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Webster-Dekker KE, Lu Y, Perkins SM, Ellis J, Gates M, Otis L, Winton R, Hacker E. Factors associated with change in activities of daily living performance in home health care patients with diabetes. Geriatr Nurs 2024; 59:543-548. [PMID: 39153463 DOI: 10.1016/j.gerinurse.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/27/2024] [Accepted: 07/14/2024] [Indexed: 08/19/2024]
Abstract
Older adults with diabetes are at risk for impairments in activities of daily living (ADL) performance. Home health (HH) services help patients regain their ability to perform ADLs following hospitalization, but there may be disparities in ADL improvement. We aimed to identify factors associated with change in ADL performance from the start of HH care to discharge in HH patients with diabetes age ≥65. This secondary analysis used Outcome and Assessment Information Set-D data collected by a HH agency. The sample (n = 1350) had a mean age of 76.3 (SD 7.3). Black/African American race and bowel incontinence/ostomy were associated with less ADL improvement. The following factors were associated with greater ADL improvement: having a caregiver who needed training/support, surgical wounds, pain that interfered with activity, confusion, and better scores in prior functioning. Overall, most patients improved their ADL performance while receiving HH care, but there are disparities that should be addressed.
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Affiliation(s)
| | - Yvonne Lu
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46220, USA.
| | - Susan M Perkins
- Indiana University School of Medicine, Department of Biostatistics and Health Data Science, 410W. 10th Street, Indianapolis, IN 46202, USA.
| | - Jennifer Ellis
- Aveanna Healthcare, 400 Interstate N Pkwy #1600, Atlanta, GA 30339, USA
| | - Maria Gates
- Aveanna Healthcare, 400 Interstate N Pkwy #1600, Atlanta, GA 30339, USA
| | - Laurie Otis
- Aveanna Healthcare, 400 Interstate N Pkwy #1600, Atlanta, GA 30339, USA
| | - Rebecca Winton
- CenterWell Home Health, 3350 Riverwood Parkway SE #1400, Atlanta, GA 30339, USA
| | - Eileen Hacker
- The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd., Houston, TX 77230, USA.
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Hellman-Bronstein AT, Luukkaala TH, Ala-Nissilä SS, Nuotio MS. Do urinary and double incontinence predict changes in living arrangements and mobility in older women after hip fracture? - a 1-year prospective cohort study. BMC Geriatr 2024; 24:100. [PMID: 38273298 PMCID: PMC10811924 DOI: 10.1186/s12877-023-04637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/24/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Continence problems are known to be associated with disability in older adults. Costs of disability and resulting need for more supported living arrangements are high after a hip fracture. The aim was to examine pre-fracture urinary incontinence (UI) and double incontinence (DI, concurrent UI and fecal incontinence) as predictors of changes in mobility and living arrangements in older female hip fracture patients in a 1-year follow-up. METHODS Study population comprised 1,675 female patients aged ≥ 65 (mean age 82.7 ± 6.8) sustaining their first hip fracture between 2007-2019. Data on self-reported pre-fracture continence status was collected. The outcomes were declined vs. same or improved mobility level and need for more assisted vs same or less assisted living arrangements 1-year post-fracture. Separate cohorts of 1,226 and 1,055 women were generated for the mobility and living arrangements outcomes, respectively. Age- and multivariable-adjusted logistic regression models were used to determine the associations of UI, DI, and other baseline characteristics with the outcomes. RESULTS Of the patients, 39% had declined mobility or more assisted living arrangements at 1-year follow-up. Adjusting for age, both pre-fracture UI and DI were associated with changes in mobility and living arrangements. In the multivariable analysis, UI (OR 1.88, 95% CI 1.41-2.51) and DI (1.99, 95% CI 1.21-3.27) were associated with decline in mobility level while only DI (OR 2.40, 95% CI 1.22-4.75) remained associated with the need for more assisted living arrangements. CONCLUSIONS Both pre-fracture UI and DI in older women are risk factors for declining mobility level, but only DI for more supported living arrangements 1-year post-hip fracture. UI likely develops earlier in life and might not necessarily be strongly associated with the onset or increasing disability in later years. DI may indicate more marked vulnerability and burden to patients as well as to formal and informal caregivers.
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Affiliation(s)
- Aino T Hellman-Bronstein
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland.
| | - Tiina H Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Seija S Ala-Nissilä
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Maria S Nuotio
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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Brubaker L, Barthold J, Fitzgerald CM, Kenton K, Lewis CE, Lowder J, Lukacz ES, Markland A, Meister M, Miller J, Mueller ER, Rudser K, Smith AL, Newman DK. The RISE FOR HEALTH study: Methods for in-person assessment and biospecimen collection. Neurourol Urodyn 2023; 42:1011-1021. [PMID: 36573845 PMCID: PMC10290574 DOI: 10.1002/nau.25108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/15/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To describe the methods for the in-person assessment of the RISE FOR HEALTH (RISE) study, a population-based multicenter prospective cohort study designed to identify factors that promote bladder health and/or prevent lower urinary tract symptoms in adult women, conducted by the Prevention of Lower Urinary Tract Symptoms Research Consortium (PLUS). METHODS AND RESULTS A subset of RISE participants who express interest in the in-person assessment will be screened to ensure eligibility (planned n = 525). Eligible consenting participants are asked to complete 15 physical assessments in addition to height and weight, to assess pelvic floor muscle function, musculoskeletal (MSK) status, and pain, and to provide urogenital microbiome samples. Pelvic floor muscle assessments include presence of prolapse, strength, levator attachment integrity (tear) and myofascial pain. MSK tests evaluate core stability, lumbar spine, pelvic girdle and hip pain and function. Participants are asked to complete the Short Physical Performance Battery to measure balance, lower extremity strength, and functional capacity. All participants are asked to provide a voided urine sample and a vaginal swab for microbiome analyses; a subset of 100 are asked to contribute additional samples for feasibility and validation of a home collection of urinary, vaginal, and fecal biospecimens. RESULTS Online and in-person training sessions were used to certify research staff at each clinical center before the start of RISE in-person assessments. Standardized protocols and data collection methods are employed uniformly across sites. CONCLUSIONS The RISE in-person assessment is an integral portion of the overall population-based RISE study and represents an innovative approach to assessing factors hypothesized to promote bladder health and/or prevent lower urinary tract symptoms. Data collected from this assessment will be used to prioritize future research questions and prevention strategies and interventions. This description of the assessment methods is intended to provide methodologic transparency and inform other researchers who join efforts to understand and improve bladder health.
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Affiliation(s)
- Linda Brubaker
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, University of California San Diego, La Jolla, California
| | - Julia Barthold
- Senior Scientific Advisor, Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda MD
| | - Colleen M. Fitzgerald
- Department of Obstetrics, Gynecology and Urology, Loyola University Chicago, Chicago, IL
| | - Kim Kenton
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Cora E. Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Jerry Lowder
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis MO
| | - Emily S. Lukacz
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, University of California San Diego, La Jolla, California
| | - Alayne Markland
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, School of Medicine, University of Alabama at Birmingham
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL
| | - Melanie Meister
- Department of Obstetrics and Gynecology, University of Kansas, Kansas City, KS
| | - Janis Miller
- School of Nursing, University of Michigan, Ann Arbor, Michigan, Department of Obstetrics, Gynecology and Urology, Loyola University Chicago, Chicago, IL
| | - Elizabeth R. Mueller
- Department of Obstetrics, Gynecology and Urology, Loyola University Chicago, Chicago, IL
| | - Kyle Rudser
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Ariana L. Smith
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Diane K. Newman
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Lim YM, Baek J, Lee S, Kim JS. Association between Loneliness and Depression among Community-Dwelling Older Women Living Alone in South Korea: The Mediating Effects of Subjective Physical Health, Resilience, and Social Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159246. [PMID: 35954597 PMCID: PMC9368532 DOI: 10.3390/ijerph19159246] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/23/2022] [Accepted: 07/24/2022] [Indexed: 11/16/2022]
Abstract
Social isolation and loneliness are the key risk factors for depression in late life. Older adults living alone and socially isolated are at greater risk for physical and mental health. This study aims to examine the mediating effects of subjective physical health, resilience, and social support on the association between loneliness and depression among the elderly female population living alone in South Korea. We included a total of 308 older women aged 60 years or older who live alone in a medium-sized city in South Korea. The survey data was collected using the validated survey instruments between November 2015 and April 2016. A parallel mediation model was performed to investigate whether physical health, resilience, and social support had mediating effects on the association of loneliness with depression. The findings of this study showed that loneliness was directly and indirectly associated with depression through its association with the subjective physical health, resilience, and social support among the older female population living alone. Our results suggest the importance of supporting community-based programs to improve physical and mental health of the elderly people as a way to minimize the level of loneliness and prevent depression.
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Affiliation(s)
- Young Mi Lim
- Department of Nursing, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;
| | - Juha Baek
- Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, Sejong-si 30146, Korea
- Correspondence:
| | - Sungmin Lee
- Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, TX 77840, USA;
| | - Jung Sug Kim
- Department of Nursing, Yeoju Institute of Technology, Yeoju 12652, Korea;
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