Recent Faculty Articles

Gerontol Geriatr Educ. 2008;28(3):89-104
An innovative home-based interdisciplinary service-learning experience.
McWilliams A, Rosemond C, Roberts E, Calleson D, Busby-Whitehead J.

The University of North Carolina Mobile Student Health Action Coalition (UNC MSHAC) at Chapel Hill, North Carolina is a voluntary service-learning program in which interdisciplinary teams of graduate level health professional students provide monthly home visits to isolated, community-dwelling elders with complex medical and social issues. Students are mentored by UNC clinical faculty and retirees from the local community. Together, mentors and students generate action plans to improve the health and well-being of the participating elders. We report here the qualitative and quantitative results from our program evaluation demonstrating UNC MSHAC as an effective, service-learning model that compliments curricula, is satisfactory to students, and is a vehicle for academic institutions to serve elders in the local community.

J Am Geriatr Soc. 2008 Apr;56(4):683-8
Pain, dyspnea, and the quality of dying in long-term care.
Caprio AJ, Hanson LC, Munn JC, Williams CS, Dobbs D, Sloane PD, Zimmerman S.

OBJECTIVES: To evaluate the relationship between pain, dyspnea, and family perceptions of the quality of dying in long-term care. DESIGN: After-death interviews. SETTING: Stratified random sample of 111 nursing homes and residential care and assisted living facilities in four states. PARTICIPANTS: Paired interviews from facility staff and family caregivers for 325 deceased residents. MEASUREMENTS: The outcome variable was the Quality of Dying in Long-Term Care (QOD-LTC), a psychometrically sound, retrospective scale representing psychosocial aspects of the quality of dying, obtained from interviews with family caregivers. Facility staff reported the presence, frequency, and severity of pain and dyspnea. RESULTS: During the last month of life, nearly half of residents experienced pain or dyspnea. QOD-LTC scores did not differ for residents with and without pain (4.15 vs 4.02, P=.16). Overall, residents with dyspnea had better QOD-LTC scores than those without dyspnea (4.20 vs 3.99, P=.006). The association between dyspnea and a better QOD-LTC score was strongest in cognitively impaired residents and for those dying in residential care and assisted living facilities. CONCLUSION: For residents dying in long-term care, pain and dyspnea were not associated with a poorer quality of dying as perceived by families of deceased residents. Instead, dyspnea may alert staff to the need for care. Initiatives to improve the quality of dying in long-term care should focus not only on physical symptoms, but also on the alleviation of nonphysical sources of suffering at the end of life.

J Am Geriatr Soc. 2008 Jan;56(1):91-8. Epub 2007
Symptom experience of dying long-term care residents.
Hanson LC, Eckert JK, Dobbs D, Williams CS, Caprio AJ, Sloane PD, Zimmerman S.

OBJECTIVES: To describe the end-of-life symptoms of nursing home (NH) and residential care/assisted living (RC/AL) residents, compare staff and family symptom ratings, and compare how staff assess pain and dyspnea for cognitively impaired and cognitively intact residents. DESIGN: After-death interviews. SETTING: Stratified random sample of 230 long-term care facilities in four states. PARTICIPANTS: Staff (n=674) and family (n=446) caregivers for dying residents. MEASUREMENTS: Interview items measured frequency and severity of physical symptoms, effectiveness of treatment, recommendations to improve care, and staff report of assessment. RESULTS: Decedents' median age was 85, 89% were white, and 77% were cognitively impaired. In their last month of life, 47% had pain, 48% dyspnea, 90% problems with cleanliness, and 72% symptoms affecting intake. Problems with cleanliness, intake, and overall symptom burden were worse for decedents in NHs than for those in RC/AL. Treatment for pain and dyspnea was rated very effective for only half of decedents. For a subset of residents with both staff and family interviews (n=331), overall ratings of care were similar, although agreement in paired analyses was modest (kappa=-0.043-0.425). Staff relied on nonverbal expressions to assess dyspnea but not pain. Both groups of caregivers recommended improved application of treatment and increased staffing to improve care. CONCLUSION: In NHs and RC/AL, dying residents have high rates of physical symptoms and need for more-effective palliation of symptoms near the end of life.

Nurs Res. 2007 Mar-Apr;56(2):97-107
Differences in resident characteristics and prevalence of urinary incontinence in nursing homes in the southeastern United States.
Boyington JE, Howard DL, Carter-Edwards L, Gooden KM, Erdem N, Jallah Y, Busby-Whitehead J.

BACKGROUND: Relatively little is known about differences in the prevalence of urinary incontinence (UI) by race and region in the United States. OBJECTIVES: To use the 1999-2002 Centers for Medicare and Medicaid Services (CMS) Minimum Data Set (MDS), Atlanta Region, to investigate the prevalence of UI among African American and Caucasian residents of nursing homes (NH) in the southeastern United States. METHODS: A repeated-measures, two time-period design was employed. Data for 95,911 residents in 7,640 NH were extracted using the study's inclusion and exclusion criteria. Residents' admission and annual assessment records were accessed; UI presence and relevant indicators were captured; and admission and postadmission UI prevalence rates were determined by region, state, race, and gender. Logistic regression, adjusting for residents' demographics, morbidity status, bed mobility, and cognitive and functional statuses, was conducted also. RESULTS: The majority of residents were Caucasian (82.4%) and women (76.5%) with mean (+/-SD) age of 82.7 +/- 7.58 years. Regional UI prevalence was 65.4% at admission and 74.3% postadmission. Postadmission, 73.5% of Caucasian and 78.1% of African Americans were incontinent. Similarly, 72.2% of men and 75% of women were incontinent. For African Americans postadmission, adjusted odds of UI were OR = 1.07 (95% CI: 1.01, 1.14). DISCUSSION: Prevalence of UI was high in this region and the odds of UI was significantly higher among African Americans in two of eight states, suggesting racial disparity in this condition in these states. Factors contributing to this disparity should be explored to increase quality care to vulnerable populations.

Gerontologist. 2005 Oct;45 Spec No 1(1):106-14
Factors associated with nursing assistant quality-of-life ratings for residents with dementia in long-term care facilities.
Winzelberg GS, Williams CS, Preisser JS, Zimmerman S, Sloane PD.

PURPOSE: We identify resident, nursing assistant, and facility factors associated with nursing assistant quality-of-life ratings for residents with dementia in long-term care. DESIGN AND METHODS: We used a cross-sectional survey of 143 nursing assistants providing care to 335 residents in 38 residential care/assisted living (RC/AL) facilities and nursing homes in four states. We assessed resident quality of life by using the Quality of Life-Alzheimer's Disease Scale (QOL-AD). RESULTS: Scores on the quality-of-life scale were most strongly associated with resident clinical conditions, including severity of cognitive and functional impairments, depression, and behavioral symptoms of dementia. There was also an independent positive association between nursing assistants' ratings of resident quality of life and their own attitudes regarding dementia-person-centered care as well as training. However, the results of hierarchical linear modeling suggest that some sources of nursing assistant variability in quality-of-life ratings remain unidentified. IMPLICATIONS: Quality-of-life ratings by nursing assistants may be influenced by their attitudes about dementia and their confidence in addressing residents' fundamental care needs.

Nat Rev Mol Cell Biol. 2007 Sep;8(9):703-13
How stem cells age and why this makes us grow old.
Sharpless NE, DePinho RA.

Recent data suggest that we age, in part, because our self-renewing stem cells grow old as a result of heritable intrinsic events, such as DNA damage, as well as extrinsic forces, such as changes in their supporting niches. Mechanisms that suppress the development of cancer, such as senescence and apoptosis, which rely on telomere shortening and the activities of p53 and p16(INK4a), may also induce an unwanted consequence: a decline in the replicative function of certain stem-cell types with advancing age. This decreased regenerative capacity appears to contribute to some aspects of mammalian ageing, with new findings pointing to a 'stem-cell hypothesis' for human age-associated conditions such as frailty, atherosclerosis and type 2 diabetes.