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J N Morris

Publications and source records attributed to J N Morris.

At least 55 records · Page 3Linked to original sources
PubMed1997

Measurement choices in multi-site studies of outcomes in dementia.

This paper summarizes the measurement choices made by selected current or recently completed multi-site projects with a common emphasis on measuring outcomes in dementia. Information on number of items and scoring, reason(s) for selecting the measure, and reliability and validity of the measure (either citations providing this information or a report of pertinent unpublished findings) is presented for eight domains: cognition, behavioral symptoms, physical health status, physical functioning and self-care abilities, quality of life, family/staff caregiver outcomes, service use, and cost. We found considerable reliance on the published literature as a guide to measurement choice, motivated largely by measures' superior psychometric properties, their ubiquity in the literature, and/or their brevity or ease of use. There is still evidence of "starting from scratch" in some domains, however. To the extent that these projects reflect the state of the art in dementia-relevant outcomes research, we conclude that comparison of outcomes across studies will continue to be problematic. However, as long as dissemination of methodological as well as substantive findings continues to characterize outcome studies in dementia, there is hope that a more congruent view of how to assess key outcomes in dementia will emerge.

Caregivers↗
PubMed1997

The potential for using administrative and clinical data to analyze outcomes for the cognitively impaired: an assessment of the minimum data set for nursing homes.

Quite frequently, data from administrative or clinical data sets are not considered suitable for research because of concerns about their validity and reliability. The authors discuss the important role that such data sets may play in the future of health care. To provide an indication that all administrative and clinical data bases do not provide inferior data, the authors compare the internal consistency and predictive validity of information from three statewide administrative/clinical databases, focusing on nursing home residents with comparable data from a research database. These databases contain information gathered using the Minimum Data Set (MDS) for Nursing Home Resident Assessment and Care Screening. The two dimensions of status considered in this illustration are cognition and physical function. The results of this comparison indicate that the assessment data in three statewide clinical/administrative databases are as reliable and valid as the data found in the research database. Finally, the authors discuss the precepts one might follow in developing clinical/administrative databases that provide good data. These precepts also can be used as guidelines in the evaluation of the probable usefulness of such databases for assessing outcomes among cognitively impaired nursing home residents.

Aged↗
PubMed1996

Evaluating a national assessment strategy for urinary incontinence in nursing home residents: reliability of the minimum data set and validity of the resident assessment protocol.

Evaluation of 1 million incontinent American nursing home residents is hampered by both failure to detect incontinence and logistical barriers to diagnostic testing. The nationally mandated Minimum Data Set (MDS) and Resident Assessment Protocol (RAP) were devised to address these deficiencies. Although both instruments are also used in at least 18 other countries, neither has been evaluated. Our goal was to determine the reliability of the MDS and the accuracy of the RAP in predicting the lower urinary tract cause of incontinence. We determined interrater reliability for the 13 MDS items related to urinary incontinence in 123 randomly selected residents of 13 nursing homes in 5 states; forms were completed blindly by 2 nurses from each facility who were trained for a day. The RAP was assessed in 102 representative institutionalized women by blinded evaluation of its diagnostic accuracy compared with the multichannel videourodynamic criterion standard. For the MDS, interrater reliability for incontinence of all grades was excellent (weighted kappa correlation coefficient = 0.90), although reliability was greater at the extremes of measurement than for incontinence of intermediate severity. With the exception of delirium, correlations for the 11 MDS items related to incontinence were 0.65-0.96; for 6 items, correlations were > or = 0.8. The diagnostic accuracy of the RAP, successfully administered to 80% of women, was 70%. The accuracy of the nearly identical algorithm that formed the basis for the RAP was 84%. Importantly, serious misclassifications were not observed for either the RAP or the algorithm. Although its definitions should be modified slightly, the MDS appears to be feasible and reliable when administered by trained staff. In women, the diagnostic accuracy and safety of the RAP are good-particularly when administered as instructed-but the original, sex-specific algorithm is preferable. Together, the MDS and modified RAP provide a useful, stepwise, and non-urodynamically based strategy to guide evaluation and therapy of incontinence in this setting.

Aged↗
PubMed1996

Development, testing, and validation of two scales measuring nursing home management of subjects with mental disorder.

This paper describes the development, testing, and validation of summary scales measuring nursing processes commonly used in caring for elderly nursing home residents with cognitive, mood, and behavior problems, or other markers of mental disorder. Data were obtained from a cross-sectional study of 1017 residents from a proportionate random sample in Delaware nursing facilities, to determine the prevalence of mental disorders and to describe distinguishing characteristics and treatments. An exploratory factor analysis was performed on 11 frequently encountered nursing management strategies as applied to 808 subjects with some indicator of mental disorder. Two factors emerged, which were subsequently conceptualized as separate scales (composed of six and five elements, respectively) that measure the basic approaches termed Encouragement and Control. Alpha reliability levels determined internal consistency for each scale. Cognitive, behavioral, and mood correlates were identified for each scale using multiple regression. Replication and validation were achieved when similar findings were obtained using a random sample of 290 residents at Hebrew Rehabilitation Center for Aged, a 725-bed long-term care facility in Boston. LISREL analyses confirmed the presence of at least two dimensions in behavior management strategies. The identification of these approaches is significant in providing non-pharmacologic and non-restraint alternatives to managing elderly residents with symptom distress.

Aged↗
PubMed1996

Facility and area variation affecting the use of physical restraints in nursing homes.

OBJECTIVES: Various individual characteristics increase a nursing home resident's likelihood of being mechanically restrained. However, there is not good information on the role played by facility characteristics and geographic area in determining the likelihood of physical restraint use. This study investigates the importance of individual, facility, and area indicators in determining the likelihood of restraint use. METHODS: This research uses data on 2,000 nursing home residents receiving care in more than 250 nursing homes in 10 different areas. Resident-level data were collected in 1990 by research nurses using the Minimum Data Set for Nursing Home Resident Assessment and Care Screening. Facility-level data were gathered by telephone interviews with facility staff. The relations among the variables were investigated using contingency tables and multivariate logistic regression models. RESULTS: Controlling for residents' physical and cognitive function, facility characteristics and location had a significant impact on restraint practices. Those facilities with low nurse staffing were more likely to restrain residents. Furthermore, controlling for these factors, restraint practices varied significantly across the geographic areas in the study. CONCLUSIONS: Like hospitals, nursing homes exhibit significant interfacility and regional variation in their clinical practices. Future analyses of nursing home care might benefit from considering both factors in much finer detail.

Activities of Daily Living↗
PubMed1996

Levels of mortality, education, and social conditions in the 107 local education authority areas of England.

STUDY OBJECTIVE: To investigate the relationships between education, social conditions, and mortality. DESIGN: An ecological study relating several measures of mortality to local rates of educational attainment at age 15/16 years and scores on the Department of the Environment's index of local conditions. SETTING: England and its 107 local education authority areas in 1991. MAIN RESULTS: Educational attainment was closely associated with all cause, coronary, and infant mortality and strongly associated with the index of local conditions. This social index was also closely associated with all the measures of mortality. In multiple regression, the social index was the stronger correlate of all cause mortality but for coronary and infant mortality, educational attainment remained highly statistically significant. CONCLUSIONS: Area levels of both educational attainment and deprivation-affluence are strong correlates of local mortality rates in England. In these analyses educational attainment may be indexing the general cultural level of a community. Preliminary investigation with these ecological data suggests that deprivation-affluence has the stronger association but a surer assessment of their relative importance will require individual level information.

Adolescent↗
PubMed1996

A dynamic model for explaining changes in use of IADL/ADL care in the community.

Evidence exists that support services for community elders vary with need. However, few controlled longitudinal analyses have been carried out regarding descriptive profiles of elders experiencing differential change in service levels -- the focus of analysis here. Using a multivariate profile procedure (PC-Group), 1,730 elders followed over an 18-month period were first classified according to change in functional status groupings that predicted change in hours of service over this period, and each group was subsequently subdivided. Five of nine profiles identified (82% of the sample) were relatively stable functionally. In general, changes in service levels reflected change in functional status; profiles reflected differential change in service level depending upon whether functional status declined; the network provided an unusually high level of service (overextended) at baseline; or the informal network consisted exclusively of children.

Activities of Daily Living↗
PubMed1995

Reliability estimates for the Minimum Data Set for nursing home resident assessment and care screening (MDS).

The MDS is a core set of items, definitions, and response categories used to assess all of the nation's 1.5 million nursing home residents who reside in facilities participating in the Medicare or Medicaid programs. Further, the Health Care Financing Administration (HCFA) has proposed a rule that would require facilities to computerize MDS data and submit it to state and federal agencies, paving the way for a national database. This article describes the process of testing the reliability of the MDS items in 13 nursing homes in five states. The results demonstrate that MDS data gathered in a research effort attain reliabilities that make such data useful. MDS items met a standard for excellent reliability (i.e., intraclass correlation of .7 or higher) in key areas of functional status, such as cognition, ADLs, continence, and diagnoses. Sixty-three percent of the items achieved reliability coefficients of .6 or higher. Eighty-nine percent of the items in the MDS achieved .4 or higher.

Activities of Daily Living↗
PubMed1994

MDS Cognitive Performance Scale.

BACKGROUND: Chronic cognitive impairment is a major problem in U.S. nursing homes, yet traditional assessment systems in most facilities included only limited information on cognitive status. Following the Congressional mandate in the Omnibus Reconciliation Act of 1987 (OBRA '87), U.S. nursing homes now complete the Minimum Data Set (MDS), a standardized, comprehensive assessment of each resident's functional, medical, psychosocial, and cognitive status. We designed a Cognitive Performance Scale (CPS) that uses MDS data to assign residents into easily understood cognitive performance categories. METHODS: Information was drawn from three data sets, including two multistate data sets constructed for the Health Care Financing Administration. The prevalence and reliability of the MDS cognitive performance variables were established when assessed by trained nursing personnel. Five selected MDS items were combined to create the single, functionally meaningful seven-category hierarchical Cognitive Performance Scale. RESULTS: The CPS scale corresponded closely with scores generated by the Mini-Mental State Examination and the Test for Severe Impairment, nursing judgments of disorientation, and neurological diagnoses of Alzheimer's disease and other dementias. CONCLUSIONS: The new CPS provides a functional view of cognitive performance, using readily available MDS data. It should prove useful to clinicians and investigators using the MDS to determine a resident's cognitive assets.

Activities of Daily Living↗
PubMed1994

A longitudinal study of risk factors associated with the formation of pressure ulcers in nursing homes.

OBJECTIVE: To determine risk factors associated with the formation of stage II-IV pressure ulcers in nursing homes. DESIGN: Since the incidence rate for pressure ulcer formation varies among nursing homes, the homes were divided into tertiles based on these rates. Pooled logistic regression was used to model which factors are associated with the formation of pressure ulcers in both high and low incidence homes. SETTING: 78 National HealthCorp nursing homes. SUBJECTS: We studied 4232 nursing home residents free of pressure ulcers on admission to a nursing facility and at 3-months follow-up. All remained in the home for at least 3 additional months to a maximum of 21 months. MEASUREMENTS: The effects of age, gender, race, antipsychotic drug use, urinary incontinence, fecal incontinence, body mass index, diabetes mellitus, disorientation, ambulation, physical restraints, activities of daily living of bathing, feeding, or transferring, and nursing home bed size on the formation of a stage II-IV pressure ulcer while the subject was a resident in the nursing home were studied. MAIN RESULTS: Significant factors associated with the formation of pressure ulcers in high incidence homes (21-month incidence = 19.3%) were ambulation difficulty (OR = 3.3; CI = 2.0, 5.3), fecal incontinence (OR = 2.5; CI = 1.6, 4.0), diabetes mellitus (OR = 1.7; CI = 1.2, 2.5), and difficulty feeding oneself (OR = 2.2; CI = 1.5, 3.3). In the low incidence homes (21-month incidence = 6.5%), significant factors associated with pressure ulcer incidence were ambulation difficulty (OR = 3.6; CI = 1.7, 7.4), difficulty feeding oneself (OR = 3.5; CI = 2.0, 6.3), and male gender (OR = 1.9; CI = 1.2, 3.6). CONCLUSIONS: Although low and high incidence homes share similar risk factors, such as ambulation and feeding activities of daily living, the main difference was that diabetes and fecal incontinence played a major role only in high risk homes, while male gender was an important discriminator only in low incidence homes. Yet, it is unclear if these factors explain the three-fold difference in the incidence rates for pressure ulcers in these facilities. Baseline or resident clinical characteristic differences of any one factor between the high and low incidence homes varied by no more than 5%. While we identified certain conditions which are associated with pressure ulcer formation, there may be unknown or unmeasured facility effects in addition to the characteristics of a given resident in a particular home.

Activities of Daily Living↗
PubMed1994

Exercise in the prevention of coronary heart disease: today's best buy in public health.

Forty years of population studies have shown that physical activity can protect against coronary heart disease (CHD) in men of middle and early old age. Vigorous aerobic effort was required for protection of British civil servants; high levels of other activity usually accompanied this. Serious methodologic problems are illustrated from studies of these British office workers, elite Harvard alumni, and U.S. men at high risk. Because of uncertainties in defining optimal exercise, the strength of protection may be underestimated. Some possible lines of advance are suggested: collaboration between physiologists and epidemiologists to expand the content of activity information beyond caloric costs; study of sweating and hard breathing as indicators of activity that is "vigorous" for the individual; focusing on coronary thrombosis, hypothetically the principal locus of protection; a shift to measurement of cardiorespiratory, endurance fitness; and randomized trial, e.g., of high risk men with low HDL-C and high fibrinogen levels. Responding to public need and the opportunities, physical activity could be today's "best buy" in public health for the West.

Adult↗
PubMed1993

Impact near the hip dominates fracture risk in elderly nursing home residents who fall.

Hip fractures among the elderly are a significant and rapidly growing public health problem. The prevailing view is that most hip fractures are the consequence of age-related bone loss or osteoporosis. However, because over 90% of hip fractures are the result of falls, we have undertaken a falls surveillance study to determine if factors related to the mechanics of falling are associated with increased risk of hip fracture. Case subjects with hip fracture and control subjects without hip fracture were sampled from falls recorded at the Hebrew Rehabilitation Center for Aged, a chronic care facility. Fall information was obtained by interview of the subject and witnesses if the fall was witnessed. Data were analyzed by multiple logistic regression. Increased risk of hip fracture from a fall was associated with impacting on the hip or side of the leg and potential energy associated with the fall. Quetelet, or body mass index, was inversely related to fracture risk. The adjusted odds ratio of hip fracture for a fall involving impact on the hip region was 21.7 (95% confidence interval, 8.2-58). The potential energy associated with these falls was an order of magnitude greater than the average energy required to fracture elderly, cadaveric, proximal femurs in earlier in vitro experiments. We conclude, therefore, that a fall from standing height should no longer be considered minimal trauma but rather trauma of sufficient magnitude to pose a high risk of hip fracture if impact occurs on the hip and if energy-absorbing processes are inadequate.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidental Falls↗
PubMed1993

Effects of cognitive impairment on the reliability of geriatric assessments in nursing homes.

OBJECTIVE: To explore the relationship between an elderly subject's cognitive status and the reliability of multidimensional assessment data. DESIGN: Survey, with cognitive status as the independent variable and interrater reliability as dependent variable. SETTING: Medicare/Medicaid-certified nursing homes. PARTICIPANTS: 147 residents age 65 or older. MEASUREMENTS: Dual assessments of elderly nursing home residents were performed by nurse assessors using the Health Care Financing Administration's new Minimum Data Set for Nursing Home Resident Assessment and Care Screening (MDS). Assessments were classified on the basis of residents' cognitive status, and levels of disagreement between assessors were analyzed. MAIN RESULTS: Overall assessment reliability, agreement concerning a resident's activities of daily living status, and the reliability of estimates of his or her communication skills and sensory abilities were significantly affected by a resident's cognitive status. The presence of cognitive impairment made these measurements less reliable--especially those related to communication skills, vision, and hearing. CONCLUSIONS: Assessments of residents suffering from cognitive impairment were significantly less reliable than assessments of cognitively intact residents. However, these differences in reliability were not uniform across all assessment domains. When treating the cognitively impaired elderly, clinicians must exercise caution in their reliance on standardized measurements that may be less reliable for this population.

Activities of Daily Living↗