Abstract:
OBJECTIVES:To describe current practices of incontinence care in nursing homes (NHs) provided by certified nurse assistants (CNAs), and to evaluate the feasibility and acceptability of an integrated incontinence care product, the One Step Incontinence System (OSIS) in the NH setting. While the ultimate purpose of OSIS is to encourage more consistent skin cleansing and thus reduce perineal dermatitis and risk of pressure ulcers, this study reports an initial feasibility test of OSIS. DESIGN:Controlled trial at two NH sites, with one ward at each site assigned to intervention with OSIS and one ward at each site assigned to a control condition with a box of wipes placed at the bedside (BW). SETTING:Two NHs (one community and one Veterans Administration) in the Los Angeles area. PARTICIPANTS:24 incontinent NH residents and 61 CNAs. INTERVENTION:OSIS integrates an adult brief and two cleansing/protective wipes into a single item by way of a waterproof pouch that is removed at the time of incontinence care. The OSIS briefs were placed on the intervention wards in the same location(s) and adjacent to regular adult briefs. MEASUREMENTS:Structured observations of incontinence care episodes were performed by trained research staff at baseline on all wards, and at follow-up with either the intervention (OSIS) or control condition (BW) in place. Observations included resident location, thoroughness and duration of incontinence care, and materials used. In addition, CNAs' opinions of their preferred incontinence care materials and their experience using OSIS were obtained by self-administered survey. RESULTS:Use of OSIS resulted in significantly greater frequency of use of cleansing wipes (97% of episodes) compared to the baseline (77% of episodes) and BW conditions (41% of episodes). In 59% of the observed episodes in the BW condition, the box of wipes was actually missing from the bedside, or completely absent from the patient's room and had to be replaced. The two wipes that were incorporated with OSIS were used for perineal skin cleansing immediately when providing incontinence care. There was a significant reduction in the percentage use of and number of cloth towels used during incontinence care with OSIS (53% of episodes, 0.8 towels) compared to baseline (67%, 1.1 towels) and BW conditions (82%, 1.2 towels; p=.002 and p=.012, respectively). CNAs were significantly less often interrupted by the need to find supplies during OSIS condition (13%) compared to baseline (23%) and BW (36%; p= .005). There were no significant differences between conditions in the thoroughness of observed cleansing. The average observed time for incontinence care from putting on gloves to fastening the clean adult brief (T1) and between uncovering the resident to fastening a clean adult brief (T2) decreased significantly within both groups (OSIS and BW) at follow-up (all p-values <.05), but there were no significant differences in T1 and T2 between groups at follow-up. CNAs were more likely to report that they felt that OSIS facilitated skin cleansing compared to the BW. CONCLUSION:We successfully implemented a trial of an innovative adult brief that encouraged skin cleansing during incontinence care. The system was easily and effectively incorporated into the nursing home, was used by CNAs whenever available (97% of the time), and was favored by CNAs. Patterns of incontinence care differed at follow-up with OSIS compared to BW, with fewer linens used, fewer wipes used, and less CNA interruption during care, which may result in greater privacy and comfort for residents.
journal_name
J Am Med Dir Assocjournal_title
Journal of the American Medical Directors Associationauthors
Al-Samarrai NR,Uman GC,Al-Samarrai T,Alessi CAdoi
10.1016/j.jamda.2006.10.001subject
Has Abstractpub_date
2007-05-01 00:00:00pages
253-61issue
4eissn
1525-8610issn
1538-9375pii
S1525-8610(06)00530-5journal_volume
8pub_type
杂志文章,多中心研究,随机对照试验abstract:BACKGROUND:Discussions about advance directives should be offered to all nursing home residents. Managed Medicare programs for nursing home residents allow for the development of performance improvement initiatives to ensure that these discussions occur and are documented. PURPOSE:To assess the effectiveness of an int...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:
更新日期:2001-05-01 00:00:00
abstract:OBJECTIVES:To establish the reliability and validity of a measure to assess pain in individuals with advanced dementia. DESIGN:Sixty-five residents of long-term care facilities were assessed using a new rating tool, the Pain Assessment for the Dementing Elderly (PADE), in two separate studies: (1) Residents were asses...
journal_title:Journal of the American Medical Directors Association
pub_type: 临床试验,杂志文章
doi:10.1097/01.JAM.0000043419.51772.A3
更新日期:2003-01-01 00:00:00
abstract:OBJECTIVE:To determine the association between hypertension at age 90 years, treatment, and 5-year mortality. DESIGN:A prospective observational study of a representative community-dwelling birth cohort (born 1920-1921) by the Jerusalem Longitudinal Study (1990-2015). SETTING:Home-assessment. PARTICIPANTS:480 subjec...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2016.12.076
更新日期:2017-03-01 00:00:00
abstract:OBJECTIVES:To provide an estimate and level of uncertainty for Medicaid cost savings due to Minnesota's Return to Community Initiative (RTCI). DESIGN:Medicaid cost savings are estimated using a semi-Markov model and simulation approach. SETTING AND PARTICIPANTS:RTCI is a statewide program that assists private paying ...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2020.07.016
更新日期:2020-08-28 00:00:00
abstract:OBJECTIVES:Structured programs for routine pain assessment and treatment are necessary to optimize care for residents of long-term care facilities (LTCFs). A pilot study was designed to develop, implement, and evaluate a system for pain assessment and monitoring in a LTCF. Additional goals were to determine whether a v...
journal_title:Journal of the American Medical Directors Association
pub_type: 临床试验,杂志文章
doi:10.1016/j.jamda.2004.12.024
更新日期:2005-03-01 00:00:00
abstract:OBJECTIVES:Age-related changes mean that the older population can encounter barriers toward taking medication orally. Further work is needed to identify the characteristics of oral solid dosage forms that will improve patient acceptance and adherence. The aim of this systematic review was to identify if and how formula...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,评审
doi:10.1016/j.jamda.2020.01.108
更新日期:2020-08-01 00:00:00
abstract:OBJECTIVES:To describe the recruitment strategy and association between facility and staff characteristics and success of resident recruitment for the Promoting Independence in Residential Care (PIRC) trial. DESIGN:Cross-sectional study of staff and facility characteristics and recruitment rates within facilities with...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jamda.2007.11.008
更新日期:2008-05-01 00:00:00
abstract:OBJECTIVES:Nursing facilities have lagged behind in the adoption of interoperable health information technology (ie technologies that allow the sharing and use of electronic patient information between different information systems). The objective of this study was to estimate the nationwide prevalence of electronic he...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2018.11.002
更新日期:2019-08-01 00:00:00
abstract:OBJECTIVES:The objective of this study was to evaluate the benefits of influenza vaccination against hospitalization and mortality on frail elderly people. DESIGN:The design was a population-based retrospective cohort study. SETTING:Taiwan's National Health Insurance claims data. PARTICIPANTS:Participants were 5063 ...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2013.12.003
更新日期:2014-04-01 00:00:00
abstract:OBJECTIVE:Motoric cognitive risk syndrome (MCR) is a predementia stage associated with increased risk for falls. There are conflicting results regarding its association with recurrent falls and no information about its association with postfall fractures. The aim of the study was to examine the association of MCR and i...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2019.04.021
更新日期:2019-10-01 00:00:00
abstract::Memantine is approved for treatment of moderate to severe Alzheimer disease (AD) but is also investigated as a treatment option for a number of different conditions, and even though there are reports of a number of adverse effects, including new-onset seizures and psychosis, it is considered to be generally well toler...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2013.01.010
更新日期:2013-05-01 00:00:00
abstract:OBJECTIVES:In nursing home settings, providers often think that most percutaneous endoscopic gastrostomy (PEG) tubes are placed in older people, some perhaps inappropriately. We sought to describe the relationships between patient age and the indications for, the decision making behind, and the outcomes of gastrostomy ...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2005.05.010
更新日期:2005-11-01 00:00:00
abstract:OBJECTIVES:This study examined the extent to which program site-based and Veteran characteristics were associated with potentially avoidable hospitalizations or other hospitalization of Veterans enrolled in the Veterans Affairs (VA) Home Based Primary Care (HBPC). DESIGN:Retrospective claims-based study. SETTING AND ...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2020.12.033
更新日期:2021-01-29 00:00:00
abstract:OBJECTIVE:To identify predictors of adverse outcomes (nursing home placement and hospital length of stay) in a cohort of older hospitalized patients. DESIGN:Prospective cohort study. SETTING:A suburban medical center in the New York City metropolitan area. PARTICIPANTS:Patients aged 65 years and older admitted from ...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:
更新日期:2000-09-01 00:00:00
abstract:OBJECTIVE:Venous thromboembolism (VTE) is common in the elderly, but its epidemiology in nursing home residents remains unclear. This study estimated rates of VTE recorded on nursing home admission and incidence during residence. DESIGN:Retrospective analysis of AnalytiCare long term care (LTC) database for the period...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2013.02.003
更新日期:2013-08-01 00:00:00
abstract::Chronic indwelling catheters are used to manage urinary retention, especially in the presence of urethral obstruction, and to facilitate healing of incontinence-related skin breakdown. These indwelling foreign bodies become coated and sometimes obstructed by biofilm laden with bacteria and struvite crystals. Bacteria ...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,评审
doi:10.1016/j.jamda.2006.01.020
更新日期:2006-07-01 00:00:00
abstract:BACKGROUND:Although many older adults require skilled nursing facility (SNF) care after acute hospitalization, it is unclear whether internal medicine residents have sufficient knowledge of the care that can be provided at this site. METHODS:We developed a 10-item multiple choice pre-test that assessed knowledge of th...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2014.08.004
更新日期:2014-01-01 00:00:00
abstract:OBJECTIVES:Patients discharged to a skilled nursing facility (SNF) for post-acute care have a high risk of hospital readmission. We aimed to develop and validate a risk-prediction model to prospectively quantify the risk of 30-day hospital readmission at the time of discharge to a SNF. DESIGN:Retrospective cohort stud...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2019.01.137
更新日期:2019-04-01 00:00:00
abstract:BACKGROUND/OBJECTIVE:Falls are common in nursing homes and cause a high burden of injuries. The objective of this study was to analyze factors associated with serious consequences of falls in nursing home residents. DESIGN:Prospective observational study. SETTING:Falls were recorded over 1 year, covering all resident...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2014.03.015
更新日期:2014-08-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to document the growth of postacute care and contemporaneous staffing trends in US nursing homes over the decade 2001 to 2010. DESIGN:We integrated data from all US nursing homes longitudinally to track annual changes in the levels of postacute care intensity, therapy staffing...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2013.05.013
更新日期:2013-11-01 00:00:00
abstract:OBJECTIVES:To examine the bidirectional temporal relationship between depressive symptoms and cognition in relation to risk, reaction, and prodrome. DESIGN:Cross-lag analysis of longitudinal data collected online at baseline and 12-month follow-up. SETTING AND PARTICIPANTS:A United Kingdom population cohort of 11,855...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2020.01.106
更新日期:2020-08-01 00:00:00
abstract:OBJECTIVES:To determine the prevalence and characteristics of advance care planning (ACP) among persons dying in long-term care (LTC) facilities, and to examine the relationship between respondent, facility, decedent, and family characteristics and ACP. DESIGN:After-death interviews of family members of decedents and ...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2008.10.015
更新日期:2009-05-01 00:00:00
abstract:OBJECTIVE:To examine whether established diabetes risk factors and diabetes risk algorithms are associated with future frailty. DESIGN:Prospective cohort study. Risk algorithms at baseline (1997-1999) were the Framingham Offspring, Cambridge, and Finnish diabetes risk scores. SETTING:Civil service departments in Lond...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2013.08.016
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:Poor gait performance predicts risk of developing dementia. No structured critical evaluation has been conducted to study this association yet. The aim of this meta-analysis was to systematically examine the association of poor gait performance with incidence of dementia. METHODS:An English and French Medli...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.jamda.2015.12.092
更新日期:2016-06-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to evaluate the potential association between anemia associated with chronic kidney disease (CKD) and the ability for older nursing home (NH) residents with these conditions to perform basic activities of daily living (ADL). DESIGN:This is a multicenter, retrospective, observationa...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jamda.2008.08.012
更新日期:2009-02-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to examine whether a 12-week combined physical exercise training and nutritional intervention improves physical performance and enhances health-related quality of life (HRQOL) among prefrail elderly women living in the community. DESIGN:This was a randomized controlled trial in...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jamda.2014.12.005
更新日期:2015-03-01 00:00:00
abstract::Vital signs are objective measures of physiological function that are used to monitor acute and chronic disease and thus serve as a basic communication tool about patient status. The purpose of this analysis was to review age-related changes of traditional vital signs (blood pressure, pulse, respiratory rate, and temp...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,评审
doi:10.1016/j.jamda.2010.04.009
更新日期:2011-06-01 00:00:00
abstract::The purpose of this literature review was to assess the current state of affairs in end-of-life care for persons with dementia, to identify barriers to the provision of high-quality care, and to describe exemplary programs that have discovered ways to overcome these barriers. The literature reviewed included English-l...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:
更新日期:2002-03-01 00:00:00
abstract::A case is reported of an initially 78-year-old man whose presentation and course, closely followed over 10 years by an academic neurologist, were consistent with classic idiopathic Parkinson's disease (PD), including unilateral onset, obvious cogwheeling, and a very good prolonged response to levodopa/carbidopa (LD/CD...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1097/01.JAM.0000141949.31853.25
更新日期:2004-11-01 00:00:00
abstract:PURPOSE:Long-term care facilities have lagged heavily behind other health providers in adopting health information technology (IT). This article examines the facility characteristics that are associated with health IT adoption. DESIGN AND METHODS:This study is a secondary data analysis of information gathered between ...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2016.02.028
更新日期:2016-05-01 00:00:00