Jiska Cohen-Mansfield

..Behavioral symptoms are common in persons with dementia, and nonpharmacological interventions are recommended as the first line of therapy. We describe barriers to conducting nonpharmacological interventions for behavioral symptoms...

..Engagement refers to the act of being occupied or involved with an external stimulus. In dementia, engagement is the antithesis of apathy...

..Alternately, it can be used in the aggregate as a guideline for designing programs of care to reflect the preferences of a majority of older persons...

..Self-care preferences can be used in designing programs of care. Yet little has been documented concerning the self-care habits and preferences of older adults...

..This study investigated the temporal pattern of agitated behaviors in nursing home residents with dementia and compared it with temporal patterns of pleasure, interest in the environment, and sleep...

..The results present a methodology that caregivers can use to increase the detection of pain in persons with dementia, enabling them to treat it more effectively, and thereby improve life quality for dementia patients...

..The results also suggest that addressing patient mental health variables may be important in delaying institutionalization in this population...

..The objective of this study was to examine the efficacy of a systematic algorithm for providing individualized, nonpharmacological interventions for reducing agitated behaviors in nursing home residents with dementia...

..The paper seeks thereby to operationalize those aspects of the nursing home practice style that can be improved...

..This information could be useful in developing forums for communication among the professionals to enhance mutual understanding...

..A case study demonstrates the efficacy of this approach in reducing agitated behaviors during bathing...

..1995 and Resnick et al., 2000). We aimed to validate the models with data from a different sample, and to examine whether any of these models explained a greater proportion of the variance in exercise behavior in this population...

..There was no effect on agitation. Incorporating prior preferences into care routines can contribute to the quality of life of dementia patients...

..The framework is rooted in a cognitive-behavioral theory that conceptualizes behaviors as resulting from an interaction of cognitive processes and environmental events...

..Flexibility is an essential ingredient of person-centered care. We illustrate the potential impact of flexibility by portraying a nursing home that uses flexibility in its approach to residents and staff members...

..The results of this study clarify the complexity of factors affecting the decision-making process and suggest a methodology that may assist in discerning those factors in the future...

..The experimental treatment had effects that were superior to those of the nonexperimental activities. The results highlight the powerful roles that perception of self and fulfillment of self-identity play in overall well-being...

..We describe the validation of an informant-based pain assessment for persons suffering from dementia called Pain Assessment in Noncommunicative Elderly persons (PAINE) using 2 different samples...

..Results suggest that a multimethod type assessment may be needed to effectively manage pain...

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..To examine how presentation of different stimuli impacts affect in nursing home residents with dementia...

..To compare physicians (MDs), psychologists (PhDs), and nurse practitioners (NPs) regarding their approach to dementia-associated behavior problems in nursing home residents...

..These findings have direct implications for the way in which caregivers could structure the environment in the nursing home and how they could present stimuli to residents in order to optimize engagement in persons with dementia...

..Interventions that involve objects or tasks with meaning specific to the person with dementia will be more likely to engage that person. Future research could explore more identity roles as well as other mechanisms affecting engagement...

..To determine which stimuli are 1) most engaging 2) most often refused by nursing home residents with dementia, and 3) most appropriate for persons who are more difficult to engage with stimuli...

..This study is unique in examining the impact of utilization of a variety of services for older persons, while comparing these individuals to a local group of community-dwelling older persons who are without NORC services...

..We examined engagement with stimuli in 193 nursing home residents with dementia. We hypothesized that activities and stimuli based on a person's past and current preferences would result in more engagement than other activities/stimuli...

..Nursing home residents rarely get the opportunity or venue to discuss these topics and the ethical will enables them to have conversations about issues they feel are important...

..Because of its strong significance within the baseline predictors, the meaning of depressed affect and why it was such a potent predictor of nursing home entry, yet still not reported by caregivers, should be studied further...

..The aim of this article is to delineate the underlying premises of the concept of engagement in persons with dementia and present a new theoretical framework of engagement...

..There are many ways to implement system evaluations. However, the use of electronic-based records increases the likelihood of maintaining and utilizing the system...

..To examine the impact of personal attributes on engagement in persons with dementia...

..To describe physicians' perceptions of their role in treating the behavior problems associated with dementia that commonly occur in the nursing home, both the way it is currently and the way they think it should be...

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..The effect of material and color was not statistically significant. These findings may assist nursing home caregivers who wish to provide appropriate stimuli for engaging nursing home residents with dementia...

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..The purpose of this study is to characterize the dressing activity of daily living (ADL) of nursing home residents suffering from dementia and thereby identify ways to improve the dressing process...

..These results validate and expand prior cross-sectional research on the correlates of aggression in other populations, and guide in the development of interventions...

..To examine preferences concerning social and environmental aspects of exercise in the elderly population...

..The goal of the proposed study was to clarify how advance directives are summarized in the patient's record and to clarify how physicians perceive the same advance directives and formal orders...

..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...

..Future research should clarify what proportion of symptoms currently identified as psychotic are attributable to related etiologies...

..This paper describes the medical decision-making process at the time of status change events in the nursing home...

..To date, little research attention has been given to the degree to which these two methods converge...

..This study examined the reliability and validity of geriatricians' assessments of pain in cognitively impaired nursing home residents...

..Troubled breathing emerges as an end-of-life symptom for many residents. An analysis of the decision-making process and its evaluation could foster improved care of these symptoms...

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..Different indicators provided best utility depending on the criterion applied...

..The case study illustrates how self-identity can change throughout dementia, and how it can be utilized to improve quality of life...

..This study addressed that issue by examining the effects of discontinuing treatment with haloperidol, thioridazine, and lorazepam among residents of a large suburban nursing home...

..The process for identifying and analyzing status-change events in the nursing home requires several steps and much persistence...

..Despite this high prevalence, significant underuse of hearing aids or other assistive devices exists, especially among those with dementia...

..Nursing staff members' ratings of pain were correlated with residents' level of cognitive functioning and with intake of pain medication. The results underscore the difficulty in assessing pain in those with severe cognitive impairment...

..The paper delineates some of the steps that are needed to move toward a more appropriate treatment of persons with dementia who manifest behavior problems...

..The clinicians felt that with appropriate systemic change many behavior problems can be either prevented or treated effectively by nonpharmacological means...

..The present study was conducted to examine the robustness of two major syndromes, verbal agitation and physical non-aggressive agitation, as assessed via direct observations...

..Understanding the past and present self-identities of persons with diminished cognitive abilities is crucial in the effort to provide individualized care and enhance participant experiences...

..Knowledge of sleep habits and preferences is important so that it can be taken into account by those responsible for planning care for older adults or for aiding their adaptation to a new setting...

..We investigated the feasibility of using a "wash-and-dry" toilet in the nursing home...

..The goal of this study was to describe bathing, toileting, and mouth care habits and preferences of older persons, as well as the importance of such habits...

..The results represent preliminary data concerning decision-making processes surrounding death of the cognitively-impaired in the nursing home. Additional research is needed to elucidate the trends uncovered in this study...

..This study examined barriers to hearing aid use among persons who were reported to have a hearing aid and among those reported to have hearing difficulties but no hearing aids...

..There is a need for future policy development to improve both the quality of hearing aids and the financial mechanisms that will allow nursing home residents to use them. Plans to move the policy agenda forward are suggested...

..We found differences across professional groups in recommended improvements, a finding that suggests the importance of interdisciplinary communication and developing an integrated viewpoint in optimizing care for older persons...

..This study examines (a) whether loneliness increases with age, (b) characteristics of the lonely older population, and (c) predictors of becoming lonely in old age...

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..To assess the relative effect of different types of stimuli on agitated behaviors of nursing home residents with dementia...

..CONCLUSIONS. Although the specific models need validation using larger samples, they demonstrate a method that facilitates transfer of information concerning treatment preferences if future incapacitation occurs...

..We examine the relationship between the perceived needs and assessed needs of community-dwelling seniors...

..Human and live stimuli resulted in significantly more engagement than their counterparts. Giving any social stimulus to the residents is preferable to providing none, and the social attributes of stimuli should be maximized...

..To assess nursing home physicians' and social workers' perceptions of the new Maryland Patient Plan of Care Form (PPOC)...

..To provide further empirical evaluation of the effectiveness of animal-assisted therapy in nursing home residents with dementia...

..Given the centrality of the MDS in the U.S. as a tool for clinical decision-making in long-term care, there seems to be an urgent need to improve either the MDS pain assessment tools or the procedures used for completing them...

..However, relative's pain ratings are only useful when relatives visit regularly. Like other informants, relatives have more difficulty rating pain when the resident is severely cognitively impaired...

..The importance of being aware of self-care changes lies in the value of maintaining continuity with the customary preferences and routines of the older person...

..To determine correlates of hoarding behavior in frail elderly persons...

..This paper reports on a survey documenting physicians' assessment of current levels of care in the nursing home and of the importance and feasibility of strategies to improve care...

..Consistencies that deserve further research pertain to the perceptions of the types of vocalizations the person tends to emit and to the physical health of the person...

..Knowledge of changes in self-care routines can be used to guide interventions to bring past and current practices into greater concordance...

..Interacting with the cats was linked with decreased agitation and increased pleasure and interest. The study is intended to pave the way for future research on robotherapy with nursing home residents...

..CONCLUSIONS: Dental problems are underdetected and undertreated in the nursing home. Better training for non-dentists in detection of such problems and better reimbursement for dental care are needed to improve care of residents...

..The authors' major point is that effective nonpharmacologic interventions are available for a variety of behavioral problems that are commonly observed in long-term care settings...

..In 2005, the FDA issued a black box warning regarding increased risk of mortality associated with the use of atypical antipsychotic drugs in this patient population...

..The authors tested the CMAI factor structure by use of data from three samples of nursing home patients categorized a priori as having at least mild behavioral and psychological symptoms of dementia...

..The impairment-impact assessment facilitates creating individualized exercise prescriptions for individuals with impairments...

..To assess the incidence of and factors related to nondisabled but functionally limited older adults aged 75 to 85 years losing the ability to walk 400 m...

..Results are discussed in the context of theories of cognitive reserve...

..Clear guidance on the management of DLB is urgently needed. Virtually unrecognised 20 years ago, DLB could within this decade be one of the most treatable neurodegenerative disorders of late life...

..PHS 398 (Rev. 05/01) Page 2 Principal Investigator/Program Director (Last, first, middle): Cohen-Mansfield, Jiska ..

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..In that way, it presents an exciting prospect for improving the quality of life in demented persons, thereby reducing their caregivers' burden. ..

..The quality of life agitated nursing home residents, residents who are exposed to the agitation, and nursing home caregivers would thereby be improved. ..

..The proposed study will address some of these issues...