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Biomedical subjects

J G Ouslander

Publications and source records attributed to J G Ouslander.

At least 127 records · Page 7Linked to original sources
PubMed1986

Diagnostic evaluation of geriatric urinary incontinence.

Most continent geriatric patients can be managed appropriately after a clinical assessment including a history, physical examination, urinalysis and culture, and simple tests of bladder function. A subgroup will benefit from urologic, gynecologic, and formal urodynamic evaluation. Algorithms described in this chapter are being developed and tested; these algorithms will make clinical assessment more practical and cost effective.

Aged↗
PubMed1986

Drug therapy for geriatric urinary incontinence.

This article summarizes drugs currently available to treat the different types of geriatric urinary incontinence. Practical aspects of using these drugs and evidence in the literature for their efficacy are reviewed. Directions for further research on drug treatment of this condition are also discussed.

Aged↗
PubMed1985

Management of urinary incontinence in Veterans Administration nursing homes.

Nursing Home Care Units in Veterans Administration Medical Centers across the country were surveyed to determine methods of management of urinary incontinence (UI) in the nursing home (NH) setting. Information was obtained from 90 of the VA NHs on demographic aspects of the NH population, prevalence and severity of urinary and fecal incontinence, common problems encountered, and specific strategies and techniques. Written guidelines for bladder training and catheter care from many of the NHs were analyzed. The results of the survey reinforce the need for research designed to improve the care of the incontinent NH patient.

Aged↗
PubMed1984

The costs of urinary incontinence in nursing homes.

A simple model was used to calculate the contribution of urinary incontinence (UI) to the costs of nursing home care. First-order costs are defined as the costs of managing UI: supplies, laundry, and labor. Second-order costs are defined as the costs of managing the complications of UI. Data were gathered from nursing homes, medical supply companies, and a large laundry company. First-order costs of four common methods of managing UI range between $ 3.00 and $ 11.00 per incontinent patient per day. Based on these estimates, UI accounts for between $ 0.5 and $ 1.5 billion (3-8%) of the costs of nursing home care. Management of UI with indwelling catheters results in the lowest first-order costs, but the second-order costs (as well as the potential increased morbidity and mortality risks) probably outweigh any cost savings. More active evaluation and treatment of UI in nursing homes could result in considerable cost savings and improved well-being for both patients and caregivers.

Bedding and Linens↗
PubMed1982

Urinary incontinence in elderly nursing home patients.

Among elderly nursing home patients, urinary incontinence is a prevalent and costly condition. In seven nursing homes studied, 419 (50%) of the elderly patients were incontinence of urine. Most had been incontinent at admission (64%), had more than one incontinent episode per day or a catheter (72%), and had concomitant fecal incontinence (64%). The majority of incontinent patients had substantial cognitive impairment and limitations in mobility. The severity of these impairments was related to the extent of incontinence. Complications such as urinary tract infection and skin breakdown occurred in almost 45% and were more common in patients with catheters. Physicians recorded incontinence as a problem, or any efforts to evaluate it, in the nursing home records of less than 15% of these patients.

Aged↗
PubMed1981

Drug therapy in the elderly.

Age-related biologic and physiologic changes in the elderly may lead to altered pharmacokinetics. Volume of distribution, half-life, systemic clearance, and receptor sensitivity have been shown to change with increasing age. Unique features of illness in the elderly may interfere with effective drug therapy more than changed pharmacokinetics in some patients. Physical, psychologic, and socioeconomic considerations often interfere with ability to obtain and comply with health care. Disease is often difficult to recognize in elderly patients. Multiple chronic conditions, many of which may be undetected, may be exacerbated by or alter drug therapy for other illnesses. Cognitive impairment and diminished vision and hearing may make patient education difficult, and compliance poor. The elderly are also more susceptible to adverse drug reactions. The recommendations for clinical practice and directions for future research that are presented should help make drug therapy in the elderly safer and more effective.

Aged↗
PubMed1981

Drug prescribing for the elderly.

Age-related biologic and physiologic changes, the accumulation of multiple pathologic conditions with increasing age and several socioeconomic considerations combine to make drug prescribing for the elderly one of the most challenging tasks in clinical medicine. Numerous studies in older persons have documented alterations in the pharmacology of many drugs. Several general recommendations are presented which should make drug prescribing for elderly patients safer and more effective.

Adolescent↗
PubMed1981

Urinary incontinence in the elderly.

Urinary incontinence is a common and distressing problem for elderly patients, their families and friends, and the health professionals who care for them. It is a heterogeneous condition, and appropriate management depends on a thorough evaluation and understanding of the multiple factors that can play a role in its cause and perpetuation. Identifying reversible causes of transient incontinence, and appropriate management of incontinence that is associated with acute illness, can be important in preventing the problem from becoming established.A thorough diagnostic evaluation of urinary incontinence in the elderly, and appropriate use of the different types of therapy, will greatly improve the management in these cases. The need and opportunities for research to improve the management of incontinent elderly persons should be considered by all those involved in caring for this population.

Aged↗
PubMedDate not supplied

Individualizing nighttime incontinence care in nursing home residents.

BACKGROUND: Urinary incontinence is a common problem among nursing home (NH) residents and can be successfully treated with prompted voiding during daytime hours. A previous study of incontinent NH residents demonstrated that noise from the staff and other residents and light and noise from staff-initiated incontinence care routines were associated with waking episodes. Nighttime incontinence care should be individualized to minimize sleep disruption while considering moisture exposure that could affect skin health. Although descriptive studies have been published, there are no published intervention studies describing attempts to improve nighttime environmental factors in NHs. OBJECTIVE: To individualize nighttime incontinence care while minimizing sleep disruption among NH residents. METHOD: Subjects were assigned to a 2- or 4-hour incontinence care schedule based on each resident's risk of skin problems using objective data of spontaneous body movements at night and skin health during baseline, and the research staff provided incontinence care if residents were found awake. RESULTS: Awakenings due to light and sound associated with incontinence care were significantly reduced during the intervention phases (p < .001), and there were no adverse changes in skin health or on most risk factors associated with skin (e.g., exposure to moisture, body turns). CONCLUSIONS: Incorporating this intervention component into more comprehensive efforts to improve sleep and evaluating the long-term effects of the intervention on skin health are recommended.

Activities of Daily Living↗
PubMedDate not supplied

Implementation of a nursing home urinary incontinence management program with and without tolterodine.

OBJECTIVE: To evaluate the implementation of a nursing home urinary incontinence management program. DESIGN: A prospective field trial of the program incorporating practice guidelines and principles of continuous quality improvement. SETTING: Five nursing homes in New York, Virginia, and Georgia PARTICIPANTS: One hundred fifty-one residents identified as being incontinent of urine and who met inclusion criteria for ongoing participation in the program. INTERVENTION: Key multidisciplinary staff from the five nursing homes were trained in the program and assumed responsibility for implementing it in their facilities. The program consisted of a clinical assessment, toileting protocols, and the addition of the antimuscarinic drug tolterodine in selected residents who did not respond well to toileting alone. Data on dryness rates during the 60-day toileting protocols, collected by nursing home staff, were analyzed on a weekly basis by an overall project coordinator who sent data back to the nursing homes in an easy-to-read graphical format. MEASURES: (1) The dryness rate, defined as the number of times the resident was dry divided by the number of times the resident was checked (every 2 hours from 7 a.m. to 7 p.m.); and (2) adverse events (eg, dry mouth, increased confusion, need for dosage reduction). RESULTS: Of 645 residents in the 5 nursing homes, 377 (58%) were identified as incontinent of urine, of whom 151 (40%) were placed on an ongoing toileting program. Of these 151 residents, 48 (32%) were prescribed tolterodine, and 117 (78%) completed the 60-day trial. The initial dryness rate was 57%, and for the group as a whole remained essentially unchanged (increase in dryness 1%, P = 0.50). Among 50 clinically stable residents on a toileting program alone, the increase in the dryness rate was 16% (P = 0.001), and for 31 clinically stable residents prescribed tolterodine, the increase in the dryness rate was 29% (P = 0.012). Two residents had their dosage of tolterodine reduced because of dry mouth and nausea,one resident was taken off the drug because of increased pain in the back and legs and increased confusion. CONCLUSIONS: Overall, this program resulted in significant increases in dryness rates for clinically stable incontinent nursing home residents. These residents represented 22% of the total number of residents identified as incontinent in the five participating nursing homes. Tolterodine was prescribed for approximately one-third of incontinent residents as a supplement to a toileting program, and was well tolerated. Nursing homes should be encouraged to implement similar urinary incontinence programs, target toileting protocols to the most responsive residents, and maintain the program using principles of continuous quality improvement.

Journal Article↗