The proposed research is relevant to public health because it will allow nursing home providers, residents, and their families make informed, individualized decision making surrounding common urologic procedures. Thus, the proposed research is relevant to the part of the NIA's mission to improve our knowledge to develop more effective ways to prevent, diagnose, and treat common diseases and conditions of aging in this underserved and vulnerable population
There is a fundamental gap in our understanding of outcomes related to common urologic procedures in frail nursing home residents. The decision to perform surgery in this unique population, however "minor" or "routine", is complex and should be considered carefully by balancing the risks and benefits in each individual with the ultimate goal of improving quality of life. However, the risks and benefits of common urologic procedures (e.g., cystoscopy, bladder biopsy, transurethral resection of bladder tumor, transurethral resection and incision of the prostate, prostate biopsy, and operations for stress urinary incontinence) in nursing home residents are unknown. The long-term goal is to broaden our understanding quality of life in this patient population with limited life expectancy and to direct surgical and urologic care towards this aim. The objective of this particular application is to gain an understanding of the immediate and long-term outcomes related to common urologic procedures in nursing home residents that go beyond procedure-specific complications and mortality to measure functional and cognitive status, which matter greatly to this population. The central hypothesis is that there are substantial and significant immediate and long-term complications resulting from common urologic procedures among the nursing home population, spanning from high rates of procedure-specific complications (e.g. longer hospital stays, hospital readmissions, repeat urologic procedures, blood transfusions and new diagnoses of urinary tract infection and hematuria) and mortality to lasting functional and cognitive declines, warranting careful consideration when making the decision to undergo these procedures in future nursing home residents. This hypothesis will be tested by leveraging the Minimum Data Set (MDS) for Nursing home Resident Assessment and Medicare data to pursue two specific aims: 1) Determine the immediate (30-day) outcomes following common urologic procedures (e.g. cystoscopy, bladder biopsy, transurethral resection of bladder tumor, transurethral resection and incision of the prostate, prostate biopsy, and operations for stress urinary incontinence) among nursing home residents and determine factors associated with adverse outcomes; and 2) Determine long-term (1-year) functional and cognitive outcomes following common urologic procedures among nursing home residents and determine factors associated with outcomes. This project is innovative because it is the first to look at any urologic procedures in the nursing home population, it goes beyond commonly measured surgical outcomes to evaluate long-term functional and cognitive outcomes after urologic procedures that matter dearly to residents and impact their quality of life, and importantly, the proposed project raises questions about the appropriateness of performing diagnostic and discretionary procedures in this frail population with limited life expectancy. The proposed research is significant because it will greatly enhance our understanding of the risks and benefits associated with these procedures in this patient population and will improve informed decision making among nursing home providers, residents, and their families, which is critical to patient-centered surgical care.