SD=3.9) minutes, respectively. Of those subjects who were not at risk, 76.1% had read the leaflet and 74.6% of those considered it useful. This study provides preliminary evidence for the feasibility in terms of time investment to integrate a nurse-led multifactorial fall intervention in current care for older persons living at home. However, further investigation to increase compliance with recommendations and more insight in the GP's role relating to the management of patients at risk for falls is needed.
Accidental Falls↗