Birmingham Atlanta Geriatric Research

Birmingham, AL, United States

Birmingham Atlanta Geriatric Research

Birmingham, AL, United States
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Woodby L.L.,Birmingham Medical Center | Woodby L.L.,Birmingham Atlanta Geriatric Research | Williams B.R.,Birmingham Medical Center | Wittich A.R.,Birmingham Medical Center | Burgio K.L.,Birmingham Medical Center
Qualitative Health Research | Year: 2011

Qualitative researchers who explore the individual's experience of health, illness, death, and dying often experience emotional stress in their work. In this article, we describe the emotional stress we experienced while coding semistructured, after-death interviews conducted with 38 next of kin of deceased veterans. Coding sensitive topic data required an unexpected level of emotional labor, the impact of which has not been addressed in the literature. In writing this discussion article, we stepped back from our roles as interviewers/coders and reflected on how our work affected us individually and as a team, and how a sequence of exposures could exert a cumulative effect for researchers in such a dual role. Through this article, we hope to generate an expanded discourse on how qualitative inquiry impacts the emotional well-being of researchers. © The Author(s) 2011.

Markland A.D.,Birmingham Atlanta Geriatric Research | Markland A.D.,University of Alabama at Birmingham | Palsson O.,University of North Carolina at Chapel Hill | Goode P.S.,Birmingham Atlanta Geriatric Research | And 5 more authors.
American Journal of Gastroenterology | Year: 2013

Objectives: Epidemiological studies support an association of self-defined constipation with fiber and physical activity, but not liquid intake. The aims of this study were to assess the prevalence and associations of dietary fiber and liquid intake to constipation. Methods: Analyses were based on data from 10,914 adults (≥20 years) from the 2005-2008 cycles of the National Health and Nutrition Examination Surveys. Constipation was defined as hard or lumpy stools (Bristol Stool Scale type 1 or 2) as the "usual or most common stool type." Dietary fiber and liquid intake from total moisture content were obtained from dietary recall. Co-variables included: age, race, education, poverty income ratio, body mass index, self-reported general health status, chronic illnesses, and physical activity. Prevalence estimates and prevalence odds ratios (POR) were analyzed in adjusted multivariable models using appropriate sampling weights. Results: Overall, 9,373 (85.9%) adults (4,787 women and 4,586 men) had complete stool consistency and dietary data. Constipation rates were 10.2% (95% confidence interval (CI): 9.6, 10.9) for women and 4.0% (95% CI: 3.2, 5.0) for men (P<.001). After multivariable adjustment, low liquid consumption remained a predictor of constipation among women (POR: 1.3, 95% CI: 1.0, 1.6) and men (POR: 2.4, 95% CI: 1.5, 3.9); however, dietary fiber was not a predictor. Among women, African-American race/ethnicity (POR: 1.4, 95% CI: 1.0, 1.9), being obese (POR: 0.7, 95% CI: 0.5,0.9), and having a higher education level (POR: 0.8, 95% CI: 0.7, 0.9) were significantly associated with constipation. Conclusions: The findings support clinical recommendations to treat constipation with increased liquid, but not fiber or exercise. © 2013 by the american College of Gastroenterology.

Wang H.E.,University of Alabama at Birmingham | Shah M.N.,University of Rochester | Allman R.M.,Birmingham Atlanta Geriatric Research | Allman R.M.,Center for Aging | Kilgore M.,University of Alabama at Birmingham
Journal of the American Geriatrics Society | Year: 2011

Objectives To characterize emergency department (ED) use by nursing home residents in the United States. Design Analysis of the National Hospital Ambulatory Medical Care Survey. Setting U.S. EDs from 2005 to 2008. Participants Individuals visiting U.S. EDs stratified according to nursing home residency. Measurements All ED visits by nursing home residents were identified. The demographic and clinical characteristics and ED resource utilization, length of stay, and outcomes of nursing home residents and nonresidents were compared. Results During 2005 to 2008, nursing home residents accounted for 9,104,735 of 475,077,828 U.S. ED visits (1.9%; 95% confidence interval (CI) = 1.8-2.1%). The annualized number of ED visits by nursing home residents was 2,276,184. Most nursing home residents were older (mean age 76.7, 95% CI = 75.8-77.5), female (63.3%), and non-Hispanic white (74.8%). Nursing home residents were more likely to have been discharged from the hospital in the prior 7 days (adjusted odds ratio (aOR = 1.4, 95% CI = 1.1-1.9), to present with fever (aOR = 1.9, 95% CI = 1.5-2.4) or hypotension (systolic blood pressure ≤90 mmHg, aOR = 1.8, 95% CI = 1.5-2.2), and to receive diagnostic tests (OR = 1.9, 95% CI = 1.6-2.2), imaging (OR = 1.5, 95% CI = 1.3-1.7), or procedures (OR = 1.6, 95% CI = 1.4-1.7) in the ED. Almost half of nursing home residents visiting the ED were admitted to the hospital. Nursing home residents were more likely to be admitted to the hospital (aOR = 1.8, 95% CI = 1.6-2.0) and to die (aOR = 2.3, 95% CI = 1.6-3.3). Conclusion Nursing home residents account for more than 2.2 million ED visits annually in the United States. Nursing home residents have greater medical acuity and complexity. These observations highlight the national challenges of organizing and delivering ED care to nursing home residents in the United States. © 2011, The American Geriatrics Society.

McIlvennan C.K.,Aurora University | Jones J.,Aurora University | Allen L.A.,Aurora University | Swetz K.M.,Birmingham Atlanta Geriatric Research | And 3 more authors.
JAMA Internal Medicine | Year: 2016

IMPORTANCE: For patients and their loved ones, decisions regarding the end of life in the setting of chronic progressive illness are among the most complex in health care. Complicating these decisions are increasingly available, invasive, and potentially life-prolonging technologies such as the left ventricular assist device (LVAD). OBJECTIVE: To understand the experience of bereaved caregivers and patients at the end of life who have an LVAD. DESIGN, SETTING, AND PARTICIPANTS: Semistructured, in-depth interviewswere conducted between September 10 and November 21, 2014, with 8 bereaved caregivers of patients with an LVAD who were recruited from a single institution. Data were analyzed from December 13, 2014, to February 18, 2015, using a mixed inductive and deductive approach. MAIN OUTCOMES AND MEASURES: Themes from semistructured interviews. RESULTS: The 8 caregivers (6 females) described 3 main themes that coalesced around feelings of confusion in the final weeks with their loved ones: (1) the process of death with an LVAD, (2) the legal and ethically permissible care of patients with an LVAD approaching death, and (3) fragmented integration of palliative and hospice care. CONCLUSIONS AND RELEVANCE: Despite increasing use of LVADs in patients with advanced heart failure, bereaved caregivers of patients with an LVAD describe a high level of confusion at the end of life. There remains a need for the health care community to develop clear guidance on the management of patients with an LVAD at the end of life. Future work will focus on the educational process and the ideal timing and reiteration of such information to patients and families. Copyright 2016 American Medical Association. All rights reserved.

Bowling C.B.,Birmingham Atlanta Geriatric Research | Muntner P.,University of Alabama at Birmingham
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2012

The National Kidney Foundation (NKF), Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification expanded the focus of chronic kidney disease (CKD) management from end-stage renal disease (ESRD) to the entire spectrum of kidney disease including early kidney damage through the stages of kidney disease to kidney failure. A consequence of these guidelines is that a large number of older adults are being identified as having CKD, many of whom will not progress to ESRD. Concerns have been raised that reduced estimated glomerular filtration rate (eGFR) among older adults may not represent "disease" and using age-specific cut-points for staging CKD has been proposed. This implies that among older adults, CKD, as currently defined, may be benign. Several recent studies have shown that among people greater than or equal to 80 years old, CKD is associated with an increased risk for concurrent complications of CKD (eg, anemia, acidosis) and adverse outcomes including mortality and cardiovascular disease (CVD). Further, among older adults, CKD is associated with problems not traditionally thought to be associated with kidney disease. These nondisease-specific outcomes include functional decline, cognitive impairment, and frailty. Future research studies are necessary to determine the impact of concurrent complications of CKD and nondisease-specific problems on mortality and functional decline, the longitudinal trajectories of CKD progression, and patient preferences among the oldest old with CKD. © The Author 2012. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.

Goode P.S.,Birmingham Atlanta Geriatric Research | Goode P.S.,University of Alabama at Birmingham | Burgio K.L.,Birmingham Atlanta Geriatric Research | Burgio K.L.,University of Alabama at Birmingham | And 3 more authors.
JAMA - Journal of the American Medical Association | Year: 2010

Urinary incontinence is a common geriatric syndrome that affects at least 1 in 3 older women and can greatly diminish quality of life. Incontinence has been associated with increased social isolation, falls, fractures, and admission to long-term care facilities. Often unreported and thus untreated, it is important to include incontinence as part of the review of systems for all olderwomen. Using the case of Mrs F, we highlight the chronicity of incontinence and discuss the evidence base for evaluation of incontinence in older women, with proper initial diagnosis of the type of incontinence - stress, urgency,or mixed - in order to prescribe optimal treatment. We present an evidence-based discussion of available incontinence treatments including pelvic floor muscle exercises, stress strategies, urge-suppression strategies, fluid management, medications, intravaginal pessaries, intravesical injection of botulinum toxin, percutaneous tibial nerve stimulation, sacral neuromodulation, and surgical procedures for stress incontinence. Special considerations in evaluation and treatment of patients with dementia are presented. Urinary incontinence treatments yield high levels of patient satisfaction and improvements in quality of life. ©2010 American Medical Association. All rights reserved.

Sexton C.C.,United Biosource Corporation | Coyne K.S.,United Biosource Corporation | Thompson C.,United Biosource Corporation | Bavendam T.,Pfizer | And 3 more authors.
Journal of the American Geriatrics Society | Year: 2011

Objective: To evaluate the prevalence and effect of overactive bladder (OAB) on healthcare-seeking behavior, mental health, and generic and condition-specific health-related quality of life (HRQL) in older adults. Design: Secondary analysis of the U.S. sample of the Epidemiology of Lower Urinary Tract Symptoms (EpiLUTS) study-a population-based, cross-sectional, Internet-based survey. Setting: Community. Participants: Two thousand four hundred eighty-five men and 2,877 women aged 65 and older. Measurements: Prevalence and effect on HRQL of urinary symptoms, including OAB. OAB was defined as the presence of urinary urgency and/or urinary urgency incontinence. Descriptive analyses and subgroup comparisons were conducted to evaluate the prevalence of OAB in men and women aged 65 and older and the effect of OAB on various aspects of HRQL. Results: The survey response rate was 46.9% of men and 61.0% of women. Prevalence rates of OAB at least "sometimes" were 40.4% in men and 46.9% in women. OAB was associated with significant impairments across all domains of patient-reported outcomes, including general HRQL (Medical Outcomes Study 12-item Short-Form Survey), ratings of anxiety and depression (Hospital Anxiety and Depression Scale), and urinary condition-specific outcomes (Overactive Bladder Questionnaire Short Form and Patient Perception of Bladder Condition) (P<.001). Conclusion: OAB is common in older adults in the United States and is associated with substantial impairment in mental health and HRQL, but rates of treatment seeking behavior are low. Older patients should be assessed for OAB. © 2011, The American Geriatrics Society.

Barrett Bowling C.,Birmingham Atlanta Geriatric Research | Inker L.A.,Tufts Medical Center | Gutierrez O.M.,University of Alabama at Birmingham | Allman R.M.,Birmingham Atlanta Geriatric Research | And 3 more authors.
Clinical Journal of the American Society of Nephrology | Year: 2011

Background and objectives It has been suggested that moderate reductions in estimated GFR (eGFR) among older adults may not reflect chronic kidney disease (CKD). Design, setting, participants, & measurements We examined age-specific (<60, 60 to 69, 70 to 79, and ≥80 years) associations between eGFR level and six concurrent CKD complications among 30,528 participants from the National Health and Nutrition Examination Survey (NHANES) 1988 to 1994 and 1999 to 2006 (n = 8242 from NHANES 2003 to 2006 for hyperparathyroidism). Complications included anemia (hemoglobin <12 g/dl women, <13.5 g/dl men), acidosis (bicarbonate <22 mEq/L), hyperphosphatemia (phosphorus ≥4.5 mg/dl), hypoalbuminemia (albumin <3.5 mg/dl), hyperparathyroidism (intact parathyroid hormone ≥70 pg/ml), and hypertension (systolic/diastolic BP ≥140/90 mmHg or antihypertensive use). Results Among participants ≥80 years old, compared with those with estimated GFR (eGFR) ≥60 ml/min per 1.73 m 2, the multivariable adjusted prevalence ratios (95% confidence interval) associated with eGFR levels of 45 to 59 and <45 ml/min per 1.73 m 2 were 1.39 (1.11 to1.73) and 2.06 (1.59 to 2.67) for anemia, 1.33 (0.89 to 1.98) and 2.47 (1.52 to 4.00) for acidosis, 1.11 (0.70 to 1.76) and 2.16 (1.36 to 3.42) for hyperphosphatemia, 2.04 (1.39 to 3.00) and 2.83 (1.76 to 4.53) for hyperparathyroidism and 1.09 (1.03 to 1.14), and 1.12 (1.05 to 1.19) for hypertension, respectively. Higher prevalence ratios for these complications at lower eGFR levels were also present at younger ages. Reduced eGFR was associated with hypoalbuminemia only for adults <70. Conclusions Reduced eGFR was associated with a higher prevalence of several concurrent CKD complications, regardless of age. © 2011 by the American Society of Nephrology.

Burgio K.L.,University of Alabama at Birmingham | Burgio K.L.,Birmingham Atlanta Geriatric Research
Current Urology Reports | Year: 2013

Behavioral and physical therapies have been used for many years to treat incontinence and overactive bladder (OAB). This paper focuses on programs that include pelvic floor muscle training (PFMT) as a component in treatment for women or men. PFMT was long used almost exclusively for treatment of stress incontinence. When it became evident that voluntary pelvic floor muscle contraction can be used to control bladder function, PFMT was also integrated into the treatment of urge incontinence and OAB as part of a broader behavioral urge suppression strategy. PFMT has evolved over decades, both as a behavioral therapy and a physical therapy, combining principles from behavioral science, nursing, and muscle physiology into a widely recommended conservative treatment. The collective literature indicates that PFMT is effective for incontinence, as well as urgency, frequency, and nocturia. It can be combined with all other treatment modalities and holds potential for prevention of bladder symptoms. © 2013 Springer Science+Business Media New York (outside the USA).

Clevenger C.K.,Birmingham Atlanta Geriatric Research | Clevenger C.K.,Emory University | Chu T.A.,Birmingham Atlanta Geriatric Research | Yang Z.,Emory University | Hepburn K.W.,Birmingham Atlanta Geriatric Research
Journal of the American Geriatrics Society | Year: 2012

The segment of older adults who present to the emergency department (ED) with cognitive impairment ranges from 21% to 40%. Difficulties inherent in the chaotic ED setting combined with dementia may result in a number of unwanted clinical outcomes, but strategies to minimize these outcomes are lacking. A review of the literature was conducted to examine the practices undertaken in the care of persons with dementia (PWD) specific to the ED setting. PubMed and Cumulative Index to Nursing and Allied Health Literature were searched for published articles specific to the care of PWD provided in the ED. All English-language articles were reviewed; editorials and reflective journals were excluded. Seven articles ultimately met inclusion criteria; all provided Level 7 evidence: narrative review or opinions from authorities. The articles recommended clinical practices that can be categorized into five themes: assessment of cognitive impairment, dementia communication strategies, avoidance of adverse events, alterations to the physical environment, and education of ED staff. Many recommendations are extrapolated from residential care settings. Review results indicate that there is minimal guidance for the care of PWD specific to the ED setting. There are no empirical studies of the care (assessment, interventions) of PWD in the ED. The existing (Level 7) recommendations lack a research base to support their effectiveness or adoption as evidence-based practice. There is a significant opportunity for research to identify and test ways to meet the needs of PWD in the ED to ensure a safe visit, accurate diagnosis, and prudent transfer to the most appropriate level of care. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

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