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PubMedDate not supplied

Time for change: the role of nonpharmacological interventions in treating behavior problems in nursing home residents with dementia.

This paper discusses the etiology of behavior problems in dementia and concludes that a substantial portion of such behaviors arise when care does not appropriately address the underlying causes. The needs of persons with dementia are frequently unrecognized and not addressed because of a combination of factors including communication problems, the multidimensional nature of etiologies and needs, the discounting of the needs of the patient with dementia, an environment that lacks knowledge and resources, and the improper allocation of resources on the part of policy makers, clinicians, and caregivers. The paper delineates some of the steps that are needed to move toward a more appropriate treatment of persons with dementia who manifest behavior problems.

Aged↗
PubMed2003

[Effects of emotion-oriented care on elderly people with cognitive impairment and behavioral problems in residential homes].

This study investigates the effects of emotion-oriented care on the behavior of elderly people with cognitive impairment and behavioral problems. This approach is mainly based on the validation approach, but uses also insights from other approaches like reminiscence and sensory stimulation. Sixteen homes for the aged with structured day care units were randomly allocated to an intervention or control group. 151 Residents with cognitive impairment and behavioral problems were included in the study. The eight intervention homes received a training program with regard to emotion-oriented care. In the eight control homes usual care was continued. Measurements were performed at baseline and after three, six and twelve months of follow-up (assessment by caregivers and relatives). The primary outcome measure was the change in behavior of the residents. The results of multilevel analyses (overall, subgroup and per protocol) showed no statistically significant, nor clinically relevant effects in favor of the intervention group on the behavioral outcome measures. A possible reason for this is that the intervention did not result in significant contrast between the study groups. There is insufficient scientific evidence yet to justify the implementation of emotion-oriented care in residential homes, for residents with moderate to severe cognitive impairment and behavioral problems, on a large scale. Additional studies are needed in which special attention should be given to the implementation process.

Aged↗
PubMed1994

Aggressive behavior directed at nursing home personnel by residents' family members.

Anecdotal evidence suggests there is a significant amount of aggressive behavior directed at nursing home personnel by residents' family members. This exploratory study describes a random sample survey of 70 Florida nursing homes. Administrators reported 1,193 acts of verbal aggression and 13 acts of physical aggression for a 6-month period. Dissatisfaction over how the specific and overall care needs of residents were being met was most frequently cited as the contributing factor. Social work staff and directors of nursing were most often called on to resolve these conflicts. The authors conclude with recommendations for research and conflict resolution.

Aged↗
PubMed1993

Biomedical and behavioral research in nursing homes: guidelines for ethical investigations.

As nursing homes become increasingly important sites for biomedical and behavioral research, researchers must address the ethical problems of increased vulnerability and the high prevalence of mental and physical disorders in the nursing home population. Obtaining valid informed consent is but one of the many difficult issues that confronts the investigator in the nursing home. Efforts should be made to involve nursing home residents, as well as family and staff members, in the review of research. The benefits and burdens of research protocols should be equitably distributed, and potential conflicts of interest for staff members and physicians should be minimized or their potential adverse impact ameliorated. Appropriate attention to these ethical concerns may facilitate nursing home research while still safeguarding vulnerable residents. We offer proposed guidelines for the ethical conduct of research in nursing homes in an effort to stimulate discussion among investigators, nursing home staff and residents, residents' families, and ethicists.

Behavioral Research↗
PubMed1991

Types and meanings of caring behaviors among elderly nursing home residents.

This grounded theory study explored and described the types and meanings of caring behaviors engaged in by elderly nursing home residents. Data were derived from observation of participants and in-depth interviews with residents in one nursing home during a three-month period. One of two substantive theories--a categorical model of the various types of caring behaviors residents engaged in--is discussed. Engagement in caring behaviors was found to be a universally important means for residents to maintain their esteem, self-identity and continuation of personhood. The properties of caring which emerged included protecting, supporting, confirming and transcending.

Aged↗
PubMed2003

The Revised Memory and Behavior Problems Checklist--Nursing Home: instrument development and measurement of burden among certified nursing assistants.

Confirmatory factor analysis of the Revised Memory and Behavior Problems Checklist--Nursing Home (RMBPC) replicated the factor structure of the community-based RMBPC (L. Teri et al., 1992). The reliability of the total score was high as indexed by estimates of internal consistency (alpha = .95), test-retest reliability (r = .86), and interrater reliability between 2 interviewers (r = .88). Notably, the interrater reliability between 2 independent certified nursing assistants (CNAs) regarding residents' behavior problem frequency was more modest (r = .46), possibly reflecting the degree to which resident behaviors capture individual CNA's attention. This may have implications for the interpretation of data from the Minimum Data Set. CNAs reported moderately severe burden associated with behavior problems in 47% of residents under their care.

Adult↗
PubMed1994

Nursing-home staff perception of behavior disturbance and management of confused residents.

An exploratory study was conducted to identify nursing-home staff's perceptions of confused residents' behavior problems and what they did to intervene. Six focus groups were conducted at two nursing homes. A convenience sample of 58 health care providers participated: registered nurses and licensed practical nurses; certified nursing assistants; social workers; clinical nurse specialists; therapeutic recreation therapists; and physical, speech, and occupational therapists. Four categories of behavior disturbances emerged: verbal, fear-related, wandering, and level of awareness-related. Four categories emerged from intervention data analysis: interpreting reality, maintaining normalcy, meeting basic needs, and managing behavior disturbances.

Aged↗
PubMed2002

Home-based cognitive-behavioral treatment of chronic, refractory obsessive-compulsive disorder can be effective. Single case analysis of four patients.

Four patients with obsessive-compulsive disorder (OCD) were referred for home-based cognitive-behavioral therapy. All patients had failed extensive trials of behavioral and cognitive therapy and pharmacotherapy in a variety of settings (e.g., outpatient, inpatient, and day program) and were generally considered chronic and refractory to treatment. Generalization from treatment sites to natural settings in which they lived did not occur. They were evaluated at baseline, after treatment, and at an 18-month follow-up using the Yale-Brown Obsessive Compulsive Scale. Conducting end-state functioning and reliable change assessment according to the methods specified by Jacobson and Truax, the authors found that 3 patients achieved clinically significant gains after treatment and 2 patients maintained those gains at the 18-month follow-up. Data suggested better overall adjustment for 3 of the patients at follow-up. This study demonstrates the effectiveness of home-based cognitive-behavioral therapy for chronic, refractory OCD; implications for further, controlled trials are discussed.

Adult↗
PubMed1989

A home evaluation of a behavioral response measure of sleep/wakefulness.

15 women and 3 men enrolled in a first-year undergraduate psychology course participated in a study concerned with evaluating the home use of a behavioral response monitor of sleep/wakefulness. The subjects, representing a range of fairly poor to good sleepers, used the device for three consecutive nights in their own homes. The 1967 Monroe Questionnaire was used to differentiate "good" sleepers from "poorer" sleepers. The behavioral response system indicated that subjects could adequately report how long they slept but consistently underestimated their number of arousals and could not reliably specify sleep-onset latency. The behavioral response measure was an effective and economical means of obtaining in-home objective sleep data and holds potential for clinical evaluation of disorders of initiating and maintaining sleep.

Adolescent↗
PubMed2005

Effects of rivastigmine treatment on the neuropsychiatric and behavioral disturbances of nursing home residents with moderate to severe probable Alzheimer's disease: a 26-week, multicenter, open-label study.

BACKGROUND: Alzheimer's disease (AD) is the most common form of dementia and is characterized clinically by a gradual decline in cognitive performance, an increasingly impaired ability to perform activities of daily living, and neuropsychiatric and behavioral disturbances. OBJECTIVE: The goal of this study was to assess the effect of rivastigmine on the neuropsychiatric and behavioral disturbances of nursing home residents with moderate to severe probable AD and to evaluate the safety and tolerability of rivastigmine in this population. METHODS: This prospective, 26-week, open-label study was conducted in 13 centers in the United States and involved a total of 29 nursing homes. The effects of rivastigmine 3 to 12 mg/d for 26 weeks were assessed in nursing home residents with moderate to severe probable AD. Efficacy was evaluated using the Neuropsychiatric Inventory-Nursing Home (NPI-NH) scale for neuropsychiatric and behavioral disturbances; the Mini-Mental State Examination and the naming subset of the Alzheimer's Disease Assessment Scale-Cognitive subscale for cognitive performance; and the simplified Clinician's Interview-Based Impression of Change Plus Caregiver Input for global functioning. RESULTS: A total of 173 patients (141 women, 32 men; mean [SD]age, 82.6 [5.9] years) were enrolled. After 26 weeks of rivastigmine treatment, the mean (SD) change from baseline for all treated patients in the observed cases population was -2.5 (16.4) (n = 100; P = 0.138); it was -0.8 (16.5) (n = 149; P = 0.576) for the last-observation-carried-forward population. Patients with at least 1 neuropsychiatric symptom present at baseline showed a 3.2-point mean improvement in NPI-NH total score (n = 92; P = 0.062), with 49% of these patients demonstrating a clinically meaningful (ie, > or = 30%) reduction from baseline. At 26 weeks, scores for 8 of the 12 neuropsychiatric and behavioral disturbances in patients with the specific symptom present at baseline showed statistically significant improvements from baseline (delusions [n = 32; P = 0.007], hallucinations [n = 15; P < 0.001], agitation [n = 58; P = 0.044], apathy/indifference [n = 37; P < 0.001], irritability/lability [n = 50; P < 0.001], aberrant motor behavior [n = 32; P < 0.001], nighttime disturbances [n = 22; P < 0.001], and appetite/eating changes [n = 28; P = 0.002]) in the observed cases population. Limitations of this study include that it was open label and not restricted to patients with behavioral disturbances at baseline. CONCLUSION: In the current study, rivastigmine treatment for 26 weeks in nursing home residents with moderate to severe probable AD was associated with decreased NPI-NH item scores for a wide range of behavioral disturbances in the subgroup of patients with behavioral symptoms at baseline.

Aged↗
PubMed2006

Aggressive marital conflict, maternal harsh punishment, and child aggressive-disruptive behavior: evidence for direct and mediated relations.

Direct associations between aggressive marital conflict and child aggressive-disruptive behavior at home and school were explored in this cross-sectional study of 360 kindergarten children. In addition, mediated pathways linking aggressive marital conflict to maternal harsh punishment to child aggressive-disruptive behavior were examined. Moderation analyses explored how the overall frequency of marital disagreement might buffer or exacerbate the impact of aggressive marital conflict on maternal harsh punishment and child aggressive-disruptive behavior. Hierarchical regressions revealed direct pathways linking aggressive marital conflict to child aggressive-disruptive behavior at home and school and a partially mediated pathway linking aggressive marital conflict to child aggressive-disruptive behavior at home. Further analyses revealed that rates of marital disagreement moderated the association between aggressive marital conflict and child aggressive-disruptive behavior at home, with an attenuated association at high rates of marital disagreement as compared with low rates of marital disagreement.

Aggression↗
PubMed1998

Cognitive-behavioral pain management for elderly nursing home residents.

A cognitive-behavioral pain management program for elderly nursing home residents with chronic pain was compared with an attention/support control treatment in a randomized pre-/post-comparison group design with follow-up. Thirteen women and nine men, ranging in age from 61 to 98 (M = 77.2), from two large nursing homes participated in the treatment programs through 10 weekly group sessions. Results revealed that the subjects who received the cognitive-behavioral training reported less pain and pain-related disability, although the two programs were perceived as equally credible both before and after treatment. No significant treatment effects were found for depression and physician medication ratings. Treatment effects were maintained at 4-month follow-up, despite an overall increase in reported pain. Findings indicate that elderly nursing home residents with chronic pain and without serious cognitive impairment can benefit substantially from training in cognitive and behavioral pain management strategies that are known to be effective with younger age groups and the community-resident elderly population.

Aged↗
PubMed2004

Long-term effects of rivastigmine treatment on neuropsychiatric and behavioral disturbances in nursing home residents with moderate to severe Alzheimer's disease: results of a 52-week open-label study.

OBJECTIVES: To evaluate the safety and efficacy of long-term treatment with rivastigmine (3-12 mg/day) and its effects on neuropsychiatric and behavioral disturbances in nursing home patients with moderate to severe probable Alzheimer's disease (AD). METHODS: A prospective, multicenter 26-week open-label extension to a 26-week open-label study (52 week results) of rivastigmine treatment in patients with Mini-Mental State Examination (MMSE) scores of 6-15 inclusive, residing in nursing homes at 13 centers in the US. Effects of treatment with rivastigmine for up to 52 weeks on neuropsychiatric and behavioral symptoms were examined using the Neuropsychiatric Inventory-Nursing Home (NPI-NH) scale. Cognitive function was assessed by the MMSE, and the Naming Objects and Fingers Test (NOFT) subset of the Alzheimer's Disease Assessment Scale -- Cognitive subscale (ADAS-Cog). Global functioning was assessed using the simplified Clinician's Interview-Based Impression of Change Plus Caregiver Input (CIBIC-Plus). RESULTS: Rivastigmine (3-12 mg/day) significantly improved neuropsychiatric and behavioral symptoms compared to baseline (in patients with specific behavioral disturbances at baseline) in observed cases (OC) and last observation carried forward (LOCF) analyses. Over 52 weeks, treatment with rivastigmine significantly improved 10 of 12 individual NPI-NH domains from baseline in LOCF patients with symptoms present at baseline. Cognitive function was stable, indicated by the lack of decline in MMSE and the NOFT. Global function was stabilized or improved in greater than half of the patients as indicated by the simplified CIBIC-Plus scores. CONCLUSION: Rivastigmine showed potential benefit in the long-term treatment of behavioral symptoms as well as cognitive and global functioning in nursing home residents with moderate to severe AD with concurrent behavioral symptoms present at baseline. Although these results suggest that treatment with rivastigmine may have beneficial behavioral effects and cognitive benefits on patients with moderate to severe AD, they are subject to the limitations of an open-label study.

Administration, Oral↗
PubMed1975

Behavior modification in the home with students as co-therapists.

This case report illustrates the application of behavior modification techniques for managing children's misbehavior. The important elements of this report are the use of graduate students as co-therapists, the implementation of the program directly in the family's home, and the focus on shaping the mother's disciplinary behavior.

Attitude↗
PubMed1994

Behavioral management for bladder control: response in selected rural residential care homes.

Urinary incontinence is a problem for elders in many settings, including rural residential care homes (RCHs). Behavioral techniques for the management of urinary incontinence have been successful with community-dwelling and nursing home populations. A study was undertaken to evaluate the feasibility of implementing bladder diaries and bladder training to assist RCH residents with bladder control. These techniques were found not to be successful in selected rural RCHs. The characteristics of rural RCHs are explored, and the impediments and incentives to the use of behavioral management techniques for urinary incontinence in these settings are examined.

Aged↗
PubMed1998

Diet for a small primate: insectivory and gummivory in the (large) patas monkey (Erythrocebus patas pyrrhonotus).

A 17 month field study of unprovisioned patas monkeys (Erythrocebus patas pyrrhonotus) in Laikipia, Kenya, using both ad libitum and scan sampling techniques, revealed that the diet of patas monkeys consists primarily of gum of Acacia drepanolobium, arthropods (both free-living and concentrated in the swollen thorns of A. drepanolobium), and other animals. This type of diet is normally found only in smaller-bodied primates. Results from vegetational transects suggest that the larger-bodied patas monkey can subsist on such a diet because gum and arthropods are relatively easily found in their habitat, thereby minimizing search time. Patas monkeys also spend more time moving and less time feeding (while not moving) than other Old World primates. The characteristic long limbs of patas may have evolved in response to feeding on small, nonusurpable, and widely distributed foods, in which access to foods is maximized while time and energy spent in terrestrial travel between food sites are minimized.

Acacia↗
PubMed1998

Sex-specific usage patterns of sleeping sites in grey mouse lemurs (Microcebus murinus) in northwestern Madagascar.

Sleeping sites are a potentially important resource for grey mouse lemurs since they are confronted with high daily temperature fluctuations and a high predation pressure. In order to determine the existence and degree of resource competition, sleeping site characteristics, locations, and usage patterns as well as sleeping group compositions were investigated in a 3 month field study in a dry deciduous forest of northwestern Madagascar. The daily sleeping sites of females were on average better insulated and safer than those of males. Males used more sleeping sites and changed the site more often than females. During the whole study, males slept alone, whereas the females formed stable sleeping groups in on average 83.7% of the days. Sex-specific differences in usage patterns might be explained by intersexual resource competition and female dominance and could possibly be related to differential parental investment of the sexes. The underlying study indicates that sleeping sites may be a restricted and defendable resource for grey mouse lemurs. The investigation gives new insights into the distribution patterns and social organization of this species.

Animals↗