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Pain Management in Moderate and Advanced Dementias

Pain Management in Moderate and Advanced Dementias

Teaser: 

Eric Widera, MD, Division of Geriatrics, University of California at San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
Alex Smith, MD, Division of Geriatrics, University of California at San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.

This article highlights the complex challenges seen when managing pain in patients with moderate or advanced dementia. Recent evidence demonstrates that pain is often poorly recognized and treated in patients with cognitive impairment. The progressive decline in cognitive function often leads to difficulties in expressing and recalling painful experiences. Making pain assessments routine and combining patient reports, caregiver reports, and direct observation may help alleviate this poor recognition of pain. Once pain is confirmed, a comprehensive history and physical examination are central in determining the underlying cause of pain and in choosing the best modality to treat the pain.
Key words: dementia, cognitive impairment, pain, opioids, assessment.

Assessing Cancer-Related Fatigue: Conceptualization Challenges and Implications for Research and Clinical Services

Assessing Cancer-Related Fatigue: Conceptualization Challenges and Implications for Research and Clinical Services

Teaser: 


Pascal Jean-Pierre, PhD, Department of Radiation Oncology, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA.
Gary Morrow, PhD, MS, Department of Radiation Oncology, Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA.

Fatigue due to cancer and its treatments is a highly prevalent and debilitating symptom experienced by many patients. This symptom is often present prior to a pathologically confirmed diagnosis of cancer and can be experienced both during and for considerable periods after treatment. Oncology professionals are becoming more cognizant of the impact of cancer-related fatigue on key aspects of patients’ psychosocial performance, cognitive functioning, and overall quality of life. This paper discusses the importance of cancer-related fatigue, the challenges involved in assessing this debilitating symptom among cancer patients, and the influence of researchers’ conceptualization of this symptom on the characteristics of the measures developed to assess it. Strategies to facilitate differential diagnosis of cancer-related fatigue are also presented and discussed.
Key words: cancer-related fatigue, assessment, measurement dimension, older adults, quality of life.

The Clinician’s Role in the Treatment of Bathing Disability

The Clinician’s Role in the Treatment of Bathing Disability

Teaser: 

Meera George, JD, Postgraduate Fellow, Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center, Houston,TX, USA.
Aanand D. Naik,MD, Assistant Professor, Health Services Research and Geriatrics, Baylor College of Medicine; Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center, Houston,TX, USA.

Many older adults have difficulty bathing.Those unable to bathe are more likely to need formal home care and to be admitted to long-term care than those who can bathe without help. Disability with bathing function is complex, involving multiple subtasks; inability to perform those subtasks has many attributable causes. Bathing disability can be remediated through timely diagnosis and prescription of appropriate assistive devices and adaptations to the home bathing environment. Clinicians have an important role in the diagnosis of bathing disability, and collaborative planning of bathing remediation with patients, caregivers, and allied health providers is key.
Keywords: activities of daily living, assessment, disability, assistive devices.

Pain and Depression in Aging Individuals

Pain and Depression in Aging Individuals

Teaser: 


Lucia Gagliese, PhD, CIHR New Investigator, School of Kinesiology and Health Science, York University; Department of Anesthesia, Behavioural Sciences & Health Research Division, University Health Network; Departments of Anesthesia and Psychiatry, University of Toronto, Toronto, ON.

Depression is highly prevalent among older adults with chronic pain living both in community and institutional settings. It is associated with decreased quality of life, including impairments in physical and social well-being. This article reviews the relationship between pain and depression. The potential mediating role of disability, life interference, and perceived control are described. Routine assessment of both pain and mood, using scales validated for this age group, is advocated. Finally, the importance of integrating pharmacological and psychological interventions for the management of pain and depression in the older adult is highlighted.
Key words: chronic pain, depression, mood disturbance, assessment, management.

Preventive Skin Care for Older Adults

Preventive Skin Care for Older Adults

Teaser: 

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.

Assessment of Mobility Impairment

Assessment of Mobility Impairment

Teaser: 


Roger Y. Wong, MD, FACP, FRCPC, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, BC.

Mobility impairment is a common cause of disability in older persons. The etiology is often multiple, with medical illnesses that affect the musculoskeletal, neurologic, cardiac, and/or respiratory systems superimposed on aging-related changes in gait and balance. A detailed history on the onset, duration, nature, and course of the mobility impairment is helpful. Physical examination should focus on direct observation of gait and balance, while performance- based tests can quantify the abnormalities. Simple tests for assessing walking speed, endurance, and balance are available for both outpatient and inpatient settings. The management of mobility impairment requires a multifaceted interdisciplinary approach.
Key words: mobility, gait and balance, impairment, assessment, walk tests.

Wandering: Clues to Effective Management

Wandering: Clues to Effective Management

Teaser: 


Donna L. Algase, PhD, RN, FAAN, FGSA, School of Nursing, University of Michigan, Ann Arbor, MI, USA.

Wandering is among the most challenging behaviours associated with dementia. While research is progressing toward a fuller understanding of this phenomenon, the basis for deriving effective and tested interventions has not been fully developed. In this paper, wandering is defined from multiple perspectives, and its various outcomes and risks are discussed. Putative causes of wandering are summarized. Finally, an approach to aid clinicians in discovering effective strategies for managing an individual’s wandering is presented.
Key words: wandering, dementia, assessment, intervention, primary care.

Approaches to Treating the Older Substance User

Approaches to Treating the Older Substance User

Teaser: 

Randy Harris, MSW, RSW, Mental Health Therapist, Community Geriatric Mental Health Services, Calgary Health Region, Calgary, AB.

Substance abuse experienced by older clients is frequently seen in medical practices. This article reviews approaches to assessing and treating older adults, including practical ideas for conducting interviews with older clients. A philosophical stance that recognizes a client’s readiness to change is also discussed.

Key words:
older adults, substance use, stages of change, assessment, intervention.

Assessment of Cardiac Palpitations in Ambulatory Older People: An Update

Assessment of Cardiac Palpitations in Ambulatory Older People: An Update

Teaser: 

Roger Y. Wong, BMSc, MD, FRCPC, Division of Geriatric Medicine, University of British Columbia, Vancouver Hospital & Health Sciences Centre, Vancouver, BC.

Palpitations are common in ambulatory older people and have a variety of causes. The correlation of palpitations and cardiac arrhythmias is poor. Basic assessment, which includes history taking, physical examination, 12-lead electrocardiogram (ECG), and laboratory data, is necessary but may not be sufficient to diagnose the underlying problem. Ambulatory ECG monitoring can be helpful, depending on the frequency of the palpitations. Continuous-loop event monitors are cost-effective in diagnosing palpitations, and the optimal duration of monitoring is two weeks. The overall clinical outcomes of patients with palpitations are favourable, with low mortality but high recurrence risk.

Key words: palpitations, arrhythmias, assessment, cardiac, older adults.

Management of Urinary Incontinence in Older Women

Management of Urinary Incontinence in Older Women

Teaser: 

Sue O’Hara, RN, MScN, ACNP, GNC(C), Nurse Practitioner/Clinical Nurse Specialist, Specialized Geriatric Services, St. Josephs Health Care London, Parkwood Hospital, London, ON.; Michael J. Borrie, BSc, MB, ChB, FRCPC, Professor, Department of Medicine, Division of Geriatric Medicine, The University of Western Ontario, London, ON.

Urinary incontinence is a significant problem in older women. Prevalence rates vary from 4.5–44% in healthy older women and increase to 22–90% in patients in long-term care facilities. Canadian Continence Guidelines have recently been developed to assist patients and health care professionals in assessment, treatment and follow-up of urinary incontinence. Urinary incontinence can be treated successfully, improved or better managed in most patients. Treatment falls into four major categories: behavioural, pharmacologic, surgical and supportive measures. Education, the key to effectively addressing the needs of women with incontinence, is aimed at the patient and/or their caregiver, as well as health care professionals.
Key words: urinary incontinence, older women, assessment, treatment, Canadian Continence Guidelines.