Effects of Oral Estrogen and Progestin on the Lower Urinary Tract Among Female Nursing Home Residents

OBJECTIVE: To examine the effects of oral estrogen/progestin on incontinence and related lower urinary tract conditions among female nursing home (NH) residents. DESIGN: Randomized placebo-controlled trial. SETTING: Five NHs. PARTICIPANTS: Thirty-two incontinent female residents of average age 88. MEASUREMENTS: Subjects were randomized to receive either oral estrogen (0.625 mg) combined with progesterone (2.5 mg) or placebo, daily for 6 months. Measures of incontinence severity, the clinical appearance of the vagina, vaginal and urethral cytology, and urine and vaginal cultures were made at baseline, 3 months, and 6 months. In addition to active drug or placebo, all subjects received regular toileting assistance (prompted voiding) by trained research aides during 3-day data-collection periods to compensate for mobility and cognitive impairments. RESULTS: At 3 and 6 months there were no significant differences between the groups in the severity of incontinence, the prevalence of bacteriuria, or the results of vaginal cultures. Several clinical findings associated with atrophic vaginitis improved more in the active than the placebo group and vaginal pH and vaginal and urethral cytology exhibited a partial estrogenic effect. CONCLUSIONS: Our results must be interpreted with caution because of the size and the select nature of our subject sample. Up to 6 months of oral estrogen had only a partial estrogenic effect on vaginal and urethral epithelium and no clinical effects in this patient population. We believe that future studies of estrogen for urinary incontinence in frail NH residents should utilize a topical preparation and consider targeting urinary tract infection as an additional outcome measure.     

Ethical Perspectives on Self‐Neglect Among Older Adults

Self‐neglect is a serious and growing problem among older adults. A 2004 survey from Adult Protective Services (APS) showed that adults age 60 or older were named in 85,000 reports of self‐neglect from 21 states (Naik, Lai, Kunik, & Dyer, 2008 ; Teaster, Dugar, Mendiondo, Abner, & Cecil, 2006 ). Although rehabilitation nurses are obligated to uphold the autonomy of older adults and strengthen their independence, dilemmas result when people's poor health behaviors put them or others at risk for negative consequences. When making decisions about nursing actions related to self‐neglecting elderly people, the basic principles of autonomy, beneficence, nonmaleficence, and capacity must be considered. The purpose of this article is to discuss major ethical perspectives related to self‐neglect among older adults.     

Anticipatory Stress Response in PTSD: Extreme Stress in Children

TOPIC: Anticipatory stress chronically activates the stress response in children with post‐traumatic stress disorder (PTSD). Effects of the allostatic load may begin even before birth in a stressful environment. PURPOSE: The purpose of this paper is to discuss the anticipatory stress response in children with PTSD. The paper discusses the etiology, the impact of the disorder on long‐term health, cognitive and behavioral manifestations, and clinical management and treatment options. SOURCES USED: A review on current literature is presented and includes several key studies. CONCLUSIONS: Anticipatory stress in PTSD has acute and long‐term health implications for the child. The psychiatric nurse plays a key role in preventing the long‐term effects of PTSD.