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At least 253 records · Page 14Linked to original sources

Assessing disruptive behaviors of nursing home residents: use of microcomputer technology to promote objectivity in planning nursing interventions.

1. Simultaneous recording of multiple behaviors, as well as their antecedents and consequences, is made possible with the use of microcomputers. 2. Objective identification of key environmental events provides significant assessment data to plan care for the person with dementia. 3. With a more precise assessment base through naturalistic observation of disruptive behaviors, management of these behaviors can affect, more positively, the quality of life of the nursing home resident.

Dementia↗

Temporal patterns of negative and positive behavior among nursing home residents with Alzheimer's disease.

Although clinical observations suggest a late-day peak in disruptive behavior in persons with dementia, results from studies of temporal patterns of behavior are equivocal. This study used direct observation methods and systematic time sampling to examine temporal patterns of negative and positive behavior in 177 residents of 2 long-term care facilities with clinically diagnosed Alzheimer's disease (AD). The authors found small statistically significant diurnal variation in both negative and positive behavior, characterized by a curvilinear pattern with a single peak. This pattern was unaffected by seasonal differences in length of day, severity of cognitive impairment, level of behavior, or sleep disturbances. Time when behavior peaked differed by type of behavior and by facility, and there was substantial heterogeneity in behavior patterns.

Affect↗

Do preset per visit payment rates affect home health agency behavior?

This article reports on preliminary impacts during the first year of a demonstration in which home health agencies (HHAs) were paid a prospectively set rate for each Medicare home health visit rendered, rather than being reimbursed for costs. Forty-seven agencies in five States participated. The evaluation compared the experiences of randomly assigned treatment agencies and their patients with those of control agencies and their patients and found no compelling evidence of any demonstration impact on agency cost per visit, the volume of home health services, agency revenue and profit, patient selection and retention, quality of care, or use and cost of Medicare services.

Costs and Cost Analysis↗

Behaviors of nursing home residents with dementia: examining nurse responses.

It is challenging for nurses to understand and respond to behaviors expressed by individuals with dementia. Nurses in this study responded to behaviors in 4 discrete ways--with no treatment, treatment without assessment, repetitive use of ineffective treatments, and with comprehensive assessment followed by treatment. Using ineffective treatments and treating without assessing were associated with recurrence of behaviors. This study suggests there is a need for more assessment and critical thinking when addressing behavior change in individuals with dementia.

Aged↗

Aggressive behavior in the home as a function of the age and sex of control-problem and normal children.

This cross-sectional study investigated the ability of age, sex, and clinic-referred or nonreferred status of children to account for variance in the performance of aggressive behavior. Two clinic-referred groups and one normative group of children, composed of 137 males and 86 females between the ages of 3 and 13, were observed during unstructured family interactions in the home setting. Measures of aggressive/aversive child behavior included a composite total aversive behavior (TAB) score, a physical aggression (PAB) score, a verbal aggression (VAB) score, a passive-dependent behavior (PDB) score, and a disobedience (DSB) score. The total regression model and referral status were significant for each of these dependent variables. Age was significant for each variable except VAB, and sex was significant only for PAB. Significant age X group interactions were obtained for TAB, PDB, and DSB. Rates of behavior clearly differentiated groups, but the relationship of age and sex of child to behavior rates was the same across groups. Decreases in all behaviors with increasing age, except for VAB, replicate findings from previous studies in preschool settings. However, the meager sex differences failed to replicate more robust findings generally reported in previous research.

Adolescent↗

A chest harness and pole-leash for routine transfer of rhesus monkeys from home cage to behavioral test apparatus and back.

A chest harness and pole-leash method to transfer rhesus monkeys (Macaca mulatta) weighing up to 16 kg from home cage to primate restraint chair was designed. The harness was made of leather straps that crossed the chest in an X-fashion, and created a V-neck. The V-neck eliminated the strangulation hazard of neck collars, and minimized interference between the harness and neck hole of restraint chairs. Two pole-leashes attached to 2 points on the harness gave the handler considerable control over the posture of the monkey, making it easier to teach the monkey to walk with a leash and to climb into its restraint chair or test apparatus. During transfer the rigid pole prevented escape and protected the handler from attack. Quick release mechanisms on the pole-leash allowed prompt, complete separation from the animal when it re-entered its home cage.

Animals↗

Behavioral problems in nursing home residents. Safe ways to manage dementia.

Behavioral problems in nursing home residents are already common and are likely to increase in number with the "graying" of the population. Effective treatment is available, and a structured and logical approach to management is needed. Patients should be assessed to differentiate delirium from dementia, and possible precipitants of disturbed behavior should be investigated. The best treatment of dementia-related behavioral problems includes nonpharmacologic measures (eg, environmental changes) and appropriate choice, dosing, and monitoring of pharmacologic agents. Long-term success with demented patients may depend on realistic expectations.

Aged↗

Sexuality in the nursing home, part 2: Managing abnormal behavior-legal and ethical issues.

Everyone, regardless of age, needs love, touch, companionship, and intimacy. The 1.6 million elderly in the 20,000 U.S. nursing homes are not an exception. The literature indicates that nursing home residents continue to have an interest in sexual activity regardless of age. Sexuality, however, is frequently overlooked by physicians and staff working with nursing home residents. Many staff members have only a vague understanding of the sexual needs of the elderly. This results in a perception of residents' sexual interests as behavioral problems rather than expressions of need for love and intimacy. Inappropriate sexual behaviors in the nursing home can create an intense burden for nursing home staff. This article discusses ways to dealing with inappropriate sexual behaviors in long-term care settings and the ethical issues involved.

Aged↗

Assessment of smoking behaviors in the home and their influence on children's passive smoking: development of a questionnaire.

PURPOSE: To construct and validate a questionnaire aiming to measure children's exposure to environmental tobacco smoke (ETS) in the home. METHODS: The development of the instrument included epidemiological studies, qualitative interviews, pilot studies, and validation with biomarkers and is described in seven consecutive steps. Parents of preschool children, from different population-based samples in south-east Sweden, have participated in the studies. RESULTS: Content and face validity was tested by an expert panel and core elements for the purpose of the instrument identified. Reliability was shown with test-retest of the first version. The validation with biomarkers indicated that the sensitivity of the instrument was high enough to discriminate between children's ETS exposure levels. Cotinine/creatinine levels were related to parents' described smoking behaviors. Differences were shown between children from non-smoking homes, and all groups with smoking parents, independent of their smoking behavior (p < 0.01), as well as between parents smoking strictly outdoors and parents reporting indoor smoking (p < 0.001). CONCLUSION: The results indicate that the presented instrument can be used to discriminate between different levels of ETS exposure and when children's level of tobacco smoke exposure is to be assessed.

Adult↗

Effects of behavioral interventions on disruptive behavior and affect in demented nursing home residents.

BACKGROUND: Disruptive behaviors are prevalent in nursing home residents with dementia and often have negative consequences for the resident, caregiver, and others in the environment. Behavioral interventions might ameliorate them and have a positive effect on residents' mood (affect). OBJECTIVES: This study tested two interventions-an activities of daily living and a psychosocial activity intervention-and a combination of the two to determine their efficacy in reducing disruptive behaviors and improving affect in nursing home residents with dementia. METHODS: The study had three treatment groups (activities of daily living, psychosocial activity, and a combination) and two control groups (placebo and no intervention). Nursing assistants hired specifically for this study enacted the interventions under the direction of a master's prepared gerontological clinical nurse specialist. Nursing assistants employed at the nursing homes recorded the occurrence of disruptive behaviors. Raters analyzed videotapes filmed during the study to determine the interventions' influence on affect. RESULTS: Findings indicated significantly more positive affect but not reduced disruptive behaviors in treatment groups compared to control groups. CONCLUSIONS: The treatments did not specifically address the factors that may have been triggering disruptive behaviors. Interventions much more precisely designed than those employed in this study require development to quell disruptive behaviors. Nontargeted interventions might increase positive affect. Treatments that produce even a brief improvement in affect indicate improved quality of mental health as mandated by federal law.

Activities of Daily Living↗