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Biomedical subjects

J Cohen-Mansfield

Publications and source records attributed to J Cohen-Mansfield.

At least 19 recordsLinked to original sources
PubMed1999

Predictors of mortality in nursing home residents.

A prospective cohort study was conducted to examine predictors of mortality in the nursing home. Participants were 399 long-term nursing home residents, who were followed up for 11 years at the end of which 380 had died, 16 were still alive, 2 were discharged with unknown status, and 1 was alive when discharged. The median duration from baseline to death was 2.75 years. For cognitively intact residents, male gender, larger number of medical diagnoses, and manifestations of physically nonaggressive agitated behaviors (e.g., restlessness, pacing) were significant predictors. For cognitively impaired residents, the significant predictors were older age, impaired activities of daily living, and screaming behavior at a high frequency. Cognitive impairment is important both in predicting death in this population and in understanding the impact of other predictors. The impact of agitated behaviors, quality of social relations, and appetite on mortality highlights issues of quality of life at the end of life.

Activities of Daily Living↗
PubMed1999

Measurement of inappropriate behavior associated with dementia.

Inappropriate behaviors in dementia affect caregivers, causing depression, burden, stress, and affecting caregivers' social life, morale, and somatic health. These behaviors also may signal that the elderly individuals with dementia are distressed and because of a combination of inappropriate behaviors and loss of communication skills, these individuals may not receive adequate assessment or treatment. This article discusses the assessment of behavior problems in elderly individuals suffering from dementia. The following issues are addressed: the need for assessment; difficulties in assessment of inappropriate behaviors; approaches to the assessment of behavior problems, including caregiver ratings, observational methods, and technological devices; and issues in the clinical use of assessments.

Aged↗
PubMed1998

Pain in participants of adult day care centers: assessment by different raters.

The aim of this study is to compare the assessment of pain in 200 elderly persons participating in five senior day care programs, as rated by family caregivers, day care staff members, and the participants themselves. Staff members and participants provided information in a face-to-face interview. Family members provided information about the participants and their demographic characteristics via a mailed questionnaire. Agreement rates among informants ranged between 63% and 69%, showing moderate agreement rates. Health status (as reflected in number of medications taken and the presence of a diagnosis of musculoskeletal disease) and depression were associated with ratings of pain by all the informants. The assessment of pain in the elderly population is very difficult and there is a need for reliable and valid pain assessments to be used by different raters. The relationship between pain, depression and other variables should be further explored.

Aged↗
PubMed1998

The validity of cognitive testing in screening for dementia.

The concept of "cognitive impairment," as an indicator of dementia, defined in 1980 as a loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning, is the model which has been adopted for a condition, which has recently been reclassified from an "organic" to a "cognitive disorder." Data derived from the assessment of a sample of older people demonstrated the extreme sensitivity of a widely employed cognitive assessment instrument to all levels of educational experience, and educational correlates, notably level of physical disability, were identified as other independent predictors of test performance. The analyses raise questions with regard to the reinterpretation of "lack of education," from a confounding factor in prevalence estimates of cognitive impairment to a "risk factor" for dementia, and support those who have questioned the validity of the one-dimensional "cognitive paradigm," and the trend to diagnosis based upon objective assessment with standardized instruments.

Activities of Daily Living↗
PubMed1998

Which stress matters? The examination of temporal aspects of stress.

In this study, the impact of past experiences, present stressors, and expectations of future stress on psychological distress were explored. Participants were 38 male and 41 female spouses of patients hospitalized with non-life-threatening diseases. Participants completed questionnaires on which they appraised past, present, and future stressors and described their levels of psychological distress. Five models of the relationships between appraisals of past, present, and future stressors with psychological distress were examined. Only one model was confirmed by the data. It suggests that an appraisal of past stressors affects the appraisal of present stressors only indirectly, through its effect on the appraisal of future stressors. This model also maintains that only the appraisal of present stressors affects psychological distress directly. The implications of these findings for stress research are discussed.

Adaptation, Psychological↗
PubMed1998

Longitudinal changes in behavioral problems in old age: a study in an adult day care population.

BACKGROUND: Four types of agitation have been identified: physically aggressive behaviors, physically nonaggressive behaviors, verbally aggressive behaviors, and verbally nonaggressive behaviors. These pose a major challenge to caregivers and are sometimes indicators of the emotional state of the older person. Longitudinal changes in these four subtypes of agitated behaviors were examined. METHODS: One hundred and four community-dwelling participants of five senior day care centers (mean age = 79) were followed up for 2 years. Their agitation was assessed, as was their cognitive functioning, affect, and medical functioning. RESULTS: Although physically nonaggressive, physically aggressive, and verbally aggressive behaviors increased significantly over 2 years, verbally nonaggressive behaviors did not show significant changes over time. These patterns can be partially explained by the relationship between the different types of agitation and cognitive functioning. Increases in physically nonaggressive behaviors from start to end of the 2 years were predicted by greater cognitive impairment at baseline and by receiving a smaller number of medications at baseline. Increases in verbally aggressive behaviors and in physically aggressive behaviors during the study period correlated significantly with a greater decline in cognitive functioning and increased depression at baseline. In addition, increases in physical aggression were correlated with greater cognitive impairment at baseline. CONCLUSIONS: The course of change for each type of agitation was unique. The relationships between inappropriate behaviors, cognitive functioning, physical health, and depression over time are complex and vary by type of agitation.

Affect↗
PubMed1998

Predictors of aggressive behaviors: a longitudinal study in senior day care centers.

Aggressive behaviors place elderly persons and their caregivers at risk. This study examines longitudinally the predictors of aggressive behaviors based on staff and family members' ratings of 200 community-dwelling participants from senior day care centers. The main difference between physically and verbally aggressive behaviors was found to be the role of physical and mental health. Cognitive impairment and poor quality of relationship were the main predictors of physically aggressive behaviors. Verbally aggressive behaviors were predicted mainly by depressed affect, low quality of relationships, and poor physical health. These results validate and expand prior cross-sectional research on the correlates of aggression in other populations, and guide in the development of interventions.

Aged↗
PubMed1998

The effects of an enhanced environment on nursing home residents who pace.

This study sought to enhance the well-being of older nursing home residents who pace and wander by enriching their nursing home environment. Visual, auditory, and olfactory stimuli were added to the nursing home unit environment to simulate two types of environments: a home environment and an outdoor nature environment. Participants seemed to prefer the enhanced environments by choosing to spend more time in them, and by sitting on benches in those environments. There was a trend toward less trespassing, exit-seeking, and other agitated behaviors being exhibited in the enhanced environment, and residents were observed to manifest more pleasure in it. Staff members and family members definitely expressed a preference for the enhanced environment over the regular one. Although effects on residents were limited, this approach offers a low-cost method for making the nursing home environment a better place for those residents.

Aged↗
PubMed1998

Delusions and hallucinations in an adult day care population. A longitudinal study.

The frequency of the manifestation of delusions and hallucinations (d/h) among participants of adult day care centers was examined, as was the relationship of d/h to demographic and medical variables, agitation, depressed affect, and dementia. Changes in d/h were also assessed over a 1-year period, and those changes were compared with changes in agitation, depressed affect, and dementia. Depressed affect and agitation were related both to delusions and to hallucinations. Dementia was also related to d/h, although a substantial percentage of individuals who were not diagnosed with dementia also experienced some type of d/h. Finally, delusions were more prevalent and generally tended to relate more strongly to agitation, depressed affect, and dementia than did hallucinations.

Aged↗
PubMed1997

Typology of disruptive vocalizations in older persons suffering from dementia.

Verbal and vocal disruptive behaviors (VDB) are important clinical features in dementia because they frequently signal discomfort experienced by an elderly person and because they are disturbing to caregivers, thereby affecting the care of elderly persons manifesting them. This article describes a typology of VDB, the Typology of Vocalizations-TOV. The conceptual framework underlying the development of this typology includes the assumptions that VDB consist of more than one type of behavior and that interventions should be matched to the etiology of the specific type of VDB. The article reports interrater reliability of the typology and validates it against Ryan's classification of verbal and vocal disruptive behaviors. Critical dimensions of the typology are examined and used for its refinement. Finally, use of the TOV for matching individuals to the most effective intervention is demonstrated.

Aged↗
PubMed1997

Management of verbally disruptive behaviors in nursing home residents.

BACKGROUND: Verbally disruptive behaviors (VDB) are verbal or vocal behaviors that are inappropriate to the circumstances in which they are manifested. These behaviors are a source of concern because they disturb persons around the older person and may be an indicator of distress. METHODS: Three interventions were tried and compared to a control no-intervention phase. The interventions were: (1) Presentation of a videotape of a family member talking to the older person, (2) in vivo social interaction, and (3) use of music. RESULTS: Thirty-two nursing home residents suffering from dementia and manifesting VDB were observed before, during, and after the interventions, and the duration of VDB was recorded. The behaviors decreased by 56% during the social interaction, 46% during the videotape, 31% during the music, and 16% during the no-intervention. CONCLUSIONS: The effects of the interventions were clinically and statistically significant, indicating the importance of providing stimulating activities and a richer environment to cognitively impaired nursing home residents.

Aged↗
PubMed1997

Assessing patterns of agitation in Alzheimer's disease patients with the Cohen-Mansfield Agitation Inventory. The Alzheimer's Disease Cooperative Study.

As part of the effort of the NIA Alzheimer's disease cooperative study to develop improved instruments for quantifying effects in Alzheimer's disease (AD) clinical trials, patterns of agitated behaviors were evaluated with the Cohen-Mansfield Agitation Inventory (CMAI) in 241 AD patients and 64 healthy elderly controls with valid baseline assessment on the CMAI. The test-retest reliability of the CMAI over 1 month was good (r = 0.74 to 0.92). Physically and verbally nonaggressive behaviors were most often reported, whereas physically aggressive behaviors were rare. Frequency of agitated behaviors increased with dementia severity, especially for patients with a Mini-Mental Status Exam score of 0-4. Agitation tended to increase in the evening with dementia severity for the more impaired patients. Amount of agitation did increase after 12 months in all but controls and mildly demented patients. The CMAI shows promise for evaluating a unique aspect of behavior and may be useful in assessing the effects of cognitive enhancers and other types of psychotropic drugs on behavior in dementia patients.

Aged↗
PubMed1997

Evaluation of an inservice training program on dementia and wandering.

This study assessed the impact of an inservice training program in four nursing homes on nursing staff's knowledge of dementia, pacing/wandering behavior and management strategies, staff satisfaction, and their perceptions of work difficulty and quality of care. Additionally, unit-level behavioral observations of agitated behavior and the nature of resident interactions with staff members and other residents were also performed to assess whether changes in nursing staff's knowledge impacted the residents or interactions with the residents. Analyses revealed that quiz scores were significantly improved immediately following the inservice program as compared to pretest but returned to near pretest levels at the 1-month follow-up. Additionally, nursing staff reported that residents were allowed to pace/wander to a greater extent at follow-up compared to pretest. Methods for improving the effectiveness of inservice training are discussed.

Aged↗
PubMed1997

Turnover among nursing home staff. A review.

Turnover is especially critical in nursing homes: continuity of care and personal relationships between care-givers and residents are important determinants of quality of care. Additionally, for the cognitively impaired nursing home resident, constant change of staff is bound to aggravate disorientation. Research demonstrates links between turnover and employment/employee characteristics and employment availability.

Humans↗
PubMed1996

Assessment of agitation.

Agitation is inappropriate verbal, vocal, or motor activity, which is common among older persons with dementia. Its assessment is complicated both by communication difficulties and by the complexity of the manifested behaviors. Three general approaches are used to assess agitation: informant ratings, observational methods, and technological devices. Within each category, several assessment instruments exist. The approaches differ as to time sampling, objectivity, and cost. Assessment of agitation in pharmacological studies should include consideration of the specific meaning to the agitated behavior for the older person and for the caregiver, along with an evaluation of the consequences of the behavior. At times, the agitated behavior seems to signal a specific need, and alternative methods for fulfilling that need should be considered. Evaluation studies of pharmacologic agents should include consideration of the impact of these agents on nontarget behaviors, as well as an awareness of the large intraperson and interperson variability in agitated behaviors.

Activities of Daily Living↗