Agitation is a significant problem for elderly persons, their families, and their caregivers. This study describes the agitated behaviors of 408 nursing home residents. Nurses who were familiar with the residents used a 7-point scale to rate how often each resident manifested 29 agitated behaviors. Each resident was rated independently by three nurses, one from each of the three nursing shifts. Results showed that agitated behaviors occurred most often during the day shift (i.e., when residents were most active), and least often during the night shift. The most frequently exhibited agitated behaviors were general restlessness, pacing, repetitious sentences, requests for attention, complaining, negativism, and cursing. Most agitated behaviors correlated significantly across shifts, suggesting that such behaviors occur and reoccur throughout the 24-hour day. Factor analysis yielded three syndromes of agitation: aggressive behavior, physically nonaggressive behavior, and verbally agitated behavior. These results provide a foundation for further studies of agitation in elderly persons.

Purpose: The aim of this paper is to delineate the underlying premises of the concept of engagement in persons with dementia and present a new theoretical framework of engagement. Setting/Subjects:The sample included 193 residents of 7 Maryland nursing homes. All participants had a diagnosis of dementia. Methodology:We describe a model of factors that affect engagement of persons with dementia. Moreover, we present the psychometric qualities of an assessment designed to capture the dimensions of engagement (OME, Observational Measurement of Engagement). Finally, we detail plans for future research as well as data analyses that are currently underway.Discussion: This paper lays the foundation for a new theoretical framework concerning the mechanisms of interactions between persons with cognitive impairment and environmental stimuli. Additionally, the study examines what factors are associated with interest and negative and positive feelings in engagement. KeywordsEngagement; dementia; nursing home residents; person attributes; environment attributes; stimulus attributesThe concept of engagement has been documented in a range of settings, including the clienttherapist relationship (1), providing intellectual tasks for students and professionals (2), and in studies of nursing home residents (3). Studies have shown that nursing home residents spend the majority of their time not engaged in any meaningful activity (3;4;5). Prolonged lack of stimulation can be particularly detrimental to persons in nursing homes who suffer from dementia, as it magnifies the apathy, boredom, depression, and loneliness that often accompany the progression of dementia (6;7). Consequently, it is of critical importance that engagement of these residents becomes a priority within nursing facilities.Engaging older persons with dementia in appropriate activities has been shown to yield beneficial effects such as increasing positive emotions, improving activities of daily living NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript (ADL) and improving the quality of life (8;9) developing constructive attitudes toward dementia among nursing staff members (10) and decreasing problem behaviors among nursing home populations (11).The study of engagement is a necessary foundation for the development of nonpharmacological interventions for persons with dementia, whether the interventions address depression, agitation, apathy, loneliness, or boredom. The analysis of different forms of engagement of persons with dementia is expected to help such persons by reducing boredom and loneliness, and by increasing interest and positive emotions. It is also expected to help staff members by providing them with tools that they can utilize in caring for these persons. Although apathy, boredom, depression, and loneliness frequently accompany the progression of dementia, engagement of the demented nursing home residents in constructive, meaningful activities creates a possibility for enhancing the level of their daily functioning and f...

This study aimed to ascertain perceived barriers and motivators to exercise in people age 74–85 and to clarify the meaning of these barriers and motivators by examining participant characteristics that relate to them. 324 community-dwelling participants age 74–85 completed a health questionnaire that included items on barriers and motivators to exercise, as well as questions on demographic variables, health, and exercise. Selected participants then completed a physical-performance battery to measure functional performance. Barriers and motivators were related internally, as well as to many other factors including pain and depressed affect on the Geriatric Depression Scale. The findings suggest a need for individualized and comprehensive approaches to the presentation of exercise programs. Health interventions are needed that will address both physical pain and depressed affect and explain the importance of exercise even in the presence of health problems. An understanding of the context of reported barriers and motivators is necessary for correct interpretation and program development.

The Unmet Needs Model states that problem behaviors of people with dementia result from unmet needs stemming from a decreased ability to communicate those needs and to provide for oneself. The purpose of this study is to describe the unmet needs of persons with dementia exhibiting behavior problems. Eighty-nine residents from 6 Maryland nursing homes with dementia were assessed by research assistants and nursing assistants for their unmet needs using multiple assessment tools. Three unmet needs per resident were identified on average, with informants rating boredom/sensory deprivation, loneliness/need for social interaction, and need for meaningful activity as the most prevalent needs. Discomfort was associated with higher levels of verbally agitated behaviors (e.g., complaining). Based on results and independent ratings of pain, the authors estimate notable under detection of discomfort and pain by both types of informants. The study demonstrates methodologies for uncovering unmet needs among persons with dementia and highlights the importance of developing programs that address those unmet needs, especially social and activity needs of nursing home residents. The detection of pain, and possibly that of discomfort, may require a different methodology.