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The AARP Andrus Foundation funded research on successful aging and adaptation in the context of management of chronic diseases. The basic question is that older adults confront multiple health problems in their everyday life, how do they cope? What is successful aging under this context? What are risk and protective factors toward successful health maintenance among community-dwelling older adults? How do extant models and theories of coping deal with these practical issues? This symposium highlights research tat address these theoretically and practically challenging questions.

Studies of successful aging are often based on criteria established by researchers rather than participants. We asked 747 men and women age 65-80 from the 1999 follow-up of the Alameda County Study to rate their own successful aging; 52% said they were aging successfully. To elicit predictors of successful aging from middle-age, we examined responses to the 1974 questionnaire. Results were adjusted for age, sex, and chronic conditions. Among socio-economic variables, only income above the lowest quintile was predictive. Predictive health measures included: self-assessed health as better than others and less effortfulness (3 item scale: having much more energy than others, not being worn out days end, not getting very tired in a short time). Predictive health behaviors included physical activity, eating breakfast, and not smoking. Other strong predictors included often reading, enjoying free time, and positive affect. Being married was not predictive but 3 measures of marital quality were: receiving as much affection as one likes, being understood, and marital happiness. Women were more likely to assess themselves as aging successfully but there were no gender differences for any predictors. Discussion focuses on the diversity of middle-age activities and characteristics that cast long shadows on successful aging years later.

With greater numbers of older adults and increasing prevalence of chronic conditions, an understanding of factors associated with taking on and continuing self-care behaviors becomes essential. We explored factors associated with following recommendations in 528 of 899 Alameda County Study men and women age 65-99 taking part in a 1999 survey of successful aging who responded that they had been told to either exercise or follow special diets. Adherence to each recommendation was scored as follow recommendations all or most of the time versus some of the time or never. 62% reported adhering to the exercise recommendation, while 86% adhered to the diet recommendation. Factors associated with adherence to both exercise and diet included higher optimism (Life Orientation Test), higher sense of perceived control, and lower cynical distrust. Higher self-rated health, positive affect (Bradburn), and social connections were only associated with adherence to exercise, while marital quality and older age were only associated with adherence to diet. There was no association with gender. African-American subjects were only half as likely as White subjects to follow the exercise recommendations although the association was only marginally significant. Discussion focuses on the potential clinical implications of differential motivators for self-care behaviors.

Counterfactuals, if-then statements of imagined outcomes, are associated with mental health, cognitive efficacy, personal control, life quality, and life satisfaction in young adults; constructs affecting successful aging. 893 adults, aged 65-99, participants in the 1999 Alameda County Study, wrote answers to the question, 'If you had your life to live over, what, if any, change would you make?' Demographics, cognitive well-being, and physical health were analyzed for relationships with coded response statements. 545 (61%) desired to change the past; 29% did not; 10% made no statement. Of the 545 persons desiring change, 345 (63%) responded with a counterfactual. Those desiring change were more depressed (p

PURPOSE/OBJECTIVES: To provide an overview of the immune system and describe the systemic and local immune response to human papilloma virus (HPV) infection in the cervix and to the development of cervical dysplasia. DATA SOURCES: Historical and current medical and nursing literature, current gynecologic oncology texts. DATA SYNTHESIS: The immune system provides protection against a wide variety of pathogens and plays a role in the response of the body to neoplastic cells. The immune system orchestrates the functions of various immune cells and proteins to fight against invading pathogens. Mucosal immunity is one of the key functions of the immune system and has unique features. Humoral and cytotoxic responses in the cervix and in the peripheral blood are seen during clearance of an HPV infection. CONCLUSIONS: The functional status of the immune system is associated closely with the development of cervical dysplasia and cancer in women with HPV infection. Clinicians must assist women in maintaining proper functioning of immune responses. IMPLICATIONS FOR NURSING PRACTICE: A better understanding of local and systemic immune responses to HPV infection may help nurses who provide care to women with cervical disease and women at high risk for cervical cancer to deliver better care and clearer information to patients. [ABSTRACT FROM AUTHOR]

Objectives: Qualitative evidence suggests that stigma experienced by people who are d/Deaf and hard of hearing (d/DHH) can reduce willingness to engage with health services. Quantitative evidence remains lacking, however, about how health care providers (HCPs) perceive societal stigma toward people who are d/DHH, how HCPs might enact d/DHH stigma within provider-patient encounters, and what patients who are d/DHH share with providers about those patients' perceptions and experiences of stigma. Such quantitative evidence would allow HCPs to understand if and how stigma influences hearing health decisions made by people who are d/DHH. It could also shape practices to reduce d/DHH stigma within clinical encounters and guide providers in considering stigma as a driving force in their patients' hearing health care decisions. Building that evidence base requires validated quantitative measures. In response, the present study initiated an iterative process toward developing and preliminarily validating HCP self-report measures for different forms of d/DHH stigma. These measures draw upon HCPs' own perspectives, as well as their reports of secondhand information about stigma shared during clinical conversations. We developed and preliminary validated four measures: (1) provider-perceived stigma (HCPs' perceptions of the existence of negative attitudes and stereotypes toward d/DHH individuals in society), (2) provider-enacted stigma (self-reported subtle or indirect acts of stigma HCPs might commit during clinical encounters), (3) secondhand patient-experienced stigma (external acts of stigma reported to HCPs by patients who are d/DHH during clinical encounters), and (4) secondhand patient-perceived stigma (perceptions of negative attitudes and stereotypes reported to HCPs by patients who are d/DHH during clinical encounters)., Design: Scale items were extracted from a comprehensive literature review of stigma measures. Question stems and individual items were adapted for HCPs, cognitively tested on 5 HCPs, and pretested with 30 HCPs. The 4 scales were then validated on a sample of primary care providers and hearing care specialists (N = 204) recruited through an online survey. All data were collected in the United States., Results: We conducted an exploratory factor analysis of the four proposed d/DHH stigma HCP stigma scales. Scale items loaded satisfactorily with ordinal alphas ranging between 0.854 and 0.944., Conclusions: The four measures developed and preliminarily validated in this study can provide opportunities for HCPs to develop a more nuanced understanding of stigma experienced and perceived by their patients who are d/DHH and how that stigma manifests across social contexts, including health care settings. Further, the ability to assess forms of d/DHH stigma in clinical encounters, as well as their association with patient disengagement and resistance to advanced hearing care, could lead to innovative stigma-reduction interventions. Such interventions could then be evaluated using the measures from this article and then applied to clinical practice. We envision these measures being further refined, adapted, and tested for a variety of health care contexts, including primary care settings where hearing difficulties may first be identified and in hearing health care settings where audiologic rehabilitation is initiated., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Smoking is one of the most important modifiable risk factors for excess morbidity and mortality in adults with serious mental illness (SMI). Many smokers with SMI are reportedly motivated to quit, however success rates among these smokers remain low and evidence-based treatment targeting this vulnerable group is limited. The purpose of this paper is to report the results of a qualitative inquiry of participants. Methods: We conducted a pilot two-arm randomized controlled trial (RCT) targeting adults with SMI. Our smoking cessation intervention included: (a) group-based physical activity (PA) game intervention (50 minutes, 3X/week for 12 weeks), (b) pharmacotherapy (bupropion or nicotine replacement therapy), and (c) smoking cessation counseling. Upon completion of the program, participants in the active and control groups completed a qualitative semi-structured interview in order to determine how the program impacted their smoking cessation. Grounded Theory methodology guided our data collection and analysis. Results: Twenty participants completed an interview. Participants described how the "whole package" of the 3 components of the intervention were critical to their smoking cessation process. The group-based program provided the structure, resources, and encouragement needed to start the process of quitting. Conclusion: Adults with SMI need support, resources, and engaging activities as they begin quitting and practice the skills needed to quit., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Objectives: Little is known about hearing loss and tinnitus associated with neurotoxic chemotherapy. Study evaluated for differences in occurrence rates and effects of hearing loss and tinnitus in survivors who received a platinum alone, a taxane alone or a platinum and taxane containing regimen., Methods: Total of 273 survivors with breast, gastrointestinal, gynaecological or lung cancer completed self-report measures of hearing loss and tinnitus and had an audiometric assessment that obtained pure tone air conduction thresholds bilaterally at frequencies of between 0.25 kHz to 16.0 kHz. To adjust for age-related and gender-related changes in hearing, each survivor's audiogram was evaluated using the National Health and Nutrition Examination Survey-modified Occupational Safety and Health Administration standards. Survivor was classified as having hearing loss if at any frequency they scored poorer than the 50th percentile for their age and gender. Survivors were categorised as having tinnitus if they reported that for > 10% of their time awake, they were consciously aware of their tinnitus. Differences among the chemotherapy groups were evaluated using parametric and non-parametric tests., Results: For most of the demographic and clinical characteristics, no differences were found among the three chemotherapy groups. Occurrence rates for audiogram-confirmed hearing loss ranged from 52.3% to 71.4%. Occurrence rates for tinnitus ranged from 37.1% to 40.0%. No differences were found among the three chemotherapy groups in the occurrence rates or effects of hearing loss and tinnitus., Conclusion: These findings suggest that regardless of the chemotherapy regimen common mechanistic pathway(s) may underlie these two neurotoxicities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Evaluate for differences in demographic and clinical characteristics, occurrence of common symptoms, symptom severity scores, and quality of life (QOL) outcomes in survivors with (n = 155) and without (n = 118) audiometrically confirmed hearing loss., Methods: Survivors, who were recruited from throughout the San Francisco Bay area, completed the self-report questionnaires to obtain the information of demographic and clinical characteristics; the occurrence and severity of depression, anxiety, fatigue, decrements in energy, sleep disturbance, pain, and cognitive impairment; and the general and cancer-specific QOL outcomes. Parametric and non-parametric tests were used to evaluate for differences between the two survivor groups., Results: Survivors with audiometrically confirmed hearing loss were older, more likely to be male, were more likely to be unemployed, report a lower annual household income, and had a higher comorbidity burden. Except for the severity of worst pain, no between-group differences were found in the occurrence rates for or severity of any of the symptoms. Survivors with hearing loss reported worse physical function and general health scores., Conclusions: While no between-group differences in symptom occurrence rates and severity scores were found, across the total sample, a relatively high percentage of survivors who were over 6 years from their cancer diagnosis reported clinically meaningful levels of depression (25%), anxiety (50%), fatigue (40%), decrements in energy (70%), sleep disturbance (58%), cognitive impairment (57%), and pain (60%)., Implications for Cancer Survivors: Clinicians need to perform routine assessments of hearing loss, as well as common co-occurring symptoms and initiate individualized symptom management interventions., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Aims: Implantable cardioverter-defibrillator (ICD) treatment has expanded due to its effectiveness. However, there are concerns about complications, and use in the most elderly has been questioned. There is scarce data on qualitative aspects regarding experiences of living with an ICD among patients above the age of 80 years. The aim of this study was to explore octogenarians' experience, knowledge, and attitude of living with an ICD., Method and Results: We used semi-structured interviews to collect data from 20 patients, aged 80-89 years (90% men). The data were then structured and analysed through deductive thematic analysis network approach using the ATLAS.ti v.8.4 software. The framework of the analysis was based on the Successful Aging Theory. Three main themes emerged regarding the patients' experiences: Life goes on; Their Health, The Janus-Faced Device; Their attitudes, and Mind the gap; Their knowledge. None of the octogenarians regretted receiving their ICD, instead, they presented with feelings such as gratitude towards the device. However, a lack of knowledge about the devices was expressed, which can be a risk for potential complications, in turn causing suffering and unnecessary concerns., Conclusion: Overall, the ICD did not pose a threat towards successful ageing. It was mainly considered a life-saving device. However, the lack of knowledge might hinder informed choices close to death and contribute to ethical dilemmas when deactivation of the ICD is a reasonable option., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.)

One of the today's greatest challenges is to adjust our behavior so that we can avoid a major climate disaster. To do so, we must make sacrifices for the sake of the environment. The study reported here investigates how anchors (extrinsic motivational-free information) and normative messages (extrinsic motivational information) influence people's tradeoffs between travel time and carbon dioxide (CO 2 ) emissions in the context of car travel and whether any interactions with environmental concern (an intrinsic motivational factor) can be observed. In this study, people received either a CO 2 , health or no normative message together with either a high anchor, a low anchor, or no anchor. People that received both a high anchor and a CO 2 emission normative message were willing to travel for a longer time than those that only received a high anchor. If a low anchor was presented, no differences in willingness to travel for a longer time were found between the three different conditions of normative message groups, i.e., CO 2 normative message, health normative message, or no normative message. People with higher concern for the environment were found to be willing to travel for a longer time than those with lower concern for the environment. Further, this effect was strongest when a high anchor was presented. These results suggest that anchors and normative messages are among the many factors that can influence people's tradeoffs between CO 2 emission and travel time, and that various factors may have to be combined to increase their influence over pro-environmental behavior and decisions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Andersson, Ahonen-Jonnarth, Holmgren, Marsh, Wallhagen and Bökman.)

Background: Self-reported health status as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) in patients with primary prevention implantable cardioverter defibrillators (ICDs) has mainly been reported from randomized trials. However, these studies are often limited to short follow-up and are subject to selection bias. The aim of this study was to assess KCCQ-12 in patients with primary prevention ICD due to either ischemic or nonischemic heart failure., Methods: This cross-sectional observational study included all patients in Region Gävleborg, Sweden, who because of primary prevention due to heart failure, had an ICD or underwent device replacement between 2007 and 2017. After validation using medical records patients were sent and returned the KCCQ-12 by regular mail., Results: A total of 118 questionnaires were analyzed (response rate 71.1%). The mean age was 70.9 ± 9.8 years, and a minority was female (n = 20, 16.9%). The mean overall summary score was 71.5 ± 22.4, there was no significant difference between ischemic and nonischemic heart failure (69.5 ± 23.1 vs. 74.4 ± 21.3; p = 0.195). Atrial fibrillation at baseline was associated with lower score for the domains Symptom frequency (70.2 ± 23.2 vs. 82.2 ± 19.2; p = 0.006) and Social limitation (62.1 ± 26.0 vs. 75.6 ± 26.6; p = 0.006) as well as the overall summary score (63.9 ± 21.3 vs. 74.8 ± 22.2; p = 0.004)., Conclusion: In a real-world setting, primary prevention ICD patients with heart failure report an acceptable disease-specific health status at long-term follow-up. Ischemic and nonischemic etiology showed similar health status whereas atrial fibrillation was associated with worse outcome., (© 2021. The Author(s).)

Objectives: Decisions regarding implantable cardioverter defibrillators (ICDs) must consider information about presumed health-related quality of life (HRQL). The purpose of the study was to assess HRQL in patients with ICD and compare it to a Swedish age-matched and sex-matched population., Design: Cross-sectional observational trial., Setting: Swedish ICD cohort., Interventions: Short form 36 (SF-36) questionnaires from ICD recipients implanted 2007-2017 (response rate 77.2%) were analysed using Mann-Whitney U test and effect size (ES)., Results: In total, 223 patients (mean age 71.1±9.7 years, 82.1% men) were included. In most SF-36 domains (physical functioning (PF), role physical, general health (GH), vitality, social functioning and mental health), the score for patients with ICD was significantly lower (ES range 0.23-0.41, ie, small difference) than norms, except for bodily pain and role emotional. Both the physical component summary (PCS) and the mental component summary (MCS) scores had ES=0.31. Men and women had similar scores. Primary and secondary prevention patients scored similarly, except for worse GH in primary prevention (p=0.016, ES=0.35). Atrial fibrillation was associated with worse PF (ES=0.41) and PCS (ES=0.38). Appropriate therapy, inappropriate shock or complications requiring surgery were not associated with lower scores in any domain. In primary prevention due to ischaemic versus non-ischaemic cardiomyopathy, no domain was significantly different. PCS decreased with higher age strata (p=0.002) in contrast to MCS (p=0.986)., Conclusions: Patients with ICDs have lower physical and mental HRQL than age-matched and sex-matched norms; however, the ESs are small. HRQL is similar regardless of sex, primary/secondary prevention indication, appropriate therapy, inappropriate shock or complications, but decreases with advancing age., Competing Interests: Competing interests: PM has received speaker fees or grants from Abbott, Alnylam, Amicus Therapeutics, Bayer, AstraZeneca, BMS, Boehringer‐Ingelheim, Internetmedicin, Lilly, MSD, Novo Nordisk, Octopus Medical, Pfizer, Vifor Pharma and Zoll. GM has received speaker fee from Alnylam, Internetmedicin and MSD., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Editor's note: This article is by 22 nursing gerontology experts who are all advocates of nursing home reform. They are listed at the end of this article., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Naxos disease is a rare entity that manifests with woolly hair, keratosis of extremities, and cardiac manifestations that resemble arrhythmogenic right ventricular cardiomyopathy. It is inherited in an autosomal recessive pattern and mutations affecting plakoglobin and desmoplakin have been identified. There is an increased risk of arrhythmias, including sudden cardiac death at a young age. Right ventricular systolic dysfunction often progresses and left ventricular involvement may also occur., Areas Covered: This article reviews historic background, epidemiology, clinical characteristics, genetics, and pathogenesis as well as therapeutic management and future perspectives., Expert Opinion: The principles of evaluation and treatment are based on arrhythmogenic right ventricular cardiomyopathy (ARVC) and general heart failure guidelines, because specific data on Naxos disease are limited. Therefore, larger registries on Naxos disease are welcome in order to gain more knowledge about clinical course and risk stratification. Translational research on pathophysiological mechanisms has evolved, including promising approaches using stem cells for novel targets.

Aims and Objectives: The findings presented in this manuscript address two key research questions: (a) What factors contribute to the initiation and maintenance of the caregiving role as performed by the grandparent-caregivers; and (b) What are the perceived benefits of caregiving as reported by grandparent-caregivers?, Background: Grandparents in sub-Saharan Africa have cared for their grandchildren for generations, yet little is known about this role in the context of the HIV epidemic. Although the impact of the epidemic is overwhelmingly negative, specifically in Uganda, knowledge of familial context and underlying motivations and rewards that incentivise grandparent-caregivers remains limited in the literature., Methods: Using a constructivist grounded theory approach, we explored the experiences of 32 Ugandan grandparents of grandchildren affected by HIV. Data were collected using a semi-structured and open-ended interview guide, participant observation and fieldnotes. Data analysis included open, focused and axial coding., Findings: The data revealed the influences of extended familial structures and of cultural and gender expectations on the decision-making processes and rewards of caregiving as perceived by the grandparent-caregivers., Discussion and Recommendation: These findings provide a broad foundation for policy, practice, research and education interventions needed to support grandparents so they can enjoy the benefits of raising their grandchildren., Implications for Practice: Our findings can guide education programs and clinical practice for nurses, nursing students, and other health providers on cultural considerations for holistic care provided for older adults-especially older caregivers., (© 2020 John Wiley & Sons Ltd.)

Studies of caregiving provided to HIV/AIDS orphans by sub-Saharan African grandparents have found that it has physical, financial, and emotional consequences. Our study extended this research by identifying and characterizing the symptoms experienced by Ugandan grandparent- caregivers, particularly as related to the caregiving role, loss and grief. Grounded theory methodology was used to conduct and analyze audio-recorded, semi-structured interviews with 32 grandparents. Findings revealed a cluster of biopsychosocial distress symptoms, especially anguish (driven by traumatic anxiety and disbelief), depression, and somatic symptoms that were linked primarily to psychological distress. The impact of cultural practices and beliefs on these symptoms was also identified. Results have implications for public health, research, and policy changes needed to alleviate symptoms of biopsychosocial distress among Uganda grandparent-caregivers.

Importance: Nearly 38 million individuals in the United States have untreated hearing loss, which is associated with cognitive and functional decline. National initiatives to address hearing loss are currently under way., Objective: To determine whether untreated hearing loss is associated with increased health care cost and utilization on the basis of data from a claims database., Design, Setting, and Participants: Retrospective, propensity-matched cohort study of persons with and without untreated hearing loss based on claims for health services rendered between January 1, 1999, and December 31, 2016, from a large health insurance database. There were 154 414, 44 852, and 4728 participants at the 2-, 5-, and 10-year follow-up periods, respectively. The study was conceptualized and data were analyzed between September 2016 and November 2017., Exposures: Untreated hearing loss (ie, hearing loss that has not been treated with hearing devices) was identified via claims measures., Main Outcomes and Measures: Medical costs, inpatient hospitalizations, total days hospitalized, 30-day hospital readmission, emergency department visits, and days with at least 1 outpatient visit., Results: Among 4728 matched adults (mean age at baseline, 61 years; 2280 women and 2448 men), untreated hearing loss was associated with $22 434 (95% CI, $18 219-$26 648) or 46% higher total health care costs over a 10-year period compared with costs for those without hearing loss. Persons with untreated hearing loss experienced more inpatient stays (incidence rate ratio, 1.47; 95% CI, 1.29-1.68) and were at greater risk for 30-day hospital readmission (relative risk, 1.44; 95% CI, 1.14-1.81) at 10 years postindex. Similar trends were observed at 2- and 5-year time points across measures., Conclusions and Relevance: Older adults with untreated hearing loss experience higher health care costs and utilization patterns compared with adults without hearing loss. To further define this association, additional research on mediators, such as treatment adherence, and mitigation strategies is needed.

Context: The most common adverse effects from neurotoxic chemotherapy are chemotherapy-induced neuropathy (CIPN), hearing loss, and tinnitus. Although associations between perceived stress and persistent pain, hearing loss, and tinnitus are documented, no studies have examined these associations in cancer survivors who received neurotoxic chemotherapy., Objectives: In this cross-sectional study, we evaluated for associations between perceived stress and the occurrence of CIPN, hearing loss, and tinnitus, in 623 adult cancer survivors who received platinum and/or taxane compounds., Methods: Survivors completed self-report measures of hearing loss, tinnitus, and perceived stress (i.e., Impact of Events Scale-Revised [IES-R]). Separate logistic regression analyses were done for each neurotoxicity to evaluate whether each of the IES-R subscale (i.e., intrusion, avoidance, hyperarousal) and total scores made a significant independent contribution to neurotoxicity group membership., Results: Of the 623 survivors in this study, 68.4% had CIPN, 34.5% reported hearing loss, and 31.0% reported tinnitus. Older age, higher body mass index, poorer functional status, being born prematurely, cancer diagnosis, and higher intrusion (P = 0.013), hyperarousal (P = 0.014), and total (P = 0.047) IES-R scores were associated with CIPN. Older age, being male, poorer functional status, a worse comorbidity profile, and a higher IES-R hyperarousal (P = 0.007) score were associated with hearing loss. Being male, having less education, a worse comorbidity profile, and a higher IES-R hyperarousal (P = 0.029) score were associated with tinnitus., Conclusion: These findings suggest that increased levels of perceived stress are associated with the most common chemotherapy-induced neurotoxicities., (Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Limited information is available on the impact of chemotherapy (CTX)-induced neurotoxicity on adult survivors' symptom experience and quality of life (QOL). Purposes were to describe occurrence of hearing loss and tinnitus and evaluate for differences in phenotypic characteristics and measures of sensation, balance, perceived stress, symptom burden, and QOL between survivors who received neurotoxic CTX and did (i.e., neurotoxicity group) and did not (i.e., no neurotoxicity group) develop neurotoxicity. Neurotoxicity was defined as the presence of chemotherapy-induced neuropathy (CIN), hearing loss, and tinnitus. Survivors in the no neurotoxicity group had none of these conditions., Methods: Survivors (n = 609) completed questionnaires that evaluated hearing loss, tinnitus, stress, symptoms, and QOL. Objective measures of sensation and balance were evaluated., Results: Of the 609 survivors evaluated, 68.6% did and 31.4% did not have CIN. Of the survivors without CIN, 42.4% reported either hearing loss and/or tinnitus and 48.1% of the survivors with CIN reported some form of ototoxicity. Compared to the no neurotoxicity group (n = 110), survivors in the neurotoxicity group (n = 85) were older, were less likely to be employed, had a higher comorbidity burden, and a higher symptom burden, higher levels of perceived stress, and poorer QOL (all p < .05)., Conclusions: Findings suggest that CIN, hearing loss, and tinnitus are relatively common conditions in survivors who received neurotoxic CTX., Implications for Cancer Survivors: Survivors need to be evaluated for these neurotoxicities and receive appropriate interventions. Referrals to audiologists and physical therapists are warranted to improve survivors' hearing ability, functional status, and QOL.

Pain is a significant problem for nursing home residents, yet its assessment is complex. Certified nursing assistants (CNAs) spend significant time with residents, but their role in understanding residents' pain is largely unexplored. The current qualitative grounded theory study analyzed interviews with 16 CNAs who described their experiences caring for residents in pain. Findings revealed how CNAs understood, recognized, interpreted, and responded to residents' pain. CNAs were found to differentiate between pain that they considered normal (everyday pain) and new pain judged significant enough to report to licensed nurses. CNAs exhibited a holistic understanding of pain, knowledge of strategies to identify and interpret pain, and actions to independently mitigate and report pain. Although additional confirmatory data are needed, the differentiation made between everyday and reportable pain may have important clinical implications suggesting that CNAs should always report to a licensed nurse when they perceive or suspect that residents have pain. [Journal of Gerontological Nursing, 44(4), 29-36.]., (Copyright 2018, SLACK Incorporated.)

Purpose: The purpose of this study was to evaluate for differences in demographic, clinical, and pain characteristics, as well as measures of sensation, balance, perceived stress, symptom burden, and quality of life (QOL) among survivors who received neurotoxic chemotherapy (CTX) and who reported only chemotherapy-induced neuropathy (CIN, n = 217), CIN and hearing loss (CIN/HL, n = 69), or CIN, hearing loss, and tinnitus (CIN/HL/TIN, n = 85). We hypothesized that as the number of neurotoxicities increased, survivors would have worse outcomes., Methods: Survivors were recruited from throughout the San Francisco Bay area. Survivors completed self-report questionnaires for pain and other symptoms, stress and QOL. Objective measures were assessed at an in person visit., Results: Compared to survivors with only CIN, survivors with all three neurotoxicities were less likely to be female and less likely to report child care responsibilities. In addition, survivors with all three neurtoxicities had higher worst pain scores, greater loss of protective sensation, and worse timed get up and go scores. These survivors reported higher state anxiety and depression and poorer QOL. For some outcomes (e.g., longer duration of CIN, self-reported balance problems), significantly worse outcomes were found for the survivors with CIN/HL and CIN/HL/TIN compared to those with only CIN., Conclusions: Our findings suggest that compared to survivors with only CIN, survivors with CIN/HL/TIN are at increased risk for the most severe symptom burden, significant problems associated with sensory loss and changes in balance, as well as significant decrements in all aspects of QOL., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Despite increasing numbers of studies investigating grandparent-caregivers of children orphaned by HIV/AIDS in sub-Saharan Africa, research on their mental and physical health remains inadequate. We provide a qualitative account of the nature, extent, and relationships among multiple variations of loss emerging from 32 interviews with Ugandan grandparent-caregivers of grandchildren affected by HIV/AIDS. Regardless the type or nature of the loss, participants expressed physical, emotional, and financial distress as a result. This cumulative loss and subsequent grief could potentially be associated with mental and physical health problems. Research to further explore the concept of loss among this vulnerable population is recommended.

Background and Purpose: Drug-related ototoxicity may exacerbate presbycusis (age-related hearing loss); yet, few data are available on the prevalence of ototoxic medication use by older adults. The purposes of this study were to assess the impact of aging and ototoxicity on hearing loss, the prevalence of ototoxic medication use, and select characteristics associated with ototoxic medication use among older adults., Methods: Cross-sectional analyses were conducted using select variables extracted from the baseline and 10-year follow-up assessments of the two population-based epidemiological studies to compare two points in time., Results: Ninety-one percent of the sample was taking a medication reported to be ototoxic. Nonsteroidal anti-inflammatory drugs were the most commonly used (75.2%), followed by acetaminophen (39.9%) and diuretics (35.6%). Hypertension, diabetes, cardiovascular disease, and history of smoking were associated with ototoxic medication use. Participants with hearing loss were taking a significantly greater number of ototoxic medications than those without hearing loss., Conclusion: Known ototoxic medications are widely used. Any subsequent ototoxicity may interact with age changes and a more severe hearing loss than that associated with only age., Implications for Practice: Nurse practitioners should inform older adults about the possibility of drug-related ototoxicity and monitor hearing acuity of all older adults taking known ototoxic medications.