Marcia S. Marx

Screaming in Nursing Home Residents

This article reports the results of two studies of screaming in the nursing home. The first was a survey study of 408 nursing home residents, which revealed that 25% of the residents screamed at least four times a week. Screaming was associated with cognitive impairment, depressed affect, social networks of poor quality, and severe impairment in the performance of activities of daily living. The second study was an in‐depth observational study of five residents who screamed frequently. Residents screamed more often when they were alone in their rooms during the evening hours, suggesting that screaming may arise as a response to social isolation.

Physical restraints and agitation in nursing home residents.

An observational study was performed to determine whether the use of physical restraints in agitated nursing home residents leads to decreased or increased agitation. Results indicate that restraint use does not decrease agitation in nursing home residents. Residents exhibited either the same amount or more agitated behaviors when they were restrained than when they were not restrained, suggesting that the act of restraining may itself contribute to manifestations of agitation. The implications of the use of restraints in agitated nursing home residents are discussed, with particular reference to the prevention of falls.

Agitation in elderly persons: an integrative report of findings in a nursing home.

Agitated behaviors in the nursing home pose a major problem for caregivers. Our data showed that the three syndromes of agitation--aggressive behaviors, physically nonaggressive behaviors, and verbally agitated behaviors--are differentially related to medical and psychosocial variables. Physically nonaggressive behaviors may be adaptive for a resident who presents a deteriorated stage of dementia, since these behaviors offer stimulation and exercise. Verbally agitated behaviors may be a form of help-seeking behavior for residents with physical disease and depressed affect. Aggressive behaviors are those least understood, although these behaviors correlate with advanced stages of dementia and with poor interpersonal relationships. These findings should be a basis for further studies, with the ultimate goal being improved care for agitated elderly persons.

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.

An observational study of agitation in agitated nursing home residents.

Direct observations of 24 highly agitated, cognitively impaired nursing home residents were performed during each hour of the 24-hour day for 2-3 months. Results showed that agitated behaviors (in particular, strange noises, requests for attention, repetitious mannerisms, picking at things, strange movements, and pacing) were manifested at very high frequencies. The data also showed that daytime agitation was positively related to nighttime agitation. Patterns of agitation were specific to each resident, an important finding for future research and intervention.

Engagement in Persons With Dementia: The Concept and Its Measurement

PURPOSE 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. SETTING/SUBJECTS The sample included 193 residents of seven Maryland nursing homes. All participants had a diagnosis of dementia. METHODOLOGY The authors describe a model of factors that affect engagement of persons with dementia. Moreover, the authors present the psychometric qualities of an assessment designed to capture the dimensions of engagement (Observational Measurement of Engagement). Finally, the authors detail plans for future research and data analyses that are currently underway. DISCUSSION This article lays the foundation for a new theoretical framework concerning the mechanisms of interactions between persons with cognitive impairment and environmental stimuli. Additionally, the study examines what factors are associated with interest and negative and positive feelings in engagement.

Predictors of Mortality in Nursing Home Residents

A prospective cohort study was conducted to examine predictors of mortality in the nursing home. Participants were 399 long-term nursing home residents, who were followed up for 11 years at the end of which 380 had died, 16 were still alive, 2 were discharged with unknown status, and 1 was alive when discharged. The median duration from baseline to death was 2.75 years. For cognitively intact residents, male gender, larger number of medical diagnoses, and manifestations of physically nonaggressive agitated behaviors (e.g., restlessness, pacing) were significant predictors. For cognitively impaired residents, the significant predictors were older age, impaired activities of daily living, and screaming behavior at a high frequency. Cognitive impairment is important both in predicting death in this population and in understanding the impact of other predictors. The impact of agitated behaviors, quality of social relations, and appetite on mortality highlights issues of quality of life at the end of life.

Observational Data on Time Use and Behavior Problems in the Nursing Home

A 3-month observational study of 24 agitated and severely cognitively impaired nursing home residents was conducted to document the typical ways in which residents spend their time and how time use relates to the manifestation of agitated behaviors. We found that these residents were involved in no activity during 63% of the observations. In addition, residents spent little time in structured activities (e.g., music therapy) or social activities (e.g., receiving visitors). Yet data analysis revealed that residents manifested a greater number of agitated behaviors when they were unoccupied and fewer agitated behaviors when involved in structured or social activities. We discuss implications for caregivers.

Can agitated behavior of nursing home residents with dementia be prevented with the use of standardized stimuli

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

The Relationship between Low Vision and Performance of Activities of Daily Living in Nursing Home Residents

Objective: To explore the link between low vision and Activities of Daily Living (ADL) performance in cognitively intact nursing home residents.