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Biomedical subjects

B W Rovner

Publications and source records attributed to B W Rovner.

At least 37 records · Page 2Linked to original sources
PubMed1995

Neuroleptic use and behavioral disturbance in nursing homes: a 1-year study.

This article discusses a longitudinal study of change in disruptive behaviors among nursing home residents treated with neuroleptics compared with those not treated with neuroleptics. Observations were made of 201 participants on admission to and after 1 year in eight skilled nursing facilities. Nine disruptive behaviors were measured using the Psychogeriatric Dependency Rating Scale with nursing assistants. Neuroleptic use was documented from medication records. Odds ratios are reported for the association of behavior at baseline and use of neuroleptics on nine problem behaviors. For those who received neuroleptics during the year, there was greater change in both developing and resolving disruptive behaviors than for those not receiving neuroleptics. For both groups, restless or pacing behavior and belligerent behavior manifested by refusing instructions changed the most, both in developing and in apparently resolving. Our results show that change in disruptive behaviors occurs among nursing home residents regardless of neuroleptic use, but it occurs more frequently among those who receive neuroleptic medication. Knowledge of which disruptive behaviors are most likely to resolve or develop is important in training nursing home staff to cope with the behaviors as well as in planning interventions that may modify such behaviors.

Adult↗
PubMed1994

Benzodiazepine utilization in a university hospital.

OBJECTIVE: To assess benzodiazepine utilization and documentation in hospitalized medical and surgical patients in relation to demographic characteristics. METHODS: Retrospective review of computerized university hospital database and medical records. SUBJECTS: 6,020 consecutive medical and surgical admissions from January through June 1992. MEASUREMENTS: Utilization of four commonly prescribed benzodiazepines (Halcion, Ativan, Valium, Xanax) in relation to age, race, sex, length of stay, hospital service; and documentation of indications for use. RESULTS: 2,491 patients (41.4%) were prescribed a benzodiazepine during their hospital stay. Patients over 65 were as likely to receive a benzodiazepine as younger patients. Benzodiazepine utilization was associated with admission to a surgical compared to a medical service (49.0% vs. 37.3%, P < .001), race (white 45.7% vs. non-white 29.9%, P < .001) and length of stay (11.8 days vs. 6.8 days, P < .001). Review of 30 medical and 30 surgical medical records revealed no documentation of purpose for benzodiazepine use other than as a preanesthetic agent in 23 (38.3%) cases. CONCLUSIONS: Benzodiazepines are widely prescribed in the hospital setting in the absence of appropriate documentation. Older patients are as likely to receive benzodiazepines as younger patients, despite the known morbidity associated with their use in this population. Differences in prescribing practices by race, the longer length of stay among patients receiving benzodiazepines, and the appropriate use of benzodiazepines in the elderly require further study.

Adult↗
PubMed1993

Depression and increased risk of mortality in the nursing home patient.

Depression is a common clinical syndrome in the elderly, often resulting in attempted and/or successful suicide. Within the community and in a wide range of medical care settings, including nursing homes, depression is often undiagnosed and untreated. In a 1-year investigation that included 454 new patient admissions to eight Baltimore area nursing home facilities, major depressive disorder occurred in 12.6% of patients; an additional 18.1% had depressive symptoms. Most cases of depression were unrecognized and therefore untreated by nursing home physicians. Major depressive disorder was found to be an independent risk factor for mortality that increased the likelihood of death by 59% in the first year after diagnosis. Because new federal regulations now mandate the assessment of depression in nursing home patients, improved diagnosis and therapy (and therefore reduced disability and mortality) may be expected in the future.

Aged↗
PubMed1993

Urinary incontinence in nursing homes: incidence, remission and associated factors.

OBJECTIVE: To determine the incidence and remission rates of daytime urinary incontinence (UI) in a cohort of newly admitted nursing home (NH) residents. DESIGN: Prospective cohort study. SETTING: Eight proprietary NHs in Maryland. SUBJECTS: Four hundred thirty new admissions age 65 or older who were participants in a larger prospective study of mental morbidity and adjustment to the NH. MEASURES: Nurses aides' reports of continence status, psychiatric examinations, and nursing staff assessments of mobility at 2 weeks, 2 months, and 1 year after NH admission. RESULTS: The prevalence of daytime UI at admission was 39% in both females and males. Among the 293 members (68%) of the admission cohort remaining in the NHs 2 months after admission, the incidence of daytime UI was 27% (21% in females, 51% in males); daytime UI resolved in 23% (24% in females, 20% in males). Among the 178 members (41%) of the admission cohort remaining in the NHs 1 year after admission, the incidence of daytime UI between 2 months and 1 year after admission was 19% (16% in females, 46% in males); daytime UI resolved in 22% (23% in females, 14% in males). The continence status of about two-thirds of residents remaining in the NH at 1 year after admission was stable over time: 22% had daytime UI, and 42% were continent at all three data collection points. The development of daytime UI was associated with male sex, the diagnosis of dementia, fecal incontinence, and the inability to ambulate or transfer independently. Resolution of daytime UI was associated with the absence of these characteristics. CONCLUSIONS: Despite limitations attributable to the method of defining UI and potential biases related to the attrition of the admission cohort over time, this is the first large prospective study to examine the incidence and remission patterns of daytime UI among NH residents. The strong association between UI and dementia was validated for the first time by direct psychiatric examinations. Sex and mobility are also closely associated with the development and remission of UI in this setting. This study provides some valuable data that can be used to assess the impacts of the recently developed Resident Assessment Protocol for UI and Agency for Health Care Policy and Research Clinical Practice Guidelines.

Activities of Daily Living↗
PubMed1992

The role of mental morbidity in the nursing home experience.

The history of a newly admitted cohort to eight nursing homes (N = 454) was studied prospectively over the first year of residence. Data were gathered at admission, 2 months, and 1 year, and included full psychiatric examination and staff reports of behavior. Chart reviews collected additional data on preadmission and postdischarge information. At admission, 80% of the population had mental illnesses, 60% of which were dementia, and about half of demented patients had other complicating mental illnesses. Use of mixed-effects linear model analysis revealed significant associations of mental morbidity, restraints, and psychotropic medication with behaviors indicative of noncoping and nonadaptation to the nursing home settings.

Adaptation, Psychological↗
PubMed1992

A longitudinal approach to modeling outcomes in a nursing home study.

Recent developments in longitudinal statistical methodology have improved our ability to model dynamic processes such as adaptation to nursing homes. Longitudinal observations provide information on individual patterns of change and factors affecting them. However, longitudinal analyses are often complicated by unequal periods of observation and individual variability in patterns of change. This paper demonstrates the use of a linear mixed-effects model to study adaptation in a longitudinal nursing home study with different numbers of repeated measurements for each individual because of discharges, transfers, and mortality.

Adaptation, Psychological↗
PubMed1992

Mental illness and the use of restraints in nursing homes.

Using data from 441 newly admitted nursing home residents, we examined whether the diagnoses of mental illnesses, as well as other resident characteristics, were associated with use of physical restraints in both high restraint and low restraint use homes. Predictors of restraint use during both the first month and the first year of admission were inability to transfer and having a combination of severe ADL and cognitive impairment. Other predictors were wandering, inability to dress, symptoms of depression, and severity of cognitive impairment.

Activities of Daily Living↗
PubMed1992

Physical restraint use and cognitive decline among nursing home residents.

OBJECTIVE: This study investigated the association between physical restraint use and decline in cognition. DESIGN: Cohort analytic study describing changes in resident characteristics. SETTING: Eight nursing homes, both urban and suburban, operated by a proprietary corporation in a large metropolitan area. PARTICIPANTS: 437 nursing home admissions, with 201 remaining at 1 year. MAIN OUTCOME MEASURES: Cognitive status was measured by geropsychiatrists, using the Folstein Mini-Mental State Exam, during a psychiatric evaluation of the resident. Daily restraint use was documented from nursing orders. Observations were made at 2 weeks, 10 weeks, and 1 year. RESULTS: Restraint use alone and in combination with neuroleptic use was associated with poor cognition. Other variables associated with poor cognitive scores were: ADL impairment, poor adaptive behavior, and longer time in the nursing home. The use of neuroleptics alone was not significant. Variables which were associated with good cognitive status were: being non-ambulatory but without dementia and having strong social support. CONCLUSIONS: These findings raise the possibility that restraint use may contribute to cognitive impairment, specifically among residents who have moderate to no cognitive impairment at admission; however, the findings do not exclude an alternative explanation that residents undergoing cognitive decline are more likely to be put in restraints. Further research is needed to understand whether factors which can be manipulated contribute to cognitive decline.

Activities of Daily Living↗
PubMed1992

The impact of antipsychotic drug regulations on psychotropic prescribing practices in nursing homes.

The authors prospectively studied psychotropic prescribing practices and quality assurance data in 17 nursing homes in the Baltimore area to assess the impact of federal antipsychotic drug regulations. There was a 36% reduction in prescriptions for neuroleptics over 6 months, no increase in prescriptions for sedative/hypnotics, and a small increase in prescriptions for antidepressants. The authors conclude that psychotropic drug prescribing practices and patient outcomes remain important areas of study in nursing homes.

Drug Prescriptions↗
PubMed1991

Depression and mortality in nursing homes.

To determine the prevalence rates of major depressive disorder and of depressive symptoms and their relationship to mortality in nursing homes, research psychiatrists examined 454 consecutive new admissions and followed them up longitudinally for 1 year. Major depressive disorder occurred in 12.6% and 18.1% had depressive symptoms; the majority of cases were unrecognized by nursing home physicians and were untreated. Major depressive disorder, but not depressive symptoms, was a risk factor for mortality over 1 year independent of selected physical health measures and increased the likelihood of death by 59%. Because depression is a prevalent and treatable condition associated with increased mortality, recognition and treatment in nursing homes is imperative.

Activities of Daily Living↗
PubMed1991

Psychosis and physical aggression in probable Alzheimer's disease.

OBJECTIVE: The purpose of this study was to determine the frequency and type of psychotic symptoms in patients with probable Alzheimer's disease and to test whether there is a relationship between specific psychotic symptoms and episodes of physical aggression. METHOD: From 209 patients with possible or probable Alzheimer's disease who had been assessed in a research clinic every 6 months for up to 4.5 years, 181 subjects with probable Alzheimer's disease were selected for study. On the basis of the summary note for each visit in the patients' charts, the presence of delusions, hallucinations, misidentifications, and episodes of physical aggression was determined. Data regarding psychotic symptoms and aggression were available for 170 and 169 subjects, respectively. RESULTS: Delusions had been reported for 74 (43.5%) of the patients and were the most frequent psychotic symptom; persecutory delusions were the most common type. Physical aggression had been noted for 50 (29.6%) of the patients. Delusions and misidentifications frequently preceded and were significantly associated with episodes of physical aggression. The presence of delusions was a significant predictor of physical aggression but accounted for only 3.5% of the variance. CONCLUSIONS: This study suggests that delusions are a risk factor for physical aggression in patients with probable Alzheimer's disease who have moderate to severe cognitive impairment. As delusions accounted for only a small percentage of the variance, further research is needed to identify other variables that may be significant predictors of physical aggression in this population.

Aged↗
PubMed1991

Agitation and other noncognitive abnormalities in Alzheimer's disease.

Agitation and other noncognitive abnormalities in patients with Alzheimer's disease are present in at least 50% of patients and are a serious problem for caregivers. Agitation can be divided into aggressive agitation, physically nonaggressive agitation, and verbal agitation. Persecutory delusions of suspiciousness and stealing are the most common psychotic symptoms. Auditory and visual hallucinations are also associated with delusions. Similar to delusions are misidentifications, which are false beliefs probably secondary to agnosia. They occur in one third of patients with dementia of the Alzheimer type in the form of the belief that strangers are living in the home and misidentification of the patient's home and reflection in the mirror. Passive personality changes are present early in the disease, whereas agitation and psychotic symptoms occur with disease progression and predict a more rapid rate of cognitive decline. Agitation and wandering are related to more severe cognitive impairment and psychosocial variables, and neurochemical variables that may be related to behavior disturbance require further study. There are few systematic studies of behavioral or environmental interventions for behavioral symptoms in patients with Alzheimer's disease. Current treatment emphasizes education of families, the formation of Alzheimer units in the nursing home, and adjunctive psychotropic agents to treat well-defined target symptoms.

Alzheimer Disease↗
PubMed1990

The prevalence and management of dementia and other psychiatric disorders in nursing homes.

The prevalence of psychiatric disorders among new admissions to nursing homes is unknown. Such data are needed to estimate the psychiatric needs of this population. We report the prevalence of specific psychiatric disorders in 454 consecutive new nursing home admissions who were evaluated by psychiatrists and diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised. Eighty percent had a psychiatric disorder. The commonest were dementia syndromes (67.4%) and affective disorders (10%). Also, 40% of demented patients had additional psychiatric syndromes such as delusions or depression, and these patients constituted a distinct subgroup that predicted frequent use of restraints and neuroleptics, and the greatest consumption of nursing time. These data demonstrate that the majority of nursing home residents have psychiatric disorders on admission, and that their management is often quite restrictive. Research is now needed to determine the best methods of treatment for nursing home patients with mental disorders.

Aged↗
PubMed1990

Delusions in newly admitted residents of nursing homes.

Two psychiatrists, using standardized clinical examinations, found that 21% of 125 patients newly admitted to nursing homes had delusions. The psychiatric disorders associated with these delusions are described. Delusional patients were more behaviorally disturbed before admission than nondelusional patients. These behavior problems were often the reason for admission, and they persisted after admission. Nursing home staff members infrequently identified and often inappropriately treated delusional patients. Since delusions are an important potentially treatable cause of behavior problems in nursing home residents, the authors suggest ways to improve the recognition and management of delusions.

Aged↗