Every month, the leadership team at the Gerontological Advanced Practice Nurses Association (GAPNA) highlights the most important published literature that impacts geriatric practice. This month, Sherry A. Greenberg, PhD, RN, GNP-BC, FGSA, FAANP, FAAN discusses person-centered care for older adults, what makes a city age-friendly during the COVID-19 pandemic, and improving patient and caregiver outcomes at an integrated memory clinic.

Person-centered gerontological nursing: an overview across care settings

J Gerontol Nurs. 2021;47(2):7-12.

This article provides a conceptual review of person-centered care for older adults across various care settings from a gerontologic nursing perspective.


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Person-centered care focuses on comprehensive assessment and care planning to meet older adults’ needs and goals. The authors present an adapted “Person-Centered Nursing Framework for Gerontological Nurses” to help guide approaches to care of older adults across care settings. The adapted framework illustrates how gerontological nurses can provide person-centered, best practice approaches to care and how these approaches affect outcomes.

Commentary by Dr Greenberg:

Practice and policy initiatives in long-term care settings, such as improvements to the physical environment to mimic a home setting, can affect outcomes for both residents and staff. Increased interaction between residents and staff can improve job satisfaction and decrease staff turnover while increasing resident care satisfaction and decreasing behavioral issues.

In the ambulatory care setting, addressing family and caregiver needs as well as primary and transitional care issues can improve care quality and safety and decrease emergency department visits, hospital admission, and readmission rates. Addressing these issues also improves care satisfaction and patient self-management of health issues as well as reduces stress.

In acute care settings, person-centered approaches should focus on the need for communication, collaboration, and continuity of care across health care providers and care settings. Evidence-based approaches to care lead to improved staff outcomes, such as decreased turnover rates and improved staff satisfaction, as well as improved clinical outcomes such as decreased pressure injuries, falls, and urinary catheter infections.

Advanced practice providers and all health care professionals caring for older adults should implement evidence-based approaches to improve safety and quality of care while improving institutional and clinical outcomes.

Age-friendly cities during a global pandemic

J Gerontol Nurs. 2020;46(12):7-13.

This article focuses on age-friendly cities during the COVID-19 pandemic. A qualitative study was conducted with gerontologists to gain an understanding of the effects of the pandemic on implementation of age-friendly initiatives and identify best practices that promote safety, wellness, and empowerment for older adults and persons with disabilities.

Commentary by Dr Greenberg:

The Age-Friendly Health Systems movement is expanding among acute care, ambulatory care, and convenient care settings through Institute for Healthcare Improvement initiatives funded by The John A. Hartford Foundation.

The guiding set of 4Ms, What Matters, Medication, Mentation, and Mobility, is an evidence-based approach to age-friendly care. In addition to the age-friendly health system movement, there are age-friendly universities and age-friendly cities.

The age-friendly cities framework has 8 domains with age-friendly communities at its center: outdoor spaces and buildings, transportation, housing, social participation, respect and social inclusion, civic participation and employment, communication and information, and community support and health service.

Results of the study demonstrated that all age-friendly city domains have been affected by the COVID-19 pandemic, some positively and some negatively.

Advanced practice providers have a responsibility to promote safety, physical and mental health and wellness, provide access to care, and address social determinants of health. This is best accomplished using a team-based approach that includes older adults, their families and caregivers, community agencies, and groups that address these domains within the age-friendly cities framework.

Future research is needed to help older adults continue to safely age-in-place in the community during and after the COVID-19 pandemic.

Patient and caregiver outcomes at the integrated memory care clinic

Geriatr Nurs. 2020;41(6):761-768.

This article explored outcomes of persons living with dementia and caregivers at an integrated memory care clinic, a collaborative interprofessional dementia care program run by advanced practice nurses that provides dementia care and primary care to persons living with dementia throughout their lifetime or until institutionalization.

Improvements were noted in caregivers’ distress regarding patients’ neuropsychiatric symptoms such as delusions, anxiety, severity of delusions, depression, and total symptom severity.

Commentary by Dr Greenberg:

As the number of persons living with dementia increases, formal assistance is needed to help them age in place in the community. Ambulatory practices typically provide general primary care and health care providers at these practices are not necessarily skilled to address complex issues involved in dementia care.

More recently, dementia care practices are being developed to improve access to evidence-based, high-quality dementia care. These practices provide the specialty care needed for comprehensive assessment and management for persons living with dementia and also address caregiver needs.

This integrated memory care clinic is an example of an advanced practice nurse-led model of dementia care. The model focuses on helping persons living with dementia age in place with the crucial interprofessional components needed to provide primary care while addressing specialized dementia and caregiver needs.

More specialized dementia programs will be needed to decrease institutionalization and meet the caregiving demand of those living with dementia.

References

  1. Sillner AY, Madrigal C, Behrens L. Person-centered gerontological nursing: An overview across care settingsJ Gerontol Nurs. 2021;47(2):7-12. doi:10.3928/00989134-20210107-02
  2. DeLange Martinez P, Nakayama C, Young HM. Age-friendly cities during a global pandemicJ Gerontol Nurs. 2020;46(12):7-13. doi:10.3928/00989134-20201106-02
  3. Kovaleva MA, Higgins M, Jennings BM, et al. Patient and caregiver outcomes at the integrated memory care clinicGeriatr Nurs. 2020;41(6):761-768. doi:10.1016/j.gerinurse.2020.05.006