Objective: The objective of this systematic review was to identify factors that consistently predict nursing home admission (NHA) in persons with dementia. Methods: Studies published in English were ...retrieved by searching the MEDLINE (1966-2006), PSYCINFO (1950-2006), CINAHL (1982-2006), and Digital Dissertations (1950-2006) databases. Bibliographies of retrieved studies were also searched. Information on study characteristics and empirical results were extracted using a standardized protocol. Results: Of 782 relevant studies identified 80 were selected for review based upon eligibility criteria. The most consistent predictors of NHA in persons with dementia included severity of cognitive impairment, Alzheimer disease diagnosis, basic activity of daily living dependencies, behavioral symptoms, and depression. Caregivers who indicated greater emotional stress, a desire to institutionalize the care recipient, and feelings of being "trapped" in care responsibilities were more likely to admit persons with dementia to nursing homes. Demographic variables, incontinence, and service use did not consistently predict NHA. Conclusions: Several results seemed to challenge conventional assumptions of what precipitates NHA among persons with dementia. Caregiver stressors in conjunction with care recipient characteristics are important to consider when assessing NHA risk. The findings emphasize the need to construct more complex models of institutionalization when designing risk measures to target interventions.
Abstract
Background
Recruiting older adults with Alzheimer’s disease (AD) dementia into clinical trials is challenging requiring multiple approaches. We describe recruitment and screening processes ...and results from the Functional Improvement from Aerobic Training in Alzheimer’s Disease study (FIT-AD Trial), a single-site, pilot randomized controlled trial testing the effects of a 6-month aerobic exercise intervention on cognition and hippocampal volume in community-dwelling older adults with mild-to-moderate AD dementia.
Methods
Ten recruitment strategies and a 4-step screening process were used to ensure a homogenous sample and exercise safety. The initial target sample was 90 participants over 48 months which was increased to 96 to allow those in the screening process to enroll if qualified. A tertiary analysis of recruitment and screening rates, recruitment yields and costs, and demographic characteristics of participants was conducted.
Results
During the 48-month recruiting period, 396 potential participants responded to recruitment efforts, 301 individuals were reached and 103 were tentatively qualified. Of these, 67 (69.8%) participants completed the optional magnetic resonance imaging and 7 were excluded due to abnormal magnetic resonance imaging findings. As a result, we enrolled 96 participants with a 2.92 screen ratio, 2.14 recruitment rate, and 31.9% recruitment yield. Referrals (28.1%) and Alzheimer’s Association events/services (21.9%) yielded over 49% of the enrolled participants. Total recruitment cost was $38 246 or $398 per randomized participant.
Conclusions
A multiprong approach involving extensive community outreach was essential in recruiting older adults with AD dementia into a single-site trial. For every randomized participant, 3 individuals needed to be screened. Referrals were the most cost-effective recruitment strategy.
Clinical Trials Registration Number: NCT0194550
Recurrent lower urinary tract infections in women are a highly prevalent and burdensome condition for which best practice guidelines for treatment and prevention that minimize harm and optimize ...well-being are greatly needed. To inform development of practice recommendations, a rapid literature review of original research, systematic reviews, meta-analyses and practice guidelines was conducted.
PubMed®, Embase®, Opus, Scopus®, Google Scholar, The Cochrane Library and the U.S. National Guideline Clearinghouse electronic databases were searched from inception to September 22, 2017. Articles and practice guidelines were included if they were in English, were peer reviewed, included women, involved treatment or prevention strategies for recurrent urinary tract infection and reported an outcome related to recurrence rates of urinary tract infection. Critical appraisal of original studies was conducted using the Cochrane risk of bias tool, and of systematic reviews using the AMSTAR 2 tool.
Of 1,582 citations identified 74 met our study inclusion criteria. These comprised 49 randomized controlled trials, 23 systematic reviews (16 with meta-analyses) and 2 practice guidelines. No study reported a multi-targeted treatment approach. There was a lack of high quality studies and systematic reviews evaluating prevention strategies for recurrent urinary tract infection.
We recommend an algorithmic approach to care that includes education on lifestyle and behavioral modifications, and addresses specific populations of women with antimicrobial based and nonantibiotic alternatives. This approach includes the use of vaginal estrogen with or without lactobacillus containing probiotics in postmenopausal women, low dose post-coital antibiotics for recurrent urinary tract infection associated with sexual activity in premenopausal women, low dose daily antibiotic prophylaxis in premenopausal women with infections unrelated to sexual activity, and methenamine hippurate and/or lactobacillus containing probiotics as nonantibiotic alternatives. Future research should involve consistent use of terminology, validated instruments to assess response to interventions and patient perspectives on care. Our treatment algorithm is based on the best available evidence, and fills a gap in the literature and practice regarding effective strategies to prevent recurrent urinary tract infection in women.
Aerobic exercise has shown inconsistent cognitive effects in older adults with Alzheimer's disease (AD) dementia.
To examine the immediate and longitudinal effects of 6-month cycling on cognition in ...older adults with AD dementia.
This randomized controlled trial randomized 96 participants (64 to cycling and 32 to stretching for six months) and followed them for another six months. The intervention was supervised, moderate-intensity cycling for 20-50 minutes, 3 times a week for six months. The control was light-intensity stretching. Cognition was assessed at baseline, 3, 6, 9, and 12 months using the AD Assessment Scale-Cognition (ADAS-Cog). Discrete cognitive domains were measured using the AD Uniform Data Set battery.
The participants were 77.4±6.8 years old with 15.6±2.9 years of education, and 55% were male. The 6-month change in ADAS-Cog was 1.0±4.6 (cycling) and 0.1±4.1 (stretching), which were both significantly less than the natural 3.2±6.3-point increase observed naturally with disease progression. The 12-month change was 2.4±5.2 (cycling) and 2.2±5.7 (control). ADAS-Cog did not differ between groups at 6 (p = 0.386) and 12 months (p = 0.856). There were no differences in the 12-month rate of change in ADAS-Cog (0.192 versus 0.197, p = 0.967), memory (-0.012 versus -0.019, p = 0.373), executive function (-0.020 versus -0.012, p = 0.383), attention (-0.035 versus -0.033, p = 0.908), or language (-0.028 versus -0.026, p = 0.756).
Exercise may reduce decline in global cognition in older adults with mild-to-moderate AD dementia. Aerobic exercise did not show superior cognitive effects to stretching in our pilot trial, possibly due to the lack of power.
Although exercise is often recommended for managing osteoarthritis (OA), limited evidence-based exercise options are available for older adults with OA. This study compared the effects of Hatha yoga ...(HY) and aerobic/strengthening exercises (ASE) on knee OA. Randomized controlled trial with three arms design was used: HY, ASE, and education control. Both HY and ASE groups involved 8 weekly 45-min group classes with 2–4 days/week home practice sessions. Control group received OA education brochures and weekly phone calls from study staff. Standardized instruments were used to measure OA symptoms, physical function, mood, spiritual health, fear of falling, and quality of life at baseline, 4 and 8 weeks. HY/ASE adherences were assessed weekly using class attendance records and home practice video recordings. Primary analysis of the difference in the change from baseline was based on intent-to-treat and adjusted for baseline values. Eight-three adults with symptomatic knee OA completed the study (84% female; mean age 71.6 ± 8.0 years; mean BMI 29.0 ± 7.0 kg/m
2
). Retention rate was 82%. Compared to the ASE group at 8 weeks, participants in the HY group had a significant improvement from baseline in perception of OA symptoms (−9.6 95% CI −15.3, −4;
p
= .001), anxiety (−1.4 95% CI −2.7, −0;
p
= .04), and fear of falling (−4.6 −7.5, −1.7;
p
= .002). There were no differences in class/home practice adherence between HY and ASE. Three non-serious adverse events were reported from the ASE group. Both HY and ASE improved symptoms and function but HY may have superior benefits for older adults with knee OA.
Trial registration
The full trial protocol is available at clinicaltrials.gov (NCT02525341).
ABSTRACTOsteoarthritis (OA) is a highly prevalent and disabling chronic condition. Because physical activity is a key component in OA management, effective exercise interventions are needed. Yoga is ...an increasingly popular multimodal mind-body exercise that aims to promote flexibility, strength, endurance, and balance. Its gentle approach is potentially a safe and effective exercise option for managing OA. The purpose of this focused review is to examine the effects of yoga on OA symptoms and physical and psychosocial outcomes. A comprehensive search was conducted using seven electronic databases. Twelve reports met inclusion criteria involving a total of 589 participants with OA-related symptoms. A variety of types, frequencies, and durations of yoga interventions were reported; Hatha and Iyengar yoga were the most commonly used types. Frequency of intervention ranged from once a week to 6 days a week. Duration of the interventions ranged from 45 to 90 mins per session for 6 to 12 wks. Yoga intervention resulted in reductions in pain, stiffness, and swelling, but results on physical function and psychosocial well-being were inconclusive because of a variety of outcome measures being used.
Introduction
Few instruments measure knowledge, attitudes, and beliefs (KAB) related to bladder health. Existing questionnaires have predominantly focused on KAB related to specific conditions such ...as urinary incontinence, overactive bladder, and other pelvic floor disorders. To address this literature gap, the Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium developed an instrument that is being administered in the baseline assessment of the PLUS RISE FOR HEALTH longitudinal study.
Methods
The bladder health knowledge, attitudes, and beliefs (BH‐KAB) instrument development process consisted of two phases, item development and evaluation. Item development was guided by a conceptual framework, review of existing KAB instruments, and a review of qualitative data from the PLUS consortium Study of Habits, Attitudes, Realities, and Experiences (SHARE). Evaluation comprised three methods to assess content validity and reduce and refine items: q‐sort, e‐panel survey, and cognitive interviews.
Results
The final 18‐item BH‐KAB instrument assesses self‐reported bladder knowledge; perceptions of bladder function, anatomy, and related medical conditions; attitudes toward different patterns of fluid intake, voiding, and nocturia; the potential to prevent or treat urinary tract infections and incontinence; and the impact of pregnancy and pelvic muscle exercises on bladder health.
Conclusion
The PLUS BH‐KAB instrument may be used independently or in conjunction with other KAB instruments for a more comprehensive assessment of women's KAB related to bladder health. The BH‐KAB instrument can inform clinical conversations, health education programming, and research examining potential determinants of bladder health, LUTS, and related behavioral habits (e.g., toileting, fluid intake, pelvic muscle exercises).
Background: Despite the significant clinical benefit in hemoglobin A1c reduction, diabetes applications (apps) use is low. The goal of this study was to assess app usability based on the heuristics ...of intuitive designs and the Theory of Self-Determination on motivation. Diabetes apps were evaluated by clinicians and patients for motivational properties that target patient needs to learn blood glucose trends and patterns (competence), to personalize choices to change (autonomy) and to connect with healthcare providers (feel related).
Method: Two top-rated Android apps, mySugr and OnTrack, underwent evaluation by four clinicians (three physicians and one diabetes nurse educator) and 92 adults with type 1 or 2 diabetes on insulin. Each app was tested for seven diabetes-related tasks including data entry, analysis, report view options (by the day of the week and by meals), and report email. Clinicians evaluated if the app violated Nielsen's Ten Heuristics on user-friendly designs. Both clinicians and patients completed a questionnaire on the ease of use - System Usability Scale (SUS).
Results: OnTrack and mySugr target two behavior needs important for motivation in diabetes self-management. App usability was suboptimal to low. Clinicians rated an “F” for mySugr (15 ± 5) scoring < 60 and a “D” for OnTrack (61 ± 28) scoring between 60-69. Patients rated an “F” for mySugr (55 ±18) and a “D” for OnTrack (68 ±15). Clinicians identified many heuristic violations (n=169): mySugr (90) and OnTrack (77). Heuristic principles violated the most frequently were “Help and Documentation” (38), followed by “Aesthetic and Minimalist Design” (43) and “Error Prevention” (24).
Conclusions: Commercially available diabetes app usability was marginally acceptable to unacceptable according to clinicians and patients. Future diabetes app design needs to target patient motivation and incorporate key heuristic principles to provide self-tutorials, enhance graphical or screen views, and eliminate error-prone conditions.
Disclosure
H.N. Fu: None. T. Adam: Stock/Shareholder; Self; GlaxoSmithKline plc. J.F. Wyman: None.
Funding
Robert Wood Johnson Foundation; Sigma Theta Tau International-Zeta Chapter
Mentored research career development programs are excellent training opportunities for junior faculty/early-stage investigators to transition into independent research careers. However, there is ...limited evidence that provides guidance on best practices for measuring the impact and reach of these programs, both for individual Scholars and the program as a whole. This article evaluates both the individual and overall impact of the Building Interdisciplinary Research Careers in Women's Health (BIRCWH) National Institutes of Health research career development award at the University of Minnesota.
BIRCWH Scholars (
= 16) and a comparison group (
= 17) were evaluated on traditional metrics (
, publications, grant funding) in addition to bibliometrics (
, network growth, interdisciplinary collaborations, international reach, policy impact).
Traditional metric findings showed that BIRCWH Scholars had significantly more publications from pre- to post-BIRCWH experience than the comparison group and more grant funding. Bibliometric findings showed exponential network growth, interdisciplinary collaborations, international citations, and policy impact from pre- to post-BIRCWH Scholar experience.
Findings from this evaluation have potential important implications. At the Scholar level, the results can be used to provide evidence of research impact in materials developed for merit review and promotion as well as in job and research grant applications. At the program level, the results can be used at the institutional level to gain broad administrative support and leverage additional funds for program activities and for evidence of program success for continuation funding from federal agencies.
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