Lené Levy-Storms

The minimum data set pressure ulcer indicator: does it reflect differences in care processes related to pressure ulcer prevention and treatment in nursing homes?

Objectives: To determine whether nursing homes (NHs) that score in the extreme quartiles of pressure ulcer (PU) prevalence as reported on the Minimum Data Set (MDS) PU quality indicator provide different PU care.

The effects of staffing on in-bed times of nursing home residents.

Objectives: To examine the effect of staffing level on time observed in bed during the daytime in nursing home (NH) residents.

The Minimum Data Set Weight-Loss Quality Indicator: Does It Reflect Differences in Care Processes Related to Weight Loss?

Objectives: To determine whether nursing homes (NHs) that score differently on prevalence of weight loss, according to a Minimum Data Set (MDS) quality indicator, also provide different processes of care related to weight loss.

Use of mammography screening among older Samoan women in Los Angeles county: a diffusion network approach

Minority migrant populations, such as older Samoan women, are likely to underuse preventive health services, including mammography screening. The purpose of this paper is to explore how informal (lay peers from churches) and formal (health care providers) health communication networks influence mammography screening use among older Samoan women. To do so, we apply diffusion of innovation theory and network analysis to understand how interpersonal networks may affect mammography use in this urban-dwelling, migrant population. The data come from a survey of 260 Samoan women, aged 50 years or older, who attended 39 randomly sampled Samoan churches in Los Angeles County (USA) between 1996 and 1997. Retrospective data, based over a 20-year period from this samples year of first use of mammography screening, suggest that interpersonal networks may have accounted for the dramatic increase in the rate of adoption within the past 5 years of the survey. Using this information, we categorized women into mutually exclusive stages of mammography use and regressed these stages of mammography use on formal (had a provider referral) and informal (level of connectedness with peers in churches) health communication networks. The results indicated that being well-connected within womens informal, church-based health communication networks increased the likelihood of being in the decision (planned to have) and implementation and confirmation (had a recent mammogram) stages, but having a provider referral for a mammogram (formal networks) only increased the likelihood of being in the latter stages compared to women in the knowledge and persuasion stages. Formal and informal health communication networks influence recent use of mammography screening, but informal networks, in and of themselves, are also influential on future intention to use mammography screening.

The Minimum Data Set Bedfast Quality Indicator: Differences Among Nursing Homes

Background:Excessive time in bed has negative effects on both physical conditioning and functioning. There are no data or practice guidelines relevant to how nurses should manage the in-bed times of nursing home residents, although all nursing homes receive a bedfast prevalence quality indicator report generated from the Minimum Data Set. Objectives:To compare nursing homes that score in the upper and lower quartiles on the Minimum Data Set bedfast prevalence quality indicator for proportion of bedfast residents, activity and mobility nursing care, and amount of time all residents spend in bed, and to evaluate whether residents who spend more time in bed are different from those who spend less time in bed according to functional measures. Methods:A cohort design used medical records, resident interviews, and direct observation data to compare 15 nursing homes (n = 451 residents) on the proportion of bedfast residents, the amount of time residents spent in bed, the frequency of activity, and the scores on six activity and mobility care process indicators. Results:Significant differences were found between upper (i.e., higher prevalence of bedfast residents) and lower quartile nursing homes in the proportion of time residents were observed in bed (43% vs. 34%, respectively; p = .007), and in the proportion of residents who spent more than 22 hours in bed per day (18% vs. 8%, respectively; p = .002). All nursing homes underestimated the number of bedfast residents. The residents of upper quartile homes showed more activity episodes and reported receiving more walking assistance than the residents of lower quartile homes. Discussion:Minimum Data Set bedfast quality indicator identified nursing homes in which residents spent more time in bed, but did not reflect differences in activity and mobility care. In fact, upper quartile homes provided more activity and mobility care than lower quartile homes. Across all the nursing homes, most of the residents spent at least 17 hours a day in bed. Further study of activity and mobility care and bedfast outcomes in nursing homes is needed, and nurses need to note the amount of time nursing home residents spend in bed.

Predictors of Varying Levels of Nonadherence to Mammography Screening in Older Women

Objectives: To identify predictors of varying levels of nonadherence to mammography screening in older women.

Network Composition and Health Behaviors Among Older Samoan Women

Purpose: The purpose of this article is to explore how kin and nonkin social support networks influence health behaviors among older Samoan women. Method: Using a cross-sectional survey design, 290 Samoan women who were age 50 years and older were interviewed. Using separate logistic regressions, each health behavior was regressed on age and kin and nonkin social support networks after controlling for background characteristics and health status. Results: In multivariate analyses, higher scores on kin increased the likelihood of never salting food, getting screened for diabetes in the past year, and having had a mammogram in the past 2 years, whereas higher scores on nonkin increased the likelihood of exercising at all and ever trying to lose weight. Discussion: Kin networks positively affect mostly chronic disease-related health behaviors, whereas nonkin networks positively affect mostly lifestyle-related health behaviors.

Family Caregiver Involvement and Satisfaction With Institutional Care During the 1st Year After Admission

The purpose of this research is to examine the relationship between caregivers’ involvement and their satisfaction with institutional care during the 1st year. This panel study includes 145 care-givers. A summary indicator of satisfaction was analyzed (a) near admission and (b) for change 1 year after admission. Caregivers were least satisfied with physicians and the number of staff at both time points. Satisfaction at admission and change in satisfaction from admission to 1 year later were regressed on caregivers’ involvement after controlling for caregivers’ depression, family tension, and perceived behavioral problems of their relatives. Multivariate results indicated that more involved caregivers at admission were less satisfied with institutional care at admission and became less satisfied during the year after admission. More involved caregivers may be less satisfied because they see firsthand problems with nursing home care and because a meaningful caregiving role after institutionalization is not facilitated by nursing homes.

Parks for an Aging Population: Needs and Preferences of Low-Income Seniors in Los Angeles

Problem, research strategy, and findings: Parks provide important physiological and psychological benefi ts to seniors, improving their quality of life; they are particularly important for low-income, inner-city seniors who lack access to open and green space. However, seniors do not often use parks partly because park design and programming are not responsive to their diverse needs and values. To identify what low-income, inner-city seniors seek and value in neighborhood parks, and to provide guidance to planners on how to better design senior-friendly parks, we conducted a literature review and held focus groups with 39 low-income, ethnically diverse seniors in an inner-city neighborhood in Los Angeles (CA). We asked these seniors about their preferences as well as the challenges and barriers they encounter in using neighborhood parks. Seniors report many impediments to park use; they are not provided appropriate programming that allows opportunities for socializing, safety, and security within the park and along access routes; opportunities for exercise and walking; and aesthetic and natural elements that provide contact with nature. Takeaway for practice: Park planners and designers should seek to incorporate senior voices in park design and programming in four ways by developing appropriate programming sensitive to diverse needs, accommodating the desire for “seniors-only” parks, promoting security and safety in the park and along access routes, and offering open and green space. We also fi nd the need for additional research on seniors from different racial and ethnic backgrounds.

Individualized Care in Practice: Communication Strategies of Nursing Aides and Residents in Nursing Homes

Individualizing care in nursing homes can be difficult and complex. The purpose of this study is to characterize the meaning of and experiences with individualized care from the perspectives of both nursing aides and nursing-home residents. Eight focus groups of nursing aides (N =17) and residents (N=15) from two nursing homes generated four dialectical themes related to communication strategies: (a) getting to know versus maintaining a protective distance, (b) mutual respect versus disrespect, (c) avoiding versus addressing conflict, and (d) equity versus perceived favoritism. These findings suggest dialectics in how interpersonal communication affects individualized care from the perspectives of both nursing aides and residents.