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Biomedical subjects

J Cohen-Mansfield

Publications and source records attributed to J Cohen-Mansfield.

At least 37 records · Page 2Linked to original sources
PubMed1998

Delusions and hallucinations in an adult day care population. A longitudinal study.

The frequency of the manifestation of delusions and hallucinations (d/h) among participants of adult day care centers was examined, as was the relationship of d/h to demographic and medical variables, agitation, depressed affect, and dementia. Changes in d/h were also assessed over a 1-year period, and those changes were compared with changes in agitation, depressed affect, and dementia. Depressed affect and agitation were related both to delusions and to hallucinations. Dementia was also related to d/h, although a substantial percentage of individuals who were not diagnosed with dementia also experienced some type of d/h. Finally, delusions were more prevalent and generally tended to relate more strongly to agitation, depressed affect, and dementia than did hallucinations.

Aged↗
PubMed1997

Typology of disruptive vocalizations in older persons suffering from dementia.

Verbal and vocal disruptive behaviors (VDB) are important clinical features in dementia because they frequently signal discomfort experienced by an elderly person and because they are disturbing to caregivers, thereby affecting the care of elderly persons manifesting them. This article describes a typology of VDB, the Typology of Vocalizations-TOV. The conceptual framework underlying the development of this typology includes the assumptions that VDB consist of more than one type of behavior and that interventions should be matched to the etiology of the specific type of VDB. The article reports interrater reliability of the typology and validates it against Ryan's classification of verbal and vocal disruptive behaviors. Critical dimensions of the typology are examined and used for its refinement. Finally, use of the TOV for matching individuals to the most effective intervention is demonstrated.

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PubMed1997

Management of verbally disruptive behaviors in nursing home residents.

BACKGROUND: Verbally disruptive behaviors (VDB) are verbal or vocal behaviors that are inappropriate to the circumstances in which they are manifested. These behaviors are a source of concern because they disturb persons around the older person and may be an indicator of distress. METHODS: Three interventions were tried and compared to a control no-intervention phase. The interventions were: (1) Presentation of a videotape of a family member talking to the older person, (2) in vivo social interaction, and (3) use of music. RESULTS: Thirty-two nursing home residents suffering from dementia and manifesting VDB were observed before, during, and after the interventions, and the duration of VDB was recorded. The behaviors decreased by 56% during the social interaction, 46% during the videotape, 31% during the music, and 16% during the no-intervention. CONCLUSIONS: The effects of the interventions were clinically and statistically significant, indicating the importance of providing stimulating activities and a richer environment to cognitively impaired nursing home residents.

Aged↗
PubMed1997

Assessing patterns of agitation in Alzheimer's disease patients with the Cohen-Mansfield Agitation Inventory. The Alzheimer's Disease Cooperative Study.

As part of the effort of the NIA Alzheimer's disease cooperative study to develop improved instruments for quantifying effects in Alzheimer's disease (AD) clinical trials, patterns of agitated behaviors were evaluated with the Cohen-Mansfield Agitation Inventory (CMAI) in 241 AD patients and 64 healthy elderly controls with valid baseline assessment on the CMAI. The test-retest reliability of the CMAI over 1 month was good (r = 0.74 to 0.92). Physically and verbally nonaggressive behaviors were most often reported, whereas physically aggressive behaviors were rare. Frequency of agitated behaviors increased with dementia severity, especially for patients with a Mini-Mental Status Exam score of 0-4. Agitation tended to increase in the evening with dementia severity for the more impaired patients. Amount of agitation did increase after 12 months in all but controls and mildly demented patients. The CMAI shows promise for evaluating a unique aspect of behavior and may be useful in assessing the effects of cognitive enhancers and other types of psychotropic drugs on behavior in dementia patients.

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PubMed1997

Evaluation of an inservice training program on dementia and wandering.

This study assessed the impact of an inservice training program in four nursing homes on nursing staff's knowledge of dementia, pacing/wandering behavior and management strategies, staff satisfaction, and their perceptions of work difficulty and quality of care. Additionally, unit-level behavioral observations of agitated behavior and the nature of resident interactions with staff members and other residents were also performed to assess whether changes in nursing staff's knowledge impacted the residents or interactions with the residents. Analyses revealed that quiz scores were significantly improved immediately following the inservice program as compared to pretest but returned to near pretest levels at the 1-month follow-up. Additionally, nursing staff reported that residents were allowed to pace/wander to a greater extent at follow-up compared to pretest. Methods for improving the effectiveness of inservice training are discussed.

Aged↗
PubMed1997

Turnover among nursing home staff. A review.

Turnover is especially critical in nursing homes: continuity of care and personal relationships between care-givers and residents are important determinants of quality of care. Additionally, for the cognitively impaired nursing home resident, constant change of staff is bound to aggravate disorientation. Research demonstrates links between turnover and employment/employee characteristics and employment availability.

Humans↗
PubMed1996

Assessment of agitation.

Agitation is inappropriate verbal, vocal, or motor activity, which is common among older persons with dementia. Its assessment is complicated both by communication difficulties and by the complexity of the manifested behaviors. Three general approaches are used to assess agitation: informant ratings, observational methods, and technological devices. Within each category, several assessment instruments exist. The approaches differ as to time sampling, objectivity, and cost. Assessment of agitation in pharmacological studies should include consideration of the specific meaning to the agitated behavior for the older person and for the caregiver, along with an evaluation of the consequences of the behavior. At times, the agitated behavior seems to signal a specific need, and alternative methods for fulfilling that need should be considered. Evaluation studies of pharmacologic agents should include consideration of the impact of these agents on nontarget behaviors, as well as an awareness of the large intraperson and interperson variability in agitated behaviors.

Activities of Daily Living↗
PubMed1996

Agitation: Subtypes and Their Mechanisms.

Agitation includes inappropriate verbal, vocal, or motor behaviors that, in the opinion of an observer, do not result directly from the needs or confusion of the agitated individual. Those behaviors affect the well-being of older persons and their caregivers, and therefore also the care rendered to the older person, including the likelihood of institutionalization. The inappropriate nature of agitated behavior is judged from the standpoint of an observer rather than that of the agitated person and may be subject to bias. Research to help clinicians disentangle the meaning of agitation and reduce the effects of observer bias has produced an approach to classification that is useful as a starting point. Agitated behaviors can be divided into physical and verbal, aggressive and non-aggressive. The available literature suggests that the different agitated behaviors have different meanings. Most seem to be associated with discomfort, which may include physical pain, external restraint, or feelings of depression or of loneliness. In contrast, some of the behaviors, especially in the physically nonaggressive category, may be adaptive and not an indication of discomfort. Other behaviors may result directly from neurological damage. On the basis of these interpretations of the reasons for disruptive behaviors, several approaches for treatment follow logically. Although there is much literature on behavioral, environmental, social, and pharmological approaches to treatment of agitation, large well-designed studies are conspicuously lacking. Both good intervention studies and improved methods for tailoring treatment to the specific needs and background of individual elderly persons are needed to better treat this complex phenomenon.

Journal Article↗
PubMed1996

Clinical decision making of experienced and novice nurses.

Decision making is an important daily nursing activity. Given contradictory past findings concerning the ease of use cognitive schema for reaching decisions among experts and novices, we chose to examine consistency of information as a parameter that may clarify the process of decision making. Ninety-two experienced nurses and 65 nursing students rated their decisional difficulty and levels of certainty in reaching a diagnosis for two scenarios: one including consistent information and one providing information that was partly inconsistent with the given diagnosis. For the consistent information, students showed more difficulty and less certainty in the given diagnosis than the experienced nurses. The inconsistent scenario was perceived as more difficult by nurses in comparison to students. The cognitive processes responsible for these results are discussed.

Adult↗
PubMed1996

Longitudinal changes in cognitive functioning in adult day care participants.

This study examines longitudinal changes in cognitive functioning over the course of 2 years in participants of adult day cae programs. Cognitive measures included the Brief Cognitive Rating Scale (BCRS) and the Mini-Mental State Examination (MMSE). Longitudinal data were available for five measurement points over 2 years for 82 participants (22 males and 60 females). Overall, results from this study suggest that there were significant cognitive declines on BCRS and MMSE, even after only 1 or 2 years in the study. The rates of impairment over the 2 years for BCRS and MMSE were highly correlated. Within each measure, the individual rates of decline were very heterogenous and were influenced by the presence, type, and prognosis of dementia. Participants with multi-infarct dementia had greater cognitive decline than did those with other types of dementias. Initial cognitive functioning and physician's prognosis of dementia trajectory were also significant predictors of change over time. Results suggest a floor effect in the BCRS.

Activities of Daily Living↗
PubMed1996

Staging methods for the assessment of dementia: Perspectives.

Most dementias in old age are characterized by a progressive course with interindividual variability in pattern and rate of progression. Developing a system for staging such dementia poses a challenge in capturing this variability in a system that will afford comparisons among individuals and predictions of future change. Several core questions underlie the development of such systems: (1) Is there a definable order in which abilities are lost? (2) Which skills and functions should be considered essential for the staging of dementia and what is their relative weight? (3) Can the different skills be captured within one staging system? (4) How is the whole range of function captured, and are the differences between stages clearly defined? (5) Which populations can be rated with each staging system? The determination of this last question is based on understanding which other medical conditions may interfere with the course of dementia and how prior characteristics, such as education, affect ratings on specific scales for the staging of dementia. Several systems for staging dementia in older adults are described. These include the Clinical Dementia Rating, the Global Deterioration Scale/Brief Cognitive Rating Scale/Functional Assessment Staging System, the Six Clinical Phases of Cognitive Decline, the Hierarchic Dementia Scale, and the Functional Capacity Scale. Some aspects of the utility of these systems are reviewed, and the issues for further research are discussed.

Activities of Daily Living↗
PubMed1996

Nursing staff back injuries: prevalence and cost in long term care facilities.

This report describes the period prevalence and cost of back injuries to nursing staff of long term care facilities in comparison to nurses employed industry wide and to other occupations industry wide. The period prevalence of back injuries to nursing staff in long term care facilities was highest for nurse aides, followed by LPNs and then RNs. Nurses (combined) had a period prevalence of back injuries nearly 1.5 times higher than all employees of long term care facilities and 6 times higher than all occupations combined industry wide. Within long term care facilities, nurses sustaining back injuries were younger and had been employed for a shorter period of time than the average for all nurses employed in long term care facilities. Back injuries accounted for more than half of the indemnity and medical costs for all injuries incurred in nursing homes and industry wide. The findings highlight the need for better prevention and rehabilitation

Adult↗
PubMed1995

Autonomy for nursing home residents: the role of regulations.

The importance of autonomy and choice to nursing home residents' well-being has been well established. This paper examines the complex role of regulation as it affects the autonomy of nursing home residents. Nonstandardized interviews with residents, family members, nursing staff members, and administrators were conducted at three nursing homes in suburban Maryland. These anecdotal interviews identified the most problematic areas where regulations enforce barriers to autonomy and control. These areas include: scheduling of activities of daily living, food portions, physical environment, and documentation. Suggestions for possible improvements are discussed.

Adaptation, Psychological↗
PubMed1995

Agitation among elderly persons at adult day-care centers: the experiences of relatives and staff members.

Two hundred participants (mean age = 80 years) from five senior day-care centers were included in a study of agitation. Staff members at the centers and participants' relatives rated the frequency with which participants displayed agitated behaviors, via an expanded version of the Cohen-Mansfield Agitation Inventory. The most frequent behaviors noted were general restlessness, repetitious sentences, verbal interruptions, and pacing. A three-factor solution for staff members' ratings included (a) physically nonaggressive behaviors, including general restlessness and pacing; (b) verbally agitated behaviors, including complaining and constant requests for attention; and (c) aggressive verbal behaviors, including cursing and temper outbursts. A three-factor solution for relatives' ratings included (a) physically nonaggressive behaviors, including general restlessness and pacing; (b) verbally agitated behaviors, including constant requests for attention and related interruptions; and (c) aggressive behaviors, including cursing, grabbing, kicking, and pushing. The syndromes of both models showed similarity to the factors found in a nursing home population, although differences were also apparent.

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PubMed1995

Temporal order of cognitive and functional loss in a nursing home population.

OBJECTIVE: The order in which cognition and the ability to perform activities of daily living (ADLs) are lost in an institutionalized aged population was examined. Understanding the order of loss of function is important for preparing caregivers and planning of care. METHOD: The conditional probabilities of the inability to perform activity A when there exists the inability to perform activity B were explored in secondary analyses of cross-sectional data describing 408 nursing home residents. Residents' abilities to perform ADLs were rated by nursing staff using Linn and Linn's Rapid Disability Rating Scale (RDRS-2); cognitive functioning was rated by social workers and nursing staff using a modified version of Reisberg et al.'s Brief Cognitive Rating Scale (BCRS, with 4 axes: orientation, concentration, recent memory, and past memory). RESULTS: The results regarding ADLs confirm previous findings of a natural order of loss of ability (from the one lost first to last): bathing, dressing, grooming, toileting, walking, and eating. The examination of order in the loss of concentration, recent memory, past memory, and orientation revealed that these seem to be lost concurrently when the cutpoint was 3 (i.e., relatively normal functioning vs. moderate and severe dementia). When the cutpoint was 6 (i.e., severe dementia vs. higher levels of functioning), the order that emerged was: recent memory, past memory, concentration, and orientation. CONCLUSIONS: Although there is a significant relationship between loss of ability to perform ADLs and stage of cognitive impairment, the loss of any specific ADL is not uniquely related to any one stage of cognitive deterioration in this diverse population. This may be explained by the high prevalence of disease in this institutionalized population, as exemplified by the 60% suffering from arthritis and the 17% suffering from neurological disorders other than dementia.

Activities of Daily Living↗