Pressure ulcers and nutritional deficits in elderly long-term care patients: Effects of a comprehensive nutritional program on pressure ulcer healing, length of hospital stay and charges to patients

The elderly are at the highest risk of developing pressure ulcers that result in prolonged hospitalization, high health care costs, increased mortality, and decreased quality of life. The burden of pressure ulcers will intensify because of a rapidly increasing elderly population in the United States (US). Poor nutrition is a major predictor of pressure ulcer formation. The purpose of this study was to examine the effects of a comprehensive, interdisciplinary nutritional protocol on: (1) pressure ulcer wound healing (2) length of hospital stays, and (3) charges for pressure ulcer management. Using a pre-intervention/post intervention quasi-experimental design the study sample was composed of 100 patients 60 years or older, admitted with or acquiring a pressure ulcer. A pre-intervention group (n= 50) received routine pressure ulcer care (standard diet, dressing changes, and equipment). A post-intervention group received routine care plus an interdisciplinary nutrition intervention (physical therapy, speech therapy, occupational therapy, added protein and calories to the diet). Research questions were analyzed using descriptive statistics, frequencies, Chi-Square Tests, and T-tests. Findings indicated that the comprehensive, interdisciplinary nutritional protocol had a significant effect on the rate of wound healing in Week3 and Week4, total hospital length of stay (pre-intervention M= 43.2 days, SD=31.70 versus M=31.77, SID-12.02 post-intervention), and pressure ulcer length of stay (pre-intervention 25.28 days, SD5.60 versus 18.40 days, SD 5.27 post-intervention). Although there was no significant difference in total charges for the pre-intervention group ($727,245.00) compared to the post-intervention group ($702,065.00), charges for speech (m=$5885.12, SD=$332.55), pre albumin (m=$808.52,SD= $332.55), and albumin($278 .88, SD=55.00) were higher in the pre-intervention group and charges for PT ($5721.26, SD$3655.24) and OT($2544 .64, SD=1712.863) were higher in the post-intervention group. Study findings indicate that this comprehensive nutritional intervention was effective in improving pressure ulcer wound healing, decreasing both hospital length of stay for treatment of pressure ulcer and total hospital length of stay while showing no significant additional charges for treatment of pressure ulcers.

Health care utilization behavior of elders in a multicultural urban environment

The objective of this research is to determine the influences of social, environmental, behavioral, and economic forces on the health care service utilization of four racial/ethnic groups of non-institutionalized elders in a multicultural urban environment. To address these issues this dissertation examines three intertwined themes of culture, aging, and health, using a sample of elders residing in Miami-Dade County, FL in four racial/ethnic groups: white non-Hispanic; black non-Hispanic English speakers; Cuban; and non-Cuban Hispanic. ^ The research questions were analyzed using both quantitative and qualitative data. Data for the quantitative component uses telephone survey data from the Dade County Needs Assessment. The purpose of this component is to develop a more comprehensive model of elder health care utilization behavior. The qualitative component uses data from focus groups from Dade County Needs Assessment, archival data and a literature review of previous ethnographic research. The purpose of this component is to gain a better understanding of the social construction of the terms “age”' and “aging,” as well as to place issues of health and health care in the lives of elders. ^ The findings raised several important issues. First, just because people share a common chronological age does not mean that they are the same in every other respect. Examining elders as a homogeneous group of users of formal health care services in a community is simplistic. Placing “aging” and “health” in a cultural context is important. My findings confirm that the meaning of “aging” and “old” are socially constructed. Further, the term “aging” is NOT synonymous with ill health or frailty. This was a consistent finding in both the quantitative and qualitative results. ^ While all aging individuals share a mutual orientation toward aging (i.e., biological process), they do not age the same way (i.e., social construction of “aging”). Thus, policymakers and others serving the elder population must be aware of the particular cultural context, as well as the previous life experiences of the individuals that they serve. This analysis documents the importance of culture and geographic community in understanding health care service utilization of elders. ^

Structural Health Monitoring using Index Based Reasoning for Unmanned Aerial Vehicles

Unmanned Aerial Vehicles (UAVs) may develop cracks, erosion, delamination or other damages due to aging, fatigue or extreme loads. Identifying these damages is critical for the safe and reliable operation of the systems. ^ Structural Health Monitoring (SHM) is capable of determining the conditions of systems automatically and continually through processing and interpreting the data collected from a network of sensors embedded into the systems. With the desired awareness of the systems’ health conditions, SHM can greatly reduce operational cost and speed up maintenance processes. ^ The purpose of this study is to develop an effective, low-cost, flexible and fault tolerant structural health monitoring system. The proposed Index Based Reasoning (IBR) system started as a simple look-up-table based diagnostic system. Later, Fast Fourier Transformation analysis and neural network diagnosis with self-learning capabilities were added. The current version is capable of classifying different health conditions with the learned characteristic patterns, after training with the sensory data acquired from the operating system under different status. ^ The proposed IBR systems are hierarchy and distributed networks deployed into systems to monitor their health conditions. Each IBR node processes the sensory data to extract the features of the signal. Classifying tools are then used to evaluate the local conditions with health index (HI) values. The HI values will be carried to other IBR nodes in the next level of the structured network. The overall health condition of the system can be obtained by evaluating all the local health conditions. ^ The performance of IBR systems has been evaluated by both simulation and experimental studies. The IBR system has been proven successful on simulated cases of a turbojet engine, a high displacement actuator, and a quad rotor helicopter. For its application on experimental data of a four rotor helicopter, IBR also performed acceptably accurate. The proposed IBR system is a perfect fit for the low-cost UAVs to be the onboard structural health management system. It can also be a backup system for aircraft and advanced Space Utility Vehicles. ^

Community-based older adults' perceptions of factors that influence successful aging in place

The purpose of this study was to obtain an understanding of older adults' perceptions of independence and the factors that allow them to remain living independently in the community. A questionnaire was mailed to a random sample of 500 community-based older adults. One hundred seventy eight questionnaires were returned (36%). Respondents were asked questions related to independence, self-health rating, functional difficulties, and social supports. Most respondents indicated Mental Health (97%), Physical Health (97%), Control of choices (97%), and Social Support Systems (93%) contributed to maintaining independence in the community. Age, education, fewer chronic health conditions, and a higher self-health rating were found to be significant predictors of actual independence. Family members were identified as the primary source of assistance with advice on major life decisions and financial matters. Findings indicate age, education, health status and the social support of family and friends all play an important role for older adults to live independently in the community. Occupational therapy could be instrumental in extending the health, highest level of independent functioning, and the number of years older adults remain living in the community.

Health Literacy and Medicare Recipient's Knowledge of Health Insurance Options

Health literacy is a major problem for the aging population (Parker, Ratzan, & Lurie, 2003). The significance of this study was to access the relationship between health literacy and knowledge of Medicare to determine ways in which seniors can effectively navigate their healthcare insurance.