Biomedical subjects

M S Marx

Publications and source records attributed to M S Marx.

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↗

PubMed1993

Pain and depression in the nursing home: corroborating results.

The relationship between depressed affect and pain was examined in secondary analysis of data on 408 nursing home residents. Also assessed were cognitive impairment, activities of daily living impairment, quality of social networks, and number of medical diagnoses. Analysis revealed that depressed residents were more likely to have pain, regardless of the presence of cognitive impairment. Multiple regression revealed that depressed affect was predicted by more pain, a greater number of medical diagnoses, and poor quality of the social network. These findings corroborate and extend those from a recent study of nursing home and congregate apartment residents (Parmelee et al., 1991). This corroboration and extension of findings occurred despite differences between the two studies with regard to characteristics of participants (this research included residents with all levels of cognitive impairment, and research by Parmelee et al. excluded those who were too disoriented to respond to questions), type of data collection employed (this research used ratings by professional caregivers whereas research by Parmelee et al. used self-report), and assessment instruments used to tap constructs.

Activities of Daily Living↗

PubMed1993

Restraining cognitively impaired nursing home residents.

Patterns of physical restraint use were measured according to time of day, location on the unit, and persons in the environment on three units of one long-term care facility. An in-depth examination clarifies aspects of temporal, environmental and social conditions under which restraint use typically occurs in cognitively impaired and agitated nursing home residents.

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PubMed1992

Temporal patterns of agitated nursing home residents.

Twenty-four highly agitated, cognitively impaired nursing home residents were studied in depth to determine whether they manifested temporal patterns of agitation. Results demonstrated that agitated behaviors were significantly associated with temporal factors. For instance, residents made more requests for attention during lunch than other time periods, and residents screamed most often during the night. Some agitated behaviors (e.g., aggression) were manifested more frequently in the evening than in the day, consistent with the notion of sundowning in the nursing home. Implications of temporal patterns of agitation for caregivers of severely cognitively impaired and agitated nursing home residents are discussed.

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PubMed1992

Agitation in elderly persons: an integrative report of findings in a nursing home.

Agitated behaviors in the nursing home pose a major problem for caregivers. Our data showed that the three syndromes of agitation--aggressive behaviors, physically nonaggressive behaviors, and verbally agitated behaviors--are differentially related to medical and psychosocial variables. Physically nonaggressive behaviors may be adaptive for a resident who presents a deteriorated stage of dementia, since these behaviors offer stimulation and exercise. Verbally agitated behaviors may be a form of help-seeking behavior for residents with physical disease and depressed affect. Aggressive behaviors are those least understood, although these behaviors correlate with advanced stages of dementia and with poor interpersonal relationships. These findings should be a basis for further studies, with the ultimate goal being improved care for agitated elderly persons.

Activities of Daily Living↗

PubMed1992

The relationship between low vision and performance of activities of daily living in nursing home residents.

OBJECTIVE: To explore the link between low vision and Activities of Daily Living (ADL) performance in cognitively intact nursing home residents. DESIGN: Survey. SETTING: A non-profit geriatric long-term care facility. SUBJECTS: 21 males, 82 females, aged 66-98. MEASURES: Survey of 103 nursing home residents. ADL functioning assessed via Maryland Appraisal of Patient Progress (MAPP); medical data collected through chart review; ophthalmological data obtained through dilated eye examination by an ophthalmologist. RESULTS: In comparison with residents having good vision (n = 52), a significantly greater proportion of residents with low vision (n = 51) were dependent on caregivers for performing ADLs (eg, toileting, transferring, washing). Residents with low vision had significantly more eye pathology (eg, cataracts, age-related macular degeneration) than did residents with good vision. There were no significant differences between groups with regard to presence of musculoskeletal problems (eg, arthritis) or number of medical conditions (eg, cardiovascular disorder, cerebrovascular accident). CONCLUSIONS: There is a strong link between low vision and ADL disability in nursing home residents. Moreover, ADL dependency is significantly related to the presence of eye disorders.

Activities of Daily Living↗

PubMed1992

Observational data on time use and behavior problems in the nursing home.

A 3-month observational study of 24 agitated and severely cognitively impaired nursing home residents was conducted to document the typical ways in which residents spend their time and how time use relates to the manifestation of agitated behaviors. We found that these residents were involved in no activity during 63% of the observations. In addition, residents spent little time in structured activities (e.g., music therapy) or social activities (e.g., receiving visitors). Yet data analysis revealed that residents manifested a greater number of agitated behaviors when they were unoccupied and fewer agitated behaviors when involved in structured or social activities. We discuss implications for caregivers.

Activities of Daily Living↗

PubMed1991

Two studies of pacing in the nursing home.

Two studies concerning pacing by nursing home residents are presented. The first was a cross-sectional survey of 402 residents, which found that 39% of the subjects were pacers. In comparison to residents who did not pace, the pacers had fewer medical diagnoses, better appetites, and had resided in the facility for fewer years. Additionally, pacing was positively related to cognitive impairment and to past life-threatening experiences. Results of the second study, an observational study of six cognitively impaired residents who paced frequently, showed that these residents paced more when the environmental conditions were conducive to pacing (e.g., adequate lighting, enough room within which to pace). We believe that pacing is a reflection of good health within the nursing home population and suggest that caregivers may want to encourage rather than inhibit this behavior in some nursing home residents.

Activities of Daily Living↗

PubMed1990

Visual acuity estimates in noncommunicative elderly persons.

The acuity card procedure has been shown to provide reliable grating acuity estimates in pediatric patients. The current study was conducted to determine the usefulness of this procedure in another group of persons in whom conventional acuity measurements are not possible, ie, nursing home residents who suffer from dementing disorders. Binocular visual acuity estimates were obtained in 13 cognitively impaired nursing home residents. Test sessions took 20-30 min each. Both test-retest agreement and inter-observer agreement of Teller Acuity Card (TAC) acuity estimates were good (within 0.5 octave for all residents), demonstrating that this procedure yields reasonable acuity estimates in noncommunicative nursing home residents. The authors stress the potential of this tool for nursing home administrators as well as for researchers.

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PubMed1990

Dementia and agitation in nursing home residents: how are they related?

The link between agitated behaviors and cognitive functioning in 408 nursing home residents was examined. Results showed that cognitively impaired residents manifested aggressive behaviors (e.g., cursing, hitting) and physically nonaggressive behaviors (e.g., pacing). The highest levels of physically nonaggressive behaviors were manifested by those residents who presented intermediate levels of impairment in their performance of activities of daily living. Cognitively intact residents exhibited verbally agitated behaviors (e.g., complaining). These findings have important implications for caregivers of agitated nursing home residents.

Activities of Daily Living↗

PubMed1990

Screaming in nursing home residents.

This article reports the results of two studies of screaming in the nursing home. The first was a survey study of 408 nursing home residents, which revealed that 25% of the residents screamed at least four times a week. Screaming was associated with cognitive impairment, depressed affect, social networks of poor quality, and severe impairment in the performance of activities of daily living. The second study was an in-depth observational study of five residents who screamed frequently. Residents screamed more often when they were alone in their rooms during the evening hours, suggesting that screaming may arise as a response to social isolation.

Activities of Daily Living↗

PubMed1990

Agitation and falls in institutionalized elderly persons.

The occurrence of falls and the manifestations of three dimensions of agitation (aggressive behaviors, physically nonaggressive behaviors, verbal behaviors) were recorded in 408 nursing home residents during each of the three nursing shifts. Falls occurred most frequently during the busiest shift (the day shift) and least frequently during the night shift when most residents were sleeping and nursing staff were not as busy, a result that confirms previous reports. In comparison to residents who did not fall, residents who fell manifested significantly more physically nonaggressive behaviors, more aggressive behaviors, more verbally agitated behaviors, and overall, a greater total number of agitated behaviors.

Accidental Falls↗

PubMed1989

Full moon: does it influence agitated nursing home residents?

This study examined the effect of the full moon on agitation manifested by nursing home residents (N = 24). Observations of agitation were recorded on a behavioral mapping instrument, and occurrence of the full moon was operationalized in the three ways most commonly cited in the literature. The hypothesis that elderly nursing home residents become increasingly agitated during a full moon was not supported by this study. In all analyses, agitation was observed less often when the full moon was full than during the other three lunar phases, although differences were not statistically significant.

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PubMed1989

The effect of intraocular 6-hydroxydopamine on retinal processing of primates.

In previous studies, we showed that in the monkey, systemically administered N-methyl, 4-phenyl, 1-2-3-6 tetrahydropyridine (MPTP) produces a chronic parkinsonian syndrome accompanied by spatial frequency-dependent abnormalities in both the pattern electroretinogram and visual evoked potential. We describe the effect of intravitreally administered 6-hydroxydopamine (6-OH-DA) on the pattern electroretinogram and pattern visual evoked potential of 3 aphakic monkeys. Because of the aphake condition, several complexities of intravitreal injection of 6-OH-DA could be avoided. Nevertheless, following 6-OH-DA treatment, both the phase and the amplitude of pattern electroretinogram and pattern visual evoked potential became abnormal. This abnormality was most pronounced for the higher spatial frequencies (2.5 and 3.5 cycles per degree), whereas lower spatial frequencies (0.5 and 1.2 cycles per degree) were less impaired. The effects of systemically administered MPTP on pattern electroretinogram and pattern visual evoked potential are similar to the effects of intravitreal injections of 6-OH-DA, suggesting that a retinal catecholaminergic system plays an important role in pattern vision of primates.

Animals↗

PubMed1989

An observational study of agitation in agitated nursing home residents.

Direct observations of 24 highly agitated, cognitively impaired nursing home residents were performed during each hour of the 24-hour day for 2-3 months. Results showed that agitated behaviors (in particular, strange noises, requests for attention, repetitious mannerisms, picking at things, strange movements, and pacing) were manifested at very high frequencies. The data also showed that daytime agitation was positively related to nighttime agitation. Patterns of agitation were specific to each resident, an important finding for future research and intervention.

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PubMed1989

A description of agitation in a nursing home.

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.

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PubMed1989

Physical restraints and agitation in nursing home residents.

An observational study was performed to determine whether the use of physical restraints in agitated nursing home residents leads to decreased or increased agitation. Results indicate that restraint use does not decrease agitation in nursing home residents. Residents exhibited either the same amount or more agitated behaviors when they were restrained than when they were not restrained, suggesting that the act of restraining may itself contribute to manifestations of agitation. The implications of the use of restraints in agitated nursing home residents are discussed, with particular reference to the prevention of falls.

Adult↗

PubMed1989

Do past experiences predict agitation in nursing home residents?

The relationships between the three syndromes of agitated behavior aggressive, physically nonaggressive, and verbally agitated) and three aspects of past personality (exposure to stress, history of a mental disorder, and leisure habits) were examined in 408 nursing home residents. Results showed that residents who had experienced the following stressful events during their lives-a life-threatening experience, separation from spouse, retirement, financial problems, and immigration-exhibited more physically nonaggressive behaviors (such as, pacing). Residents who had not experienced the stressful event of relocation manifested more aggressive (e.g., hitting) and physically nonaggressive behaviors. Neither history of a mental disorder nor past preferences for leisure activities were found to be related to agitated behaviors manifested by nursing home residents. Possible explanations for these results are discussed.

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