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Joseph G Ouslander

Publications and source records attributed to Joseph G Ouslander.

11 recordsLinked to original sources
PubMed2003

Does an exercise and incontinence intervention save healthcare costs in a nursing home population?

OBJECTIVES: To determine whether an intervention that combines low-intensity exercise and incontinence care offsets some of its costs by reducing the incidence of selected health conditions in nursing home residents. DESIGN: Randomized, controlled trial with the incidence and costs of selected, acute conditions compared between a 6-month baseline and an 8-month intervention phase. SETTING: Four nursing homes. PARTICIPANTS: One hundred ninety incontinent, long-stay nursing home residents. INTERVENTION: Low-intensity, functionally oriented exercise and incontinence care were provided every 2 hours from 8:00 a.m. to 4:00 p.m. for 5 days a week for 8 months. MEASUREMENTS: Predefined acute conditions hypothesized to be related to physical inactivity, incontinence, or immobility were abstracted from residents' medical records by blinded observers during a 6-month baseline period and throughout the 8-month intervention. Conditions included those in the dermatological, genitourinary, gastrointestinal, respiratory and cardiovascular systems; falls; pain; and psychiatric and nutritional disturbances. Costs were determined using Current Procedural Terminology Center and Medicare allowable cost reimbursement at a rate of 80%. RESULTS: The intervention group had significantly better functional outcomes than the control group (strength, mobility endurance, urinary and fecal incontinence) and a reduction of 10% in the incidence of the acute conditions, which was not significant. There were no significant differences between groups in the cost of assessing and treating these acute conditions between baseline and intervention. CONCLUSION: The intervention, which is consistent with federal and clinical practice guidelines, significantly improved functional outcomes but did not reduce the incidence and costs of selected acute health conditions. The cost of implementing these labor-intensive interventions for frail nursing home residents will have to be justified based on functional and quality-of-life outcomes and are unlikely to be offset by savings in medical care costs in this population.

Acute Disease↗
PubMed2003

Effects of an exercise intervention on immunologic parameters in frail elderly nursing home residents.

BACKGROUND: Aging is associated with decline in both cell-mediated and humoral immunity and may contribute to increased incidence and severity of infections in frail elderly. Exercise, depending on intensity, has significant effects on the immune system. We conducted a randomized, controlled clinical trial of a 32-week functionally oriented exercise program in frail elderly living in nursing homes and determined whether the exercise intervention was associated with a change in immune parameters in this frail elderly nursing home population. METHODS: Nursing home residents were randomly assigned to an intervention (n = 94) and control group (n = 96). The intervention consisted of a functionally oriented endurance and resistance exercise training that was provided every 2 hours from 8:00 AM to 4:00 PM for 5 days a week for 8 months. Lymphocyte subpopulations, including activation markers (CD28, CD25, HLA-DR), in vitro proliferation, and soluble products of cytokine activity (neopterin and sTNF-RII) in serum were measured by taking blood samples at baseline and after 8 weeks and 32 weeks of the intervention. RESULTS: Exercise training did not induce changes in lymphocyte subpopulations, activation markers (CD28, CD25, HLA-DR), in vitro proliferation, and soluble products of cytokine activity (neopterin and sTNF-RII) in serum. CONCLUSIONS: A 32-week exercise intervention did not bring about beneficial or detrimental effects on immune parameters in the frail elderly nursing home population and may explain why the intervention was not associated with a change in the incidence of infections in the intervention group compared with the control group.

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PubMed2003

Arginine vasopressin and nocturnal polyuria in older adults with frequent nighttime voiding.

PURPOSE: We determined in older adults whether frequent nighttime voiding is associated with urine overproduction at night or nocturnal polyuria (NP) and whether NP is associated with abnormalities of arginine vasopressin (AVP) blood levels and/or renal responsiveness to AVP. MATERIALS AND METHODS: We used a convenience sample of adults 65 years and older in home and general clinical research center settings. A total of 45 participants completed the 3-day general clinical research center stay. We used 7-day voiding diaries to determine which participants had 2 or greater nighttime voids and NP, defined as 35% or greater of 24-hour urine output at night. Abnormalities in AVP release and secretion were determined by water deprivation testing and by twice daily blood AVP measurement. RESULTS: There was a strong positive association between the number of nighttime voids and the proportion of urine produced at night (r = 0.6, p <0.001). There was no association between NP and AVP blood levels or action. Participants with and without NP had similar maximum urine osmolality following water deprivation and exogenous AVP administration (mean 549 mOsm, range 422 to 713 and 547 mOsm, range 353 to 692, respectively). CONCLUSIONS: We found no association between NP and AVP abnormalities in this sample of older adults. Study participants had low maximal urine osmolality in response to fluid deprivation and exogenous vasopressin administration irrespective of whether they were identified as having NP.

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PubMed2002

Geriatric considerations in the diagnosis and management of overactive bladder.

Numerous considerations affect the diagnosis and management of overactive bladder (OAB) in older patients, including neurologic and cardiovascular disorders, musculoskeletal conditions, diabetes, and psychiatric disorders. Older patients are commonly prescribed multiple medications, and many medications can contribute to OAB symptoms and/or interact with drug treatment for OAB. In addition to chronic illnesses and related medications, several factors outside the lower urinary tract can play an important part in managing OAB in older patients. These factors include mobility disorders, cognitive impairment, bowel habits, and fluid intake. Moreover, OAB often does not occur in isolation in the geriatric population. Estrogen deficiency and sphincter weakness in women, prostatic enlargement and obstruction in men, and impaired bladder contractility in both sexes are common and can have prominent effects on management. The diagnostic evaluation of geriatric patients with OAB can usually be accomplished with a basic assessment, without more invasive and expensive procedures. Treatment depends on numerous factors, ranging from comorbidities and functional status to transportation, finances, and patient and caregiver preferences. Adverse effects of bladder-relaxant medications can be bothersome and exacerbate existing conditions common in older patients (eg, constipation, glaucoma, gastroesophageal reflux, and dementia). Setting realistic goals for treatment and communicating them clearly to older patients and their caregivers are crucial for patient satisfaction. There are myriad opportunities for research designed to improve the management of OAB in the geriatric population.

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PubMed2002

Translating clinical research into practice: a randomized controlled trial of exercise and incontinence care with nursing home residents.

OBJECTIVES: To examine clinical outcomes and describe the staffing requirements of an incontinence and exercise intervention. DESIGN: Randomized controlled trial with blinded assessments of outcomes at three points over 8 months. SETTING: Four nursing homes. PARTICIPANTS: Two hundred fifty-six incontinent residents. INTERVENTION: Research staff provided the intervention, which integrated incontinence care and exercise every 2 hours from 8:00 a.m. to 4:00 p.m. 5 days a week. MEASUREMENTS: Average and maximum distance walked or wheeled, level of assistance required to stand, maximum pounds lifted by arms, fecal and urinary incontinence frequency, and time required to implement intervention. RESULTS: Intervention residents maintained or improved performance whereas the control group's performance declined on 14 of 15 outcome measures. Repeated measures analysis of variance group-by-time significance levels ranged from P <.0001 to.05. The mean time required to implement the intervention each time care was provided was 20.7 +/- 7.2 minutes. We estimate that a work assignment of approximately five residents to one aide would be necessary to provide this intervention. CONCLUSIONS: The incontinence care and exercise intervention resulted in significant improvement for most residents, and most who could be reliably interviewed expressed a preference for such care. Fundamental changes in the staffing of most nursing homes will be necessary to translate efficacious clinical interventions into everyday practice.

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PubMed2002

A prospective evaluation of the glomerular filtration rate in older adults with frequent nighttime urination.

PURPOSE: We assessed the association of renal function with frequent nighttime urination in older adults. MATERIALS AND METHODS: We recruited a convenience sample of 48 adults 65 years old and older, and admitted them to a general clinical research center. Of the 48 participants 45 completed a 7-day voiding record, ate a research diet for 4 days and finished a 3-day stay with 3 glomerular filtration rate measurements, including an estimation of serum creatinine using the Cockcroft-Gault formula, a calculation using 24-hour urine volume and a determination by 131iodine iothalamate clearance. RESULTS: Subjects with frequent nighttime voiding, defined as a mean of 2 or more voiding episodes from 11 p.m. to 7 a.m., had slightly lower but statistically similar glomerular filtration rate measurements than those with a mean of less than 2 nighttime voids. The glomerular filtration rate did not correlate with the number of nighttime voids (Pearson correlation coefficient -0.006, p = 0.971). Mean 24-hour urine output was similar in the 2 groups and the correlation of the number of nighttime voids with 24-hour urine output was insignificant (Pearson correlation coefficient -0.06, p = 0.683). A greater number of nighttime voids was associated with producing more urine at night and smaller mean voided volume. CONCLUSIONS: As determined by a gold standard glomerular filtration rate measurement, renal function was not associated with the number of nighttime voids in our study population. Total 24-hour urine output was also not associated with the number of nighttime voids. Our findings confirmed the positive association of a greater number of nighttime voids with greater nighttime urine production and lower bladder voided volume.

Aged↗
PubMedDate not supplied

Incidence and costs of acute medical conditions in long-stay incontinent nursing home residents.

OBJECTIVES: To determine the incidence of acute medical conditions in incontinent nursing home residents, and associated costs of diagnostic testing and treatment DESIGN: Prospective, cohort study. SETTING: Three community nursing homes. PARTICIPANTS: 161 long-stay residents with urinary incontinence in (mean age 86 years, 77% female, 92% white). MEASUREMENTS: Acute medical conditions were identified prospectively through medical record review based on standardized criteria. All diagnostic testing and treatment provided for these conditions were recorded, and related costs in the nursing home were assigned based on 1997-1998 Medicare and Medicaid reimbursement. RESULTS: The highest incidences of illness were for dermatological conditions (107 episodes per 1000 patient-weeks, involving 70% of subjects), respiratory illnesses (29 per 1000 patient-weeks, 47% of subjects) and gas-trointestinal illnesses (24 per 1000 patient-weeks, 36% of subjects). Among episodes with an incidence of at least 5 per 1000 patient-weeks, the illness events with the highest median diagnostic testing and treatment costs per episode were pneumonia, acute bronchitis, and depression. Only 42 out of the total 1071 episodes identified resulted in a hospitalization. Significant predictors of higher illness incidence included greater baseline comorbidity and higher number of routine medications (model adjusted R-square = 0.319, P = 0.021). CONCLUSION: Acute illness is very common among incontinent nursing home residents, and is generally diagnosed and treated at the nursing home site, with variation among conditions in associated costs. Important policy implications include resource allocation (including appropriate staffing patterns), educational and quality improvement activities, and future research and guideline development for the optimal management of medical conditions in the nursing home setting.

Acute Disease↗