Adult and Gerontology Area of Study

Current Grants

Hydration: LTC Intervention to Prevent Acute Confusion National Institute for Nursing Research
Kennith Culp, PI
Janet Mentes, Co-PI

This is a clinical investigation of the effectiveness of a hydration management protocol for elderly long-term care residents. The treatment group receives a hydration goal based on body weight and the control group gets routine care. Hydration status is measured by urine color, urine specific gravity, and bioimpedance analysis. Urine testing is done with a Photometric Urine Analyzer. The outcomes of interest for the treatment group are reduced incidence of acute confusion and urinary tract infection.

Exercise-Based Fall Prevention Program for Elders in Long-Term Care
Deborah Perry Schoenfelder, PI

The purpose of this study is to test the effectiveness of an ankle strengthening and walking program (3 times/week for 3 months) in improving balance, ankle strength, walking speed, and falls efficacy (confidence to perform daily activities without falling); and decreasing fear of falling, and preventing falls in elderly nursing home residents. Over the past 2 years, subjects have been recruited from 10 long-term care facilities and matched in pairs by fall risk scores and then randomly assigned within each pair to the exercise or control group. Both groups are assessed (for the outcome variables listed above) at baseline,3 and 6 months following initiation of the intervention.

The Iowa-VA Nursing Research Consortium
The Iowa-VA Nursing Research Consortium, initiated in June, 1993, is an innovative collaborative agreement between the University of Iowa College of Nursing and four Veterans Affairs Facilities in the state of Iowa: Iowa City VAMC, Knoxville VAMC, Des Moines VAMC and the Iowa Veterans Home (Marshalltown). The overall purpose of the Consortium is to improve the health care provided to aging veterans by developing and implementing research based practice guidelines while contributing to the overall advancement of nursing science through large-scale, multisite research studies. The Consortium is headed by Toni Tripp-Reimer, PhD, RN, FAAN, Professor and Associate Dean for Research Development and Utilization. Paula Mobily, PhD, RN, Associate Professor at the College of Nursing serves as the Research Coordinator. Each facility is represented by the director of nursing and a site research coordinator. In addition, the work of the Consortium is enhanced by a collegiate workgroup that includes additional faculty, several doctoral students and two postdoctoral fellows.

The initial research endeavor focused on the assessment and management of acute confusion in the elderly. A multiphase program of research has been developed and implemented. In Phase I, current strategies used by nursing staff (N=578) to assess, prevent and treat acute confusion were examined as well as the identification of the most pressing nursing management problems involved in caring for acutely confused patients. Major care problems identified included alterations in thought processes, risk for violence and self-injury and self-care deficits. The research confirmed that acute confusion is a major clinical problem for nursing staff at both acute and long-term care facilities.

Phase II focused on determination of the incidence and prevalence of acute confusion in both acute and long-term care facilities, as well as the determination of acute confusion profiles and the natural history and evolution of acute confusional episodes and their sequellae.

Phase III was designed to test prevention, surveillance, behavioral management and treatment interventions for acutely confused elders. The initial project for this phase was the development of an educational program to train Acute Confusion Resource Nurses with expertise in the assessment and management of acute confusion. To date, two workshops have been given with more than 100 nurses from the four VA facilities participating. An additional clinical project is underway at this time focusing on the development, implementation and testing of interventions to manage dehydration, a common antecedent for acute confusion. More recently, the focus of the research endeavors has been expanded to include foci on assessment and management of pain, wound healing and pressure ulcer care. Initial endeavors in these areas are currently in the planning phase.

Two research based protocols have evolved to date from the work of the Consortium, in collaboration with the Gerontological Nursing Interventions and Research Center at the University of Iowa College of Nursing. These are listed below:

Rapp, C.G., & the Iowa Veterans Affairs Nursing Research Consortium.
(1998). Research-Based Protocol: Acute Confusion/Delirium. Iowa City, IA: The University of Iowa Gerontological Nursing Interventions Research Center, Research Development and Dissemination Core.

Mentes, J.C., & the Iowa- Veterans Affairs Nursing Research Consortium (1998). Hydration Management Research -Based Protocol. Iowa City, IA: The University of Iowa Gerontological Nursing Interventions Research Center Research Development and Dissemination Core.