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

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

Trabecular Bone Structure and Cellular Morphology in the Primate Craniofacial Skeleton

The primate craniofacial skeleton is complex and highly variable across species. Assessing the variation of gross bone morphometry and orientation and cell microstructure in the low strain browridge and the high strain zygoma between species can aid in our understanding of craniofacial adaptation and evolution. In this study, μCT was used to characterize the trabecular bone morphology and primary trabecular orientation in the browridge of 8 humans, 5 Pan, 7 Cebus, 4 Papio, and 1 Gorilla and the zygoma of 10 humans and 5 Pan. Orientation of trabeculae in each region were compared to primary strain orientations in browridge and zygoma trabecular regions of 4 Pan finite element cranial models. Three dimensional images of the osteocytic network within high strain (anterior zygomatic root) and low strain (supraorbit) cortical regions of human and chimpanzee bone study were created using FITC staining and confocal microscopy. Quantification of osteonal osteocyte cell body shape and was carried out using Imaris Software. It was hypothesized that trabecular orientation and morphometry would be reflective of strain patters observed in Pan finite element models during premolar and molar biting. The results found that trabecular bone in the supraorbital browridge does not lie along primary strain orientations, but instead is composed of dense, sagittally oriented plates, that may serve to protect the eyes and brain from facial assaults. Trabecular bone morphometry in the body of the zygoma was orthotropic and primarily oriented in a medio-lateral direction, demonstrating a more predictable pattern of trabecular bone morphometry, anisotropy, and orientation. It was predicted that osteocytes in the supraorbital regions of both species will be significantly more oblate, spherically shaped, and smaller with shorter, thicker dendritic processes relative to osteocytes in the zygoma. Imaris analysis of osteocyte shape in the anterior root of the zygoma and the supraorbit found that human osteocytes in the supraorbit are significantly less oblate and spherical than those in the robust Pan supraorbital region and osteocytes in the Pan supraorbit are significantly more oblate than osteocytes in the Pan zygoma. In addition to offering a mechanistic explanation for systemic differences between humans and Pan, these results provide a mechanism of bone adaption that is consistent with studies that show that the low strained supraorbital region demonstrates greater sensitivity to changes in orofacial function

The mental health nurse experience of providing care for people with delirium superimposed on dementia: influences in an activity system

Background: People with severe dementia are frequently cared for by registered mental health nurses due to their often complex cognitive or psychological care needs. This may present challenges in practice due to the inter relatedness of physical and mental health that accompanies dementia, not least the presentation of delirium superimposed on dementia (DSD). This study aimed to explore and describe the experiences of mental health nurses who provide care for people with DSD. This will support better understanding of what influences or impacts their work. Methodology and Methods: Using Activity Theory to guide the study throughout, a mixed methods exploratory sequential design was constructed. Semi structured interviews were undertaken to collect qualitative data, before a quantitative exploration through questionnaire development and completion. Data analysis was undertaken utilising framework analysis in the qualitative phase, and descriptive statistics in the quantitative phase. Integration of data was undertaken, and findings presented in an activity system graphic. Participants were registered mental health nurses working in 24-hour care settings for people with dementia. Findings: Five key themes emerged from the data: 1. For RNMHs to use tools (such as scores or guidelines), they need to see them as useful and contextually relevant. Whilst they are aware of tools, they may choose not to use them if they do not see the value in them. 2. Knowing the person for whom they provide care is central and personal. The RNMHs favour aesthetic ways of knowing and use this to guide their care provision. 3. Hierarchy within the multidisciplinary team remains, however this is not seen as a negative. The RNMHs feel supported and secure within their wider MDT. 4. Burdens of care felt by the RNMHs is driven by the care environment and care context. 6. There remains a disconnection of mental and physical health in both care environments and how the RNMHs see their role

Climate Scenario analysis for pension schemes:a UK case study

This paper demonstrates how climate scenario analysis can be used for forward-looking assessment of the risks and opportunities for financial institutions, using a case study for a UK defined benefit pension scheme. It uses a top-down modelling tool developed by Ortec Finance in partnership with Cambridge Econometrics to explore the possible impacts of three plausible (not extreme) climate pathways of the scheme’s assets and liabilities. It finds that the funding risks are greater under all three climate pathways than under the climate-uninformed base scenario. In the absence of changes to the investment strategy or recovery plan, the time taken to reach full funding is increased by three to nine years. Given that most models currently used by actuaries do not make explicit adjustments for climate change, these modelled results suggest it is quite likely that pension schemes are systematically underestimating the funding risks they face

Climate scenario analysis:An illustration of potential long-term economic & financial market impacts

This paper illustrates the potential impacts of climate change on financial markets, focusing on their long-term significance. It uses a top-down modelling tool developed by Ortec Finance in partnership with Cambridge Econometrics that combines climate science with macro-economic and financial effects to examine the possible impacts of three plausible (not extreme) climate pathways. The paper first considers the impact on gross domestic product (GDP), finding that GDP is lower in all three pathways, with the most severe reduction in the Failed Transition Pathway where the Paris Agreement climate targets are not met. The model then translates these GDP impacts into financial market effects. In the Failed Transition Pathway, cumulative global equity returns are approximately 50% lower over the period 2020–2060 than in the climate-uninformed base case. For the other two pathways where the Paris Agreement targets are met, the corresponding figures are 15% and 25% lower returns than in the base case. Results are provided for other asset classes too. These demonstrate that climate change represents a significant market risk, with implications for financial planning, modelling and regulation