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Purpose: To determine the prevalence and predictors of IAD prevention in older (65+ years) NH residents with incontinence and assess for racial/ethnic disparities in this care.
Methods: We analyzed data of residents who newly developed incontinence after NH admission but were still free of IAD (n=10,713) in a cross-sectional design. Residents were 71% female, aged 83(8) years (mean(SD)), 89% White, 8% Black, 1.3% Hispanic, 1.2% Asian, 0.5% American Indian and in 448 proprietary NHs in 28 states. ~2.3 million practitioner orders were reviewed for reports of IAD prevention. Predictors of IAD prevention were obtained from four datasets over 3 years (2000-2002): Minimum Data Set (resident demographics/health), Online Survey, Certification and Reporting (NH staffing/care deficiencies) and US Census (socioeconomic status of NH communities).
Predictors of IAD prevention were examined using generalized linear mixed model with random intercepts. Disparities were assessed using the Peters-Belson method. Models provided estimates of the proportion of each minority expected to receive IAD prevention had they been in the White group which were compared to the proportion observed to receive prevention (z-test); all alpha levels p<.05.
Results: 12% of incontinent residents received IAD prevention. There were no disparities in IAD prevention for any minority (p>.05). Predictors of receiving IAD prevention were having greater deficits in activities of daily living (1.02, 1.01-1.03) (OR, 95% CI), more oxygenation problems (1.12, 1.05-1.20), and poorer nutrition (1.20, 1.07-1.33).
Conclusions: The absence of racial/ethnic disparity in IAD prevention in NHs is a positive outcome but IAD prevention is low overall. There is a need for WOC nurses to promote IAD prevention in NHs.