This study demonstrates the value of individualized activities for nursing home residents with dementia. In a stringent test, residents were happier and less angry during a customized intervention compared with a standardized intervention. Even brief individualized CNA-led activities bring pleasure to nursing home residents and constitute an effective strategy to enhance positive affect and engagement in persons with dementia.
Background
Neuropsychiatric symptoms (NPS) occur in people with dementia throughout disease course and across etiologies. NPS are associated with significant morbidities and hastened disease processes. Nevertheless, people with dementia are not systematically assessed for NPS in clinical settings. We review existing NPS measures for clinical and/or research purposes, and identify measurement gaps.
Methods
We conducted a computerized search of peer-reviewed published studies of measures (January 1, 1980–December 1, 2013) using multiple search terms. Measures selected for review were in English, had adequate psychometric properties, and were developed for or used with people with dementia. Papers describing measures were evaluated by three coders along seven characteristics: behavioral domains, number of items, method of administration, response categories, targeted population, setting, and psychometric properties.
Results
Overall, 2,233 papers were identified through search terms, and 36 papers from manual searches of references. From 2,269 papers, 85 measures were identified of which 45 (52.9%) had adequate psychometric properties and were developed or used with dementia populations. Of these, 16 (35.6%) were general measures that included a wide range of behaviors; 29 (64.4%) targeted specific behaviors (e.g. agitation). Measures differed widely as to behaviors assessed and measurement properties.
Conclusions
A robust set of diverse measures exists for assessing NPS in different settings. No measures identify risk factors for behaviors or enable an evaluation of the context in which behaviors occur. To improve clinical efforts, research is needed to evaluate concordance of behavioral ratings between formal and informal caregivers, and to develop and test measures that can identify known risks for behaviors and the circumstances under which behaviors occur.
Utilizing data from 80 adult children-older parent dyads, this study examined the degree to which adult children could predict the psychosocial preferences of their older parents. Overall, children demonstrated good knowledge about parent preferences, although there was wide variability within the sample and across preference domains. Children underestimated how important parents considered continued enrichment and personal growth. Knowledge was associated with parents' functional status and mood. Parent, but not child, perceptions of family flexibility and cohesion were related to children's knowledge. Findings suggest that family life education and intervention programs need to address contextual factors as a means to improve intergenerational knowledge and enhance the likelihood that parent preferences are considered in care planning.
A valid tool is needed to assess preferences that are relevant and important to nursing home (NH) residents. Originally developed for older adults receiving home care services, the authors adapted the Preferences for Everyday Living Inventory (PELI) for use with NH residents. Content validity was initially established using a panel of experts in long-term care. PELI items were cognitively interviewed with 31 Veteran and 39 non-Veteran participants (N = 70). Responses from cognitive interviewing guided substantial revisions of the PELI (>25% of items) to include language that NH residents use and understand, reducing potential measurement error and ensuring the preferences assessed are relevant to NH residents. Future work will further adapt the PELI for use with more diverse groups and health care settings, and assess its psychometric properties. Using the PELI will help move clinical teams closer to the goal of providing person-centered care informed by individual preferences.
This article reports the results of two policy-capturing studies that investigated individual differences in the meaning of religiousness. Policy capturing requires judges to respond to a large number of hypothetical scenarios or profiles that differ along a number of potentially relevant cues or attributes. Multiple regression analyses are then conducted to ascertain which cues are influencing each judge's responses. For both studies, 100 profiles were developed describing hypothetical individuals who differed on 10 cues thought to influence perceptions of religiousness (e.g., church attendance, doctrinal orthodoxy), and judges rated each profile on a 9-point religiousness scale. Judges in Study 1 were 27 Roman Catholic and Protestant college students.
Policy-capturing analyses identified clear individual differences in the cues thatThe authors would like to thank Michael Doherty, Leona Aiken, and the anonymous reviewers for their valuable comments; the participants in this study; and the former graduate students who assisted in the study:
Understanding patient preferences is core to person-centered care. The consistency of everyday preference reporting was assessed comparing responses of Veteran (VA) and non-VA nursing home (NH) residents on the Preferences for Everyday Living Inventory (PELI) at baseline and 5 to 7 days later. Non-VA NH residents demonstrated higher perfect agreement than VA residents (66% vs. 56%, respectively) and higher acceptable agreement (95% vs. 88%, respectively). Multiple regression analyses examined significant predictors of reliability using demographics, cognitive functional variables, and interviewer ratings. In the VA group, higher perfect agreement was associated with residents who were less likely to have hearing deficits, better cognition, and better interviewer ratings related to energy, attention, and comprehension. In the non-VA group, higher perfect agreement was associated with residents who were younger and more independent with walking. Overall, higher agreement was associated with being female, non-VA, and having better cognition. Implications for future research and clinical practice are highlighted. [
Journal of Gerontological Nursing, 46
(3), 15–25.]
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