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AIM This analysis sought to define the concept of individualized aging. BACKGROUND The growing older adult population and shortage of health professionals with adequate knowledge of their specialized needs will [...]

Objective. The study objective was to describe self-reported advance care planning, health care preferences, use of advance directives, and health perceptions in a very elderly community-dwelling sample. Methods. We interviewed surviving participants of the original cohort of the Framingham Heart Study who were cognitively intact and attended a routine research examination between February 2004 and October 2005. Participants were queried about discussions about end-of-life care, preferences for care, documentation of advance directives, and health perceptions. Results. Among 220 community-dwelling respondents, 67% were women with a mean age of 88 years (range 84-100 years). Overall, 69% discussed their wishes for medical care at the end of life with someone, but only 17% discussed their wishes with a physician or health care provider. Two thirds had a health care proxy, 55% had a living will, and 41% had both. Most (80%) respondents preferred comfort care over life-extending care, and 71% preferred to die at home; however, substantially fewer respondents said they would rather die than receive specific life-prolonging interventions (chronic ventilator [63%] or feeding tube [64%]). Many were willing to endure distressing health states, with fewer than half indicating that they would rather die than live out their life in a great deal of pain (46%) or be confused and/or forgetful (45%) all of the time. Conclusions. Although the vast majority of very elderly community-dwellers in this sample appear to prefer comfort measures at the end of life, many said they were willing to endure specific life-prolonging interventions and distressing health states to avoid death. Our results highlight the need for physicians to better understand patients' preferences and goals of care to help them make informed decisions at the end of life. Key Words: Advance directives--Geriatrics--End-of-life care--Patient-centered care--Decision making.

Background. Falls are common among hospital inpatients, particularly in rehabilitation wards. Standing balance impairment is widely held to be a contributing factor to fails, is a component of several falls risk screening tools, and has motivated the development of balance retraining programs for the reduction of in-hospital falls. Little rigorous investigation of the link between standing balance impairment and in-hospital falls has been undertaken. Methods. We identified optimal cut-off points of four commonly used balance measures (functional reach, Timed Up and Go, step test, and timed static stance) in a prospective multicenter cohort study. Admission data (n = 1373) were clustered and matched by center then randomly allocated to development and validation data sets. Results. Optimal cut-off points for each test were identified from the development data set. The predictive accuracy of all four balance tests was poor when the optimal cut-off was applied to the validation data set (Youden Index scores ranged between 0.02 and 0.15). Conclusions. These findings do not support an association between admission standing balance and falls in a geriatric rehabilitation setting. This result has implications for content of falls risk screening tools and interventions to prevent falls in a geriatric rehabilitation population. Key Words: Falls--Predicting falls--Predictive value of tests--Rehabilitation.

Purpose: Performance measurement systems for nursing homes assume that facility performance contributes heavily to individual outcomes. This research illustrates how that assumption can be assessed using the change in residents' activities of daily living (ADLs). Design and Methods: The data used in these analyses were all from residents with both an admission and a quarterly assessment in a sample of all admissions to a randomly chosen 10% of Medicare- or Medicaid-certified nursing homes operating during 2002. Results: Models including both facility and individual variables explained up to 20% of the variation in ADL change after admission. Facility identity in isolation explained between 8% and 14% of the variation in ADL change. Implications: The results suggest that quality indicators based on change in ADLs may be problematic when used in nursing home performance measurement systems. More generally, the results recommend that the level of variation in performance measures attributable to facility identity or performance become a much more central consideration when researchers evaluate quality indicators for use in nursing home performance measurement systems. Key Words: Nursing homes, Quality indicators, Long-term care, Quality of care

Applying theory to practice is a longstanding issue in the nursing profession; the complexities of this as far as nurses are concerned are not always appreciated by academics. This research [...]

The 'plight' of older people in A&E departments has received much media coverage in the past few years. In a BBC news report in December 2000, the charity, Help the [...]

Having established an academic and clinical infrastructure, geriatric nursing is well positioned to play a central role in improving the health of the nation's older adults now and in the future. Currently, whether working independently, in collaborative practice with physicians, or as members of geriatric teams, geriatric nurse practitioners and clinical specialists have been shown to improve care to older adults in the community, in hospitals, and in skilled nursing facilities. Sixty-three master's programs now prepare advanced practice geriatric nurses. Geriatric nurse researchers have contributed to our understanding of the most pressing problems that impact profoundly on the health and quality of life of older adults. Despite these advances, the number of geriatric nurse specialists remains small, with only 4200 certified specialists and a serious shortage of geriatric nursing faculty. Geriatric nursing is moving to ensure geriatric competency in all nurses who work with older adults in the future. The future should see the benefits of current efforts to infuse geriatric content into baccalaureate programs that prepare registered nurses, into master's programs that prepare adult and family nurse practitioners, and into the day-to-day practice of the nation's 2.2 million practicing registered nurses.

Anticipation of increased numbers of older persons throughout the coming decades who will require care and assistance with chronic illnesses and functional deficits has correspondingly increased awareness of the need for nursing research to support best geriatric nursing practices. Although badly needed, research in nursing homes presents challenges. This article discusses issues and challenges of ethically acceptable and rigorous research in nursing homes that are related to the dependency and institutionalization of older persons and to setting, staff, and resident characteristics. Strategies for easing the challenges of nursing research in nursing homes are offered.

The Nurses' Observation System for Geriatric Referrals is a 30-item observational scoring system for geriatric inpatients. As constructed, it is scored into six subscales of five items each; however, these six factors have not been empirically validated. A confirmatory factor analysis, performed on a sample of 218 completed forms for 218 geriatric inpatients, did not support the six original factors. Exploratory factor analysis gave a five-factor solution that partially replicated the scale's original factors but which also indicated important differences for interpretation and clinical use.

Using the lifetime experience of residents in seven continuing care retirement communities, we examine the probability of moving from independent living to assisted-living and nursing unit beds, and calculate the length of stay within each level of care. Between 50% to 70% of entering residents can be expected to use either (or both) assisted-living or nursing units during their tenure. Length of stay in independent living is increased and the length of stay in assisted living is reduced within high-rise facilities. There is a minor substitution effect between assisted-living and nursing unit use, especially among women. The nursing unit results are not affected by high rise or garden apartment design of the facility, or the percentage of nursing beds to total beds.

As the delivery of health and human services has become more complicated, fragmented, and expensive, case management has gained popularity. Various case management models have emerged in social work (Loomis, [...]

Iatrogenic, prosthetic, and other perspectives are used to derive hypotheses concerning the roles of perceived health and residence satisfaction in mediating the effects of nursing home institutionalization on subjective well-being. The findings show that perceived health and residence satisfaction are important intervening variables. Institutionalization has a positive effect on well-being, mediated by perceived health, but institutionalization has a stronger negative effect on well-being, mediated by residence satisfaction. Thus, institutionalization's total effect on well-being is negative. Theoretical and policy implications of these findings are discussed.

Research was conducted to examine nine neglected or abused elders who went through comprehensive interdisciplinary geriatric team assessment and intervention at the Harris County Hospital District with three and six-month follow up. Results indicate that instead of prolonged low quality dependent states, geriatric assessment leads to higher, more independent functioning when the geriatric team assumes primary care and provides aggressive, targeted interventions.

Aphasia is a reduced ability to understand and use written or spoken language and can be caused by damage to the brain following a stroke. Strokes can also cause dysarthria, [...]

Graham Stokes and Fiona Goudie Speechmark 288pp 25.95 £ ISBN 0863882447 This handbook is an ideal basic text. The emphasis throughout is on trying to understand what the person with [...]

Diana Williams Jessica Kingsley 321 pp 15.95 £ ISBN 1853026492 Writing Skills in Practice presents a comprehensive overview of the development of writing skills for both practitioners and students working [...]

Government guidance on funding for continuing care has been `misinterpreted and misapplied', the health service ombudsman has ruled, leading to hardship and injustice for some care home residents. After an [...]

In late January, the Department of Health published new good practice guidance on hospital discharge. Updating a previous 1994 workbook (Henwood 1994), the document examines each stage of the discharge [...]

Ministers have admitted there is little data available on the impact of hospital-acquired infection (HAI) on patients' discharge but say there is no evidence that care homes are refusing to [...]

Two new inspection bodies for health and social care were among the cornerstones of the new Health and Social Care (Community Health and Standards) Bill published by health secretary Alan [...]

Falls among older people cost the NHS 1.7 £ billion a year and eight people die each day as a result of falls, an analysis of figures published by the [...]