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Chen C, Yu L. Chinese older adults' prior-to-death disability profiles and their correlates. BMC Geriatr 2024; 24:479. [PMID: 38824494 PMCID: PMC11143689 DOI: 10.1186/s12877-024-05105-y] [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: 05/06/2023] [Accepted: 05/24/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Disability prior to death complicates end-of-life care. The present study aimed to explore the prior-to-death disability profiles of Chinese older adults, the profiles' links to end-of-life care arrangements and place of death, and predictors of the profiles. METHODS In total, data were extracted from the records of 10,529 deceased individuals from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Latent profile analyses, bivariate analysis, and multivariate logistic regression were applied to identify prior-to-death disability profiles, explore the profiles' links to end-of-life care arrangements and place of death, and examine predictors in the profiles, respectively. RESULTS Three prior-to-death disability profiles, namely, Disabled-Incontinent (37.6%), Disabled-Continent (34.6%), and Independent (27.8%), were identified. Those with the Independent profile were more likely to live alone or with a spouse and receive no care or care only from the spouse before death. Disabled-Continent older adults had a higher chance of dying at home. Being female, not "married and living with a spouse", suffering from hypertension, diabetes, stroke or cerebrovascular disease (CVD), bronchitis/emphysema/pneumonia, cancer, or dementia, and dying in a later year were associated with more severe prior-to-death disability patterns. Not having public old-age insurance predicted lower chances of having a Disabled-Incontinent profile, and advanced age increased the chance of having a Disabled-Continent profile. CONCLUSIONS Three prior-to-death disability patterns were identified for Chinese adults aged 65 years and older. These profiles were significantly linked with the end-of-life caregiving arrangements and place of death among older adults. Both demographic information and health status predicted prior-to-death disability profiles.
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Affiliation(s)
- Chuqian Chen
- Department of Medical Humanities, School of Humanities, Southeast University, Nanjing, China.
- Jiangsu Ageing-Responsive Civilization Think Tank, Nanjing, China.
| | - Lingling Yu
- Department of Philosophy and Science, School of Humanities, Southeast University, Nanjing, China
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Uzun LN, Hançer Tok H. Perineal care incontinence training for caregivers: randomised controlled trial. BMJ Support Palliat Care 2023:spcare-2023-004633. [PMID: 37907251 DOI: 10.1136/spcare-2023-004633] [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: 09/30/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES The aim of this study was to implement training to increase the perineal care knowledge of relatives caring for incontinent palliative care patients and to examine the effectiveness of this training. METHODS This study was designed as a pretest-post-test randomised controlled trial. The study included 84 relatives of patients with incontinence (experimental group, n=42; control group, n=42). The experimental group was given one-on-one face-to-face training on perineal care for patients with incontinence, while the control group was given training through a brochure. Data were collected using a personal information form and the Perineal Care Knowledge Test. The Wilcoxon signed-rank and Mann-Whitney U tests were used for statistical analysis. RESULTS The difference between the pretest and post-test scores of the experimental group was found to be statistically significant (p<0.05), while the difference between the pretest and post-test scores of the control group was not significant (p>0.05). The post-test scores of the experimental group were higher than those of the control group (p<0.05). CONCLUSIONS It was found that one-on-one face-to-face perineal care training was a more effective method for increasing the perineal care knowledge of patients' relatives than brochures.
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Affiliation(s)
| | - Hümeyra Hançer Tok
- Department of Nursing, Ministry of Health Bolu İzzet Baysal Mental Health and Diseases Hospital, Bolu, Turkey
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3
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Jackson D. Incontinence in palliative care: assessment to promote dignity. Br J Community Nurs 2022; 27:242-250. [PMID: 35522447 DOI: 10.12968/bjcn.2022.27.5.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article will explore the district nurse (DN) role in caring for palliative service users and their responsibility to prepare them and their family members to understand the trajectory of their prognosis and the possible decline in urinary function and incontinence. Educating DNs to advise service users in appropriate management options and collaborating with the wider multidisciplinary team (MDT) to ensure service users' individual goals and aims are followed as closely as possible. Urinary incontinence (UI) is not a natural part of the ageing process, although the prevalence of UI is increased as people age, through multi-morbidities, polypharmacy, cognitive decline, mobility limitations or life-limiting conditions. UI affects an individual's dignity and can cause a negative impact on self-esteem, and it is often accompanied by a perceived stigma that can lead to anxiety, depression and a reluctance to ask for help and advice.
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Affiliation(s)
- Debra Jackson
- District Nurse Apprentice, Salford Royal NHS Trust (Northern Care Alliance)
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4
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Russell D, Stoddard MD, Morgan N, McDonald MV, Dignam R, Bowles KH, Prigerson HG, Chughtai B. Nurse perspectives on the psychosocial care of patients with urinary incontinence in home hospice: A qualitative study. Palliat Med 2022; 36:135-141. [PMID: 34479463 DOI: 10.1177/02692163211043378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Urinary incontinence is prevalent among patients receiving home hospice and presents multiple care management challenges for nurses and family caregivers. AIM This study sought to understand how urinary incontinence influences the psychosocial care of patients receiving home hospice and the strategies that nurses employ to maximize patient and family comfort. DESIGN Qualitative descriptive study using semi-structured interviews. SETTING/PARTICIPANTS Nurses employed at a large not-for-profit hospice agency in New York City. RESULTS Analyses of 32 interviews revealed three primary themes. First, nurses considered urinary incontinence to be associated with multiple psychosocial issues including embarrassment for patients and caregiver burden. Second, nurses described urinary incontinence as a threat to patient dignity and took steps to preserve their continence function. Third, nurses assisted patients and their families to cope with urinary incontinence through normalization, reframing incontinence as part of the disease process, mobilizing caregiving assistance, and encouraging use of continence supplies such as diapers and liners. CONCLUSION Urinary incontinence influences the psychosocial care of patients receiving home hospice and nurses employ strategies to maximize patient and family comfort. Additional research is needed to examine the psychosocial benefits of facilitated discussions with patients and family members about incontinence, provision of caregiving support, and distribution of comprehensive incontinence supplies to patients with fewer resources.
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Affiliation(s)
- David Russell
- Department of Sociology, Appalachian State University, Boone, NC, USA.,Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Michelina D Stoddard
- Department of Urology, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA.,Weill-Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, NY, USA
| | - Natalie Morgan
- Department of Sociology, Appalachian State University, Boone, NC, USA
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | | | - Kathryn H Bowles
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA.,Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Bilal Chughtai
- Department of Urology, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
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5
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Habib MH, Arnold RM. Urinary Incontinence in Palliative Care Settings: Part 1: Etiology and Workup #425. J Palliat Med 2021; 24:1732-1733. [PMID: 34726522 DOI: 10.1089/jpm.2021.0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Stoddard MD, Russell D, McDonald MV, Dignam R, Bowles KH, Prigerson HG, Chughtai B. Nurse Perspectives on Urinary Incontinence in the Home Hospice Setting. J Pain Symptom Manage 2021; 62:383-390. [PMID: 33271313 DOI: 10.1016/j.jpainsymman.2020.11.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 01/08/2023]
Abstract
CONTEXT To date, no studies have characterized the impacts of urinary incontinence (UI) at the end of life in the home hospice (HH) setting. UI is highly prevalent at the end of life and adversely affects quality of life. OBJECTIVES To characterize HH nurses' perspectives on UI in HH patients. METHODS We conducted a qualitative descriptive study of interviews between HH nurses and the study investigator. Thirty-two interviews with HH nurses were transcribed and analyzed. Nurses were mostly female, college-educated, and had several years of experience in HH nursing. RESULTS We identified findings in four major themes: 1) HH nurses' definition and identification of UI, 2) the absence of formal guidelines for diagnosing UI in HH patients, 3) UI's adverse effect on HH patients and their families, and 4) the lack of standardized guidelines for the management of UI in the HH setting. We found that there was a general lack of clarity on the subtypes of UI and no standardized guidelines for management of UI in the HH setting. Nurses reported that UI was bothersome to HH patients and their caregivers, citing patient discomfort, loss of dignity, and additional labor burden as reasons for this. Management strategies for UI lacked standardization. CONCLUSION UI is a prevalent and debilitating condition in HH patients. There is a need for studies to further characterize the impacts of UI on HH patients and their caregivers. Formal training on UI subtypes and management is needed to facilitate proper documentation, research, and improve patient outcomes.
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Affiliation(s)
- Michelina D Stoddard
- Department of Urology, Weill Cornell Medicine/New York Presbyterian, New York, New York, USA; Weill-Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, New York, USA
| | - David Russell
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York, USA; Department of Sociology, Appalachian State University, Boone, North Carolina, USA
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York, USA
| | - Ritchell Dignam
- Visiting Nurse Service of New York Hospice, New York, New York, USA
| | - Kathryn H Bowles
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York, USA; Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Holly G Prigerson
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medicine/New York Presbyterian, New York, New York, USA.
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Smith N, Rajabali S, Hunter KF, Chambers T, Fasinger R, Wagg A. Bladder and bowel preferences of patients at the end of life: a scoping review. Int J Palliat Nurs 2020; 26:432-442. [PMID: 33331214 DOI: 10.12968/ijpn.2020.26.8.432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Following patient preferences at the end of life should improve outcomes of care, yet patient preferences regarding bladder and bowel care are not often accommodated, as they are not well known in the literature. AIMS This scoping review sought to identify bladder and bowel care preferences of patients at the end of life in published literature. METHODS Papers published in or after 1997 (in English) that focused on adult preferences for bladder and bowel care at the end of life were included. FINDINGS Scant literature exists on preferences for bladder and bowel care for adult patients at end of life. Further investigation is warranted to arrive at a better understanding of preferences regarding bladder and bowel symptom management. CONCLUSIONS Future research should explore if prioritising the symptoms caused by incontinence, among the many symptoms experienced at the end of life, could be achieved through careful questioning and development of a standardised tool focused on improving patient care and incorporating patient preferences for care.
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Affiliation(s)
| | - Saima Rajabali
- Clinical Trials Project Coordinator for Division of Geriatric Medicine, Division of Geriatric Medicine, Faculty of Medicine and Dentistry, University of Alberta
| | - Kathleen F Hunter
- Professor, Division of Geriatric Medicine, Faculty of Medicine and Dentistry, University of Alberta
| | - Thane Chambers
- Research Impact Librarian, Faculty of Nursing, University of Alberta
| | - Robin Fasinger
- Professor, Faculty of Medicine and Dentistry, University of Alberta
| | - Adrian Wagg
- Professor/Director, Faculty of Medicine and Dentistry, University of Alberta
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Staats K, Grov EK, Husebø BS, Tranvåg O. Dignity and loss of dignity: Experiences of older women living with incurable cancer at home. Health Care Women Int 2020; 41:1036-1058. [DOI: 10.1080/07399332.2020.1797035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Katrine Staats
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
| | - Ellen Karine Grov
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Bettina S. Husebø
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
| | - Oscar Tranvåg
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Oslo University Hospital, Norwegian National Advisory Unit on Women’s Health, Oslo, Norway
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Ostaszkiewicz J, Dickson-Swift V, Hutchinson A, Wagg A. A concept analysis of dignity-protective continence care for care dependent older people in long-term care settings. BMC Geriatr 2020; 20:266. [PMID: 32727481 PMCID: PMC7392826 DOI: 10.1186/s12877-020-01673-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/23/2020] [Indexed: 12/25/2022] Open
Abstract
Background Although codes of conduct, guidelines and standards call for healthcare practitioners to protect patients’ dignity, there are widespread concerns about a lack of attention to the dignity of older people who need assistance with toileting, incontinence or bladder or bowel care in health or social care settings that provide long-term care. Incontinence and care dependence threatens patient dignity. The aim of this research was to explore, describe and explain the concept of dignity as it relates to continence care for older people requiring long-term care. Methods The first four steps of Rodgers evolutionary method of concept analysis were followed. First, a comprehensive and systematic search of databases and key guidelines about continence care was undertaken to identify empirical research about dignity and continence care in older people in facilities that provide permanent residential or inpatient care of older people for day-to-day living. Data were extracted on the authors, date, sample, country of origin, and key definitions, attributes, contexts and consequences from each included record. Findings were inductively analysed and grouped according to whether they were the key attributes and antecedents of dignity in relation to continence care or the consequences of undignified continence care. Results Of 625 articles identified, 18 were included in the final analysis. Fifty individual attributes were identified that were categorised in 6 domains (respect, empathy, trust, privacy, autonomy and communication). A further 15 were identified that related to the environment (6 physical and 9 social). Key consequences of undignified continence care were also identified and categorised into 3 levels of impact (resident/family member, staff or organisation). Conclusions This research resulted in a conceptual understanding of dignity that can be used as a value or guiding principle in an ethic of care for older people who need assistance with toileting, incontinence or bladder or bowel care in long-term care settings.
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Affiliation(s)
- Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research - Barwon Health Partnership, Institute for Healthcare Transformation, Deakin University, Geelong, VIC, 3220, Australia. .,School of Nursing and Midwifery, Deakin University, Gheringhap St, Geelong, VIC, 3220, Australia. .,National Ageing Research Institute, P.O Box 2127, Royal Melbourne Hospital, 21, Melbourne, VIC, 3530, Australia.
| | - Virginia Dickson-Swift
- Centre for Quality and Patient Safety Research - Barwon Health Partnership, Institute for Healthcare Transformation, Deakin University, Geelong, VIC, 3220, Australia.,School of Nursing and Midwifery, Deakin University, Gheringhap St, Geelong, VIC, 3220, Australia
| | - Alison Hutchinson
- Centre for Quality and Patient Safety Research - Monash Health Partnership, Institute for Healthcare Transformation, Deakin University, Burwood, VIC, 3125, Australia
| | - Adrian Wagg
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Savas S, Saka B, Akın S, Tasci I, Tasar PT, Tufan A, Yavuzer H, Balci C, Sezgin G, Karan MA. The prevalence and risk factors for urinary incontinence among inpatients, a multicenter study from Turkey. Arch Gerontol Geriatr 2020; 90:104122. [PMID: 32610211 DOI: 10.1016/j.archger.2020.104122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the prevalence and the factors associated with urinary incontinence (UI) among inpatients in Turkey. METHOD The population of this study comprised of patients screened by the "National Prevalence Measurement of Quality of Care (LPZ)" study in 2017 and 2018. Age, gender, comorbidities, length of hospital stay, sedative medications, SARC-F score, anthropometric measurements, and care parameters such as malnutrition, falls, UI-fecal incontinence (FI), restraints, and care dependency score (CDS) were noted. The LPZ questionnaire was performed by trained researchers, and multiple logistic regression analysis was performed to determine the factors associated with UI. RESULTS The prevalence of UI was 29.4 % among 1176 inpatients, and 41.6 % in patients ≥65 years. Urinary incontinence was associated with older age (OR, 1.966, 95 % CI 1.330-2.905), female sex (OR, 2.055, 95 % CI 1.393-3.030), CDS (OR, 3.236, 95 % CI 2.080-5.035), the number of comorbidities (OR, 1.312, 95 % CI 1.106-1.556), end-of life management (OR, 3.156, 95 % CI 1.412-7.052), sedative medications (OR, 1.981, 95 % CI 1.230-3.191), and FI (OR, 12.533, 95 % CI 4.892-32.112) in all adults, where CDS (OR, 2.589, 95% CI 1.458-4.599), end-of life management (OR, 2.851, 95 % CI 1.095-7.424), sedative medications (OR, 2.529, 95 % CI 1.406-4.548), and FI (OR, 13.138, 95 % CI 4.352-39.661) were associated with UI among geriatric patients. CONCLUSIONS The factors associated with UI in geriatric and all adult inpatients are CDS, sedative medications, end-of life management, and FI plus older age, female sex, and comorbidities for the latter. The factors associated with UI vary in different age groups.
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Affiliation(s)
- Sumru Savas
- Division of Geriatrics, Department of Internal Medicine, School of Medicine, Ege University, Izmir, Turkey.
| | - Bülent Saka
- Division of Geriatrics, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sibel Akın
- Division of Geriatrics, Department of Internal Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Ilker Tasci
- Gulhane Medical School & Gulhane Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Pinar Tosun Tasar
- Department of Internal Medicine, School of Medicine, Atatürk University, Erzurum, Turkey
| | - Asli Tufan
- Division of Geriatrics, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Hakan Yavuzer
- Division of Geriatrics, Department of Internal Medicine, School of Medicine, Cerrahpaşa University, Istanbul, Turkey
| | - Cafer Balci
- Division of Geriatrics, Department of Internal Medicine, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Gülbüz Sezgin
- Division of Geriatrics, Department of Internal Medicine, School of Medicine, Maltepe University, Istanbul, Turkey
| | - Mehmet Akif Karan
- Division of Geriatrics, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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