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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Nursing Science: Adults and Older Adults Study Section (NSAA)
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Huss, Karen
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University of Minnesota Twin Cities
Schools of Nursing
United States
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Harms, Susan; Bliss, Donna Z; Garrard, Judith et al. (2014) Prevalence of pressure ulcers by race and ethnicity for older adults admitted to nursing homes. J Gerontol Nurs 40:20-6
Eberly, Lynn E; Hodges, James S; Savik, Kay et al. (2013) Extending the Peters-Belson approach for assessing disparities to right censored time-to-event outcomes. Stat Med :
Bliss, Donna Z; Harms, Susan; Garrard, Judith M et al. (2013) Prevalence of incontinence by race and ethnicity of older people admitted to nursing homes. J Am Med Dir Assoc 14:451.e1-7