A New Role For Skilled Nursing in Long Term Care

When I was a medical resident at Boston City Hospital, a large, public, inner city hospital, I began wondering whether hospitals sometimes caused as many problems as they cured. Over and over, I saw older patients admitted with one disease such as pneumonia or a heart attack, who ended up falling and breaking a bone or getting a blood clot from being confined to bed. So I did a study in which I measured how often older people became confused, stopped eating, developed incontinence, or fell while they were in the hospital. I tried to separate out those cases in which the new symptom could be plausibly related to the admitting diagnosis: for example, someone who was hospitalized with a stomach ulcer would normally stop eating during the initial treatment, and someone with a stroke might well be confused. Then I compared the rates at which people over 70 developed these unexpected complications with the rates at which younger people developed them. Finally, I speculated that each of these problems might trigger a cascade of adverse events: a patient who became incontinent might have a catheter placed in his bladder, which in turn might cause a urinary tract infection; a patient who got confused might be physically restrained and his immobility might lead to a blood clot.

GeroNursePrep

What I found was that among the 502 patients I examined, a startling 41% of those over 70 developed 1 or more of the 4 problems I was interested in compared to only 9% of the younger group—and these were all problems that could not clearly be related to the acute illness for which the patient was being treated. It made me question whether hospitals were a safe place for older patients.

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Reference:
Murriel Gillick, “Barking Up the Wrong Tree”,
http://blog.drmurielgillick.com/2014/02/barking-up-wrong-tree.html

Sedentary Lifestyle Increases Risk for Heart Failure

We are all aware of the risks of heart disease: diet, exercise, smoking, lipid levels, stress, genetics, etc. Now, research is showing us more specifically to what these lifestyle risks relate. A recent study published in the Journal Circulation: Heart Failure, found that a high sedentary lifestyle increased the chance of having heart failure, as much as 1.34 times that of a low sedentary lifestyle.

Heart Failure

Picture Source: USAToday.com

Similarly, the study found that lower levels of physical activity were also related to heart failure, as much as 1.52 times as likely to get heart failure that those with high levels of physical activity. It is crucial to stress the importance of healthy, active lifestyle for all, to the individual’s highest ability, to protect the heart from disease. This evidence can be used as a motivator to discourage sedentary behaviors.

Young DR, Reynolds K, Sidell M, Brar S, Ghai NR, Sternfeld B, et al. Effects of physical activity and sedentary time on the risk of heart failure. Circ Heart Fail. 2014 Jan 1;7(1):21-7.

For more on this study, see: http://www.ncbi.nlm.nih.gov/m/pubmed/24449810/

Music to reduce stress and anxiety for coronary heart disease patient

Individuals with coronary heart disease often suffer from severe distress, putting them at greater risk for complications, including sudden cardiac death. It is therefore important that the care of people with coronary heart disease focuses on psychological as well as physiological needs. Music interventions have been used for many years to reduce anxiety and distress and improve physiological responses such as heart rate and respiratory rate in medical patients.

This review is an update of a previous Cochrane review from 2009 which suggested that music interventions may have a beneficial effect on anxiety and physiological responses in people with coronary heart disease but the quality of the evidence was not strong and the clinical significance unclear.

Music to reduce stress and anxiety

For this review, we searched for additional trials on the effect of music interventions on stress and anxiety in people with coronary heart disease. We searched for studies published up until November 2012 as well as ongoing studies until November 2012. We considered all studies in which any form of participation in music (e.g. listening to music, singing, playing music) was compared with any form of standard treatment and included persons with confirmed coronary heart disease. We identified four new trials for this update.

This review includes 26 trials with a total of 1369 participants. The trials were small in size. The findings suggest that listening to music may have a beneficial effect on systolic blood pressure and heart rate in people with coronary heart disease. Listening to music also appears to be effective in reducing anxiety in people with myocardial infarction, especially when they are given a choice of which music to listen to. Listening to music may also reduce pain and respiratory rate. However the size of the effects on pain and respiratory rate is small. Therefore, its clinical importance is unclear. Finally, listening to music appears to improve patients’ quality of sleep following a cardiac procedure or surgery. We found no evidence of effect for depression or heart rate variability, and inconsistent results for mood. No adverse effects of music interventions were reported. The majority of the studies examined the effects of listening to pre‐recorded music. More research is needed on the effects of music interventions offered by a trained music therapist. Overall, the quality of the evidence is not strong thus the results should be interpreted with caution.

Read the complete story here

Reference
Cochrane Database of Systematic Reviews,”Music to reduce stress and anxiety for people with coronary heart disease“.

Smart Hiring Practices Improves Nurse Retention

The turnover rate for long-term care nurses is far higher than the national average, but facilities can improve retention by adjusting human resources practices, a top workforce researcher said in a McKnight’s webcast Thursday.

While it is no secret that long-term care operators see high turnover rates, the hard numbers show just how serious the issue is, said Frederick Morgeson, Ph.D., of Michigan State University. The national turnover rate for all professions is about 4.5 years, while the rate for registered nurses in long-term care is about a year, according to Morgeson. Organizations with 150 nurses could face between $1.25 million to $2 million a year in the costs of losing nurses, he said.

nurse-rentention

Providers should consider the recruitment messages they are sending and how these can sow the seeds of future turnover, he said. For example, if a job posting promises opportunities for relocation or career advancement, this could effectively address nurses’ desire for professional growth — the lack of which they often cite as a source of dissatisfaction, according to Morgeson. However, if a provider cannot actually deliver on this promise, the company is likely to attract and hire an applicant who will go on to be unhappy and leave the job.

Read more here

Reference
Tim Mullaney, Staff Writer,”Improved nurse retention begins with smart hiring practices“.

Registration Now Open for ANCC Certification Conference

Designation as a board-certified nurse is the ultimate credential for high-quality nursing. Join 500 of your dedicated nursing colleagues at the ANCC Board Certification Nursing Conference to renew that commitment to nursing excellence.

Registration Now Open for ANCC Certification Conference

Up to 14.5 contact hours

Top 3 Reasons to Attend:

  1. Connect With Peers—Network with your certified nurse peers.
  2. Commit to Professional Growth—Participate in hands-on sessions led by experts in your field.
  3. Excel at Patient Care—Meet the highest standards of excellence and continue delivering high-quality health care.

Conference Highlights:

  • Earn CEs for renewal—including pharmacology!
  • Learn about clinical and professional best practices in nursing that you can implement right away.
  • Hear about new trends in nursing’s healthcare services and technologies.
  • Choose from two educational tracks—clinical or professional/business.

Register now to ensure you gain the knowledge and skills necessary to maintain your certification and deliver advanced patient care.

The ANCC Board Certification Nursing Conference will also be celebrating Certified Nurses Day (March 19th) and the 40th anniversary of the ANCC Certification Program.

Register Now

Cure or Treatment for Dementia by 2025

The NY Times didn’t cover it; neither did the Washington Post or the Wall Street Journal. But the BBC made a big deal of the G8 “dementia summit,” hosted by the UK just a month ago. Representatives from the research world, the pharmaceutical industry, and the Organization of Economic Development, along with government health leaders, met to discuss what to do about Dementia.

Almost all the members of the G8 took the conference seriously: the UK, Canada, France, Germany, Italy, Japan, and Russia each sent their top health representative. The US didn’t send the Secretary of Health and Human Services or an assistant secretary. The US sent the “acting assistant secretary for planning and evaluation” in the Department of Health and Human Services. This says it all: the US didn’t regard this conference as a priority.

What is Dementia?

  • It is an umbrella term that describes about 100 diseases in which brain cells die on a huge scale.
  • All damage memory, language, mental agility, understanding and judgement.
  • Alzheimer’s disease is the most common form, affecting 62% of those living with dementia.
  • It gets worse with time and eventually people are left completely dependent on carers.
  • It is incurable

Dementia across the Globe

Dementia across the globe

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Reference:
Murriel Gillick, “The Latest War”,
http://blog.drmurielgillick.com/2014/01/the-latest-war.html

How’s that for a New Year’s Resolution

From both an individual and a public health perspective, frailty is one of the most important conditions affecting older people. Along with dementia, which is really just cognitive as opposed to physical frailty, it is a devastating syndrome. Frailty predisposes to recurrent hospitalizations and leads to the dreaded cascade of iatrogenic complications once someone is in the hospital. Frailty leads to nursing home placement and to disability and death. So a recent consensus statement discussing how to approach frailty is one of the most exciting and significant papers to appear in the recent geriatric literature. Published in a third tier medical journal, it’s only by chance that I stumbled on the article at all.

Fragile: Handle with Care

No one wants to be labeled “frail.” It’s up there along with “elderly” or “old” as a term everyone seems to want to avoid. But far better to prevent or treat the condition than to pretend it doesn’t exist. It’s time for doctors to pay attention to frailty—to recognize when it’s present and to intervene when possible. How’s that for a New Year’s Resolution!

Read more…

Reference:
Murriel Gillick, “Fragile Handle with care”, http://blog.drmurielgillick.com/2013/12/fragile-handle-with-care.html

How the Affordable Care Act Affects Baby Boomers and Medicare Beneficiaries

Webinar for Journalists – “How the Affordable Care Act Affects Baby Boomers and Medicare Beneficiaries” presented by the Kaiser Family Foundation’s Media Fellowships Program.

Featuring two Kaiser Family Foundation experts, the webinar began with brief presentations of the major changes for older people. Senior Fellow Karen Pollitz focused on the ACA’s role for baby boomers who are not yet 65 and eligible for Medicare and their access to new coverage options in marketplaces and/or their eligibility for premium subsidies or Medicaid expansions. Associate Director of the Program on Medicare Policy Juliette Cubanski talked about how the ACA impacts Medicare benefits and beneficiaries. We also touched on some of the major open enrollment issues for both Obamacare and Medicare. Most of the hour was devoted to a question and answer session with the participating audience.

Baby Boomers

Watch the webinar here- COMPLETE WEBINAR

Reference
Kaiser Family Foundation, “Webinar for Journalists“, www.kff.org/