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author:("fulker, TERRY")
1.  Screening for Elder Mistreatment in a Dental Clinic Population 
Journal of elder abuse & neglect  2012;24(4):326-339.
The purpose of this study was to establish the feasibility and utility of screening for elder mistreatment in a dental clinic population. We approached older adults in a busy dental clinic, and enrolled 139 persons over the age of 65 who completed an Audio Computer Assisted Self Interview (ACASI), which included the Hwalek-Sengstock Elder Abuse Screening Test (HS-EAST). Overall, 48.4% of the participants scored 3 or greater on the HS-EAST, and 28.3% scored 4 or greater. Our study suggests that there is an opportunity to screen in busy dental clinics and to facilitate early detection for those patients who screen positive for elder mistreatment.
doi:10.1080/08946566.2012.661683
PMCID: PMC3462354  PMID: 23016728
dental clinics; elder mistreatment; screening; ACASI
2.  Screening for elder mistreatment in dental and medical clinics 
Gerodontology  2012;29(2):96-105.
Objective
Elder mistreatment (EM) is a potentially fatal and largely unrecognised problem in the United States. The purpose of this study was to determine the prevalence of EM in busy clinics and specifically, we report on the feasibility of screening for EM as well as the appropriate instrumentation for screening.
Background Data
Prevalence estimates for elder mistreatment vary, but recent data from a national sample of community-residing adults over age 60 indicate that 11.4% of older adults report some form of elder mistreatment (1). There is a paucity of research related to screening in dental and medical clinics to understand the prevalence in such practice settings.
Methods
A cross-sectional study from January 2008 to March 2009. We enrolled 241 patients at two clinics: a medical clinic (N=102) and the dental clinics (N=139). A mini-mental status exam was conducted with a minimum of 18 or better for inclusion. An elder mistreatment screen was next used (EAI-R for medical, HS-EAST for dental).
Results
For the 241 patients, we were able to compare data from the EAI-R with the HS-EAST. This pilot work demonstrates the feasibility of screening for EM in busy clinics and we documented patient enrolment of 20% in the medical clinics, and 66% in dental clinics. Patients are willing to answer extremely-sensitive questions related to elder mistreatment, and are also willing to use computer technology for interviewing.
Conclusion
Dental and medical clinics are important practice venues to screen for elder mistreatment.
doi:10.1111/j.1741-2358.2010.00405.x
PMCID: PMC3325327  PMID: 22225431
elder mistreatment; screening; quality of life; geriatrics
3.  Oral Health 
Nursing Research and Practice  2012;2012:809465.
doi:10.1155/2012/809465
PMCID: PMC3399457  PMID: 22830008
4.  The Primary Care Visit: What Else Could Be Happening? 
Nursing Research and Practice  2012;2012:720506.
The Institute of Medicine Report called for a greater role for nurses within the context of oral health in two recent publications, Advancing Oral Health in America (2011) and Improving Access to Oral Health Care for Vulnerable and Underserved Populations (2011). Nurses provide care for many vulnerable persons, including frail and functionally dependent older adults, persons with disabilities, and persons with intellectual and developmental disabilities. These persons are the least likely to receive necessary, health-sustaining dental care (which is distinct from mouth care). The mouth, or more accurately, plaque, serves as a reservoir for bacteria and pathogens. The link between mouth care, oral health, and systemic health is well-documented; infections such as pneumonia have been linked to poor oral health. Nurses, therefore, need to reframe mouth care as oral infection control and infection control more broadly. The can provide the preventive measure that are crucial to minimizing systemic infections. Nurses in all settings can potentially provide mouth care, conduct oral health assessments, educate patients about best mouth care practices, and make dental referrals. Yet, nurses are often hesitant to do anything beyond basic oral hygiene—and even in this area, often fail to provide mouth care based on best practices.
doi:10.1155/2012/720506
PMCID: PMC3377192  PMID: 22720152
5.  A Prospective Population-Based Study of Differences in Elder Self-Neglect and Mortality Between Black and White Older Adults 
Background.
Self-neglect is the behavior of an elderly person that threatens his or her own health and safety, and it is associated with increased morbidity and mortality. Although report of self-neglect is more common among black older adults, the racial/ethnic differences in mortality remain unclear.
Methods.
The Chicago Healthy Aging Project is a population-based cohort study conducted from 1993 to 2005. A subset of these participants were suspected to self-neglect and were reported to a social services agency. Mortality was ascertained during follow-up and from the National Death Index. Cox proportional hazards models were used to assess the mortality risk.
Results.
In the total cohort, there were 5,963 black and 3,475 white older adults, and of these, 1,479 were reported for self-neglect (21.7% in black and 5.3% in white older adults). In multivariable analyses with extensive adjustments, the interaction term indicated that impact of self-neglect on mortality was significantly stronger in black than in white older adults (parameter estimate, 0.54, SE, 0.14, p < .001). This difference persisted over time. In race/ethnicity-stratified analyses, at 6 months after report of self-neglect, the hazard ratio for black older adults was 5.00 (95% confidence interval, 4.47–5.59) and for white older adults was 2.75 (95% confidence interval, 2.19–3.44). At 3 years after report, the hazard ratios were 2.61 (95% confidence interval, 2.25–3.04) and 1.47 (95% confidence interval, 1.10–1.96) for black older adults and white older adults, respectively.
Conclusions.
Future studies are needed to qualify the casual mechanisms between self-neglect and mortality in black and white older adults in order to devise targeted prevention and intervention strategies.
doi:10.1093/gerona/glr053
PMCID: PMC3110911  PMID: 21498840
Self-neglect; Health disparity; Population-based study; Race/ethnicity; Mortality
6.  Practitioners’ Views on Elder Mistreatment Research Priorities: Recommendations from a Research-to-Practice Consensus Conference 
Journal of elder abuse & neglect  2011;23(2):115-126.
This article presents recommendations from expert practitioners and researchers regarding future directions for research on elder abuse prevention. Using the Research-to-Practice Consensus Workshop model, participants critiqued academic research on the prevention of elder mistreatment and identified practice-based suggestions for a research agenda on this topic. The practitioners’ critique resulted in 10 key recommendations for future research that include the following priority areas: defining elder abuse, providing researchers with access to victims and abusers, determining the best approaches in treating abusers, exploiting existing data sets, identifying risk factors, understanding the impact of cultural factors, improving program evaluation, establishing how cognitive impairment affects legal investigations, promoting studies of financial and medical forensics, and improving professional reporting and training. It is hoped that these recommendations will help guide future research in such a way as to make it more applicable to community practice.
doi:10.1080/08946566.2011.558777
PMCID: PMC3076805  PMID: 21462046
elder mistreatment research; consensus workshop; research-practice collaboration
7.  Physical Function Decline and the Risk of Elder Self-neglect in a Community-Dwelling Population 
The Gerontologist  2009;50(3):316-326.
Purpose: This longitudinal study examines the association between physical function decline and the risk of elder self-neglect in a community-dwelling population. Design and Methods: Of the 5,570 participants in the Chicago Health Aging Project, 1,068 were reported to social services agency for suspected elder self-neglect from 1993 to 2005. The primary predictor was objectively assessed physical function using decline in physical performance testing. Secondary predictors were assessed using the decline in self-reported Katz, Nagi, and Rosow–Breslau scales. Outcome of interest was elder self-neglect. Logistic and linear regression models were used to assess these associations. Results: After adjusting for confounding factors, every 1-point decline in physical performance testing was associated with increased risk of reported elder self-neglect (odds ratio [OR], 1.05, confidence interval [CI], 1.03–1.07, p < .001). Decline in Katz (OR, 1.05, CI, 1.00–1.10, p < .05) and decline in Rosow–Breslau (OR, 1.19, CI, 1.11–1.27, p < .001) were associated with increased risk of reported elder self-neglect. Decline in physical performance testing (standardized parameter estimate [PE]: 0.19, SE: 0.06, p = .002), Katz (PE: 0.65, SE: 0.14, p < .001), Nagi (PE: 0.48, SE: 0.14, p < .001), and Rosow–Breslau (PE: 0.57, SE: 0.21, p = .006) scales were associated with increased risk of greater self-neglect severity. Implications: Decline in physical function was associated with increased risk of reported elder self-neglect and greater self-neglect severity in this community-dwelling population.
doi:10.1093/geront/gnp164
PMCID: PMC2904533  PMID: 20019180
Self-neglect; Physical function decline; Longitudinal study
8.  The Attending Nurse: An Evolving Model for Integrating Nursing Education and Practice 
The discipline of nursing continues to evolve in keeping with the dramatic expansion of scientific knowledge, technology, and a concomitant increase in complexity of patient care in all practice settings. Changing patient demographics require complex planning for co-morbidities associated with chronic diseases and life-saving advances that have altered mortality in ways never before imagined. These changes in practice, coupled with findings from sophisticated nursing research and the continuous development of new nursing knowledge, call for realignments of the relationships among academic faculty in schools of nursing, advanced practice nurse administrators, and staff nurses at the forefront of practice. This article offers a model designed to bridge the gaps among academic settings, administrative offices and the euphemistic “bedsides” where staff nurses practice. Here we describe the nurse attending model in place at the New York University Langone Medical Center (NYULMC) and provide qualitative data that support progress in our work.
doi:10.2174/1874434601105010009
PMCID: PMC3109526  PMID: 21660179
Collaboration; attending nurse; practice support.
9.  Elder Self-neglect and Abuse and Mortality Risk in a Community-Dwelling Population 
Context
Both elder self-neglect and abuse have become increasingly prominent public health issues. The association of either elder self-neglect or abuse with mortality remains unclear.
Objective
To examine the relationship of elder self-neglect or abuse reported to social services agencies with all-cause mortality among a community-dwelling elderly population.
Design, Setting, and Participants
Prospective, population-based cohort study (conducted from 1993 to 2005) of residents living in a geographically defined community of 3 adjacent neighborhoods in Chicago, Illinois, who were participating in the Chicago Health and Aging Project (CHAP; a longitudinal, population-based, epidemiological study of residents aged ≥65 years). A subset of these participants had suspected elder self-neglect or abuse reported to social services agencies.
Main Outcome Measures
Mortality ascertained during follow-up and by use of the National Death Index. Cox proportional hazard models were used to assess independent associations of self-neglect or elder abuse reporting with the risk of all-cause mortality using time-varying covariate analyses.
Results
Of 9318 CHAP participants, 1544 participants were reported for elder self-neglect and 113 participants were reported for elder abuse from 1993 to 2005. All CHAP participants were followed up for a median of 6.9 years (interquartile range, 7.4 years), during which 4306 deaths occurred. In multivariable analyses, reported elder self-neglect was associated with a significantly increased risk of 1-year mortality (hazard ratio [HR], 5.82; 95% confidence interval [CI], 5.20–6.51). Mortality risk was lower but still elevated after 1 year (HR, 1.88; 95% CI, 1.67–2.14). Reported elder abuse also was associated with significantly increased risk of overall mortality (HR, 1.39; 95% CI, 1.07–1.84). Confirmed elder self-neglect or abuse also was associated with mortality. Increased mortality risks associated with either elder self-neglect or abuse were not restricted to those with the lowest levels of cognitive or physical function.
Conclusion
Both elder self-neglect and abuse reported to social services agencies were associated with increased risk of mortality.
doi:10.1001/jama.2009.1109
PMCID: PMC2965589  PMID: 19654386

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