Barbara Jensen

The Preference and Importance of Bathing, Toileting and Mouth Care Habits in Older Persons

Purpose: 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. Design and Methods: Fifty-eight community-dwelling older persons were administered the Self-maintenance Habits And Preferences in Elderly questionnaire (SHAPE) during a one-on-one interview with a research assistant. Preferences were described by frequency distributions and mean importance for each item was calculated. Gender differences in preferences were examined using χ2 analyses, t tests were used to compare importance levels. Results: Women reported spending a longer time bathing, they were more likely to have privacy while bathing, to use a washcloth, a regular size towel, and less likely to use a large towel than were men. One-third of the women reported using some type of absorbent undergarment, while no men did so. Mouth care was the category that received the highest importance ratings. Although order of importance of items was similar across genders, women assigned higher levels of importance to these items than did men. Importance ratings given to atypical habits, such as unusually long or more than 1 bath/day, were higher than those attributed to more usual habits. Implications: Knowledge of the range and importance of such self-care practices can provide information useful in the development of programs and for individualized care.

An analysis of the relationships among engagement, agitated behavior, and affect in nursing home residents with dementia

BACKGROUND Affect, behavior, and cognition can be considered as basic constructs that dictate human functioning, with intricate and bi-directional relationships among them. Prior to the present study, relationships among these constructs have not been systematically examined within the context of dementia. METHODS Sample 1 contained 185 nursing home residents with a diagnosis of dementia. Sample 2 contained 117 residents with dementia, all of whom manifested agitated behaviors. Outcome measures included stimulus engagement (assessed via the Observational Measure of Engagement), affect (measured using Lawtons Modified Behavior Stream), and agitation/problem behavior (recorded via the Agitated Behaviors Mapping Instrument). Real time direct observations were collected during both stimulus presentation and control conditions. RESULTS The relationship of engagement with positive affect, represented by the variables of interest and pleasure, were high and positive. No relationship emerged for engagement with negative affect or agitated behavior. A consistent positive relationship was found between agitated behavior and negative affect, and in Sample 2, a negative relationship between agitated behavior and both pleasure and interest. CONCLUSION This is the first study to examine relationships among variables that are typically examined individually and, in doing so, has clarified the nomenclature used to describe the constructs of affect, engagement, and agitated behaviors in persons with dementia. The finding that the constructs of engagement, agitated behavior, and affect are multidimensional and that relationships among these constructs occur for some of the dimensions is important for the development of interventions and for clear communication in practice and research.

Knowledge of and Attitudes Toward Nonpharmacological Interventions for Treatment of Behavior Symptoms Associated With Dementia: A Comparison of Physicians, Psychologists, and Nurse Practitioners

PURPOSE OF THE STUDY Behavior problems are common in nursing homes. Current guidelines recommend nonpharmacological interventions (NPHIs) as first-line treatment, but pharmacological regimens (PIs) continue to be used. Given differences in background and training of those who treat behavior problems in residents, we compared attitudes of physicians (MDs), psychologists (PhDs), and nurse practitioners (NPs) concerning PI and NPHI usage as well as knowledge of NPHIs. DESIGN AND METHODS One hundred and eight MDs, 36 PhDs, and 89 NPs responded to a web-based questionnaire that captured level of agreement with statements concerning treatment of behavior symptoms and familiarity with NPHIs. RESULTS NPs were the most favorable toward NPHIs. MDs were significantly more favorable to the use of PIs than were PhDs, with attitudes of NPs falling in between. All felt that NPHI usage should increase and that NPHIs should be implemented before using PIs but also believed that PIs work well for behavior problems. MDs had significantly lower knowledge of NPHIs than PhDs or NPs. Overall, NPHI knowledge was similar for PhDs and NPs, although they differed on their use of specific interventions. IMPLICATIONS As levels of knowledge and familiarity with NPHIs differed among providers, it is conceivable that all might benefit from training and experience with a wider range of NPHIs. Future studies might evaluate the impact of a uniform understanding of NPHI on communication and teamwork in nursing homes and examine ways to enhance a multidisciplinary approach that would allow for the tailoring and individualization that is required of successful interventions.

Self-maintenance Habits and Preferences in Elderly (SHAPE): reliability of reports of self-care preferencesi n older persons

Background and aims: 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. Methods: This study assessed the reliability of reports of self-care preferences and their importance among older adults using the Self-maintenance Habits and Preferences in Elderly (SHAPE) instrument. Twenty community- dwelling seniors completed the SHAPE questionnaire twice within a one- to two-week interval. Percent agreement, both exact and close/partial, was computed to assess the reliability of preference content, and intra-class correlations (ICCs) were used for preference importance. Test and subject factors affecting reliability were also investigated. Results: Exact agreement rate for item content was 73%, and that for close/partial agreement was 93%. Mean ICC for item importance was 0.72. Reliability was greater for dichotomous items than for either ordinal or categorical questions. Reliability of item content varied with number of response options and importance reliability varied with age and IADL status. Conclusions: Information from SHAPE about self-care preferences can be used to plan services for seniors and to individualize care for older persons, especially those transitioning to new living environments or those receiving home care.

Assessment and treatment of behavior problems in dementia in nursing home residents: a comparison of the approaches of physicians, psychologists, and nurse practitioners

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

Do interventions bringing current self-care practices into greater correspondence with those performed premorbidly benefit the person with dementia? A pilot study.

This article assessed whether bringing current self-care practices into greater correspondence with those performed before the onset of dementia benefits the dementia patient. Participants were 20 nursing home residents with dementia, their spouses, and nursing assistants. Past and current self-care routines were determined by proxy responses of spouses and nursing assistants, respectively, using the Self-maintenance Habits and Preferences in Elderly questionnaire. Interventions were proposed based on current practices that were inconsistent with those practiced in the past and that had been important to residents. Residents showed engagement with the interventions, as these resulted in significantly more positive than negative or neutral responses. There was no effect on agitation. Incorporating prior preferences into care routines can contribute to the quality of life of dementia patients.

Sources of Discomfort in Persons With Dementia

Author Contributions: Study concept and design: All authors. Acquisition of data: Abbo, Beekmann, Polgreen. Analysis and interpretation of data: All authors. Drafting of the manuscript: Abbo, Beekmann, Hooton. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Beekmann. Obtained funding: Hooton, Polgreen. Administrative, technical, and material support: Beekmann, Polgreen. Study supervision: Abbo, Hooton, Polgreen.

Changes in Habits Related to Self-care in Dementia: The Nursing Home Versus Adult Day Care

Little is known about the changes that occur for older persons with dementia in the practice of self-care routines. This study assesses the concordance of past and current self-care practices of day care and nursing home persons using spouse reports, the degree of spouse awareness of these changes, and spouse perception of how important self-care practices had been to their partner. Participants were spouses of 12 older persons with dementia in day care and spouses of 20 nursing home residents. Self-care routines were assessed using the Self-maintenance Habits and Preferences in Elderly (SHAPE) questionnaire. Day care attendees showed few changes in self-care routines compared to nursing home residents. Spouses of nursing home residents underestimate the changes in self-care that occur with nursing home admission. 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.

Sleep-related habits and preferences in older adults: a pilot study of their range and self-rated importance.

This article explores the sleep-related habits of older persons, as well as the level of importance they assign to these practices. A convenience sample of 58 community-dwelling seniors responded to sleep-related items from the Self-Maintenance Habits and Preferences in Elderly questionnaire. Sleep practices varied greatly across individuals, but did not show much systematic difference between men and women. However, as with many health care issues, women rated them as more important than did men. 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.

Intergenerational Programs in Schools: Prevalence and Perceptions of Impact.

This study examined the prevalence, types, and perceived impact of intergenerational programs in schools. Programs involving senior volunteers assisting children, or children participating in activities with older people were considered. Of the schools reached, 47% reported intergenerational programming. Thirty-three schools in the Tel-Aviv region participated in the study. Data were collected from 85 seniors, 26 teachers, and 20 coordinators. Assessments included program characteristics, program preparation, and perceived benefits and difficulties. Both programs were reported to have beneficial effects for seniors and to benefit children in the academic, social, and emotional domains. However, programs appeared to attract different types of volunteers and different degrees of volunteer commitment. Findings suggest that there is a need to pay additional attention to both participants’ specific requests and needs and to the allocation of resources to improve the design and implementation of intergenerational programs.