Susan Harms

Prevalence and correlates of perineal dermatitis in nursing home residents

Background: Perineal dermatitis is an adverse outcome of incontinence, which is common in older nursing home residents; yet knowledge about perineal dermatitis in this population is sorely lacking. Objectives: To determine the prevalence and significant correlates of perineal dermatitis in older nursing home residents. Methods: Assessment data from 59,558 records in the Minimum Data Set (MDS) were linked with 2,883,049 orders in the medical record which enabled definition of variables related to perineal dermatitis, identification of cases, and determination of the prevalence of perineal dermatitis. Data from two subsamples, each with the records of 10,215 older nursing home residents, were analyzed using logistic regression to identify the significant correlates of perineal dermatitis. Results: Perineal dermatitis was found in 5.7% (n = 3,405) of residents and 73% of these were incontinent. Having perineal dermatitis was significantly associated with (a) impairments in tissue tolerance (i.e., more health problems, presence of a fever, requiring nutrition support, and having more problems of diminished perfusion or oxygenation); (b)problems of the perineal environment (i.e., having fecal incontinence only, double incontinence, and more items associated with mechanical chafing); and (c) altered toileting ability from daily use of restraints. Discussion: Several correlates of perineal dermatitis (mechanical chafing, fecal and double incontinence, and use of restraints) appear modifiable through nursing intervention. Clinical interventions should consider the complex health status of this population.

Antiepileptic drug use in nursing home admissions

Although 1 of 10 nursing home residents is taking an antiepileptic drug (AED), no study to our knowledge has determined whether most residents are already receiving AED treatment when they are admitted or are given these drugs afterward. That differentiation was the focus of this study. The study group consisted of 10,318 residents, 65 years and older, admitted to 510 nursing homes located throughout the United States during the first quarter of 1999. AED prevalence at admission was 7.7%; three fifths had an epilepsy/seizure indication. In a multivariate analysis, factors associated with AED use at admission included epilepsy/seizure, bipolar depression, age group, and cognitive performance. In the follow‐up cohort (N = 9,516), postadmission initiation of AEDs was 2.7%; one fifth had an epilepsy/seizure indication. In the multivariate analysis, factors associated with postadmission AED initiation included epilepsy/seizure indication, bipolar depression, age group, peripheral vascular disease, and cognitive performance. This rate of AED postadmission initiation within the first 3 months of admission was much higher than expected, suggesting that new symptoms may develop after admission. Results also show that the rate of AED use in nursing homes is not static. Ann Neurol 2003;54:000–000

Prevalence of Incontinence by Race and Ethnicity of Older People Admitted to Nursing Homes

OBJECTIVE While admissions of minorities to nursing homes (NHs) are increasing and prevalence of incontinence in NHs remains high, little is known about incontinence among racial-ethnic groups of NH admissions other than blacks. The purpose of this study was to describe the prevalence of incontinence among older adults admitted to NHs by race/ethnicity at three levels of measurement: individual resident, NH, and Census division. DESIGN Cross-sectional and descriptive. PARTICIPANTS AND SETTING Admissions of persons age 65 or older to 1 of 457 NHs of a national, for-profit chain over 3 years 2000-2002 (n = 111,640 residents). METHODS Data sources were the Minimum Data Set v. 2.0 and 2000 US Census. Prevalence of the following definitions of incontinence was analyzed: Only Urinary Incontinence (UI), Only Fecal Incontinence (FI), Dual Incontinence (DI; UI and FI), Any UI (UI with or without FI), Any FI (FI with or without UI), and Any Incontinence (UI and/or FI and/or DI). RESULTS Asian patients, black patients, and Hispanic patients had a higher prevalence of Any Incontinence (67%, 66%, and 58%, respectively) compared to white patients (48%) and American Indian patients (46%). At the NH level, all prevalence measures of incontinence (except Only UI) appear to trend in the opposite direction from the percentage of NH admissions who were white. Among Asian and white patients, there was a higher prevalence of all types of incontinence in men compared with women except for Only UI. Among Census divisions, the prevalence of all types of incontinence, except Only UI, was lowest in the 2 divisions with the highest percentage of white admissions to their NHs. CONCLUSIONS NHs admitting more racial/ethnic minorities may be faced with managing more incontinence and needing additional staffing resources. The association of the prevalence of most types of incontinence with the race/ethnicity of NH admissions at all levels of measurement lend support to the growing evidence that contextual factors beyond individual resident characteristics may contribute to NH differences.

Prevalence of Appropriate and Problematic Antiepileptic Combination Therapy in Older People in the Nursing Home

Objectives: To determine the prevalence of mono‐ and poly‐antiepileptic drug (AED) therapy in a cohort of nursing home (NH) residents and to describe specific AED combinations used, as well as demographic, clinical, and functional factors associated with poly‐AED therapy and the most common AED combination.

Ginkgo biloba Use in Nursing Home Elderly with Epilepsy or Seizure Disorder

Summary:  Purpose: Ginkgo biloba, among the most widely used herbs, possesses the capacity both to induce and to inhibit seizures. The purpose of this study was to describe the prevalence of ginkgo and other common herb prescribing in a sample of nursing home (NH) elderly diagnosed with epilepsy/seizure (Epi/Sz) disorder and to determine demographic, clinical, and functional factors associated with ginkgo use.

Use of Antiepileptic Medications In Nursing Homes

The University of Minnesota Epilepsy Research and Education Program published two studies evaluating the use of antiepileptic drugs (AEDs) among nursing home (NH) elderly. The studies used a large, nongovernmental data set for studying this population. This chapter is a summary of those two studies. In the first study, a 1-day point prevalence study, 10.5% of the NH residents had one or more AED orders, a prevalence 10 times greater than that found in the community. In a multivariate analysis of factors associated with AED treatment, seizure indication was the most important factor, and age was inversely related to AED use. Phenytoin was the most commonly used AED, followed by carbamazepine, phenobarbital, and valproic acid. The most frequently used combination was phenytoin and phenobarbital. In the second study, evaluating NH admission data, 8% of newly admitted residents were already receiving one or more AEDs when they entered the NH. Factors associated with AED use in this group included epilepsy/seizure disorder, age, cognitive performance, and manic depression (bipolar disease). Among residents recently admitted who were not using an AED at entry, 3% were initiated on an AED within 3 months of admission. Among the factors associated with the initiation of AEDs during this period, the strongest association was with epilepsy/seizure disorder. Manic depression (bipolar disease) was also significantly associated with initiation of an AED after admission. In this group, there was an inverse relationship between age and initiation of an AED.

Prevalence of Pressure Ulcers by Race and Ethnicity for Older Adults Admitted to Nursing Homes

Little is known about the prevalence of pressure ulcers (PUs) among racial and ethnic groups of older individuals admitted to nursing homes (NHs). NHs admitting higher percentages of minority individuals may face resource challenges for groups with more PUs or ones of greater severity. This study examined the prevalence of PUs (Stages 2 to 4) among older adults admitted to NHs by race and ethnicity at the individual, NH, and regional levels. Results show that the prevalence of PUs in Black older adults admitted to NHs was greater than that in Hispanic older adults, which were both greater than in White older adults. The PU rate among admissions of Black individuals was 1.7 times higher than White individuals. A higher prevalence of PUs was observed among NHs with a lower percentage of admissions of White individuals. [Journal of Gerontological Nursing, 40(3), 20-26.].

Are there racial-ethnic disparities in time to pressure ulcer development and pressure ulcer treatment in older adults after nursing home admission?

Objective: The objective of this study was to assess whether there are racial and ethnic disparities in the time to development of a pressure ulcer and number of pressure ulcer treatments in individuals aged 65 and older after nursing home admission. Method: Multi-level predictors of time to a pressure ulcer from three national surveys were analyzed using Cox proportional hazards regression for White Non-Hispanic residents. Using the Peters–Belson method to assess for disparities, estimates from the regression models were applied to American Indians/Alaskan Natives, Asians/Pacific Islanders, Blacks, and Hispanics separately resulting in estimates of expected outcomes as if they were White Non-Hispanic, and were then compared with their observed outcomes. Results: More Blacks developed pressure ulcers sooner than expected. No disparities in time to a pressure ulcer disadvantaging other racial/ethnic groups were found. There were no disparities in pressure ulcer treatment for any group. Discussion: Reducing disparities in pressure ulcer development offers a strategy to improve the quality of nursing home care.

Time to and predictors of dual incontinence in older nursing home admissions

There are few studies of nursing home residents that have investigated the development of dual incontinence, perhaps the most severe type of incontinence as both urinary and fecal incontinence occur. To determine the time to and predictors of dual incontinence in older nursing home residents.

Racial disparities in primary prevention of incontinence among older adults at nursing home admission.

Maintaining continence of nursing home (NH) residents promotes dignity and well‐being and may reduce morbidity and healthcare treatment costs. To determine the prevalence of older continent adults who received primary prevention of incontinence at NH admission, assess whether there were racial or ethnic disparities in incontinence prevention, and describe factors associated with any disparities.