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.     

Maintaining ambulation in the frail nursing home resident: a nursing administered walking program

This article describes a walking program that was implemented at a 550-bed long-term care facility. The program was developed in order to promote functional mobility in the frail nursing home population. The aim of the program is to establish a nursing procedure that focuses on the individual resident's need to walk, and to improve or maintain the ambulatory status of the frail elderly. Twenty nursing home residents from the first three units on which the program was implemented were evaluated before and after the implementation of the program. The data show that the participants improved their ambulatory status after participating in the walking program. This improvement was accompanied by a decrease in the proportion of residents falling.     

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.     

Longitudinal prescribing patterns of psychotropic drugs in nursing home residents.

Changes in the use of psychotropic drugs in a large nursing home were examined both in terms of usage for the total facility and in longitudinal changes within individuals. Data for the nursing home showed a gradual increase in use of antidepressants; a decrease in use of antianxiety medications and of sedative-hypnotics. Changes in the number of residents prescribed antipsychotics were not marked. Data within residents showed a great variability in number of psychotropic drugs used, in number of changes in dosage, and in specific patterns of medication change. The first drug change after admission (excluding day of admission) was more likely to involve initiation rather than discontinuation of psychotropic drugs. The medications studied were used over 4–7 months on the average, covering 20–30% of the resident's nursing home stay. The findings suggest that there is continued monitoring of psychotropic medications in the nursing home. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multilingualism and cognitive state in the oldest old.

In this study, the authors examined whether the number of languages a person speaks predicts performance on 2 cognitive-screening tests. Data were drawn from a representative sample of the oldest Israeli Jewish population (N = 814, M age = 83.0 years; SD = 5.4) that was interviewed first in 1989 and then twice more within the following 12 years. Cognitive state differed significantly among groups of self-reported bilingual, trilingual, and multilingual individuals at each of the 3 interview waves. Regression analyses showed that the number of languages spoken contributed to the prediction of cognitive test scores beyond the effect of other demographic variables, such as age, gender, place of birth, age at immigration, or education. Multilingualism was also found to be a significant predictor of cognitive state in a group of individuals who acquired no formal education at all. Those who reported being most fluent in a language other than their mother tongue scored higher on average than did those whose mother tongue was their best language, but the effect of number of languages on cognitive state was significant in both groups, with no significant interaction. Results are discussed in the context of theories of cognitive reserve. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characteristics of adult day care participants who enter a nursing home.

The authors sought to determine the characteristics of individuals enrolled in adult day care who are most likely to enter a nursing home. The status of 201 adult day care participants was assessed at baseline and at least 3 years after baseline evaluation. Risk factors for nursing home entry were identified on the basis of staff and family caregiver reports, participant testing, chart review, and physician evaluations. Cox regression analyses of baseline data such as medical diagnoses, affect, and demographic information were used to identify risk factors for institutionalization. Multivariate Cox regression analysis identified depressed affect of the care recipient as an important predictor of institutionalization; other predictors were low frequency of socializing with relatives and friends, higher number of psychiatric diagnoses, and increased age. The findings highlight the importance of socialization and suggest that a focus on successful and reinforcing socialization should be an important component of adult day care programming. The results also suggest that addressing patient mental health variables may be important in delaying institutionalization in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.