1
|
Liu W, Chen Y. Sequential relationships of food intake in nursing home residents with dementia: Behavioural analyses of videotaped mealtime observations. J Clin Nurs 2023; 32:3482-3495. [PMID: 35706419 PMCID: PMC9972876 DOI: 10.1111/jocn.16411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 05/23/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES This study examined the sequential relationships of food intake and the moderating role of the characteristics of intake and resident conditions. BACKGROUND Nursing home residents commonly experience insufficient food intake. While multilevel factors influence intake, evidence on sequential relationships is lacking. DESIGN The study was an observational study using secondary, behavioural analyses following the STROBE Statement. METHODS Videotaped observations (N = 160) collected from a dementia communication trial during 2011-2014 were coded using the refined Cue Utilisation and Engagement in Dementia Mealtime Video-coding Scheme during 2018-2019. The 160 videos involved 27 residents living with dementia and 36 staff in 9 nursing homes. Independent variables were the state (solid intake, liquid intake, no intake) of an intake episode occurring during mealtime (current episode), eating technique (resident-initiated, staff-facilitated) used in the next episode occurring after the current episode (subsequent episode), interval between adjacent episodes, and resident comorbidities and dementia stage. The dependent variable was the state of subsequent episode. RESULTS Successful liquid and solid intake increased odds of subsequent liquid and solid intake. Comorbidities were associated with decreased odds of subsequent liquid and solid intake for staff-facilitated episodes. When liquid intake occurred, staff-facilitation decreased odds of subsequent liquid intake; longer intervals between adjacent episodes increased odds of subsequent solid intake. CONCLUSION Food intake was strongly and sequentially associated, and such temporal relationships were dependent on characteristics of the intake process and resident conditions. RELEVANCE TO CLINICAL PRACTICE The study findings supported that initiating successful intake facilitates continuity of successful intake during mealtime. Behavioural interventions tailored by comorbidities that modify characteristics of the food intake process may improve food intake.
Collapse
Affiliation(s)
- Wen Liu
- The University of Iowa College of Nursing, Iowa City, Iowa, USA
| | - Yong Chen
- Department of Industrial and Systems Engineering, The University of Iowa College of Engineering, Iowa City, Iowa, USA
| |
Collapse
|
2
|
Mundadan RG, Savundranayagam MY, Orange JB, Murray L. Language-Based Strategies that Support Person-Centered Communication in Formal Home Care Interactions with Persons Living with Dementia. J Appl Gerontol 2023; 42:639-650. [PMID: 36464843 PMCID: PMC9996793 DOI: 10.1177/07334648221142852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Language-based strategies are recommended to improve coherence, clarity, reciprocity, and continuity of interactions with persons living with dementia. Person-centered care is the gold standard for caring for persons with dementia. Person-centered communication (PCC) strategies include facilitation, recognition, validation, and negotiation. Little is known about which language-based strategies support PCC in home care. Accordingly, this study investigated the overlap between language-based strategies and PCC in home care interactions. Analysis of conversation of 30 audio-recorded interactions between personal support workers (PSWs) and persons living with dementia was conducted. The overlap between PCC and language-based strategies was analyzed. Of 11,347 communication units, 2578 overlapped with PCC. For facilitation, 21% were yes/no questions. For recognition, 25% were yes/no questions and 22% were affirmations. For validation, 81% were affirmations and positive feedback. Finally, 60% were yes/no questions for negotiation. The findings highlight the person-centeredness of language-based strategies. PSWs should use diverse language-based strategies that are person-centered.
Collapse
Affiliation(s)
- Reanne G Mundadan
- Health and Rehabilitation Sciences, 6221Western University, London, ON, Canada
| | | | - J B Orange
- School of Communications Sciences and Disorders, 6221Western University, London, ON, Canada
| | - Laura Murray
- School of Communications Sciences and Disorders, 6221Western University, London, ON, Canada
| |
Collapse
|
3
|
Kim S, Liu W. Psychometric Properties of Instruments Measuring Dyadic Communication and Environment in Dementia Care: A Systematic Review. THE GERONTOLOGIST 2023; 63:52-70. [PMID: 34864998 DOI: 10.1093/geront/gnab178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES A valid and reliable assessment of dementia dyadic communication and environment is essential to understand and facilitate social interaction and quality care. This review described the characteristics and evaluated psychometric properties of instruments that assess dyadic communication and environment between persons living with dementia and their caregivers. RESEARCH DESIGN AND METHODS A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Literature published until June 30, 2021, was searched. Ten psychometric properties and the ratio of sample size to the number of items were evaluated using the Psychometric Assessment for Self-report and Observational Tool. RESULTS A total of 3,708 scholarly records was identified, and 24 eligible instruments from 48 scholarly records were evaluated. Twenty-two instruments assessed dyadic communication, and 2 assessed both dyadic communication and environment. Eighteen instruments were developed to assess task-related communication and 15 for paid (professional) caregivers. All instruments were scored as low psychometric quality (score range = 0-7). Behavioral Observation Scoring System was scored the highest (total score = 7), followed by Dyadic Dementia Coding System, Grid for observation of physical and verbal behaviors of caregiver and resident, and Trouble-Indicating Behaviors and Repair (total score = 6). These instruments had low psychometric evidence for internal consistency, content validity, and structural validity. DISCUSSION AND IMPLICATIONS Existing instruments are in the early stages of development and validation in dementia population. Further testing is needed in diverse communication types in paid and unpaid dementia caregiver populations.
Collapse
Affiliation(s)
- Sohyun Kim
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Wen Liu
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| |
Collapse
|
4
|
Backhouse T, Killett A, Mioshi E, Khondoker M. What are the factors associated with people with advanced dementia refusing assistance with personal care? Int J Geriatr Psychiatry 2023; 38:e5857. [PMID: 36490270 PMCID: PMC10107826 DOI: 10.1002/gps.5857] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND People with dementia sometimes refuse assistance with personal care activities such as washing or dressing. We aimed to investigate the factors associated with refusals of care in advanced dementia. METHODS A cross-sectional study using informant-based measures. Participants were people with advanced dementia and their caregivers (family carers or care-home staff) (n = 260, 130 dyads) in the UK. Mixed effects linear models were used to examine the effects of neuropsychiatric behaviours, ability with activities of daily living, professional input, co-morbidities, psychotropic medications, environment modifications, and caregiver factors including type and training status on refusals of care. The Refusal of Care Informant Scale was used, range 1-13; higher scores indicate more refusal behaviours. RESULTS Higher independence in activities of daily living was associated with less refusal behaviours (coefficient = -0.11, p < 0.001 [95% confidence interval -0.15, -0.07]). Higher agitation was associated with more refusal behaviours (0.11, p < 0.001 [0.06, 0.15]). No other statistically significant differences were found. There was no demonstrable evidence of differences in number of refusals of care between family and care-home caregivers or between dementia-trained or -untrained caregivers. CONCLUSIONS Results suggest refusals of care have similar prevalence regardless of caregiver type (family or care home) or dementia training status, indicating that current dementia training has no impact on refusals of care or may not be implemented as intended. Improving independence in activities of daily living and reducing agitations may help prevent refusals of care. To establish causality, future research should consider embedding these factors into interventions targeting refusal of care.
Collapse
Affiliation(s)
- Tamara Backhouse
- School of Health SciencesUniversity of East AngliaNorwichNorfolkUK
| | - Anne Killett
- School of Health SciencesUniversity of East AngliaNorwichNorfolkUK
| | - Eneida Mioshi
- School of Health SciencesUniversity of East AngliaNorwichNorfolkUK
| | | |
Collapse
|
5
|
Liu W, Perkhounkova Y, Hein M. Person-centred and task-centred care: Impact on mealtime behaviours in nursing home residents with dementia. Int J Older People Nurs 2023; 18:e12512. [PMID: 36374224 PMCID: PMC9976786 DOI: 10.1111/opn.12512] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 08/16/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Mealtime is a critical daily activity to ensure nutrition, hydration, function and socialisation. Interactions between staff and residents during mealtimes are complex and dynamic processes including verbal and/or nonverbal communication that can be positive/neutral or challenging. This study examined characteristics of and relationships between person-centred and task-centred care and positive/neutral and challenging mealtime behaviours in persons with dementia. METHODS This study was a secondary behavioural analyses of videotaped mealtime observations (n = 110) involving 42 unique staff-resident dyads (29 staff and 25 residents with dementia) in nine nursing homes. The refined Cue Utilization and Engagement in Dementia mealtime video-coding scheme was used to code videos during 2019-2020. Dependent variables representing resident mealtime behaviours included positive verbal behaviours, positive/neutral nonverbal behaviours, functional impairments (nonverbal) and resistive behaviours (verbal and nonverbal). Independent variables were staff person-centred and task-centred approaches (verbal and nonverbal). Relationships between resident mealtime behaviours and staff approaches were examined using bivariate analysis and logistic regression. RESULTS Staff person-centred verbal approaches were associated with resident positive verbal behaviours (OR = 1.38, 95% CI = 1.09-1.76), functional impairments (OR = 0.81, 95% CI = 0.66-1.00) and resistive behaviours (OR = 1.65, 95% CI = 1.18-2.31). Staff person-centred nonverbal approaches were associated with resident functional impairments (OR = 1.33, 95% CI = 1.02-1.74). Staff task-centred approaches were not associated with resident positive/neutral or challenging mealtime behaviours. CONCLUSION This study characterised staff approaches and resident behaviours during mealtime care and provided preliminary support on associations between staff person-centred approaches and resident positive and challenging behaviours. Person-centred mealtime care practice is recommended by focusing on support of common, challenging behaviours and reinforcement of positive behaviours with adequate consideration of individual needs and preferences.
Collapse
Affiliation(s)
- Wen Liu
- The University of Iowa College of Nursing Iowa City Iowa USA
| | | | - Maria Hein
- The University of Iowa College of Nursing Iowa City Iowa USA
| |
Collapse
|
6
|
Backhouse T, Jeon YH, Killett A, Mioshi E. How do family carers and care-home staff manage refusals when assisting a person with advanced dementia with their personal care? DEMENTIA 2022; 21:2458-2475. [PMID: 36053711 PMCID: PMC9583289 DOI: 10.1177/14713012221123578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background and objectives Caregivers may encounter, or inadvertently cause, refusals of care by a care
recipient. Managing refusals of care can be challenging and have potential
negative consequences. We aimed to examine caregivers’ (care-home staff and
family carers) experiences of managing refusals of personal care in advanced
dementia. Research design and methods One-to-one semi-structured interviews with 12 care assistants from six care
homes and 20 family carers who were physically assisting a person with
advanced dementia with their personal care in the UK. Interviews were audio
recorded and transcribed verbatim, with data analysed using qualitative
content analysis. Findings Core to the caregiver experience of refusals of care was
knowing the person. This underpinned
five key themes identified as caregivers’ strategies used in preventing or
managing refusals of care: (1) finding the right moment to care; (2) using
specific communication strategies; (3) being tactful: simplifying, leaving,
or adapting care; (4) having confidence in care; and (5) seeking support
from others when safety is at risk. Discussion and implications Different caregiver relationships with the person with dementia influenced
how they managed refusals of care. Refusals of care can place caregivers in
tough situations with tensions between providing care when it is seemingly
not wanted and leaving care incomplete. Both caregiver groups require
support such as coaching, mentoring and/or advice from other health and
social care practitioners to manage difficult personal care interactions
before crisis points occur.
Collapse
Affiliation(s)
- Tamara Backhouse
- School of Health Sciences, 83726University of East Anglia, Norwich, Norfolk, UK
| | - Yun-Hee Jeon
- Sydney Nursing School, 4334The University of Sydney, Sydney, NSW, Australia
| | - Anne Killett
- School of Health Sciences, 83726University of East Anglia, Norwich, Norfolk, UK
| | - Eneida Mioshi
- School of Health Sciences, 83726University of East Anglia, Norwich, Norfolk, UK
| |
Collapse
|
7
|
Paudel A, Galik E, Resnick B, Doran K, Boltz M, Zhu S. Factors Associated With the Quality of Staff-Resident Interactions in Assisted Living. J Nurs Care Qual 2022; 37:168-175. [PMID: 34446666 PMCID: PMC8866198 DOI: 10.1097/ncq.0000000000000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Care interactions are verbal or nonverbal interactions between staff and residents during social or physical care activities. The quality of care interactions could be positive, negative, or neutral. PURPOSE The purpose of this study was to examine the resident- and facility-level factors associated with the care interactions in assisted living (AL). METHODS Regression analysis was performed using a stepwise method utilizing baseline data of 379 residents from 59 AL facilities recruited in a randomized trial. RESULTS Accounting for 8.2% of variance, increased resident agitation was associated with negative or neutral quality interactions while for-profit ownership was associated with positive quality interactions. CONCLUSIONS To promote positive care interactions, findings suggest the need to educate staff about strategies to minimize resident agitation (eg, calm posture and respectful listening) and work toward optimizing care interactions in nonprofit settings. Future research could further explore the influence of staff-level factors on care interactions.
Collapse
Affiliation(s)
- Anju Paudel
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21218
| | - Elizabeth Galik
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21218
| | - Barbara Resnick
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21218
| | - Kelly Doran
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21218
| | - Marie Boltz
- Pennsylvania State University, College of Nursing, 306 Nursing Sciences Building, University Park, PA 16802
| | - Shijun Zhu
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21218
| |
Collapse
|
8
|
Lagerlund H, Thunborg C, Sandborgh M. Behaviour-directed interventions for problematic person transfer situations in two dementia care dyads: a single-case design study. BMC Geriatr 2022; 22:261. [PMID: 35351026 PMCID: PMC8966167 DOI: 10.1186/s12877-022-02952-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 03/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background Persons with dementia living in nursing homes need assistance with moving and transfers; however, caregivers assisting persons with dementia in their daily person transfers report strain-related and complicated transfer-related behavioural problems. The reciprocity of complex dyadic transfer-related behaviours is affected by environmental factors, the health status of the person with dementia and the caregiver’s skills and knowledge. The aim of this study was to explore tailored interventions guided by a functional behaviour analysis for problematic person transfer situations in two dementia care dyads. Methods This study was a quasi-experimental single-case study with an A-B design. Tailored interventions were developed in a five-step model for functional behavioural analysis. The study was conducted in a dementia special care unit at a nursing home, and the inclusion criteria were caregivers’ experiences of physical strain and/or resistiveness to care, which led to complex transfer-related behaviour. Two care dyads were included. Transfer situations were video-recorded and evaluated with the Dyadic Interaction in Dementia Transfer Assessment Scale, Pain Assessment in Advanced Dementia Scale, and Resistiveness to Care Scale for Dementia of the Alzheimer’s Type. The caregiver experience was evaluated with study-specific items addressing caregiver self-efficacy, catastrophizing thoughts, perceived control, and perceived physical strain. Scorings were graphically displayed. The graphs were inspected visually to identify changes in trend, level, latency, and variability. Nonoverlap of all pairs (NAP), including 90% confidence intervals (CIs), was calculated to complement the visual inspection. Results Verbal and nonverbal discomfort decreased in care dyad 1, which mirrored the caregiver changes in adapting their actions to the needs of the person with dementia. High variability was seen in both the intervention and the baseline phases in care dyad 2. In both care dyads, caregiver transfer-related behaviour improved. Conclusions The results indicate that the transfer-related behaviours of the care dyad might be improved through a behaviour-directed intervention tailored to meet the care dyad´s needs. The small number of cases and observations limits the generalizability, and the results should be interpreted in consideration of the piloting approach of the study. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02952-5.
Collapse
Affiliation(s)
- Hanna Lagerlund
- Rehabilitation Unit, Nyköping Municipality, 611 83, Nyköping, Sweden
| | - Charlotta Thunborg
- Department of Neurobiology, Care Sciences and Society Division of Clinical Geriatrics, Karolinska Institute, Karolinska vägen 37A, 171 76, Stockholm, SE, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden
| | - Maria Sandborgh
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden.
| |
Collapse
|
9
|
Nguyen H, Eccleston CE, Doherty KV, Jang S, McInerney F. Communication in dementia care: Experiences and needs of carers. DEMENTIA 2022; 21:1381-1398. [PMID: 35333128 DOI: 10.1177/14713012221080003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To ensure the well-being, quality of life and quality of care of people living with dementia, carers need to have the necessary communication knowledge and skills to respond appropriately to a person's changing abilities and needs. Understanding carers' communication experiences and needs in the context of dementia care is an important step in enabling effective education and support for carers. This study aimed to investigate communication challenges faced by carers and their coping strategies, influencing factors, and communication education and training needs. The sample involved 258 carers enrolled in an online dementia care program, and data were collected using a 16-item questionnaire. Descriptive statistics and non-parametric inferential statistics, including Chi-square, Mann-Whitney U, Kruskal-Wallis and Spearman's rho, were used to analyse the data. The participants reported experiencing a range of challenges in communicating with people living with dementia and employing various strategies in addressing these challenges, either independently or with the support of others. Improvements in a number of factors would be beneficial for carers, including more time for caring, more care and social support, as well as enhanced skills in communicating with people living with dementia. A large majority of the participants indicated their need for education or training in communication knowledge and skills, and those with higher learning needs were likely to be younger, care workers and other health professionals, and those with less care experience. Recommendations are made for future research and efforts to maximise effective education and support for carers of people living with dementia.
Collapse
Affiliation(s)
- Hoang Nguyen
- Wicking Dementia Research & Education Centre, College of Health and Medicine, 3925University of Tasmania, Hobart AU-TAS 7001, Australia
| | - Claire Ea Eccleston
- Wicking Dementia Research & Education Centre, College of Health and Medicine, 3925University of Tasmania, Hobart AU-TAS 7001, Australia
| | - Kathleen Veronica Doherty
- Wicking Dementia Research & Education Centre, College of Health and Medicine, 3925University of Tasmania, Hobart AU-TAS 7001, Australia
| | - Sunny Jang
- Wicking Dementia Research & Education Centre, College of Health and Medicine, 3925University of Tasmania, Hobart AU-TAS 7001, Australia
| | - Fran McInerney
- Wicking Dementia Research & Education Centre, College of Health and Medicine, 3925University of Tasmania, Hobart AU-TAS 7001, Australia
| |
Collapse
|
10
|
Beogo I, Tchouaket EN, Sia D, Bationo NJC, Collin S, Tapp D, Kassim SA, Ramdé J, Gagnon MP. Promising best practices implemented in long-term care homes during COVID-19 pandemic to address social isolation and loneliness: a scoping review protocol. BMJ Open 2022; 12:e053894. [PMID: 34980621 PMCID: PMC8724591 DOI: 10.1136/bmjopen-2021-053894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/03/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Prior to the COVID-19 pandemic, social isolation and loneliness (SIL) affected at least one-third of the older people. The pandemic has prompted governments around the world to implement some extreme measures such as banning public gatherings, imposing social distancing, mobility restrictions and quarantine to control the spread and impact of the novel coronavirus. Though these unprecedented measures may be crucial from a public health perspective, they also have the potential to further exacerbate the problems of SIL among residents in long-term care homes (LTCHs). However, some LTCHs have developed promising best practices (PBPs) to respond to the current situation and prepare for future pandemics. Key aspects of such practices revolve around maintaining and strengthening social connections between residents and their families which helps to reduce SIL. This scoping review looks at existing PBPs that have been implemented to reduce SIL among LTCH residents during the most recent pandemics. METHODS AND ANALYSIS We will follow Arksey and O'Malley's framework of scoping review, further developed by Levac et al. In addition, we will also apply the Joanna Briggs Institute Reviewers' 'Methodology for Scoping Reviews'. Ten electronic databases and grey literature will be searched for articles published from January 2003 to March 2021 in either English or French. Two reviewers will independently screen titles and abstracts and then full texts for final inclusion. Data will be extracted using a standardised form from 'Evidence for Policy and Practice Information'. The results will be presented in a tabular form and will be summarised and interpreted using a narrative synthesis. ETHICS AND DISSEMINATION Formal ethical approval is not required as no primary data are collected. Findings will be used to develop a solid knowledge corpus to address the challenges of SIL in LTCHs. Our findings will help to identify cutting edge practices, including technological interventions that could support health services in addressing SIL in the context of LTCHs and our ageing society.
Collapse
Affiliation(s)
- Idrissa Beogo
- École des sciences infirmières / School of Nursing, Pavillon Roger-Guindon / Roger-Guindon Hall, Faculté des sciences de la santé / Faculty of Health Sciences, Université d'Ottawa / University of Ottawa, Ottawa, 451, chemin Smyth Road, Pièce 3236A / Room 3236A, Office: 613-562-5800 ext. 8148, Ontario, Canada
| | - Eric Nguemeleu Tchouaket
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Drissa Sia
- Département Sciences Infirmières, Université du Québec en Outaouais, Saint-Jerôme, Québec, Canada
| | | | - Stephanie Collin
- Faculté des sciences de l'éducation, Université Laval, Québec, Québec, Canada
| | - Diane Tapp
- École des hautes études publiques, Faculté des arts et des sciences sociales, Université de Moncton, Nouveau Brunswick, Moncton, Canada
| | - Said Abasse Kassim
- Faculté des sciences infirmières, Université Laval, Québec, Québec, Canada
| | - Jean Ramdé
- Centre de recherche en gestion des services de santé, Département de management, Faculté des sciences de l'administration, Université Laval, Québec, Québec, Canada
| | | |
Collapse
|
11
|
Mealtime nonverbal behaviors in nursing home staff and residents with dementia: Behavioral analyses of videotaped observations. Geriatr Nurs 2022; 44:112-124. [PMID: 35131660 PMCID: PMC8995379 DOI: 10.1016/j.gerinurse.2022.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 02/01/2023]
Abstract
This study characterized mealtime nonverbal behaviors of nursing home staff and residents with dementia and examined the relationships between individual characteristics and nonverbal behaviors. Videotaped observations (N=110) involving 25 residents and 29 staff (42 unique staff-resident dyads) in 9 nursing homes were coded using the refined Cue Utilization and Engagement in Dementia Mealtime Video-Coding Scheme. Wilcoxon rank-sum test or Kruskal-Wallis test were used for continuous characteristics, and Fisher's exact test for categorical characteristics. Residents primarily exhibited challenging behaviors including resistive behaviors (35.7%), chewing/swallowing difficulties (33.5%), and functional impairments (9.9%), followed by positive/neutral behaviors (20.9%). Staff primarily used person-centered behavioral strategies, including modifications of: 1) resident abilities (41.9%), 2) care approaches (35.1%), and 3) dining environment (13.6%), followed by task-centered behaviors (9.3%). Residents challenging behaviors were correlated with staff person-centered behavioral strategies. Dyadic nonverbal behaviors were correlated with multiple individual characteristics. Understanding dyadic nonverbal interactions facilitates use of person-centered, multilevel, behavioral strategies to optimize mealtime outcomes.
Collapse
|
12
|
Liu W, Williams K, Batchelor M, Perkhounkova Y, Hein M. Mealtime verbal interactions among nursing home staff and residents with dementia: A secondary behavioural analysis of videotaped observations. J Adv Nurs 2021; 77:1244-1257. [PMID: 33222218 PMCID: PMC7902310 DOI: 10.1111/jan.14647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/25/2020] [Accepted: 10/27/2020] [Indexed: 12/01/2022]
Abstract
AIMS To characterize dyadic mealtime verbal interactions and examine the associations with staff and resident characteristics. DESIGN A secondary analysis of 110 videotaped mealtime observations collected from a dementia communication trial during 2011-2014. METHODS Videos involved 25 residents with dementia and 29 staff in nine nursing homes. Verbal behaviours (utterances) were coded during 2018-2019 using the Cue Utilization and Engagement in Dementia mealtime video-coding scheme, addressing eight positive behaviours and four negative behaviours. Bivariate analyses and multivariate regression models were used. RESULTS Staff spoke three times more frequently (76.5%) than residents (23.5%). Nearly all staff utterances were positive (99.2%); 85.1% of residents' utterances were positive and 14.9% negative. Staff positive utterances were correlated with their negative utterances and resident positive and negative utterances. Staff negative utterances were correlated with resident negative utterances. Resident positive and negative utterances were correlated. Resident positive utterances were significantly associated with staff care-giving length in the current nursing home (OR = 1.430, 95% CI = 1.008, 2.027). Resident negative utterances were significantly associated with resident gender (female versus male, OR = 11.892, 95% CI = 1.237, 114.289) and staff years worked as a caregiver (OR = 0.838, 95% CI = 0.710, 0.989). Staff positive and negative utterances were not associated significantly with any participant characteristics. CONCLUSIONS Staff engage residents using primarily positive verbal strategies. Staff-resident mealtime verbal interactions were dynamic, interactive, and complex and related to multiple individual characteristics. IMPACT Positive dyadic mealtime interactions are critical to engage residents in eating. Little work has characterized dyadic mealtime interactions, limiting the development of effective interventions. Findings showed staff-resident mealtime verbal interactions were primarily positive, inter-related, and associated with multiple individual characteristics. Findings inform directions to improve mealtime care practice and develop person-centred mealtime interventions targeting modifiable factors, including staff care-giving experiences.
Collapse
Affiliation(s)
- Wen Liu
- College of Nursing, The University of Iowa, Iowa City, IA, USA
| | | | - Melissa Batchelor
- School of Nursing, George Washington University, Washington, DC, USA
| | | | - Maria Hein
- College of Nursing, The University of Iowa, Iowa City, IA, USA
| |
Collapse
|
13
|
Resnick B, Boltz M, Galik E, Fix S, Holmes S, Zhu S, Barr E. Testing the Impact of FFC-AL-EIT on Psychosocial and Behavioral Outcomes in Assisted Living. J Am Geriatr Soc 2021; 69:459-466. [PMID: 33095469 PMCID: PMC8116977 DOI: 10.1111/jgs.16886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study tested the impact of Function Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT) on: (1) care interactions between residents and direct care staff; and (2) behavior and psychological symptoms associated with dementia among residents. DESIGN This was a randomized controlled trial. SETTING A total of 59 assisted living facilities in Maryland, Pennsylvania, and Massachusetts participated. PARTICIPANTS The sample included 550 mostly White (98%), female (69%) residents with a mean age of 89.30 (standard deviation = 7.63) years. INTERVENTION The four-step FFC-AL-EIT intervention was implemented by a function focused care nurse facilitator working with a facility champion over 12 months. The steps included: (1) environment and policy assessments; (2) education; (3) establishing resident function focused care service plans; and (4) mentoring and motivating. MEASURES Resident descriptive data (e.g., age, sex, education, and comorbidities), depression, agitation, resistiveness to care, and the quality of care interactions were obtained at baseline and 4 and 12 months. Treatment fidelity data included environment and policy assessments, performance of function focused care by staff, and service plan assessments. RESULTS There was a significant positive treatment effect related to depression, agitation, resistiveness to care, and quality of care interactions with either less decline or some improvement in these behaviors and symptoms in the treatment versus control group. CONCLUSION The study provides some statistical support, which may not necessarily be clinically significant evidence, for psychosocial outcomes of residents and care interactions between staff and residents in assisted living settings.
Collapse
Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, 655 West Lombard St, Baltimore MD 21218
| | - Marie Boltz
- Pennsylvania State University College of Nursing, 306 Nursing Sciences Building, University Park, PA 16802
| | - Elizabeth Galik
- University of Maryland School of Nursing, 655 West Lombard St, Baltimore MD 21218
| | - Steven Fix
- University of Maryland School of Nursing, 655 West Lombard St, Baltimore MD 21218
| | - Sarah Holmes
- University of Maryland School of Nursing, 655 West Lombard St, Baltimore MD 21218
| | - Shijun Zhu
- University of Maryland School of Nursing, 655 West Lombard St, Baltimore MD 21218
| | - Erik Barr
- University of Maryland School of Nursing, 655 West Lombard St, Baltimore MD 21218
| |
Collapse
|
14
|
A communication model for nursing staff working in dementia care: Results of a scoping review. Int J Nurs Stud 2020; 113:103776. [PMID: 33120133 DOI: 10.1016/j.ijnurstu.2020.103776] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/04/2020] [Accepted: 09/13/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Communication between nursing staff and people with dementia can be challenging. According to the literature, communication is seen as a process of social- and/or informational exchange between a sender and a receiver in a context. Factors related to these elements determine the quality of communication. Insight into the factors involved in the communication process between nursing staff and people with dementia is limited and a comprehensive model of communication in dementia care is lacking. OBJECTIVES To identify and visualize factors associated with communication between nursing staff and people with dementia. DESIGN A scoping review of scientific literature. DATA SOURCES Scientific articles were retrieved from the bibliographic databases of PubMed, CINAHL and PsycINFO. REVIEW METHODS The reviewing process was directed by the Joanna Briggs guidelines for scoping reviews. Full-text articles describing the communication process between nursing staff and people with dementia were eligible for inclusion. A data extraction form was used to identify factors associated with communication. Following a directed content analysis approach, factors were categorized in one of three categories: nursing staff; people with dementia; or context. Each category was thematically analysed to identify themes and subthemes. Results were visualized into a communication model. RESULTS The review included 31 articles; in total, 115 factors were extracted. Thematic analysis of nursing staff factors (n = 78) showed that communication is associated with professional characteristics, individual experiences, verbal- and non-verbal communication skills, communication approach and values. Factors attributed to people with dementia (n = 22) concerned client characteristics, functional status, behaviour, verbal communication skills and values. Contextual factors (n = 15) related to organization of care, time and situation. Based on these results, the Contac-d model was constructed. CONCLUSIONS The Contac-d model gives a comprehensive overview of factors involved in the communication process between nursing staff and people with dementia, providing insight in potential starting points for communication improvement, e.g. respect for needs, identity and privacy of people with dementia, a flexible and adapted communication approach and matching language. Additionally, results suggest that an appealing location, longer duration of the interaction, and music in the surrounding may improve communication in certain situations. However, it was not feasible based on current literature to recommend what works to improve communication in which situations. Future studies should study factors and their interrelatedness in specific care situations. Authors further believe that more attention should be paid to strengths and capabilities of people with dementia and to non-modifiable factors that influence communication.
Collapse
|
15
|
Backhouse T, Dudzinski E, Killett A, Mioshi E. Strategies and interventions to reduce or manage refusals in personal care in dementia: A systematic review. Int J Nurs Stud 2020; 109:103640. [DOI: 10.1016/j.ijnurstu.2020.103640] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 11/25/2022]
|
16
|
Zhang M, Zhao H, Meng FP. Elderspeak to Resident Dementia Patients Increases Resistiveness to Care in Health Care Profession. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2020; 57:46958020948668. [PMID: 32783479 PMCID: PMC7425308 DOI: 10.1177/0046958020948668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Resistiveness to care is very common among patients of dementia as these patients do not take medicines, meals or bath very easily. Indeed, it is a very challenging task for health caregivers and there is a significant rise in time and cost involved in managing dementia patients. Amongst different factors, the type of communication between resident dementia patients and health caregivers is an important contributing factor in the development of resistiveness to care. Elderspeak (baby talk) is a type of communication in which health caregivers adjust their language and style while interacting with elderly and dependent patients. It involves the use of short sentences, simple grammar, slow and high pitch voice, repeating phrases to provide a comfortable and friendly environment to patients. Most of the time, caregivers tend to adapt elderspeak as they handle weak and fragile older patients for routine activities. Although elderspeak is meant to provide support, warmth and care to patients, yet patients perceive elderspeak as patronizing and it induces negative feelings about self-esteem. Scientists have found a correlation between the development of resistiveness to care and the extent of elderspeak in communication. Therefore, there have been strategies to develop alternative communication strategies by avoiding the use of elderspeak. Moreover, the beneficial effects of such communications have been documented as it improves the quality of life, reduces aggression, agitation and psychosocial symptoms. The present review discusses the scientific studies discussing the use of elderspeak in communication and development of resistiveness to care in resident patients of dementia.
Collapse
Affiliation(s)
- Min Zhang
- China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hui Zhao
- The Second Hospital of Jilin University, Changchun, China
| | - Fan-Ping Meng
- China-Japan Union Hospital of Jilin University, Changchun, China
| |
Collapse
|
17
|
Paudel A, Resnick B, Galik E. The Quality of Interactions Between Staff and Residents With Cognitive Impairment in Nursing Homes. Am J Alzheimers Dis Other Demen 2020; 35:1533317519863259. [PMID: 31327235 PMCID: PMC6980162 DOI: 10.1177/1533317519863259] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Positive and effective staff-resident interactions are imperative to adequately assess and meet the needs of cognitively impaired residents in nursing homes and optimize their quality of life. AIM The purpose of this study was to quantify, describe, and analyze the interaction between staff and cognitively impaired residents in nursing homes, using the Quality of Interaction Schedule (QuIS). METHOD This descriptive analysis utilized baseline data from the first 2 cohorts in a randomized clinical trial including 341 residents from 35 nursing homes. RESULTS Five hundred fifty-six staff-resident interactions were evaluated; majority were positive (n = 466, 83.8%) and the remaining were either neutral (n = 60, 10.8%) or negative (n = 30, 5.4%). The quality of interactions varied by interaction location, interpersonal distance, and resident participation. CONCLUSION Future research should focus on decreasing the negative/neutral interactions and explore staff characteristics (eg, gender, level of experience) and facility factors (eg, size, ownership) that might influence the quality of interactions.
Collapse
Affiliation(s)
- Anju Paudel
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, MD, USA
| |
Collapse
|
18
|
Kim DE, Sagong H, Kim E, Jang AR, Yoon JY. A Systematic Review of Studies Using Video-recording to Capture Interactions between Staff and Persons with Dementia in Long-term Care Facilities. ACTA ACUST UNITED AC 2019. [DOI: 10.12799/jkachn.2019.30.4.400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Da Eun Kim
- Visiting Scholar, School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Hae Sagong
- Doctoral Student, College of Nursing, Seoul National University, Seoul, Korea
| | - Eunjoo Kim
- Doctoral Student, College of Nursing, Seoul National University, Seoul, Korea
| | - Ah Ram Jang
- Doctoral Student, College of Nursing, Seoul National University, Seoul, Korea
| | - Ju Young Yoon
- Associate Professor, College of Nursing · Research Institute of Nursing Science, Seoul National University, Seoul, Korea
| |
Collapse
|
19
|
Teipel S, König A, Hoey J, Kaye J, Krüger F, Robillard JM, Kirste T, Babiloni C. Use of nonintrusive sensor-based information and communication technology for real-world evidence for clinical trials in dementia. Alzheimers Dement 2018; 14:1216-1231. [PMID: 29936147 PMCID: PMC6179371 DOI: 10.1016/j.jalz.2018.05.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/20/2018] [Accepted: 05/03/2018] [Indexed: 12/11/2022]
Abstract
Cognitive function is an important end point of treatments in dementia clinical trials. Measuring cognitive function by standardized tests, however, is biased toward highly constrained environments (such as hospitals) in selected samples. Patient-powered real-world evidence using information and communication technology devices, including environmental and wearable sensors, may help to overcome these limitations. This position paper describes current and novel information and communication technology devices and algorithms to monitor behavior and function in people with prodromal and manifest stages of dementia continuously, and discusses clinical, technological, ethical, regulatory, and user-centered requirements for collecting real-world evidence in future randomized controlled trials. Challenges of data safety, quality, and privacy and regulatory requirements need to be addressed by future smart sensor technologies. When these requirements are satisfied, these technologies will provide access to truly user relevant outcomes and broader cohorts of participants than currently sampled in clinical trials.
Collapse
Affiliation(s)
- Stefan Teipel
- Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany; DZNE, German Center for Neurodegenerative Diseases, Rostock, Germany.
| | - Alexandra König
- Centre Mémoire de Ressources et de Recherche (CMRR), Centre Hospitalier Universitaire Nice, Cobtek (Cognition-Behaviour-Technology) Research Lab, Université de Nice Sophia Antipolis, Nice, France
| | - Jesse Hoey
- David R. Cheriton School of Computer Science, University of Waterloo, Waterloo, Canada
| | - Jeff Kaye
- NIA - Layton Aging & Alzheimer's Disease Center and ORCATECH, Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA
| | - Frank Krüger
- Institute of Communications Engineering, University of Rostock, Rostock, Germany
| | - Julie M Robillard
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Thomas Kirste
- Institute of Computer Science, University of Rostock, Rostock, Germany
| | - Claudio Babiloni
- Department of Physiology and Pharmacology "Vittorio Erspamer", University of Rome "La Sapienza", Rome, Italy; Institute for Research and Medical Care, IRCCS San Raffaele IRCCS San Raffaele and Cassino, Rome and Cassino, Italy
| |
Collapse
|
20
|
Teipel S, Heine C, Hein A, Krüger F, Kutschke A, Kernebeck S, Halek M, Bader S, Kirste T. Multidimensional assessment of challenging behaviors in advanced stages of dementia in nursing homes-The insideDEM framework. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2017; 8:36-44. [PMID: 28462388 PMCID: PMC5403785 DOI: 10.1016/j.dadm.2017.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Assessment of challenging behaviors in dementia is important for intervention selection. Here, we describe the technical and experimental setup and the feasibility of long-term multidimensional behavior assessment of people with dementia living in nursing homes. METHODS We conducted 4 weeks of multimodal sensor assessment together with real-time observation of 17 residents with moderate to very severe dementia in two nursing care units. Nursing staff received extensive training on device handling and measurement procedures. Behavior of a subsample of eight participants was further recorded by videotaping during 4 weeks during day hours. Sensors were mounted on the participants' wrist and ankle and measured motion, rotation, as well as surrounding loudness level, light level, and air pressure. RESULTS Participants were in moderate to severe stages of dementia. Almost 100% of participants exhibited relevant levels of challenging behaviors. Automated quality control detected 155 potential issues. But only 11% of the recordings have been influenced by noncompliance of the participants. Qualitative debriefing of staff members suggested that implementation of the technology and observation platform in the routine procedures of the nursing home units was feasible and identified a range of user- and hardware-related implementation and handling challenges. DISCUSSION Our results indicate that high-quality behavior data from real-world environments can be made available for the development of intelligent assistive systems and that the problem of noncompliance seems to be manageable. Currently, we train machine-learning algorithms to detect episodes of challenging behaviors in the recorded sensor data.
Collapse
Affiliation(s)
- Stefan Teipel
- Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany.,DZNE, German Center for Neurodegenerative Diseases, Rostock, Germany
| | - Christina Heine
- Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany
| | - Albert Hein
- Department of Computer Science, University of Rostock, Rostock, Germany
| | - Frank Krüger
- Department of Computer Science, University of Rostock, Rostock, Germany
| | | | - Sven Kernebeck
- DZNE, German Center for Neurodegenerative Diseases, Witten, Germany
| | - Margareta Halek
- DZNE, German Center for Neurodegenerative Diseases, Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Sebastian Bader
- Department of Computer Science, University of Rostock, Rostock, Germany
| | - Thomas Kirste
- Department of Computer Science, University of Rostock, Rostock, Germany
| |
Collapse
|
21
|
Galik E, Resnick B, Vigne E, Holmes SD, Nalls V. Reliability and Validity of the Resistiveness to Care Scale Among Cognitively Impaired Older Adults. J Am Med Dir Assoc 2017; 18:59-64. [PMID: 27776986 PMCID: PMC5183554 DOI: 10.1016/j.jamda.2016.08.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 08/19/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Resistiveness to care is behavior that prevents or interferes with caregivers' performing or assisting with activities of daily living and puts residents at risk for inappropriate use of antipsychotic drugs, other restraining interventions, social isolation, and physical abuse. The purpose of this study was to establish the psychometric properties of a previously developed Resistiveness to Care measure. PROCEDURES This was a descriptive study using baseline data from an ongoing randomized controlled trial testing a Function and Behavior Focused Care (FBFC) intervention. Residents were eligible to participate if they were 55 years of age or older, had a Mini-Mental State Exam (MMSE) score of 15 or less, and were not enrolled in hospice or admitted for subacute care. Descriptive information included age, race, gender, cognitive status, and marital status. In addition to the Resistance to Care Scale, the Barthel Index, the Physical Activity Survey in Long Term Care (PAS-LTC), and the Cohen-Mansfield Agitation Inventory (CMAI) were completed. Psychometric testing was done using Rasch analysis and the Winsteps statistical program. MAIN FINDINGS The participants were moderate to severely cognitively impaired (MMSE of 7.23), functionally dependent (Barthel Index 47.31, SD 27.59), and engaged in only 134.17 (SD = 207.32) minutes of physical activity daily. Reliability was supported based on a Cronbach alpha of 0.84 and the DIF analysis, as there was no difference in function of the items between male and female participants. Validity was supported as all items fit the measurement model based on INFIT and OUTFIT statistics. CONCLUSIONS The findings support the reliability and validity of the Resistiveness to Care Scale for use with older adults with dementia in nursing home settings. Future work with the measure may benefit from the addition of items that are easier to endorse with regard to resistiveness to care (shutting eyes or spitting out food may be useful additions).
Collapse
Affiliation(s)
| | | | - Erin Vigne
- University of Maryland School of Nursing, Baltimore, MD
| | | | | |
Collapse
|