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Biomedical subjects

L D Burgio

Publications and source records attributed to L D Burgio.

At least 19 recordsLinked to original sources
PubMed1992

Physicians' acceptance of behavioral treatments and pharmacotherapy for behavioral disturbances in older adults.

In response to growing interest in employing behavioral treatments and environmental modification for behavioral disturbances in older adults, we employed vignette methodology to examine physicians' acceptance of two behavioral treatments and haloperidol using Kazdin's Treatment Evaluation Inventory. Physicians assigned the highest acceptability ratings to the behavioral treatments and the lowest ratings to haloperidol. The patient's cognitive capacity, living situation (nursing home vs. community), and the type of behavior problem mediated treatment acceptability ratings.

Aged↗
PubMed1992

Urinary incontinence: an augmented prompted void approach.

Continence improves from 44.7% dryness at baseline to 54.7% at the end of treatment, an improvement of 22%, or about one incontinent episode per day. Urinary incontinence is improved in cognitively impaired residents by augmenting the prompted voiding procedure with a bellpad. Bladder behavior changes with behavioral treatment strategies, because the volume voided into an appropriate receptacle increased an average of 26 mL per 2 hours. Reimbursement policies should not exclude treatment of the severely cognitively impaired nor the immobile in nursing homes.

Adult↗
PubMed1991

Behavioral assessment of the effects of psychotropic medications on demented nursing home residents.

The effects of different psychotropic medications were examined for the control of behavior problems associated with dementia in three elderly nursing home residents. A reversal design was used in which the medications were introduced and withdrawn, and their effects were assessed on various resident behaviors using behavioral and motor performance assessments. All medications were effective in decreasing aberrant behaviors, but they also increased sedation in all three subjects. Performance on the motor assessments decreased for all subjects after the introduction of medication and improved after the medication was withdrawn. The results highlight the utility of behavioral assessment strategies for assessing the effects of psychotropic medication on elderly nursing home residents.

Activities of Daily Living↗
PubMed1991

Assessing toileting skills and habits in an adult day care center.

In a structured assessment of mobility and toileting skills, all the continent clients but only 46.2% of incontinent clients were able to toilet themselves, even with verbal and physical guidance. Unobtrusive observation of toileting habits indicated that incontinent clients used the toilet less often than continent clients and used more staff assistance to do so. On mental status examination, incontinent clients scored significantly lower than continent clients. Incontinence in this population is a multidimensional disorder in which physical disability is a predominant factor.

Aged↗
PubMed1990

A descriptive analysis of nursing staff behaviors in a teaching nursing home: differences among NAs, LPNs, and RNs.

Various staff behaviors in a nursing home were sampled seven times a day, 5 days a week over 37 months and were coded separately for LPNs, RNs, and NAs. The behavior most frequently observed was patient care, which occurred during 56.9% of the samples. We observed staff interacting with patients during 10.7% and with other staff during 19.5% of the samples. The LPNs displayed significantly more patient care behaviors and NAs significantly more nonwork behaviors than other nursing staff. RNs displayed the least nonwork behavior. We conclude that nursing staff devote most of their time to patient needs and relatively little time to nonproductive activities.

Behavior↗
PubMed1990

Behavioral treatments and pharmacotherapy: acceptability ratings by elderly individuals in residential settings.

We presented residents of a life care community and several nursing homes with written scenarios depicting a 75-year-old woman with a behavior problem. The client in the case varied by cognitive capacity (impaired or intact) and behavior problem (aggression, verbal abuse, or noncompliance). Participants rated three treatments with Kazdin's (1980) Treatment Evaluation Inventory: differential reinforcement of incompatible behavior (DRI), time-out, and haloperidol. All treatments were considered acceptable, and DRI was rated the most acceptable. Ratings for haloperidol and time-out varied by whether the case client was described as demented.

Aged↗
PubMed1990

A staff management system for maintaining improvements in continence with elderly nursing home residents.

We developed a staff management system for maintaining treatment gains achieved on a specialized continence unit located in a geriatric nursing home. Geriatric assistants learned to use a prompted voiding procedure to maintain improved dryness for 4 elderly residents. The staff management system included self-monitoring and recording of prompted voiding activities and supervisory monitoring and feedback based on group performance of these activities. Results show that the system was effective in maintaining prompted voiding activities with corresponding maintenance of improved patient continence. However, a gradual decline in staff performance was noted 4 to 5 months after the initiation of the system. During a subsequent phase of the study, provision of individual feedback restored staff performance to previous levels. Results are discussed in relation to the practicality of prompted voiding interventions in nursing home environments and the applicability of staff management systems in this setting.

Aged↗
PubMed1990

Institutional staff training and management: a review of the literature and a model for geriatric, long-term-care facilities.

In geriatric, long-term-care facilities, nursing assistants (NA) fulfill a primarily custodial function, and the manner in which they interact with patients can reinforce dependent behavior. If the goal of long-term-care is to progress from the custodial model to a therapeutic model of rehabilitation, the role of the NA must be redesigned. Effective training and management systems will be needed to teach new skills and to assure performance of these skills during daily work activities. This article reviews current methods of institutional staff training and management and proposes a model for geriatric, long-term-care facilities. Organizational resistance is discussed, and suggestions are made for enhancing cooperation.

Aged↗
PubMed1989

Behavioral treatments and pharmacotherapy: acceptability ratings for elderly individuals.

Two studies compared acceptability ratings of a positive behavioral treatment (differential reinforcement of incompatible behavior), a mildly aversive behavioral procedure (time-out), and pharmacotherapy used for older adults. In Study 1, college students were presented with descriptions and asked to rate the treatments of case clients who were depicted as either young or elderly, cognitively intact or impaired, and engaging in physical aggression, verbal abuse, or noncompliance. The respondents in Study 2 were adults aged 30-49, and senior center participants aged greater than or equal to 60 who were asked to evaluate only the scenarios involving elderly case clients. The Treatment Evaluation Inventory and a Semantic Differential Scale were used to assess acceptability. Results showed that: (a) college students rated medication higher for elderly case clients, and the behavioral treatments higher when applied with children; (b) adult and elderly respondents assigned the highest acceptability ratings to the differential reinforcement of incompatible behavior procedure, followed by medication and time-out; (c) all respondents assigned differential acceptability ratings depending on the behavior problem described, with more severe problems generally warranting more invasive treatments; (d) acceptability ratings of treatments did not differ as a function of cognitive capacity of case clients. Implications of these results for clinicians employing behavioral interventions with elderly clients are discussed, and suggestions are made for additional research.

Adolescent↗
PubMed1988

Stimulus variation as a means of enhancing punishment effects.

We compared the effects of varied punishers (presentation of one of three available punishers) with the single presentation of one of the punishers on the occurrence of inappropriate behaviors with three developmentally delayed children. Two children were presented with varied-punisher conditions in which either overcorrection, time-out, or a verbal "no" was presented contingent upon inappropiate behavior. A loud noise was substituted for overcorrection for a third child. Results of the multielement with reversal design indicated that both punishment formats produced a decrease in the target behaviors with the varied-punisher format slightly more effective than the single presentations of the punishers. The results suggest the use of varied punishers as a means of enhancing the effects of less intrusive procedures to effectively reduce inappropriate behaviors.

Child↗
PubMed1986

Assessment and treatment of multiple behavior problems exhibited by a profoundly retarded adolescent.

The severe aggression and noncompliance of a profoundly retarded blind male were subjected to extensive behavioral assessment in order to identify controlling variables. The assessment, conducted across settings and therapists, suggested that these inappropriate behaviors functioned to avoid or terminate nonpreferred activities. Intervention consisted of manual guidance when there was noncompliance with instructions and edible reinforcement upon compliance; there were no direct contingencies for the inappropriate behaviors. Treatment procedures were implemented in a multiple baseline design across therapists and settings. Results show that the intervention consistently increased compliance, with concurrent decreases in inappropriate behaviors. Edible reinforcement and neuroleptic medication were withdrawn systematically with no loss of therapeutic gains. Family members and school personnel were trained to use the intervention procedures. Results are discussed in terms of functional assessment, response covariation, compliance training, parent and staff training, and behavioral assessment of the effects of neuroleptic medication.

Adolescent↗
PubMed1986

Behavioral gerontology: application of behavioral methods to the problems of older adults.

Elderly persons are under-represented in research and clinical applied behavior analysis, in spite of data suggesting that behavior problems are quite prevalent in both community dwelling and institutionalized elderly. Preliminary investigations suggest that behavioral procedures can be used effectively in treating various geriatric behavior problems. We discuss a number of areas within behavioral gerontology that would profit from additional research, including basic field study, self-management, community caregiver training, institutional staff training and management, and geriatric behavioral pharmacology. Special considerations for adapting behavioral procedures are discussed, and suggestions for expanding the role of behavior analysis in geriatric care are offered.

Aged↗
PubMed1986

Increasing distance and independence of ambulation in elderly nursing home residents.

We tested the effectiveness of a prompt-and-praise procedure for increasing walking distance and independence in eight nursing home residents. Walking distance and method of ambulation were observed just prior to mealtimes; in addition, mobility and social interaction were time-sampled in the living areas throughout the day. Treatment was lagged in a multiple baseline design across lunch and dinner meals within subjects, and across subjects within each of three units. In the mealtime setting, two subjects began walking the maximum scored distance during baseline; the other six subjects showed a marked increase in walking beginning with the first meal in which the intervention was applied. Six of the eight subjects also progressed to more independent means of ambulation. Generalization of walking to the second meal was observed in all four of the subjects in whom this could be assessed. Generalization across subjects was not observed nor was generalization to the living areas. Staff successfully implemented the procedures in the mealtime settings and the effects were maintained at the 4-month follow-up.

Aged↗
PubMed1986

Behavior therapies for urinary incontinence in the elderly.

Behavior therapies improve continence through systematic changes in environmental conditions. A range of procedures from self-management techniques for cooperative, independent patients to external management by caregivers for patients with significant functional impairment are described. Carefully planned and implemented behavioral interventions have been shown to reduce incontinence in several patient populations.

Aged↗