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Kang B, Karel MJ, Corazzini KN, McConnell ES. A mixed methods study on the manifestations of behavioural symptoms of dementia among veterans with and without posttraumatic stress disorder. J Adv Nurs 2021; 77:3176-3188. [PMID: 33969916 DOI: 10.1111/jan.14864] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/11/2021] [Accepted: 03/30/2021] [Indexed: 12/20/2022]
Abstract
AIMS To explore how behavioural symptoms of dementia are manifested among veterans in residential long-term care settings, in the context of personal, interpersonal/social and environmental triggers and how the manifestations differ between veterans with and without posttraumatic stress disorder. DESIGN Secondary analysis using a mixed methods approach. METHODS We analysed text data from a stratified random sample of 66 cases derived from the programme evaluation dataset of the Staff Training in Assisted Living Residences-Veterans Health Administration (STAR-VA) intervention from 2013 to 2016, using framework analysis. The detailed behavioural assessment descriptions in this dataset are consistent with contemporary non-pharmacologic symptom management. Qualitative categories were converted to quantitative variables for two group comparisons. RESULTS Four patterns emerged linking specific types of triggers and behavioural symptoms: (1) unmet physical needs or emotional distress triggers non-aggressive behaviours; (2) unsolicited direct care approach triggers care refusal, resistance or combativeness; (3) interpersonal interactions interfering with self-direction trigger aggressive behaviours; and (4) uncontrolled stimulation from environments trigger non-aggressive behaviours. The organisational culture of care influenced how staff conceptualised behavioural symptoms. Veterans with co-existing posttraumatic stress disorder and dementia tended to exhibit rejection of care with aggression compared to those with dementia alone. CONCLUSION Contextualised accounts of behavioural symptoms of dementia revealed symptom heterogeneity, with different clusters of multi-level triggers arising from specific personal, interpersonal and environmental circumstances. Distinct patterns of symptom manifestations between veterans with and without posttraumatic stress disorder suggest a tailored approach is required to meet each veteran's unique biopsychosocial needs. IMPACT Classifying behavioural symptoms with their triggers rather than solely by behaviours provides important new information for developing person-centred, non-pharmacological interventions to improve outcomes for veterans with dementia. Multi-level interventions should be considered to meet veteran's needs that account for their earlier life history and current life circumstances.
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Affiliation(s)
- Bada Kang
- School of Nursing, Duke University, Durham, NC, USA.,Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea
| | - Michele J Karel
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, DC, USA
| | - Kirsten N Corazzini
- School of Nursing, Duke University, Durham, NC, USA.,School of Nursing, University of Maryland, College Park, MD, USA
| | - Eleanor S McConnell
- School of Nursing, Duke University, Durham, NC, USA.,Geriatric Research, Education and Clinical Center, Durham Department of Veterans Affairs Medical Center, Durham, NC, USA
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Nori VS, Hane CA, Martin DC, Kravetz AD, Sanghavi DM. Identifying incident dementia by applying machine learning to a very large administrative claims dataset. PLoS One 2019; 14:e0203246. [PMID: 31276468 PMCID: PMC6611655 DOI: 10.1371/journal.pone.0203246] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 06/20/2019] [Indexed: 01/31/2023] Open
Abstract
Alzheimer's disease and related dementias (ADRD) are highly prevalent conditions, and prior efforts to develop predictive models have relied on demographic and clinical risk factors using traditional logistical regression methods. We hypothesized that machine-learning algorithms using administrative claims data may represent a novel approach to predicting ADRD. Using a national de-identified dataset of more than 125 million patients including over 10,000 clinical, pharmaceutical, and demographic variables, we developed a cohort to train a machine learning model to predict ADRD 4-5 years in advance. The Lasso algorithm selected a 50-variable model with an area under the curve (AUC) of 0.693. Top diagnosis codes in the model were memory loss (780.93), Parkinson's disease (332.0), mild cognitive impairment (331.83) and bipolar disorder (296.80), and top pharmacy codes were psychoactive drugs. Machine learning algorithms can rapidly develop predictive models for ADRD with massive datasets, without requiring hypothesis-driven feature engineering.
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Woods DL, Buckwalter K. Taking Another Look: Thoughts on Behavioral Symptoms in Dementia and Their Measurement. Healthcare (Basel) 2018; 6:healthcare6040126. [PMID: 30360369 PMCID: PMC6316419 DOI: 10.3390/healthcare6040126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/12/2018] [Accepted: 10/16/2018] [Indexed: 11/16/2022] Open
Abstract
This article proposes taking another look at behavioral symptoms of dementia (BSDs) both from a theoretical perspective that informs research and practice and from a measurement perspective. We discuss why this rethinking of behaviors impacts current models of care and our ability to better detect outcomes from interventions. We propose that BSDs be viewed from a pattern perspective and provide some suggestions for how to identify and measure these patterns that can influence the timing and type of intervention. Evidence suggests that BSDs are complex, sequential, patterned clusters of behavior recurring repeatedly in the same individual and escalate significantly without timely intervention. However, BSDs are frequently viewed as separate behaviors rather than patterns or clusters of behaviors, a view that affects current research questions as well as the choice, timing, and outcomes of interventions. These symptoms cause immense distress to persons with the disease and their caregivers, trigger hospitalizations and nursing home placement, and are associated with increased care costs. Despite their universality and that symptoms manifest across disease etiologies and stages, behaviors tend to be underrecognized, undertreated, and overmanaged by pharmacological treatments that may pose more harm than benefit.
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Affiliation(s)
- Diana Lynn Woods
- School of Nursing, Azusa Pacific University, Azusa, CA 91702, USA.
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4
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The Role of Physicians Practicing in Assisted Living: What Changes Do We Really Need? J Am Med Dir Assoc 2018; 19:104-105. [DOI: 10.1016/j.jamda.2017.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 12/04/2017] [Indexed: 11/21/2022]
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O'Connell B, Guse L, Greenslade L, Osterreicher A, Jensen F. Undergraduate Placements in Geriatric Care Facilities: Students Gaining Experience With Challenging/Responsive Behaviors. J Nurs Educ 2017; 56:623-627. [DOI: 10.3928/01484834-20170918-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/30/2017] [Indexed: 11/20/2022]
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Williams KN, Perkhounkova Y, Herman R, Bossen A. A Communication Intervention to Reduce Resistiveness in Dementia Care: A Cluster Randomized Controlled Trial. THE GERONTOLOGIST 2017; 57:707-718. [PMID: 27048705 PMCID: PMC5881770 DOI: 10.1093/geront/gnw047] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/03/2015] [Indexed: 11/14/2022] Open
Abstract
Purpose of the Study Nursing home (NH) residents with dementia exhibit challenging behaviors or resistiveness to care (RTC) that increase staff time, stress, and NH costs. RTC is linked to elderspeak communication. Communication training (Changing Talk [CHAT]) was provided to staff to reduce their use of elderspeak. We hypothesized that CHAT would improve staff communication and subsequently reduce RTC. Methods Thirteen NHs were randomized to intervention and control groups. Dyads (n = 42) including 29 staff and 27 persons with dementia were videorecorded during care before and/or after the intervention and at a 3-month follow-up. Videos were behaviorally coded for (a) staff communication (normal, elderspeak, or silence) and (b) resident behaviors (cooperative or RTC). Linear mixed modeling was used to evaluate training effects. Results On average, elderspeak declined from 34.6% (SD = 18.7) at baseline by 13.6% points (SD = 20.00) post intervention and 12.2% points (SD = 22.0) at 3-month follow-up. RTC declined from 35.7% (SD = 23.2) by 15.3% points (SD = 32.4) post intervention and 13.4% points (SD = 33.7) at 3 months. Linear mixed modeling determined that change in elderspeak was predicted by the intervention (b = -12.20, p = .028) and baseline elderspeak (b = -0.65, p < .001), whereas RTC change was predicted by elderspeak change (b = 0.43, p < .001); baseline RTC (b = -0.58, p < .001); and covariates. Implications A brief intervention can improve communication and reduce RTC, providing an effective nonpharmacological intervention to manage behavior and improve the quality of dementia care. No adverse events occurred.
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Affiliation(s)
| | | | - Ruth Herman
- Center for Public Partnerships and Research, University of Kansas, Lawrence
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7
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Huang TY, Wei YJ, Moyo P, Harris I, Lucas JA, Simoni-Wastila L. Treated Behavioral Symptoms and Mortality in Medicare Beneficiaries in Nursing Homes with Alzheimer's Disease and Related Dementias. J Am Geriatr Soc 2015; 63:1757-65. [DOI: 10.1111/jgs.13606] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ting-Ying Huang
- Department of Pharmaceutical Health Services Research; School of Pharmacy; University of Maryland; Baltimore Maryland
| | - Yu-Jung Wei
- Department of Pharmaceutical Health Services Research; School of Pharmacy; University of Maryland; Baltimore Maryland
| | - Patience Moyo
- Department of Pharmaceutical Health Services Research; School of Pharmacy; University of Maryland; Baltimore Maryland
| | | | - Judith A. Lucas
- Department of Behavioral and Community Health; College of Nursing; Seton Hall University; South Orange New Jersey
| | - Linda Simoni-Wastila
- Department of Pharmaceutical Health Services Research; School of Pharmacy; University of Maryland; Baltimore Maryland
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8
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Caspi E. Does self-neglect occur among older adults with dementia when unsupervised in assisted living? An exploratory, observational study. J Elder Abuse Negl 2014; 26:123-49. [PMID: 24499280 DOI: 10.1080/08946566.2013.830532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The phenomenon of older adults with dementia who develop behavioral expressions when they are unsupervised in assisted living residences is understudied. This qualitative study aimed to bridge this gap in the literature by focusing on 12 residents in various stages of dementia. Grounded Theory was followed to guide data collection and analysis. Data were collected in two special care units of an assisted living residence for 10 months. Participant observation was the primary data collection strategy. Semistructured interviews with staff and managers and review of clinical records augmented the observation data. While unsupervised, residents exhibited a wide spectrum of negative emotional states, behavioral expressions, functional difficulties, wayfinding difficulties, serious hygiene problems, and safety risks. More than half of the identified incidents represented self-neglectful behaviors. The study highlights the need for enhanced supervision and targeted interventions for residents with dementia who are susceptible to self-neglect.
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Affiliation(s)
- Eilon Caspi
- a Geriatrics & Extended Care Data & Analyses Center, Providence VA Medical Center , Providence , Rhode Island , USA
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Mitzner TL, Chen TL, Kemp CC, Rogers WA. Identifying the Potential for Robotics to Assist Older Adults in Different Living Environments. Int J Soc Robot 2014; 6:213-227. [PMID: 24729800 PMCID: PMC3979567 DOI: 10.1007/s12369-013-0218-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
As the older adult population grows and becomes more diverse, so will their needs and preferences for living environments. Many adults over 65 years of age require some assistance [1, 2]; yet it is important for their feelings of well-being that the assistance not restrict their autonomy [3]. Not only is autonomy correlated with quality of life [4], autonomy enhancement may improve functionality [2, 5]. The goal of this paper is to provide guidance for the development of technology to enhance autonomy and quality of life for older adults. We explore the potential for robotics to meet these needs. We evaluated older adults' diverse living situations and the predictors of residential moves to higher levels of care in the United States. We also examined older adults' needs for assistance with activities of daily living (ADLs), instrumental activities of daily living (IADLs), and medical conditions when living independently or in a long-term care residence. By providing support for older adults, mobile manipulator robots may reduce need-driven, undesired moves from residences with lower levels of care (i.e., private homes, assisted living) to those with higher levels of care (i.e., skilled nursing).
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Phillips LR, Guo G, Kim H. Elder mistreatment in U.S. residential care facilities: the scope of the problem. J Elder Abuse Negl 2013; 25:19-39. [PMID: 23289415 DOI: 10.1080/08946566.2012.712851] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Many in the United States believe elder mistreatment in long-term care is serious and widespread, but until recently few studies focused on the problem. This study was designed to describe the scope of mistreatment in assisted living facilities (ALFs) in Arizona during a 3-year period. Findings showed that receiving citations for elder mistreatment was relatively rare. However, analysis of narrative reports from only 7% of facilities showed 598 allegations of mistreatment in complaint investigations, of which 372 (62.2%) were substantiated and given citations for something other than mistreatment. Results show that elder mistreatment in ALFs is seriously underidentified, even by state inspectors.
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Affiliation(s)
- Linda R Phillips
- School of Nursing, University of California-Los Angeles, Los Angeles, California 90095-1702, USA.
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Selbæk G, Engedal K, Bergh S. The Prevalence and Course of Neuropsychiatric Symptoms in Nursing Home Patients With Dementia: A Systematic Review. J Am Med Dir Assoc 2013; 14:161-9. [DOI: 10.1016/j.jamda.2012.09.027] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022]
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Moore RL, Faller DV. SIRT1 represses estrogen-signaling, ligand-independent ERα-mediated transcription, and cell proliferation in estrogen-responsive breast cells. J Endocrinol 2013; 216:273-85. [PMID: 23169992 PMCID: PMC3852670 DOI: 10.1530/joe-12-0102] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In prostate and breast cancer, the androgen receptor and estrogen receptor (ER) mediate induction of androgen- and estrogen-responsive genes respectively and stimulate cell proliferation in response to the binding of their cognate steroid hormones. Sirtuin 1 (SIRT1) is a NAD+-dependent class III histone deacetylase that has been linked to gene silencing, control of the cell cycle, apoptosis, and energy homeostasis. In prostate cancer, SIRT1 is required for androgen antagonist-mediated transcriptional repression and growth suppression of prostate cancer cells. Whether SIRT1 plays a similar role in the actions of estrogen or antagonists had not been determined. We report here that SIRT1 represses the transcriptional and proliferative response of breast cancer cells to estrogens, and this repression is ERα dependent. Inhibition of SIRT1 activity results in the phosphorylation of ERα in an AKT-dependent manner, and this activation requires phosphoinositide 3-kinase activity. Phosphorylated ERα subsequently accumulates in the nucleus, where ERα binds DNA ER-responsive elements and activates transcription of estrogen-responsive genes. This ER-dependent transcriptional activation augments estrogen-induced signaling, but also activates ER signaling in the absence of estrogen, thus defining a novel and unexpected mechanism of ligand-independent ERα-mediated activation and target gene transcription. Like ligand-dependent activation of ERα, SIRT1 inhibition-mediated ERα activation in the absence of estrogen also results in breast cancer cell proliferation. Together, these data demonstrate that SIRT1 regulates the most important cell signaling pathway for the growth of breast cancer cells, both in the presence and the absence of estrogen.
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Affiliation(s)
- Robert L Moore
- Cancer Center, Boston University School of Medicine, 72 East Concord Street, Room K-701, Boston, Massachusetts 02118-2307, USA
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Zimmerman S, Cohen LW, Reed D, Gwyther LP, Washington T, Cagle JG, Beeber AS, Sloane PD. Comparing families and staff in nursing homes and assisted living: implications for social work practice. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2013; 56:535-53. [PMID: 23869592 PMCID: PMC3772131 DOI: 10.1080/01634372.2013.811145] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Nursing homes and residential care/assisted living settings provide care to 2.4 million individuals. Few studies compare the experience of, and relationships between, family and staff in these settings, despite ongoing family involvement and evidence that relationships are problematic. Data from 488 families and 397 staff members in 24 settings examined family involvement and family and staff burden, depressive symptoms, and perceptions; and staff absenteeism and turnover. There were few differences across setting types. Although conflict rarely occurred, there was room for improvement in family-staff relations; this area, and preparing family for their caregiving roles, are appropriate targets for social work intervention.
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Affiliation(s)
- Sheryl Zimmerman
- School of Social Work and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Abstract
BACKGROUND The purpose of this study was to investigate the relationship between dementia severity, age, gender, and prescription of psychotropics, and syndromes of agitation and depression in a sample of nursing home residents with dementia. METHODS The Cohen-Mansfield Agitation Inventory (CMAI) was administered to residents with dementia (N = 304) of 18 nursing homes. Agitation symptoms were clustered using factorial analysis. Depression was estimated using the Dementia Mood Assessment Scale (DMAS). Dementia severity was assessed categorically using predefined cut-off scores derived from the Mini-Mental State Examination (MMSE). The relationship between agitation and its sub-syndromes, depression, and dementia severity was calculated using χ 2-statistics. Linear regression analyses were used to calculate the effect of dementia severity and psychotropic prescriptions on agitation and depression, controlling for age and gender. RESULTS Increasing stages of dementia severity were associated with higher risk for physically aggressive (p < 0.001) and non-aggressive (p < 0.01) behaviors, verbally agitated behavior (p < 0.05), and depression (p < 0.001). Depressive symptoms were associated with physically aggressive (p < 0.001) and verbally agitated (p < 0.05) behaviors, beyond the effects of dementia severity. Prescription of antipsychotics was correlated with depression and all agitation sub-syndromes except hiding and hoarding. CONCLUSIONS Dementia severity is a predictor for agitation and depression. Beyond that, depression increased with dementia severity, and the severity of depression was associated with both physically and verbally aggressive behaviors, indicating that, in advanced stages of dementia, depression in some patients might underlie aggressive behavior.
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Phillips LR, Ziminski C. The Public Health Nursing Role in Elder Neglect in Assisted Living Facilities. Public Health Nurs 2012; 29:499-509. [DOI: 10.1111/j.1525-1446.2012.01029.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Linda R. Phillips
- Center for the Advancement of Gerontological Nursing Science; UCLA School of Nursing; Los Angeles; California
| | - Carolyn Ziminski
- Center for the Advancement of Gerontological Nursing Science; UCLA School of Nursing; Los Angeles; California
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Burack OR, Weiner AS, Reinhardt JP. The Impact of Culture Change on Elders’ Behavioral Symptoms: A Longitudinal Study. J Am Med Dir Assoc 2012; 13:522-8. [DOI: 10.1016/j.jamda.2012.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 12/30/2011] [Accepted: 02/17/2012] [Indexed: 10/28/2022]
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Sharpp TJ, Kayser-Jones JS, Young HM. Care for Residents with Dementia in an Assisted Living Facility. Res Gerontol Nurs 2012; 5:152-62. [DOI: 10.3928/19404921-20120410-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 07/18/2011] [Indexed: 11/20/2022]
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McKenzie G, Teri L, Pike K, LaFazia D, van Leynseele J. Reactions of Assisted Living Staff to Behavioral and Psychological Symptoms of Dementia. Geriatr Nurs 2012; 33:96-104. [DOI: 10.1016/j.gerinurse.2011.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 12/15/2011] [Accepted: 12/30/2011] [Indexed: 10/14/2022]
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Sloane PD, Zimmerman S, Perez R, Reed D, Harris-Wallace B, Khandelwal C, Beeber AS, Mitchell CM, Schumacher J. Physician perspectives on medical care delivery in assisted living. J Am Geriatr Soc 2011; 59:2326-31. [PMID: 22091932 DOI: 10.1111/j.1532-5415.2011.03714.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe the provision of medical care in assisted living (AL) as provided by physicians who are especially active in providing care to older adults and AL residents; to identify characteristics associated with physician confidence in AL staff; and to ask physicians a variety of questions about their experience providing care to AL residents and how it compares with providing care in the nursing home and home care settings. DESIGN Cross-sectional descriptive study. SETTING AL communities in 27 states. PARTICIPANTS One hundred sixty-five physicians and administrators of 125 AL settings in which they had patients. MEASUREMENTS Interviews and questionnaires containing open- and close-ended questions regarding demographics, care arrangements, attitudes, and behaviors in managing medical problems. RESULTS Most respondents were certified in internal medicine (46%) or family medicine (47%); 32% were certified in geriatrics and 30% in medical directorship. In this select sample, 48% visited the AL setting once a year or less, and 19% visited once a week or more. Mean physician confidence in AL staff was 3.3 (somewhat confident), with greater confidence associated with smaller AL community size, nursing presence, and the physician being the medical director. Qualitative analyses identified differences between settings including lack of vital sign assessment in the home setting, concern about the ability of AL staff to assess and monitor problems, and greater administrative and regulatory requirements in AL than in the other settings. CONCLUSION Providing medical care for AL residents presents unique challenges and opportunities for physicians. Nursing presence and physician oversight and familiarity and communicating with AL staff who are highly familiar with a given resident and can monitor care may facilitate care.
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Affiliation(s)
- Philip D Sloane
- Department of Family Medicine; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
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Woods DL, Phillips LR, Martin JL. Biological Basis for Sleep Disturbance and Behavioral Symptoms in Dementia: A Biobehavioral Model. Res Gerontol Nurs 2011; 4:281-93. [DOI: 10.3928/19404921-20110302-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 10/26/2010] [Indexed: 11/20/2022]
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McKenzie GL, Teri L, Salazar MK, Farran CJ, Beck C, Paun O. Relationship between System-Level Characteristics of Assisted Living Facilities and the Health and Safety of Unlicensed Staff. ACTA ACUST UNITED AC 2011. [DOI: 10.1177/216507991105900403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined system-level characteristics of assisted living facilities and the association between these characteristics and the health and safety outcomes of unlicensed staff. Forty-two unlicensed direct care workers completed a survey related to system-level stressors and the individual stress responses of staff. Measurement tools included the Work Stressor Inventory (WSI), General Health Questionnaire (GHQ-12), and Maslach Burnout Inventory (MBI). High levels of emotional exhaustion, psychiatric distress, and work-related injuries were reported by unlicensed staff. Providing care to residents with dementia-related behaviors and supporting families were the most frequently reported work stressors. System-level factors were significantly associated with staff role competence, job commitment, and emotional exhaustion. These results support the need for continued exploration, development, and evaluation of strategies to reduce occupational stressors at multiple levels in assisted living facilities.
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Phillips LR, Guo G. Mistreatment in assisted living facilities: complaints, substantiations, and risk factors. THE GERONTOLOGIST 2011; 51:343-53. [PMID: 21278080 DOI: 10.1093/geront/gnq122] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY Use archived public data from Arizona to explore relationships among selected institutional and resident risk and situation-specific factors and complaints and substantiated allegations of various types of mistreatment in assisted living facilities (ALFs). DESIGN AND METHODS An exploratory/descriptive 2-group design was used. Facilities in the complaint group were identified from narrative data that appeared suspicious for mistreatment based on definitions for physical, verbal, psychological, medication, sexual abuse, neglect, financial exploitation, and physical restraint. Facilities in the comparison group were those that had no citations or complaints in 2007-2008. Narrative data were content analyzed, and chi-square analysis was used to answer 3 research questions. RESULTS The complaint group was comprised of significantly more assisted living centers, large facilities (51-101+), facilities licensed to provide personal care services, and facilities owned by national corporations. Substantiated allegations were significantly more frequent in assisted living centers, facilities with more than 51 beds, and those owned by national corporations. Facility risk factors were related to some types of substantiated mistreatment and not others. IMPLICATIONS Findings suggest the need to evaluate use of only unlicensed assistive personnel in facilities, increase oversight of care by professional nurses, rethink the practice of not licensing small facilities, and monitor more closely practices and procedures in facilities operated by national corporations.
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Affiliation(s)
- Linda R Phillips
- School of Nursing, University of California-Los Angeles, Los Angeles, CA 90095, USA.
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Monitoring quality of care for nursing home residents with behavioral and psychological symptoms related to dementia. J Am Med Dir Assoc 2010; 12:660-7. [PMID: 21450223 DOI: 10.1016/j.jamda.2010.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 11/05/2010] [Accepted: 11/08/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Behavioral and psychological symptoms associated with dementia are common in nursing home residents. Quality indicators (QI) assessing quality of care for these residents are minimally risk adjusted and can provide inaccurate information regarding the quality of care provided by the facility. OBJECTIVE Evaluate the performance of a new QI for the incidence of worsening behaviors in nursing home residents with behavioral and psychological symptoms association with dementia. DESIGN Retrospective cohort study. SETTING A total of 381 Minnesota nursing homes with 26,165 residents. DATA SOURCES Minimum Data Set records for the first 2 calendar quarters of 2008. MEASUREMENTS We calculated incidence of worsening behaviors QI by comparing items from the "behavior" section of the Minimum Data Set records from 2 consecutive quarters and reported the incidence rates by both the residents' level of cognitive impairment and the presence or absence of special care unit for dementia (SCU). RESULTS The incidence rates of the worsening behavior QI in SCU ranged from 14% in residents with very severe cognitive impairment (a cognitive performance score = 6) to 30% in those with moderate cognitive impairment (a cognitive performance score = 3). The incidence QI rates among residents residing in conventional unit ranged from 15% among those with very severe cognitive impairment to 20% among those with moderate cognitive impairment. These differences in QI rates between the 2 units were statistically significant with a P value = .001. After risk adjustment for level of cognitive impairment, number of facilities with SCUs that flagged for problem behaviors dropped from 18.4% to 12.4% and the number of conventional units in the low-risk category from 16.8% to 4.7%. CONCLUSION Resident cognitive function and the facility utility of SCU are associated with worsening behavior QI and should be adjusted for in any nursing home quality reporting measure.
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Abstract
OBJECTIVES To investigate a protocol for identifying and evaluating treatment fidelity in Staff Training in Assisted-living Residences (STAR), a structured but flexible program to train direct care staff to improve care of residents with dementia. DESIGN Multisite feasibility trial. SETTING Assisted living facilities (ALFs). PARTICIPANTS Forty-four direct care staff and 36 leadership staff. INTERVENTION STAR is a comprehensive, dementia-specific training program to teach direct care staff in ALFs to improve care and reduce affective and behavioral problems in residents with dementia. It is conducted on-site over 2 months through 2 half-day group workshops and four individualized sessions. MEASURES Treatment fidelity was assessed following the National Institute of Health Behavior Change Consortium model utilizing observations and self-report of trainers, direct care staff, and leadership. RESULTS Each key area of treatment fidelity was identified, measured, and yielded significant outcomes. For example, significant increases included direct care staff identifying activators, behaviors, and consequences (an essential component of training); understanding basics of dementia care; and applying STAR techniques. CONCLUSIONS Results support that STAR is ready to be translated and disseminated into practice. Because ALFs will continue to provide care for individuals with dementia, the need for effective, practical, and sustainable staff training programs is clear. STAR offers one such option. It is hoped that this report will encourage others to conduct comprehensive evaluations of the treatment fidelity of their programs and thereby increase the availability of such programs to enhance care.
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Woods DL, Guo G, Kim H, Phillips LR. We’ve Got Trouble: Medications in Assisted Living. J Gerontol Nurs 2010; 36:30-9. [DOI: 10.3928/00989134-20100302-02] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Accepted: 12/09/2009] [Indexed: 11/20/2022]
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Smith M, Samus QM, Steele C, Baker A, Brandt J, Rabins PV, Lyketsos C, Rosenblatt A. Anxiety symptoms among assisted living residents: implications of the "no difference" finding for participants with and without dementia. Res Gerontol Nurs 2010; 1:97-104. [PMID: 20078022 DOI: 10.3928/19404921-20080401-06] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Anxiety is a distressing experience at any age but may be particularly disabling when coupled with dementia. Dementia-related anxiety is associated with a range of additional problems among community-dwelling older adults, but little is known about its occurrence in assisted living environments. The purpose of this article is to describe the prevalence of anxiety symptoms among older adults who participated in Phase I of the Maryland Assisted Living Study, a cross-sectional study of 198 participants who underwent comprehensive dementia evaluations. Participants with dementia diagnoses (n=134) were compared with those without dementia (n=64) using two measures of anxiety. Anxiety was common in both groups: 22% of each group were assessed to have one or more anxiety symptoms using proxyrated methods, and 45% had at least mild anxiety using direct observation and interview. Factors that contribute to variability in reports of dementia-related anxiety are reviewed.
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Affiliation(s)
- Marianne Smith
- The University of Iowa College of Nursing, Iowa City, IA 52242, USA.
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Davis BH, Pope C. Institutionalized ghosting: policy contexts and language use in erasing the person with Alzheimer's. LANGUAGE POLICY 2010; 9:29-44. [PMID: 20585465 PMCID: PMC2888108 DOI: 10.1007/s10993-009-9153-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The ordinary social engagement of human life would not usually be considered an arena for language policy. Yet clinical evidence mounts that social interaction improves our lives as we age. Since social engagement decreases cardiovascular risks (Ramsay et al. in Ann Epidemiol 18:476-483, 2008) and delays memory loss among those living in communities (Ertel et al. in Am J Public Health 98:1215-1220, 2008), practices that prohibit social interaction threaten human well-being. For persons who have Alzheimer's disease (AD), social interaction continues to play an integral part in cognitive function and delays in memory loss, according to a longitudinal study of social networks (Bennett et al. in Lancet Neurol 5:406-412, 2007). Increasingly, person-centered care that promotes social engagement for those with AD is promoted as an institutional policy to improve outcomes of dementia care (Edvardsson et al. in Int Psychogeriatr 20:764-776, 2008). Yet the training of caregivers may neither reflect person-centered care nor include attention to communication, suggesting covert policies in practice.
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Affiliation(s)
- Boyd H. Davis
- 255A Fretwell, University of North Carolina-Charlotte, 9201 University City Drive, Charlotte, NC 28212, USA,
| | - Charlene Pope
- Medical University of South Carolina, 99 Jonathan Lucas Street, MSC 160, Charleston, SC 29425, USA,
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Kang H, Smith M, Buckwalter KC, Ellingrod V, Schultz SK. Anxiety, depression, and cognitive impairment in dementia-specific and traditional assisted living. J Gerontol Nurs 2010; 36:18-30; quiz 32-3. [PMID: 20047249 DOI: 10.3928/00989134-20091204-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Accepted: 09/16/2009] [Indexed: 11/20/2022]
Abstract
With the rapid growth of the assisted living (AL) industry, the number of AL residences providing dementia care continues to increase. The purpose of this article is to describe and compare demographic characteristics; frequency and type of psychiatric diagnoses; level of cognition, depression, and anxiety symptoms; and use of psychotropic medication among older adults in dementia-specific assisted living (DSAL) and traditional assisted living (TAL) residences. Secondary analysis of screening data collected during a cross-sectional, descriptive pilot project compared 18 participants from two DSAL facilities and 28 participants from three TAL facilities. DSAL participants with dementia were more cognitively impaired than TAL participants with dementia (p < 0.001) and used more antipsychotic (67%), anxiolytic (60%), antidepressant (53%), and cognitive-enhancing (87%) medications. No statistically significant differences in demographic factors or levels of anxiety or depression were observed among residents in either setting.
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Affiliation(s)
- Hyunwook Kang
- The University of Iowa College of Nursing, Iowa City, Iowa 52242, USA.
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Whall AL, Colling KB, Kolanowski A, Kim H, Son Hong GR, DeCicco B, Ronis DL, Richards KC, Algase D, Beck C. Factors associated with aggressive behavior among nursing home residents with dementia. THE GERONTOLOGIST 2009; 48:721-31. [PMID: 19139246 DOI: 10.1093/geront/48.6.721] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE In an attempt to more thoroughly describe aggressive behavior in nursing home residents with dementia, we examined background and proximal factors as guided by the Need-Driven Dementia-Compromised Behavior model. DESIGN AND METHODS We used a multivariate cross-sectional survey with repeated measures; participants resided in nine randomly selected nursing homes within four midwestern counties. The Minimum Data Set (with verification by caregivers) identified participants. We used a disproportionate probability sample of 107 participants (51% with a history of aggressive behavior) to ensure variability. Videotaped care events included four of direct care (shower baths, meals, dressing, and undressing) and two of nondirect care (two randomly selected 20-minute time periods in the afternoon and evening). The majority of participants (75%) received three shower baths, for a total of 282 videotaped baths. RESULTS Because the shower bath was the only care event significantly related to aggressive behavior (F = 6.9, p < .001), only those data are presented. Multilevel statistical modeling identified background factors (gender, mental status score, and lifelong history of less agreeableness) and a proximal factor (amount of nighttime sleep) as significant predictors (p < .05) of aggressive behavior during the shower bath. We found significant correlations between aggressive behavior and negative subject affect (r = .27) during the bath, and aggressive behavior and lifetime agreeableness level (r = -.192). We also found significant correlations between mental status and the amount of education (r = .212), and between negative caregiver affect and negative participant affect (r = .321). IMPLICATIONS We identified three background and one proximal factor as significant risk factors for aggressive behavior in dementia. Data identify not only those persons most at risk for aggressive behavior during care, but also the care event most associated with aggressive behavior. Together these data inform both caregiving for persons with dementia as well as the design of intervention studies for aggressive behavior in dementia.
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Affiliation(s)
- Ann L Whall
- University of Michigan School of Nursing, Ann Arbor, MI 48109-0482, USA.
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Dettmore D, Kolanowski A, Boustani M. Aggression in persons with dementia: use of nursing theory to guide clinical practice. Geriatr Nurs 2009; 30:8-17. [PMID: 19215808 DOI: 10.1016/j.gerinurse.2008.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 02/29/2008] [Accepted: 03/01/2008] [Indexed: 12/21/2022]
Abstract
With approximately four million people in the United States today diagnosed with dementia, one of the most devastating problems faced by caregivers and patients is dealing with aggressive behavior. Aggression occurs in half of persons diagnosed with dementia and is associated with more rapid cognitive decline, increased risk of abuse, and caregiver burden. This paper uses the Need-driven Dementia-compromised Behavior (NDB) model to explain aggression and discusses therapeutic approaches to care that combines non-pharmacological and pharmacological interventions targeting both the management of aggression crisis and preventing its future recurrence. A clinical algorithm guided by the NBD model is provided for practitioners.
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Affiliation(s)
- Diane Dettmore
- Henry P. Becton School of Nursing and Allied Health, Farleigh Dickinson University, Teaneck, NJ, USA
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Smith M, Buckwalter KC, Kang H, Ellingrod V, Schultz SK. Dementia care in assisted living: needs and challenges. Issues Ment Health Nurs 2008; 29:817-38. [PMID: 18649209 PMCID: PMC3093103 DOI: 10.1080/01612840802182839] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Assisted living (AL) is an increasingly popular long-term care option for older adults with dementia. Recent reports suggest that as many as 68% of AL residents have dementia, and that frequency of both behavioral symptoms and psychotropic medications are high. This pilot project explored the feasibility of research methods for use in AL facilities. Findings suggest that most AL residents with dementia have moderate to severe dementia, and the majority are taking one or more psychotropic medication. Descriptive and qualitative findings related to health records, caregiver perceptions of behavioral symptoms, and practicality of assessment methods undertaken are described and implications for psychiatric nursing practice and research are reviewed.
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Affiliation(s)
- Marianne Smith
- University of Iowa, College of Nursing, Iowa City, Iowa 52242, USA.
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Smith M, Buckwalter KC, Kang H, Ellingrod V, Schultz SK. Dementia-specific assisted living: clinical factors and psychotropic medication use. J Am Psychiatr Nurses Assoc 2008; 14:39-49. [PMID: 21672880 PMCID: PMC3122161 DOI: 10.1177/1078390307310692] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Assisted living (AL) is an increasingly popular long-term care alternative for older adults with dementia, making this setting an important focus for both clinical practice and research among psychiatric nurses. OBJECTIVES This article describes results from a pilot study focusing on residents' cognitive and emotional status as well as psychotropic drug use. Findings are compared to reports from larger studies in the literature. STUDY DESIGN A descriptive, correlational design was used to collect data from 17 residents in two dementia-specific AL facilities. RESULTS Thirty-one psychiatric diagnoses were identified for 17 participants. Anxiety and depression symptoms were endorsed by more than 50% of participants, and 88% were prescribed psychotropic medications. CONCLUSIONS AL residents may experience problems with cognition and emotional symptoms such as anxiety and depression, creating important roles for psychiatric nurses in staff education, promotion of nonpharmacologic interventions, and monitoring of psychotropic medication use in this growing population. J Am Psychiatr Nurses Assoc, 2008; 14(1), 39-49. DOI: 10.1177/1078390307310692.
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Cummings JL, Mackell J, Kaufer D. Behavioral effects of current Alzheimer's disease treatments: a descriptive review. Alzheimers Dement 2008; 4:49-60. [PMID: 18631950 DOI: 10.1016/j.jalz.2007.10.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Accepted: 10/03/2007] [Indexed: 12/14/2022]
Abstract
BACKGROUND Behavioral abnormalities and neuropsychiatric symptoms are common manifestations of Alzheimer's disease (AD). Many clinical trials of cholinesterase inhibitors (ChE-Is) and memantine have included behavioral measures as primary or secondary outcomes, and most have observed behavioral benefits in conjunction with treatment. The purpose of this review was to determine the frequency of positive behavioral outcomes in AD clinical trials and clinical reports, to determine the symptoms most responsive to antidementia agents, and to explore factors that correlate with negative outcomes in clinical trials of antidementia agents with regard to behavioral measures. METHODS We performed a computerized search of randomized clinical trials and open-label studies of ChE-Is and memantine for AD including a behavioral outcome measure. Studies involving 10 or more patients using therapeutic doses of the target agents and including a behavioral measure as a primary or secondary outcome were included in this review. RESULTS One hundred fifty-seven peer-reviewed articles and 68 publicly presented abstracts were identified in the literature search. Subsequent review established that 15 publications arising from 13 randomized, double-blind, placebo-controlled AD trials met the review inclusion criteria. Positive outcomes on behavioral measures were reported in 8 of 15 publications as a primary or secondary outcome. In most blinded AD clinical trials, behavioral measures were secondary outcomes. Mood symptoms and apathy have most commonly responded to ChE-Is, whereas memantine has been associated with a reduction in irritability and agitation. However, there is substantial variability among trials in terms of behavioral outcomes. Studies that assessed patients with more severe dementia, included patients with less severe behavioral disturbances at baseline, involved institutionalized patients, or were international in scope tended to have negative outcomes. In institutionalized patients there is commonly an improvement in the placebo group that confounds the observation of any drug-placebo difference. CONCLUSIONS Antidementia agents have been associated with beneficial behavioral outcomes in many randomized clinical trials and open-label studies. Most studies are not designed to test the psychotropic properties of antidementia drugs. Trials with negative behavioral outcomes are most likely to involve patients who are institutionalized and have few behavioral disturbances at baseline. Clinical trials designed to assess behavioral effects of antidementia agents should anticipate these factors.
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Maidment ID, Fox CG, Boustani M, Rodriguez J, Brown RC, Katona CL. Efficacy of memantine on behavioral and psychological symptoms related to dementia: a systematic meta-analysis. Ann Pharmacother 2007; 42:32-8. [PMID: 18056833 DOI: 10.1345/aph.1k372] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The behavioral and psychological symptoms related to dementia (BPSD) are difficult to manage and are associated with adverse patient outcomes. OBJECTIVE To systematically analyze the data on memantine in the treatment of BPSD. METHODS We searched MEDLINE, EMBASE, Pharm-line, the Cochrane Centre Collaboration, www.clinicaltrials.gov, www.controlled-trials.com, and PsycINFO (1966-July 2007). We contacted manufacturers and scrutinized the reference sections of articles identified in our search for further references, including conference proceedings. Two researchers (IM and CF) independently reviewed all studies identified by the search strategy. We included 6 randomized, parallel-group, double-blind studies that rated BPSD with the Neuropsychiatric Inventory (NPI) in our meta-analysis. Patients had probable Alzheimer's disease and received treatment with memantine for at least one month. Overall efficacy of memantine on the NPI was established with a t-test for the average difference between means across studies, using a random effects model. RESULTS Five of the 6 studies identified had NPI outcome data. In these 5 studies, 868 patients were treated with memantine and 882 patients were treated with placebo. Patients on memantine improved by 1.99 on the NPI scale (95% Cl -0.08 to -3.91; p = 0.041) compared with the placebo group. CONCLUSIONS Initial data appear to indicate that memantine decreases NPI scores and may have a role in managing BPSD. However, there are a number of limitations with the current data; the effect size was relatively small, and whether memantine produces significant clinical benefit is not clear.
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Affiliation(s)
- Ian D Maidment
- Kent & Medway NHS and Social Care Partnership Trust, Kent Institute of Medicine and Health Studies, University of Kent, Kent, England.
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Testad I, Aasland AM, Aarsland D. Prevalence and correlates of disruptive behavior in patients in Norwegian nursing homes. Int J Geriatr Psychiatry 2007; 22:916-21. [PMID: 17323402 DOI: 10.1002/gps.1766] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although Behavioral and Psychological Symptoms of Dementia (BPSD) increase with increasing dementia severity, and institutionalization of an individual with dementia is often caused by behavioral symptoms, relatively few studies have explored the prevalence of BPSD in nursing homes. OBJECTIVE To study the prevalence and correlates of agitation in residents with dementia, in Norwegian nursing homes. METHODS This study has taken place in dementia wards in four Norwegian nursing homes. To measure agitation in residents with dementia we used the Cohen-Mansfield Agitation Inventory (CMAI), consisting of 29 agitation items. Dementia stage was measured by Functional Assessment Staging (FAST). RESULTS Two hundred and eleven patients (71% female) were included in the study: mean (SD) age 85.5 (8.4), FAST 4.7 (2.1), CMAI total sumscore 39.5 (12.6). Dementia was present in 167 (79%) subjects. Among those with dementia, weekly occurrence of at least one CMAI item (i.e. a score of 3 or higher) occurred in 75.4% (95% CI 68.4-81.4). Six of the items occurred at least weekly in 20% of the residents with dementia, and 11 of the items, including physical aggression, occurred in less than 5% of the residents. Agitation was associated with more severe dementia (p = 0.001), but not with age and gender. CONCLUSION Symptoms of agitation were common, but may nevertheless be lower compared to findings in other geographical areas. Further studies are warranted to test this hypothesis, and if confirmed, to explore possible causes for such differences.
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Affiliation(s)
- I Testad
- Stavanger University Hospital, Psychiatric Clinic, Stavanger, Norway.
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Shega J, Emanuel L, Vargish L, Levine SK, Bursch H, Herr K, Karp JF, Weiner DK. Pain in persons with dementia: complex, common, and challenging. THE JOURNAL OF PAIN 2007; 8:373-8. [PMID: 17485039 DOI: 10.1016/j.jpain.2007.03.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Joseph Shega
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Zuidema SU, de Jonghe JFM, Verhey FRJ, Koopmans RTCM. Agitation in Dutch institutionalized patients with dementia: factor analysis of the Dutch version of the Cohen-Mansfield Agitation Inventory. Dement Geriatr Cogn Disord 2007; 23:35-41. [PMID: 17077631 DOI: 10.1159/000096681] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND/AIMS To establish the construct validity of the Dutch version of the Cohen-Mansfield Agitation Inventory (CMAI-D) in institutionalized patients with dementia. METHODS The CMAI-D was administered to a large sample of 1,437 patients with moderate to severe dementia, receiving nursing home or outreaching nursing home care. Exploratory factor analysis was used to examine the behavioral dimensions underlying CMAI-D observations. RESULTS A restricted 3-factor solution showed 3 factors, i.e. physical aggression, physically nonaggressive behavior and verbally agitated behavior, with prevalences of 62, 67 and 62%, respectively. An unrestricted factor solution revealed 3 additional behavioral dimensions: hiding/hoarding, vocal agitation and a factor of miscellaneous items (i.e. repetitious mannerisms, spitting), which occurred in 30, 28 and 35% of the patients, respectively. CONCLUSION The 3-factor solution of physical aggression, physically nonaggressive behavior and verbally agitated behavior corroborates earlier findings in other patient samples and therefore establishes the construct validity in institutionalized patients with severe dementia. The robustness of these findings across different care settings suggests that agitated behaviors have a common basis. In addition, unrestricted factor analysis showed 3 other important independent behavioral symptoms in dementia, but they are in fact too small to be used as a subscale. These findings might add to the taxonomy of agitation and aggression in dementia.
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Affiliation(s)
- Sytse U Zuidema
- Department of Nursing Home Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Maas ML, Buckwalter KC. Providing Quality Care in Assisted Living Facilities: Recommendations for Enhanced Staffing and Staff Training. J Gerontol Nurs 2006; 32:14-22. [PMID: 17112134 DOI: 10.3928/00989134-20061101-04] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Meridean L Maas
- John A. Hartford Center of Geriatric Nursing Excellence, University of Iowa College of Nursing, Iowa City, Iowa 52246, USA
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Current awareness in geriatric psychiatry. Int J Geriatr Psychiatry 2006; 21:500-7. [PMID: 16739260 DOI: 10.1002/gps.1490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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