Disparities in incontinence and perineal skin damage in nursing home elderly


Disparities in Incontinence and Perineal Skin Damage in Nursing Home Elderly

This project is a study of race, ethnic, and socioeconomic (SES) disparities as they relate to the development and management of incontinence, perineal dermatitis (PD), pressure ulcers (PUs), and associated quality of life in older nursing home (NH) residents. Reports of disparities in incontinence and perineal skin damage and their management are a serious ethical and clinical concern warranting further investigation. Incontinence, PUs and PD are long-standing, widespread, and costly problems to which race, ethnic and SES disparities may contribute significantly. Annual treatment costs are in the billions of dollars, and each condition is significantly associated with psychological distress, physical discomfort, and lower quality of life. Complications of PUs can be fatal. Reducing health disparities offers a profound opportunity for improving the health of disadvantaged minority populations. Because health outcomes of NH residents and disparities in those outcomes are influenced by multiple factors at the individual, group NH, and community levels before and during a NH stay, investigation to detangle their contributions requires a multi-level approach. 

These researchers are analyzing three large population datasets: Minimum Data Set (MDS) records and practitioner orders for all residents of a large, for-profit NH chain; the Online Survey, Certification, and Reporting (OSCAR) files; and the US Census tract data. They are simultaneously measuring factors at the individual, NH, and community levels that are associated with disparities in the development, prevention, and management of fecal and/or urinary incontinence, PD, PUs, and associated quality of life. In addition, they compare disparities in these health conditions and management plans in residents of the proprietary set of NHs with those in a set of national for-profit and non-profit NHs using a fourth database of MDS records (without practitioner orders) and OSCAR and census data in a multi-level sensitivity analysis. Doing this will provide context to the findings and strengthen the researchers’ ability to make more informed recommendations. This study will provide the best evidence to date about which of the many possible modifiable factors associated with disparities in these outcomes should be targeted for intervention and ascertain the level of their contribution. The group's findings are critical before interventions aimed at reducing disparities in incontinence and perineal skin damage can be undertaken or successful. 

A bibliography of this group’s publications acknowledging MSI is attached.

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