In this installment, the leadership team at the Gerontological Advanced Practice Nurses Association (GAPNA) highlights the most important published literature that impacts geriatric practice. This month, GAPNA Past-President Sherry A. Greenberg, PhD, RN, GNP-BC, FGSA, FNAP, FAANP, FAAN, reviews 3 studies: the first on the use of robots to engage seniors in activities; the second on transitioning from skilled nursing care to home care; and the third on the need for more training to care for LGBTQI seniors.
Use of robots to encourage social engagement between older adults
Geriatr Nurs. 2022;43(1):43-97.
Summary: The use of emotional support animals, dolls, and robots have been shown to improve engagement among older adults living in long-term care facilities. The study authors designed a robot to engage pairs of older adults in activities for 3 weeks. Seven pairs (14 individuals) completed the experiment. Ages ranged from 70 to 90 years with a mean age of 83.0 (± 6.1). Most were women (79%). Three adults were screened as having normal cognition, 10 had mild cognitive impairment, and 1 adult self-reported a diagnosis of Alzheimer’s disease.
Commentary by Dr. Greenberg: Older adults, living with and without cognitive impairment, need innovative methods to encourage social engagement. Prior literature suggests that socially assistive robots (SARs) help older adults with physical, cognitive, and social needs. The researchers present an observational study that examined if a robot intervention fostered human-human interaction and if the type of activity influenced human-human and/or human-robot interaction.
The study was conducted with 6 different activity sessions, such as Simon Says and book sorting, over 3 weeks at 2 long-term care facilities. The researchers found that SAR intervention activities had a positive effect on overall engagement. The type of activity, with and without virtual reality, influenced the results by type of engagement such as visual or verbal engagement.
Advanced practice providers may conduct their own research or collaborate in developing novel ways to promote social, emotional, and behavioral engagement and interaction with others. Health care providers should promote access to programs or institutions providing such resources as activity, cognitive and sensory stimulation, and engagement may increase quality of life and health care outcomes.
Transitional care following a skilled nursing facility stay: Utilization of nurse practitioners to reduce readmissions in high risk older adults
Geriatr Nurs. 2021;42(6):1594-1596
Summary: This article describes the importance of transitional care services following a nursing facility stay in patients at risk for readmission. The authors were able to identify gaps in care as well as prevent hospital readmission among elderly at-risk patients seen for transitional care visits.
Commentary by Dr. Greenberg: The transitional care model developed by Mary D. Naylor, PhD, RN, FAAN, and colleagues at the University of Pennsylvania School of Nursing remains an exemplary evidence-based model of care focused on continuity of care for high-risk patients during transitions of care. This quality improvement project evaluated nurse practitioners (NPs) conducting transition care visits in people’s homes soon after discharge from a skilled nursing facility that followed a hospitalization.
Patients were identified as high-risk for hospital readmission based on readmission risk prediction using metrics such as hospital length of stay, acuity, Charlson Comorbidity Index, and emergency department visits in the previous 6 months, as well as frailty measured by the Rockwood Clinical Frailty Scale or electronic health record frailty index.
Nurse practitioners conducted transitional care visits within 72 hours of discharge from a skilled nursing facility and focused on medication reconciliation, physical examination, follow-up plan, communication with primary care provider postvisit, education related to disease and self-management, referral to community resources, assessment of the environment, confirmation of home health service arrangements and start date, and if any ordered durable medical equipment was received.
Nurse practitioners and all advanced practice providers provide continuity of care and positively affect patient and health care outcomes such as reducing hospital readmissions and decreasing health system costs while increasing patient and caregiver satisfaction. They have an important role in the care of older adults, many of whom have multiple chronic conditions, medication complexity, functional deficits, and some with limited support systems and challenges accessing care.
Advanced practice providers are in an excellent position to conduct medication reconciliation to decrease the risk for medication discrepancies, ensure a prompt start of home health care and visiting nurse visits, and assure timely follow-up with primary care providers, specialists, and interprofessionals to promote effective transitions of care.
Advancing gerontological health research with sexual and gender minorities across the globe
J Gerontol Nurs. 2022;48(4):13-20
Summary: Health care access and use of related aging and social services in the older LBGTQI community are affected by historic and current environmental factors. The current article presents results of a scoping review of international research on the health and health care needs of sexual and gender minority (SGM) older adults. According to the authors of the study, “there is a critical need for training and future research, and health professionals are needed to advance gerontological health and health care research and improve the health and care of SGM older adults globally.”
Commentary by Dr Greenberg: In the current climate, it is important to consider principles of diversity, equity, inclusion, and accessibility in clinical practice, research, policy, and education. This article presents results of a scoping review of international research on the health and health care needs of sexual and gender minority older adults. A total of 33 peer-reviewed articles from 19 countries were reviewed using the Sexual and Gender Minority Health Disparities Research Framework incorporating individual, interpersonal, community, and societal levels affecting health.
Findings demonstrate that historic and environmental factors such as stigma, discrimination, and social exclusion affect health, access to health care services, as well as use of aging and social services. A link was noted between health outcomes and experiences of homophobic antitransgender stigma and discrimination, and rejection from biological families, communities, and society as a whole. Common physical outcomes included asthma, dementia, end-of-life issues, HIV/AIDS, osteoporosis, poor health, and premature mortality.
Advanced practice providers need to be mindful that sexual and gender minority older adults have unique health care and long-term care needs. Further, there is a critical need for training and research to address gaps and barriers to quality care. Older adults are living longer with multiple chronic conditions, including HIV/AIDS. Advanced practice providers are in an excellent position to develop and implement innovative practice, research, education, and policy approaches to promote equity, accessibility, inclusivity, and belonging in the evidenced-based care of all older adults.
1. Lin Y-C, Fan J, Tate JA, Sarkar N, Mion, LC. Use of robots to encourage social engagement between older adults. Geriatr Nurs. 2022;43(1):43-97.doi.org/10.1016/j.gerinurse.2021.11.008
2. Rose T, Frith K, Zimmer R. Transitional care following a skilled nursing facility stay: utilization of nurse practitioners to reduce readmissions in high risk older adults. Geriatr Nurs. 2021;42(6):1594-1596.doi.org/10.1016/j.gerinurse.2021.06.024
3. Flatt JD, Cicero EC, Kittle KR, et al. Advancing gerontological health research with sexual and gender minorities across the globe. J Gerontol Nurs. 2022;48(4):13-20.doi:10.3928/00989134-20220304-03