The nation's aging demography, few nursing faculty with gerontological nursing expertise, and insufficient geriatric content in nursing programs have created a national imperative to increase the supply of nurses qualified to provide care for older adults. Geriatric Nursing Education Consortium (GNEC), a collaborative program of the John A. Hartford Foundation, the American Association of Colleges of Nursing, and the New York University (NYU) Nursing Hartford Institute for Geriatric Nursing, was initiated to provide faculty with the necessary skills, knowledge, and competency to implement sustainable curricular innovations in care of older adults. This article describes the background, step-by-step process approach to the development of GNEC evidence-based curricular materials, and the dissemination of these materials through 6-, 2-, and a half-day national Faculty Development Institutes (FDIs). Eight hundred eight faculty, representing 418 schools of nursing, attended. A total of 479 individuals responded to an evaluation conducted by Baruch College that showed faculty feasibility to incorporate GNEC content into courses, confidence in teaching and incorporating content, and overall high rating of the GNEC materials. The impact of GNEC is discussed along with effects on faculty participants over 2 years. Administrative- and faculty-level recommendations to sustain and expand GNEC are highlighted.
A pilot program in gerontological nursing was developed for senior baccalaureate nursing students but could not be implemented due to lack of student interest. As a consequence, the authors conducted a descriptive survey research study to determine the knowledge base and attitudes of junior and senior baccalaureate nursing students toward older adults. A sample of 55 students was surveyed using two instruments: Palmore's revised Facts on Aging Quiz (FAQ 1) and Kogan's Attitudes Toward Old People Scale (KOP). While neither the junior or senior student group scored high on the FAQ 1, an analysis of variance revealed a significant difference between the groups in overall knowledge about the elderly. The mean KOP score of neither group indicated a high positive attitude toward the elderly and there was no significant difference between the groups in this area. The relationships between participants' demographic characteristics and KOP results also were explored. Findings support research indicating that nursing students often lack knowledge of the elderly and need opportunities to develop positive attitudes toward them. Implications are identified that relate to curriculum development, students, and faculty.
This 1-year demonstration project looked at the effects of gentle massage on two groups of elderly nursing home residents: those suffering from chronic pain and those with dementia who were exhibiting anxious or agitated behaviors. The certified nursing attendants were trained by a licensed massage therapist. The project was divided into three 12-week phases; different staff and residents were involved in each phase. Fifty-nine of 71 residents completed the 12-week program. Pain scores declined at the end of each phase, and anxiety scores declined in two of the three phases. Eighty-four percent of the nursing attendants reported that the residents enjoyed receiving tender touch, and 71% thought this type of massage improved their ability to communicate with the residents.
Hip fracture is always a very traumatic event, especially for an older person. Often, it is followed by a marked decrease in the level of functioning a patient is able to achieve after recovery. It is even more debilitating when a previously independent person must be discharged to an institution. This study examined factors and trends associated with discharge to a skilled nursing facility following hip fracture surgery. Data were analyzed for 89,723 hip fracture patients admitted in New York State from 1986 to 1996. Factors examined included age, gender, race, type of fracture, surgical technique, comorbidities, length of hospitalization and year of admission. Thirty-five percent (32,130) of the patients were discharged to skilled nursing facilities. They tended to be 85+ years old, female, white, have 3+ comorbidities, a history of dementia, have sustained an intertrochanteric fracture, and have been admitted after 1990. In addition, there was a gradual increase in institutionalizations after 1990. In this study, factors were found that predicted discharge to skilled nursing facilities following hip fracture.
Alzheimer's disease (AD) remains a major neurocognitive disorder of global health significance. Globalizing ancestral diversity in AD genetics is essential to identify causal variants, improve diagnosis, and enable equitable therapeutic interventions across populations. The Recruitment and Retention for Alzheimer's Disease Diversity Genetic Cohorts in the ADSP (READD-ADSP) initiative addresses this by including African ancestry and Hispanic/Latinx (HL) ancestry populations. READD-ADSP, a case-control study, aims to recruit, evaluate, and retain 13,000 participants: 5000 Indigenous Africans, 4000 African Americans, and 4000 Hispanic/Latinix individuals. In Africa, recruitment involves nine sub-Saharan African countries under the African Dementia Consortium, and with protocols ensuring standardized data collection, phenotype harmonization, culturally informed diagnostic algorithms, and robust community engagement. Study pparticipants are recruited, ascertained and retained. Blood samples and fractions (DNA, plasma, RNA) are biobanked for genomic, epigenomic, proteomic, and transcriptomic analyses. This study will advance precision ADRD medicine and establish a model for working with diverse global cohorts of brain disorders. Recruitment and Retention for Alzheimer's Disease Diversity Genetic Cohorts in the ADSP (READD-ADSP) addresses critical gaps in Alzheimer's Disease and Related Dementias (ADRD) research by including underrepresented groups.The study recruits 13,000 participants of African, African American, and Hispanic/Latinx ancestries.Standardized protocols enable rigorous phenotyping and harmonization across diverse populations.Findings will inform precision medicine and reduce health disparities in ADRD outcomes.
A nurse practitioner (NP) psychiatric consultation service was established to provide the residents of five nursing homes with on-site assessment and follow-up treatment for behavioral and psychiatric problems under OBRA and Medicare guidelines. During the 1-year project, 175 residents were referred by the nursing home (NH) staff for agitation, disruptive behavior, depressive symptoms, or decline in activities of daily living. An outcome evaluation documented that the NP recommendations resulted in positive behavioral changes in 62% of residents. Primary physicians, NH staff, and administrators validated that close monitoring of psychotropic medications and staff education in behavioral management strategies provided an effective, collaborative service. The practical aspects of establishing this consult service are addressed.
An 86-year-old woman in a residential health care facility suffered a massive stroke; immediate intubation was performed, she was transferred to a nearby hospital where she died two months later. Within 48 hours of this event, three mentally competent residents and one family member on the unit requested a do-not-resuscitate order. They, along with the seven other mentally competent and non-terminal residents on the unit, participated in a questionnaire survey, the purpose of which was to elicit information on DNR attitudes. Only one respondent requested cardiopulmonary resuscitation. All insisted that do-not-resuscitate decisions were theirs alone to make. A staff questionnaire was given to 81 employees having many years of health care experience. Most had witnessed death and cardiopulmonary resuscitation and knew of its poor outcome. However, 51% were very willing to participate in cardiopulmonary resuscitation, and 65% thought cardiopulmonary resuscitation was worthwhile in residential health care facilities. Furthermore, 56.8% thought that families should participate in the decision. The dichotomy between residents' wishes and staff perceptions merits recognition and further study.
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Individuals with Alzheimer's disease (AD) commonly experience neuropsychiatric symptoms of psychosis (AD+P) and/or affective disturbance (depression, anxiety, and/or irritability, AD+A). This study's goal was to identify the genetic architecture of AD+P and AD+A, as well as their genetically correlated phenotypes. Genome-wide association meta-analysis of 9988 AD participants from six source studies with participants characterized for AD+P AD+A, and a joint phenotype (AD+A+P). AD+P and AD+A were genetically correlated. However, AD+P and AD+A diverged in their genetic correlations with psychiatric phenotypes in individuals without AD. AD+P was negatively genetically correlated with bipolar disorder and positively with depressive symptoms. AD+A was positively correlated with anxiety disorder and more strongly correlated than AD+P with depressive symptoms. AD+P and AD+A+P had significant estimated heritability, whereas AD+A did not. Examination of the loci most strongly associated with the three phenotypes revealed overlapping and unique associations. AD+P, AD+A, and AD+A+P have both shared and divergent genetic associations pointing to the importance of incorporating genetic insights into future treatment development. It has long been known that psychotic and affective symptoms are often comorbid in individuals diagnosed with Alzheimer's disease. Here we examined for the first time the genetic architecture underlying this clinical observation, determining that psychotic and affective phenotypes in Alzheimer's disease are genetically correlated.Nevertheless, psychotic and affective phenotypes in Alzheimer's disease diverged in their genetic correlations with psychiatric phenotypes assessed in individuals without Alzheimer's disease. Psychosis in Alzheimer's disease was negatively genetically correlated with bipolar disorder and positively with depressive symptoms, whereas the affective phenotypes in Alzheimer's disease were positively correlated with anxiety disorder and more strongly correlated than psychosis with depressive symptoms.Psychosis in Alzheimer's disease, and the joint psychotic and affective phenotype, had significant estimated heritability, whereas the affective in AD did not.Examination of the loci most strongly associated with the psychotic, affective, or joint phenotypes revealed overlapping and unique associations.
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This article describes an innovative post-master's advanced certificate in gerontology program developed by the Hartford Institute for Geriatric Nursing at the New York University Rory Meyers College of Nursing. The program provides advanced practice registered nurses geriatric content to meet eligibility criteria for the Adult-Gerontology Primary Care NP certification exam and develops interprofessional care providers to care for complex older adults.
Morbidly obese patients in a long-term care (LTC) facility have special physical and emotional needs that must be considered when planning care. Special attention to the skin, vital sign monitoring, and rehabilitative care are among the interventions that must be integrated into the otherwise standard care of the morbidly obese patient. A case study is used to illustrate the challenges and special needs of such patients in an LTC facility in New York state. Morbidly obese people (nonambulatory people who are obese) frequently are unable to perform self-care. The care of the morbidly obese adult who resides in an LTC or postacute care facility, in particular, offers unique challenges to nursing staff.
It is unknown whether rates of cognitive decline differ between older women and men with type 2 diabetes (T2D) and overweight or obesity. Two to four cognitive assessments were obtained across up to 10 years from 2799 adults (mean age 68 years; 62% women) with T2D who had been enrolled in a clinical trial of weight loss intervention. Sex-related differences in means and rates of decline of cognitive scores were assessed. Women outperformed men in verbal learning and processing speed (P < 0.001), but not executive function (P = 0.22). The rates of decline over time for women and men were similar (P ≥  0.10); however women, but not men, with apolipoprotein E (APOE) ε4 alleles had steeper declines in verbal learning (P = 0.02) and processing speed (P = 0.007) than those without these alleles. Cognitive advantages for women with T2D and overweight/obesity over men are preserved as they age; however, these are eroded by the APOE ε4 genotype.
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An emergent challenge in geriatric care is improving the quality of care, which requires insight from stakeholders. Qualitative methods offer detailed insights, but they can be biased and have limited generalizability, while quantitative methods may miss nuances. Network-based approaches, such as quantitative ethnography (QE), can bridge this methodological gap. By leveraging the strengths of both methods, QE provides profound insights into need-finding interviews. In this paper, to better understand geriatric care attitudes, we interviewed ten nursing assistants, used QE to analyze the data, and compared their daily activities in real life with training experiences. A two-sample t-test with a large effect size (Cohen's d=1.63) indicated a significant difference between real-life and training activities. The findings suggested incorporating more empathetic training scenarios into the future design of our geriatric care simulation. The results have implications for human-computer interaction and human factors. This is illustrated by presenting an example of using QE to analyze expert interviews with nursing assistants as caregivers to inform subsequent design processes.