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PubMedDate not supplied

Medical and functional status changes among nursing facility residents: implications for dentistry.

This paper reports the results of a study that investigated changes in the medical and functional status of nursing facility residents over a 2.9 year period. Sixty-seven residents from 10 nursing facilities were included in the study, which demonstrated that the resident's medical and functional status deteriorated during this period. These changes adversely affected the residents' ability to receive recommended dental treatment, suggesting that early, definitive, and often aggressive treatment approaches be used in providing services to these individuals.

Aged↗
PubMed1995

An instrument to assess the oral health status of nursing home residents.

This article presents data from the development and testing of an instrument to evaluate the oral health of nursing home residents by nursing personnel (RNs, LVNs, and CNAs). After the instrument was developed, nursing staff were taught to do a brief oral health status examination (BOHSE). Using the instrument, a dentist examined 100 residents; the examination was repeated on the same residents by each category of nurse examiners. Correlation coefficients indicate that statistically significant interrater reliability between the three categories of nursing personnel and the dentist was established, suggesting that nursing staff can be taught to evaluate the oral health of residents. Replication of the study in multiple sites is recommended.

Aged↗
PubMed2001

Health and health care status of African-born residents of Metropolitan Washington, DC.

This study examines health status, health behaviors, and health care access and utilization among African-born residents of the metropolitan Washington, DC area. A telephone survey was administered to a random sample of 525 African-born adults. Results are compared to those for the general local and regional population. Twenty-nine percent of respondents were uninsured; 24% lacked a usual, appropriate source of primary care. Among female respondents, 44% and 34% reported never having had a mammogram or pap smear, respectively. Most health status indicators demonstrated relatively good health, but 15% of respondents reported one of the infectious diseases we investigated. Consumption of alcohol and tobacco was relatively low. African-born residents are generally at risk regarding access to health care, and certain segments (the uninsured, recent arrivals) face critical access barriers. Infectious diseases are a notable feature of health status, and use of some preventive and dental services is considerably lower than for the general population.

Journal Article↗
PubMed2005

Is it possible to increase weight and maintain the protein status of debilitated elderly residents of nursing homes?

BACKGROUND: The care of elderly persons in chronic care nursing wards is generally complicated by nutritional problems such as weight loss and worsening protein status. An inability or refusal of the patient to consume enough food often necessitates the use of expensive commercial formulas for nutritional support. The purpose of this study was to determine whether the use of an in-house (high-protein, milk-based) low-cost formula with added minerals and vitamins for total nutritional support would be effective in maintaining weight and protein status of patients in the long term. METHODS: Participants were recruited from five nursing care units of a single geriatric facility. All residents who required formula feeding were followed prospectively. The formula was provided either as a pudding or a milkshake for oral feeding or as a liquid for tube feeding and served as the sole source of nutrition. Data were collected regarding the participants' weight (monthly), serum albumin level (periodically), and the manner of formula administration (oral, nasogastric, or gastrostomy tube). RESULTS: One hundred forty-three participants who received this formula were followed for a maximum period of 6 years. Mean weight increased by 5 kg during the first year and remained stable thereafter. Those participants who died within 6 months had no increase in weight. The long-term mean serum albumin level of all participants was an acceptable 4 g/dL. CONCLUSION: The long-term use of an inexpensive in-house formula for total nutritional support increased weight and maintained serum albumin levels in most of the chronically ill elderly nursing care patients who participated in the study.

Aged↗
PubMed1987

Pediatric residency guidelines for management of status epilepticus.

We reviewed 21 protocols for the evaluation and treatment of status epilepticus currently in use in pediatric residency programs. Guidelines were compared to determine variations in the recommendations for initial patient assessment, choice of anticonvulsant therapy, and instructions for medication administration. There was wide variation in recommendations for patient stabilization procedures and laboratory measurements. Fifteen different sequences of anticonvulsant administration were listed. The initial drug of choice was intravenous diazepam in 81% of the programs, in doses ranging from 0.1 to 0.75 mg/kg. The preference for the second-line anticonvulsant was divided equally between phenytoin and phenobarbital. Phenytoin was not mentioned at all in three (14%) of the protocols, while paraldehyde was included in 14 (66%). Instructions for paraldehyde administration were confusing, imprecise, and occasionally inappropriate. We conclude that there is no well-accepted approach to the management of status epilepticus in pediatric patients. Furthermore, the guidelines in current use frequently are incomplete and probably confusing to residents.

Child↗
PubMed1994

Mortality rates, causes of death, and health status among displaced and resident populations of Kabul, Afghanistan.

OBJECTIVE: To determine the mortality and health effects from the current civil war in Kabul, Afghanistan. SUBJECTS: One resident population and one displaced population. DESIGN: Between November 22 and December 16, 1993, we conducted a retrospective, population-based, household survey, interviewing 312 displaced families and 300 resident families. RESULTS: During the 285 days before the survey, the highest average daily crude mortality rate and the mortality rate for those younger than 5 years (0.9 and 2.6 per 10,000 population per day, respectively) were among residents who had lived at their current location for 10 months or less. The average daily crude mortality rate and the mortality rate for those younger than 5 years were lower among displaced persons (0.6 and 1.9 per 10,000 per day) and lowest among residents who had lived at their current location for more than 10 months (0.5 and 0.6 per 10,000 per day). Overall, the most common cause of death for both groups was gunshot or other war trauma; for children younger than 5 years, deaths resulting from measles, diarrhea, and acute respiratory tract infection predominated. CONCLUSIONS: While provision of basic public health measures would likely decrease mortality among both displaced and resident populations, the most urgent health need is for a cessation of hostilities against the civilian population. During humanitarian relief operations, organizations should not focus exclusively on persons identified as displaced.

Adolescent↗
PubMed2001

Pain and cognitive status among nursing home residents in Canada.

BACKGROUND: There is little information available on the rates of pain in institutionalized elderly persons, and this is particularly true for Canada. OBJECTIVES: To provide information about the prevalence and clinical correlates of pain in a sample of Canadian nursing homes, to determine whether residents with cognitive impairment experience lower rates of health conditions associated with pain (eg, arthritis) than residents without cognitive impairment and to determine whether the associations (ie, odds ratios) for pain with such health conditions vary as a function of cognitive status. DESIGN: The study is based on a secondary analysis of data collected with the minimum data set (MDS 2.0). SETTING AND PARTICIPANTS: The study comprised 3195 nursing home residents in Ontario, Manitoba and Saskatchewan. SUBJECTS AND METHODS: All residents were assessed with the MDS 2.0 by trained clinicians (usually nurses). Pain was documented if it had occurred within the seven days before the assessment. Assessors were trained to look for overt signs of discomfort, such as wincing or verbalizations. Self-report ratings were obtained when possible. RESULTS: The overall prevalence of pain in this sample was 49.7%, and 23.7% of residents experienced pain daily. Persons with and persons without cognitive impairments did not differ with respect to the prevalence of conditions likely to cause pain and the associations of pain with such health conditions. Regional differences were found, with Ontario residents having a higher frequency and intensity of pain than their counterparts in Saskatchewan and Manitoba. This may be due, at least in part, to regional differences in nursing home admission criteria. CONCLUSIONS: The findings suggest that the prevalence of identified pain is lower among nursing home residents with higher levels of cognitive impairment. These results do not support the notion that this is a function of lower prevalence rates of pain-causing conditions in nursing home residents with dementia. Furthermore, the results do not support the view that residents with cognitive impairments are less sensitive to pain. This study highlights the need for more comprehensive tools to assess pain in persons with cognitive impairments. Nonetheless, the MDS may be a useful instrument for detecting pain in such populations, because it does not rely exclusively on self-report.

Aged↗
PubMed2006

Cervical cancer survival by socioeconomic status, race/ethnicity, and place of residence in Texas, 1995-2001.

OBJECTIVE: The current study explored whether socioeconomic status (SES), race/ethnicity, and rural residence may be linked to poorer cervical cancer survival by stage at diagnosis. METHODS: Data from 7,237 cervical cancer cases reported to the Texas Cancer Registry from 1995-2001 were used to address the association by stage at diagnosis and cause of death. Zip code-level census data were used to classify residence and to develop a composite variable for SES. Multilevel Cox proportional hazards modeling was used to estimate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: Late stage at diagnosis was a strong predictor of cervical cancer mortality (HR = 6.2, 95% CI 5.5-7.2). SES and race/ethnicity were independently associated with stage at diagnosis. Women residing in areas with lower SES had significantly shorter survival times when diagnosed at an early stage (HR = 3.0, 95% CI 2.1-4.3). Hispanic women had a lower probability of dying from cervical cancer during the follow-up period (HR = 0.7, 95% CI 0.6- 0.8) after adjusting for confounders. The association between lower SES and poorer survival was consistent across all racial/ethnic groups, suggesting the effect of SES may be more important than race. CONCLUSIONS: SES and race/ethnicity were independently associated with poorer cervical cancer survival in this large Texas sample. Further research is needed to investigate the role of optimal treatment and comorbid conditions in the association between SES and cervical cancer survival.

Adult↗
PubMed1996

Attitudes towards financing of dental care in a Swedish population.

The aim of the present study was to describe attitudes towards financing of dental care and to investigate the importance of different background factors for these attitudes. A questionnaire was sent to a random sample of 3000 persons aged 45-69 years, living in Orebo County, Sweden, with 79.4% response. In the questionnaire the respondents indicated their agreement with four statements on issues concerning financing of dental care, using visual analogue scales. After the answers had been dichotomized, 45% agreed that "all dental care should be free of charge', 32% agreed that "all dental care should be provided by the county', 46% agreed that "it is more important to use resources on heart transplants than on dental care', and 43% agreed that "no public reimbursement should be given to cosmetic dental care'. The attitudes were associated with the following background factors: gender, age, marital status, place of residence, education, socioeconomic status, dental care system, dentist of choice, time since last dentist contact, and attitudes toward dental appearance and dental function. Different background factors were associated with each of the four different attitudes, and only educational level seemed to covary with all four attitudes. It is concluded that attitudes towards financing of dental care varied considerably within this population and that the different attitudes could be related to different background factors.

Aged↗
PubMed1986

Migration as a demographic response: the age differentials.

"This study uses the theory of demographic response as the background against which regional human migration is examined as a response to selected environmental conditions for the 1,056 counties in the North Central Region [of the United States]. Specifically, this study addresses two migration-related questions concerning county populations in the North Central Region: (1) What are the socioeconomic, demographic, and ecological factors to which county populations respond in adjusting their migration behavior? (2) Do socially important age cohorts respond to these factors differently or in a similar manner?" Factors affecting migration are employment status, income levels, educational status, ethnic group, residence location, marital status, home ownership, and age. Data are from the U.S. Census Bureau for the period 1965-1970.

Age Factors↗
PubMed1991

Adult foster care for the elderly in Oregon: a mainstream alternative to nursing homes?

BACKGROUND: In Oregon, adult foster care (AFC) homes, which are private residences where a live-in manager cares for one to five disabled residents, have been covered by Medicaid since 1981 and seem to offer a mainstream alternative to nursing homes. They house almost 6000 older people, two thirds of which pay privately. METHODS: In a cross-sectional study, we interviewed 400 AFC and 400 nursing home residents. Data analyses included descriptive cross-tabulations; hierarchial loglinear models for judging the effects of care setting and payment status on resident characteristics; and logit analyses for predicting care setting and payment status within care settings. RESULTS: On average, nursing home residents were more physically and cognitively impaired than AFC residents, but there was considerable overlap in patterns of frailty in the two settings. Medicaid AFC residents were less disabled than privately paying AFC residents. AFC residents reported more social activity, even when we controlled for disability status. AFC residents and their families were more likely to value privacy and homelike settings when choosing a care setting, whereas nursing home residents were more likely to value rehabilitation and organized activity programs. CONCLUSIONS: Both AFC and nursing homes are viable components of a long-term care repertoire. The greater disability levels of private-pay AFC residents refutes the criticisms that disabled Medicaid residents were being inappropriately channeled to AFC.

Aged↗
PubMed1988

Residence differences in the health status of elders.

Using data from the 1984 Supplement on Aging to the National Health Interview Survey, this study examined residential differences on a selected group of health status measures among persons 65 years of age and older (N = 11,497). Mean values on indicators of health and impairment for each of the residence categories were examined before and after adjusting for distributional differences in background and demographic characteristics which are associated with both health and residence. Three important conclusions emerged from the analysis: (1) health status does not vary with residence in a unitary fashion; (2) the relationship between residence and health status does not appear to fall along a straightforward rural-urban continuum; and (3) there is both diversity in, and a general patterning of, the significant relationships between health and residence with the extremes of health status located in the rural categories.

Activities of Daily Living↗
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↗
PubMed1993

Pain complaints and cognitive status among elderly institution residents.

OBJECTIVE: To examine the association between self-reported pain and cognitive impairment among frail elderly institution residents. DESIGN: A cross-sectional correlational study. SETTING: A large urban nursing home and congregate apartment complex housing predominantly Jewish elderly. PARTICIPANTS: Seven hundred fifty-eight elderly institution residents (30% in the nursing home, 70% in congregate apartments). The sample was 70% female and averaged 83.3 years of age. MEASUREMENTS: Respondent self-reports tapped pain intensity, number of localized pain complaints, cognitive status, and disability in performance of activities of daily living. Attending physicians or physician assistants rated respondents' health status. MAIN RESULTS: Pain intensity and number of localized pain complaints bore small but significant negative relationships to cognitive impairment. Pain was positively associated with physician-rated ill health and functional disability. The association between pain and cognitive status remained significant even when controlled statistically for effects of physical health and functional disability. Item-by-item examination of localized pain complaints indicated that markedly cognitively impaired individuals were less likely to report pain in the back and joints. However, examination of possible physical causes of reported pain revealed no differences between pain reports of cognitively impaired versus intact individuals in either the presence or the absence of a likely physical cause. CONCLUSIONS: These data provide no evidence for the "masking" of pain complaints by cognitive impairment. They suggest instead that, although cognitively impaired elderly may slightly underreport experienced pain, their self-reports are generally no less valid that those of cognitively intact individuals. Limitations of the research are acknowledged and implications for treatment of cognitively impaired institution residents are discussed.

Activities of Daily Living↗
PubMed2004

"Getting everyone on the same page": nursing home physicians' perspectives on end-of-life care.

PURPOSE: To improve understanding of nursing home physicians' perspectives regarding end-of-life care, and to suggest directions for further research. METHODS: An exploratory qualitative design based on interviews of 12 nursing home physicians, 10 of whom were medical directors. Medical students served as interviewers. SAMPLE: A purposeful sampling strategy yielded interviews with 12 physicians. The sample was selected based on "intensity sampling," which seeks information-rich but not extreme cases. Ten of the 12 physicians were nursing home medical directors; all respondents practiced at least 4 years part-time or full-time in a nursing home setting. Respondents varied by age, gender, urban/rural location, and fellowship training (half the sample had completed a geriatrics fellowship). Seven physicians were affiliated with an academic medical center. RESULTS: Four themes were identified in the analysis of the 12 interview transcripts: extensive familiarity with dying; consensus is integral to good end-of-life care; obstacles can interfere with consensus; and advance directives set the stage for conversations about end-of-life care. The importance of consensus, both in terms of prognosis and in developing a palliative care plan, emerged as the major finding. CONCLUSIONS: For the 12 physicians in this study consensus about the resident's status and an appropriate care plan are important features of good end-of-life care. Further research is needed to determine if other members of the health care team (i.e., residents, family members, nursing staff, social worker, etc.) also value consensus highly. It will be important to determine what barriers to consensus other team members identify. Based on the understanding generated from this study, a refinement of the general Education for Physicians on End-of-Life Care (EPEC) model describing the relationship between curative and palliative care is proposed for nursing homes. The refinement underscores the points at which the team might consider revisiting consensus about the resident's status and care plan.

Adult↗
PubMed1995

A standardized form for DSM-IV review of symptoms and mental status examination for students and residents.

A common error by medical students and residents is the inadvertent omission of some part of the mental status examination or failure to screen for a psychiatric diagnosis that is not evident on the patient's presentation. The authors introduce a structured questionnaire and standardized form to guide psychiatric and generalist medical trainees through the mental status examination. Based on criteria from the Diagnostic and Statistical Manual of Mental Disorders--Fourth Edition (DSM-IV), the questionnaire and form are intended to facilitate a psychiatric review of patients without missing key points.

Humans↗
PubMed2001

Infant sleep: resident recommendations and socioeconomic status differences in patient practices.

BACKGROUND: Although much research has focused on parental report of infant sleep position since the 1992 American Academy of Pediatrics (AAP) recommendation for non-prone placement, few studies have examined physician recommendations regarding infant sleep. This study examined differences between resident recommendations for infant sleep position and cosleeping (bed sharing) and parental report of practice. We also assessed socioeconomic differences in parent practice, awareness, and acceptability of AAP guidelines. METHODS: We conducted a telephone survey of parents of 2-, 4-, 8-, and 12-month-old infants from two family practice centers. All 27 residents at both centers completed a paper and pencil survey. RESULTS: Resident recommendations and parental practices differed significantly for both sleep positioning and cosleeping. Parents of 165 infants participated, revealing that higher socioeconomic families were more aware of compliant with, and more accepting of AAP recommendations for supine positioning. CONCLUSIONS: Parents consistently report that their physician or nurse is the primary source of information for infant sleep. Results of this study, however, indicate significant differences between physician recommendation and parental practice and acceptability of AAP guidelines. Physicians need to continue to discuss this information past the newborn period.

Child Rearing↗