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Biomedical subjects

L S Mitteness

Publications and source records attributed to L S Mitteness.

12 recordsLinked to original sources
PubMed1998

Older home health care patients and their physicians: assessment of functional ability.

Assessment of a person's level of functional impairment is a key aspect of geriatric clinical practice. This study examines the agreement between functional assessments reported by 54 physician-patient dyads. Physicians were typical of those providing services to elderly patients in an urban area. Patients, all aged 65 or more years and community-living, had been referred by these physicians for in-home health care services. Generally, physicians reported less impairment than did their patients, functional assessments by both doctors and patients matching completely in only 15 of 54 (28%) dyads. Underestimation of patient impairment occurred most commonly with respect to stair climbing, control of the urinary bladder, and bathing, but was also substantial for dressing, walking, and toileting. Few patient or doctor characteristics predicted congruence or lack thereof in assessment of functional impairments. Some implications of these findings for clinical practice and medical education are examined.

Activities of Daily Living↗
PubMed1995

Stigmatizing a "normal" condition: urinary incontinence in late life.

The geriatric medical literature presents a perspective on urinary incontinence in the elderly that is sharply divergent from the realities of medical and lay responses to incontinence. This contrast raises questions about the cultural significance of urinary incontinence. The geriatric literature reveals a consensus that urinary incontinence, a major health problem among the elderly, is treatable and frequently reversible. The elderly and their health care providers, however, not only see incontinence as an inevitable, irreversible, and normal part of growing old but also consider it a sign of incompetence. This linkage of incontinence with incompetence forces elderly people to adopt several strategies for managing their incontinence so as not to compromise their competence in the eyes of others. Incontinence is a cultural symbol for the increasing dependencies of old age, dependencies that are much feared and resented in U.S. society, where tremendous emphasis is placed on independence even into advanced old age.

Activities of Daily Living↗
PubMed1993

Constipation in the daily lives of frail elderly people.

OBJECTIVE: To examine the meaning and context of constipation in frail elders. DESIGN: Interview study with monthly follow-up for a 6-month period. SETTING: Respondents' homes. PARTICIPANTS: Two hundred eleven randomly selected community-living, frail elders receiving in-home health care. RESULTS: Constipation was spontaneously mentioned by 94 patients (45%); it was considered a major health problem by 11% of these frail elders. Of this 11%, over half rated it as one of their top three health concerns. Of elders who talked about management strategies, most (43 [61%] of 70 patients) used medication alone. Only eight people did not use pharmacologic agents. Few (16 [17%] of 94 patients) mentioned a health-care professional in the context of constipation, and only five of these people expressed satisfaction with advice or treatment. CONCLUSIONS: Constipation was a health problem for many of these elderly patients receiving home health care. Although the stated goal in the treatment of constipation is to avoid laxatives, both lay and medical management focused primarily on the use of medications. The results of this study underscore the importance of addressing quality of life as well as physiological issues for optimal treatment of constipation and similar disorders.

Aged↗
PubMed1990

Knowledge and beliefs about urinary incontinence in adulthood and old age.

Public knowledge and beliefs about urinary incontinence in adulthood are potentially significant contributors to the success or lack of success of intervention strategies. This is especially true given the repeated finding that significant proportions of incontinent people (at least half) do not report their incontinence to a physician. Although there is little literature on this topic, at least three salient features need to be recognized. First, there is an indication that laypeople have vague understandings of the causes and parameters of incontinence. The functioning of the human body is a mystery to many adult Americans. This lack of information is fostered by cultural beliefs that the body is something off-limits, that its functions are the appropriate domain of specialists. Of course, educational factors and possibly ethnic affiliations modify this lack of information. Lack of information is compounded by lack of an appropriate vocabulary. Clinicians must be aware that a patient's understanding of the body or terminology for bodily functions may not fit their own framework. Second, there is consistent evidence that elderly people often consider urinary incontinence to be an inevitable and irremediable part of the normal aging process. This linkage of incontinence and normal aging is probably protective of self-esteem but does little to foster amelioration of incontinence. The belief that incontinence signals oncoming incompetence is a cultural construction that is apparent in popular culture, such as literature and movies and reflected in the secrecy attendant on much incontinence in later life.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Personalization of formal social relationships by the elderly.

This article examines the role of formal support services in the lives of elderly residents of HUD-subsidized buildings. Tenants identified a variety of formal roles as important in their lives. The three most central roles were physician (79%), apartment manager (58%), and social worker (51%). Formal roles were an important source of both instrumental and affective support in a wide variety of circumstances. Many individuals in formal roles were considered friends and the highly personalized nature of these relationships was a surprising finding.

Aged↗