Teresa C. McCarthy

Randomized, placebo-controlled trial of the cognitive effect, safety, and tolerability of oral extended-release oxybutynin in cognitively impaired nursing home residents with urge urinary incontinence.

OBJECTIVES: Determine the cognitive effect, safety, and tolerability of oral extended‐release oxybutynin in cognitively impaired older nursing home residents with urge urinary incontinence.

Update on drug-related problems in the elderly

BACKGROUND Although pharmacotherapy for the elderly can treat diseases and improve well-being, its benefits can be compromised by drug-related problems. OBJECTIVE This article reviews recent publications concerning drug-related problems in the elderly, as well as articles describing the development of 3 sets of quality indicators for medication use in the elderly. METHODS Relevant articles were identified through a search of MEDLINE (2002-March 2003) for articles on drug-related problems, inappropriate prescribing, and adverse drug events in the elderly. RESULTS The review included 7 articles published in 2002 and 2003. A study in ambulatory elderly persons reported that approximately 5.0% of patients had > or =1 adverse drug event within the previous year. Another study found that approximately 20.0% of ambulatory elderly persons used > or =1 inappropriate drug, as defined by drug utilization review (DUR) criteria, with drug-disease interactions and duration of use being the most common drug-related problems. A third study involving elderly individuals in assisted living facilities found that 16.0% used > or =1 inappropriate drug, as defined by the Beers criteria. Another study examined whether inappropriate drug use, as defined by the Beers or DUR criteria, was associated with death or a decline in functional status; it found that only use of drugs defined as inappropriate by DUR criteria (particularly those drugs associated with drug-drug or drug-disease interactions) was associated with a decline in the ability to perform basic self-care. Three studies, 1 from the United States, 1 from the United Kingdom, and 1 from Canada, described consensus development of quality indicators for drug use in the elderly, including drugs to avoid, maximum daily dose, drug duplication, limits on duration of use, drug-drug and drug-disease interactions, need for drug monitoring, underuse of necessary drugs to treat or prevent common problems, and inappropriate drug-administration technique. CONCLUSIONS Drug-related problems are common in elderly patients. Data from recently published studies provide guidance to practitioners and directions for future research.

Improving geriatric transitional care through inter-professional care teams

OBJECTIVES The aim of this study was to examine the impact of the use of an inter-professional care team on patient length of stay and payer charges in a geriatric transitional care unit. METHODS An analysis of de-identified administrative records for transitional care patients for the 12-month period (2003-2004) cared for by the inter-professional team (n = 163) and cared for by traditional single provider care model (n = 176) was carried out. We conducted logistic regression on length of stay and charges controlling for patient demographics and acuity levels. RESULTS The inter-professional care team patients had significantly shorter lengths of stay, fewer patient days and lower total charges. Patient diagnosis and acuity were similar across groups. CONCLUSION This study provides empirical evidence of the impact of an inter-professional care model in providing cost-effective transitional care in a nursing home setting. Evidence of shorter lengths of stay, shorter patient days and lower charges suggests benefit in the development and financing of inter-professional care teams for transitional care services.

Factors associated with toileting disability in older adults without dementia living in residential care facilities

Background:Older adults without dementia living in residential care facilities with toileting disability have increased care costs and dependency. Understanding associated factors could guide prevention and management strategies. Objective:The aim of this study was to identify the prevalence of and factors associated with toileting disability in this population. Methods:This was a cross-sectional analysis of the 2010 National Survey of Residential Care Facilities. A subsample (n = 2,395) of adults aged 65 years or older, without dementia, and with the potential to implement behavioral interventions was examined. Associated factors were classified according to the disablement process as pathologies, impairments, functional limitations, coexisting disabilities, and intraindividual and extraindividual factors. Logistic regression models accounting for the stratified two-stage probability sampling design were used to identify factors associated with toileting disability. Results:Residents were mostly White women, aged 85 years and older. Prevalence of toileting disability was 15%. Associated factors included reporting fair or poor health; living in a facility with four or less residents; living in a for-profit facility; having bowel incontinence, urinary incontinence, more physical impairments, and visual and hearing impairments; and needing assistance with bathing, dressing, and transferring. Discussion:Multicomponent and multidisciplinary prevention and management efforts should be designed for residents without dementia. Future studies testing the efficacy of prevention efforts are needed and should include treatments for incontinence; physical activity programs targeting impairments with walking, standing, sitting, stooping, reaching, and grasping; and therapy to improve dressing, bathing, and transferring skills.

Defeating Urinary Incontinence with Exercise Training: Results of a Pilot Study in Frail Older Women

To determine whether combining behavioral urinary incontinence (UI) treatments with physical activity improves UI in frail older women.

Reliability and Validity of Two Measures of Toileting Skills in Frail Older Women Without Dementia.

Urinary incontinence (UI) affects 43% of frail, community-dwelling older women and threatens their independence. For these women, remaining continent depends on their ability to toilet. Treatments should include improving toileting skills. However, reliable and valid measures of toileting skills are not available to evaluate treatment efforts in this population. The current cross-sectional study of 24 frail older women (average age = 87 years) examines the reliability and concurrent validity of the Performance Oriented Timed Toileting Instrument (POTTI) and self-reported Minnesota Toileting Skills Questionnaire (MTSQ). The POTTI demonstrated strong interrater reliability (0.97) and the MTSQ demonstrated good internal consistency (Cronbach;s alpha = 0.82). Both measures had statistically significant correlations with frailty, physical performance, UI-related quality of life, and UI self-efficacy. Both instruments demonstrated good psychometric properties and show promise as outcome measures for UI clinical trials. Further work is needed to establish their responsiveness to change and minimum clinically important difference values. [Journal of Gerontological Nursing, xx(x), xx-xx.].

Antidiabetic Drug Therapy of African-American and White Community-Dwelling Elderly Over a 10-Year Period

Objectives: To determine the prevalence and predictors of antidiabetic medication use over a 10‐year period in a general population of African‐American and white community‐dwelling elderly.