Abstract: Racial and Ethnic Disparities in the Management of Incontinence of Nursing Home Residents (49th Annual Conference (May 19-23, 2017))

Tuesday, May 23, 2017: 12:00 AM

Donna Z. Bliss, PhD, RN, FAAN, FGSA¹, Olga V. Gurvich, MA¹, Lynn E. Eberly, PhD², Kay Savik, MS¹, Susan Harms, PhD, RPh¹, Jean F. Wyman, PhD, APRN, GNP-BC, FAAN¹, Christine Mueller, PhD, RN, FAAN, FGSA¹ and Beth Virnig, PhD³, (1)School of Nursing, University of Minnesota, Minneapolis, MN, (2)Biostatistics Division, School of Public Health, University of Minnesota, Minneapolis, MN, (3)School of Public Health, University of Minnesota, Minneapolis, MN

Purpose: Reports of racial/ethnic disparities in nursing home (NH) care prompted this investigation of disparities in managing incontinence that developed after NH admission.

Methods: Datasets: Minimum Data Set (residents’ characteristics, incontinence, incontinence management) and Online Survey, Certification, and Reporting (NH characteristics/staffing/care deficiencies) from 2000-2002 and 2000 US Census (socioeconomic status of communities around NHs). In a cohort design, two outcomes of incontinent residents aged 65+ years (n=8,638 in 447 NHs in 28 states) were analyzed: (1) any incontinence management versus no management; (2) conservative+behavioral management versus conservative management only.

Disparity was assessed with the Peters-Belson method: Predictors of incontinence management were modeled for Whites using logistic regression. Resulting coefficients were applied to minority groups in separate models estimating the % minorities expected to receive management, had they been in the Whites’ group. These percentages were then compared to the percentages observed to receive management using z-tests.

Results: Incontinent residents were 71% female, aged (83(8)) years (mean(SD)), 89% White, 8% Black, 1% Hispanic, and 1% Asian. Of the 7,961 residents with incontinence management data, 77% received any management; 41% of those received conservative+behavioral management. The %disparity was significant for Blacks (7.5%, p=.001) and Hispanics (8.6%, p=.006) for any management and for Blacks for behavioral+conservative management (p=.01). Significant predictors (OR(95%CI)) of receiving any incontinence management in the Whites’ model applied to Blacks were greater activity of daily living (ADL) limitations (1.02(1.01-1.03)), high school education (1.23(1.02-1.47)), fewer cognitive deficits (0.92(0.86-0.99)), and fewer quality care deficiencies (0.97(0.96-0.99)). Predictors of any management in the Whites’ model applied to Hispanics were greater ADL limitations (1.05(1.02-1.08)) and fewer cognitive deficits (0.94(0.92-0.97)). Predictors of behavioral+conservative management in the Whites’ model applied to Blacks were lesser ADL limitations (0.97(0.96-0.98)) and greater cognitive deficits (1.22(1.13-1.32)).

Conclusion: Achieving equity in incontinence management in NHs is needed and WOC nurses can assist.