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BACKGROUND: Medication mismanagement is a continuous problem particularly in older people. Numerous interventions have been developed and tested in an attempt to improve adherence with medication in this client group. OBJECTIVES: This review aimed to examine the simple to complex interventions that have been used to assess and improve adherence with medication in older people. DESIGN: An extensive review of the literature was performed and 20 relevant research papers and one report were chosen. FINDINGS: Research papers were evaluated according to design, RCTs were analysed using the JADAD scoring system, systematic reviews and reviews of the literature were reviewed using the Critical Appraisal Skills Programme and subjected to a narrative analysis. This process assisted the development to emerging themes. Four themes were developed: patient barriers, health professional involvement, and health related outcomes and formation giving. CONCLUSIONS: The salient findings of the review infer that there is no clear definition of non-adherent behaviour. Quantitative interventions fail to assess patient choice in relation to medication taking. Pharmacist-driven interventions are resource intensive. Health care outcomes and clinical effectiveness are seldom addressed in interventions. Among the many difficulties encountered when attempting to use interventions to promote adherence with medication in older people is their perceptions and beliefs, the appropriateness of the medicines prescribed as well as the impact of lifestyle patterns: smoking, alcohol and diet. Many intervention studies are of poor quality and do not include a theoretical framework to underpin the interventions being used. More focused research is needed to improve understanding of the theoretical knowledge that underpins the complexities of adherence with medication in older people. In-depth qualitative studies can be used to develop such theory. In addition, the quality of intervention research can be improved by the inclusion of a research framework such as the Medical Research Council model. [ABSTRACT FROM AUTHOR]

Rising infection rates with pathogens such as Clostridium difficile have seen UK hospitals undergo a 'deep clean', to make sure wards do not harbour diseases. Maggie Banning explains why older people are particularly at risk. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is a pathological condition that involves excessive production of mucus, chronic cough and inflammatory changes leading to airway limitation. The most common cause of COPD is cigarette smoking. COPD can be categorized into either chronic bronchitis or emphysema; both conditions can be differentiated by age and the production of copious, tenacious sputum. Patients with COPD are susceptible to pulmonary infections of bacterial or viral origin. Nurses should be aware of the subtle differences in conditions and the usefulness of antibiotics in the treatment of acute bacterial exacerbations of chronic bronchitis. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) is spread by droplets and causes infections of the upper and lower respiratory tract. It is most common in infants, children under the age of five years and the elderly. Due to the nature of the transmission, infections with RSV are contagious but usually short lived. Pharmacological treatment involves the use of antiviral medication. Nurses caring for older people, infants or young children should be aware of the risk of transmission of RSV, pathogenesis and treatment options available to effectively manage the care of patients. [ABSTRACT FROM AUTHOR]

Up to 10% of women may suffer from polycystic ovary syndrome (PCOS). The clinical symptoms may vary, so the biochemical profile and ultrasonography are used to predict an accurate diagnosis. Many studies have indicated that a relationship may exist between hyperinsulineamia and hyperandrogenism but the exact pathogenesis remains obscure. PCOS is treated by a combination of surgery or pharmacological management. Treatment is not always successful therefore women in these cases require support and care from nursing staff to help overcome the disappointment of treatment failure. To support women with PCOS, nurses need to be knowledgeable about the condition and its clinical manifestations and available treatment options. This article aims to examine the current aetiology, clinical manifestations, pathophysiology, diagnosis and treatment options available to women with a diagnosis of PCOS. [ABSTRACT FROM AUTHOR]

In the UK, medication errors are a growing problem. Dobrzanski et al (2002) estimated that in one trust the incidence of medication error ranged between 35 to 70 per cent. Such high estimations are a cause for concern, particularly when the administration and supply of medicines, which directly involves nurses, can contribute to the cause of medication error. Part of the National Patient Safety Agency's (NPSA) role is monitoring mediation errors in hospitals. Although the NPSA can provide information on drug alerts that target primary care organisations, obtaining accurate figures for medication errors is more difficult. Medication errors can be extremely harmful for older people, therefore nurses who prescribe or administer medicines should be assessed for mathematical competence, but also be aware of the potential propblems that can arise from medication errors (Banning 2005). [ABSTRACT FROM AUTHOR]

Bacteria are unique microorganisms that have a variety of physiological functions which are beneficial to human beings. However, bacteria can also be harmful and cause infections if translocated from the gastrointestinal tract to the epithelial tissue following surgery. The process of translocation can lead to surgical wounds becoming contaminated with gastrointestinal microbes such as Escherichia coli, Proteus or Klebsiella species. Bacteria can also cause severe gastrointestinal infections as a consequence of the ingestion of contaminated food. Food-borne bacterial infections can lead to serious consequences for the patient. Nurses managing the care of surgical patients and older people need to be aware of the physiological role that bacteria play but also the detrimental effects of bacterial translocation or ingestion particularly in older people, infants and people who are immunosuppressed. [ABSTRACT FROM AUTHOR]

Influenza is a common respiratory condition that has a history of developing into epidemics and pandemics. Individuals at risk of influenza and related complications include older people, young children and individuals with chronic renal, cardiac and respiratory diseases. Influenza can begin suddenly and is accompanied by fever, chills, aches, pains, headaches, fatigue, cough and generalized weakness that can last up to 14days. Complications of influenza include secondary bacterial pneumonia, post-influenza encephalitis, changes in cardiac electrocardiogram and secondary bacterial infections, such as Staphylococcus aureus-induced myositis. The influenza vaccine is the main form of treatment. Suitably qualified nurse prescribers and nurses who supply and administer the vaccine under patient group directions should be sufficiently knowledgeable about the virus and how its transmission can be prevented in order to educate patients at risk of developing influenza about the role of the vaccine in the prevention of the disease. [ABSTRACT FROM AUTHOR]

It has been estimated that 70% of all cancers are caused by the food that we consume and smoking tobacco (Wogan et al, 2004). Currently, food health advice focuses on maintaining a diet which is low in fat and calories, rather than concentrating on the cooking methods used and the amount of meat that is consumed. More time should be spent educating individuals on the importance of cooking in different ways and eating a varied diet which includes cruciferous vegetables, such as broccoli. Nurses can be influential in the provision of health education advice to patients on the types of cooking methods that can be used to reduce the risk of developing forms of cancer and also the types of food that offer protection against cancer. [ABSTRACT FROM AUTHOR]

Effective medication management is an issue for all healthcare professionals. This article explores several issues central to medication management and explains their relevance to their care of older people. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus is a Gram-positive bacterium that developed resistance to the penicillin derivative methicillin. Subsequently, methicillin-resistant S. aureus (MRSA) emerged as a bacterium that became less susceptible to the actions of methicillin and thus developed the ability to colonize and cause life-threatening infections. Globally, MRSA continues to cause hospital-acquired infections which are becoming difficult to treat owing to increasing glycopeptide resistance and the increasing development of community-associated MRSA. Nurses caring for patients in both hospital and community settings should be able to acknowledge the importance of MRSA, the difficulties of treating the bacterium and the need to comprehend and adhere to universal precautions that are important in the prevention of transmission of MRSA. [ABSTRACT FROM AUTHOR]

Cardiac disease continues to be a major cause of death in the Western world. Several preventive measures can be implemented to reduce the risk of a cardiac event. One of these measures is diet. A diet that is rich in fatty fish provides a considerable quantity of omega-3-fatty acids. These fatty acids have been shown to reduce the risk of cardiac events such as arrhythmias, stroke and thrombosis. The nurse has a key health education role to play in the promotion of healthy eating in order to reduce the incidence of cardiac events in patients with existing cardiac disease. [ABSTRACT FROM AUTHOR]

Bacteria are robust micro-organisms that can survive even in the presence of antibiotics. This has led to problems treating bacterial infections. Bacteria are the most common cause of infection and Streptococcus pneumoniae is one such infection. This bacterium causes community-acquired pneumonia in older people and, though immunisation is available, older people continue to die from pneumococcal pneumonia. Pencillin continues to be used as the main method of treatment against Streptococcus pneumoniae but antibiotic resistance is increasing. [ABSTRACT FROM AUTHOR]

AIM: The purpose of this study was to explore nurses' conceptions of evidence and evidence-based practice, whether there are differences between evidence-based practice and evidence-based medicine and to identify the uptake of research evidence in the workplace. BACKGROUND: The use and comprehension of the term 'evidence-based practice' in relation to nursing shows remarkable variation. Numerous definitions are provided, some tend to be closely related to the concept 'evidence-based medicine'. Independent nurse prescribers need to be able to understand the concept of evidence-based practice to utilize and apply this concept in order to provide adequate medication management of their patients. METHOD: Data were generated by focus group interview and open question questionnaire and analysed by analytical abstraction. RESULTS: Nurses offered a variety of views on the use and uptake of evidence in the workplace. Some nurses acknowledged that they did not read research papers but were aware that they used a lot of evidence in their practice. Nurses had difficulty differentiating evidence-based practice from evidence-based medicine. CONCLUSIONS: Nurses were familiar with the research process but not the canons of evidenced-based practice. The data generated indicate different levels of evidence are used by nurses. This may be a reflection of the level of intrigue of the nurses involved. RELEVANCE TO CLINICAL PRACTICE: The education and training of independent nurse prescribers should include the exploration of evidence from randomized controlled trials and from naturalistic studies and their contribution to evidenced-based practice and evidence-based medicine. Both concepts need to be explored in relation to the medication management of patients. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is a chronic inflammatory condition that involves all elements of the immune response. The aetiology of RA is complex and centres on the development of autoantibodies and immune complexes. The pathogenesis is multistage and involves cytokines, angiogenesis and rheumatoid factor. Nurses managing patients who suffer with RA need to be aware of the pathological changes involved in the disease and its contribution to the progression of the condition. The diagnosis of RA involves blood screening for rheumatoid factor, raised erythrocyte sedimentation rate (ESR), use of arthroscopy to provide evidence of histological changes in the synovium, presenting symptoms, and changes on X-ray. Patient assessment will consider both patient-specific and disease-specific variables, including evidence of non-articular manifestations of RA. Long-term care revolves around trying to maintain patient mobility and the protection of unaffected joints, monitoring for the side-effects from medication and progression of the disease or development of non-articular manifestations. [ABSTRACT FROM AUTHOR]

Obesity is a global problem, independent of age. The numbers of obese individuals are now,reaching epidemic proportions around the world. This is contributing to the risk of inherent comorbidity. The pathophysiology of obesity, although widely debated, is still unclear with suggestions that multiple genetic mutations may have a key role in the development, but as yet no one genetic mutation is felt to be entirely responsible. Biochemical manifestations such as diabetes may play a role. The first goal of management of the obese patient will involve dietary and behavioural modification and a programme of physical exercise. In primary care settings, nurses are suitably placed to assess and manage obese patients (National Institute for Clinical Excellence (NICE), 2001a). The nursing profession needs to rise to the challenge and prepare nurses for a specialist role in obesity management. [ABSTRACT FROM AUTHOR]

Maggi Banning considers medication management among older people and explains how nurses can work with patients and other professionals to improve concordance. [ABSTRACT FROM AUTHOR]