Nancy Bergstrom

The National Pressure Ulcer Long-Term Care Study: Pressure ulcer development in long-term care residents

Objectives: To identify resident, treatment, and facility characteristics associated with pressure ulcer (PU) development in long‐term care residents.

Description of the National Pressure Ulcer Long-Term Care Study

OBJECTIVES: To describe and provide baseline data from The National Pressure Ulcer Long‐Term Care Study (NPULS).

The National Pressure Ulcer Long‐Term Care Study: Outcomes of Pressure Ulcer Treatments in Long‐Term Care

Objectives: To identify resident, wound, and treatment characteristics associated with pressure ulcer (PrU) healing in long‐term care residents.

Sleep in Hospitalized Elders: A Pilot Study

Hospitalized elders frequently experience disturbed sleep related to environmental factors. To determine relationships between sleep and environmental noise and light, a descriptive exploratory study was conducted with 48 hospitalized older adults. Participants aged 70 years or older were monitored for sleep via wrist actigraphy, and noise and light levels were measured the first night of hospitalization. Sleep time was brief (mean, 3.75 hours) and fragmented (mean, 13 awakenings per night). The sleep environment was noisy with a median sound level of 49.65 dB(A). There was an average of 3 periods of elevated light levels (mean, 64 lux) lasting an average of 1.75 hours each night. No significant correlation was found among sleep and age, light, and sound. Recommendations include light and sound reduction measures and dedicated do not disturb times to allow for a full 90-minute sleep cycle.

Endogenous Sex Hormones and Cognitive Function in Older Adults A Systematic Review

Estrogen and testosterone may influence cognition in older adults, but the relationship between sex hormones and cognitive function is complex. The aim of this systematic review is to examine the role of sex hormones in cognitive function among older adults. A comprehensive, electronic review of literature was performed. Inclusion criteria were original quantitative research, written in English, used human subjects with a mean age of ≥60 years, and published from January 1997 through May 2012. Findings were mixed, although potential patterns were identified. Estradiol levels were potentially associated with benefits to episodic memory, semantic memory, verbal memory, and verbal learning in females only. The association between testosterone and cognitive function was mixed in both genders. Mixed findings may have been influenced by methodological differences and future studies should include research designs with ample rigor, sufficiently powered samples, consistent cognitive measurements, and clear descriptions of handling and storage of biological specimens.

Surviving the Storms: Emergency Preparedness in Texas Nursing Facilities and Assisted Living Facilities

This study assesses the preparedness of long-term care facilities in Texas responding to Hurricanes Katrina and Rita. A 41-item questionnaire was mailed to facilities; the response rate was 42%. Among responding facilities, 4513 residents were evacuated, and 6% of respondents reported resident death. Financial losses were reported by 8% of nursing facilities and 45% of assisted living facilities due to transportation and staff overtime. Respondents indicated the need for improved disaster preparednesstraining, better coordination, and transportation. Changes in policy and practice will lead to better trained staff who will provide the care residents need for improved health outcomes during future public health disasters.

Lower Urinary Tract Symptoms and Erectile Dysfunction in Men With Type 2 Diabetes Mellitus

Purpose To assess the prevalence of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) and the relationships between LUTS, ED, depression, and other factors in Korean men with type 2 diabetes mellitus (T2DM). Methods This cross-sectional study included 124 male patients with T2DM who attended a university hospital diabetes clinic between October 2010 and April 2012. Data were collected using structured interviews and chart reviews. LUTS were measured using the International Prostate Symptom Score (IPSS), ED using the five-item Korean version of the International Index of Erectile Function (IIEF), depression using the Center for Epidemiologic Studies Depression Scale, and glycosylated hemoglobin level from clinical data. Results The IPSS score was 9.2±6.6. The total IPSS scores indicated that 53.3% of the subjects had either moderate or severe symptoms. The mean IIEF score was 7.3±8.6, indicating the severity of ED to be mild, mild to moderate, moderate, and severe in 10.5%, 9.7%, 1.6%, and 66.9% of the participants, respectively. LUTS showed a significant negative correlation with ED (r=-0.26, P=0.003) and a significant positive correlation with depression (r=0.33, P<0.001). ED was negatively correlated with age (r=-0.44, P<0.001), duration of diabetes (r=-0.26, P=0.004), and depression (r=-0.24, P=0.008). Conclusions LUTS and ED were found to have a high prevalence among Korean men with T2DM. More severe ED was associated with worse LUTS, whereas more severe depressive symptoms were found to be associated with more severe ED and LUTS.

Contribution of skin temperature regularity to the risk of developing pressure ulcers in nursing facility residents.

OBJECTIVES: The purpose of the study was to determine whether characterizing skin temperature regulation as a functional property of the skin as it relates to tissue tolerance improves the clinicians understanding of pressure ulcer risk prediction. DESIGN: A 2-group time-series design was used to observe skin temperature regularity (entropy) and self-similarity (spectral exponent). METHODS: Twenty nursing facility residents wore skin temperature monitors continuously for 5 days. One bathing episode was observed because bathing is a commonly occurring care procedure. PRIMARY OUTCOME MEASURE: Difference in skin temperature multiscale entropy and spectral exponent by risk category and pressure ulcer outcome. RESULTS: Multiscale entropy (MSE) for skin temperature was lowest in those who developed pressure ulcers, F1,18 = 35.14, P < .001. Skin temperature mean MSE, F1,17 = 5.55, P = .031 and the skin temperature spectral exponent, F1,17 = 6.19, P = .023 differentiated the risk groups. The change in skin temperature entropy during bathing was significant, t(16) = 2.55, P = .021. CONCLUSIONS: Skin temperature MSE and the spectral exponent were significantly different between low-risk and higher risk residents and residents who did and did not develop pressure ulcers. The study supports measurement of skin temperature regulation as a component of tissue tolerance to pressure.

Comparison of Commonly Used Placement Sites for Activity Monitoring

Background: No accepted standard exists to evaluate nonsleep-related activity in nursing facility residents where monitors are variously placed at the ankle, waist, wrist, thigh, or embedded in sheeting and set to record activity frequency. Objectives: To determine optimal placement of activity monitors by site—at the ankle, waist, or wrist for nursing facility residents. Methods: Nursing facility residents (N = 16) wore accelerometers at three sites: the nondominant ankle, waist, and wrist, while recording activity in three modes: frequency, duration, and intensity. Results: The natural log activity mean for each mode by site and time revealed no significant differences between the three sites for activity intensity, F(2, 62.78) = .15, p = .86; activity duration, F(2, 69.84) = .50, p = .61; and activity frequency, F(2, 70.04) = 1.25, p = .29. There were no significant site—time interactions. The natural log activity by site and mode indicated no significant differences by site for the 24-hr mean, F(2, 107.64) = .20, p = .82; activity median, F(2, 100.42) = .47, p = .63; and activity standard deviation, F(2, 108.69) = 1.5, p = .23. A significant difference was seen by site for the acceleration index, F(2, 106.32) = 9.57, p < .001. No significant site—mode interactions were found. Conclusions: Similarity between ankle, waist, or wrist sites when measuring activity by various modes, frequency, duration, or intensity, suggests the monitors measure nonsleep-related activity equally well at any of the sites.

An Evidence-Based Cue-Selection Guide and Logic Model to Improve Pressure Ulcer Prevention in Long-term Care.

Pressure ulcers have consistently resisted prevention efforts in long-term care facilities nationwide. Recent research has described cueing innovations that—when selected according to the assumptions and resources of particular facilities—support best practices of pressure ulcer prevention. This article synthesizes that research into a unified, dynamic logic model to facilitate effective staff implementation of a pressure ulcer prevention program.