Assessment of Pain in adults with cognitive impairment : a review of the tools

The aim of this paper is to discuss the results of a review into the literature related to chronic pain and the older adult. Several themes within the review have been identified and reported elsewhere and the final report has been published by the University of Sheffield in the form of an annotated bibliography. This report focuses upon the findings of the in relation to the assessment of pain in the adult with cognitive impairment. Issues surrounding assessment in the non-cognitively impaired older adult have also been reported elsewhere. For this paper nine studies will be discussed which report the development and testing of pain assessment scales the focus of which is upon behavioural indicators of pain. Some scales have been omitted from the review and the rationale for this decision will be discussed. Each of the selected scales will be discussed and the authors will make recommendations for both clinical practice and for future research based upon the validity, reliability and user friendliness of the scales. From the paper it can be concluded that the Abbey, DOLOPLUS-2 and PACSLAC appear to be the most reliable and valid and in terms of the “user friendliness” would be appropriate to explore further. Recommendations are made for further multi-centre evaluation of these scales.University of Sheffiel

Assessment of pain in older people : where are we now and what needs to be done?

The purpose of this paper is to present the findings of a review of the literature into pain and older people. The funded study was part of the development of an annotated bibliography published in August 2005. The review included all major databases and involved the collection of 214 papers between the dates of 1995 and 2005. The papers were divided into several major themes, which include experiences, management (pharmacological and non-pharmacological), assessment, and attitudes. Within this paper, the results of the review into pain assessment will be discussed, which includes 42 of the collected papers. The other sections will be published later. The paper will discuss issues pertaining to the development of specific tools for older people, a discussion of tools already available, comparisons of staff versus older people’s perceptions of pain scales, and articles with cognitive impairment as a focus. Recommendations for further study are made.University of Sheffiel

Black, Red, and Gold

My thesis takes the form of a creative historical/contemporary novel that gives a new perspective on a time often thought of simply as “Nazi Germany,” as well as the culture of Germany in a more modern setting. There are two plotlines that run throughout this work. The first plotline follows Sydney Baumann, a seventeen year old girl from Pendleton, Oregon, and her struggles with culture shock, the struggles of learning a new language, and the changes she makes as a person. The second plotline focuses on the character Audrey Baumann, between the years of 1938 and 1941, as she attempts to escape the NSDAP governed Germany at the start of World War II

Nursing care for people with delirium superimposed on dementia

Nursing and healthcare is changing in response to an ageing population. There is a renewed need for holistic nursing to provide clinically competent, appropriate and timely care for patients who may present with inextricably linked mental and physical health requirements. This article explores the dichotomy in healthcare provision for ‘physical’ and ‘mental’ health, and the unique role nurses have when caring for people with delirium superimposed on dementia (DSD). Delirium is prevalent in older people and recognised as ‘acute brain failure’. As an acute change in cognition, it presents a unique challenge when occurring in a person with dementia and poses a significant risk of mortality. In this article, dementia is contrasted with delirium and subtypes of delirium presentation are discussed. Nurses can recognise DSD through history gathering, implementation of appropriate care and effective communication with families and the multidisciplinary team. A simple mnemonic called PINCH ME (Pain, INfection, Constipation, deHydration, Medication, Environment) can help identify potential underlying causes of DSD and considerations for care planning. The mnemonic can easily be adapted to different clinical settings and a fictitious scenario is presented to show its application in practice

Diet behaviour among young people in transition to adulthood (18–25 year olds) : a mixed method study

Peer reviewedPublisher PD

Activity and Culture: The Contribution to Health and Well-being in Later Life

A nurse-led multi-agency team worked with older people to develop a model of activity and culture, and evaluate its impact to health and well-being. Underpinned by a needs analysis, the project sought to identify the range of activities that older people used to engage in, currently undertake and what they aspire to engage with both inside their home and in the community. Initial findings revealed that lack of confidence, restricted opportunities and physical barriers such as transport, limited tenants' involvement with physical, social and cultural activities that could improve their health and wellbeing. The project has therefore aimed to develop a more diverse and accessible programme of activities that better reflects individual and collective needs. Following early positive evaluations, the project team are now considering how the centre could be accessed by, and benefit, a wider group of community dwelling older people and would hope to collaborate with other groups to explore how this model can be developed for use with a wider range of older people

Looking back and moving forward : a biographical approach to ageing.

In contrast to much gerontological research, which provides only a glimpse of the lived experiences of later life, this study investigated the views, practices and circumstances of older people using a biographical approach. Men and women presented a variety of meanings concerning later life and their stories both reflected and resisted some of the commonly held and socially constructed views about later life. All said that they did not feel old, although participants described times in their lives when they did feel old: when they were ill, made redundant or bereaved. Growing older was linked to illness, decline and burden even when this contradicted, as it often did, participants' substantive experiences. Although there are problems and challenges that accompany later life, they are not necessarily overwhelming. Later life was generally portrayed as an active period, in which participants continued to live their lives in an engaged way; helping others, striving for independence, celebrating older age and enjoying its freedoms. People's attitudes and experiences of later life were seen also to be a reflection of their lifetime roles, for example, whether or not they had been active in helping others or had socialised with others in the past. Capabilities and needs were not fixed but changed, according to individual experiences and attitudes, as well as requirements in the face of ill health or financial problems; needs which varied at different times and at different points of the life course. It is argued that the views and experiences of older people should be used as a basis for shaping theory, practice and research