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Biomedical subjects

C R Kovach

Publications and source records attributed to C R Kovach.

At least 19 recordsLinked to original sources
PubMed2001

Use of the assessment of discomfort in dementia protocol.

The Assessment of Discomfort in Dementia (ADD) Protocol was developed to improve recognition and treatment of physical pain and affective discomfort in people with dementia who are no longer able to clearly or consistently report on their internal states. The purpose of this study was to describe use of each step of the ADD protocol with 143 residents of long-term care facilities. Of the subjects who received nonpharmacological comfort interventions, 37% showed improved symptoms. Of the 91 protocols in which an analgesic was administered, 83.5% showed improved symptoms. People who complained verbally received considerably more analgesics and other comfort interventions. Limitations inherent in this descriptive exploratory study do not permit conclusions regarding the effectiveness of the ADD protocol. Research with a control group, random assignment, and objective measures of discomfort level is planned.

Aged↗
PubMed2000

Nurses' perceptions of pain assessment and treatment in the cognitively impaired elderly. It's not a guessing game.

The purpose of the study was to describe nurses' perceptions regarding the assessment and treatment of pain in patients with late-stage dementia. Thirty nurses from six long-term care facilities were interviewed using a semistructured format for this qualitative study. Initial results were presented to a second group for validation and refinement of findings. The most commonly cited behaviors used to indicate discomfort were facial grimacing, restless body movement, change in behavior, moaning, and tense muscles. Psychotropic drugs were perceived to be commonly misused because behavior changes were seen as a psychiatric problem rather than a representation of the patient's unmet need. Nurses had positive feelings about using both narcotics and nonnarcotic analgesics with this population but believed both types of analgesics were underused. The most common concerns regarding the administration of narcotic analgesics to this population were falls, sedation, and constipation.

Aged↗
PubMed2000

Sensoristasis and imbalance in persons with dementia.

PURPOSE: To present a model of sensoristasis and imbalance for use by health care professionals to deliver care to older adults with irreversible dementing illness. ORGANIZING CONSTRUCTS: The Sensoristasis Model shows the need of people with dementia to experience a balance between sensory-stimulating and sensory-calming activity. This model builds on Lawton's environmental docility hypothesis and on Hall and Buckwalter's Progressively Lowered Stress Threshold Model. METHODS: The model was derived from empirical evidence, theory, and clinical experience. Levels of agitation of three acute care patients experiencing sensoristasis and imbalances in sensoristasis indicate tenets of the model. FINDINGS: Older adults with dementia experience intrapsychic discomfort because of imbalances in the pacing of sensory-stimulating or sensory-calming activity. Consequences of intrapsychic discomfort include agitated behaviors and episodic or premature decline in instrumental and social function. CONCLUSIONS: Pacing of activity must be guided by interventions that facilitate optimum sensoristasis and often need to be adjusted during stress, environmental change, and progression of the illness. Interventions can ameliorate some of the negative consequences of imbalances in sensoristasis when optimal pacing is not attained.

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PubMed1999

Assessment and treatment of discomfort for people with late-stage dementia.

People with dementia have often been excluded from pain studies. However, there is evidence supporting that people with dementia experience frequent pain, often poorly assessed and undertreated, and that the etiology for pain descriptions is poorly documented. The Assessment of Discomfort in Dementia (ADD) Protocol is designed to: a) more accurately assess discomfort in people with dementia who can no longer verbally describe physical pain or affective discomfort; b) more accurately and thoroughly treat physical pain and affective discomfort; and c) decrease inappropriate use of psychotropic medication. The use of the ADD Protocol was studies with a convenience sample of 104 residents of long-term care with end-stage dementia. Use of the ADD Protocol was associated with a significant decrease in discomfort (t = 6.56, p = 0.000). The most frequently seen behavioral symptoms associated with discomfort were tense body language, sad facial expression, fidgeting, perseverant verbalizations, and verbal outburts. The ADD Protocol was also associated with a significant increase in the use of scheduled analgesics and non-pharmacological comfort interventions. The protocol was not associated with an increase in the use of prn analgesics or with prn or scheduled psychotropics. This study has provided some support for the notion that the needs of people with significant dementia can be discerned and treated.

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PubMed1998

Late-stage dementia and participation in therapeutic activities.

This study examined the participation and behavior of people with late-stage dementia during various therapeutic activities. Subjects were able to actively participate for 10 minutes or less 54% of the time. Caregivers were not responding to meet apparent resident needs 37.5% of the time. Active participation was significantly correlated with having more senses stimulated. In addition, as the length of resting time increased before a scheduled therapy, active participation significantly decreased. Subjects exhibited various behaviors during therapeutic activities. Behaviors were categorized as approaching and withdrawing, relaxing and tensing, mimicking, nonverbal connecting, and verbal connecting.

Aged↗
PubMed1998

Facilitating change in dementia care. Staff perceptions.

OBJECTIVES: The authors describe factors that facilitate positive changes in dementia care as perceived by long-term care employees. BACKGROUND: Creating positive changes in dementia care is a complex undertaking involving multiple variables. The perspectives of long-term care employees may provide important insight and direction for a successful change process. METHODS: A convenience sample of 181 long-term care employees utilized a q-sort methodology to provide data for this descriptive study. Results were analyzed using rankings and Spearman's rho correlation coefficient. RESULTS: The facility factors most often cited as important for making positive changes in dementia care involved teamwork, administrative support, staff attitude, and knowledge. There was little congruence between facility factors identified as ideal for providing dementia care and those identified as actually evident at the subjects place of employment. Personal characteristics that were identified as most important for facilitating positive changes in dementia care include genuinely liking people with dementia, being flexible, kindness, calmness, and having a positive attitude. The correlations between ideal and real personal factors were higher than for the facility factors. CONCLUSIONS: This study supports the idea that the fundamental tenets of good leadership--communication, involvement, and empowerment--are foundational for real change in dementia care to be attained and sustained.

Adult↗
PubMed1998

Nursing home dementia care units. Providing a continuum of care rather than aging in place.

Experience from the first 24 months of a new Dementia Special Care Unit is presented with an emphasis on admission and discharge criteria, length of stay, and reasons for discharge. Maintaining residents with moderate functional abilities on a Special Care Unit is examined relative to relocation stress, aging in place, and staff needs. The benefits of providing a continuum of dementia care and the risk of potential harm of frequent intra-institutional moves are discussed.

Activities of Daily Living↗
PubMed1996

Planning activities for patients with dementia: a descriptive study of therapeutic activities on special care units.

1. Therapeutic activities for people with dementia have been used to prevent behavior problems, relieve boredom, and to maintain or restore holistic health and function. 2. This study found that subjects spent more time actively participating in an activity when they were able to make a cognitive tie between the current activity and an event from their past through reminiscing. 3. Active participation in therapeutic activities was associated with increased daytime napping but was not related to continuous sleep at night.

Activities of Daily Living↗
PubMed1996

Coping with conflicting agendas: the bathing experience of cognitively impaired older adults.

The behaviors of 33 clients with cognitive impairment were examined during bath time using grounded theory methods. Analysis revealed that 73% of the adults displayed agitated behaviors during personal hygiene care. Subjects and caregivers were faced with conflicting agendas and attempted to cope by using a variety of verbal and nonverbal strategies. The strategies used by cognitively impaired older adults included: attaining control, sharing control, resigning control, and regaining inner control. Results of this study suggest that older adults with cognitive impairment have a repertoire of coping mechanisms that are used when environmental demands challenge the person's deteriorating cortical abilities.

Adaptation, Psychological↗
PubMed1994

DSCUs: a study of behavior before and after residence.

1. Environmental design, family involvement, consistent routines and activity programs designed to meet the special needs of persons with dementia are hallmarks of most dementia programs. There is a lack of research to support the usefulness of Dementia Specific Care Units (DSCUs) for residents of long-term care facilities that have irreversible dementia. 2. A specialized 24-bed DSCU was designed for those residents with cognitive impairment who would benefit from enhanced programming, and controlled and balanced environmental stimulation. 3. Assessments of residents' behavior and need for physical and chemical restraints were done one month prior to and two months after the opening of a DSCU. Of the 8 behaviors measured, 7 showed improvement and paired t-tests revealed this to be a statistically significant difference. 4. Even though causal claims cannot be made, the results strongly demonstrate an improvement in behaviors associated with dementia from pre- to post-measurement. There is a need for units to become increasingly able to meet the specialized needs of clients.

Aged↗
PubMed1993

Development and testing of the autobiographical memory coding tool.

Development and testing of the autobiographical memory coding tool (AMCT) is detailed. The tool uses quantitative content analysis procedures to code interpretations of autobiographical memories as validating or lamenting. Development of a system of measuring autobiographical memories from transcribed reminiscence interviews involved defining the units of analysis, defining the categories and themes, constructing a codebook, assessing content validity, assessing reliability and making revisions. Thirty-nine transcripts of reminiscence interviews were used for tool development and testing. The AMCT contains a series of step-by-step guidelines for conducting the analysis and includes an autobiographical memory thematic dictionary and descriptions of range and variations in each theme to assist with coding data. Intercoder reliability estimates were 0.93, 0.93 and 0.95. Test-retest reliability was 1.00.

Abstracting and Indexing↗
PubMed1993

Understanding autobiographical memories: a study of the reminiscences of elderly men.

This study examined the stability of autobiographical memory constructs and provided data about male styles of reminiscing that are useful for expanding the generalizability of the Autobiographical Memory Coding Tool. Six males ranging in age from 76 to 84 who lived in the community served as subjects. Subjects participated in two one-to-one reminiscence interviews that were conducted 8 weeks apart. Interpretations formulated by this sample of elderly men were both validating and lamenting. Dominant themes in the transcripts were joys, social connections, difficulties, and choices. The frequency with which memories involving choice and lack of choice were verbalized suggest that control may be an important issue for this sample. The interpretations were quite stable with 91% agreement between Time 1 and Time 2 transcripts.

Abstracting and Indexing↗
PubMed1991

Content analysis of reminiscences of elderly women.

The content of reminiscences of 21 cognitively intact elderly women registered in an adult daycare program was examined. Content analysis of transcripts from a semistructured interview was used to discover categories of reminiscence meaning. The interpretations made about past experiences were grouped under two categories: (a) validating reminiscences that involved confirming or verifying that one had lived a fruitful life; and (b) lamenting reminiscences that involved negative interpretations of past events. Validating themes were: positive self-appraisals, choices, social connections, joys, and past to present comparisons. Lamenting themes were: regrets, difficulties, and lacking choice.

Aged↗
PubMed1991

Reminiscence behavior: an empirical exploration.

Engagement in the process of reminiscing involves the use of detail and depth, easy access to memories, and requests for feedback from the listener. Engagement in reminiscing may be stable during old age or may follow a developmental course. Avoidance behaviors, defined as switching to non-reminiscing topics or giving neutral/informative responses, were prevalent among non-engaged reminiscers. Understanding what a person chooses to avoid reminiscing about is as important as what a person chooses to reminisce about. Diversity refers to the degree to which engaged reminiscers varied the events they reminisced about. Diversity of verbalizing both validating and lamenting reminiscences may related to the specific usefulness of reminiscence as an intervention. Two distinct reminiscence interventions are currently being used: life review and psychosocial reminiscing. Findings regarding engagement and diversity of reminiscing suggest more effort is needed in prescribing the appropriate reminiscing intervention.

Aged↗