Kimberly Van Haitsma

Psychometric Characteristics of the Minimum Data Set II: Validity

OBJECTIVE: To determine the validity of the Minimum Data Set (MDS).

God help me: II. The relationship of religious orientations to religious coping with negative life events.

This is the second in a series of investigations into the role of religion in the coping process. This study examined the relationship of intrinsic, extrinsic, and quest religious orientations to religious and nonreligious coping with a significant negative life event in a sample of 538 mainstream Christian church members. As predicted, each orientation was associated with a different way of coping with specific life problems. When coupled with the results in the first of this series of studies, these findings suggest that religious coping efforts might bridge the general religious orientation of the individual to the outcomes of critical life events. They point to the importance of the workings of religion in specific life situations.

Resident-to-Resident Aggression in Nursing Homes: Results from a Qualitative Event Reconstruction Study

PURPOSE Despite its prevalence and negative consequences, research on elder abuse has rarely considered resident-to-resident aggression (RRA) in nursing homes. This study employed a qualitative event reconstruction methodology to identify the major forms of RRA that occur in nursing homes. DESIGN AND METHODS Events of RRA were identified within a 2-week period in all units (n = 53) in nursing homes located in New York City. Narrative reconstructions were created for each event based on information from residents and staff who were involved as well as other sources. The event reconstructions were analyzed using qualitative methods to identify common features of RRA events. RESULTS Analysis of the 122 event reconstructions identified 13 major forms of RRA, grouped under five themes. The resulting framework demonstrated the heterogeneity of types of RRA, the importance of considering personal, environmental, and triggering factors, and the potential emotional and physical harm to residents. IMPLICATIONS These results suggest the need for person-centered and environmental interventions to reduce RRA, as well as for further research on the topic.

New Toolkit to Measure Quality of Person-Centered Care: Development and Pilot Evaluation With Nursing Home Communities

BACKGROUND Increasingly, nursing home (NH) providers are adopting a person-centered care (PCC) philosophy; yet, they currently lack methods to measure their progress toward this goal. Few PCC tools meet criteria for ease of use and feasibility in NHs. The purpose of this article is to report on the development of the concept and measurement of preference congruence among NH residents (phase 1), its refinement into a set of quality indicators by Advancing Excellence in Americas Nursing Homes (phase 2), and its pilot evaluation in a sample of 12 early adopting NHs prior to national rollout (phase 3). The recommended toolkit for providers to use to measure PCC consists of (1) interview materials for 16 personal care and activity preferences from Minimum Data Set 3.0, plus follow-up questions that ask residents how satisfied they are with fulfillment of important preferences; and (2) an easy to use Excel spreadsheet that calculates graphic displays of quality measures of preference congruence and care conference attendance for an individual, household or NH. Twelve NHs interviewed residents (N = 146) using the toolkit; 10 also completed a follow-up survey and 9 took part in an interview evaluating their experience. RESULTS NH staff gave strong positive ratings to the toolkit. All would recommend it to other NHs. Staff reported that the toolkit helped them identify opportunities to improve PCC (100%), and found that the Excel tool was comprehensive (100%), easy to use (90%), and provided high quality information (100%). Providers anticipated using the toolkit to strengthen staff training as well as to enhance care planning, programming and quality improvement. CONCLUSIONS The no-cost PCC toolkit provides a new means to measure the quality of PCC delivery. As of February 2014, over 700 nursing homes have selected the Advancing Excellence in Americas Nursing Homes PCC goal as a focus for quality improvement. The toolkit enables providers to incorporate quality improvement by moving beyond anecdote, and advancing more systematically toward honoring resident preferences.

Friendships among people with dementia in long-term care

Despite the growing literature on social interactions in dementia settings, few studies have investigated ‘friendships’ in people with dementia living in long-term care. ‘Social interactions’ describe communicating, verbally and/or non-verbally, at least once with another person while ‘friendship’ suggests a deeper, more meaningful connection that may include reciprocity, intimacy, and shared trust. During a 6-month, mixed-methods study, we investigated friendships among 31 assisted living residents with moderate to advanced dementia. Results revealed no correlation between test scores or demographic characteristics (except gender) and friendship dyads identified by staff. Staffs’ perceptions of residents’ friendships were not supported through our observations. We did observe friendships among residents characterized by voluntary participation and accommodation in conversation, and recognition of the uniqueness of the other. Findings suggest staff perceptions of residents’ friendships are not sufficient and that more research on this topic is needed.

BE-ACTIV for Depression in Nursing Homes: Primary Outcomes of a Randomized Clinical Trial

OBJECTIVES To report the primary outcomes of a cluster randomized clinical trial of Behavioral Activities Intervention (BE-ACTIV), a behavioral intervention for depression in nursing homes. METHOD Twenty-three nursing homes randomized to BE-ACTIV or treatment as usual (TAU); 82 depressed long-term care residents recruited from these nursing homes. BE-ACTIV participants received 10 weeks of individual therapy after a 2-week baseline. TAU participants received weekly research visits. Follow-up assessments occurred at 3- and 6-month posttreatment. RESULTS BE-ACTIV group participants showed better diagnostic recovery at posttreatment in intent-to-treat analyses adjusted for clustering. They were more likely to be remitted than TAU participants at posttreatment and at 3-month posttreatment but not at 6 months. Self-reported depressive symptoms and functioning improved in both groups, but there were no significant treatment by time interactions in these variables. DISCUSSION BE-ACTIV was superior to TAU in moving residents to full remission from depression. The treatment was well received by nursing home staff and accepted by residents. A large proportion of participants remained symptomatic at posttreatment, despite taking one or more antidepressants. The results illustrate the potential power of an attentional intervention to improve self-reported mood and functioning, but also the difficulties related to both studying and implementing effective treatments in nursing homes.

Assessing neuropsychiatric symptoms in people with dementia: A systematic review of measures

BACKGROUND Neuropsychiatric symptoms (NPS) occur in people with dementia throughout disease course and across etiologies. NPS are associated with significant morbidities and hastened disease processes. Nevertheless, people with dementia are not systematically assessed for NPS in clinical settings. We review existing NPS measures for clinical and/or research purposes, and identify measurement gaps. METHODS We conducted a computerized search of peer-reviewed published studies of measures (January 1, 1980-December 1, 2013) using multiple search terms. Measures selected for review were in English, had adequate psychometric properties, and were developed for or used with people with dementia. Papers describing measures were evaluated by three coders along seven characteristics: behavioral domains, number of items, method of administration, response categories, targeted population, setting, and psychometric properties. RESULTS Overall, 2,233 papers were identified through search terms, and 36 papers from manual searches of references. From 2,269 papers, 85 measures were identified of which 45 (52.9%) had adequate psychometric properties and were developed or used with dementia populations. Of these, 16 (35.6%) were general measures that included a wide range of behaviors; 29 (64.4%) targeted specific behaviors (e.g. agitation). Measures differed widely as to behaviors assessed and measurement properties. CONCLUSIONS A robust set of diverse measures exists for assessing NPS in different settings. No measures identify risk factors for behaviors or enable an evaluation of the context in which behaviors occur. To improve clinical efforts, research is needed to evaluate concordance of behavioral ratings between formal and informal caregivers, and to develop and test measures that can identify known risks for behaviors and the circumstances under which behaviors occur.

R-E-M psychotherapy: A manualized approach for long-term care residents with depression and dementia

ABSTRACT Although depression and dementia are common comorbid illnesses among long-term care residents, psychotherapeutic services for these individuals have not been tailored for their particular needs and circumstances. In this article we present a new model for brief individual psychotherapy-Restore, Empower, Mobilize, or R-E-M-to treat depression in long-term care residents who have mild to moderate dementia. R-E-M treatment has three goals: (1) restore self-esteem and support a positive self-concept, (2) empower residents to make use of their existing abilities, and (3) mobilize residents and the environment to achieve and maintain long-term mental health. We describe the interventions of R-E-M treatment, the construction of a treatment manual, and a pilot evaluation of the treatment with three nursing home residents. Positive outcomes in the pilot have encouraged us to pursue additional treatment development and evaluation. Standardized treatments, such as R-E-M, that yield measurable gains are needed to ensure that long-term care residents with depression and dementia receive the mental health services they require and deserve.

Increasing Pleasant Events in the Nursing Home Collaborative Behavioral Treatment for Depression

Depression is prevalent in nursing homes, but there are many barriers to effective treatment in these settings. This case study describes a successful behavioral treatment of a nursing home resident with recurrent major depression. The 10-session, manualized program involved negotiating a weekly plan to systematically increase pleasant activities, administered collaboratively with nursing home staff. At baseline, the client was socially withdrawn, participated in no regular activities, did not leave her room except for therapies, and was tearful and apathetic. Treatment outcomes included markedly improved positive affect and increased activity level at posttreatment, and absence of depressive symptoms or diagnosis at both posttreatment and after a 12-week follow-up. The case illustrates barriers to successful treatment in nursing homes such as ongoing medical stressors, poor staff follow-through, and difficulty maintaining gains, but it also supports the potential of a theoretically based, behavioral approach to treating depression in long-term care

The Prevalence of Resident-to-Resident Elder Mistreatment in Nursing Homes

Growing indirect evidence suggests that verbal and physical conflict between nursing home residents may be a large and pervasive problem. Media coverage regularly documents serious assaults of nursing home residents by other residents (13). The only empirical study of cases of physical aggression between nursing home residents (4) included cases reported to a state ombudsman program over 1 year. Although this was an important early contribution to the field, the cases were not systematically identified by using research methods. No study has used standardized and validated case-finding methodology expressly developed for estimating the prevalence of resident-to-resident elder mistreatment (R-REM) in the nursing home; indeed, a recent systematic review on the topic concluded that individual studies could not produce a prevalence rate on the basis of their design, nor could the results be meaningfully pooled because of heterogeneity (5). We provide prevalence estimates from what we believe is the first large-scale, systematic study of R-REM in the nursing home. Our goal was to estimate the prevalence of R-REM, including verbal, physical, and sexual mistreatment, and examine the prevalence according to location and timing of events and patient-, environment-, and facility-level characteristics. Methods Definition of R-REM The following definition guided the gold-standard consensus classification in adjudicating R-REM caseness (Supplements 1 and 2): Negative and aggressive physical, sexual, or verbal interactions between long-term care residents that in a community setting would likely be construed as unwelcome and have high potential to cause physical or psychological distress in the recipient. Supplement. Supplementary Material Study Design This was an observational prevalence study. The protocol was reviewed and approved by the institutional review board at Weill Cornell Medical College. Study Population Recruitment of Facilities Twelve nursing homes in New York state were selected at random by using a pseudo-random number generator procedure; 6 were selected from among the 21 nursing homes with 250 or more beds in urban regions, and 6 from among the 13 large nursing homes (200 or more beds) in suburban regions. Facilities were offered incentives for participation: a