Continence Champions: April 2025

Welcome to the latest key papers and publications focussing mainly on continence issues in the nursing profession.

Please click on the links below and enter your OpenAthens username and password to download the full text or contact the library at esth.hirsonlibrary@nhs.net to request the full text.

Experiences of Urinary Incontinence in Women Who Are Post-Menopausal: A Systematic Review
Abstract: To synthesise the qualitative knowledge of urinary incontinence in post-menopausal women to better understand the experiences and impact of urinary incontinence on quality of life. Urinary incontinence can be an unpleasant and stressful experience as many women assume it is a part of the natural ageing process. The experiences of urinary incontinence can impact many women in different ways as some are reluctant to discuss or report the incidences with health professionals. There were 85 studies identified in the review, and 61 were screened for eligibility. Only four were included in the review. Common themes were identified in the studies that included psychological, physical, informational/education, social, practical needs, intimacy and sexual aspects. The psychological and physical aspects were noted in all the included studies. Many of the studies identified the difficulties post-menopausal women endure in managing episodes of urinary incontinence, as many expressed shame and embarrassment when urinary incontinence occurred. The physical aspects included concerns about maintaining good hygiene and managing irritation on their skin from constant washing. The physical aspect also included exhaustion and tiredness from managing urinary incontinence episodes. Many women in the studies expressed a desire to have ongoing education about managing urinary incontinence and the need to discuss the topic more openly. The social impact of urinary incontinence was also captured in the review, as many women expressed the desire to be social with family and friends but felt reluctant due to the fear of urinary incontinence occurring in front of other people. The practical burden of managing urinary incontinence was illustrated in this review, as some women faced many challenges in managing soiled clothing, constant washing of clothing and the skin and the need to visit the bathroom regularly. The intimacy and sexual components of their lives have been disrupted by episodes of urinary incontinence and replaced with excuses for intimate activities. Post-menopausal women living with urinary incontinence experience a range of different burdens across many different areas in trying to manage their condition. Healthcare professionals need to acknowledge that post-menopausal women are reluctant to seek treatment due to shame and feelings that urinary incontinence is a normal part of aging. To ensure quality of life for post-menopausal women living with urinary incontinence, healthcare professionals need to tailor treatment strategies to provide better care.
Source: McKie, Amanda L. International Journal of Urological Nursing, Mar 2025; 19(1):

Adherence and uncertainty during rehabilitation for urinary incontinence: Validation of a scale
Abstract: We sought to create an Italian version of Mishel's Uncertainty in Illness Scale, dedicated to people undergoing conservative rehabilitation for urinary incontinence, for studying uncertainty as a determinant of therapeutic adherence. Urinary incontinence has a high prevalence worldwide, ranging from 25% to 45%. Incontinence is often treatable with conservative interventions but demands a long and intensive commitment from the patient. Results are not immediate, and relapses are possible. These patients can experience uncertainty and difficulty complying with rehabilitation programs, hence the importance of the therapeutic relationship with a healthcare professional. Mishel's theory of uncertainty can be used to measure uncertainty and the effects of such a relationship, but no instrument currently exists for this purpose. Prospective observational study enrolling all male and female adult patients admitted to a nurse-led outpatient pelvic clinic for non-neurogenic urinary incontinence, excluding puerpera. A scale named MUIS-PF (pelvic floor) was created, based on previous versions of Mishel's scale, and administered during the first consultation and at the end of the rehabilitation program. Internal consistency was assessed, and exploratory factor analysis was conducted. A total of 109 patients enrolled (54 M, 55 F) aged 64 ± 5 years, medial initial leakage 245 grams/day, IQR [90; 370]. Seventy-nine percent obtained continence; there were no dropouts during the study. Internal consistency of the MUIS-PF was high (93%), and structure analysis yielded a clear separation of the factors. Patient uncertainty decreased significantly at the end of the program compared to the first consultation (p < 0.001). The MUIS-PF is valid and reliable. Utilizing the correct approach, the nurse could significantly reduce the uncertainty of persons with incontinence by listening, giving clear information and searching for the best solution for their continence issues.
Source: Terzoni, S. International Journal of Urological Nursing, Oct 2024; 18(3):

Short-Term Urinary Incontinence After Radical Prostatectomy Is Still Based on Patients' Age, Nerve-Sparing Approach, and Surgical-Experience, Despite the Higher-Use of Robotic Surgery in 2022 Compared to 2016 Real-World Results of a Large Rehabilitation Center in Germany
Abstract: Background:
Despite constant improvements, incontinence is one of the most relevant and quality-of-life-reducing side effects of radical prostatectomy (RP) and, in addition to patient-specific factors such as age, the experience of the surgeon/center and the surgical technique used play an important role.
Aims:
To present current real-world data on short-term incontinence after RP from one of the largest German rehabilitation centers in 2022 and to compare it to the results from the same institution in 2016.
Methods and Results:
Retrospective, unicentric, univariate analysis of data from 1394 men after RP in 2022 on admission and discharge from the rehabilitation clinic. Incontinence defined as ≥ 1 pad/day was evaluated by quantitative measuring all day incontinence under a defined graduation and compared to the results of 2016. Totally, 1393 men were available for analysis in 2022 compared to 1390 in 2016. Median age for both cohorts was 66 years with minor differences in preoperative PSA levels. Despite different surgical approaches, no significant change in short-term incontinence rates in 2016 and 2022 were noted at discharge (76.9% vs. 77.9%, p = 0.56). A notable increase in patients with ISUP grade Group 2 and a shift towards robotic surgery were observed in 2022 (45.5%–71%). While nerve sparing led to a significant improvement in continence (p < 0.01), lymphadenectomy and T-stage were not related to any significant increase in short-term incontinence rates. Comparing age groups within the cohort, patients > 69 years exhibited the highest risk of short-term incontinence and least likelihood of regaining continence during rehabilitation (p < 0.01). Men treated at a certified prostate cancer center had significantly (p < 0.01) lower short-term incontinence rates.
Conclusion:
Our study shows little improvement in short-term postoperative incontinence rates after RP in Germany in the last 6 years and known risk factors for postoperative incontinence like age, nerve-sparing surgery, and level of experience were reproduced in our analyses. We conclude not only to carefully select but also to counsel patients before being treated for prostate cancer and to strongly advice treatment at certified centers.
Source: Püllen, L. Cancer Reports, Dec 2024; 7(12):

Adults with Intellectual Disabilities and Incontinence: Assessment and Toileting Issues
Abstract: Background:
Urinary and bowel incontinence are more common in adults with intellectual disability (ID), compared to the general population. Little is known about their incontinence experiences and toileting issues. The aim was to learn about their experiences and toileting issues.
Method:
Incontinence and toileting issues assessment was conducted with a community-based sample of 22 adults with ID and urinary incontinence, with or without bowel incontinence. Assessment included the IPSS, ICIQ-UI, and POTI checklists; bladder scans; and urine sample screening for presence of a urinary tract infection.
Results:
The majority (19 adults, 86%) developed urinary incontinence during adulthood. Seven adults (32%) also experienced bowel incontinence, and constipation was the most commonly reported health condition (13 adults, 59%), other than urinary incontinence. Fifty per cent (11 adults) had been treated for a urinary tract infection within the previous 12 months.
Conclusion:
There is an urgent need to develop accessible and reliable incontinence assessment materials with and for adults with ID and their supporters. These assessments should pay close attention to health conditions that can cause incontinence in this group and factors associated with incontinence which are more commonly experienced by adults with ID. These factors are potentially modifiable.
Source: Finlayson, J. Journal of Intellectual Disability Research, Nov 2024; 69(2):

Smart Personalized Continence Care for People with Profound Intellectual and Multiple Disabilities: A Theory and Practice- Based Implementation Guideline for a Digital Innovation
Abstract: Introducing smart technologies can personalize and improve continence care for people with profound intellectual and multiple disabilities within residential care facilities. Currently, continence care is provided according to fixed schedules. This can lead to oversaturated incontinence materials, leading to leakages and an increased chance of incontinence-associated dermatitis or unnecessary changes. Both result in an unneeded burden for individuals with profound intellectual and multiple disabilities and their caregivers. Smart technologies that notify caregivers when incontinence materials need to be changed can improve the quality of life for individuals experiencing incontinence and lead to a more efficient care process for their caregivers. Yet, implementation is challenging. We present a Guideline for Smart Continence Care (SCC) Implementation in Residential Disability Care. The guideline is systematically and iteratively developed by combining implementation literature and daily practice. Lessons learned from applying a draft version at six residential care facilities are integrated. Eight steps are identified and detailed to guide the SCC implementation process: (1) analyze and determine goals for each target group, (2) analyze the innovation, (3) analyze the context, (4) arrange preconditions, (5) formulate implementation strategy, (6) carry out and monitor the implementation, (7) evaluate and adapt implementation strategy, and (8) continued use and upscaling. The guideline is illustrated by examples from actual SCC implementation practice. This guideline is not only useful for those who lead the implementation of SCC in residential care, but may offer guidance for other care technology implementations in various care settings as well.
Source: Van Cooten, V. Journal of Policy and Practice in Intellectual Disabilities, Mar 2025; 22(1):

Urinary incontinence: implications for nursing practice
Abstract: Urinary incontinence, encompassing stress, urge, and overflow types, significantly impacts patients' physical, psychological, and social wellbeing. This article provides an overview of each type, exploring their pathophysiology, risk factors, and clinical presentations. It emphasises the crucial role of nursing and discusses evidence-based management strategies, including behavioural therapies, pharmacological treatments and patient education. The article also addresses the impact of incontinence on quality of life and future directions for research and practice, advocating a multidisciplinary approach to improve patient outcomes.
Source: Horta Reis da Silva, T. British Journal of Nursing, Dec 2024; 33(22):

Urinary incontinence in older adult women: fighting a rising tide
Abstract: The world's population is rapidly ageing, with conditions such as urinary incontinence, which are especially prevalent among older adults, expected to rise in prevalence as a result. Urinary incontinence is particularly common in older women; however, despite its profound impact on every aspect of women's health and wellbeing, it is often minimised by both individual patients and the wider healthcare system. Francesca Ramadan delves into the prevalence of and psychosocial effects and patient-related factors related to urinary incontinence in older women.
Source: Ramadan, F. British Journal of Community Nursing, Dec 2024; 30(1):

The invisible disability: how to manage urinary incontinence in a neurological patient
Abstract: Urinary incontinence is a significant challenge in patients with neurological conditions, requiring a multifaceted approach to management from a broad range of healthcare professionals. It not only affects quality of life, but also is a leading cause of emergency NHS admissions. The considerable increasing cost of emergency bladder and bowel admissions has highlighted the urgent need for education in uro-neurology across the multidisciplinary team. In response, the Uro-neurology Academy was established in 2023 and hosted an initial webinar in the summer of 2023, which explored a basic approach to managing urinary incontinence in a neurological patient from a medical, nursing and allied health perspective. The webinar also provided an update on the NHS England and NHS improvement neuroscience transformation programme which outlined future commissioning models for neurology, with implications for multiple sclerosis, bladder and urology services. This article will summarise the practical guidance and key points presented by the speakers and chair.
Source: Stross, R. British Journal of Neuroscience Nursing, April 2025; 21(2):

Revolutionising treatment for urinary incontinence and enhancing intimate wellness with EMSELLA
Abstract: Older people are at an increased risk of developing skin damage related to incontinence, including pressure ulceration and incontinence-associated dermatitis (IAD). Factors exacerbating risk in older people include: a higher rate of faecal and urinary incontinence, reduced mobility, long-term conditions and changes to skin barrier function, as a result of the ageing process. Nurses have a key role to play in the assessment of continence, IAD prevention and management. This article explores nursing knowledge in relation to continence care on six inpatient wards for older people, and describes the implementation of improvement strategies, in order to reduce voidable harm.
Source: Attewell, D. Journal of Aesthetic Nursing, Apr 2025; 14(2):

The impact of urinary and bowel incontinence: psychological and physical effects and interventions
Abstract: This clinical review explores the multifaceted impact of urinary and bowel incontinence on the physical and psychological wellbeing of individuals, particularly older adults. The psychological effects, which often include anxiety, depression and social isolation, are addressed through interventions such as cognitive behavioural therapy and peer support groups, which are crucial for alleviating the emotional burden. The review also examines conservative management strategies, such as pelvic floor muscle training, bladder retraining and dietary changes, as well as discussing pharmacological treatments and surgical options for more severe cases. A key emphasis is placed on the importance of a multidisciplinary approach and incorporating the expertise of continence nurses, physiotherapists, occupational therapists and psychologists to comprehensively address patient needs.
Source: Alsararatee, Hasan H. Gastrointestinal Nursing, Nov 2024; 22 (suppl 9):

The impact of incontinence on mental health
Abstract: Bladder and bowel issues, particularly those related to continence, can significantly impact an individual's mental health. These challenges often lead to isolation, anxiety, stress, depression and social anxiety, all of which can profoundly affect a person's quality of life. Healthcare professionals are uniquely positioned to recognise these concerns and incorporate them into assessments for bladder and bowel health. By actively listening, offering empathy and guiding patients toward further support—alongside providing practical treatment and management strategies—clinicians can play a vital role in delivering comprehensive care. This article explores common bladder and bowel issues, the psychological and social challenges they present, and the difficulties both patients and healthcare professionals face in addressing and managing them.
Source: Robson, M. British Journal of Community Nursing, Apr 2025; 30(suppl 4a):

To pad or not to pad? The use of containment products in healthcare
Abstract: Containment products, commonly known as incontinence pads, are medically used in healthcare for patients with bladder and bowel symptoms. However, using them without a clinical need or selecting the wrong style or absorbency can lead to avoidable patient harm. In some cases, product formularies are developed with a greater focus on cost than clinical need, restricting access to certain styles and limiting the number of products prescribed per day. While registered healthcare professionals are accountable for assessing and prescribing containment products for patients under their care, they may not always be aware of this responsibility. Providing pads prematurely can cause unintended physical harm, and foster psychological dependence and reluctance to pursue curative treatment.
Source: Evans, T. British Journal of Community Nursing, Apr 2025; 30(suppl 4a):

A review of the role for pelvic floor physiotherapy in postmenopausal women with urinary incontinence
Abstract: Urinary incontinence is a prevalent condition affecting women. Pelvic floor physiotherapy is a specialized field of physiotherapy dedicated to assessing and treating pelvic floor muscles. This therapy has demonstrated benefits in addressing stress urinary incontinence in premenopausal women, with numerous studies supporting its efficacy in this population. However, pelvic floor physiotherapy in the treatment of postmenopausal women is less well-established, and furthermore, the types of urinary incontinence in postmenopausal women are much broader. We provide a comprehensive review of recent literature investigating the effectiveness of pelvic floor physiotherapy therapy for various conditions in postmenopausal women, including urinary incontinence, urgency urinary incontinence, pelvic organ prolapse, genitourinary syndrome of menopause, sexual dysfunction, and urinary incontinence in the context of obesity, frailty, mobility, and dementia. After evaluating the current literature, it is evident that there is insufficient data to definitively endorse or dismiss the utilization of Pelvic floor physiotherapy for treating urinary incontinence in postmenopausal women. Nevertheless, considering the low associated risks of pelvic floor physiotherapy, we advocate for the initiation of comprehensive, large-scale randomized studies aimed at evaluating its effectiveness in addressing urinary incontinence in postmenopausal women with special attention to vulnerable subgroups, including individuals who are obese, frail or experiencing cognitive impairment.
Source: Walgren, Lauren A. Post Reproductive Health, Dec 2024; 30(4): 239-245
Contact the library for a copy of this article

Key in Lock Syndrome: A Case Report of Situational Urge Incontinence
Abstract: Urgency urinary incontinence, a subtype of overactive bladder, is a common complaint in primary care. One type of urgency urinary incontinence is key in lock or latchkey syndrome, which causes patients to release urine uncontrollably because of a situational environmental trigger or triggers. This incontinence often occurs when patients visualize the door of their house or hear running water. This article presents the case of an older adult woman experiencing recurrent genitourinary infections in the setting of worsening key in lock syndrome.
Source: White, Krista A. The Journal of Nurse Practitioners, Sep 2024; 20(8):
Contact the library for a copy of this article

Reproductive history of parous women and urinary incontinence in midlife: A National Birth Cohort follow‐up study
Abstract:
Objective:
To investigate how reproductive history was associated with urinary incontinence in midlife.
Design:
A follow‐up study.
Setting:
Denmark.
Population:
A total of 39 977 mothers who participated in the Maternal Follow up (2013–2014) in the Danish National Birth Cohort. National registries provided their reproductive history.
Methods:
How parity, mode of birth and obstetric tears associated with urinary incontinence were estimated with adjusted odds ratios (OR) and 95% CI using logistic regression.
Main outcome measures:
Self‐reported urinary incontinence including subtypes stress, urge and mixed urinary incontinence.
Results:
At an average age of 44 years, the prevalence of any urinary incontinence was 32% (21% stress, 2% urge, and 8% mixed urinary incontinence). Women with two births more often had urinary incontinence than women with one birth (OR 1.20, 95% CI 1.10–1.31). Compared with women with only spontaneous births, a history of only caesarean sections was associated with much lower odds of urinary incontinence (OR 0.39, 95% CI 0.35–0.42) and a history of instrumental births with slightly lower odds (OR 0.92, 95% CI 0.86–0.98). Compared with no tear/first‐degree tear as the largest tear, episiotomy was associated with less urinary incontinence (OR 0.91, 95% CI 0.86–0.97) whereas third/fourth‐degree tears were associated with more (OR 1.14, 95% CI 1.04–1.25). Findings were mainly explained by similar associations with stress and mixed urinary incontinence.
Conclusions:
Vaginal birth was associated with a higher risk of long‐term urinary incontinence, but our results indicate that this risk may be reduced by shortening the second stage of birth.
Source: Kjeldsen, Anne C. BJOG: An International Journal of Obstetrics and Gynaecology, Oct 2024; 131(11): 1495-1505

A study to untangle the puzzle of urinary incontinence and frailty co‐occurrence among older adults: The roles of depression and activity engagement
Abstract: Aims:
To explore the co‐occurrence of urinary incontinence and frailty by testing the roles of depression and activity engagement guided by the mechanisms of common cause and interaction pathways.
Design:
A secondary analysis of a 1‐year three‐wave panel data collected from older nursing home residents in China.
Methods:
Changes in depression and activity engagement were regressed on urinary incontinence and frailty incidence underpinned by the common cause mechanism of chronic conditions co‐occurrence, and these changes were also taken as mediators linking from frailty to urinary incontinence incidence supported by the interaction pathways' mechanism.
Results:
A total of 348 older adults were included in this study, and 55.7% were women. The co‐occurrence of urinary incontinence and frailty was found in 16.7% of the participants at baseline. Older adults with sole frailty at baseline had almost twice the rate of incident urinary incontinence (32.7%) compared with those without (16.7%) over a 1‐year period. The subsample analyses showed that changes in depression and activity engagement failed to significantly predict the incidence of urinary incontinence and frailty. The mediating roles of these changes linking frailty to urinary incontinence incidence were also not statistically significant.
Conclusion:
The co‐occurrence of urinary incontinence and frailty is prevalent in older nursing home residents. Older adults with frailty at baseline are more likely to develop urinary incontinence a year later. The common cause and interaction pathways mechanisms for the co‐occurrence of urinary incontinence and frailty were not verified with changes in depression and activity engagement.
Source: Wang, C. Journal of Advanced Nursing, Nov 2024; 80(11): 4584-4592

Care Needs of Older Adults with Urinary Incontinence: A Cross-Sectional Study
Abstract: Purpose:
To explore care requirements of older adults with urinary incontinence (UI) and contributing factors.
Method:
This cross-sectional study used the Older Adults Urinary Incontinence Care Needs Inventory to survey participants with UI in three large-scale tertiary hospitals located in Guangzhou City, China, from January 2023 to November 2023. Statistical analyses, including analysis of variance, t tests, correlation analyses, and linear regression models, were conducted to assess factors influencing participants' care needs.
Results:
A total of 530 older adults with UI participated in the survey and mean standardized score for overall care needs was 78.65 (SD = 5.01), with mean scores for each dimension ranging from 70.88 (SD = 10.55) for social participation needs to 82.45 (SD = 7.11) for health education needs. Factors that were found to influence incontinence care needs in older adults included age, literacy level, number of leaks, and type of disease (F = 37.07, adjusted R2 = 0.290, p < 0.001).
Conclusion:
Comprehensive care for older adults with UI, encompassing physiological, psychological, and social aspects, is crucial. It is essential to tailor care to individual needs and characteristics, taking into account factors, such as age and education, to ensure effective care. [Journal of Gerontological Nursing, 50(5), 43–49.]
Source: Xiang, Su Y. Journal of Gerontological Nursing, May 2024; 50(5): 43-49

Managing female stress urinary incontinence in a post mesh era: What to do and when to refer
Abstract: SUI is defined by the International Continence Society as 'the complaint of any involuntary loss of urine on effort or physical exertion (eg sporting activities), or on sneezing or coughing'.2 SUI affects many domains of a person's life, and a large proportion of SUI can be improved or cured, but SUI is often under-reported secondary to incontinence-related stigma.3 Primary care providers are therefore essential in the assessment and management of SUI. Pathophysiology and assessment of SUI is related to weakness of the pelvic floor and urethral sphincter, resulting in leakage of urine with increased intra-abdominal pressure, such as that experienced during exercise, coughing and laughing. Proactive management of constipation, as well and encouraging reduced intake of alcohol and caffeine, are suggested.9 Both body mass index and waist circumference are positively associated with SUI,10 and weight reduction has been shown to lessen SUI symptoms, as well as improve postoperative outcomes in patients undergoing surgical intervention for SUI.11 The literature demonstrates that women with chronic respiratory conditions were twice as likely to develop urinary incontinence compared to the general population, so management of respiratory comorbidities is essential.12 Smoking cessation should also be recommended to relevant patients.9 Pelvic floor muscle training (PFMT) is highly effective in managing SUI and has a strong body of evidence (particularly in mild-moderate severity SUI cohorts).13-15 PFMT aims to strengthen the pelvic floor and sphincter complex and should be recommended as a first-line therapy to all patients with SUI13'14 (Table 4). PVS were performed in increasing numbers following the concerns about the use of mesh for prolapse surgery27 and have comparable clinical outcomes to synthetic slings, without mesh-specific complications (Table 5).28 Systematic reviews quote success rates between 46.9 and 90%.22,29 Burch colposuspension Burch colposuspension is a mesh-free treatment for primary SUI and involves placing sutures between the anterior vaginal wall (either side of the urethra) and Cooper's ligaments, thereby elevating the urethra and providing a support mechanism against rises in intra-abdominal pressure.
Source: McDonald, J. Australian Journal of General Practice, May 2024: 53(5): 283-288

The impact of male urinary incontinence on quality of life and sexual health
Abstract: Men with urinary incontinence problems may have a fear of urinary incontinence during sexual intercourse, which may negatively affect their sexual lives. This study aimed to determine the effect of urinary incontinence on quality of life and erectile dysfunction in men. A total of 203 men with urinary incontinence who presented to a urology outpatient clinic were assessed using a patient information form, the International Consultation on Incontinence Questionnaire‐Urinary Incontinence Short Form (ICIQ‐SF), and the International Index of Erectile Function (IIEF). The mean age was 63.48 ± 8.80 years, the mean ICIQ‐SF score was 13.45 ± 3.14 (moderate), and the IIEF erectile dysfunction score was 18.52 ± 6.48 (mild/moderate). Patient age correlated positively with the ICIQ‐SF total score (r = 0.309, p < 0.001) and negatively with the IIEF total score (r = −0.452, p < 0.001). The ICIQ‐SF score was negatively correlated with erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction scores (p < 0.001, p = 0.015, p = 0.037, p = 0.006 and p = 0.001, respectively). More severe urinary incontinence in men was associated with lower quality of life and greater erectile dysfunction. Further studies are needed to raise men's awareness of urinary incontinence.
Source: Gezginci, E. International Journal of Urological Nursing, Nov 2024; 18(3):

Dementia Champions: March 2025

Welcome to the latest key papers and publications focussing mainly on all things dementia, delirium and ageing in the nursing profession.

Please click on the links below and enter your OpenAthens username and password to download the full text or contact the library at esth.hirsonlibrary@nhs.net to request the full text.

Keeping well with dementia: supporting the person with dementia to function to capacity
Abstract: Nearly a million people are living with dementia in the UK, and less than 65% of them have been formally diagnosed according to the Alzheimer's Society. Dementia exists on a continuum and people can have mild, moderate or severe symptoms. People with dementia are more likely to experience health problems than people of the same age who do not have dementia. Dementia affects the ability to understand and relate to the world and to manage health conditions. This article discusses how to a person with dementia can be helped to maintain health and enjoy the best possible quality of life.
Source: Nazarko L. British Journal of Community Nursing, Feb 2025; 30(3): 101-144

The care certificate: awareness of mental health, dementia and learning disability
Abstract: This article, the ninth in the series about the care certificate, will explore the meaning of the standard ‘awareness of mental health, dementia and learning disability’ and consider what this requires of the healthcare assistant.
Source: Ellis P. British Journal of Healthcare Assistants, Feb 2025; 19(2): 029-045

Managing dementia and diabetes in primary care settings
Abstract: This article looks at the links between diabetes and dementia and the prevalence of dual co-morbidity.
Source: Morris D. Independent Nurse, Feb 2025; 2025(2): 3-30

Dementia, assisted dying, euthanasia
Abstract: This article discusses assisted suicide and euthanasia in relation to dementia. It presents some broad arguments against any form of ‘assisted dying’. But then focuses on advance euthanasia directives as used in the Netherlands and the case of ‘coffee euthanasia’. Decision-making capacity and the possibility of coercion are briefly discussed. Lord Walton's robust support of the prohibition of intentional killing concludes the article.
Source: Hughes Julian C, British Journal of Neuroscience Nursing, Dec 2024; 20(6): 239-288

Immune-mediated diseases, inflammation and the increased risk of developing dementia
Abstract: Sarah Jane Palmer discusses the links between the immune system, inflammation and the increased risk of developing dementia.
Source: Palmer Sarah J. Nursing and Residential Care, Feb 2025; 27(1): 1-2

A Nurse-Initiated Protocol for Interprofessional Management of Changed Behaviours in Hospital Patients with Dementia and/or Delirium: A Modified e-Delphi Study
Abstract:
Aim: To develop a nurse-initiated protocol for early ward-based interprofessional coordination and formulation of person-centred care plans to assist in point-of-care management of behaviour in older patients on general hospital wards.
Design: A modified e-Delphi method was employed to establish expert consensus.
Method: Multidisciplinary acute-care experts experienced in hospital care of patients with dementia and/or delirium in Australia were recruited by email from 35 professional networks. Three online survey rounds were planned. The first sought free-text comments on point-of-care practices. The following rounds sought expert ratings for subsequently developed protocol components. The study occurred between January and June 2023.
Results: Fifty-three experts participated (eight completed all rounds). Existing practices, opportunities and barriers were established in round one (n = 32), informing development of three multicomponent stages: (1) a bundle of bedside care comprising generic person-centred approaches, (2) a stepped-care workflow redirecting multidisciplinary teams to adopt an interprofessional approach to formulating individualised behavioural-care and (3) a one-page Behaviour Support Plan template. Content Validity Index scores for all items in round two (n = 29) were 0.89–0.96, meeting a priori consensus criteria, and negating the need for a third round.
Conclusion: To improve outcomes for older hospital patients with changed behaviours, a multicomponent protocol for timely interprofessional formulation of point-of-care Behaviour Support Plans was established through expert panel consensus.
Impact: Management of patient behaviours has resided almost solely with nursing, ignoring the potential inherent in ward-based multidisciplinary teams. A pragmatic procedure for initiating early interprofessional support to nurses' management of behaviours may potentially improve care, safety and outcomes for patients and staff alike. Ready for feasibility testing in hospitals, the protocol capitalises on existing multidisciplinary resources.
Reporting Method: The study is reported in accordance with the Guidance on Conducting and Reporting Delphi Studies (CREDES) recommendations.
Patient or Public Contribution: No patient or public contribution.
Source: Graham Frederick A. Journal of Advanced Nursing, Jan 2025; Early View

Intensive Care Unit Admissions among Persons with Dementia: Overuse or Underuse?
Abstract: Decision-making when providing critical care to persons with dementia (PWD) should include clinical, ethical, and human rights considerations. Risks exist for both overuse and underuse of critical care among PWD since allocating resources appropriately while respecting people's wishes is challenging.
Source: Cetin-Sahin D. Journal of the American Geriatrics Society, Jan 2025; 28(7): Early View

Deprescribing considerations for central nervous system-active polypharmacy in patients with dementia
Abstract: Older adults with dementia are much more likely than those without dementia to experience polypharmacy, defined as taking at least five medications. Approximately 72% of older adults with dementia, versus only 44% of those without dementia, experience polypharmacy. Although multiple medications may be prescribed to treat multiple chronic conditions, polypharmacy in older adults is associated with increased risks of adverse drug events, cognitive and physical impairment, frailty, falls, and mortality. For older adults with dementia, the most common contributors to polypharmacy include cardiovascular medications and medications acting on the central nervous system. An estimated 73% of adults aged 65 and over with dementia use at least one cardiovascular medication, and an estimated 85% use at least one medication acting on the central nervous system. Yet another risk beyond polypharmacy alone is the concomitant use of three or more medications all acting on the central nervous system, termed central nervous system-active polypharmacy. These medications typically include: antiepileptics, antidepressants, antipsychotics, benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonist hypnotics (i.e., z-drugs), opioids, and skeletal muscle relaxants. The concomitant use of these medications is associated with increased risks of falls, cognitive decline, emergency room visits, and hospitalizations. The 2023 Beers Criteria recommend against central nervous system-active polypharmacy.
Source: Hung A. Journal of the American Geriatrics Society, Nov 2024; 73(2): 343-346

Privileges, and Permissions: Theorising Intersectionality and Cultures of Control in the Care of People Living With Dementia in Acute Hospital Settings
Abstract: A longstanding body of public enquiries and research identifies people living with dementia experience systemic inequalities within hospital settings, concluding a focus on improving care cultures is required. Drawing on a 3-year multi-sited hospital ethnography, this paper examines everyday cultures of care in NHS acute hospital wards to interrogate how ethnicity, gender and social class intersects to shape the care of people living with dementia. Drawing on Collins' concept of intersectionality and the relational nature of power, the analysis reveals that while cared for by diverse teams of healthcare professionals, a patients' age, ethnicity, gender and social class, as interconnected categories, influences the tightening of ward rules for some people living with dementia and the granting of significant privileges for others. Focussing on walking within the ward, with a large number of people living with dementia classified as ‘wandering’, we explore ways in which intersectional identities informed who was granted privileges to leave the bedside and ‘wander’ the ward, and who experienced further control. The paper concludes that institutional racism and attitudes to gender, social class and ageing permeate the routine organisation and delivery of care within NHS acute hospital wards to significantly impact people living with dementia, and in turn, increases the consideration of care pathways that emphasise their discharge to institutional settings.
Source: Mwale S. Sociology of Health and Illness, Jan 2025; 47(1): e13869

Midlife is good for more than a crisis: Exercise for dementia prevention
Abstract: Alzheimer's disease (AD) will have touched the lives of many readers, as nearly 7 million older Americans currently live with the disease. While there has been recent progress toward disease-modifying treatment, these medications have limited efficacy, carry known risks (e.g., brain bleeding and brain swelling), and are expensive. Given the current Alzheimer's landscape, identifying effective ways to prevent dementia is of paramount importance. Engaging in physical activity, or exercise, is a widely accepted strategy for dementia prevention. However, questions about the causal nature of the relationship remain. While epidemiological and cohort studies have consistently shown benefits of exercise for reducing dementia risk, evidence from randomized controlled trials (RCTs), the gold standard for assessing causality, is a mixed bag. Indeed, trials provide inconsistent results on the benefits of exercise, possibly due to difference in exercise duration, modality, and intensity, in addition to trial design and participant characteristics.
Source: Fenton L. Journal of the American Geriatrics Society, Oct 2024; 72(12): 3627-3630

Dementia Diagnosis Before and After Hip Fracture in Medicare Patients
Abstract: Dementia is a risk factor for hip fracture. Persons with both hip fracture and dementia are medically complex and have heightened risk for post-operative complications, hospital readmission, functional impairment, and death. Despite implications for healthcare quality and post-acute care reimbursement reform, little is known about the prevalence and trajectory of dementia diagnosis before and after hospitalization for hip fracture.
Source: Reider L. Journal of the American Geriatrics Society, Dec 2024; Early View

Clinician contributions to central nervous system-active polypharmacy among older adults with dementia in the United States
Abstract:
Background: Exposure to central nervous system (CNS)-active polypharmacy—overlapping exposure to three or more CNS-active medications—is potentially harmful yet common among persons living with dementia (PLWD). The extent to which these medications are prescribed to community-dwelling PLWD by individual clinicians versus distributed across multiple prescribers is unclear.
Methods: We identified community-dwelling Medicare beneficiaries with a dementia diagnosis and Medicare Parts A, B, and D coverage for at least one month in 2019. Using fill date and days' supply for prescriptions filled between January 1, 2019 and December 31, 2019, we identified beneficiaries exposed to CNS-active polypharmacy (i.e., >30 days of overlapping exposure to three or more antidepressant, antipsychotic, antiseizure, benzodiazepine, opioid, nonbenzodiazepine benzodiazepine receptor agonists, or skeletal muscle relaxant medications). We examined the number and type of clinicians who contributed to polypharmacy person-days among PLWD.
Results: The cohort included 955,074 PLWD who were primarily female (64.0%), were White (78.5%), and had a mean age of 83.4 years (standard deviation 8.0). Notably, 14.3% were exposed to CNS-active polypharmacy. At the person level, 24.6% of PLWD experienced polypharmacy prescribed by a single clinician. Considering total days of exposure, 45.3% of polypharmacy person-days were prescribed by a single clinician. Primary care physicians prescribed 63.0% of polypharmacy person-days and accounted for the plurality of days for all seven medication classes, followed by psychiatrists for antipsychotics and benzodiazepines and primary care advanced practice providers (APPs) for antidepressants and antiseizure medications.
Conclusion: In this cross-sectional analysis of Medicare claims data, primary care clinicians (both physicians and APPs) prescribed the majority of medications that contributed to CNS-active polypharmacy for PLWD. Future research is needed to identify strategies to support primary care clinicians in appropriate prescribing of CNS-active medications to PLWD.
Source: Vordenberg Sarah E. Journal of the American Geriatrics Society, Nov 2024; 73(2): 422-430

Faecal incontinence management in dementia patients
Abstract: Faecal incontinence is a complex issue faced by many older adults. This article will provide an overview of this condition and its causes. It will also provide policy and guidance on the subject, its general management, complications, the support available for carers, and the issue of faecal incontinence in someone who has dementia.
Source: Palmer, S J. British Journal of Community Nursing, Nov 2022; 27(11): 521-566

Colder Climates and Dementia: An Ecological Analysis of Climate-Patterned Temperature's Influence on Neurological Health
Abstract: Countries with lower climate-patterned temperatures (Tcp), typically colder, have not been consistently correlated with higher dementia risk in population studies. This study explores Tcp's influence on global and regional dementia rates. Country-specific Tcp data was analyzed alongside dementia incidence using bivariate analysis, partial correlation, and multiple linear regression. Factors like life expectancy (Life e(0)), economic affluence, genetic predisposition (Biological State Index), and urbanization were considered. Both Pearson's r and nonparametric tests revealed a significant inverse correlation between Tcp and dementia incidence, holding true even after adjusting for life expectancy, affluence, genetic predisposition, and urbanization. Multiple linear regression identified Tcp as a key predictor of dementia incidence, ranking second after life expectancy. Affluence, genetic predisposition, and urbanization did not significantly predict dementia rates. Tcp's predictive power was consistent across different country groups, with minor correlation variations between developing versus developed countries and LMICs versus high-income nations. Countries with colder climate (lower Tcp) may experience higher dementia rates, a correlation robust across major risk factors. Including Tcp in dementia studies is crucial for understanding its public health implications.
Source: You W. Nursing and Health Sciences, Dec 2024; 26(4): e70012

Dementia-Friendly Hospital—the Perspective of Professional Dementia Experts
Abstract:
Aim: To investigate the professional dementia experts' understanding of a dementia-friendly hospital to identify its characteristics.
Design: We used a qualitative design embedded in a case study. A total of 16 semi-structured expert interviews were conducted with 17 professional dementia experts. Using inductive content analysis, the interviews were analysed in a participatory manner involving a group of researchers and dementia experts.
Results: We identified six characteristics of dementia-friendly hospitals: Proud to be dementia-friendly—That's what we want; Seeing the human being

—Taking care of everyone; Having everyone on board—It's a collective task; Being professional

—It takes more than being nice and kind; Rethinking the ‘running’ system

—We have to change, not them; and Being part of the community

—Thinking beyond the hospital.
Conclusion: The concept of a dementia-friendly hospital seems complex and requires a rethinking of the traditional hospital. For a conceptualisation, the involvement of people with dementia and their relatives is important to gain a comprehensive understanding.
Implications for the Profession and Patient Care: A dementia-friendly hospital is characterised by professional care that comprises a safe, familiar and supportive environment, is prepared but also flexible, has everyone on board, and sees the human being. To become dementia-friendly, individual interventions such as training courses can be a starting point. However, an overall concept is required that also includes components that contribute to successful implementation and a welcoming culture of people with dementia.
Impact: Our findings on the perspective of professional dementia experts contribute to the conceptualisation of dementia-friendly hospitals.
Reporting Method: We reported our study according to the COREQ checklist.
Patient and Public Contribution: The investigation of the perspective of professional dementia experts is one part of a larger study. In this overall DEMfriendlyHospital study, we interviewed professional dementia experts, people with dementia and their relatives and also involved them in a participatory manner in various stages of the research process.
Source: Manietta C. Journal of Clinical Nursing, Sep 2024; Early View

An innovative model of behavioral healthcare for older adults with serious mental illness, substance use disorders, and dementia
Abstract:
Introduction: Older adults with serious mental illness (SMI) experience higher rates of medical comorbidities, mortality, hospital readmissions, and total healthcare spending when compared with Medicare beneficiaries without SMI. Although telehealth provides an opportunity to overcome barriers to behavioral healthcare access, older adults face unique challenges when accessing and utilizing telehealth services. We present Author Health's care model, which integrates virtual-first behavioral health care with an interdisciplinary approach to health-related social needs (HRSN) screening and intervention in older adults.
Methods: We launched an innovative behavioral healthcare delivery model in collaboration with primary care for Medicare Advantage recipients with SMI, substance use disorders (SUD), and dementia. All patients completed an intake with an MD/NP and were offered screening for HRSN at entry using the Accountable Health Communities HRSN tool. Primary diagnosis was assigned and categorized into SMI/SUD/dementia and non-SMI. Logistic regression was used to quantify the odds of food, housing, and transportation insecurity explained by SMI/SUD/dementia versus non-SMI behavioral health conditions.
Results: A total of 2301 patients completed an intake from January 2023 to March 2024. Moderate/severe depression (40%) was the most common primary target condition at intake, followed by dementia/Alzheimer's disease (12%) and bipolar disorder (5%). The rates of housing insecurity, food insecurity, and transportation insecurity were 27%, 30%, and 21%, respectively. Within our sample of Medicare Advantage participants in Florida, patients with SMI/SUD/dementia were 1.42 times (p < 0.05) and 1.58 times (p < 0.01) more likely to report housing insecurity and food insecurity, respectively, when compared with those with mild/moderate behavioral health conditions.
Conclusion: Author Health provides a blueprint for behavioral health services that remove barriers and provide tenacious, consistent, and whole-person virtual-first behavioral health care tailored to the unique needs of older adults. Our sample of Medicare Advantage participants in Florida suggests SMI/SUD/dementia may be a predictor for HRSN independent of socioeconomic status and race/ethnicity.
Source: Chukrun T. Journal of the American Geriatrics Society, Dec 2024; Early View

Organizational factors associated with less use of restraints in older adults with dementia in acute care hospitals: A scoping review
Abstract:
Objective: Dementia affects more than 55 million people worldwide. Use of restraints for hospitalized older adults with dementia is a social issue that should be addressed systematically and should not depend on the characteristics of nurses. This study reviewed the literature on organizational factors associated with reducing use of restraints in older adults with dementia admitted to acute care hospitals.
Methods: A scoping review was performed. Three databases were searched for papers that met our eligibility criteria. Factors related to restraint reduction were extracted, and results were deduced. Through inductive analysis, subthemes were categorized according to similarities and differences, which were then integrated into broader themes.
Results: Sixteen studies were eligible for inclusion. The prevalence of restraints ranged from 5.1% to 80.0% depending on how the meaning of restraint was interpreted. The most common indications for restraints were history of falls and fall risk. Interdisciplinary screening for restraints was associated with reduced prevalence of restraints, with a 0.18-fold (confidence interval [CI]: 0.12–0.24) reduction through use of a restraint decision flowchart and a 0.76-fold (CI: 0.63–0.92) reduction through consultation with a psychiatrist. Interdisciplinary members included nurses, physicians, clinical psychologists, pharmacists, respiratory therapists, and therapists.
Conclusions: Research is needed to introduce and develop an interdisciplinary restraint decision-making system and to test its effectiveness. Important factors in implementing alternatives to restraints are the harmful effects of restraints, expertise in dementia, regular education on alternative methods, an inpatient environment that ensures patient safety, and the development of human resources.
Source: Makino M. Japan Journal of Nursing Science, Sep 2024; 21(4): e12620

Supportive Interventions Involving Family Carers of Patients with Delirium Superimposed on Dementia in Hospital: A Scoping Review
Abstract:
Background: People with dementia admitted to hospital are at risk of developing delirium. Patients with delirium superimposed on dementia (DSD) have higher mortality rates, longer hospital stays and further cognitive loss. The role of family is often recommended as a resource to inform and support how patients with dementia's needs are understood. This review focuses on ward-based interventions that enable family carers and health care professionals to work together to improve patient experience and outcomes.
Aim: To review evidence on ward-based approaches involving family (or their proxies) and staff working together to prevent and manage delirium for patients living with dementia.
Methods: We undertook a scoping review including all types of research. Six electronic databases were searched (CINAHL, MEDLINE (run twice), EMBASE, Cochrane, PsycINFO and PubMed). The search was limited to papers written in English and published from 2009 to 2019. The search was updated in 2023. Papers were independently read by two researchers. Findings were presented through narrative synthesis (Prospero CRD42019130369).
Results: Fifteen papers were included. Studies focused on educational and system change to improve the care of people with DSD. Family involvement ranged from enabling baseline assessment of delirium, commenting on different resources and measures designed to support their involvement in care or simulate their presence. The evidence of effectiveness was varied. Interventions to support personalised care and give family carers and staff confidence were positively evaluated in some studies but not all included both family carers and staff. Benefits to patients over time were less clearly demonstrated.
Conclusion: This review identified the potential of family to mitigate the risk of delirium and improve patient outcomes. Further research is needed to understand how system and practitioner changes to enable family involvement in the support of people with DSD benefit patients in the short and long term.
Relevance to Clinical Practice: The review findings provide evidence for clinical practice when selecting existing interventions and approaches involving family in supporting patients with DSD.
Patient or Public Contribution: Not required as this was a review, not an original piece of research.
Source: Ashton-Gough C. International Journal of Older People Nursing, Feb 2025; 20(2): e70016

Role of a Dementia Virtual Reality App in Developing Situated Empathy, Attitude and Person-Centred Care—A Qualitative Approach
Abstract:
Background: The demands of any health education programme including nurse education would benefit from innovative ways to support students learning in an effective and efficient manner. Such approaches resonate particularly when caring for older people living with dementia, due to multifactorial manifestations of the condition, patients' difficulty in articulating their needs and the potential for negative care outcomes. Empathy is an important part of understanding dementia and is also recognised as a complex and multidimensional concept.
Objective: This study investigated the impact of undergraduate nursing students' 15-min use of the Experience Dementia in Singapore (EDIS) virtual reality app in their tutorial lesson for developing their empathy, changing their attitude and increasing their sensitivity for person-centred care of people with dementia.
Method: We carried out content and thematic analysis of data anonymously collected via the in-class learning activities at the start and at the end of the lesson.
Results: All participating students (n = 89, 89% response rate) achieved their learning goal to experience a first-person perspective and gain insights into needs and care for persons living with dementia. The results showed students transitioned from having mainly knowledge foremost in their mind, to more empathetic and care related thoughts when delivering care to persons living with dementia. The experience made more students aware of how they could communicate care, make environmental modifications to support and develop an attitude of person-centred care for persons living with dementia and their families. The analysis resulted in four themes: (1) immersive learning—walking in the shoes of the person living with dementia (2) feelings evoked from the first-person perspective (3) little things, big impact; little things, positive impact; and (4) communicating care.
Conclusion: The EDIS virtual reality app was an efficient and effective way for students to develop essential elements, especially empathy, as well as positive attitudes and sensitivity towards person-centred care for those living with dementia.
Implications for Practice: The first-hand experience the VR app offers allows students to challenge pre-conceived perceptions about older people and those living with dementia. As such, it is a versatile tool that can be incorporated into a variety of study and training programmes for students, professionals and caregivers who provide care or care solutions for persons living with dementia and their families.
Source: Tan Chin P. International Journal of Older People Nursing, Feb 2025; 20(2): e70012

Cardiovascular health, measured using Life's Essential 8, is associated with reduced dementia risk among older men and women
Abstract:
Background: Dementia poses considerable challenges to healthy aging. Prevention and management of dementia are essential given the lack of effective treatments for this condition.
Methods: A secondary data analysis was conducted using data from 928 InCHIANTI study participants (55% female) aged 65 years and older without dementia at baseline. Cardiovascular health (CVH) was assessed by the “Life's Essential 8” (LE8) metric that included health behaviors (diet, physical activity, smoking status, sleep duration) and health factors (body mass index, blood lipid, blood glucose, blood pressure). This new LE8 metric scores from 0 to 100, with categorization including “low LE8” (0–49), indicating low CVH, “moderate LE8 (50-79)”, indicating moderate CVH, and “high LE8 (80-100)”, indicating high CVH. Dementia was ascertained by a combination of neuropsychological testing and clinical assessment at each follow-up visit. Cox proportional hazards models were used to examine associations between CVH at baseline and risk of incident dementia after a median follow-up of 14 years.
Results: Better CVH (moderate/high LE8 vs. low LE8) was inversely associated with the risk of incident dementia (hazard ratio [HR]: 0.61, 95% confidence interval [CI]: 0.46–0.83, p = 0.001). Compared with health factors, higher scores of the health behaviors (per 1 standard deviation [SD]), specifically weekly moderate-to-vigorous physical activity time (per 1 SD), were significantly associated with a lower risk of incident dementia (health behaviors: HR: 0.84, CI: 0.73–0.96, p = 0.01; physical activity: HR: 0.62, CI: 0.53–0.72, p < 0.001).
Conclusion: While longitudinal studies with repeated measures of CVH are needed to confirm these findings, improving CVH, measured by the LE8 metric, may be a promising dementia prevention strategy.
Source: Li X. Journal of the American Geriatrics Society, Sep 2024; 72(12): 3695-3704

The Experience of Hospitalisation for People Living With Dementia: A Qualitative Exploration of How Context Shapes Experiences
Abstract:
Introduction: Dementia has become an increasingly pressing issue in healthcare systems, and acute care settings such as hospitals have been shown to be particularly problematic for people living with dementia. People living with dementia are hospitalised at higher rates than those without and often have poor experiences and outcomes of hospitalisation. To support the evolution of hospital systems to better meet the needs of people living with dementia, it is important to consider the relationship between the context of the hospital and the experiences of people living with dementia and their caregivers. The term context refers to the environment and conditions that shape experiences and includes elements such as policies, procedures, design and social norms. A greater understanding of the relationship between the hospital context and the experiences of people living with dementia will support the future development of interventions to modify contextual elements to improve the experiences of people living with dementia. Our aim was to explore the relationship between the experiences of people living with dementia and their caregivers in hospital, and the contextual elements of the hospital.
Methods: In this interpretive descriptive study, we conducted interviews with people living with dementia and caregivers of people living with dementia about their experiences in hospital. Interviews were conducted with people living with dementia (n = 3), caregivers of people living with dementia (n = 8) and one dyad of a person living with dementia and their caregiver (n = 1) about the hospitalisation of the person living with dementia. Using inductive and deductive methods of analysis, we describe contextual factors that shape their experiences.
Results: Our findings demonstrate how the hospital context shaped the experiences of people living with dementia and their caregivers while the person living with dementia was hospitalised. The themes reflect elements of the hospital context: communication systems, the value of caregivers, the focus on acute physical needs, staff capacity, the physical environment and normalised practices. The findings suggest that there are aspects of the hospital context that can be modified to influence the experiences of people living with dementia and their caregivers.
Conclusion: This study demonstrates how the context of hospital shapes the experiences of people living with dementia and their caregivers and points to aspects of the context that health system leaders could explore to begin to improve the capacity of hospitals to support people living with dementia.
Implications for Practice: The study provides evidence of the need for health system leaders and practitioner to explore how the hospital context shapes the experiences of people with dementia and their caregivers, and begins to explore ways that contextual changes can improve their experiences.
Source: Moody E. International Journal of Older People Nursing, Sept 2024; 19(6): e12651

Navigating Dementia and Delirium: Balancing Identity and Interests in Advance Directives
Abstract: The moral authority of advance directives (ADs) in the context of persons living with dementia (PLWD) has sparked a multifaceted debate, encompassing concerns such as authenticity and the appropriate involvement of caregivers. Dresser critiques ADs based on Parfit's account of numeric personal identity, using the often-discussed case of a PLWD called Margo. She claims that dementia leads to a new manifestation of Margo emerging, which then contracts pneumonia. Dworkin proposes that critical interests, concerning one's higher moral values, trump experiential interests (things or activities one enjoys because they are pleasurable). Dresser argues that Margo's current experiential interests override her self's critical ones, as they contribute significantly to her quality of life (QoL). To render the argument more realistic, I introduce a variation in which Margo develops delirium, a common and severe comorbidity in PLWD. I argue that delirium could precipitate a sudden decline in experiential interests and, consequently, a deterioration in QoL. Given the uncertain trajectory of Margo's illness, I contend that her competent self's critical interests, as reflected in her AD, along with her right to self-ownership, should take precedence over current experiential interests. Thus, the AD possesses moral authority. However, it is imperative for healthcare professionals to offer consultations for PLWD, facilitating an understanding of ADs and enabling a shared decision-making process. Such consultations are essential for honouring the autonomy and dignity of PLWD, ensuring that their values and preferences guide ethical decision-making amidst the complexities of dementia care.
Source: Rutenkröger M. Nursing Philosophy, Jan 2025; 26(1): e70016

The Effects of Exergaming on the Depressive Symptoms of People with Dementia: A Systematic Review and Meta-Analysis
Abstract:
Background: Depressive symptoms are common among people with dementia (PWD). Exergaming consisting of combined cognitive and physical training in gaming is increasingly used to alleviate their depressive symptoms in research. With its potential synergistic neurobiological and psychosocial effects on reducing depressive symptoms among PWD, this review aimed to understand its effectiveness and contents.
Methods: This is a systematic review of the effectiveness of exergames on depressive symptoms among older adults with dementia. A search was conducted on 7 May 2024 of the online databases CINAHL, Embase, PsycINFO, PubMed and the China Academic Journal Network Publishing Database (CNKI). The methodological quality of randomised controlled trials (RCT) and quasi-experimental studies was assessed with RoB2 and ROBINS-I, respectively. A meta-analysis of the included RCTs was conducted.
Results: Six studies consisting of four RCTs and two quasi-experimental studies involving 235 participants with various stages of dementia were included. The meta-analysis showed a significant overall improvement in depression with a large effect size (SMD = 1.46, 95% CI = −2.50, −0.43; p = 0.006). Despite high heterogeneity (I2 = 91%), all studies demonstrated a trend of improvement in depression after the intervention. The exergames adopted in the included trials had the following elements: simultaneous motor-cognitive training, a scoring mechanism and a social play. The dose of exergames ranged from 15 to 60 min per session for at least 8 weeks, with a minimum of two sessions weekly. However, the included studies had a moderate-to-serious risk of bias. The certainty of the evidence was very low.
Conclusion: Exergames could be effective at improving the depressive symptoms of older adults with dementia. Yet, a moderate-to-severe risk of bias shows a rigorous study should be conducted in the future.
Implications for Patient Care: This study provides evidence for healthcare professionals and informal caregivers to use exergames to address depressive symptoms in PWD.
Review Registration: The review was registered on PROSPERO with the reference CRD42022372762.
Source: Cheung Daphne S K. Journal of Clinical Nursing, Jan 2025; Early View

A meta-analysis of person-centered care interventions for improving health outcomes in persons living with dementia
Abstract:
Background: Person-centered care emphasizes the importance of valuing and supporting the humanness of a person living with dementia as compared to focusing heavily on disease symptom management and treatment. The state of the evidence and outcomes from person-centered care is unclear and is an important knowledge gap to address informed evidence-based care for persons living with dementia.
Aims: To synthesize the evidence on the efficacy of person-centered care in improving health outcomes in people living with dementia.
Methods: Our search using the following databases: Academic Search Complete, CINAHL, COCHRANE library, EMBASE, MEDLINE, PubMed, and Google Scholar. The methodology quality of the included studies was assessed using a revised Cochrane risk-of-bias tool for randomized trials. Meta-analyses were performed using the DerSimonian and Laird random effects model to investigate the effectiveness of person-centered care on improving health outcomes in persons living with dementia.
Results: Seventeen trials were included in this systematic review and meta-analysis. Person-centered care implementation was found to improve cognitive function (pooled SMD: 0.22; 9CRD420223808975% CI [0.04, 0.41], p = .02) in persons living with dementia, although outcomes including the impact of the care model on activities of daily living, agitation, depression, and quality of life remain inconclusive.
Linking Evidence to Action: Person-centered care improves the cognitive function of persons living with dementia, which is clinically meaningful and should not be ignored or overlooked in delivering evidence-based care to this population. The findings of this study emphasize the importance of person-centered care implementation among people living with dementia as an approach in improving health outcomes particularly on cognitive function improvement. Person-centered care emphasizes the personhood of individuals living with dementia while respecting their needs, values, and beliefs and is identified as a preferred model of delivering dementia care in all settings as a non-pharmacological approach.
Source: Saragih Ita D. Worldviews on Evidence-Based Nursing, Sep 2024; 22(1): e12746

Towards Establishing Quality Standards on Human Rights for Services in Dementia Care
Abstract:
Background: People with dementia often experience violations of fundamental human rights and impeded access to healthcare. This study aims to investigate the views of experts regarding the use of the United Nations Convention on the Rights of People with Disabilities (CRPD) principles as quality standards for human rights–based care.
Methods: A single-round Delphi e-consultation with 15 dementia experts was designed to evaluate each CRPD principle and collect feedback on their views about the application of the CRPD principles in dementia care.
Results: The CRPD principles were fully endorsed as quality standards; however, several experts commented on the complexities of the use of CRPD principles in relation to information disclosure, capacity assessment, stakeholders' involvement in decision-making, respecting needs and preferences, holistic approaches in care practice, and protection against abuse, neglect and discrimination.
Conclusions: These findings indicate the CRPD quality standards were fully applicable for people with dementia although some clarification around interpretation could assist in their use. Future research should elaborate on further points of support and guidance for dementia care providing examples of good practice from across the globe, and develop a concordant, human rights–based scheme for the implementation and evaluation of dementia services.
Implications for Practice: This study suggests that the CRPD can serve as a benchmark for human rights-based practices in dementia services globally that could enhance nursing care practice. Nursing staff are encouraged to consider human rights in relation to the complexities associated with people with dementia, their caregivers, and other services involved in their care.
Source: Panagiotidou N. Sep 2024, International Journal of Older People Nursing; 19(5): e12643

Effectiveness of Horticultural Therapy in Older Patients with Dementia: A Meta-Analysis Systemic Review
Abstract:
Aim: Our study aims to assess the effectiveness of horticultural therapy in improving outcomes in older patients with dementia.
Design: A systematic review and meta-analysis.
Methods: The included studies comprised randomised controlled trials (RCTs) that aimed to assess the effectiveness of horticultural therapy on cognitive function in older patients with dementia. The study design and data extraction were independently conducted by two investigators, who also evaluated the risk of bias using RoB 2.0. The meta-analysis was carried out using Stata 15.1 software.
Data Sources: On November 2023, we searched relevant English and Chinese publications in PubMed, Web of Science, Cochrane Library, Embase, CNKI and Wanfang databases.
Results: The meta-analysis included a total of 9 RCTs, involving 655 older patients diagnosed with dementia. The findings from these studies demonstrated that horticultural therapy had a significant positive impact on various aspects of the patients' well-being when compared to conventional care. Specifically, it was found to improve cognitive function scores, alleviate symptoms of depression, enhance daily activities and enhance overall quality of life. When conducting a subgroup analysis, it was observed that horticultural therapy had a statistically significant effect on cognitive function in older patients with dementia when the intervention frequency was at least two times per week. Furthermore, interventions with a duration of less than 6 months were found to be more effective than those lasting 6 months or longer. Additionally, outdoor horticultural therapy was found to be superior to indoor interventions. Moreover, structured interventions were observed to yield better outcomes compared to non-structured interventions.
Conclusion: More high-quality studies are needed to further corroborate these findings due to the low quality of the included studies. Horticultural therapy has been found to have a significantly positive impact on the cognitive function, depression status, ADL, and quality of life of older patients with dementia.
Implications for the Profession and/or Patient Care: We provide references for non-pharmacologic treatment of older patients with dementia.
What Problem Did the Study Address? This study aimed to measure the efficacy of horticultural therapy in older patients with dementia across four dimensions: cognitive function, depression levels, daily living activities and overall quality of life.
What Were the Main Findings? In older patients with dementia, horticultural therapy has been proven to have a significant positive impact on cognitive function, depressive status, activities of daily living and quality of life.
Where and on Whom Will the Research Have an Impact? This study will inform non-pharmacological interventions for older patients with dementia worldwide.
Patient or Public Contribution: No Patient or Public Contribution.
Source: Wang M. Journal of Clinical Nursing, Sep 2024; 33(12): 4543-4553

Effect of Massage and Touch on Agitation in Dementia: A Meta-Analysis
Abstract:
Aims and Objectives: To systematically assess the effects of massage and touch on agitation in patients with dementia and to determine the optimal intervention design.
Background: Agitated behaviour is the most common behavioural symptom in patients with dementia and can seriously affect the health status and quality of life of individuals with dementia and their caregivers. Massage and touch have been widely used as a non-pharmacological intervention to address the behavioural issues of dementia. However, current research findings on the effects of massage and touch on agitation in people with dementia are inconsistent.
Design: A meta-analysis of randomised controlled trials.
Methods: This meta-analysis complied with PRISMA guidelines, and relevant literature up to January 2024 was systematically retrieved from PubMed, Embase, Web of Science, the Clinical Trials Registry, Cochrane Library and four Chinese databases. Statistical evaluations were performed utilising Review Manager 5.4, and the included studies' bias risks were assessed with the Cochrane Collaboration tool.
Results: Seventeen randomised controlled trials involving 980 patients with dementia were included. The results of the meta-analysis showed that massage and touch could ameliorate agitation and behaviour problems in dementia. Subgroup analyses based on massage type showed that hand, head and foot massage significantly improved agitation. Massage and touch for ≤ 4 weeks were more effective in reducing agitated behaviour than those for > 4 weeks. Furthermore, subgroup analysis revealed that massages and touch were more effective for individuals with less severe dementia.
Conclusions: Massage and touch in the short term can effectively improve agitation in dementia patients, while hand, head and foot massage can effectively reduce agitation. Thus, clinical nursing staff and caregivers of individuals should be actively helped to apply massage and touch to their patients. However, more studies are needed to validate our results before we can give a more definitive recommendation.
Relevance to Clinical Practice: This study suggests that massage and touch can be used as complementary treatments for agitation in people with dementia and encourages nursing staff and caregivers to apply massage and touch to better cope with the agitated behaviour of older adults with dementia.
Patient or Public Contribution: No patient or public contribution.
Trial Registration: PROSPERO registration number: CRD42024507133
Source: Lui X. Journal of Clinical Nursing, Feb 2025; Early View

Perspectives on the Dementia Public Health Exposome
Abstract: Dementia is a public health concern in the aging population with an estimated 55 million people impacted globally. Public health initiatives that focus on minimizing dementia risk factors may support efforts to reduce the incidence of dementia in at-risk populations. Exposomics considers both modifiable and non-modifiable risk factors for disease, including genetic changes with age and lifetime exposures to environmental, social, and behavioral risk factors. Dementia precursors may remain undetected for up to 20 years. An understanding and application of the dementia exposome may promote healthy brain interventions, screening, and risk mitigation. The proposed dementia public health exposome (DPHE) provides a framework for understanding and addressing the complex interactions between genetics, health behavior, and environment (natural, built, and social) linked to modifiable and non-modifiable risk factors for dementia. The DPHE may be used to inform public health strategies and advancements in healthy brain initiatives.
Source: Flaherty Christine N. Nursing and Health Policy Perspective, Oct 2024; 42(1): 215-220

Capacity assessment for euthanasia in dementia: A qualitative study of 60 Dutch cases
Abstract:
Background: The number of patients with dementia who are granted euthanasia or assisted suicide (EAS) increases yearly in the Netherlands. By law, patients need to be decisionally competent or have an advance directive. Assessment of decisional capacity is challenging as dementia progressively affects cognitive performance. We aimed to assess qualitatively which factors, and how, influence the judgment of decisional capacity in EAS cases with dementia.
Methods: We performed a qualitative study of 60 dementia EAS case summaries published by the Dutch regional euthanasia review committees between 2012 and 2021. Included reports were evaluated using the grounded theory approach. All quotes related to decisional capacity were coded independently by two researchers and compared in an iterative process to formulate an overarching framework on the assessment of decisional capacity. We selected 20 patients who had an advance directive and were judged to be decisionally compromised, as well as a selection of 40 EAS cases judged to be decisionally competent, half of which also had an advance directive (purposive sampling).
Results: Decisional capacity was present in every case report. Predefined, external criteria were rarely described explicitly, but physicians indirectly referred to the (cognitive) criteria set by Appelbaum and Grisso. Whether the thresholds for these dimensional criteria were met was influenced by six supporting factors (level of communication, psychiatric comorbidity, personality, presence of an advance directive, consistency of the request, and, finally, the patient–physician relationship) that also directly contributed to the judgment of capacity. The involved physicians and executed investigations were the two contextual factors providing a background.
Conclusions: Decisional capacity regarding euthanasia is a multidimensional construct, often implicitly assessed and influenced by supporting and contextual factors. The subjectivity of the final judgment poses ethical and legal issues and argues for continuous quality improvement processes.
Source: Van den Bosch A. Journal of the American Geriatrics Society, Oct 2024; 73(1): 112-122

Dexmedetomidine for agitation in dementia: Current data and future direction
Abstract:
Background: The incidence and prevalence of dementia, and thus dementia-related behavioral and psychological symptoms, are increasing significantly. Currently, there are limited safe and efficacious options for treating these symptoms. Dexmedetomidine has been used for agitation related to delirium and showed significant benefit in prior studies. This raises the question whether dexmedetomidine could also provide a safe and effective treatment for BPSD, including agitation related to dementia.
Methods: Our team searched PubMed, Cochrane Database, and Ovid with the terms dexmedetomidine and dementia. Only studies published in English language journals, or with official English language translations, and human studies were included. All reports of dexmedetomidine for dementia were included regardless of study type.
Results: No completed studies on dexmedetomidine for agitation in dementia were identified. The TRANQUILITY study is in progress, although results are yet to be published.
Conclusion: Dexmedetomidine has shown benefit for hospital delirium and for agitation in schizophrenia and bipolar disorder. However, there are no completed studies published on dexmedetomidine for agitation in dementia. Controlled studies with larger sample sizes are needed to assess the efficacy, safety, and the best route of administration for this drug in managing BPSD including agitation.
Source: Murphy Kayla S. Journal of the American Geriatrics Society, Sep 2024; 73(2): 552-557

Neuropsychiatric presentations of common dementia syndromes: A concise review for primary care team members
Abstract: Dementia is a syndrome characterized by cognitive changes which interfere with daily functioning. Neuropsychiatric symptoms (NPS) are also pervasive and may even occur prior to any noticeable cognitive decline. Still, NPS are less associated with the early stages of the disease course, despite mounting research evidence that NPS present early and often in several dementia syndromes, even in the absence of cognitive decline (i.e., mild behavioral impairment [MBI]). Primary care teams are at the forefront of dementia care, yet they frequently report insufficient training in dementia diagnosis and management. This poses a serious problem considering that timely diagnosis of dementia is critical for optimal outcomes and maximum efficacy of intervention. We provide a concise narrative review of four dementia syndromes (Alzheimer's disease, vascular dementia, dementia with Lewy bodies, and behavioral variant frontotemporal dementia) and their associated neuropsychiatric presentations, as well as at-a-glance clinical guides, to help primary care team members recognize possible prodromal neurodegenerative disease and to prompt further workup. We also review next steps in the management of dementia and symptoms of MBI for primary care team members. As evidenced by the NPS profiles of these dementia syndromes, subacute new onset of psychiatric symptoms in an older adult should prompt consideration of an emerging dementia process and possible further workup of such, even in the absence of cognitive decline.
Source: Bell Z. Journal of the American Geriatrics Society, Oct 2024; 73(2): 349-357

Tissue Viability: December 2024

Welcome to the latest key papers and publications from the past few months focussing mainly on tissue viability in the nursing profession.

Please click on the links below and enter your OpenAthens username and password to download the full text or contact the library at esth.hirsonlibrary@nhs.net to request the full text.

Pressure ulcers: a clinical audit to determine compliance against the aSSKINg framework in an adult community nursing setting
Abstract: Assessment of pressure ulcer (PU) risk remains a challenge in clinical practice. The first part of this article (Martin and Holloway, 2024) discussed the evidence base underpinning the development of clinical guidelines for PUs alongside the creation of the bundle approach regarding PU prevention. This article, part two, presents the results of a clinical audit that explores compliance against a PU prevention bundle (the aSSKINg framework) in an adult community nursing setting in the south-east of England. The clinical audit was conducted between July-December 2021 and included records of 150 patients. Overall, compliance against the aSSKINg framework was poor, with only two criterion being met: equipment provision for chair and referral to the tissue viability team. Short-term recommendations are that mandatory PU training for staff in the management of PUs should be implemented, and the tissue viability nurse network should be increased. The long-term recommendation was the introduction of the aSSKINg framework as a template into the electronic patient record.
Source: Martin S. British Journal of Community Nursing, Sep 2024; 29(Sup9): S28 – S34

Nurses' views on changes to pressure ulcer categorisation: results of a Wound Care Alliance UK survey
Abstract: The Wound Care Association UK (WCAUK) is committed to supporting both the accurate and consistent delivery and reporting of pressure ulcers/injuries based on the best available research and evidence. It is known that strategic and clinical guidance to support the delivery of evidence-based care does have a significant impact. Recent proposals to change pressure ulcer categorisation led the WCAUK to undertake a questionnaire survey of its members. This article outlines the importance of evidence-based guidance on the categorisation and assessment of pressure ulcer, highlighted by the responses to published changes to pressure ulcer categorisation for nurses in England, and presents the results of the survey. The article concludes that, although the discipline of tissue viability is constantly developing, the changes must be based on evidence, and clinicians must be supported strategically and practically to implement any proposed changes. Since publication of the new guidance the document has become the subject of further discussion, following concerns raised by tissue viability nurse specialists with strategic responsibility for change, as well as generalists who are expected to implement the changes.
Source: Stephen-Haynes J. British Journal of Nursing, Nov 2024; 33(20): S16 - S22

The past, the present and the future
Abstract: Somebody asked me recently how I decide what to write about in the Editorial for BJN's Tissue Viability Supplement. I took a moment to think and gave the briefest of answers. When I reflected on it and really took the time, challenging myself, I concluded that it was a cumulative process of my experience of the past, the present and the future.
Source: Stephen-Haynes J. British Journal of Nursing, Nov 2024; 33(20): S3 - S3

The complex interplay between mechanical forces, tissue response and individual susceptibility to pressure ulcers
Abstract: Objective: The most recent edition of the International Clinical Practice Guideline for the Prevention and Treatment of Pressure Ulcers/Injuries was released in 2019. Shortly after, in 2020, the first edition of the SECURE Prevention expert panel report, focusing on device-related pressure ulcers/injuries, was published as a special issue in the Journal of Wound Care. A second edition followed in 2022. This article presents a comprehensive summary of the current understanding of the causes of pressure ulcers/injuries (PU/Is) as detailed in these globally recognised consensus documents.

Method: The literature reviewed in this summary specifically addresses the impact of prolonged soft tissue deformations on the viability of cells and tissues in the context of PU/Is related to bodyweight or medical devices.

Results: Prolonged soft tissue deformations initially result in cell death and tissue damage on a microscopic scale, potentially leading to development of clinical PU/Is over time. That is, localised high tissue deformations or mechanical stress concentrations can cause microscopic damage within minutes, but it may take several hours of continued mechanical loading for this initial cell and tissue damage to become visible and clinically noticeable. Superficial tissue damage primarily stems from excessive shear loading on fragile or vulnerable skin. In contrast, deeper PU/Is, known as deep tissue injuries, typically arise from stress concentrations in soft tissues at body regions over sharp or curved bony prominences, or under stiff medical devices in prolonged contact with the skin.

Conclusion: This review promotes deeper understanding of the pathophysiology of PU/Is, indicating that their primary prevention should focus on alleviating the exposure of cells and tissues to stress concentrations. This goal can be achieved either by reducing the intensity of stress concentrations in soft tissues, or by decreasing the exposure time of soft tissues to such stress concentrations.
Source: Gefen A. Journal of Wound Care, Sep 2024; 33(9): 620 - 628

Challenges ahead
Abstract: Happy New Year! This is an election year: I wonder what it will bring? The world of tissue viability faces many challenges and questions. Finances will remain a big challenge, whatever the outcome of the election.
Source: Stephen-Haynes J. British Journal of Nursing, Feb 2024; 33(4): S3 - S3

Key issues in an election year
Abstract: A General Election is an opportunity. So important is the government to the delivery of the NHS that, as a nurse, the coverage will be compelling viewing and listening for me. The productivity of the NHS is under scrutiny and there can be no doubt that there is a need to deliver better outcomes for the people of the UK.
One important issue is the lack of a clear strategy on social care, which has led to a crisis that has impacted the NHS. This needs to be a priority. Another issue is patients waiting on trolleys. In 2023, 35 000 patients waited for 12 hours on hospital trolleys every month in England (Lee, 2024). Working in tissue viability, my concern, apart from people waiting in discomfort or pain, is that this poses a significant challenge to pressure ulcer prevention.
Source: Stephen-Haynes J. British Journal of Nursing, Jun 2024; 33(12): S3 - S3

At a glance: pressure injuries
Abstract: Pressure injuries, also known as pressure ulcers or ‘bed sores’, are caused by prolonged pressure on the skin and underlying tissues and are common in healthcare settings. They result from a variety of factors including pressure, moisture and friction, with a higher risk among older adults, post‑surgical patients and those with limited mobility or long‑term conditions. These injuries can extend hospital stays and significantly impact patient recovery and mortality risk. Prevention includes regular repositioning, the use of pressure‑relieving devices, skin care and nutritional support. The National Institute for Health and Care Excellence provides guidelines to mitigate these risks through systematic risk assessments and targeted interventions. Early detection and specialist care by a multidisciplinary team are crucial to improving patient outcomes. Consistent pplication of prevention strategies are needed to reduce incidence, improve patient care and alleviate the economic burden of thesex injuries on the NHS.
Source: Williams L. British Journal of Nursing, Nov 2024; 33(20): S24 - S30

Integration of the aSSKINg framework into the electronic patient record: a quality improvement project
Abstract: Assessment of pressure ulcer (PU) risk is important in clinical practice and the need to document it in the patient's record is paramount. Despite national and international guidelines highlighting the need to document PU risk, nursing documentation remains variable. The first article in this series discussed the evidence base underpinning the development of clinical guidelines for PUs, alongside the creation of bundle approach for PU prevention. The second article presented the results of a clinical audit exploring compliance against a PU prevention bundle (aSSKINg framework) in an adult community nursing setting in the South East of England. This final article in the series presents the results of a quality improvement project that involved a clinical audit following the implementation of the aSSKINg framework into the electronic patient record (EPR). The aim was to improve nursing documentation for patients with PU risk. The clinical audit was conducted in two parts, with a pilot phase running between 6 February 2023 and 15 April 2023. After the template implementation into the EPR, a follow-up audit was undertaken between 1 November 2023 and 31 January 2024. Overall compliance against the aSSKINg framework improved, especially the completion of the PURPOSE-T on the first visit, full skin assessment and repositioning advice. Following the pilot phase, the aSSKINg template was rolled out in a phased approach to the adult community nursing, enhanced care home matrons and urgent community response teams.
Source: Martin S. British Journal of Community Nursing, Dec 2024; 29(Sup12): S16 - S21

Using a prognostic medical device for early identification of pressure ulcers: protocol for study design
Abstract: Background: An objective, physiological measurement taken using a medical device may reduce the incidence of pressure ulcers through earlier detection of problems signs before visual signs appear. Research in this field is hampered by variations in clinical practice and patient-level confounders.

Aim: The authors outline key considerations for designing a protocol for a study to assess the efficacy and safety of a prognostic medical device in reducing pressure ulcer incidence in a hospital, including comparators, randomisation, sample size, ethics and practical issues.

Method: Key issues relating to methodology and ethics are considered alongside a theoretical protocol, which could support future researchers in wound care trials.
Source: Keltie K. British Journal of Nursing, Jun 2024; 33(12): S8 - S18

Tissue viability and care of malignant wounds in patients near the end of life
Abstract: Skin changes at the end of life are common and can be attributed to a variety of factors. These changes can impact the appearance, texture and overall health of the skin, and can affect the person's comfort and overall wellbeing. It is important for health professionals to address these skin issues by providing appropriate skin care, pain management and emotional support. This article, the third in a series on palliative and end-of-life care, discusses risk assessment and monitoring of pressure ulcers, caring for malignant wounds and the importance of individualised care in a multiprofessional team.
Source: Russell J. Nursing Times, Jul 2024; 120(8): 44-47

Q&A approach to lower limb and leg ulcer management
Abstract: Here, Georgina Ritchie, director of education, Accelerate CIC, explains why she and colleagues decided to write a book on lower limb and leg ulcer management using a Q&A approach in order to tease out and explore the most relevant themes in this area of practice. [...]along with the important chapters on clinical assessment and management, we bring critique and synthesis to public health and the social determinants of health and how they affect patients with lower limb conditions. Interventions aimed at early management of CVI include a spectrum of approaches, including recommendations for lifestyle changes such as weight loss, increased physical activity, promoting good skin care and hygiene, and compression therapy. Early identification and referral to an appropriate specialist team for a patient suspected of having an atypical leg ulcer is essential and can assist in preventing unnecessary wound deterioration, managing the symptoms effectively, decreasing the risk of complications and improving quality of life for the individual.
Source: Anonymous. Journal of Community Nursing, 2024; 38(3): 63-66
Contact the library for a copy of this article

Frailty and the ageing skin: understanding skin tears
Abstract: The impact of ageing on the body and its association with skin harm and frailty in relation to multimorbidity, comorbidity and polypharmacy is clearly described in the literature. The ageing population globally brings with it the challenge for healthcare professionals of managing individuals with increasingly complex and inter-related needs. This article considers ageing skin and skin tears within the context of frailty as a syndrome. It discusses what frailty is understood to be, how to recognise and assess for it, and how to consider risk and prevention of harm to the skin of the ageing person with frailty.
Source: Sandoz H. Journal of Communty Nursing, Oct 2024; 38(5): 20-22, 24-26
Contact the library for a copy of this article

Content of a wound care mobile application for newly graduated nurses: an e-Delphi study
Abstract: Background: Wound care represents a considerable challenge, especially for newly graduated nurses. The development of a mobile application is envisioned to improve knowledge transfer and facilitate evidence-based practice. The aim of this study was to establish expert consensus on the initial content of the algorithm for a wound care mobile application for newly graduated nurses.

Methods: Experts participated in online surveys conducted in three rounds. Twenty-nine expert wound care nurses participated in the first round, and 25 participated in the two subsequent rounds. The first round, which was qualitative, included a mandatory open-ended question solicitating suggestions for items to be included in the mobile application. The responses underwent content analysis. The subsequent two rounds were quantitative, with experts being asked to rate their level of agreement on a 5-point Likert scale. These rounds were carried out iteratively, allowing experts to review their responses and see anonymized results from the previous round. We calculated the weighted kappa to determine the individual stability of responses within-subjects between the quantitative rounds. A consensus threshold of 80% was predetermined.

Results: In total, 80 items were divided into 6 categories based on the results of the first round. Of these, 75 (93.75%) achieved consensus during the two subsequent rounds. Notably, 5 items (6.25%) did not reach consensus. The items with the highest consensus related to the signs and symptoms of infection, pressure ulcers, and the essential elements for healing. Conversely, items such as toe pressure measurement, wounds around drains, and frostbite failed to achieve consensus.

Conclusions: The results of this study will inform the development of the initial content of the algorithm for a wound care mobile application. Expert participation and their insights on infection-related matters have the potential to support evidence-based wound care practice. Ongoing debates surround items without consensus. Finally, this study establishes expert wound care nurses’ perspectives on the competencies anticipated from newly graduated nurses.
Source: Gagnon J. BMC Nursing, May 2024; 23: 331

Managing hypergranulation in wounds
Abstract: Normal wound healing follows four distinct phases: haemostasis, inflammation, proliferation and finally, maturation. If any barriers to healing occur within these four phases, the healing process will be delayed or may even stall (Mitchell, 2021). One of the common barriers to healing is hyper or overgranulation, or 'proud flesh'. Hypergranulated wounds can cause concern to both patients and healthcare professionals, and, although common in wound care, there is a limited evidence base and currently no guidelines for management. This article discusses the causes of hypergranulation, with suggestions on how it can be managed.
Source: Brown A. Journal of Community Nursing, Feb 2024; 38(1): 24-27
Contact the library for a copy of this article

Effectiveness of interventions to enhance shared decision‐making in wound care: A systematic review
Abstract: Aims: To explore the effectiveness of interventions to enhance patient participation in shared decision‐making in wound care and tissue viability.

Background: Caring for people living with a wound is complex due to interaction between wound healing, symptoms, psychological wellbeing and treatment effectiveness. To respond to this complexity, there has been recent emphasis on the importance of delivering patient centred wound care and shared decision‐making to personalise health care. However, little is known about the effectiveness of existing interventions to support shared decision‐making in wound care.

Design: Systematic review of interventional studies to enhance shared decision‐making in wound care or tissue viability. This was reported following the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines 2020.

Methods: Interventional primary research studies published in English up to January 2023 were included. Screening, data extraction and quality appraisal were undertaken independently by two authors.

Data Sources: Medline, EMBASE, Cochrane Central Register of Controlled Trails (trials database), CINAHL, British Nursing Index (BNI), WorldCat (thesis database), Scopus and registries of ongoing studies (ISRCTN registry and clinicaltrials.gov).

Results: 1063 abstracts were screened, and eight full‐text studies included. Findings indicate, interventions to support shared decision‐making are positively received. Goal or need setting components may assist knowledge transfer between patient and clinician, and could lower short term decisional conflict. However, generally findings within this study had very low certainty due to the inconsistencies in outcomes reported, and the variation and complexity of single and multiple interventions used.

Conclusions: Future research on shared decision‐making interventions in wound care should include the involvement of stakeholders and programme theory to underpin the interventions developed to consider the complexity of interventions.

Implications for the profession and patient care: Patients setting out their needs or goals and exploring patient questions are important and should be considered in clinical care.
Source: Clemett V J. Journal of Clinical Nursing, Apr 2024; 33(8): 2813-2828

Effectiveness of specialised support surface modes in preventing pressure injuries in intensive care: A systematic review and meta-analysis
Abstract: Background: Patients in intensive care units (ICU) are at an increased risk of pressure injuries. In ICUs, specialised support surfaces are an intervention often used to prevent pressure injuries. This systematic review and meta-analysis aimed to ascertain the effectiveness of different specialised support surface modes for preventing pressure injuries to adult ICU patients.

Methods: Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, PEDro, Cochrane Library, Clinicaltrials.gov and eligible paper references were searched for appropriate studies. Studies were included if they investigated both dynamic support surface modes low-air-loss (LAL) and alternating pressure (AP), involved adult ICU patients (≥18 years old), and investigated pressure injury incidence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Mixed Methods Appraisal Tool (MMAT) checklists were used for reporting and quality assessment. Risk ratios (RRs) with 95 % Confidence Intervals (CIs) were used to summarise pressure injury incidence. The pooled RR was calculated with the random-effects model using the Mantel-Haenszel method. Further secondary analysis examined length of stay (LoS) and severity of illness.

Results: The four included studies involved 3,308 patients. These studies were heterogeneous in design. When AP surface mode was compared with LAL surface mode, there was no significant difference in the occurrence of pressure injury (8.9 % versus 10.9 %, RR 0.64). Mattress mode also had no direct association with length of stay and severity of illness.

Conclusion: This systematic review and meta-analysis found no significant difference in the effectiveness of LAL and AP support surface modes in preventing pressure injuries in adult ICU patients.

Implications for clinical practice: Clinicians should remember that mattresses are just one element within strategies to prevent pressure injuries in ICUs. The equivocal findings of this systematic review highlight the complexity of preventing pressure injuries and underscore the importance of holistic nursing care.
Source: Lane B. Intensive and Critical Care Nursing, Aug 2024; 83: 103713
Contact the library for a copy of this article

Research topics on pressure injury prevention and measurement tools from 1997 to 2023: A bibliometric analysis using VOSviewer
Abstract: Objectives: To identify and visualize studies on pressure injuries in intensive care units, prevention of pressure injuries and measurement tools, and reveal the global trends in this field.

Research methodology/design: Descriptive and bibliometric analysis method study.

Setting: Data were obtained from the “Web of Science Core Collection” database on July 12th, 2023. For bibliometric data, the Web of Science database was searched with the keywords “intensive care unit,“ ”pressure injury,“ ”prevention,“ ”risk assessment tools,“ and critical care.” Performance analysis, scientific mapping, and bibliometric analyses were completed using the VOSviewer (1.6.15) software program for a total of 326 publications.

Main outcome measures: Publication, cluster, link and network map on pressure injury, prevention and risk measurement tools.

Results: As a result of the analysis, the most used keywords were “pressure injury,” “pressure ulcer,” “critical care,” “pressure ulcers,” “intensive care unit,” and “pressure injuries.” The journal with the highest number of publications (n = 55) was “Journal of Wound Ostomy Continence Nursing”, the highest number of articles (n = 47) was published in 2022, the most active institution was “Queensland University of Technology Qut” (20 articles), the country that published the most was the United States of America (171 articles), the institution that provided the most funding was the “National Institutes of Health NIH USA” (20 articles), and Cox J. was the author who published the most articles.

Conclusion: This study highlights popular fields of research in pressure injury prevention and risk measurement tools aimed at improving quality of care in intensive care units.

Implications for Clinical Practice: The bibliometric analysis method used in the study can lead nurses to conduct research to prevent pressure injuries in critical care patients and develop risk measurement tools to overcome deficiencies such as prevention tools and objective risk measurement tools in this field.
Source: Azizoğlu F. Intensive & Critical Care Nursing, Feb 2024; 80: 103557

Introducing playing games and a fun element to help deliver wound care education
Abstract: According to Tamara Chilver, author and home-schooling mum: "fun + learning = the best educational experience." This article describes how the tissue viability team in Glasgow set about introducing a fun element into wound care education. The article also includes practical guidance on some of the games played by delegates at the education sessions.
Source: Hodgson H. Wounds UK, 2024; 20(4): 72-75
Contact the library for a copy of this article

Integrated lymphoedema and tissue viability service: improving patient and wound outcomes
Abstract: This article will focus on the integration of tissue viability and lymphoedema services to improve outcomes for patients with leg ulceration. It will highlight why there is a need for lymphoedema specialist knowledge within the care of patients with leg ulceration and how the services are closely aligned. Lymphoedema can adversely affect wound healing and the article will provide case studies that highlight how developing a hybrid tissue viability and lymphoedema clinician or integration of the specialists can provide effective patient-centred care at reduced cost. The article offers potential strategies and suggestions on how to address inequalities in care and how to improve service provision.
Source: Stanton J. British Journal of Community Nursing, Apr 2024; 29(Sup4); S19-S26

The utilisation of a negative pressure wound therapy clinical decision tree in an acute care setting tissue viability service
Abstract: The aim of this case series and service evaluation was to demonstrate the beneficial clinical and economic outcomes of the utilisation of a negative pressure wound therapy (NPWT) clinical decision tree within routine practice. A total of 16 retrospective anonymised complex wound case studies were referred to the tissue viability nursing (TVN) service. Patients received NPWT as inpatients, as per routine practice. Data was reported as an aggregated cohort, with further stratification by wound type. Descriptive statistics were utilised. The most prevalent wound type was dehisced surgical wounds (n=10; 62.5%) located on the abdomen (n=9; 56.25%). Risk of contamination (43.75%) and exudate management (43.75%) were the most common rationales for choosing traditional NPWT (tNPWT). Seven patients (43.75%) were discharged from hospital still requiring NPWT, with five (71.4%) having wound criteria suitable for single use NPWT (sNPWT). Using tNPWT and sNPWT alongside a clinical decision tree can assist in optimising NPWT delivery to patients within an acute care setting.
Source: Leek K. Journal of Wound Management, Apr 2024; 25(1): 2-9

Oxygen Saturation or Tissue Oxygen Determinations on Skin Whose Viability is at Risk
Abstract: The triad of ischaemia, neuropathy, and infection are among the principal causes of lower extremity wounds that are commonly prevalent in patients with diabetic foot (DF) a condition in which peripheral arterial disease commonly co-exists. The prevalence of this condition is increasing globally and with it, the mounting costs of its management. One aspect of management is saving limbs and or digits, a crucial part of this process is assessing tissue viability of skin which is a focus of this review: there are other aspects which are well described in the literature. Amputations are offered to limit the damage resulting from acute/chronic ischaemia. Holstein measured skin perfusion pressure using a radioisotope clearance technique to describe critically ischaemic skin; he found 30 mm Hg as the threshold above which healing may reliably be expected. Recent advances in vascular surgery and related technology have informed evidence-based advice to revascularize and save limbs; in practice, this may leave a wound in the distal skin unhealed; managing these raises questions of tissue viability. Much effort has been made to manage, prevent and to better understand these lower extremity wounds using measurements of tissue oxygen, oxygen saturation and skin imaging. The measurement techniques and their relevant merits are examined in this article. Advances in wound management systems and protocols can also facilitate the repair processes, and those which can have a particular impact on restoring or maintaining tissue perfusion are also discussed in the article.
Source: Richardson M. International journal of Lower Extremity Wounds, 2024; Mar 23(1): 55-62
Contact the library for a copy of this article

Sharing the journey ... of setting up a Tissue Viability Service in NHS Tayside: the first year
Abstract: Last year’s Wounds Scotland conference saw a number of healthcare professionals share their journey of implementing changes to the way we deliver healthcare. Here, Jane Nicoll describes setting a new tissue viability service.
Source: Nicoll J. Wounds UK, Feb 2024; 20(1): 25-26