scholarly journals Emphasizing the Nurse Practitioner Role in Addressing Unique Challenges Associated with Benzodiazepine use among the Elderly

2021 ◽  
Vol 1 (1) ◽  
pp. 37-46
Author(s):  
Jennifer Lynn Fournier ◽  
Robyn Gorham
Keyword(s):  
Elderly Patients ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Patient Population ◽  
Negative Impact ◽  
The Elderly ◽  
Monitoring Therapy ◽  
Benzodiazepine Use ◽  
The Continuum

Aim: The aim of this paper is to discuss the use of benzodiazepine medications among the elderly, and the role of a nurse practitioner within this patient population.  Background: Benzodiazepines are well known to have a negative impact on the mobility of elderly patients and to contribute to increased falls. These medications also have an impact on elderly patients’ ability to perform activities of daily living and to drive. Nurse practitioners offer holistic care to elderly patients. This includes prescribing medications, monitoring therapy, deprescribing medications and identifying opportunities for safe alternatives to treat a variety of conditions. Methods: This paper presents a narrative review focused on the effect of benzodiazepine medications on the elderly patient population, with an emphasis on the use of benzodiazepines in insomnia.  Conclusions: Findings of this review confirm the known risks associated with the use of benzodiazepines in the elderly and that these medications should be carefully considered in ongoing management.  The conclusions of this review support the use of nurse practitioners in the enhancement of the healthcare of the elderly through the continuum of assessment, monitoring, deprescribing of benzodiazepine medications when appropriate, as well as opportunities to implement alternative treatments.

scholarly journals The role of the internal medicine specialist in the management of infective complications in general surgical wards

2013 ◽  
pp. 12-19
Author(s):  
Patrizia Zoboli ◽  
Giuseppe Chesi ◽  
Fabrizio Boni ◽  
Federica Maselli ◽  
Lisa Zambianchi
Keyword(s):  
Internal Medicine ◽  
Elderly Patients ◽  
Risk Evaluation ◽  
Medical Condition ◽  
The Elderly ◽  
Operative Management ◽  
Surgical Team ◽  
Medical Consultant ◽  
Post Surgery

BACKGROUND Internal medicine specialists are often asked to evaluate a patient before surgery. Perioperative risk evaluation for elderly patients is important, because complications increase with age. The increasing age of the general population increases the probabilities of surgery in the older patients. The manifestation of a surgical problem, is more likely to be severe and complicated in the elderly patients. In fact, emergency surgery treatment occurs more frequently in the elderly (e.g., it is much more common to see intestinal obstruction complicating colorectal cancer in the elderly compared with a younger population). Old age is an independent factor for long hospital stay after surgery. The role of the preoperative medical consultant is to identify and evaluate a patient’s current medical status and provide a clinical risk profile, in order to decide whether further tests are indicated prior to surgery, and to optimise the patient’s medical condition in the attempt of reducing the risk of complications. The medical consultant must know which medical condition could eventually influence the surgery, achieve a good contact and communication between the medical and surgical team, in order to obtain the best management planning. AIM OF THE STUDY This paper focuses on the rational use of antibiotic prophylaxis and on the treatment of the complications of post-surgery infections (e.g., pulmonary complication, peritonitis, intra-abdominal infection). Specific aspects of pre-operative risk evaluation and peri and post-operative management are discussed. CONCLUSIONS The internal medicin specialist in collaboration with the surgical team is necessary in the peri and post-surgery management.

STUDY OF CLINICALAND HAEMATOLOGICAL PROFILE OF ANEMIA IN GERIATRIC PATIENTS AT A TERTIARY LEVEL CENTRE IN HARYANA

2021 ◽  
pp. 17-19
Author(s):  
Priya Dalal ◽  
Atindra Narayan ◽  
Auditi Narayan ◽  
D.K. Sharma
Keyword(s):  
Chronic Disease ◽  
Elderly Patients ◽  
Social Services ◽  
Negative Impact ◽  
Health Resources ◽  
The Elderly ◽  
Differential Count ◽  
Anemia Of Chronic Disease ◽  
Haematological Profile ◽  
Rbc Indices

Background: The demographic transition with ageing of population is a global phenomenon and in recent years there has been an increasing international awareness of health issues relating to aging population. Anemia represents an emerging global health problem producing a negative impact in the quality of life among the elderly and requiring greater allocation of health resources. Aims: To identify elderly patients with anemia and study the etiology, clinical parameters, laboratory parameters in these patients. Methods: A total of 100 patients were enrolled in this study. The entire medical history were obtained from each of the cases including previous medical reports and imaging studies. Complete blood counts , RBC indices,total WBC count, differential count, platelet count, haematocrit, ESR, peripheral smears ,reticulocyte count, ferritin, iron and TIBC were recorded for each patient. The data was compiled and analyzed using Statistical Package for social services (SPSS vs 20). Results: Among the etiologies, iron deciency anemia was seen in 43% of patients, anemia of chronic disease in 32%, anemia of chronic kidney disease and unexplained anemia in 11 % patients. Among clinical features the commonest symptom was easy fatiguability and commonest sign was pallor. Peripheral smear study showed that normocytic normochromic anemia was commonest type. Conclusion: This study showed that the commonest cause for anemia among elderly patients is iron deciency anemia followed by anemia due to chronic disease. Geriatric anemia is a disease that often goes unreported hence every effort should be made to identify the disease and evaluate the cause.

scholarly journals Treatment with CPAP in Elderly Patients with Obstructive Sleep Apnoea

2020 ◽  
Vol 9 (2) ◽  
pp. 546 ◽  
Author(s):  
Tomas Posadas ◽  
Grace Oscullo ◽  
Enrique Zaldívar ◽  
Alberto Garcia-Ortega ◽  
José Daniel Gómez-Olivas ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Elderly Patients ◽  
Obstructive Sleep Apnoea ◽  
The Elderly ◽  
Sleep Apnoea ◽  
Age Group ◽  
Obstructive Sleep ◽  
Receive Treatment ◽  
Therapeutic Tools

The population pyramid is changing as a result of the ever-increasing life expectancy, which makes it crucial to acquire an in-depth understanding of the diseases that most often affect the elderly. Obstructive sleep apnoea (OSA) affects 15%–20% of the population aged over 65 years. Despite this prevalence, there have been very few specific studies on the management of OSA in this age group, even though over 60% of the patients aged over 65-70 years who attend sleep units with suspicion of OSA receive treatment with continuous positive airway pressure (CPAP), on the basis of an extrapolation of the positive results achieved by CPAP in clinical trials involving middle-aged males. However, the latter’s form of presentation, evolution and, probably, prognosis comparing with OSA are not the same as those of elderly patients. Recent clinical trials performed on an exclusive series of elderly patients have shed light on the possible role of CPAP treatment in elderly patients with OSA, but there are still many questions that need to be answered. The physiological increase in the number of sleep-related disorders with the passing of years, and the lack of validated diagnostic and therapeutic tools for this age group are probably the greatest obstacles to define, diagnose and treat OSA in the elderly.

Aged care nurse practitioners in Australia: evidence for the development of their role

2013 ◽  
Vol 37 (5) ◽  
pp. 594 ◽  
Author(s):  
Shannon Clark ◽  
Rhian Parker ◽  
Brenton Prosser ◽  
Rachel Davey
Keyword(s):  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
The United States ◽  
Aged Care ◽  
Service Planning ◽  
Current Evidence ◽  
Ageing Population ◽  
Healthcare Outcomes ◽  
The Impact

Aim To consider evidence surrounding the emerging role of nurse practitioners in Australia with a particular focus on the provision of healthcare to older people. Methods Methods used included keyword, electronic database and bibliographic searches of international literature, as well as review of prominent policy reports in relation to aged care and advanced nursing roles. Results This paper reports on evidence from systematic reviews and international studies that show that nurse practitioners improve healthcare outcomes, particularly for hard to service populations. It also maps out the limited Australian evidence on the impact of nurse practitioners’ care in aged care settings. Conclusions If Australia is to meet the health needs of its ageing population, more evidence on the effectiveness, economic viability and sustainability of models of care, including those utilising nurse practitioners, is required. What is known about the topic? Australia, like many industrialised countries, faces unprecedented challenges in the provision of health services to an ageing population. Attempts to respond to these challenges have resulted in changing models of healthcare and shifting professional boundaries, including the development of advance practice roles for nurses. One such role is that of the nurse practitioner. There is international evidence that nurse practitioners provide high-quality healthcare. Despite being established in the United States for nearly 50 years, nurse practitioners are a relatively recent addition to the Australian health workforce. What does this paper add? This paper positions a current Australian evaluation of nurse practitioners in aged care against the background of the development of the role of nurse practitioners internationally, evidence for the effectiveness of the role, and evidence for nurse practitioners in aged care. Recent legislative changes in Australia now mean that private nurse practitioner roles can be fully implemented and hence evaluated. In the face of the increasing demands of an ageing population, the paper highlights limitations in current Australian evidence for nurse practitioners in aged care and identifies the importance of a national evaluation to begin to address these limitations. What are the implications for practitioners? The success of future healthcare planning and policy depends on implementing effective initiatives to address the needs of older Australians. Mapping the terrain of contemporary evidence for nurse practitioners highlights the need for more research into nurse practitioner roles and their effectiveness across Australia. Understanding the boundaries and limitations to current evidence is relevant for all involved with health service planning and delivery.

Associate Members: A Life Worth Living

1986 ◽  
Vol 49 (11) ◽  
pp. 362-364 ◽  
Author(s):  
Jean Parker
Keyword(s):  
Elderly Patients ◽  
Long Term Care ◽  
The Elderly ◽  
Worth Living ◽  
Term Care ◽  
Life Worth Living ◽  
Meaningful Existence ◽  
Time And Energy

Long-term care patients need a meaningful existence. It is our responsibility to ensure that time and energy are channelled into purposeful solutions for the disease of ‘time with nothing to do’. The author has taken up this challenge. Working as an activities organizer with the elderly for 11 years, she was determined never to take the role of a baby-sitter. The recreation unit has grown from its first eight guests to a purpose-built unit with approximately 1,500 attendances per month. A busy happy atmosphere now prevails where once there was a sea of dead faces. The choice to retain a sense of dignity and purpose should be available to all elderly patients who require long-term care.

scholarly journals The Role of Spinal Orthoses in Osteoporotic Vertebral Fractures of the Elderly Population (Age 60 Years or Older): Systematic Review

2020 ◽  
pp. 219256822094803
Author(s):  
Barry Ting Sheen Kweh ◽  
Hui Qing Lee ◽  
Terence Tan ◽  
Joost Rutges ◽  
Travis Marion ◽  
...  
Keyword(s):  
Systematic Review ◽  
Elderly Patients ◽  
Vertebral Fractures ◽  
Postural Stability ◽  
Elderly Population ◽  
The Elderly ◽  
Functional Improvement ◽  
Osteoporotic Vertebral Fractures ◽  
Spinal Orthoses

Study Design: Systematic review. Objective: Spinal orthoses have been generally used in the management of osteoporotic vertebral fractures in the elderly population with purported positive biomechanical and functional effects. To our knowledge, this is the first systematic review of the literature examining the role of spinal orthoses in osteoporotic elderly patients who sustain low energy trauma vertebral fractures. Methods: A systematic literature review adherent to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Methodical searches utilizing MEDLINE, EMBASE, Google Scholar, and Cochrane Databases was performed. Results: Of the 2019 articles initially retrieved, 7 published articles (4 randomized controlled trials and 3 prospective cohort studies) satisfied the inclusion criteria. Five studies reported improvement in quantitative measurements of spinal column stability when either a rigid or semirigid orthosis was used, while 1 study was equivocal. The studies also showed the translation of biomechanical benefit into significant functional improvement as manifested by improved postural stability and reduced body sway. Subjective improvement in pain scores and quality of life was also noted with bracing. Conclusion: The use of spinal orthoses in neurologically intact elderly patients aged 60 years and older with osteoporotic compression vertebral fractures results in improved biomechanical vertebral stability, reduced kyphotic deformity, enhanced postural stability, greater muscular strength and superior functional outcomes.

Self-Determination, End-of-Life Decisions, and the Role of Nurse Practitioners

2015 ◽  
Vol 21 (1) ◽  
pp. 11-14 ◽  
Author(s):  
Heather Bradley
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Terminally Ill ◽  
Self Determination ◽  
End Of Life Decisions ◽  
Supportive Role ◽  
Societal Changes

Nurse practitioners should be aware that societal changes could lead to their being asked to actively assist terminally ill patients who wish to end their lives, as opposed to their current supportive role in palliative care. With physician staff shortages and the need for nurse practitioners to fill the gaps, end-of-life responsibilities could be placed in the hands of nurse practitioners, rather than being reserved for physicians alone (Sagon, 2013). End-of-life matters raise uncertainties about the nurse practitioner role because it differs state by state, relates to ethics, reflects the religious beliefs of those involved, and concerns the conflict of nurses simultaneously caring for their patients while advocating for their right to self-determination in choosing to end their lives.

Letter to the Editor

PEDIATRICS ◽  
1972 ◽  
Vol 49 (6) ◽  
pp. 927-928
Author(s):  
Walter Pick
Keyword(s):  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Anticipatory Guidance ◽  
Subsequent Reaction ◽  
Letter To The Editor ◽  
Referring Physicians

Thank you for permitting debate on the important issue of the role of the nurse practitioner in pediatrics. Dr. A. H. Matlin comes to the surprising conclusion that nurse practitioners often practice better anticipatory guidance than physicians and "their services should, if anything, be worth more." If Dr. Matlin is serious in his view, he should experiment by referring physicians' children to the nurse practitioners for this "better guidance" and observe the subsequent reaction. In our society, a professional man is compensated for his service on the basis of his training and the responsibility he takes.

Balancing the Efficacy and Tolerability of First-line Treatment in Elderly Myeloma Patients

2010 ◽  
Vol 00 (04) ◽  
pp. 85
Author(s):  
Valeria Magarotto ◽  
Antonio Palumbo ◽  
◽  
Keyword(s):  
Elderly Patients ◽  
Elderly Population ◽  
The Elderly ◽  
New Drugs ◽  
High Dose ◽  
Standard Drug ◽  
High Dose Dexamethasone ◽  
Life Threatening ◽  
Choice Of Therapy

Multiple myeloma (MM) is the second most frequent malignancy of the blood. It is more common among the elderly population, with <28% of patients 65–74 years of age and 37% >75 years of age. Before the introduction of novel agents, melphalan and prednisone (MP) was the best treatment for patients not eligible for autologous stem cell transplantation (ASCT). Steroids provide other options but with a higher toxicity, especially in elderly patients. Currently, the association of thalidomide with MP (MPT) represents the gold standard of treatment for patients ineligible for ASCT. Bortezomib and lenalidomide associated with MP provided effective and safe alternatives. High-dose dexamethasone combined with the new drugs is effective, but very toxic for elderly patients. Trials that combine low-dose dexamethasone with thalidomide, lenalidomide and bortezomib plus other agents such as doxorubicin and cyclophosphamide are ongoing. The role of transplantation is controversial in myeloma patients >65 years of age because elderly patients are fragile and the choice of therapy must take into account the likelihood of co-morbidities. Reducing the dose of the standard drug – eventually prolonging the duration of the treatment and administering prophylaxis – allows effective treatment of MM, without important or life-threatening toxicities.

The role of the psychiatric nurse practitioner in disaster response

2009 ◽  
Vol 7 (4) ◽  
pp. 39
Author(s):  
Brenda Marshall, EdD, MSN, PMHNP-BC
Keyword(s):  
Life Cycle ◽  
Registered Nurses ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Disaster Response ◽  
Healthcare Providers ◽  
Psychiatric Nurse ◽  
Florence Nightingale

Nurses have responded to, and prepared for disasters from the time of Florence Nightingale and Harriet Werley. Nurses are the largest group of professional healthcare providers in America with more than 2.4 million registered nurses, a quarter of a million of whom are Nurse Practitioners capable of diagnosing, prescribing, and treating patients. Psychiatric Nurse Practitioners are in a position to understand the unique cultural nuances and needs of a community in all phases of the disaster life cycle.

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