Telephone Counselling Has Beneficial Effect on Treatment,||Mortality Rates

Kristin Casady, MA, Editorial Director, Geriatrics & Aging.

The association between low rates of adherence to medical treatments and poor health outcomes has been well documented, occurring even when the treatment under study was a placebo.1 Studies of adherence interventions should be of significant interest to those working with older adults, who are most likely to be on polypharmacy, yet such investigations are few when compared with the large number of trials for individual drugs and treatments.2 A recent issue of the British Medical Journal presents details of a study that investigated the effects of periodic telephone counselling by a pharmacist on medication compliance and mortality among community-dwelling patients on polypharmacy (>5 drugs).3

Preventive Skin Care for Older Adults

Barbara Brillhart, RN, PhD, CRRN, FNP-C, Arizona State University, College of Nursing, Tempe, Arizona, USA.

Prevention of and assessment for pressure ulcers and skin tears are the responsibilities of the client, family, caregivers, and the health care team. Prevention will avoid discomfort, disfigurement and decreased quality of life, and decrease health care expenses. Assessment includes use of the Braden, Gosnell, Norton, or Waterlow Scales for pressure ulcers and the Payne-Martin classification for skin tears. Factors to prevent pressure ulcers are pressure relief, prevention of shearing and friction, skin cleansing, plus adequate nutrition and hydration. Variables to prevent skin tears include nonbinding clothing, careful transfers, environmental protection, adequate nutrition and hydration, and individualized skin care.
Key words: pressure ulcers, skin tears, assessment, prevention.

Ophthalmic Interventions to Help Prevent Falls

John G. Buckley, PhD, Senior Research Fellow, Vision & Mobility Laboratory, Department of Optometry, University of Bradford, Bradford, UK.
David B. Elliott, PhD, MCOptom, FAAO, Professor of Clinical Vision Science, Department of Optometry, University of Bradford, Bradford, UK.

There is mounting evidence that visual impairment is significantly associated with the increased incidence of falling in the older adult. Surprisingly, the leading causes of visual impairment in the aging adult population are correctable and due to undercorrected refractive errors and/or cataract. This highlights that, to reduce fall risk, older people should be encouraged to have regular eye examinations to detect and subsequently correct such problems as early as possible.
Key words: falls prevention, visual impairment, ophthalmic intervention, older adult.

Yoga as a Complementary Therapy

Marian Garfinkel, EdD, Medical Researcher and Adjunct Professor, Temple University, College of Health Professions, Department of Kinesiology; Medical Researcher, University of Pennsylvania, School of Medicine, Department of Rheumatology; Veterans Administration Hospital, Department of Rheumatology; Director, BKS Iyengar Yoga Studio of Philadelphia, Philadelphia, PA, USA.

By broadening yoga’s application beyond stress-related ailments to include preventative and curative therapies, physicians today have an advantage in treating patients’ illnesses and disorders. Specifically, yoga therapy complements patients’ traditional medical treatment of osteoarthritis and other bone and joint disorders. Following anatomical guidelines, yoga teachers can adapt postures (asanas) to ensure patients’ organs, joints, and bones are aligned to achieve physiologic changes. Recent studies performed by this author assessing the effect of yoga therapy on rheumatic diseases, such as osteoarthritis, and repetitive strain injuries, such as carpal tunnel syndrome, showed that yoga therapy caused physiologic changes, relieved pain, and improved motion.
Key words: osteoarthritis, yoga, Iyengar, exercise, repetitive strain injuries.

Screening for and Prescribing Exercise for Older Adults

Barbara Resnick, PhD, CRNP, FAAN, FAANP, Professor, University of Maryland School of Nursing, Baltimore, MD, USA.
Marcia G. Ory, PhD, MPH, Professor, Social and Behavioral Health; Director, Active for Life National Program Office, School of Rural Public Health, The Texas A & M University System, College Station, TX, USA.
Michael E. Rogers, PhD, CSCS, FACSM, Associate Professor, Department of Kinesiology and Sport Studies, Center for Physical Activity and Aging, Wichita State University, Wichita, Kansas, USA.
Phillip Page, MS, PT, ATC, CSCS, Manager, Clinical Education & Research, The Hygenic Corporation, Akron, OH, USA.
Roseann M. Lyle, PhD, Purdue University, Department of Health and Kinesiology, West Lafayette, IN, USA.
Cody Sipe, MS, Program Director, A.H. Ismail Center, Purdue University, West Lafayette, IN, USA.
Wojtek Chodzko-Zajko, PhD, Professor, Department Head of Kinesiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
Terry L. Bazzarre, PhD, Senior Program Officer, Robert Wood Johnson Foundation, Princeton, NJ, USA.

Physical activity helps to maintain function, health, and overall quality of life for older adults. It is challenging, however, for health care providers and others who work with older adults to know what type of activity to encourage older adults to engage in, and how to motivate them to initiate and adhere to physical activity and exercise over time. The purpose of this piece is to provide an overview of physical activity for older adults and provide the resources needed to evaluate older adults and help them establish safe and appropriate physical activity programs, as well as providing motivational interventions that will eliminate the barriers to exercise and optimize the benefits.
Key words: exercise, screening, motivation, self-efficacy, outcome expectations.

Preventative Care in Clinical Practice

Public Reporting on Quality of Long-Term Care Homes in Ontario

Jennifer L. Gold, LLB, MPH, Kunin-Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care, Toronto, ON.
Tamara J. Shulman, BA, MSc, Kunin-Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care, Toronto, ON
Paula A. Rochon, MD, MPH, FRCPC, Kunin-Lunenfeld Applied Research Unit, Baycrest Centre For Geriatric Care; Institute for Clinical Evaluative Sciences, Sunnybrook & Women’s College Health Sciences Centre; Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.

Quality of care provided in long-term care facilities (LTC) is an important social issue. To improve quality of care, Canada is moving in the direction of public reporting. In this paper, we discuss current efforts to assess and report LTC home quality, and provide an overview of quality assessment initiatives in Canada as compared to the United States. We include a thorough description of the new Ontario Ministry of Health and Long-Term Care web-based public reporting feature, and discuss some possible future attempts at improving this tool to incorporate quality indicators.
Key words: public reporting, quality, long-term care homes.

Ethnic Differences in the Caregiving Experience: Implications for Interventions

Martin Pinquart, PhD, Associate Professor, Department of Developmental Psychology and Center for Applied Developmental Science, Friedrich Schiller University, Jena, Germany.
Silvia Sörensen, PhD, Assistant Professor, Department of Psychiatry, University of Rochester, Rochester, NY, USA.

Due to the aging of society and the increase in ethnic diversity, there is a growing interest in the needs of ethnically diverse caregivers for older adults. Based on a recent meta-analysis, this article outlines ethnic differences in caregiving stressors, available social resources, and caregiver health. We offer suggestions on how to consider ethnic differences in the planning and implementation of caregiver interventions.
Key words: family caregivers, ethnicity, stress, burden, depression.

Insomnia in Older Adults Part I: Assessment

Amit Morris, BSc, School of Medicine, Queen's University, Kingston, ON; Department of Psychiatry, Sleep and Alertness Clinic, Toronto Western Hospital, University of Toronto, Toronto, ON.

Colin M. Shapiro, MBBCh, PhD, FRCP(C), Department of Psychiatry, Sleep and
Alertness Clinic, Toronto Western Hospital, University of Toronto, Toronto, ON.

Insomnia is very common among older adults and may have serious consequences. The assessment of insomnia can be challenging, given the number of possible causes and the fact that insomnia is often not a presenting complaint. Inquiring about patients’ sleep and performing a thorough evaluation of any concerns will allow a rational and targeted approach to treatment.

Key words: insomnia, sleep, older adults, aging, diagnosis.

Atypical Presentation of Disease in Long-Term Care Patients

Anna T. Monias, MD, Erickson Retirement Communities, Oak Crest Village, Parkville, MD.

Kenneth S. Boockvar, MD, MS, Assistant Professor, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine; Investigator, Program of Research on Serious Physical and Mental Illness, Bronx Veterans Affairs Medical Center, Geriatric Research, Education, and Clinical Center, New York, NY.

Acute illness often presents atypically in long-term care patients. Atypical presentation refers to the lack of one or more symptoms or signs that usually indicate acute illness. Due to underlying medical illness, nursing home patients with acute infection, metabolic disorders, and even surgical emergencies frequently present with delirium, malaise, or weakness. Nursing assistants are often the first to recognize these non-specific indicators. It is imperative that researchers include assessments by nursing assistants when developing and validating tools to recognize early but atypical indicators of disease.

Key words: long-term care facility, atypical presentation, delirium, nursing assistants, non-specific symptoms.