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PubMed1992

Agitation in elderly persons: an integrative report of findings in a nursing home.

Agitated behaviors in the nursing home pose a major problem for caregivers. Our data showed that the three syndromes of agitation--aggressive behaviors, physically nonaggressive behaviors, and verbally agitated behaviors--are differentially related to medical and psychosocial variables. Physically nonaggressive behaviors may be adaptive for a resident who presents a deteriorated stage of dementia, since these behaviors offer stimulation and exercise. Verbally agitated behaviors may be a form of help-seeking behavior for residents with physical disease and depressed affect. Aggressive behaviors are those least understood, although these behaviors correlate with advanced stages of dementia and with poor interpersonal relationships. These findings should be a basis for further studies, with the ultimate goal being improved care for agitated elderly persons.

Activities of Daily Living↗
PubMed1991

The home care practice and attitudes of Minnesota family physicians.

OBJECTIVE: Assess home care practice and attitudes of Minnesota family physicians (FPs). DESIGN: Mailed survey. SETTING: State of Minnesota. PARTICIPANTS: Members of the Minnesota Academy of Family Physicians, 80% of the FPs practicing in the state. INTERVENTION: A 55-item mailed, self-complete questionnaire regarding general practice and personal physician characteristics (18 questions), specific questions regarding geriatric and home care practice and related attitudes (37 questions); up to four reminder or follow-up surveys were sent. MAIN OUTCOME MEASURES: Descriptive summary of FP home care practice and attitudes. RESULTS: Eighty percent of surveys were completed, 76% of responding physicians made at least one home visit in the previous year, and 92% of home visits were to geriatric patients. Discriminant function analysis identified six significant (P less than 0.001) variables that explained 52% of the variance (r2 = 0.52, Wilks Lambda = 0.48) in home visiting behavior between frequent home visiting FPs (greater than 24 visits/year) and non-visiting FPs. FPs most likely to do home visiting were older and tended to have small group or solo practices in rural settings. CONCLUSION: The survey documented continued decline (from previously published surveys) of physician home visiting behavior and widespread dissatisfaction with reimbursement. However, attitudes regarding home care provided by other professionals were highly positive.

Attitude of Health Personnel↗
PubMed1997

Risperidone for dementia-related disturbed behavior in nursing home residents: a clinical experience.

Many nursing home residents are candidates for antipsychotic pharmacotherapy for dementia-related behavioral disturbances that include physical agitation and aggression, verbal outbursts, anxiety, and depression. These patients are often resistant to or intolerant of standard neuroleptics and are usually receiving multiple medications for concurrent psychiatric or medical conditions. New medications must be carefully considered because they may interact with concurrent medications or aggravate concurrent medical problems. Low doses of risperidone may be better tolerated in the elderly because the drug poses little risk of extrapyramidal side effects or blood disorders. One hundred and nine patients with dementia-related behavioral disturbances were studied in 9 nursing homes; most initially received 0.25 to 0.5 mg of risperidone twice daily. Their behavior was recorded for up to 6 months on questionnaires completed by a nursing staff member at each home. Risperidone was well tolerated overall and nursing staff viewed it as helpful in 38 of 100 patients, moderately helpful in 26, slightly helpful in 17, and not helpful in 19.

Aged↗
PubMed1998

Peer group victimization as a predictor of children's behavior problems at home and in school.

This study reports a short-term prospective investigation of the role of peer group victimization in the development of children's behavior problems, at home and in school. Sociometric interviews were utilized to assess aggression, victimization by peers, and peer rejection, for 330 children who were in either the third or fourth grade (approximate mean ages of 8-9 years old). Behavior problems were assessed using standardized behavior checklists completed by mothers and teachers. A follow-up assessment of behavior problems was completed 2 years later, when the children were in either the fifth or sixth grade (approximate mean ages of 10-11 years old). Victimization was both concurrently and prospectively associated with externalizing, attention dysregulation, and immature/dependent behavior. Victimization also predicted increases in these difficulties over time, and incremented the prediction in later behavior problems associated with peer rejection and aggression. The results of this investigation demonstrate that victimization in the peer group is an important predictor of later behavioral maladjustment.

Aggression↗
PubMed2003

Prescription and dosage of analgesic medication in relation to resident behaviors in the nursing home.

OBJECTIVES: To examine correlates of analgesic medication prescription and administration in communicative, cognitively impaired nursing home residents. Residents' behaviors were assessed using computer-assisted real-time observations as potential adjunctive indicators of pain. DESIGN: Cross-sectional study over a 4-week period. SETTING: Five nursing homes in the greater Birmingham, Alabama, area. PARTICIPANTS: Ninety-two residents (mean age +/- standard deviation = 83.86 +/- 8.55) with a mean Mini-Mental State Examination (MMSE) score of 13.81 +/- 6.34. MEASUREMENTS: Data were obtained via chart review, resident assessments, questionnaire completion by certified nursing assistants familiar with residents' care, and direct observation of residents' daily behaviors. RESULTS: Receipt of analgesic medication was related to self-report of pain (F2,89 = 9.89, P =.0001), MMSE (F2,88 = 3.98, P =.022), and time spent inactive (F2,89 = 3.04, P =.053). Residents who received analgesic medication reported greater intensity of pain than other residents. Residents who received analgesics had higher MMSE scores than those who did not receive analgesics. Residents who received analgesics spent less time being inactive than those not prescribed analgesics. Receipt of higher dosage of opioid analgesic medication was associated with more time spent with others in verbal interaction (r =.22, P =.03). CONCLUSION: This study refines the methodology of measuring analgesic medication dosage and its effect on resident behavior. Analgesic prescription and administration patterns are related to time residents spend being inactive. Results suggest that opioid analgesics may hold particular promise in alleviating pain, as indicated by resident behaviors.

Aged↗
PubMedDate not supplied

Assessment of ambulatory behavior in nursing home residents who pace or wander: a comparison of four commercially available devices.

This study evaluated four devices--a Pedometer, Step Sensor, Actigraph, and Personal Activity Meter (PAM)--as measures of pacing behavior. Ten nursing home residents who frequently paced in a long-term care facility underwent 1 day of data collection with each of the devices. Data derived from devices were compared to behavioral observations regarding the number of steps taken. Additionally, devices were evaluated via ratings concerning ease of use, and how well residents tolerated them. All devices yielded high correlations with the observed number of steps, with highest correlations for the PAM and Actigraph. All devices were tolerated well. The Pedometer and Step Sensor were the easiest to use. This study demonstrated that these devices offer an objective means to measure pacing/wandering behavior.

Aged↗
PubMed2006

Genes and developmental stabiltiy of aggressive behavior problems at home and school in a community sample of twins aged 7-12.

Though behavioral genetic studies of aggression have implicated heritable and environmental factors, there is limited understanding of how these factors influence aggression across different settings and over time. Ratings for 732 twins were collected from parents and teachers during middle childhood and early adolescence. Total aggression scores on the Child Behavioral Checklist (CBCL) and Teacher Report Form (TRF) were examined at each age, across both settings, and developmentally. In this sample, aggressive behavior was moderately to largely heritable at each age within the home (.76-.84) and school (.42-.61). Across each age, ratings by parents and teachers were moderately correlated (.19-.36). Genetic and environmental effects that were limited to a particular setting were important etiological factors for aggressive behavior consistently within each setting, while only genetic factors influenced levels of aggression across both settings. Stability during these ages was due to genetic effects common to each age and the persistence of child-specific environmental experiences within each setting. These results suggest that genetic and environmental influences on children's aggressive behavior are largely setting specific. Levels of aggression seen consistently across both settings are due to genetic influences. Developmentally stable levels of aggressive behavior result from genetic influences common to all ages and individual environmental influences whose effects persist across ages.

Aggression↗
PubMed2004

A study on aggressive behavior among nursing home residents with cognitive impairment.

PURPOSE: With a sample of cognitively impaired nursing home residents and nursing staff, the following were examined 1) the proportion and nature of aggressive behavior, 2) the frequency and types of aggressive behavior, 3) the difference between the residents who demonstrate aggressive behavior and those who do not demonstrate aggressive behavior (age, mental status, functional status, and pain, length of nursing home stay), and 4) nursing staff responses to aggressive behavior by residents. METHODS: A cross-sectional descriptive study design was used. Data were collected from cognitively impaired nursing home residents (N=205) and nursing staff (N=60) at two nursing homes using Ryden Aggression Scale I and II, Mini-Mental State Exam, Modified Barthel Index, Verbal Descriptor Scale, and aggressive behavior management questionnaire. Data were analyzed using descriptive statistics including t-test. RESULTS: About 62.9% residents were found to be aggressive and 38.5% were both physically and verbally aggressive. Pushing, making threatening gestures, hitting, slapping, cursing/obscene/vulgar languages, making verbal threats were occurred frequently. Aggressive residents were significantly older, had more cognitive impairment, had more pain, and stayed longer in the nursing home when compared with non-aggressive residents. Considerable proportion of nursing staff responded to aggressive behaviors inadequately. CONCLUSION: Aggressive behavior among cognitively impaired nursing home residents is prevalent thus needs to be prevented and reduced. Along with environmental modification, educational programs for nursing staff and family caregivers need to be developed and implemented so that they can have extensive knowledge and skills to manage aggressive behaviors.

Aged↗
PubMed1991

Travel behavior of nursing home residents perceived as wanderers and nonwanderers.

A video-based observational methodology was used to assess the travel behaviors of 40 nursing home residents, 24 of whom were identified by nursing staff as wanderers. Travel was monitored continuously for 30 days, resulting in the recording of over 5,000 unassisted travel events. Four basic travel patterns were observed: direct travel (86.8%), lapping (11.6%), random travel (.9%), and pacing (.7%). Travel efficiency (percentage of direct travel) was significantly related to cognitive status (r = .56), with inefficient travel most prevalent in severely demented participants.

Aged↗
PubMed1996

Eating behaviors of nursing home residents who display agitation.

To determine if cognitive level and agitation affect eating behavior, 33 females and four males in a 210-bed nursing home were studied. The researcher inconspicuously observed the evening meal for subjects on three occasions. Nearly 80% of the subjects showed a high frequency of agitation and 84% exhibited cognitive impairment. More than one-half were independent in feeding, with caregivers neither touching nor encouraging subjects during more than half of the 110 meals observed. No significant relationships were demonstrated between level of agitation and eating behavior or between cognitive level and eating behavior.

Activities of Daily Living↗
PubMed2005

Managing disruptive behaviors with neuroleptics: treatment options for older adults in nursing homes.

Disruptive behaviors are frequent among elderly individuals in long-term care centers. Neuroleptics remain the most common pharmacological treatment for controlling these challenging behavioral manifestations. However, their effectiveness is a subject of controversy and it is unclear what specific behaviors are more likely to be managed with neuroleptic medications. The objective of this study was to identify the types of disruptive behaviors for which neuroleptics are given to elderly individuals in long-term care facilities and determine if the frequency of these behaviors increases the risk of being prescribed neuroleptics. A cross-sectional study was conducted with 2,332 participants ages 65 or older living in 28 long-term care facilities. Among them, 27.8% had taken at least one neuroleptic drug in the prior week. The administration of neuroleptics was not linked to the presence of any one specific disruptive behavior. However, a significant finding was that the greater the frequency of disruptive behavior exhibited by an elderly individual, the greater the risk of them being administered a neuroleptic medication. A multi-dimensional approach to the assessment of disruptive behaviors is recommended to facilitate the identification of the underlying causes of those behaviors. Accordingly, it is suggested that non-pharmacological treatment plans be adapted to each situation and then implemented to potentially reduce the use of neuroleptics.

Age Factors↗
PubMed2002

Contending with "problem behaviors" in the nursing home.

Despite the pervasiveness of challenging resident behaviors in U.S. nursing homes, the staff who work in these facilities typically have little training in mental health or behavior management. This article, based on ethnographic research in a U.S. nursing home that served a predominantly psychiatrically disabled clientele, explores how staff conceptualized and dealt with difficult resident behaviors. It investigates formal and informal strategies used by staff to contend with problematic resident behavior, as well as the obstacles--both internal and external--to effective behavior management in this context.

Adult↗
PubMed1991

Correlates of disruptive behavior in cognitively impaired elderly nursing home residents.

Disruptive behavior, resulting in negative consequences for both residents and caregivers, occurs in a large proportion of the nursing home population. This review of literature surveys studies that describe disruptive behavior and the correlates of this behavior in the cognitively impaired elderly. In the studies reviewed, the average prevalence of reported disruptive behavior among a total of 5,650 subjects was 42.8%. Correlates most frequently linked with disruptive behavior include cognitive status, functional ability, age, and premorbid personality. Suggestions for future research are discussed.

Aged↗