Donna E McCabe

Abstract

The prevalence of behavioral health conditions among older adults continues to rise while the number of specialty providers remains low. Nurses caring for aging populations across care settings have opportunities to integrate behavioral healthcare into their practice with adults to promote wellness and avoid negative outcomes. Priority issues for integrated behavioral health among older adults include depression, substance use disorders, and neurocognitive conditions. Connections to professional organizations, timely continuing education, and integration of evidenced-based clinical protocols are vital for nurses to provide effective integrated care.

Abstract

While safety should be a lifetime concern, aging brings it into sharper focus when a slow decline in all human functions commences and accommodations must be made to continue life with health, quality, and competence in life tasks and relationships. These normal declines, magnified by chronic diseases and health conditions increase vulnerability in older adults to the effects of commonly used substances. Safety can then be compromised using alcohol, tobacco, psychoactive drugs, medications, and food supplements which people ingest to alter state of mind, emotional well-being, and alleviate disease conditions and infirmities. Compromised safety can be the untoward side effect of seeking more optimal states, and older adults make choices to experience pleasure and attain pain-free states and freedom of movement. The most commonly used substance worldwide, alcohol, is legal, socially sanctioned, widely promoted, and relatively inexpensive but also the most damaging to health and safety. Tobacco is the mostly deadly, resulting in the deaths of close to 500,000 people annually and a contributing factor to 200 diseases and health conditions. This chapter identifies the scope of health and safety consequences of substances commonly used by adults over 60, detailing the safety risks of each class of drug and its detrimental health effects. While a relatively small proportion of older adults (5–6%) are ever diagnosed with a substance use disorder, many more engage in binge drinking and unhealthy levels of alcohol consumption and combine alcohol with prescribed and over-the-counter medications resulting in unsafe and at times, lethal results. Excessive levels of opioid analgesic prescribing have resulted in loss of life and severe opioid use disorders which compromise safety and quality of life for many older adults. Models of care that integrate screening and drug and alcohol interventions into primary care, expand harm reduction, and use public health approaches to raise awareness about the health implications of substance use hold promise for deterring upward trends in substance use among older adults. Policy initiatives are described as frameworks for additional interventions.

Abstract

NPs in primary care settings are well positioned to treat substance use disorders (SUDs). SUDs affect patients across the age spectrum and may be diagnosed and treated by NPs using brief interventions and pharmacologic therapies, or patients may be referred to specialty services. This article provides guidelines for screening, brief interventions, and pharmacologic therapies.

Abstract

Physical restraint use among hospitalized older adults remains an important issue. Despite evidence indicating that restraints can be harmful and strict regulatory rules restricting the use of restraints, healthcare practitioners continue to utilize physical restraints, often in the name of safety. The purpose of this study was to examine the perceptions regarding physical restraint use among registered nurses (RNs) and nursing assistants (NAs). The Perceptions of Restraint Use Questionnaire (PRUQ) was used to evaluate nursing staff perceptions. The overall mean score for the PRUQ was 2.8 out of a possible 5, indicating a neutral perception. Both RNs and NAs identified treatment interference as the most important reason for restraining a patient and substituting of restraints for staff as the least important reason. This study revealed an overall less favorable perception of restraints than previous studies. NAs favored physical restraint for fall prevention more than RNs. It was also noted that protection from physical abuse and patient combativeness was the most salient reason cited by the emergency department staff.

Abstract

The purpose of this training program was to prepare nursing staff in family-centered geriatric care that emphasizes providing culturally competent care to hospitalized elders at two major tertiary hospitals in New York. This research report corresponds to the first phase of a 3-year project. In this research project, a descriptive exploratory design was used to identify the levels of cultural awareness and cultural competence of nursing staff who participated in a family-centered geriatric care training program.