Showing papers by "Patricia S. Goode published in 2016"

Shared Risk Factors for Constipation, Fecal Incontinence, and Combined Symptoms in Older U.S. Adults.

Abstract: Objectives To estimate the prevalence of constipation, fecal incontinence (FI), and combined symptoms and to identify shared factors associated with bowel symptoms in older US men and women Design Population-based cross-sectional study Setting National Health and Nutrition Examination Survey (2005–2010) Participants Women and men aged 50 and older Measurements Constipation was defined as hard stool consistency on the validated Bristol Stool Form Scale or stool frequency of fewer than three bowel movements per week FI was defined as at least monthly loss of solid, liquid, or mucus stool Combined symptoms was defined as constipation and FI Multinomial multivarible models adjusted for age, race, socioeconomic status, education, self-rated health, depression, impairments in activities of daily living, and number of comorbidities Results Women (n = 3,078) reported higher prevalence of bowel symptoms than men (constipation 118% vs 47%%, FI 112% vs 86%, combined symptoms 14% vs 04%) In adjusted models, women had greater odds of having constipation (odds ratio (OR) = 30, 95% confidence interval (CI) = 23–38), FI (OR = 14, 95% CI = 11–18), and combined symptoms (OR = 46, 95% CI = 20–102) than men Shared risk factors included poor self-rated health and depression symptoms (constipation: OR = 18, 95% CI = 14–24 and OR = 18, 95% CI = 10–32; FI: OR = 16, 95% CI = 12–22 and OR = 23 95% CI = 14–36; combined symptoms: OR = 26 95% CI = 15–48 and OR = 46, 95% CI = 13–164) Conclusion When defining constipation and FI using validated instruments, women had a much higher prevalence of constipation than men, whereas men had a higher prevalence of FI than constipation Shared risk factors reflect the negative effect that bowel symptoms have on quality of life

Racial Differences in Processes of Care at End of Life in VA Medical Centers: Planned Secondary Analysis of Data from the BEACON Trial.

Abstract: Background: Racial differences exist for a number of health conditions, services, and outcomes, including end-of-life (EOL) care. Objective: The aim of the study was to examine differences in processes of care in the last 7 days of life between African American and white inpatients. Methods: Secondary analysis was conducted of data collected in the Best Practices for End-of-Life Care for Our Nation's Veterans (BEACON) trial (conducted 2005–2011). Subjects were 4891 inpatient decedents in six Veterans Administration Medical Centers. Data were abstracted from decedents' medical records. Multi-variable analyses were conducted to examine the relationship between race and each of 18 EOL processes of care controlling for patient characteristics, study site, year of death, and whether the observation was pre- or post-intervention. Results: The sample consisted of 1690 African American patients (34.6%) and 3201 white patients (65.4%). African Americans were less likely to have: do not resuscitate (DNR) o...

Vitamin D and incident urinary incontinence in older adults.

Abstract: The aim of this study is to determine whether vitamin D status is associated with incident urinary incontinence (UI) among community-dwelling older adults. The University of Alabama at Birmingham Study of Aging is a prospective cohort study of community-dwelling Medicare enrollees. Standardized assessment of UI was conducted using the validated Incontinence Severity Index. The analysis of 25-hydroxyvitamin D [25(OH)D] levels was performed on stored baseline sera. UI was assessed every 6–12 months for up to 42 months. The analyses included multivariable logistic regression and Cox proportional hazard models. Of 350 participants (175 male, 147 black, mean age 73.6±5.8), 54% (189/350) were vitamin D deficient (25(OH)D <20 ng/ml) and 25% (87/350) were vitamin D insufficient (25(OH)D: 20 ng/ml to <30 ng/ml). Among the 187 subjects with no UI at baseline, 57% (107/187) were vitamin D deficient and 24% (45/187) were vitamin D insufficient. A total of 175 of the 187 subjects had follow-up evaluation for incident UI over 42 months, and incident UI occurred in 37% (65/175). After adjustment, cumulative incident UI at 42 months was associated with baseline vitamin D insufficiency (P=0.03) and demonstrated a trend association with deficiency (P=0.07). There was no association between baseline vitamin D status and the time to incident UI. These preliminary results support an association between vitamin D and incident UI in community-dwelling older adults. Future studies may target specific at-risk groups, such as men with BPH or women with pelvic floor disorders for evaluation of the impact of vitamin D supplementation on urinary symptoms.

An Ethic of Heroism Shapes Next of Kin's Perceptions of Veterans' End-of-Life Care in Veterans Affairs Medical Centers

Abstract: Currently 28,000 Veterans die each year within Veterans Affairs Medical Centers. As Veterans age, the Department of Veterans Affairs faces a variety of issues, including the need for comprehensive end-of-life care. Appreciation of next of kin's assumptions regarding Veterans' care can inform the culture of end-of-life services in Veterans Affairs Medical Centers, contributing to the development of supportive practices aligned with next of kin's perspectives. This study explores next of kin's accounts of Veterans' hospital care during the last days of life to identify salient issues shaping perceptions of Veterans' care.