Omnicare Pharma (Germany)

To identify clinical characteristics of residents with a diagnosis of overactive bladder (OAB) and/or urinary incontinence (UI) to determine the prevalence of comorbidities, severe mobility impairment (SMI), moderate-to-severe cognitive impairment (MSCI), and a toileting program and the response to that program. Cross-sectional retrospective analysis. Skilled nursing facilities. Residents with a diagnosis of OAB and/or UI and an age range, and gender frequency-matched 1:1 control cohort without OAB and/or UI. None. De-identified Minimum Data Set data 3.0 records (October 1, 2010, to September 30, 2012). Of the 175,632 residents, 65% had a diagnosis of UI and 1% had a diagnosis of OAB. Those with UI and/or OAB were more likely to have MSCI (mean Brief Inventory of Mental Status score 10.2 ± 4.5 vs. 12.5 ± 3.6; P = 0.001) and SMI (49.4% vs. 26.4%; P < 0.001), multiple comorbid conditions, falls and falls with injury, hip fractures (5.5% vs. 4.9%; P < 0.001), urinary tract infections (21.4% vs. 16.5%; P = 0.001), and moisture-associated skin damage (5.2% vs. 2.6%; P = 0.001) than the control cohort. Toileting programs were attempted more often (17.0% vs. 5.1%; P < 0.001) in those with UI and/or OAB but were only minimally successful, with 4.2% having decreased wetness and 0.9% being completely dry. Residents with UI and/or OAB exhibit a higher burden of MSCI, SMI, and comorbidities than do residents without these diagnoses. Nonpharmacologic therapies such as toileting programs should be a primary focus in the nursing facility.

An 89-year-old female resident in the assisted living section of a continuing care retirement community complained of dizziness and lightheadedness at 10 am daily and was experiencing frequent falls. The facility staff requested a consultant pharmacist perform an extensive review of her medications and medical conditions. Following a chart review and interview with the resident, the consultant pharmacist found that her past medical history consists of coronary artery disease, atrial fibrillation, congestive heart failure, hypertension, dyslipidemia, osteoporosis, gastroesophageal reflux disease, glaucoma, mild dementia, overactive bladder, and Parkinson's disease (PD). The nursing staff monitored the resident's blood pressure during these episodes and determined that the resident was experiencing orthostatic hypotension (OH). During the review, the consultant pharmacist found a recent neurology note that concluded the resident may have multiple-system atrophy (MSA) and her therapy for PD may not be beneficial. As autonomic dysfunction is a common feature of MSA, it is important to minimize the use of medications that can cause or aggravate OH. Additionally, data suggest only a modest and nonsustained response to levodopa in patients with MSA. Therefore, the pharmacist recommended multiple medication changes as well as follow-up monitoring by the patient and assisted living community staff to minimize medication-related problems such as falls.

Cognitive rehabilitation therapy is a systematic effort to assist brain damaged individuals in developing ways to compensate for cognitive deficits. Although this treatment is considered standard in a field of rehabilitation, access to services is limited by the availability of specialists. A model for bringing cognitive rehabilitation techniques to children with acquired brain injury within their own school setting is presented. A convenience sample of 10 public high school students with acquired brain injury received biweekly cognitive rehabilitation sessions for 20 weeks. Treatment was based on a developmental model of brain functioning. Treatments were provided by trained school teachers under the supervision of psychologists specializing in cognitive rehabilitation. Students were evaluated pre- and post-treatment using neuropsychological tests. After treatment, the students demonstrated a significant increase in general memory ability (p < 0.05). These gains were due mostly to increases in verbal learning ability. Integration of cognitive rehabilitation therapy with public school services is a significant step in providing this valuable treatment to a wider range of children with acquired brain injury.

PHILIP J. POWELL, MS, MBA, is Assistant Director of Research and Reimbursement for HPI Health Care Services, Inc., a subsidiary of Omnicare, Inc., Los Angeles, California.