Joseph G. Ouslander

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Increasing attention is being paid to inappropriate medication use in nursing homes. However, criteria defining the appropriate or inappropriate use of medication in this setting are not readily available and are not uniform. We used a two-round survey, based on Delphi methods, with 13 nationally recognized experts to reach consensus on explicit criteria(More)
N Engl J Med 2004;350:786-99. Copyright © 2004 Massachusetts Medical Society. veractive bladder is a symptom complex that includes urinary urgency with or without urge incontinence, urinary frequency (voiding eight or more times in a 24-hour period), and nocturia (awakening two or more times at night to void). 1-3 The International Continence Society(More)
OBJECTIVE To determine the prevalence of stress, urge, and mixed urinary incontinence and associated risk factors in postmenopausal women. METHODS Before enrollment in a 4-year, randomized trial of combination hormone therapy to prevent coronary heart disease, 2763 participants completed questionnaires on prevalence and type of incontinence. We measured(More)
Antimuscarinic agents are the predominant pharmacological treatment for patients with overactive bladder (OAB). These drugs are thought to act primarily through antagonism at muscarinic M3 receptors located at neuromuscular junctions in the human bladder detrusor muscle. Several of these drugs have been shown to be efficacious in ameliorating the symptoms(More)
With increasing age, the competence of the immune system to fight infections and tumors declines. Age-dependent changes have been mostly described for human CD8 T cells, raising the question of whether the response patterns for CD4 T cells are different. Gene expression arrays of memory CD4 T cells yielded a similar age-induced fingerprint as has been(More)
Urinary and fecal incontinence are prevalent, disruptive, and expensive health problems in the nursing home population. Nursing home residents who are incontinent of urine should have a basic diagnostic assessment, including a focused history and bladder record, a targeted physical examination, a urinalysis, and a determination of postvoid residual urine(More)
A substantial proportion of hospitalizations of nursing home (NH) residents may be avoidable. Medicare payment reforms, such as bundled payments for episodes of care and value-based purchasing, will change incentives that favor hospitalization but could result in care quality problems if NHs lack the resources and training to identify and manage acute(More)
OBJECTIVES To examine clinical outcomes and describe the staffing requirements of an incontinence and exercise intervention. DESIGN Randomized controlled trial with blinded assessments of outcomes at three points over 8 months. SETTING Four nursing homes. PARTICIPANTS Two hundred fifty-six incontinent residents. INTERVENTION Research staff provided(More)
BACKGROUND Aging is associated with decline in both cell-mediated and humoral immunity and may contribute to increased incidence and severity of infections in frail elderly. Exercise, depending on intensity, has significant effects on the immune system. We conducted a randomized, controlled clinical trial of a 32-week functionally oriented exercise program(More)
OBJECTIVES To determine whether an intervention that combines low-intensity exercise and incontinence care offsets some of its costs by reducing the incidence of selected health conditions in nursing home residents. DESIGN Randomized, controlled trial with the incidence and costs of selected, acute conditions compared between a 6-month baseline and an(More)