Implementation of Evidence Based Protocol for Orthostatic Hypotension in Older Adults with Advanced Dementia


Book Description

"Orthostatic hypotension (OH) in older adults with dementia is associated with increased confusion, dizziness, syncope, and falls. These problems can be responsible for a negative, downward spiral, high morbidity and mortality. The literature supports that pharmacologic and non pharmacologic treatments are effective in the reduction of symptoms and prevention of orthostasis. The purpose of this quality improvement project was to increase staff knowledge and skill in the assessment of OH and related care for residents in dementia care units. This was accomplished by an in-service program presented to RN's, LPNs, therapists, and unlicensed caregivers using a protocol based on clinical practice guidelines. In-service pre and posttest measures confirmed increased staff knowledge. Pre and post in-service chart audits revealed increased documentation of orthostatic blood pressure measurement and use of care strategies included in the protocol. This evidence based practice will reduce symptoms of OH, increase resident safety and quality of life. Keywords: orthostatic hypotension, postural hypotension, orthostasis, clinical practice guideline, older adults, long-term care, aging, dementia, syncope and falls " -- Abstract.




Orthostatic Hypotension in Older Adults


Book Description

This book provides a comprehensive and practical guide to orthostatic hypotension (OH) for doctors and nurses involved in the care of older adults, together with a state-of-the-art update on OH, covering its epidemiology, pathophysiology, assessment, diagnosis, causes, prevention, management, and relevance for geriatric practice. In addition, it addresses mechanisms of orthostatic tolerance and other orthostasis related conditions, as well as drugs, comorbidities and geriatric syndromes related to OH. The homeostatic ability to maintain blood pressure while standing requires an adequate blood volume and the integrity of the nervous system, heart, blood vessels and muscle pump. However, in older adults, some age-related factors can contribute to the development of OH. For example, decreased baroreflex sensitivity, α-1-adrenergic vasoconstrictor response to sympathetic stimuli, parasympathetic activity, renal salt and water conservation, increased vascular stiffness and decreased ventricular diastolic filling, as well as concentrated capacities of the kidney may be associated with changes in postural blood pressure. It has also been shown that OH is associated with falls, cardiac events, heart failure, stroke, reduced quality of life, and increased risk of overall mortality in these patients. “Orthostatic Hypotension in Older Adults” will be of considerable interest to all professionals working in the fields of geriatrics, geriatric psychiatry, neurology, internal medicine, cardiology, and emergency medicine, or working with older people in hospitals or in their community.




Evidence-Based Geriatric Nursing Protocols for Best Practice


Book Description

This new edition of one of the premier references for geriatric nurses in hospital, long-term, and community settings delivers current guidelines, real-life case studies, and evidence-based protocols developed by master educators and practitioners. With a focus on improving quality of care, cost-effectiveness, and outcome, the fifth edition is updated to provide the most current information about care of common clinical conditions and issues in older patients. Several new expert contributors present current guidelines about hip fractures, frailty, perioperative and postoperative care, palliative care, and senior-friendly emergency departments. Additionally, chapters have been reorganized to enhance logical flow of content and easy information retrieval. Protocols, systematically tested by more than 300 participating NICHE (Nurses Improving Care for Health system Elders) hospitals‚ are organized in a consistent format and include an overview, evidence-based assessment and intervention strategies, and an illustrative case study with discussion. Additionally, protocols are embedded within chapter text, providing the context and detailed evidence for each. Chapter objectives, annotated references,and evidence ratings for each protocol are provided along with resources for additional study. New to the Fifth Edition: Reorganized to enhance logical flow of information and ease of use Updated and revised Includes new contributions from expert educators and practitioners Provides new chapters on perioperative and postoperative care, general surgical care, care of hip fracture, palliative care, and the senior-friendly emergency department Key Features: Includes PowerPoints and a test bank for instructors Delivers evidence-based, current guidelines and protocols for care of common clinical conditions in the older person Illustrates the application of clinical protocols to real-life practice through case studies and discussion Edited by nationally known geriatric leaders who are endorsed by the Hartford Institute for Geriatric Nursing and NICHE Written for nursing students, nurse leaders, and practitioners at all levels, including those in specialty roles




Diabetes and Hypertension


Book Description

Diabetes and hypertension have evolved as two of the modern day epidemics affecting millions of people around the world. These two common co-morbidities lead to substantial increase in cardiovascular disease, the major cause of morbidity and mortality of adults around the world. In Diabetes and Hypertension: Evaluation and Management, a panel of renowned experts address a range of critical topics -- from basic concepts in evaluation and management of diabetes and hypertension, such as dietary interventions, to evaluation and management of secondary hypertension in clinical practice. Other chapters focus on high cardiovascular risk populations such as those with coronary heart disease, chronic kidney disease and minority patients. In addition, evolving concepts and new developments in the field are presented in other chapters, such as prevention of type 2 diabetes and the epidemic of sleep apnea and its implication for diabetes and hypertension evaluation and management. An important title covering two of the most troubling disorders of our time, Diabetes and Hypertension: Evaluation and Management will provide the busy practitioner with cutting edge knowledge in the field as well as practical information that can translate into better care provided to the high-risk population of diabetics and hypertensive patients.




Acute Care for Elders


Book Description

Acute Care for Elders (ACE) is a model of care designed to improve functional outcomes and to improve the processes for the care of older patients. This model includes: an environment of care designed to promote improved function for older patients; an interdisciplinary team that works together to identify/address the vulnerabilities of the older patients; nursing care plans for prevention of disability; early planning to help prepare the patient to return home and a review of medical care to prevent iatrogenic illness. Acute Care for Elders: A Model for Interdisciplinary Care is an essential new resource aimed at assisting providers in developing and sustaining an ACE program. The interdisciplinary approach provides an introduction to the key vulnerabilities of older adults and defines the lessons learned from the Acute Care for Elders model. Expertly written chapters describe critical aspects of ACE: the interdisciplinary approach and the focus on function. The fundamental principles of ACE described in this book will further assist hospital leaders to develop, implement, sustain and disseminate the Acute Care for Elders model of care. Acute Care for Elders: A Model for Interdisciplinary Care is of great value to geriatricians, hospitalists, advance practice nurses, social workers and all others who provide high quality care to older patients.




Patient Safety and Quality


Book Description

"Nurses play a vital role in improving the safety and quality of patient car -- not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043)." - online AHRQ blurb, http://www.ahrq.gov/qual/nurseshdbk/







Geriatric Gastroenterology


Book Description

As aging trends in the United States and Europe in particular are strongly suggestive of increasingly older society, it would be prudent for health care providers to better prepare for such changes. By including physiology, disease, nutrition, pharmacology, pathology, radiology and other relevant associated topics, Geriatric Gastroenterology fills the void in the literature for a volume devoted specifically to gastrointestinal illness in the elderly. This unique volume includes provision of training for current and future generations of physicians to deal with the health problems of older adults. It will also serve as a comprehensive guide to practicing physicians for ease of reference. Relevant to the geriatric age group, the volume covers epidemiology, physiology of aging, gastrointestinal physiology, pharmacology, radiology, pathology, motility disorders, luminal disorders, hepato-biliary disease, systemic manifestations, neoplastic disorders, gastrointestinal bleeding, cancer and medication related interactions and adverse events, all extremely common in older adults; these are often hard to evaluate and judge, especially considering the complex aging physiology. All have become important components of modern medicine. Special emphasis is be given to nutrition and related disorders. Capsule endoscopy and its utility in the geriatric population is also covered. Presented in simple, easy to read style, the volume includes numerous tables, figures and key points enabling ease of understanding. Chapters on imaging and pathology are profusely illustrated. All chapters are written by specialists and include up to date scientific information. Geriatric Gastroenterology is of great utility to residents in internal medicine, fellows in gastroenterology and geriatric medicine as well as gastroenterologists, geriatricians and practicing physicians including primary care physicians caring for older adults.




The Gift of Caring


Book Description

The desire to help our elders navigate health issues is clear and universal—how to assure proper care and a good ending is not. Combining adroit storytelling skills with expert advice, The Gift of Caring: Saving Our Parents from the Perils of Modern Healthcare brings the reader into all-too-familiar scenarios facing our aging parents and offers answers to questions we may not know to ask until it’s too late. Author and biologist Marcy Houle shares her personal journey of caring for her father, a surgeon, who developed Alzheimer’s, and later her mother, who succumbed to other medical conditions. Like many children of aging parents, Marcy often felt powerless traveling this sad trajectory—watching them fall through the cracks of a fragmented and confusing healthcare system, where professionals often wrote off their symptoms as “just old age.” Not having the understanding of the changes that come with aging, she was led to believe there was nothing she could do to help. The tragic secret? According to coauthor and geriatrics physician Elizabeth Eckstrom, these symptoms frequently are not “just old age.” Rather, the problem is that the current healthcare delivery model for older people is ill-equipped to provide the comprehensive, person-centered care seniors need. Today, thousands of aging people face unnecessary suffering, hospitalizations, nursing home stays, and even death due to complications that could have been prevented or treated. Even more troubling, many healthcare professionals have had little or no training in the care of older adults. The Gift of Caring reveals these pitfalls and provides families with tools they can use to avoid them. Interspersed with every few chapters of Marcy’s riveting story, Dr. Eckstrom shares professional medical insights, compiled from the latest research, into what Marcy could have done to safeguard her parents. She shows us how to navigate the system, how we can become our loved one’s best advocate, and what we need to know to achieve healthy aging and meaningful, compassionate final years. Honest, at times humorous, and ultimately uplifting, The Gift of Caring sheds new light on aging from twin perspectives: a story of a daughter desperately seeking help for the parents she loves, and a geriatrician who gives us the knowledge we need to insist upon a better way.




Orthogeriatrics


Book Description

This new open access edition supported by the Fragility Fracture Network aims at giving the widest possible dissemination on fragility fracture (especially hip fracture) management and notably in countries where this expertise is sorely needed. It has been extensively revised and updated by the experts of this network to provide a unique and reliable content in one single volume. Throughout the book, attention is given to the difficult question of how to provide best practice in countries where the discipline of geriatric medicine is not well established and resources for secondary prevention are scarce. The revised and updated chapters on the epidemiology of hip fractures, osteoporosis, sarcopenia, surgery, anaesthesia, medical management of frailty, peri-operative complications, rehabilitation and nursing are supplemented by six new chapters. These include an overview of the multidisciplinary approach to fragility fractures and new contributions on pre-hospital care, treatment in the emergency room, falls prevention, nutrition and systems for audit. The reader will have an exhaustive overview and will gain essential, practical knowledge on how best to manage fractures in elderly patients and how to develop clinical systems that do so reliably.