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Background: A mother feels complete when she fulfills her role in protecting her child from harm. If a child is diagnosed with a terminal illness and reaches End of Life (EOL), the mother’s life is affected negatively. The mother is affected mentally, psychologically, and physically because her child is dying.Purpose: Explore the recent studies that focused on experiences of mothers caring for a child receiving End of Life Care (EOLC) at home or a healthcare facility.Methods: An electronic search was done in multiple databases, including the University of Wisconsin-Milwaukee Library, PsycINFO, PubMed, CINAHL, and Academic Search Complete. The included studies were published within the past five years, studies about EOL/ EOLC, hospice care, pediatric care, quantitative, qualitative, and mixed methods studies. Thematic synthesis following PRISMA guidelines. Results: Four themes emerged from the thematic synthesis. The main themes included decision making challenges, communication with healthcare professionals, parents’ support system, and grief. Parents were included in most studies. However, the number of mothers exceeded the number of fathers. Some researchers mentioned that there was no difference between their participants (most participants were Caucasian). Conclusion: There is limited information available about children and their family members’ experiences at EOL/ EOLC in Saudi Arabia as has been studied in other countries. Based on this systematic review, more studies are needed related to children at EOL in Saudi Arabia.

Based on the premise that stressors can have a cumulative effect on people with dementia throughout the day that contributes to negative consequences later in the day, we examined if daytime activity, unit tumult, and mood were associated with sleep quality. A convenience sample of 53 long-term care (LTC) residents participated in this correlational study. Objective sleep quality was measured using actigraphy, and comorbid illness and level of dementia were control variables. Half of the sample had a sleep efficiency that was less than 80% and was awake for more than 90 min at night. Comorbid illness, negative mood at bedtime, and daytime activity level accounted for 26.1% of the variance in total sleep minutes. Census changes and the use of temporary agency staff were associated with poor sleep. Findings suggest daytime activity, mood at bedtime, and unit tumult should be considered when designing and testing interventions to improve sleep quality.

Studies investigating children and families’ experiences at end of life in Saudi Arabia are limited. However, one factor found to have an impact on patient and primary caregiver end of life care is Islam. Since women are the primary caregivers for children in Saudi Arabia, the purpose of this study was to explore the perceptions of Muslim women caring for a child at end of life. Using a qualitative approach, interviews were conducted with 24 female primary caregivers caring for a child at end of life. Thematic analysis was used to analyze the data. The researchers found that Islamic beliefs and practices had a positive influence on primary caregivers’ experiences. Islamic beliefs and practices helped support participants through their child’s end of life experience. Results have implications for health care education, practice, policy, and future research on end of life in Saudi Arabia other Muslim countries.

Limited physical activity, sedentary behavior, and reduction in muscle mass, strength, and function are accompanied by negative outcomes. The relationship between these factors and physical and mental health-related quality of life (HRQoL) has yet to be elucidated in continuing care retirement community (CCRC) residents. The current study investigated the relationships among physical activity, sedentary behavior, and muscle mass, strength, and function to physical and mental HRQoL. A sample of 105 CCRC residents participated in this cross-sectional correlational study. Findings demonstrated that low physical activity and muscle function were significantly associated with low physical HRQoL and explained 38% of the variance in physical HRQoL. Handgrip strength was significantly associated with low mental HRQoL and explained 8% of the variance in mental HRQoL. Older adults living in CCRCs may benefit from interventions targeting physical activity and the distinct muscle components of sarcopenia that have the potential to improve physical and mental HRQoL. [ Research in Gerontological Nursing, 15 (3), 131–139.]

OBJECTIVE This study was conducted to describe and examine the impact of medication intervention practices among African-American clients in two nurse-led community nursing centers (CNCs). METHODS This study used a retrospective-descriptive design. Omaha System data from visits of 196 African-American adults living with chronic disease and having two or more CNC visits in which medication regimen was an identified problem and the main reason for the visit was analyzed. RESULTS The sample had a mean age of 53.1 (6.67) and was primarily women (82%), uninsured, and with high school or less education. A total of 9,259 Medication regimen interventions were documented and implemented during 1,146 client CNC visits. A paired samples t test revealed statistically significant improvements in Knowledge (t = 2.434, p

Background Many older adults with physical limitations living in residential care apartments are unable to exercise in a standing position and are at risk for declining in muscle function leading to falls and injury. Novel approaches to achieve exercise benefits are needed. The purpose of this study was to test the effect of semi-recumbent vibration exercise on muscle outcomes in older adults living in residential care apartment complexes (RCACs). Methods A randomized, crossover design was used to examine the effect of semi-recumbent vibration exercise on muscle function and mass among 32 RCAC residents (mean age 87.5 years) with physical limitations. Participants received a randomized sequence of two study conditions: sham or vibration for 8 weeks each separated by a 4-week washout. Before and after the 8 weeks of vibration treatment and sham treatment, muscle mechanography was used to assess muscle function including jump power, weight-corrected jump power, and jump height. Short physical performance battery (SPPB) and handgrip strength were also used to measure muscle function. Bioelectrical impedance spectroscopy was used to estimate skeletal muscle mass. The effect of the vibration treatment on muscle outcomes was analyzed through mixed effects linear regression models. Results Vibration exercise leads to better jump height (p p = 0.012). Other muscle functions tests and muscle mass parameters showed non-significant changes. Conclusion This small pilot study showed no conclusive results on the effect of semi-recumbent vibration exercise on muscle function and mass in older adults living in RCAC. However, the promising signals of improved jump performance could be used to power larger studies of longer duration with various vibration doses to determine the benefit of vibration exercise in this physically impaired, high-risk population with few exercise capabilities. Trial registration The study is registered at clinicaltrials.gov (NCT02533063; date of first registration 26/08/2015).

Restrictive ventilatory patterns (RVPs) in older adults may contribute to morbidity and decreased quality of life. The purpose of this study was to begin to understand (a) the number of older adults residing in Continuing Care Retirement Communities with RVPs, (b) factors associated with RVP, and (c) whether RVP is associated with ambulation level. This descriptive study was conducted at three sites. RVP was evident in 34 of the 65 participants (52%), and 33 (97%) of these were either moderate or severely restricted. Dementia, dyspnea, kyphosis, and lower muscle strength were significant predictors of RVP. Eighty percent of the nonambulatory participants had RVP and 38% of the ambulatory participants had RVP. Designing interventions to address modifiable factors associated with RVP may prevent respiratory infections, help people to achieve better lung health, and increase physical activity tolerance.

Sarcopenia is a major source of disability in older adults. However, limited data are available about sarcopenia components (i.e., muscle mass, strength, and function) and their relationship to psychosocial factors among older adults living in residential care apartment complexes (RCACs). The current study examined muscle mass, strength, and function and explored their relationship to self-efficacy for exercise, depressive symptoms, and social support in 31 RCAC residents. RCAC residents had lower muscle mass, strength, and function compared to values reported in studies of community-dwelling older adults. Men had higher muscle mass and strength than women. The current findings showed a trend for individuals with high self-efficacy, without depressive symptoms, and with strong social support to present numerically greater muscle mass, strength, and function. Further studies with larger samples are needed to confirm the current study findings and inform development of interventions implemented in RCAC settings. [Res Gerontol Nurs. 2018; 11(5):238–248.]

Poor health outcomes of chronically ill low-income adults are costly in both fiscal and human terms. One-third of Americans have hypertension and 43%) with high rates of exacerbations and complications [28, 10]. Low-income African American adults face life situations complicated by limited resources, high environmental and social risks, a high burden of stress and limited access to healthcare, all of which contribute to a substantial risk for multiple chronic conditions [10, 11, 19]. These factors may also contribute to a low sense of trust in the healthcare system, low self-efficacy regarding self-management behaviors to control hypertension, poor chronic disease management and costly sequelae [6, 19]. Thus, new intervention models and systems of care that are consumer-driven must be developed to improve outcomes. Client self-management of chronic diseases has emerged as a key factor in improved health outcomes [8]. We tested the effect of an innovative Ecological Nurse Case Management (ENCM) intervention on perceived stress, self-efficacy, self-management behaviors (SMB), and health status of low-income, chronically ill, African American adults. We hypothesized ENCM would reduce stress and increase self-efficacy and positively impact health status. We expected that that clients receiving this intervention would show decreased blood pressure (B/P), body mass index (BMI) and waist circumference (WC).

Muscle function decline is a commonly observed process that occurs with aging. Low muscle function, an essential component of sarcopenia, is associated with negative outcomes, including falls, fractures, and dependency. Although many tools have been developed and are used to assess muscle function in older adults, most have important limitations. Muscle mechanography is a novel method that can quantitatively assess muscle function by performing movements such as heel raises, chair rises, or jumps on a ground reaction force plate. It can also assess balance by measuring sway of the center of pressure. Muscle mechanography promises to have advantages over currently used tools, appears to have better reproducibility, and can assess a broader range of physical function—from master athletes to frail individuals. Older adults can safely perform muscle mechanography measurements. Further research is needed to determine whether muscle mechanography can predict outcomes such as falls, fractures, and mortality. [Res Gerontol Nurs. 2017; 10(1):17–24.]

Physical inactivity and loss of muscle mass, strength, and function are associated with negative outcomes including disability and a decline in health-related quality of life (HRQoL) among older adults. Older adults living in continuing care retirement communities (CCRCs) are at greater risk for declining physical activity and muscle outcomes compared to community-dwelling older adults. Few researchers studying the association of muscle and physical activity have examined the distinction between physical and mental HRQoL. Understanding the differential association of physical and mental HRQoL to physical activity and muscle outcomes can inform the development of useful interventions. The aim of this study was to examine the relationships between physical activity, muscle mass, strength, function and physical and mental HRQoL. Using a descriptive, correlational design, 105 older adults living in CCRCs were recruited. Light physical activity (LPA), moderate physical activity (MPA), sedentary behavior, and steps per day were assessed using ActiGraph GT3X. Appendicular skeletal muscle mass (ASMM) was assessed with bioelectrical impedance spectroscopy, handgrip strength with JAMAR Smart Hand Dynamometer, muscle function with the Short Physical Performance Battery (SPPB) test, and physical and mental HRQoL with the SF-36 questionnaire. The mean age of participants was 83 (SD=7.4). Using multiple regression models adjusted for sex and age, steps per day and SPPB score explained 38.4 % of the variance in physical HRQoL. Handgrip strength explained 8 % of the variance in mental HRQoL. These findings suggest that QoL improvement programs should include components to improve physical activity, muscle strength and function.

Declined food intake is prevalent among long-term care (LTC) residents with dementia and associated with deleterious health outcomes. This study explores food intake, nutritional status, and function and its associated factors in LTC residents with dementia. Data from 82 LTC residents with dementia were used in this secondary analysis. In the primary study, appetite was assessed using the Short Nutritional Assessment Questionnaire (SNAQ). Dementia level, comorbidity, agitation, pain, mood, food intake, nutritional status, and function variables were extracted from the electronic medical record, including the most recent Minimum Data Set (version 3.0) assessment. The majority of residents were either malnourished or at risk of being malnourished and demonstrated a worse appetite than previously described in the literature. Comorbid illness, depressed mood, and appetite were associated with 37.1% of the variance in food intake over 30 days. Dementia level and appetite were associated with 22.2% of the variance in nutritional status. Food intake and nutritional status were associated with 29.1% of the variance in function. This study also highlights a new demographic that may require extra assistance in combating declined food intake: LTC residents with dementia who reside in a facility that follows restrictive food practices such as a kosher diet. The potential reversibility of factors associated with food intake and nutritional status provides opportunities for intervention.

Poor muscle function is a major source of disability among older adults and leads to negative health outcomes including falls and fractures, exacerbating healthcare cost. This study was undertaken to understand: a) the characteristics of muscle function; and b) the relationship of self-management process variables (expectations regarding aging, goal congruence, and self-efficacy for physical activity) and physical activity self-management behavior to muscle function in a sample of older adults (N = 65) 75-93 years of age living in Continuing Care Retirement Communities. Using a descriptive correlational design, muscle function was measured with the Short Physical Performance Battery (SPPB) test and physical activity level with ActiGraph GT3X. Questionnaires included Expectations Regarding Aging and goal congruence scales and Physical Activity Assessment Inventory to assess self-efficacy. Pain was assessed by the PROMIS Pain Intensity 3a. Most participants (77%) performed poorly on the SPPB test. Controlling for pain, expectations regarding aging, goal congruence, self-efficacy and physical activity explained 46% of the variance in SPPB score. The model demonstrated that self-efficacy and light-intensity physical activity significantly explained 24.6 % of the variance in SPPB score; suggesting that low self-efficacy and decreased levels of light-intensity physical activity were significant predictors of low SPPB score. The findings demonstrate the need for more research documenting the underlying processes and risk factors for reduced muscle function. The potential benefits of this approach provide a basis for designing interventions to improve muscle function and delay the transfer to more restrictive living environments.

Objectives: Older adults with impaired physical function are at risk for further functional decline in part due to limited ability to engage in regular exercise. Effective approaches to exercise in this vulnerable population are needed to improve functional capacity and optimize independence. Methods: Thirty-two residential care apartment complex (RCAC) residents, age ≥70, with low short physical performance battery (SPPB) scores were recruited and randomly assigned to a crossover-design study exploring feasibility and safety of semi-recumbent vibration exercise in older adults living in one RCAC. The primary outcomes were retention and adherence rates and adverse events. Results: The retention rate was 78%. Adherence rate was 79.7% and 78.6% during the vibration and control training sessions, respectively. Thirty-eight adverse events (AEs) occurred. Mild muscle soreness and knee pain were the only AEs related to vibration exercise. No serious adverse events (SAEs) were study-related. Participants were able to increase training intensity and load and rated the training enjoyable. Conclusion: Semi-recumbent vibration exercise was feasible, well tolerated, and safe in RCAC residents with reduced physical function. Future studies need to examine the effect of this type of exercise on physical function, mobility, falls, and quality of life.

Restrictive breathing is a biologically plausible and modifiable risk factor for pneumonia and functional decline. This study was undertaken to understand: a) the number of older adults in Continuing Care Retirement Communities with spirometry-confirmed restrictive ventilatory patterns (RVP); b) extrapulmonary factors associated with RVP; and c) whether RVP is associated with ambulation level. Using a descriptive correlational design, we measured RVP with a portable spirometer, muscle strength with a Jamar® digital dynamometer, thoracic kyphosis with a flexicurve ruler, and cognitive status with the Mini Mental Status Exam. Observational tools included the PAIN-AD that captures pain with movement and the Respiratory Distress Observation Scale. Smoking history was captured by self-report, body mass index was calculated with information in the medical record, and ambulation status was retrieved from the Minimum Data Set. Of 90 consenting, 23 people were unable to complete the pulmonary function testing. Restrictive ventilatory patterns were evident in 34 of the 65 participants (52%). Dementia, respiratory distress, kyphosis, and lower muscle strength were statistically significantly related to RVP. Seventy percent of cases were coded correctly and 69% of those with a moderate or severe RVP were predicted correctly. Body mass index and musculoskeletal pain were not related to RVP. There was a statistically significant differences in ambulation between those with and without RVP. Designing interventions to address modifiable factors associated with restrictive breathing patterns may prevent respiratory infections, help people to achieve better lung health, and increase physical activity tolerance.