Patricia K. Suggs

The Association of Depressive Symptoms and Urinary Incontinence Among Older Adults

OBJECTIVES: To examine the relationship of urinary incontinence (UI) and depressive symptoms (DS) in older adults.

The quality of life of older adults with urinary incontinence: determining generic and condition-specific predictors.

Urinary incontinence (UI) is an unpleasant problem for many adults. This study determined the importance of demographic, health and incontinence variables for the generic and incontinence-specific quality of life (QoL) of older adults (age ≥ 60 years). Telephone surveys of adults reporting at least weekly episodes of UI (n = 435) were conducted as part of a randomized, controlled trial. Logistic regression analyses showed that the predictors of generic and incontinence-specific QoL differed. Life satisfaction, a generic outcome, was predicted by education, the number of days in bed due to health problems, the number of days not feeling well and the amount of urine lost. Generic health was related to education, the number of days sick in the previous 30 days and the number of days health issues restricted activities. The incontinence-specific QoL outcomes were predicted by age, mobility difficulties, the amount of urine lost, the frequency of UI, and the number of daytime and night-time voids. The specific QoL measures provide a different profile of those most affected in this sample than that obtained by the generic measures. The most affected are younger persons with severe urine loss. Older persons may have other conditions impinging on QoL and may have adapted behaviourally and psychologically to urine loss.

The effects of implementation of the agency for health care policy and research urinary incontinence guidelines in primary care practices

OBJECTIVES: To determine whether a multifaceted intervention based on the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guidelines for Urinary Incontinence would increase primary care physician screening for and management of urinary incontinence (UI).

Efficacy of a self-instruction package when compared with a traditional continuing education offering for nurses

&NA; Expanding knowledge relevant to health disciplines due to advances in medical science and practice intensifies the needs of health care professionals for continuing education (CE). Traditional methods, such as workshops, do not always result in rapid dissemination of information and/or achievement of low costs. This is especially true for those providers in isolated/rural areas. The key question for this study is: Does a multimedia, self‐instruction educational package provide the same or similar learning results as received from a conventional CE conference? Also, which method is the most economically feasible? In both the traditional CE offering and the self‐instruction learning package, statistical improvement in scores was observed. Costs for the self‐directed approach, while more expensive up front, could prove, depending upon the situation, to be more economical in the long run. These results show that self‐instruction learning packages can be viable alternatives to workshops and conferences, saving time and money for the health professional.

Research partnership with underserved African-American communities to improve the health of older persons with disability: a pilot qualitative study

Background and aims: Underserved ethnic minorities are often under-represented in clinical investigations, often in the context of poor relationships between academic institutions and their minority communities. The aim of this study was to investigate an African-American community’s perceptions about the barriers that hinder participation in research studies and, more broadly, on the status of institution/community relationships. Methods: We conducted a pilot qualitative study, based on semi-structured interviews of leaders of African-American communities in Winston-Salem, North Carolina. Relevant themes were abstracted from the interviews by a standardized iterative process. Results: Interviewees identified barriers to participation of African-Americans in research, and suggested that existing barriers may be overcome with an innovative model of a community/institution relationship, which would include open communication and cooperation, mutually beneficial programs, holistic approaches to health and disease, participatory and balanced partnerships with communities, and the establishment of multiethnic advisory boards. Conclusions: This study suggests strategies that public health researchers should consider to establish effective institution/community relationships, in order to enhance participation of underserved ethnic minorities in research studies, and to improve the health status of their most disabled and demanding seniors.

The Understanding and Creation of Rituals: Enhancing the Life of Older Adults

ABSTRACT We live in a rapidly changing culture, often with a loss of identity, community, and meaning. Rituals can give us a foundation, that sense of stability we need as we tackle the challenges and opportunities that confront us on a daily basis. Rituals must be grounded in understanding developed through particular attention to the meaning of the aging process in the context of the life span. The purpose of this article is to discuss the meanings of rituals and to present a simple method for creating rituals that can add meaning to the lives of older adults.

GERIATRIC FOOT CARE: A MODEL EDUCATIONAL PROGRAM FOR MID-LEVEL PRACTITIONERS

Studies have indicated that at least 80% of those over age 50 have at least one foot problem. Feet often reflect systemic disease conditions, especially since this population has a higher prevalence of chronic diseases such as atherosclerosis and diabetes. As a result of a needs assessment completed by nurse practitioners, the Appalachian Geriatric Education Center developed a model educational program in the area of geriatric foot care for mid-level practitioners. The program is designed to prepare the mid-level practitioner with the education and skills necessary to provide foot care to adults and elderly clients in the community. The program includes both didactic and clinical learning experiences with topics such as anatomy, physical assessment, management of minor conditions, and referral for specialty care. The total number of students who have completed the course is 72: 59 nurse practitioners; 12 physician assistants; and 1 physician. There was a significant difference in the pre- and post-test scores, with the post-test scores being significantly higher: t = -13.446, p < .000. In the follow-up evaluation, the majority of the participants said they incorporated what they learned into their clinical practices and have increased their referral base to podiatrists and orthopedic surgeons.

RESTORATIVE (GERIATRIC SUBACUTE) CARE: THE EDUCATIONAL COMPONENT

Rural hospitals face difficult times as Medicare health insurance threatens their survival. A small community in Polk County, North Carolina, developed a program that was designed to take advantage of the Medicare skilled nursing benefit as a payment source and which can be implemented by any rural hospital that has Medicare-certified swing beds or distinct nursing facilities. This program involves the development of a special unit, the Restorative Care Unit (RCU), which provides subacute care to older adults. A major element in the RCU care system is a highly structured continuing education program for hospital staff. The continuing education component trains personnel to implement and manage the RCU care system using a team approach. The Appalachian Geriatric Education Center Consortium recognized the need for dissemination of this model of service. They took the concept, developed a curriculum and implemented it with eight rural hospitals. The purpose of this article is to describe in detail the RCU ca...

Book Reviews : Diane Wiatt Rich, Thomas A. Rich, and Larry C. Mullins (Eds.), Old and Homeless—Double Jeopardy. Westport, CT: Auburn House, 1995.

With the increasing numbers of homeless persons in the United States, Old and Homeless-Double Jeopardy comes at a very appropriate time. It provides an excellent overview of the homeless condition: its beginnings, the primary conditions under which homeless persons live, the compounded problem of being old and homeless, and interventions that have worked, as well as new interventions that have great potential. Old and Homeless-Double Jeopardy was initiated by the Retirement Research Foundation, which funded a project in 1991 to develop, test, and evaluate a national model training program for those working with older homeless adults. Participating institutions included the Department of Aging and Mental Health, the Center for Applied Gerontology, and the Department of Gerontology, University of South Florida. The examination of homelessness in Florida was an excellent choice for this

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Effective continuing education for health professionals occurs only when there are strong and stable resources available. In the current environment, these resources seem anything but stable. Education and training of service providers appears to be secondary to funding for basic services, therefore, educational institutions and agencies must be creative in order to acquire the resources necessary to continue to meet the needs for trained personnel who will provide health services for older adults. This is most likely to occur when educational collaborations are formed. The purpose of this article is to demonstrate the efficacy of Area Health and Geriatric Education Centers working collaboratively. A partnership between these two entities will insure a stronger resource base from which to offer high quality continuing education in the area of geriatrics and gerontology.