Screening for nutritional risk in community-dwelling old-old.

Screening tools for detecting declining nutrition in community-dwelling old-old are few and problematic. The purpose of this study was to identify the leading risk factors associated with noninvasive measures of poor nutritional status among elders aged 80 or older still living independently in the community. This cross-sectional descriptive study included 68 community-dwelling old-old (average age 85.7). Participants were recruited by parish nurses. In-home interviews were conducted. Relationships between five well-established measures of nutritional risk factors and two measures of nutritional status, body mass index (BMI) categories, and unintentional weight loss were examined. Depression and the food pyramid groups with adequate amounts eaten were predictive of unintentional weight loss in the previous 6 months (p = 0.013) but not of high or low BMI. In this sample, 25% were obese. Screening for depression and food intake may be useful in predicting nutritional decline among community-dwelling old-old and point to targeted interventions in a population who are large users of health care dollars.

Patient-centered interventions: implications for incontinence.

BACKGROUND: Nurse researchers in incontinence have focused on testing the effects of standardized interventions; however, nurses in practice usually customize interventions with patients. Patient-centered interventions promise to bring research and practice closer together.Tailored interventions, one kind of patient-centered intervention, have been associated with improved health outcomes and can guide research interventions regarding incontinence. OBJECTIVES: To define the concept "patient-centered," discuss four kinds of patient-centered interventions, offer examples of tailored interventions, and suggest ideas for future incontinence research. METHODS: Existing literature on patient-centered interventions was analyzed to generate a plan for future research. RESULTS: Research is needed to demonstrate the efficacy of patient-centered interventions in outcomes, to determine bio-psycho-social factors of subgroups (race, gender, ethnicity) in order to more accurately describe prevalence rates and create effective interventions, and to find common variables among successful interventions. CONCLUSIONS: Developing and testing patient-centered interventions regarding incontinence promises to advance knowledge about more effective interventions, conditions under which they are more or less effective, and how they are effective.

Shaping future directions for incontinence research in aging adults: executive summary.

BACKGROUND: The Center for Gerontological Nursing, School of Nursing, University of Minnesota, as part of the John A. Hartford Foundation's Geriatric Nursing Initiative, convened an invitational nursing research summit on incontinence in St. Paul, Minnesota on October 16-18, 2003. OBJECTIVE: To identify new approaches for conducting urinary and fecal incontinence research in aging adults, identify strategies for reinvigorating and better positioning nursing research on incontinence, and develop recommendations for attracting new nurse investigators to incontinence research and facilitating their research training and mentorship. METHOD: Forty-seven researchers, project officers, clinician leaders, doctoral students, and consumer advocates from the United States, Canada, United Kingdom, Japan, Norway, and Australia attended a 1(1/2) day conference involving trigger talks, reaction papers, and small and large group discussions around broad thematic areas on incontinence research. Recommendations with suggested strategies were derived from the discussion groups. RESULTS: Participants identified issues related to each of the summit objectives and discussed potential strategies to overcome these challenges. Twenty-one recommendations were derived: eleven recommendations focused on new approaches to incontinence research; eight on reinvigorating and repositioning nursing research on incontinence; and two on attracting and mentoring new investigators. CONCLUSIONS: The summit model used effectively engaged an international cadre of researchers and clinicians in stimulating discussions that yielded the identification of strategic directions for conducting and funding incontinence research and strategies for reinvigorating and repositioning nursing research on incontinence.

Frequency of hallway ambulation by hospitalized older adults on medical units of an academic hospital.

Lack of activity during hospitalization may contribute to functional decline. The purpose of this study was to determine the frequency of hallway walking by older adults hospitalized for medical illness. The study was an observational time-sampled study, which was conducted in the hallways of 3 medical units of a 485-bed academic health care center. Each unit was observed weekdays for eight 3-hour intervals covering 8 AM to 8 PM. Before each observation, nursing staff were questioned about walking abilities of patients aged

Admission and discharge mobility of frail hospitalized older adults.

Functional decline during hospitalization is an important clinical problem with potential longlasting undesirable outcomes in frail elders. However, little is known about the change in mobility during hospitalization and the association with discharge status. A Mobility Classification Tool has been developed that categorizes progression of patients' in-hospital mobility using a 5-point scale. The validity and clinical usefulness of this tool was evaluated in a sample of 60 frail older adults hospitalized for medical illness. The tool allows nurses to assess, quantify, and communicate mobility levels and changes in mobility more accurately.

Effects of urinary incontinence: psychological well-being and distress in older community-dwelling women.

Urinary incontinence (UI) has been related to lower quality of life. However, the research has generally been cross-sectional, and causal relationships have not been determined. This research was a secondary analysis of a 6-year longitudinal study of chronic illness and psychological well-being in older (mean age = 73 at Time 1), community-dwelling women (n = 103). Over time, women with UI reported significantly lower subjective health, purpose in life, affect balance, personal growth, positive relations with others, and self-esteem and higher scores for depression, compared to women without UI. Incontinence had broad effects on multiple domains of psychological well-being that persisted over time and need to be addressed by clinicians.

Views of community-dwelling, old-old people on barriers and aids to nutritional health.

PURPOSE: To examine barriers and aids to maintaining the nutritional health of community-dwelling old-old residents from their perspectives. DESIGN: Cross-sectional exploratory study completed in March 2002 of old-old people living independently in one county in the Midwestern United States (US). METHODS: Sixty-eight in-home interviews were conducted with community-dwelling people aged 80 or older. Content analysis was done to examine answers to two open-ended questions about barriers and helps to nutritional health. FINDINGS: These old-old people believed they were doing well nutritionally despite reduced independence and physical limitations. They were positive about their lives and creative in problem solving to remain independent. Social connectedness was the major factor for maintaining independence into old age. The leading barrier to maintaining nutritional health was health problems. Those with more barriers were more likely to be depressed. CONCLUSIONS: Knowledge of aids and barriers to nutritional health, from a personal perspective, gives an understanding of the issues and concerns of old-old people.

Patient-centered interventions.

Patient-centered care is valued in nursing. However, until recently, nurse-researchers have focused on testing the effects of standardized rather than patient-centered interventions (PCIs). The latter are those interventions that are altered to address selected patient characteristics (e.g., beliefs, habits, or goals). PCIs have been well received, and in some studies they have been associated with improved health outcomes. In this article we describe briefly the concept patient centered, summarize the development of research on PCIs, discuss kinds of PCIs, provide examples of PCIs and how they have been derived and implemented, and raise issues for theory and future research.