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This is the introductory article in a six-part series in Nursing Older People exploring the nursing care of people living with advanced dementia. It discusses the complex and progressive array of nursing required to meet the needs of individuals, the provision of personal care, learning and leadership, meaningful activity, and palliative and end of life care. A main theme of the series is the exceptional nursing skills and knowledge required to deliver evidence-informed care with compassion and respect for people living with advanced dementia. This introductory article provides background information to contextualise advanced dementia and identify the main challenges facing nurses, nurse educators and nurse leaders. [ABSTRACT FROM AUTHOR]

Abstract: This article reports the results of an exploratory survey of nursing home care in 30 countries. Most countries used either a social or nursing home model, with a physician model being less common. Resident Assessment Instruments were used in only 35% of countries. Physician visits to the nursing home occurred in 37%. All but 2 countries used advanced practice nurses. Medication use was high, with 82% of countries reporting residents taking 6 or more medicines a day. [Copyright &y& Elsevier]

The aim of this secondary analysis was to examine the relationships between the ways in which caregivers coped with caregiving stressors and their experience of distress over time. Three coping subscales were derived from the Carers' Assessment of Management Index (CAMI) coping scale: “maintaining balance”, “focusing on caregiving” and “avoidance”. A proportional (relative) scoring technique was applied. The analysis was based on the responses of 115 pairs of caregivers and care recipients. Care recipients were aged 66-92 years, with no symptoms of dementia, and the majority had mild to moderate hearing impairment. Data were collected at baseline and 6 months later. Caregivers who increased the proportion of strategies endorsed in the “maintaining balance” subscale experienced a decrease in distress, irrespective of change in the proportion of strategies endorsed in the “avoidance” subscale. “Focusing on caregiving” was not significantly related to distress. The results highlight the potential benefits to these caregivers of maintaining a balance in their lives by taking breaks from caregiving. [ABSTRACT FROM AUTHOR]

The article describes the development and implementation of a generic integrated care pathway designed to enhance the quality of care provided throughout the Department of Medicine for the Elderly in a hospital in Great Britain. Along with the implementation of the said program is the development of a comprehensive nursing assessment. Moreover, working groups are set-up to implement the said program.

The International Association of Gerontology and Geriatrics, in association with the World Health Organization, set up a task force in response to the urgent need to improve long-term care, and address the variations in standards of nursing home care worldwide. This task force was charged with identifying the main clinical, quality and research concerns and actions that would enhance the care provided in nursing homes. As a result, recommendations have been developed. The authors argue that nurses worldwide have a responsibility to support and implement the international nursing home development agenda. [ABSTRACT FROM AUTHOR]

Abstract: This article reports the findings of a policy survey designed to establish research priorities to inform future research strategy and advance nursing home practice. The survey was administered in 2 rounds during 2013, and involved a combination of open questions and ranking exercises to move toward consensus on the research priorities. A key finding was the prioritization of research to underpin the care of people with cognitive impairment/dementia and of the management of the behavioral and psychological symptoms of dementia within the nursing home. Other important areas were end-of-life care, nutrition, polypharmacy, and developing new approaches to putting evidence-based practices into routine practice in nursing homes. It explores possible innovative educational approaches, reasons why best practices are difficult to implement, and challenges faced in developing high-quality nursing home research. [Copyright &y& Elsevier]

Abstract: Objective: To examine effects of individual thematically-based reminiscence sessions based on the SolCos model for older adults with dementia because of Alzheimer disease (AD) as a pilot study. Background: Reminiscence activities are popular within nursing homes and generally considered to be enjoyable and helpful, however, there is a paucity of robust data demonstrating therapeutic impact. Criticisms of existing reminiscence studies include the failure to explicate the reminiscence protocol and to standardize delivery and choice of outcome measures. Methods: In this study, 82 older adults with probable AD were recruited from psychiatric day care, inpatient, and long term care facilities. Of the study group, 41 participants were randomly selected for individual reminiscence sessions during 4 weeks performed by 1 facilitator. A control group of 41 older adults were randomly involved and had no planned reminiscence treatment of any kind in the study period. All study participants were tested pre- and postintervention period with validated assessment scales to evaluate cognition and behavior. Analyses were based on delta scores, the differences between assessment scales pre- and postintervention scores, compared between the intervention and the control group. Results: A structured reminiscence protocol was developed with user involvement, and intervention group participants received 6–8 reminiscence sessions (average 7.4). The primary outcomes of Mini- Mental State Examination (MMSE) and Geriatric Depression Scale (GDS-30) delta scores of the intervention group were significantly better than those of the control group. Participants of the intervention group with both mild and moderate AD had significantly better GDS-30 delta scores compared with the control group. Significantly better MMSE delta scores were found only in the intervention sub-group with moderate AD. Logistic regression analyses with all study participants showed an impact of reminiscence sessions on depressive symptoms measured with GDS-30. Conclusions: The pilot study results showed positive effects associated with individual thematically-based reminiscence on well-being such as depressive symptoms and cognition of participants. This is an encouraging finding after a relatively short period. Further study is necessary to confirm these results, determine sustainability and optimal delivery methods. [Copyright &y& Elsevier]

Abstract: Objective: To assess preliminary effects of a program of transcutaneous posterior tibial nerve stimulation (TPTNS) on lower urinary tract symptoms and number of episodes of urinary and fecal incontinence in older adults in residential care homes and the feasibility of a full-scale randomized trial. Design: Pilot randomized single-blind, placebo-controlled trial. Setting: Seven residential care homes and 3 sheltered accommodation complexes in the United Kingdom. Participants: Thirty care home residents aged 65 and older with urinary or bowel symptoms and/or incontinence. Interventions: Twelve 30-minute sessions of TPTNS or sham stimulation (placebo). Measurements: Lower urinary tract symptoms using American Urological Society Symptom Index, urinary incontinence using International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), postvoid residual urine volumes using portable bladder scanning, bowel symptoms and fecal incontinence using selected ICIQ questions. Results: Total American Urological Society Symptom Index scores improved, showing a median reduction of 7 (interquartile range [IQR] –8 to –3) in the TPTNS group and a median increase in the sham stimulation (placebo) group of 1 (IQR –1 to 4) (Mann-Whitney U 16.5000, Z –3.742, P < .001). Total ICIQ-SF scores improved by a median of 2 (IQR –6 to 0) in the TPTNS group and 0 points (IQR –3 to 3) in the sham stimulation group (Mann-Whitney U 65.000, Z –1.508, P = .132). Significant reduction was found in postvoid residual urine of 55 mL in the TPTNS group (t = –2.215, df 11.338, P = .048). Bowel urgency improved in 27% of the TPTNS group compared with 8% of the sham group (χ2 2.395, df 2, P > .302), fecal leakage improved in 47% of the TPTNS group compared with 23% of the sham group (χ2 4.480, df 2, P > .106); however, these differences were not significant. No adverse effects were reported by older adults or care staff. Conclusion: TPTNS is safe and acceptable with evidence of potential benefit for bladder and bowel dysfunction in older male and female residents of care homes. Data support the feasibility of a substantive trial of TPTNS in this population. [Copyright &y& Elsevier]