B. Joan McDowell

An Interdisciplinary Approach to the Assessment and Behavioral Treatment of Urinary Incontinence in Geriatric Outpatients

To test the effectiveness of an interdisciplinary assessment and behavioral treatment of persistent urinary incontinence in geriatric outpatients.

Effectiveness of behavioral therapy to treat incontinence in homebound older adults.

OBJECTIVES: To examine the (1) short‐term effectiveness of behavioral therapies in homebound older adults and (2) characteristics of responders and nonresponders to the therapies.

Excess Disability During Morning Care in Nursing Home Residents With Dementia

Excess disability was examined in 17 nursing home residents with dementia by comparing their performance of morning care tasks under two activities of daily living (ADL) caregiving approaches-a dependence-supportive one under usual care and an independence-supportive one under functional rehabilitation. The results suggest that excess disability in severely cognitively impaired and functionally disabled residents can be reduced by increasing opportunities for independent activity, and substituting nondirective and directive verbal assists for physical assists. Further, the findings indicate that increased independence in ADL can be achieved without increasing disruptive behaviors and can foster appropriate requests for task-related help during caregiving. Functional rehabilitation, however, requires more time than usual care.

Prevalence and Recognition of Depressive Symptoms Among Homebound Older Adults with Urinary Incontinence

Within a group of homebound elders with urinary incontinence, the objectives of this study were to (1) examine the prevalence of depressive symptoms, (2) examine the extent to which depression had previously been recognized by health care providers, (3) describe the type and intensity of antidepressant treatment prescribed for subjects, and (4) identify the demographic and functional characteristics associated with depressive symptomatology. A descrip tive correlational design was used. The 15-item Geriatric Depression Scale (GDS-15) was administered to 345 homebound adults age 60 years and over referred to a study examining the effectiveness of behavioral therapy for urinary incontinence. Individuals were referred to the study by home care nurses from two large Medicare-approved home health agencies in a large metropolitan county in Pennsylvania. Data were collected during in-home assess ments and by chart review. Measures included the GDS-15, structured medical history, in-home review of medications, Older Americans Research and Service Center Physical and Instrumental Activities of Daily Living scales, Mini- Mental State Examination (MMSE), Clock Drawing Test, Performance-Based Toileting Assessment, and bladder diaries. One half of the participants (n = 173; 50.1%) had significant depressive symptomatology, with 35.7% having scores suggesting mild depression and 14.5% severe depression. Only 26.4% and 34.7% of those with mild and severe depressive symptoms, respectively, had a previous diagnosis of depression and only 21.7% and 34.0%, respectively, had been prescribed an antidepressant. The most commonly prescribed class of antidepressants was tricyclic anti depressants, being taken by 9.0% (n = 31) of the total sample, 14 (11.4%) of those with mild symptoms and 4 (8.0%) of those with severe depressive symptomatology. A little over half (60.0%) of subjects being treated with antide pressants continued to exhibit significant depressive symptomatology. Greater dependence in physical activities of daily living, the need for assistance during ambulation, higher MMSE scores, and higher levels of comorbidity were associated (P < .05) with a GDS-15 score of 5 or higher. Depression symptoms are common in homebound older adults with urinary incontinence, but clinical recognition and treatment are limited. (J Geriatr Psychiatry Neurol 2001; 14:130-139).

Characteristics of Urinary Incontinence in Homebound Older Adults

OBJECTIVE: To describe the characteristics of urinary incontinence and related factors in incontinent homebound older adults.

Preventive health practices: comparison of family caregivers 50 and older.

The purpose of this study was to describe adherence to recommended preventive health practices among middle-aged and older male and female family caregivers of individuals receiving home health services. Perceptions of the burden and benefit of caregiving, wellness orientation, social participation, and community resource use by the caregiving dyad (caregiver and carereceiver) were also explored using the t test and the chi2 test to detect gender differences. A sample of 319 participants 50 and older was recruited from a home health agency in southwestern Pennsylvania to participate in a telephone survey. Results revealed that caregivers had performed 86% of age- and gender-appropriate preventive health practices, but they currently adhered to guidelines for 63% of such behaviors, regardless of gender. Men experienced less burden than women, and were more likely to acknowledge that caregiving made them feel useful and appreciated and gave more meaning to their lives. The study suggests that family caregivers may be as vigilant in their preventive health behavior as the general population, despite their responsibilities. Nurses in contact with middle-aged and older family caregivers are well positioned to encourage health promotion and disease prevention behaviors in this accessible population.

Identification and Intervention for Urinary Incontinence by Community Physicians and Geriatric Assessment Teams

Objective: To determine the difference in the recognition and intervention/referral rates for urinary incontinence (UI) by out‐patient Geriatric Assessment Units (GAUs) and private physicians in community‐based practices (CMDs).

To treat or not to treat : Issues in decisions not to treat older persons with cognitive impairment, depression, and incontinence

OBJECTIVES: To examine decisions not to treat problems identified during outpatient geriatric assessment, particularly problems of cognitive impairment, depression, or urinary incontinence.

Assessment of Urinary Incontinence in the Elderly

&NA; Urinary incontinence is a major health problem affecting the lives of many elderly people. A formal urologic examination often is not required for proper diagnosis and successful treatment of incontinence. This article focuses on safe, accurate, and inexpensive methods of incontinence assessment that can be performed in a variety of settings by nurse practitioners. The evaluation described incorporates medical, behavioral, and physiologic assessment of deficits commonly encountered in older incontinent individuals.

Behavioral and pharmacological treatment of persistent urinary incontinence in the elderly.

&NA; Research has demonstrated that behavioral interventions can help to decrease or eliminate unnary incontinence. Pharmacological agents have also been shown to be effective in the management of this problem. This article describes simple low risk behavioral techniques and pharmacological approaches that can be used by nurse practitioners to assist their incontinent patients to control this embarrassing and expensive problem.