This 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. Previous studies have focused primarily on individual level resident characteristics or controlled for only a few NH factors;none has used a multi-level, multi-factoral approach. Because of our datasets, we are uniquely able to simultaneously measure 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. We will analyze 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. In addition, we will 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. In so doing, we will provide context to our findings and strengthen our ability to make more informed recommendations. Our 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. Therefore, our findings are critical before interventions aimed at reducing disparities in incontinence and perineal skin damage can be undertaken or successful.

Public Health Relevance

This is a study of differences in the involuntary leakage of urine and stool, associated skin damage, and quality of life that exist because of race, ethnic background, and social and economic status of older nursing home residents. This study will also examine nursing home and community factors that may play a role in the occurrence, prevention, and management of these health problems that greatly reduce physical and psychological well-being.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
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Study Section
Nursing Science: Adults and Older Adults Study Section (NSAA)
Program Officer
Huss, Karen
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University of Minnesota Twin Cities
Schools of Nursing
United States
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Bliss, Donna Z; Gurvich, Olga V; Eberly, Lynn E et al. (2018) Time to and predictors of dual incontinence in older nursing home admissions. Neurourol Urodyn 37:229-236
Bliss, Donna Z; Gurvich, Olga; Savik, Kay et al. (2017) Racial and ethnic disparities in the healing of pressure ulcers present at nursing home admission. Arch Gerontol Geriatr 72:187-194
Bliss, Donna Z; Gurvich, Olga V; Eberly, Lynn E et al. (2017) Racial disparities in primary prevention of incontinence among older adults at nursing home admission. Neurourol Urodyn 36:1124-1130
Bliss, Donna Z; Mathiason, Michelle A; Gurvich, Olga et al. (2017) Incidence and Predictors of Incontinence-Associated Skin Damage in Nursing Home Residents With New-Onset Incontinence. J Wound Ostomy Continence Nurs 44:165-171
Bliss, Donna; Harms, Susan; Eberly, Lynn E et al. (2017) Social Engagement After Nursing Home Admission: Racial and Ethnic Disparities and Risk Factors. J Appl Gerontol 36:1306-1326
Bliss, Donna Z; Gurvich, Olga V; Mathiason, Michelle A et al. (2017) Prevention of Incontinence-Associated Skin Damage in Nursing Homes. West J Nurs Res 39:643-659
Bliss, Donna Z; Gurvich, Olga V; Savik, Kay et al. (2015) Analysis of Racial and Ethnic Disparities as Possible Risk Factors for Development of Incontinence by Nursing Home Residents. Res Nurs Health 38:449-61
Adanyeguh, Isaac M; Henry, Pierre-Gilles; Nguyen, Tra M et al. (2015) In vivo neurometabolic profiling in patients with spinocerebellar ataxia types 1, 2, 3, and 7. Mov Disord 30:662-70
Eberly, Lynn E; Cunanan, Kristen; Gurvich, Olga et al. (2015) Statistical Approaches to Assessing Health and Healthcare Disparities. Res Nurs Health 38:500-8
Bliss, Donna Z; Gurvich, Olga; Savik, Kay et al. (2015) Are there racial-ethnic disparities in time to pressure ulcer development and pressure ulcer treatment in older adults after nursing home admission? J Aging Health 27:571-93

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