Exercise with physically restrained nursing home residents: maximizing benefits of restraint reduction.

Objective: To evaluate an exercise protocol designed to improve strength and mobility, and to decrease injury risk factors in physically restrained nursing home residents.

Design: A randomized controlled trial.

Participants: Ninety-seven residents were randomized into either exercise or control groups.

Effects of prompted voiding on fecal continence among nursing home residents.

Objective: To determine the effects of prompted voiding on fecal continence in nursing home residents.

Design: Prospective, uncontrolled trial of prompted voiding for urinary incontinence.

Participants: One hundred sixty-five nursing home residents who completed a 9 to 10-week trial.

Pyuria among chronically incontinent but otherwise asymptomatic nursing home residents.

Objective: To determine the prevalence of pyuria and its relationship to bacteriuria in a representative sample of chronically incontinent nursing home residents.

Design: Prospective, descriptive case series.

Setting: Six nursing homes.

Perioperative care in the elderly urologic patient.

This article summarizes the preoperative evaluation and postoperative care recommended for elderly patients undergoing urologic procedures. Most of the common issues faced during the perioperative period are discussed, but many other topics require reference to other sources or consultation with specialists. A thorough preoperative evaluation is needed, and meticulous attention to postoperative care is mandatory.

A walking program for nursing home residents: effects on walk endurance, physical activity, mobility, and quality of life.

Objectives: To determine the effects of a 12-week walking program on walk endurance capacity, physical activity level, mobility, and quality of life in ambulatory nursing home residents who had been identified as having low physical activity levels and low walk endurance capacities. To determine the effects of 12 versus 22 weeks of walk training on walk endurance capacity, physical activity level, mobility, and quality of life in ambulatory nursing home residents.

Design: Experiment 1: Residents of one nursing home campus were assigned to the walking program, and residents of a second campus were assigned to the social visit control group.

Use of the Minimum Data Set to rate incontinence severity.

Objectives: To assess the relationship of the MDS incontinence severity ratings to direct measures of incontinence frequency.

Design: Two methods of measuring incontinence were compared: the MDS rating as recorded by nursing home (NH) staff and physical checks for wetness performed by research staff.

Setting And Participants: A total sample of 293 older residents from nine nursing homes located in Iowa, the State of Washington, and the Los Angeles area were assessed once.

Functional Incidental Training, mobility performance, and incontinence care with nursing home residents.

Objective: To determine if an exercise intervention, Functional Incidental Training (FIT), results in improvements in mobility endurance and physical activity when compared with prompted voiding (PV) among cognitively and mobility impaired nursing home residents.

Design: Residents from four nursing homes were randomized into either a PV only (PV) or a PV plus FIT (FIT) intervention group for 8 weeks. Research staff implemented all intervention and measurement protocols.

The use of a computer-based model to implement an incontinence management program.

A computerized total quality management model was used to implement an incontinence system in eight nursing homes. Research staff measured resident wetness for one month, provided training in the implementation of the program in less than five days, and measured resident wetness for six months after implementation. Seven of the eight nursing homes significantly improved resident dryness for a six-month period.

A cost and value analysis of two interventions with incontinent nursing home residents.

Objective: More than half of nursing home residents suffer from urinary incontinence. These residents typically have long stays and, because of comorbid cognitive and physical impairments, have little hope of living again in a noninstitutional environment The value of interventions to change functional status of this chronically institutionalized population is often questioned. This paper explores this value issue in the context of two incontinence management interventions that have been shown to improve functional status: (1) Functional Incidental Training (FIT), and (2) Prompted Voiding (PV).

Does physical activity improve sleep in impaired nursing home residents?

Objectives: To determine if two physical activity programs of varying intensity would result in improved sleep among incontinent and physically restrained nursing home residents.

Design: Controlled trials of two physical activity programs.

Setting: Seven community nursing homes in the Los Angeles area.

Accuracy of rapid urine screening tests among incontinent nursing home residents with asymptomatic bacteriuria.

Objective: To determine the accuracy of rapid urine screening tests in detecting bacteriuria among incontinent nursing home residents.

Setting: Six nursing homes.

Participants: 214 chronically incontinent, but otherwise asymptomatic, nursing home residents who were enrolled in a clinical intervention trial for urinary incontinence.

Does oxybutynin add to the effectiveness of prompted voiding for urinary incontinence among nursing home residents? A placebo-controlled trial.

Objective: To determine if oxybutynin, a bladder relaxant medication, adds to the effectiveness of prompted voiding (PV) in the management of urinary incontinence among nursing home residents.

Design: Randomized, placebo-controlled, double-blinded, dose-adjusted, crossover trial of oxybutynin added along with PV.

Setting: Seven nursing homes in Los Angeles County, California.

Does eradicating bacteriuria affect the severity of chronic urinary incontinence in nursing home residents?

Objective: To determine the effects of eradicating otherwise asymptomatic bacteriuria on the severity of chronic urinary incontinence among nursing home residents.

Design: Residents were categorized as nonbacteriuric or bacteriuric on the basis of urine cultures. Bacteriuric residents were then randomly assigned to immediate and delayed treatment groups.

Predictors of successful prompted voiding among incontinent nursing home residents.

Objective: To develop a simple, noninvasive assessment strategy that will enable nursing home staff to identify incontinent residents who respond well to prompted voiding.

Design: Incontinent nursing home residents underwent an extensive clinical and functional assessment and then 7 days of prompted voiding. Data from the assessment and the first 3 days of prompted voiding were used to predict responsiveness to the intervention.

Wheelchairs as mobility restraints: predictors of wheelchair activity in nonambulatory nursing home residents.

Objective: The purpose of this paper is to describe factors affecting wheelchair mobility in nonambulatory nursing home (NH) residents.

Design: Prospective descriptive study of a convenience sample of nonambulatory NH residents.

Setting: Seven nursing homes.

Incontinence in the nursing home.

Urinary and fecal incontinence are prevalent, disruptive, and expensive health problems in the nursing home population. Nursing home residents who are incontinent of urine should have a basic diagnostic assessment, including a focused history and bladder record, a targeted physical examination, a urinalysis, and a determination of postvoid residual urine volume done by catheterization or ultrasonography. Potentially reversible conditions, such as fecal impaction and drug side effects, should be identified and treated.

Urine specimen collection from incontinent female nursing home residents.

Objective: To determine if a clean catch technique can accurately diagnose bacteriuria among incontinent female nursing home residents.

Design: Cultures and dipstick screening test results from paired urine specimens, one collected by a clean catch technique and the other collected by sterile in-and-out catheterization, were compared.

Participants: A total of 101 incontinent female nursing home residents who were being assessed for participation in a larger clinical intervention trial for incontinence.

Use of a portable ultrasound device to measure post-void residual volume among incontinent nursing home residents.

Objective: To determine the accuracy of a portable ultrasound device for the assessment of post-void residual (PVR) volume among incontinent nursing home (NH) residents.

Design: Prospective, clinical series.

Setting: Seven community-based nursing homes.

Safety assessment for the frail elderly: a comparison of restrained and unrestrained nursing home residents.

Objective: To facilitate clinicians' judgement concerning physical restraint decisions by identifying potentially reversible injury risk factors that differentiate representative samples of restrained and unrestrained nursing home residents.

Design: Comparison of restrained and unrestrained nursing home residents on a safety assessment for the frail elderly (SAFE) protocol.

Setting: Long-term care facilities in the Greater Los Angeles Area.

Physician evaluation and management of nursing home residents.

The diverse goals of nursing home care, the heterogeneity of nursing home residents, and the varied circumstances under which physicians care for them make their evaluation and care complex and challenging. When evaluating and caring for nursing home residents, physicians must address many issues besides treatment of multiple chronic diseases (including impairments in cognitive and physical functioning, sensory deficits, depression, and behavioral disorders associated with dementia) and concerns of family members. The physician should be integrated with an interdisciplinary team composed of nurses, rehabilitation therapists, social workers, and others.

How informed can consent be? New light on comprehension among elderly people making decisions about enteral tube feeding.

Elderly people in long-term care facilities do not understand much about various medical procedures, including enteral feeding. After presentation of empirically precise information about enteral tube feeding, residents in both long-term care and community-dwelling groups showed significant improvement in their understanding. The community-dwelling group showed even greater improvement.