Abstract:
PURPOSE:Urinary incontinence (UI) is common but inadequately assessed and treated in nursing facility (NF) residents. The purpose of this study is two-fold: (1) to determine perceptions about the importance of UI and its management in the NF setting compared with other geriatric syndromes and (2) to compare barriers to UI care as perceived by physicians, geriatric nurse practitioners (GNPs), directors of nursing and other nurses in administrative positions (DONs), and nursing assistants (NAs). METHODS:Computer-based surveys of physicians and DONs and a hard copy survey of NAs at their national meetings; an online survey of GNPs. RESULTS:Responses included 395 physicians (31% response rate), 152 DONs (34%), 118 GNPs (23%), and 277 NAs (60%). Physicians, GNPs, and DONs evaluated and managed UI significantly less often than 5 other geriatric syndromes (behavioral symptoms of dementia, falls, unintended weight loss, pain, and delirium). In contrast, NAs were more likely to be involved in UI care than in care provided for residents with any of the other 5 syndromes. All 4 groups agreed that UI has less effect on clinical outcomes than the other 5 syndromes. However, DONs rated UI first with respect to cost of care; NAs third behind falls and pain; and physicians and GNPs rated UI fourth behind falls, behavioral symptoms, and delirium. With respect to quality of life effects, physicians and GNPs rated UI fifth and fourth respectively and DONs fourth. In contrast, NAs rated UI second only to pain with respect to its effect on quality of life. Perceived barriers differ among the 4 groups with physicians relatively more concerned that drug treatment alone is ineffective (P = .002); GNPs relatively more concerned with lack of effective nondrug interventions (P = .001); and DONs relatively more concerned about sufficient time to assess and manage UI (P = .001). NA respondents rated concern about anticholinergic drug effects lower than did respondents in the other 3 groups (P = .001). CONCLUSION:Physicians, GNPs, and DONs are more likely to be involved in evaluating and managing behavioral symptoms of dementia, pain, falls, delirium, and unintended weight loss than UI in the NF setting. This leaves NAs as first-line managers for a condition that they perceive to have an important impact on quality of life. Perceived barriers to improving UI care differ among the 4 groups suggesting that approaches to overcoming the barriers should be multi-faceted.
journal_name
J Am Med Dir Assocjournal_title
Journal of the American Medical Directors Associationauthors
Lawhorne LW,Ouslander JG,Parmelee PA,Resnick B,Calabrese Bdoi
10.1016/j.jamda.2007.08.003subject
Has Abstractpub_date
2008-01-01 00:00:00pages
29-35issue
1eissn
1525-8610issn
1538-9375pii
S1525-8610(07)00354-4journal_volume
9pub_type
杂志文章abstract:OBJECTIVE:To assess whether medical orders within Physician Orders for Life-Sustaining Treatment (POLST) forms reflect patients' preferences for care at the end of life. DESIGN:This cross-sectional study assessed the agreement between medical orders in POLST forms and the free-form text documentation of an advance car...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2020.10.016
更新日期:2020-11-13 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: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
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更新日期:2014-04-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2015.06.023
更新日期:2015-12-01 00:00:00
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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:BACKGROUND:Nursing home residents' repeated transfers to hospital are costly and can lead to in-hospital complications and high mortality for frail residents. However, no research has examined the trajectory of residents' symptoms over their nursing home residency and its relationship to hospital transfer. AIM:The pur...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2016.06.019
更新日期:2016-11-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,评审
doi:10.1016/j.jamda.2010.12.004
更新日期:2012-03-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2010.03.003
更新日期:2011-06-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
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更新日期:2021-01-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,评审
doi:10.1016/j.jamda.2016.03.005
更新日期:2016-06-01 00:00:00
abstract::A consensus among geriatricians, ethicists, and neurologists supports a palliative approach to the care of individuals with late-stage dementia. But ten years after the publication of the first large study demonstrating the lack of efficacy of percutaneous endoscopic gastrostomy (PEG) tubes in prolonging life for pati...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2008.03.011
更新日期:2008-06-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2012.04.010
更新日期:2012-07-01 00:00:00
abstract:INTRODUCTION:According to the World Health Organization (WHO) and FDI World Dental Federation (FDI), malnutrition and bad oral health are of great concern to global health, especially among the older population. This study aimed to assess the associations between oral health problems ([artificial] teeth problems, chewi...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2017.05.022
更新日期:2017-11-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2020.08.006
更新日期:2020-09-19 00:00:00
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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.2010.02.010
更新日期:2011-01-01 00:00:00
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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.2018.09.004
更新日期:2019-03-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2019.02.023
更新日期:2019-09-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2009.07.006
更新日期:2010-02-01 00:00:00
abstract::While federal law establishes guidelines that designated facilities must follow in providing information about a patient's rights regarding self-determination in the health care decision-making process, state law determines the decision-making process and the legal requirements pertaining thereto. A person's capacity ...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,评审
doi:10.1016/j.jamda.2006.01.001
更新日期:2006-06-01 00:00:00
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pub_type: 杂志文章,随机对照试验
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更新日期:2015-03-01 00:00:00
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更新日期:2013-02-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2016.03.014
更新日期:2016-07-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2020.01.002
更新日期:2020-09-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,评审
doi:10.1016/j.jamda.2020.05.010
更新日期:2020-09-01 00:00:00
abstract::Up to 80% of nursing home residents are affected by pain. Pain assessment aims to determine pain intensity, quality, and course of pain to underpin diagnostic decision making. In the nursing home population, pain assessment is frequently compromised by cognitive impairment. Characteristics of the nursing home setting,...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2019.08.002
更新日期:2020-02-01 00:00:00
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journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2014.03.008
更新日期:2014-09-01 00:00:00
abstract::Sexuality is an important component of emotional and physical intimacy that men and women experience throughout their lives. Research suggesting that a high proportion of men and women remain sexually active well into later life refutes the prevailing myth that aging and sexual dysfunction are inexorably linked. Age-r...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章,评审
doi:10.1016/j.jamda.2013.01.022
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVES:To investigate the current evidence on the use of point-of-care chest ultrasonography in older patients and geriatric settings and present the current state of the art of chest ultrasound applications. DESIGN:Special article based on a literature review with narrative analyses and expert clinical knowledge....
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2019.06.018
更新日期:2020-04-01 00:00:00
abstract:OBJECTIVES:Older age is associated with higher risk of death during acute exacerbations of chronic obstructive pulmonary disease (AE-COPD). Older patients hospitalized for AE-COPD often require post-acute care after acute phase. The aim of this study was to evaluate components of a comprehensive geriatric assessment an...
journal_title:Journal of the American Medical Directors Association
pub_type: 杂志文章
doi:10.1016/j.jamda.2019.01.125
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVES:Coronavirus disease 2019 (COVID-19) has caused many nursing homes to prohibit resident visits to prevent viral spread. Although visiting restrictions are instituted to prolong the life of nursing home residents, they may detrimentally affect their quality of life. The aim of this study was to capture perspec...
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pub_type: 杂志文章
doi:10.1016/j.jamda.2020.09.031
更新日期:2020-12-01 00:00:00