Evidence and Practice
Understand the challenges posed by urinary tract infections in older people
Why you should read this article: • To be aware that people living with advanced dementia whose ability to speak is limited may communicate using their body and facial responses • To identify the changing and complex health needs of people living with advanced dementia • To recognise the challenges experienced by family carers of people living with advanced dementia This is the first article in a six-part series in Nursing Older People exploring the nursing care of people living with advanced dementia. This article discusses the changes that may occur as dementia progresses, from the perspective of the individual, their family and other carers. A person living with advanced dementia is likely to experience physical, cognitive and social changes that can be profound and debilitating. Healthcare needs intensify as new and co-existing issues result in increasing dependency on others for support with activities of daily living. These activities can include eating, drinking, mobility and personal care. Consequently, family carers may find their role has to develop and change to provide increasing support in response to these complex needs. These increasing needs can result in care transitions to hospitals or care homes. Careful and collaborative management of care is crucial to maintain quality of life for the person with dementia and family carers.
Why you should read this article: • To increase your awareness of the post-diagnostic support needed by people with dementia and their family carers • To recognise the challenges involved in supporting carers of people with dementia by telephone • To enhance your understanding of how to use a framework to reflect on your practice In the UK, the quality of post-diagnostic care and support for people with dementia and their family carers is variable and depends on the availability of services in each person’s local area. This article considers the support services available for families affected by dementia and discusses how telephone helplines can assist those who may have no access to other types of support. It presents a case study describing a call to the Admiral Nurse Dementia Helpline, a service run by nurses with expertise in dementia care and provided by the charity Dementia UK. This is followed by a reflection on the call from the nurse’s perspective. The case study-based reflection demonstrates the complexity of providing support through a helpline and the specialist knowledge and skills required to provide the appropriate level of support.
Testing acceptability of Project Extension for Community Healthcare Outcomes (ECHO)
Why you should read this article: • To recognise the importance of evidence-based best practice for people living with advanced dementia, delivered with compassion and dignity • To be aware of the exceptional advanced nursing practice skills and knowledge required to deliver evidence-based care • To identify the main challenges experienced by nurses, nurse leaders and nurse educators in delivering evidence-based care to people living with advanced dementia This is the introductory article in a six-part series in Nursing Older People exploring the nursing care of people living with advanced dementia. It discusses the complex and progressive array of nursing required to meet the needs of individuals, the provision of personal care, learning and leadership, meaningful activity, and palliative and end of life care. A main theme of the series is the exceptional nursing skills and knowledge required to deliver evidence-informed care with compassion and respect for people living with advanced dementia. This introductory article provides background information to contextualise advanced dementia and identify the main challenges facing nurses, nurse educators and nurse leaders.
Why you should read this article: • To understand how suboptimal posture in older people can negatively affect their well-being • To recognise the role of night-time positioning equipment in improving posture in older people • To improve your knowledge on the wider benefits of night-time positioning in older people Background Twenty four-hour postural care that includes the use of night-time positioning equipment (NTPE) is being increasingly recommended. However, because most of the published studies focus on children, there is a lack of evidence on the use of NTPE in adults. Aim The aim of this pilot study was to assess the effect of NTPE use in UK care home residents with complex health conditions and postural asymmetry. Methods Ten care home residents trialled NTPE over a 12-week period. Qualitative and quantitative data were collected before and after each trial using standardised assessment tools. Semi-structured interviews were conducted with participants and relatives after each trial. Staff’s views were elicited via two focus groups at the end of the study. Results There were notable benefits of NTPE use in terms of participants’ pain levels, sleep quality, risk of pressure ulcers, risk of choking, and weight. There was also evidence of improvements in participants’ function, ability to undertake activities of daily living and quality of life. However, some equipment was abandoned during the trials because participants found it too hot or restrictive. Conclusion This pilot study increases the evidence base for a personalised approach to 24-hour postural care that can support older people’s health and well-being. Further empirical studies are required to determine how NTPE can be used to improve older people’s quality of life.
This article defines sexual health and explores the changes people experience in later life
Newcastle Model’s biopsychosocial framework is revisited to understand the caregiving context
Nurses need to be aware of the risk factors and identify at-risk patients
Clinicians do not always recognise depression in older people as they attribute symptoms to the ageing process and the effects of failing health. Similarly, older people do not always appreciate that their symptoms relate to their mood. Understanding how depression affects older people can improve access to support, thereby improving overall health and quality of life. To ensure these outcomes we need a workforce with excellent communication skills that supports therapeutic relationships, promotes recognition of symptoms, and enhances assessment, diagnosis, treatment and management.
How nurses can have a positive effect on the lives of people with COPD
Nurses can overcome communication barriers through thoughtful interventions
Hearing loss is a common problem in older people and may have a negative effect on their care while in hospital, as well as resulting in significant cost to the NHS. This article outlines the findings of a two-year project in an NHS trust to improve the care of older people with hearing loss. An important outcome of the project was the development of a hearing loss toolkit containing good practice recommendations and tools to help staff in all NHS trusts, and other care settings, implement practical and cost-effective improvements.
Admission to a care home is a major event for many individuals and, for some, a time when they may lose their independence. It is at this juncture that they should be given the opportunity to participate in planning their future care. An advance care plan (ACP) is a means for people with capacity to document their preferences for their care and to enable providers to advocate on their behalf. Some people will have lost mental capacity before admission to a care facility, so it is essential for staff to be familiar with the complexities of the Mental Capacity Act 2005 to support residents approaching the end of life. This article outlines the processes of ACP and identifies resources available to support the introduction of ACP into care homes.
Guidelines recommend prompt detection by screening older people on admission to hospital
Medicines optimisation can help ensure appropriate polypharmacy
Discuss the wishes of people with dementia proactively due to its progression
Older people approaching the end of life can be helped by asking the right questions
Safety concerns prevent care home residents doing everyday tasks that benefit them
Discrimination against older people can mean inferior standards in services that affect them