Self-care of elderly people with diabetes mellitus and the nurse-patient interpersonal relationship

ABSTRACT Objective: To analyze the self-care activities of elderly people with diabetes mellitus and its correlation with the nurse-patient interpersonal relationship. Methods: Cross-sectional quantitative study, with 144 elderly people followed up in Family Health Units, with data collected by the Diabetes Self-Care Activities Questionnaire and Interpersonal Relationship Questionnaire in Nursing Care, being analyzed by descriptive and inferential statistics. Results: There was a greater accomplishment of the activities Take insulin injections as recommended (6.74), Take diabetes medications as recommended (6.55) and Take the indicated number of diabetes pills (6.52). The interpersonal relationship showed moderate effectiveness (80.6%). The correlation between self-care with diabetes and interpersonal relationships showed a positive and significant value in the dimension Specific feeding. Conclusion: The effectiveness of the interpersonal relationship in nursing care resulted in greater compliance with activities related to specific food.

Internet System Supporting the Work of Nurses in Long-Term Geriatric Care

The development of health sciences along with the continuous technological progress contribute to the emergence of web applications. There exist many applications supporting the work of doctors, whereas the market definitely lacks solutions supporting the work of nurses. This is particularly evident in long-term geriatric home care, in which the nursing specialization is developing rapidly. Care of elderly patients requires the nurse to collect medical documents from each visit. Considering the large number of diseases affecting elderly people and the number of required visits – which should exceed 4 a week – a decision was made to develop an Internet application supporting the work of nurses in long-term geriatric care. The application facilitates the process of geriatric patient description in order to eliminate the need for filling in paper medical records. This study presents the method of developing an Internet application supporting the work of nurses in long-term geriatric care. The software was developed based on an analysis of conclusions from a social study carried out in a group of 42 nurses providing geriatric long-term home medical care services in the district of Białystok, Poland. The aim of the study was to determine the features, functionality, and declarative interest in using the software. Conclusions from the analysis indicated that the attempt to develop the application had been justified. Moreover, conclusions from the social survey formed the basis for formulating the design assumptions. The web application was developed in the following technologies: HTML 5, CSS3, JavaScript, PHP 7, and MySQL. First, a prototype of the solution was tested in a XAMPP environment. After successful tests, the app was tested in a nursing practice. The obtained test results raise high hopes for potential commercialization of the application.

The Relationship between the Presence of White Nails and Mortality among Rural, Older, Admitted Patients: A Prospective Cohort Study

White nails are a sign of various physical deteriorations, including poor nutrition, organ damage, and aging. During a physical examination, white nails can be a helpful health indicator in older patients with vague and multiple symptoms. In this prospective cohort study of patients admitted to the Department of General Medicine in a rural community hospital, we investigated the relationship between white nails and patient mortality. Patient data, including age, sex, condition, and bloodwork results, were collected. Trained family physicians confirmed the presence of white nails. Logistic regression analysis was performed to determine the relationship between white nails and death during hospitalization. Of 711 study participants, 74 died during hospitalization. White nails, male sex, and caregiver dependence were associated with high in-hospital mortality (odds ratio (OR) = 3.47, p < 0.001; OR 2.05, p = 0.01; OR 1.92, p = 0.049, respectively). High albumin concentration was associated with low in-hospital mortality (OR = 0.44, p < 0.001). White nails, along with serum albumin concentration, male sex, and caregiver dependence, are associated with mortality. The identification of white nails can predict the deterioration of patients. Various professionals should learn to identify the presence of white nails to facilitate the care of elderly patients.

Moral Distress in Community and Hospital Settings for the Care of Elderly People. A Grounded Theory Qualitative Study

Background: Moral distress has frequently been investigated in single healthcare settings and concerning a single type of professional. This study aimed to describe the experience of moral distress in all the types of professionals providing daily care to elderly patients and residents. Methods: The Grounded Theory approach, developed by Corbin and Strauss, was used. This study included participants from hospital and nursing homes of northern Italy. Purposive and theoretical sampling was used. Between December 2020 and April 2021, semi-structured interviews were conducted. Results: Thirteen participants were included in the study. Four categories were derived from the data: talking and listening, care provider wellbeing, decision making, protective factors, and potential solutions. The core category identified was “sharing daily”. Interviewees confirm how hard it may be to communicate to the elderly, but at the same time, how adequate communication with the leader is a protective factor of moral distress. They also confirm how communication is key to managing or downsizing misunderstandings at all levels. Findings highlight the scarcity of operators as a fundamental trigger of moral distress. Conclusions: Many determinants of this phenomenon lie behind the direct control of professionals, but education can help them learn how to prevent, manage, or downsize the consequences.

Application Effect of Targeted Nursing in the Care of Elderly Patients with Severe Pneumonia and Its Influence on Psychological State and Sleep Quality

Objective. To explore the application of targeted nursing in the care of elderly patients with severe pneumonia and its influence on psychological state and sleep quality. Methods. 90 elderly patients with severe pneumonia treated in our hospital from January 2019 to January 2020 were chosen for the study and split into the control group and the experimental group, with 45 cases in each group. Routine nursing was performed to the control group, and the targeted nursing was introduced on this basis to the experimental group to compare their nursing satisfaction and inflammatory factor indicators, and evaluate their sleep quality and metal state by referring to the Pittsburgh Sleep Quality Index (PSQI) and Mental Status Scale in Non-Psychiatric Settings (MSSNS) before and after intervention. Results. Compared with the control group, the experimental group achieved significantly better PSQI scores (P<0.001), higher nursing satisfaction (P<0.05), and lower CRP indicators (P<0.001), TNF-a indicators (P<0.001), IL-6 indicators (P<0.005) as well as MSSNS scores (P<0.001). Conclusion. Performing targeted nursing to the elderly patients with severe pneumonia can effectively improve the clinical indexes, alleviate the negative emotions, and enhance the quality of life, which is worthy of application and promotion.

Estimating the Risk of Chemotherapy Toxicity in Indian Geriatric Patient Population and Utility of Chemotherapy Risk Assessment Scale for High Age Patients (CRASH) Score

Background Aging is a heterogeneous process, and elderly population is diverse in health status and functional reserve. The present study was undertaken to predict severe chemotherapy toxicity using the Chemotherapy Risk Assessment Scale for High-Age Patients’ (CRASH) score. Materials and Methods Elderly patients (age ≥65 years) with malignancy, who were planned to be treated with a new course of cytotoxic chemotherapy, were enrolled. The CRASH score was calculated, and patients were stratified into four categories, that is, low (0–3), intermediate (Int)-low (4–6), Int-high (7–9), and high (<9). Patients developing grade 3/4/5 nonhematologic (NH) or grade 4/5 hematologic (H) toxicity were taken as the development of severe toxicity. Results Of 100 enrolled patients, 64 (64%) were able to complete their prescribed treatment. Forty-four percent of patients (44 patients) of our study cohort experienced grade-4 H or grade 3/4 NH toxicity. The highest score in each category (heme/nonheme/CRASH) predicts nearly 100% toxicity risk. At a critical value of CRASH ≥ 6.5, the sensitivity is calculated as 100%, while specificity is 89.09%. The accuracy of prediction is 93.88%. The median time taken to develop toxicity was 39.5 days. Conclusion CRASH score utilizes clinical assessment and basic laboratory values. Yet, it accurately predicts severe chemotherapy toxicity above a critical value of 6.5. Based on the above study, the first 30 days are crucial as 45% of patients experienced toxicity in this time frame. With the help of these clinical predictive markers, the care of elderly will be optimized.

1602 A Quality Improvement Project on The Management of Patients with Traumatic Head Injury Presenting to A District General Hospital

Introduction Traumatic Brain Injury (TBI) is associated with morbidity and mortality. All District General Hospitals (DGH) in West Midlands liaise with Neurosurgery centres for management of these patients through a referral system (NORSe). The aim of this study was to assess outcomes in TBI following the implementation of vital interventions. Method A retrospective data was collected between 1/1/2019 and 1/12/2020. We included all patients admitted with traumatic brain injury over the age of 16. We accessed the data from the hospital database, clinical notes, and NORSe. A re-audit was performed following implementations of recommendations (proforma and care of elderly input). Further data were collected prospectively. Results Our cohort included n1=61 patients (first cycle) and n2= 29 (second cycle). The demographic age and gender were comparable in both cycles. The median time for Neurosurgery advice was 229 minutes (IQR 60-690) in the first cycle as compared to 80 minutes (IQR 40-120, P &lt; 0.05) and the main cause for delay was inadequate information transfer. The mortality rate was 24% (5 were attributed to sepsis), as compared to 14% in the second cycle. The median length of stay (LOS) was 4 days (IQR 3-13.5) in the first cycle, which translates to a cost of £26,815 per quarter. In comparison, LOS was 3 days (IQR 2-4), which translates to the cost of bed occupancy of £12,771 and saving of £14,043 per quarter, in the second cycle. Conclusions The introduction of simple interventions in a DGH can help to significantly improve patient outcomes in those admitted with Traumatic brain injury.

Gender Issues in the Care of Elderly: A Narrative Review

Aging is an inevitable physiological process. A significant increase has been noted in the elderly population over the years. Aging population face challenges with physical health conditions, but also mental health problems. Care of the elderly is influenced by health conditions, health services, as well socio cultural factors. Gender plays an important role in the aging process with significant differences noted in the aging process, variations in health conditions as well care received. The current review addresses the role of gender in the aging process and its influence in the prevalence, clinical presentation and course of various mental and physical health conditions in the elderly. The review identifies gaps in understanding the gender perspectives related to long-term elderly care, legal and financial issues. The review emphasizes the necessity to address the gender perspective in aging to adequately meet the health demands of the elderly.