The need-driven dementia-compromised behavior model-- a framework for understanding the behavioral symptoms of dementia.
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Biomedical subjects
Publications and source records attributed to A M Kolanowski.
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Four million Americans suffer from some form of dementia. Over 50% of these individuals exhibit behaviors that are perceived as "disturbing" by family and caregivers. The Need-driven Dementia-compromised Behavior Model was developed by a group of nurse researchers to study and understand these behaviors. The model changes the view of dementia behaviors as "disturbing" to that of behavior as signifying potentially understandable needs. This article reviews the model and demonstrates how interventions derived from the model can be used to respond to dementia behaviors in a holistic fashion.
Aggressive physical behaviour (APB) is common in persons with dementia and often leads to negative consequences such as use of restraints and staff member burnout. For the past several years, a group of nurse researchers has collaborated to develop a model that views dementia behaviors as need-driven but dementia-compromised. The model posits that background variables of the demented person interact with proximal (or current situational) variables to produce APB. The purpose of this study was to test a part of that model by addressing the question: Which premorbid factors predict APB in a sample of 84 demented institutionalized elders? This was a cross-sectional descriptive study that obtained measures of the following characteristics of residents: (1) aggressive behavior as assessed by nursing home staff members using the Ryden Aggression Scale, (2) premorbid personality traits as assessed by a member of the resident's family using the NEO Five Factor Inventory and (3) history of psychosocial stress as assessed by a member of the residents' family using the modified Social Readjustment Rating Scale. Of the sample of 84 residents, 44% exhibited physical aggression. Background factors in the model were not predictive of aggressive behavior in late-stage dementia, although the relation between premorbid neuroticism and physical aggression was in the predicted direction.
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PURPOSE: To propose an alternative view of personality change in dementia by presenting existing evidence for the continuity of personality. SIGNIFICANCE: As the population continues to age, dementing illnesses will account for a greater proportion of morbidity and mortality; the care of these people will have a significant effect on the health care system. ORGANIZING FRAMEWORK: Life-span perspective of personality continuity. SCOPE METHOD: Review of current literature on personality in dementia using Medline, 1980-1994; CINAHL, 1990-1994; and Psych Lit., 1980-1994. FINDINGS: Although there are systematic shifts in personality with dementia, individuals tend to maintain their unique pattern of premorbid personality traits. CONCLUSIONS: The personalities of dementia patients seem to reflect adaptive patterns that served them in the past. IMPLICATIONS: Use of a life-span perspective can enhance individualized care for demented patients and advance theory development.
This article describes the use of concept synthesis, as defined by Walker and Avant, to extract meaningful syndromes of disturbing behaviors as they are manifested in demented elders. The process resulted in the identification of five distinct behavioral clusterings: Aggressive Psychomotor Behavior, Nonaggressive Psychomotor Behavior, Verbally Aggressive Behavior, Passive Behavior and Functionally Impaired Behavior. These synthesized concepts are an initial attempt at clarifying nursing perspective on disturbing behaviors in dementia.
1. Nurses need to be aware of the effects of artificial lights on the aged because the aged spend a greater amount of time under these lights than do younger people. 2. Although the aged require more light than younger people to see, bright lights may cause glare. The use of indirect lighting is recommended to reduce problems with glare. 3. The aged see best under artificial lighting that simulates natural sunlight. 4. Nurses who work in institutional settings should be sensitive to the need for individualized light-dark cycles.
The concept of restlessness has been explored and a definition proposed. The behavior has been described within the framework of Activation Theory, and several approaches to measurement have been suggested. It remains for nursing researchers to test the adequacy of this analysis, to support or reject the antecedents, and to propose interventions which are philosophically congruent.
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