Kratom a danger for
Older adults are using kratom, often as an alternative to opioids for pain relief.
As the plant-based substance’s popularity has grown, however, so have calls to poison centers, often with severe consequences for older adults.
Janessa Graves, associate professor at the Washington State University College of Nursing, is the lead author of a study on kratom exposures among older adults published in the Journal of the American Geriatrics Society.
“Growing numbers of Americans may consider it for themselves or their parents for pain control because they think it’s safer than an opioid, but the outcomes aren’t great,” Graves said.
Graves’ study said poison centers in the United States have reported a rapid increase in calls about kratom, with nearly 5% of kratom-related calls concerning adults aged 60 and over. Of those calls, nearly 50% of cases were life-threatening or resulted in significant disability, and eight people died.
People 70 or older were much more likely than younger users to report an adverse reaction to kratom. Poison centers report 23 deaths due to kratom exposure among that age group from 2014 to 2019.
Graves’ study suggests that healthcare providers question older patients – especially those being treated for pain – about all medications and substances they’re using.
Health threat from wildfire smoke, heat and power outages to be studied
Assistant Professor Claire Richards of the Washington State University College of Nursing will study the public health threat posed by the combination of wildfire smoke, extreme heat, and power outages.
Richards’ study was one of nine proposals awarded funding under WSU’s New Faculty Seed Grant Competition.
She became interested in the topic after seeing widespread power outages affect family and friends in her home state of California during recent wildfire seasons, she said. Outages can occur when power is turned off during hazardous conditions to prevent fire, when excess demand during a heatwave causes rolling blackouts, or when the transmission lines are damaged by a wildfire.
“Washington state is also vulnerable,” Richards said. “It’s getting hotter and drier here. Climate change is a progressive condition that is accelerating in its impacts. We need to take action on this issue.”
Richards added that the people considered most susceptible to power outages are the growing population of older adults who rely on electricity-dependent medical equipment. Some studies have also found that low-income communities and communities of color experience longer power outages with less notice and material resources to prepare.
The extent of the public health threat is not well understood and, as a result, emergency response systems cannot be fully prepared.
Three College of Nursing-related projects awarded seed money
Three projects led by or including WSU College of Nursing researchers were awarded seed-grant funding by the Washington State University Health Equity Research Center (HERC) to address aspects of health inequity – the economic, social or historical obstacles to living your healthiest possible life.
They are among the six projects awarded funding this year by the center, which supports innovative research on health disparities and the development of partnerships with communities and health systems.
The purpose of the Health Equity Research Center seed grant program is to jump-start research addressing the myriad causes of health inequity. The grants range can range in size from $10,000-$50,000 to address health equity issues in ways that present new opportunities for impact and the potential for additional grant funding from an external source.
The projects involving WSU College of Nursing faculty are:
“Building capacity to reduce agricultural worker exposure to smoke and heat during wildfires”
The research team will build partnerships with a federally qualified health center that serves agricultural workers and a research center focused on agricultural safety and health. It will examine current risk communication tools for heat and wildfire smoke used by Spanish-speaking agricultural workers and protective actions to take to minimize risk.
Principal investigator: Julie Postma, Associate Dean for Research, WSU College of Nursing
“Coalition building for anti-racism and community-participatory health equity research in Asian communities and Pacific Islander communities: Planting the seed to dismantle structural racism”
This project has three aims: to lay the groundwork for a multi-state Equity, Diversity, Inclusion and Justice Coalition for anti-racism; to identify community perspectives on healthcare needs and barriers to accessing healthcare among Asian families and Pacific Islander families; and to explore experiences of racial discrimination, trauma, healing and resilience with multi-generational households. The project also will assess feasibility and acceptability of physiological stress measurement via hair cortisol concentration among Asian families and Pacific Islander families.
Principal investigator: Connie Kim Yen Nguyen-Truong, Assistant Professor, WSU College of Nursing
Principal Investigator: Sara F. Waters, Assistant Professor, WSU College of Agricultural, Human, and Natural Resource Sciences, Human Development Department
“Decolonizing the Outdoors: A Community-Based Approach to Improving Health Equity in Early Childhood”
This project focuses on the first licensed, all-outdoor preschool in the U.S., Tiny Trees in Burien, Washington. All 200 children enrolled this fall come from families of color. The WSU HERC-funded study will hold focus groups and establish a community working group to design an activity to optimize physical and mental health in preschool-aged children through nature-based learning. It also includes a health needs assessment and survey.
Principal investigator: Amber Fyfe-Johnson, Assistant Research Professor, IREACH, WSU Elson S. Floyd College of Medicine.
Co-Principal investigator: Ka’imi Sinclair, Associate Professor, IREACH, WSU College of Nursing.
Kratom a danger for
People have become accustomed to having their temperature checked during the pandemic because fever is a key indicator of COVID-19.
A commentary by WSU College of Nursing Associate Professor Catherine Van Son and Clinical Assistant Professor Deborah Eti proposes that taking a temperature is a less useful indicator of infection in older adults and that a pulse oximeter be used instead.
The paper, published in Frontiers in Medicine, said baseline temperatures are lower in older adults. A lower baseline temperature means a fever may be overlooked using the CDC’s standard definition of 100.4 degrees Fahrenheit or greater.
“In fact,” the paper says, “upwards of 30% of older adults with serious infections show mild or no fever.”
Other common signs of COVID may also be dismissed and attributed to aging, such as fatigue, body aches and loss of taste or smell.
Additionally, some COVID-19 patients have no visible signs of having low oxygen levels, such as shortness of breath, yet have oxygen saturation below 90%. Such asymptomatic hypoxia can be associated with extremely poor outcomes.
Van Son and Eti say inexpensive, portable pulse oximeters should be considered for wide use in COVID-19 screenings of older adults because the devices can detect changes in oxygen saturation without other indications of infection.
Touch can be a therapeutic tool in nursing
Touching patients while providing care is an important and unavoidable aspect of the nursing profession. Nurses can also transform touch into a useful therapeutic tool to improve patients’ – and their own – wellbeing.
That’s the topic of a study, “’Permission to Touch’: Nurses’ Perspectives of Interpersonal Contact during Patient Care,” published in the Western Journal of Nursing Research. The authors include two Washington State University College of Nursing faculty, Associate Professor Marian Wilson and Assistant Professor Tullamora Landis, former faculty member Michele Shaw, and lead author Enrico DeLuca, of Sapienza University of Rome, Italy, who visited WSU in 2018 to work with Wilson on the study.
Nurses touch patients frequently for tasks and to provide comfort and emotional support. Studies have looked at physical contact occurring during nursing care, offering several definitions. “Expressive” touch, for example, is spontaneous and used to establish contact, reassure or give comfort, such as laying a hand on a patient’s shoulder.
Most previous studies have looked at the effect of such touch on patients; this study looks at how interpersonal contact is perceived by nurses. Nurses were also asked about their view of massage as a form of intentional touch in a clinical setting.
Through focus groups and interviews, participants said they found touch and massage helpful when providing patient care and saw them as especially important resources in providing emotional care.
The study noted that touch and massage techniques are useful tools that are already being employed by many nurses, but that it would be helpful to clarify the types of interpersonal contact used by nurses and possibly include touch as a competency in nursing education.