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.
Objectives-The objective of this paper was to assess the relative impact of different types of stimuli on agitated behaviors of nursing home residents with dementia.Design Setting/Participants-Participants were 111 residents of 7 Maryland nursing homes with a diagnosis of dementia who exhibited agitation.Intervention-Different types of stimuli (music, social stimuli, simulated social stimuli, and individualized stimuli based on the person's self-identity) to prevent behavior problems. Measurements-Agitation was directly observed and recorded via the Agitated Behaviors Mapping Instrument.Results-All stimulus categories were associated with significantly less physical agitation than baseline observations, and all except for manipulative stimuli were associated with significantly less total agitation. Live social stimuli were associated with less agitation than music, self-identity, work, simulated social, and manipulative stimulus categories. Task and reading stimulus categories were each associated with significantly less agitation than work, simulated social, and manipulative stimulus categories. Music and self-identity stimuli were associated with less agitation than simulated social and manipulative stimuli.Conclusion-Providing stimuli offers a proactive approach to preventing agitation in persons with dementia, with live social stimuli being most successful.
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