Amanda F. Elliott

Pain Assessment in Persons with Dementia: Relationship Between Self‐Report and Behavioral Observation

OBJECTIVES: To investigate the relationship between self‐report and behavioral indicators of pain in cognitively impaired and intact older adults.

Vision Health Disparities in the United States by Race/Ethnicity, Education, and Economic Status: Findings From Two Nationally Representative Surveys

PURPOSE To assess vision health disparities in the United States by race/ethnicity, education, and economic status. DESIGN Cross-sectional, nationally representative samples. METHODS We used national survey data from the National Health and Nutrition Examination Survey (NHANES) and the National Health Interview Survey (NHIS). Main outcome measures included, from NHANES, age-related eye diseases (ie, age-related macular degeneration [AMD], cataract, diabetic retinopathy [DR], glaucoma) and from NHIS, eye care use (ie, eye doctor visits and cannot afford eyeglasses when needed) among those with self-reported visual impairment. The estimates were age- and sex-standardized to the 2000 US Census population. Linear trends in the estimates were assessed by weighted least squares regression. RESULTS Non-Hispanic whites had a higher prevalence of AMD and cataract surgery than non-Hispanic blacks, but a lower prevalence of DR and glaucoma (all P < .001 in NHANES 2005-2008). From 1999 to 2008, individuals with less education (ie, high school) and lower income (poverty income ratio [PIR] <1.00 vs ≥ 4.00) were consistently less likely to have had an eye care visit in the past 12 months compared with their counterparts (all P < .05). During this period, inability to afford needed eyeglasses increased among non-Hispanic whites and Hispanics (trend P = .004 and P = .007; respectively), those with high school education (trend P = .036), and those with PIR 1.00-1.99 (trend P < .001). CONCLUSIONS Observed vision health disparities suggest a need for educational and innovative interventions among socioeconomically disadvantaged groups.

Disparities in Eye Care Utilization Among the United States Adults With Visual Impairment: Findings From the Behavioral Risk Factor Surveillance System 2006-2009

PURPOSE To estimate the prevalence of annual eye care among visually impaired United States residents aged 40 years or older, by state, race/ethnicity, education, and annual income. DESIGN Cross-sectional study. METHODS In analyses of 2006-2009 Behavioral Risk Factor Surveillance System data from 21 states, we used multivariate regression to estimate the state-level prevalence of yearly eye doctor visit in the study population by race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, and other), annual income (≥

Associations of Special Care Units and Outcomes of Residents With Dementia: 2004 National Nursing Home Survey

35,000 and <

Vision‐Enhancing Interventions in Nursing Home Residents and Their Short‐Term Effect on Physical and Cognitive Function

35,000), and education (< high school, high school, and > high school). RESULTS The age-adjusted state-level prevalence of yearly eye doctor visits ranged from 48% (Missouri) to 69% (Maryland). In Alabama, Colorado, Indiana, Iowa, New Mexico, and North Carolina, the prevalence was significantly higher among respondents with more than a high school education than among those with a high school education or less (P < .05). The prevalence was positively associated with annual income levels in Alabama, Georgia, New Mexico, New York, Texas, and West Virginia and negatively associated with annual income levels in Massachusetts. After controlling for age, sex, race/ethnicity, education, and income, we also found significant disparities in the prevalence of yearly eye doctor visits among states. CONCLUSION Among visually impaired US residents aged 40 or older, the prevalence of yearly eye examinations varied significantly by race/ethnicity, income, and education, both overall and within states. Continued and possibly enhanced collection of eye care utilization data, such as we analyzed here, may help states address disparities in vision health and identify population groups most in need of intervention programs.

Effects of an Analgesic Trial in Reducing Pain Behaviors in Community-Dwelling Older Adults With Dementia

PURPOSE We compared the rates of specialized care for residents with Alzheimers disease or dementia in special care units (SCUs) and other nursing home (NH) units and examined the associations of SCU residence with process of care and resident outcomes. DESIGN AND METHODS Data came from the 2004 National Nursing Home Survey. The indicators of process of care included physical restraints, continence management, feeding tubes, and influenza and pneumococcal vaccinations. Resident outcomes included pressure ulcers, hospitalization, emergency room visits, weight loss, and falls. Analyses were conducted by using Stata SE version 10. RESULTS Multivariate logistic regression analyses show that SCU residents were more likely to have received specialized dementia care and specialized behavioral problem management. They were less likely to have bed rails (adjusted odds ratio [AOR] = 0.39, AOR = 0.35, ps < .01), use catheters (AOR = 0.33, AOR = 0.33, ps < .01), and yet more likely to have toilet plans/bladder training for incontinence control (AOR = 1.90, AOR = 1.62, ps < .01) than those in regular units and those in NHs without an SCU. Moreover, SCU residents were less likely to have pressure ulcers, hospitalization than those in regular units, and less likely to have experienced weight loss than those in NHs without an SCU. However, they were more likely to have falls (AOR = 1.32, AOR = 1.36, ps < .05) than those in regular units and those in NHs without an SCU. IMPLICATIONS Our study shows that SCU residents had, in general, better process of care than those in regular units and in NHs without an SCU. Further studies are needed to assess specific outcome changes among SCU residents and to evaluate the cost-effectiveness of having such units.

The Nursing Home Minimum Data Set for Vision and Its Association with Visual Acuity and Contrast Sensitivity

OBJECTIVES: To evaluate the effect of vision‐enhancing interventions (cataract surgery or refractive error correction) on physical function and cognitive status in nursing home residents.

Vision Impairment Among Older Adults Residing in Assisted Living

Background: Analgesic trials have been advocated as a means to reduce pain in persons with dementia (PWDs), but few systematic studies have been reported. Objectives: The aims of this study were to assess the feasibility of conducting a repeated-measures study of pain in PWDs and to investigate the effect of the scheduled dosing of acetaminophen in reducing observable pain behaviors in community-dwelling PWDs. Methods: A within-subjects ABAB withdrawal design was utilized in this pilot study, with data collected daily for 24 days. Two baseline (nontreatment) phases were alternated with two treatment phases to examine the effects of scheduled extended-release acetaminophen (1.3 g every 8 hr) in reducing pain-related behaviors. The sample consisted of 3 participants (2 women; mean age = 85 years; mean Mini-Mental State Examination score = 11.7) with osteoarthritis. Pain behaviors were measured during a daily, videotaped activity-based protocol designed to elicit pain. Results: The results indicate that it is possible to conduct this type of intensive, daily pain investigation in community-dwelling older adults with moderate to severe dementia. Behavioral indicators of pain varied daily and in response to treatment. During treatment phases, pain behaviors decreased in both frequency and duration relative to the control and baseline phases and increased when treatment was withdrawn. Discussion: Acetaminophen use reduced pain behaviors associated with musculoskeletal pain in this sample of PWDs. This provides preliminary evidence that acetaminophen is an effective pain reliever for this population. In addition, the study supports the use of a within-subjects design to examine daily variability in pain behaviors and to demonstrate treatment effects in PWDs.

Use of electronic health records and administrative data for public health surveillance of eye health and vision-related conditions in the United States.

OBJECTIVES: To evaluate the association between the Minimum Data Sets (MDS) Vision Patterns section and near and distance visual acuity and contrast sensitivity in nursing home residents.

The variability of vision loss assessment in federally sponsored surveys: Seeking conceptual clarity and comparability

Objective: To examine rates of visual impairment of older adults in assisted living facilities (ALFs). Methods: Vision screening events were held at 12 ALFs in Jefferson County, Alabama, for residents above 60 years of age. Visual acuity, cognitive status, and presence of eye conditions were assessed. Results: A total of 144 residents were screened. Of these 67.8% failed distance screening, 70.9% failed near screening, and 89.3% failed contrast sensitivity screening. A total of 40.4% of residents had cognitive impairment and 89% had a least one diagnosed eye condition. Visual acuities did not differ significantly between cognitive status groups or with greater numbers of eye conditions. Discussion: This study is the first to provide information about vision impairment in the assisted living population. Of those screened, 70% had visual acuity worse than 20/40 for distance or near vision, and 90% had impaired contrast sensitivity. Cognitive impairment accounted for a small percentage of the variance in near vision and contrast sensitivity.