PURPOSE: The purpose of this study was to investigate if pain mediates or moderates the relationship between cognitive impairment and aggressive behaviors in nursing home residents with dementia based on the Need-driven Dementia-compromised Behavior model. METHODS: This was a secondary analysis of the Minimum Data Set assessment data on long-term care from the state of Florida during calendar year 2009. The data used in this study was the first comprehensive assessment data from residents with dementia (N = 56,577) in Medicare-certified or Medicaid-certified nursing homes. Path analysis using a series of hierarchical regression analyses and two-way analysis of variance was used to evaluate the mediating and moderating effect of pain on the relationship between the level of cognitive impairment and aggression. RESULTS: Results indicated that pain did not mediate the relationship between cognition and aggressive behaviors, but there was evidence of a significant moderating effect of pain only for residents with severe cognitive impairment. Only among the residents with severe cognitive impairment, those with pain had significantly more frequent aggressive behaviors than those without pain. CONCLUSION: A change in the frequency of aggressive behaviors in severely cognitively impaired residents should signal the possibility that the person is experiencing pain. Accurate but simple pain assessment in this population including these behavioral changes should be developed further, and pain should be well controlled to reduce these problematic behaviors.
Aged ; Aged, 80 and over ; *Aggression ; Cognition Disorders/*complications/psychology ; Dementia/*complications/psychology ; Female ; Florida ; Humans ; Long-Term Care ; Male ; Nursing Homes ; Pain/*complications/psychology ; Pain Measurement/methods ; Self Report ; *Social Behavior

PURPOSE: The purpose of the study was to explore and describe the experience of adult Korean children who are caregivers for parents institutionalized with dementia. METHODS: Participants were fourteen adult children caregivers of elders institutionalized with dementia. Data were collected through in-depth unstructured interviews with individual participants from August to November, 2012. Theoretical sampling was used to the point of theoretical saturation. Data were analyzed using Strauss and Corbin's Grounded Theory Method. RESULTS: From open coding, 67 concepts, 29 sub-categories, and 14 categories were identified. Analysis revealed that the core category of the experience of adult children caring for their parents institutionalized with dementia was 'enduring the role of a prop' consisting of four phases: initial turmoil, exploration, role adjustment, and acclimation. To manage the role of a prop, participants utilized various action/interactional strategies such as overcoming the unfamiliarity, overseeing the nursing home care, and counterbalancing the caring roles. As a result, participants experienced ambivalence towards the existence of parents with dementia, changes in family relationships, altered viewpoint towards nursing homes, and restructuring of life. CONCLUSION: In-depth understanding of the experience will guide nurses to promote effective interventions in order to better support the Korean family caregivers of parents institutionalized with dementia.
Adaptation, Psychological ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Caregivers/*psychology ; Dementia/*nursing ; Family Relations ; Humans ; Interviews as Topic ; Middle Aged ; Nursing Homes ; Parents/psychology ; Quality of Life ; Republic of Korea

PURPOSE: This study was conducted to explore the impact of registered nurse/nurses' aid (RN/NA) staffing and turnover rate on inpatient health outcomes in long term care hospitals. METHODS: A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals in October-December 2010 and hospital general characteristics in July-September 2010. Final analysis of data from 610 hospitals included RN/NA staffing, turnover rate of nursing staff and 5 patient health outcome indicators. RESULTS: Finding showed that, when variables of organization and community level were controlled, patients per RN was a significant indicator of decline in ADL for patients with dementia, and new pressure ulcer development in the high risk group and worsening of pressure ulcers. Patients per NA was a significant indicator for new pressure ulcer development in the low risk group. Turnover rate was not significant for any variable. CONCLUSION: To maintain and improve patient health outcomes of ADL and pressure ulcers, policies should be developed to increase the staffing level of RN. Studies are also needed to examine causal relation of NA staffing level, RN staffing level and patient health outcomes with consideration of the details of nursing practice.
Activities of Daily Living ; Dementia/physiopathology ; Humans ; Inpatients/*psychology ; Long-Term Care ; National Health Programs ; Nursing Staff, Hospital/psychology/*statistics & numerical data ; Personnel Turnover ; Pressure Ulcer/etiology ; *Quality Indicators, Health Care ; Risk Factors

PURPOSE: The purpose of the study was to understand and describe the overcoming experiences of family members caring for elderly patients with dementia at home. METHODS: Data came from autobiographies on the overcoming experiences of caregiving from 31 participants, who had submitted the autobiographies to a public contest held by the Seoul Metropolitan Center for Dementia in 2012. Data were analyzed using qualitative content analysis. RESULTS: Four overcoming stages emerged from the analysis: confronting stage; challenging stage; integrating stage; and transcendental stage, representing transformation of experiences from frustration and suffering to happiness and new hope in life. The confronting stage illustrates severe negative feelings and exhaustion occurring after the diagnosis of dementia. The challenging stage signifies major driving forces in taking good care of their patients. It includes tender loving memories about the patients as well as family and social supports. The integrating stage shows genuine empathy for the patients' situation and the happiness of 'here and now', while the transcendental stage represents new hope in the future. CONCLUSION: Health professionals need to support caregivers to find true meaning of caring and happiness in everyday life, while providing specific information on dementia care and relieving various negative feelings.
*Adaptation, Psychological ; Caregivers/*psychology ; Dementia/*nursing ; Family Relations ; Female ; Home Nursing ; Humans ; Male ; Stress, Psychological ; Writing

PURPOSE: The purpose of this study was to explore characteristics of eating behavior according to level of functional status of elders with dementia (EWD), and to examine feeding time, change in food intake and body mass index (BMI) according to eating behavior. METHODS: Participants were 149 EWD residing in long-term care facilities located in Seoul or Gyeonggi province and evaluated using the Mini-Mental State Exam-Korean version, Korean version-Activities of Daily Living, and Eating Behavior Scale (EBS). Feeding time, change in food intake, and BMI were also measured. Data were analyzed using SPSS 17.0, specifically descriptive statistics, ANOVA, and Chi-square test. RESULTS: Participants' mean EBS score was 10.43+/-6.01 and half of them (54.4%) needed moderate or total assistance while eating. The EBS score was significantly lower for elders with severe dementia compared to those with mild or moderate dementia; and elders with severe ADL dependence compared to those with mild or moderate ADL dependence. Lower EBS scores were related to longer feeding time, a greater the rate of participants with decreased food intake and 'underweight' BMI. CONCLUSION: Nursing intervention programs which are designed for EWD are needed to maintain functional eating skills and prevent negative consequences in this population.
Aged ; Aged, 80 and over ; Body Mass Index ; Dementia/*psychology ; Eating ; *Feeding Behavior ; Female ; Humans ; Long-Term Care ; Male ; Nursing Homes ; Time Factors

PURPOSE: The purpose of the study was to examine the effects of multisensory stimulation (MSS) using familiarity on persons with dementia (PWDs) residing in nursing homes in Korea. METHODS: A nonequivalent control group with pre and posttests was used. Fifty one PWDs were included if they: 1) were over 65 yr old, 2) were diagnosed with dementia, 3) had no visual or speech impairments, 4) were able to communicate, and 5) had spent more than one month in a nursing home. The experimental group (n=25) received a 55 min MSS program twice a week for 10 weeks. The outcome variables included were cognition, activities of daily living, grip strength, depression, wandering, and aggressive behaviors. Repeated ANOVA was used for data analysis. RESULTS: There were no significant differences in demographics or the main variables at pretest. Cognition, depression, wandering, and aggressive behaviors were significant over time between the two groups. Grip strength was only significant when accounting for interaction between group and time. CONCLUSION: An intervention of MSS using familiarity was marginally effective in improving cognition, depression, wandering, and aggression. Future study is suggested with a larger sample and longer treatment to retest the effects of MSS.
Aged ; Aged, 80 and over ; Aggression ; Analysis of Variance ; Cognition ; Dementia/*nursing/psychology ; Demography ; Depression ; Female ; Humans ; Long-Term Care ; Male ; Program Evaluation ; *Recognition (Psychology) ; Republic of Korea ; Wandering Behavior

PURPOSE: This study was a qualitative research study in which focus group interviews were used to collect data on the meaning of respite for family caregivers who are taking care of elders with dementia. METHODS: The focus group interviews and participants consisted of 2 family caregiver groups, for a total of 8 people taking care of their elders and 5 professional caregivers working in a geriatrics hospital or social welfare institutions. Content analysis was used and debriefing notes were referred in order to analyze the data. RESULTS: The meaning of respite in this research was measured using 4 main categories: 'Temporary break from routine', 'direct help', 'psychological comfort', 'valuables which cannot be taken easily' and 9 subcategories: 'Temporary diversion of attention', 'temporarily free from my duty', 'taking care of oneself', 'receiving economic help', 'empathize with others', 'comfort based on trust', 'resting together with the elder', 'no time to rest', 'cannot get out of one's obligatory duty'. CONCLUSION: The findings of the study show that rest means not only a temporary relief from caretaking, but also a real respite based on the patients' stable state and comfort. These results indicate a new meaning for respite, that the first step of respite program has to begin even when the caregivers do not recognize the need for respite.
Adult ; Aged ; Caregivers/*psychology ; Dementia/*nursing ; Family ; Female ; Geriatric Nursing ; Home Nursing ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Nurse-Patient Relations ; *Respite Care

INTRODUCTIONThis study aims to validate the Zarit Burden Interview as an instrument to measure the level of burden experienced by caregivers of patients with dementia (PWD) in Singapore.

MATERIALS AND METHODSAdult family caregivers of PWD were recruited from the ambulatory dementia clinic of a tertiary hospital and the Alzheimer's Disease Association. All subjects completed a battery of questionnaires which consisted of demographic questions and the following instruments: the Zarit Burden Interview (ZBI), Burden Assessment Scale (BAS), General Health Questionnaire (GHQ-28), Dementia Management Strategies Scale (DMSS), and the Revised Memory and Behaviour Problems Checklist (RMBPC). A subgroup of subjects also completed the ZBI for the second time 2 weeks after the fi rst survey.

RESULTSA total of 238 subjects completed the survey. As hypothesised, the Zarit burden score was strongly correlated with BAS, GHQ-28, DMSS, and RMBPC scores (Pearson's correlation coefficient: 0.53 to 0.73); caregivers who undertook the major role in caregiving, had spent >1 year in caregiving, or experienced financial problems had higher Zarit burden scores than those who were not main carers, with ≤1 year of caregiving, or reported no/minimal financial problems, respectively. The Cronbach's alpha value for the ZBI items was 0.93; the intra-class correlation coefficient for the test-retest reliability of the Zarit burden score was 0.89 (n = 149).

CONCLUSIONThe results in this study demonstrated that the Zarit Burden Interview is a valid and reliable instrument for measuring the burden of caregivers of PWD in Singapore.

Adult ; Caregivers ; psychology ; Cost of Illness ; Dementia ; nursing ; Female ; Humans ; Interview, Psychological ; methods ; standards ; Male ; Middle Aged ; Psychiatric Status Rating Scales ; standards ; Stress, Psychological ; diagnosis ; ethnology

PURPOSE: The purpose of the study was to identify functional structure and patterns of dialogue sequence in conversations between elderly patients with dementia and nurses in a long-term care facility. METHODS: Conversation analysis was used to analyze the data which were collected using video-camera to capture non-verbal as well as verbal behaviors. Data collection was done during February 2005. RESULTS: Introduction, assessment, intervention, and closing phases were identified as functional structure. Essential parts of the conversation were the assessment and intervention phases. In the assessment phase three sequential patterns of nurse-initiated dialogue and four sequential patterns of patient-initiated dialogue were identified. Also four sequential patterns were identified in nurse-initiated and three in patient-initiated dialogues in the intervention phase. In general, "ask question", "advise", and "directive" were the most frequently used utterance by nurses in nurse-initiated dialogue, indicating nurses' domination of the conversation. At the same time, "ask back", "refute", "escape", or "false promise" were used often by nurses to discourage patients from talking when patients were raising questions or demanding. CONCLUSION: It is important for nurses to encourage patient-initiated dialogue to counterbalance nurse-dominated conversation which results from imbalance between nurses and patients in terms of knowledge and task in health-care institutions for elders.
Aged ; Aged, 80 and over ; *Communication ; Dementia/*psychology ; Female ; Humans ; Long-Term Care ; Male ; Nurse-Patient Relations ; Nursing Methodology Research ; Video Recording

PURPOSE: This study investigated various factors relatied to wandering behavior of Korean elders with dementia (KED). METHODS: A sample of 160 ambulatory residents with dementia from 14 long term care facilities was used to examine demographic, individual, cognitive, physical health, and environmental characteristics by comparing wanderers (N=108) to nonwanders (N=52). Subjects were evaluated by Korean versions of the Mini-mental State Exam (K-MMSE), the Physical and Instrumental Activities of Daily Living (K-PIADL), and the Revised Algase Wandering Scale Nursing Home version (KRAWS-NH) along its six dimensions. Demographic and environmental data were also obtained. Independent sample ttests, Chi-square test, Fisher's Exact tests, and ANCOVAs were used to examine differences between wanderers and nonwanders. RESULTS: Wanderers were significantly (p<.05) older and had more limitations in K-PADL and K-IADL. The degree of overall wandering and certain features of wandering were significantly different (p<.05) by total number of residents in the facility, type of bedroom (i.e., "Ondol"), and color of bedroom and living-room walls (i.e., sky blue). CONCLUSIONS: Findings of this study may be useful in understanding wandering behavior of KEDs and thus developing more culturally specific management strategies.
Activities of Daily Living ; Aged ; Aged, 80 and over ; Dementia/*psychology ; Demography ; Female ; Homes for the Aged ; Humans ; Korea ; Male ; Middle Aged ; Nursing Homes ; *Wandering Behavior