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J G Ouslander

Publications and source records attributed to J G Ouslander.

At least 19 recordsLinked to original sources
PubMed1992

Inappropriate medication prescribing in skilled-nursing facilities.

OBJECTIVE: To quantify the appropriateness of medication prescriptions in nursing home residents. DESIGN: Prospective, cohort study. SETTING: Twelve nursing homes in the greater Los Angeles area. PARTICIPANTS: A total of 1106 nursing home residents. MAIN OUTCOME MEASURES: The appropriateness of medication prescriptions was evaluated using explicit criteria developed through consensus by 13 experts from the United States and Canada. These experts identified 19 drugs that should generally be avoided and 11 doses, frequencies, or durations of use of specific drugs that generally should not be exceeded. RESULTS: Based on the consensus criteria, 40% of residents received at least one inappropriate medication order, and 10% received two or more inappropriate medication orders concurrently; 7% of all prescriptions were inappropriate. Physicians prescribed a greater number of inappropriate medications for female residents. Regression analysis, corrected for clustering effects within facilities, showed that a greater number of inappropriate medication prescriptions were ordered in larger nursing homes. Inappropriate prescriptions were not related to the proportion of Medicaid (Medi-Cal) residents or the number of physicians practicing in the homes. CONCLUSIONS: Inappropriate medication prescribing in nursing homes is common. Female residents and residents of large nursing homes are at the greatest risk for receiving an inappropriate prescription.

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PubMed1992

A computerized system for identifying and informing physicians about problematic drug use in nursing homes.

With growing concern over the quality of medication use in nursing homes, physicians, administrators, pharmacists, and regulators are looking for effective and efficient methods to improve it. Pharmacy consultation alone appears to be ineffective in controlling the use of inappropriate drugs. We describe here a computerized drug utilization review system designed for use in nursing homes. The system evaluates the appropriateness of medication use by criteria developed through the consensus of experts in geriatrics and specifically designed to address the pharmacological needs of elderly, nursing home residents. The program not only determines the frequency of inappropriate prescriptions, but produces written, educational statements to be given to prescribing physicians. These statements can also be given to nurses to educate them about issues in geriatrics pharmacology. Additionally, the system produces medication order forms that may help focus physicians' attention on the need to evaluate drugs individually.

Clinical Pharmacy Information Systems↗
PubMed1992

Geriatric urinary incontinence.

Urinary incontinence (UI) is now recognized as a prevalent, physically and emotionally disruptive, and costly health problem in the geriatric population. Because incontinence may be a manifestation of a subacute or reversible process within or outside of the lower urinary tract, and because effective treatment is available, it is important for primary care physicians to identify and appropriately assess incontinence in their geriatric patients. The initial evaluation of an incontinent geriatric patients. The initial evaluation of an incontinent geriatric patient includes a targeted history and physical examination, urinalysis, and simple tests of lower urinary tract function. Potentially reversible conditions that may be causing or contributing to the incontinence, such as delirium and urinary tract infection (UTI), should be identified and managed. Patients who may benefit from further testing, including urologic or gynecologic examination and/or complex urodynamic tests, should be identified and referred. Several therapeutic modalities can be used to treat geriatric UI. Behavioral therapies are noninvasive and effective, both in functional community-dwelling geriatric patients and in functionally impaired nursing home residents. Behavioral therapies include bladder training, pelvic muscle exercises, biofeedback, scheduled toileting, habit training, and prompted voiding. Pharmacologic therapy is often used in conjunction with behavioral therapy. For stress incontinence, alpha-adrenergic drugs are used and can be combined with topical or oral estrogen therapy in women. For urge incontinence, pharmacologic treatment involves drugs with anticholinergic and direct bladder muscle relaxant properties. Pharmacologic therapy for overflow incontinence is generally not effective on a long-term basis. Surgical treatment is indicated when a pathologic lesion such as a tumor is diagnosed, or when anatomic obstruction is believed to be the cause of the patient's symptoms. Surgical treatment of stress incontinence can be highly effective in properly selected women. Nonspecific, supportive treatments are also important in managing geriatric UI. Education for patients and caregivers is critical for the success of most therapies. Environmental manipulations and the appropriate use of toilet substitutes are especially important in frail, functionally impaired patients. Highly absorbent adult undergarments are helpful for managing many patients, but should not be used as the initial response to incontinence, and are best used in conjunction with more specific treatment whenever possible. Chronic indwelling catheterization should only be used to manage incontinence when it is associated with clinically significant urinary retention, skin conditions that cannot heal because of incontinence, or severe illness that makes the catheter the most comfortable method of management.(ABSTRACT TRUNCATED AT 400 WORDS)

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PubMed1991

Risk factors for urinary incontinence one year after nursing home admission.

Secondary data analysis was conducted from a longitudinal nursing home study to identify nonurologic risk factors for continence outcomes at 1 year after admission. Of 434 nursing home admissions, 196 subjects (45%) remained. At 1 year prevalence of incontinence was 43.8%. Age was not associated with prevalence or incidence. Risk factors identified were of male gender, urinary incontinence and poor behavioral adjustment at 2 weeks, presence of dementia and impaired mobility at 2 months. Once established, incontinence tended to persist. The data suggest types of residents who might be targeted for early preventive intervention.

Activities of Daily Living↗
PubMed1991

Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine.

Increasing attention is being paid to inappropriate medication use in nursing homes. However, criteria defining the appropriate or inappropriate use of medication in this setting are not readily available and are not uniform. We used a two-round survey, based on Delphi methods, with 13 nationally recognized experts to reach consensus on explicit criteria defining the inappropriate use of medications in a nursing home population. The criteria were designed to use pharmacy data with minimal additional clinical data so that they could be applied to chart review or computerized data sets. The 30 factors agreed on by this method identify inappropriate use of such commonly used categories of medications as sedative-hypnotics, antidepressants, antipsychotics, antihypertensives, nonsteroidal anti-inflammatory agents, oral hypoglycemics, analgesics, dementia treatments, platelet inhibitors, histamine2 blockers, antibiotics, decongestants, iron supplements, muscle relaxants, gastrointestinal antispasmodics, and antiemetics. These criteria may be useful for quality assurance review, health services research, and clinical practice guidelines. The method used to establish these criteria can be used to update and expand the guidelines in the future.

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PubMed1991

Urinary incontinence in the geriatric population.

Urinary incontinence in the geriatric population is prevalent, morbid, and costly. Despite the high prevalence and adverse effects, many incontinent geriatric patients do not undergo any type of diagnostic evaluation. Assessment of incontinence in this patient population should focus on identifying reversible factors that may contribute to the incontinence, determining whether the patient should be referred for further evaluation before initiating treatment, and pinpointing the cause(s) of the incontinence so that appropriate treatment can be instituted. Many different therapeutic modalities can be helpful for geriatric urinary incontinence, including behavioral, pharmacologic, and surgical approaches. Chronic catheters and diapers should generally not be used as the initial treatment, and be reserved for patients who fail more specific treatment approaches. Although it may not be possible to cure the incontinence, it is almost always possible to ameliorate the problem, and prevent discomfort, complications, and excessive costs.

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PubMed1990

Perceptions of urinary incontinence among elderly outpatients.

We examined the perceptions about urinary incontinence (UI) among 164 females and 35 males (mean age = 78.5) referred to an outpatient continence clinic. Between 60 and 76% of the patients felt that the UI was inconvenient, embarrassing, or distressing, and 37% indicated that it significantly interfered with their daily lives. Over half said they would consider surgery if necessary to correct the UI. Amount rather than frequency or duration of urinary loss was significantly associated with negative perceptions of the UI.

Activities of Daily Living↗
PubMed1990

Incontinence among elderly community-dwelling dementia patients. Characteristics, management, and impact on caregivers.

Incontinence was identified by 36% of 184 caregivers as a problem in their care of older community-dwelling patients with dementia. Incontinent dementia patients had greater impairment of cognitive function and more frequent behavioral problems than did patients without incontinence. Burden scores were higher among caregivers of incontinent patients, but multiple regression analyses indicated that factors other than incontinence contributed more to perceived burden. Follow-up interviews revealed that incontinence had played an important role in most decisions to institutionalize among caregivers of patients who were placed in a nursing home between interviews; it rarely, however, was the primary reason. The majority of incontinent patients still residing in the community were being managed by nonspecific techniques such as diapers and toileting schedules. These data emphasize the need to educate community caregivers of dementia patients in the appropriate management of incontinence and the need for further research on methods of effectively targeting assessment and treatment strategies to this patient population.

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