Greetings!

Welcome to the Hartford Institute for Geriatric Nursing's October 2008 eNewsletter featuring articles, reference materials, useful links, calendar of events and other best practice information on the care of older adults.

This eNewsletter is sponsored by ConsultGeriRN.org, the authoritative geriatric clinical nursing website of the Hartford Institute for Geriatric Nursing, New York University College of Nursing and the NICHE (Nurses Improving Care for HealthSystem Elders) program, (www.nicheprogram.org). ConsultGeriRN.org contains evidence-based protocols and topics for nurses and other healthcare professionals on the care of older adults. Content is updated regularly.

We would like to hear from you!

Topic content by:
Madeline A. Naegle, APRN-BC, PhD, FAAN
Professor and Coordinator Advanced Practice Psychiatric-Mental Health Nursing
College of Nursing, New York University

Several factors increase the risks associated with alcohol and drug use for an older individual, making any drug use in circumstances that, earlier in life were commonplace, potentially harmful. Constitutional risk factors include changes in body composition like decreased muscle mass, decreased organ efficiency (especially kidney and liver), and increased vulnerability of the central nervous system.

The consequences of alcohol use in combination with other drugs and excessive use include falls, impaired cognition, malnourishment, and decreased resistance to disease, interpersonal, and legal problems.

Learn more about "Substance Abuse in Older Adults," with references and resources by visiting ConsultGeriRN.org.

Hartford Institute's evidence-based protocols were accepted for posting on the Agency for Healthcare Research and Quality: National Guidelines Clearinghouse (AHRQ NGC) web site. These protocols are part of the book, Evidence-based Geriatric Nursing Protocols for Best Practice, 3rd edition, editors Elizabeth Capezuti, DeAnne Zwicker, Mathy Mezey, and Terry Fulmer. It was published by Springer Publishing Company in 2008. The protocols were developed by national experts, based on the best available evidence which was systematically evaluated and rated.

To view, go to www.guideline.gov/whatsnew/whatsnew_GuidelineIndex.aspx and scroll down to the section 'Hartford Institute for Geriatric Nursing'.

The National Guideline Clearinghouse™ (NGC) is a comprehensive database of evidence-based clinical practice guidelines and related documents. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. NGC was originally created by AHRQ in partnership with the American Medical Association and the American Association of Health Plans (now America's Health Insurance Plans [AHIP]).

The Edinburgh Feeding Evaluation in Dementia (EdFED) scale is an 11-item instrument developed to assess eating and feeding problems in people with late-stage dementia. By looking for certain behaviors - spilling food while eating or turning the head when prompted to eat, for example - a nurse can predict a patient's needs and build an effective care plan. The scale takes as little as five minutes to complete.

Through patient observation and information obtained using the EdFED tool, nurses find unique opportunities to address nutritional needs and reduce caregiver anxiety over feeding problems. The video for this topic is presented in several chapters: assessment, interpretation and care plan development; and expert interview on the topic. To learn more about this topic view the article and videos available online.

The How to Try This series is funded by the John A. Hartford Foundation to the Hartford Institute for Geriatric Nursing at New York University's College of Nursing in collaboration with the American Journal of Nursing (AJN). This initiative translates the evidence-based geriatric assessment tools in the Try This Assessment Series into cost-free, web-based print and video resources, for caring for older adults. This series can be viewed, downloaded, and shared without any fees. Articles may be printed and copied for educational use without copyright fees. View more information

Carolyn Auerhahn, Ed.D, GNP-BC, NP-C, FAANP
Clinical Associate Professor, College of Nursing, New York University
Coordinator: Geriatric and Adult / Geriatric Nurse Practitioner Programs

Some of you may be asking . . .Who are the "Boomers"?
A "Boomer" (AKA Baby Boomer) is someone who was born between 1946 and 1964. They have dominated US culture since the end of WWII and the first wave of them became eligible for Social Security in January 2008. As they move into "old age", the elderly population in the US is expected to double, if not triple, by 2030.

The Boomers, with their "won't grow old" philosophy, will be more informed and will demand more from the system and providers than have previous generations. Going forward, we will see increases in the numbers of older children (70's) caring for older parents (90's), increasing numbers of older ethnic and racial minorities, the "graying" of the prison population, huge increases in chronic illness, and huge increases in disability especially in those over the age of 85. Healthcare costs are expected to escalate at a rate not seen before.

As a result we are facing one of the major healthcare challenges of the 21st century: the provision of quality, comprehensive, cost-effective care for this ever-growing number of older adults. Providing care for the older adult is not merely providing care for an adult who is older. It requires specialized knowledge and skills, as well as a proactive attitude and approach. Despite the recent increased emphasis on gerontology in medical and nursing curriculum, the emergence of specialized care units in hospitals, and the development of alternative long term care options, the demand will still overwhelm the supply of qualified healthcare providers.

Now you may be asking . . . What can I do?
There is a substantial body of evidence that shows that nurses can have a major positive impact on the health of older adults. Care by nurses with geriatric preparation has been shown to decrease mortality, reduce disability & illness, improve patient & family satisfaction, improve quality of life, including at the end of life, and decrease health care costs.

Nursing has always responded in time of crisis - and we are doing it again! Numerous initiatives are underway to "gerontologize" the nursing workforce - including this eNewsletter and website. We are getting ready. The fact that you are reading this eNewsletter means that you are getting ready! Nursing can make a difference and we will make a difference!

Mathy Mezey, EdD, RN, FAAN
Professor and Director
Hartford Institute for Geriatric Nursing
New York University College of Nursing

In this Sound Off! we reference a study (Mezey, Mitty, Burger, 2008) that shows that students in geriatric dentistry, medicine, nursing, pharmacy, and social work meet very similar competencies in their education programs. A new term "trans-disciplinary," which means working together using a shared framework for care, focusing on problems stated in language that brings disciplines together, has been proposed as a way to educate students and improve coordination of care. Trans-disciplinary education should be a "no-brainer" given the findings of our study, and the fact that very few health care students choose geriatrics as a specialty. Yet we continue to educate geriatric students with little or no sharing of classes, faculty, resources or clinical experiences. Bring this up and talk about it in your clinical agencies and academic settings. Perhaps you can start a revolution of trans-disciplinary education.

From www.ngna.org & www.cjcngna.org

Across the nation, the effort of thousands of nurses who work with the older patient population will be the focus of National Gerontological Nursing Week, October 1st to 8th, 2008. Promoted each year by the National Gerontological Nursing Association (NGNA), this organization encourages communities and work settings to celebrate and honor nurses who work with and care for our older population.

At the urging of the Central Jersey Chapter of NGNA, Governor Jon Corzine issued a proclamation in recognition of the dedication of the hard work of the gerontological nurses in the State of New Jersey, and declared October 1st to 8th as National Gerontological Nursing Week.

Who are Gerontological Nurses?
Every nurse is a gerontological nurse. No matter what setting we work in, we touch the lives of the older population. Although nurses work in a variety of settings, such as acute care, long-term care, assisted living, rehab, home care, hospice, day care, and learning institutions, our clients are often elderly. Even in settings that we don't normally associate with the elderly, such as schools, pediatrics and even the newborn nursery, nurses will encounter the older adult. These individuals may be the grandparents of an infant or child, who are responsible for their care.
Read more about this week and celebration events.