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PubMedDate not supplied

Effects of the Serial Trial Intervention on discomfort and behavior of nursing home residents with dementia.

This study tested the effectiveness of the Serial Trial Intervention (STI), an innovative clinical protocol for assessment and management of unmet needs in people with late-stage dementia. A double-blinded randomized experiment was conducted in 14 nursing homes with 114 subjects. The treatment group had significantly less discomfort than the control group at posttesting and more frequently had behavioral symptoms return to baseline. The group of nurses using the STI also showed more persistence in assessing and intervening than control group nurses did. There was a statistically significant difference between the groups in the use of pharmacological, but not nonpharmacological, comfort treatments. Results suggest that the STI is effective and that effective treatment of discomfort is possible for people with late-stage dementia.

Aged, 80 and over↗
PubMed2003

Behavioral parent training for Taiwanese parents of children with attention-deficit/hyperactivity disorder.

It has been observed that it is relatively difficult for children with attention-deficit/hyperactivity disorder (ADHD) to follow social rules and behave in a socially desirable manner. The ADHD children in Chinese culture, which emphasizes Confucian values, might encounter even greater adjustment difficulties. The purpose of the present study is to implement a behavioral parent training program in a Confucian environment and examine its effectiveness. Twenty-three ADHD preschoolers (age: 3-6 years) and their parents were selected to participate in the present study. Fourteen of these 23 parents completed a 10-session parent training program. Parent ratings of ADHD/oppositional defiant disorder (ODD) symptoms and problem behaviors at home were collected at the first, fourth, sixth, seventh, and tenth sessions. Three instruments were used to evaluate treatment outcome: the Disruptive Behavior Rating Scale-Parent Form, Child Attention Profile, and Home Situations Questionnaire. The results showed that both ADHD/ODD symptoms and home behaviors of these 14 children improved significantly after the parent training. There was also a significant decline in the severity of symptoms and problem behaviors at home with the progression of training. These findings support the effectiveness of this parent training program for parents of ADHD children in an environment of Confucianism. Limitations of the present study and future direction for research are discussed.

Adult↗
PubMed1995

Neuroleptic use and behavioral disturbance in nursing homes: a 1-year study.

This article discusses a longitudinal study of change in disruptive behaviors among nursing home residents treated with neuroleptics compared with those not treated with neuroleptics. Observations were made of 201 participants on admission to and after 1 year in eight skilled nursing facilities. Nine disruptive behaviors were measured using the Psychogeriatric Dependency Rating Scale with nursing assistants. Neuroleptic use was documented from medication records. Odds ratios are reported for the association of behavior at baseline and use of neuroleptics on nine problem behaviors. For those who received neuroleptics during the year, there was greater change in both developing and resolving disruptive behaviors than for those not receiving neuroleptics. For both groups, restless or pacing behavior and belligerent behavior manifested by refusing instructions changed the most, both in developing and in apparently resolving. Our results show that change in disruptive behaviors occurs among nursing home residents regardless of neuroleptic use, but it occurs more frequently among those who receive neuroleptic medication. Knowledge of which disruptive behaviors are most likely to resolve or develop is important in training nursing home staff to cope with the behaviors as well as in planning interventions that may modify such behaviors.

Adult↗
PubMedDate not supplied

Acoustic properties of vocally disruptive behaviors in the nursing home.

BACKGROUND: Disruptive vocalizations are among the most common behavior problems in the nursing home. However, their acoustic properties have not been previously investigated. OBJECTIVE: This paper examines the acoustic properties of disruptive vocalizations and attempts to link them to resident and verbalization characteristics. METHODS: This study characterizes the sounds emitted by 26 nursing home residents who manifested disruptive vocalizations. Verbalizations were audiotaped and then used in a sonographic evaluation and an acoustic analysis. RESULTS: Vocalizations of verbally agitated nursing home residents were characterized by their relatively short duration. Consistent positive correlations were found between seemingly disturbing types of vocalizations, such as yelling and howling, and higher levels of several parameters of the fundamental frequency. A similar positive correlation was also found between acoustic parameters and medical disease indicators. With the exception of the length of stream of utterances, the indicators did not differentiate between types of dementia. CONCLUSIONS: Because of the large number of comparisons undertaken, it is difficult to conclude which associations between acoustic properties and resident or vocalization characteristics are attributable to real underlying trends and which are due to chance and error. Consistencies that deserve further research pertain to the perceptions of the types of vocalizations the person tends to emit and to the physical health of the person.

Aged↗
PubMed1981

Factors affecting home health agency behavior: an interactionist view.

Much attention has been given to developing alternatives to institutionally based long term care. For most of the alternative programs the community agencies are assumed to be the health provider of health and personal care services. An analysis of 18,000 patients discharged from 45 home health agencies in one state reveals that the agencies provide very different patterns of services in terms of skilled and personal care. Agencies also vary widely in the type of person served in terms of disability and reimbursement. It appears that the home health agencies through a process of internal and external interactions establish their role in the long term care delivery system and subsequent referral patterns reflect that role.

Aged↗
PubMed2005

Nature and development of Huntington disease in a nursing home population: The Behavior Observation Scale Huntington (BOSH).

OBJECTIVE: The Behavior Observation Scale Huntington (BOSH) was developed to obtain a detailed description of the manifestation of Huntington disease (HD) in the final stages. BACKGROUND: The Unified Huntington's Disease Rating Scale (UHDRS), developed to assess Huntington patients' clinical capacities, does not differentiate adequately in later stages of the disease. A scale easy to administer by nursing personnel for progression of the disease in later stages was needed. METHOD: Two pilot questionnaires preceded the final version of the BOSH. Observers administered the final version twice independently on 91 patients in 4 nursing homes. RESULTS: The BOSH contains 32 items in 3 subscales: 1) activities of daily living (ADL), 2) social-cognitive functioning, and 3) mental rigidity and aggression. Internal and interrater reliabilities were between 0.83 and 0.95. Rigidity and aggression become more frequent as the disease progresses; later on, this behavior diminishes. Social-cognitive capabilities deteriorate more rapidly in later stages. CONCLUSIONS: This study sought to develop a scale for assessing behaviors and individual differences in later stages of HD. The findings support the use of the BOSH in identifying these behaviors and differences.

Activities of Daily Living↗
PubMed2001

Aggressive behaviors among demented nursing home residents in Japan.

This study investigates the frequency of aggressive behaviors in a sample of elderly nursing home residents with dementia in Japan. Behavioral data were collected on 391 residents using the Cohen-Mansfield Agitation Inventory (CMAI). Data were also gathered on residents' age, sex, and ability to perform self-care. Another scale was used to code the degree of resistance that each resident manifested during bathing, toileting, dressing and eating. In addition, qualitative data were collected from caregivers regarding their main caregiving problems with dementia residents. Findings show that 45.4% of the sample manifested aggressive behavior during the 2-week study period. Men were significantly more likely to manifest physically aggressive behavior, but there was no gender difference for verbal aggression. Age had no relationship to aggressive behavior. Residents who were most dependent in self-care had significantly higher frequencies of aggressive behaviors. Caregivers reported that most aggressive behavior took place during personal care. The majority of caregivers identified verbal agitation rather than physical aggression as their main caregiving problem. This study represents the first time that the CMAI has been translated and used in Japan and the first time empirical data has been collected on the behavior of dementia patients in Japanese nursing homes.

Activities of Daily Living↗
PubMed1996

[Limitations in feeding behavior in nursing home patients].

Disabilities in nutrition behaviour of 250 residents and 264 newly admitted patients, 65 years and older, of a nursing home were related to their main disorder (stated as the reason for admission). More than 60% of the newly admitted patients and 80% of the residents suffered from disabilities in one or more of the four following aspects of nutrition behaviour: mostly in making a choice, often in bringing food to the mouth and chewing and to a lesser extent in swallowing food. Most of the residents also needed help in obtaining extras and preparing their sandwich meal. Disabilities in choosing, feeding and chewing were particularly frequent in the group of psychogeriatric patients while disabilities in swallowing were relatively frequent in the group of newly admitted neurological patients. The most frequent type of help offered in the case of a disability existed, was personal support and adaptation of the consistency of the food; devices to enable the patient to function independently were rarely used. The care needed by nursing home patients in nutrition behaviour, which can vary between and within patients between deserves more attention because it can determine the intake of food.

Aged↗
PubMed1977

Sex differences in parent and infant behavior in the home.

Observations were made in the homes of 32 families, each with a child aged around 12 or 24 months. 16 of the children were boys and 16 girls. Boys showed more active play, play with transportation toys, and play generally forbidden by parents. Girls played more with soft toys and dolls. On questionnaire responses many parents rated these and other behaviors as sex appropriate. However, actual sex differences in immediate parental response to children were few or undetected. Sex differences in children's behavior did not appreciably increase from 12 to 24 months. Also, there was no correlation with how stereotyped parents' questionnaire responses were and the degree to which their children exhibited sex-typed behavior.

Child Behavior↗
PubMed1994

Evaluation of the Eyberg Child Behavior Inventory as a predictor of disruptive behavior during an initial pediatric dental examination.

The purpose of this study was to investigate relationships between the Eyberg Child Behavior Inventory (ECBI), a parent rating scale of children's behaviors at home, and children's disruptive behaviors during an initial dental visit. Behaviors of 18 Headstart children, 40 to 55 months of age, undergoing an initial exam were observed. Four possible negative behaviors based upon the North Carolina Behavior Rating Scale (NCBRS), were recorded by two observers for each subject during five phases of an initial dental visit and statistically compared to the total ECBI score and individual answers within the ECBI questionnaire. Overall, the majority of subjects displayed clinically acceptable behavior. Four disruptive behaviors explained 92.9% of the variation in responses by the subjects to the initial visit. These were: high hand movement during the intraoral examination, crying or verbal protest during prophylaxis, oral physical resistance during prophylaxis, and oral-physical resistance during fluoride application. The following 6 questions explained 99.3% of the variation in ECBI responses by parents or guardians: (#9) refuses to obey until threatened with punishment, (#15) whines, (#18) hits parents, (#24) verbally fights with friends his own age, (#28) constantly seeks attention, and (#35) is overactive or restless. While the total number of subjects observed were too low to generate statistically significant results, the trends appear to indicate that a child's disruptive or nondisruptive behavior at home is not a reliable predictor of disruptive or nondisruptive behavior within the dental setting. These findings are independent of gender or race.

Analysis of Variance↗
PubMedDate not supplied

The relationship between parental ratings of child behaviors, interaction, and the home environment.

PROBLEM: What is the relationship between child behaviors as perceived by the mother and father, mother-child interaction, and the home environment? SUBJECTS: A subsample of 28 families of healthy, full-term newborns recruited from a larger longitudinal study. METHODS: Mothers and fathers completed the Eyberg Child Behavior Inventory when their child was 24 months old. NCATS and HOME Inventory were administered. The Neonatal Perception Inventory was previously completed by the mother within 72 hours of birth and at 1 month postpartum. FINDINGS: Significant interparent correlations for intensity of child behaviors; however, the association for behaviors considered to be problematic was not significant. Fathers tended to report fewer behavior problems and less frequent occurrences. Several significant relationships were found between child behavior ratings, interaction, and the home environment. Gender of child and maternal employment status did not significantly influence parental perceptions of child behavior. CONCLUSIONS AND IMPLICATIONS FOR NURSING: While parents may share perceptions of child behaviors, they may differ in interpretation of whether those behaviors are problematic. Administering behavior inventories to both parents may help them identify and respect each other's differing opinions. These same inventories can be used to measure effects of interventions, and are adjuncts to direct behavioral observations of parent-child interaction.

Attitude↗
PubMedDate not supplied

Prospective measurement of behavioral disturbances in nursing homes.

OBJECTIVE: To determine the reliability and validity of a behavior measurement scale (BMS) that rates behavioral disturbances (BD) prospectively in four categories. DESIGN: A prospective observational study. PARTICIPANTS AND SETTING: A total of 70 long-term care residents from two nursing homes. MEASUREMENTS: Registered nurses (RNs), licensed practical nurses (LPNs), and certified nurses' assistants (CNAs) performed behavior ratings concurrently and independently on 30 residents for a period of 2 weeks. One RN performed ratings on the additional 40 residents. Each category of behavior was rated either present (occurred at least once) or absent (never occurred) at the end of each nursing shift. The Kappa (k) statistic and Cronbach's alpha were used to measure the BMS interrater reliability and internal consistency, respectively. Spearman's coefficient was used to measure correlation between total BMS scores and the level of functional impairment (construct validity). RESULTS: Interrater reliability was marginal to good for RN-LPN paired ratings (weighted k = 0.30-0.53) and good to excellent for LPN-CNA paired ratings (weighted k = 0.68-0.90). The internal consistency reliability of the BMS was 0.75. Total BMS scores correlated with the level of functional impairment (P = 0.021). CNAs reported significantly more behavior episodes than RNs and LPNs. Nonaggressive verbal agitation was the most frequently encountered behavior in both nursing homes. There were no missing observations during the 2-week rating period. CONCLUSIONS: The BMS is a simple and reliable tool that a variety of nursing staff members can use consistently for behavior measurement at the bedside. CNAs, who have more direct contact with nursing home residents, reported more BD than RNs and LPNs. Standardized behavior measurements can be used to monitor the frequency of BD and to evaluate the efficacy of interventions targeted either to individuals or to nursing homes. A simple and reliable tool such as the BMS may increase the likelihood that consistent reporting of BD is routinely available in nursing homes.

Journal Article↗
PubMed1998

[Changes in homes for the aged and nursing homes: functional impairments and behavioral disorders of residents are increasing].

Residents in homes for the elderly and in nursing homes suffer from physical and mental disorders that are prevalent far above average. In the course of the changes that are presently taking place in the German health care system there is now an increase in the number of mentally ill and severely impaired persons residing in old-age homes. Earlier epidemiological studies do not yield any conclusive predictions of changes in residential structures and hence in nursing care requirements. Two cross-sectional studies are presented on the prevalence of physical and mental diseases, daily and behaviour problems among residents of old-age and nursing homes in Mannheim. There was a distinct increase in average age, functional impairment, depression and disoriented behaviour among residents in 12 homes for the elderly in Mannheim conducted in 1988 (n = 542) and 1992 (n = 497). During the period it was noted that disoriented behaviour significantly increased the mortality risk. In another study the by far larger group of nursing home residents was investigated. So far we have data for 1995 and 1996 on results obtained from 1178 residents of Mannheim homes for the elderly and nursing homes. Among the residents of nursing homes there was a much higher prevalence of functional impairment and behaviour problems than among those of homes for the elderly. Despite a very high prevalence of depression or disorientation, only every third resident was diagnosed as suffering from organic brain disease and only every tenth resident had a depressive disorder. Since a growing proportion of residents will be mentally ill or severely impaired, these institutions will be facing increasing medical and nursing demands. Due to limited resources, the homes cannot meet these demands adequately. Hence, health policy changes are mandatory to improve nursing care and to avoid placing an increasing burden on the nursing staff.

Activities of Daily Living↗
PubMed1991

Regulating the behavior of nursing homes through positive incentives: an analysis of Illinois' Quality Incentive Program (QUIP).

The Illinois Quality Incentive Program (QUIP) offers nursing homes a separate bonus payment per Medicaid day for achievement of each of 6 quality standards. Using data from 809 participating nursing homes between 1985-1988, this study found that over 90% of eligible facilities chose to participate annually. Success in achieving bonus payments in multiple standards increased over time, with 27% qualifying for 5 or 6 components by 1988. But the validity of the individual measures and the relationship between achievement of QUIP standards and resident quality was not firmly established. The resident satisfaction standard proved insensitive, with 92% of participating facilities qualifying on this standard.

Humans↗