Perla Werner

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.

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.

Knowledge about osteoporosis: assessment, correlates and outcomes

During the last 10 years, we have witnessed an impressive increase in the number of studies examining knowledge about osteoporosis. The aim of the present paper is to examine the status of research on knowledge about osteoporosis by reviewing and analyzing the current literature as it pertains to assessment of knowledge about osteoporosis, factors associated with knowledge, and relationship between knowledge about osteoporosis and participation in health-related behaviors. Finally, future directions in the field are discussed. Many of the studies are still characterized by the lack of a theoretical framework, as well as by various methodological flaws. Serious deficits in knowledge are reported among healthy and diagnosed women and men, as well as among health professionals. Educational interventions are accompanied by an increase in knowledge, but no change in behavior. There is need to expand the research on knowledge about osteoporosis, especially in an effort to increase its impact on the prevention and early diagnosis of the disease. The deficits found in the knowledge of both the general population and among health care professionals, should be addressed by providing updated and reliable information through appropriate health promotion and professional venues.

Environmental influences on agitation: An integrative summary of an observational study

This paper consolidates empirical findings from an observational study aimed at elucidating the environmental conditions surrounding the manifestation of agitated behaviors. Although great variability was found between and within participants, when environmental conditions were analyzed separately, different behaviors occurred under different environmental conditions and seem to have different meanings. For example, verbally disruptive behaviors seem to be associated with discomfort. Others, such as requests for attention and aggressive behaviors, may be adaptive, and may signal an attempt to communicate needs. Additionally, certain environmental conditions seem to affect agitation regardless of the specific manifestation, such that most agitated behaviors seem to increase when the resident is physically restrained, inactive, or alone.

Self-stigma, self-esteem and age in persons with schizophrenia

BACKGROUND The relationship between self-stigma and self-esteem in patients with schizophrenia is receiving increased attention. However, studies to date have been limited to samples of persons under the age of 65. AIM To examine the relationship between self-stigma and self-esteem in people with schizophrenia in both younger and older age groups. METHODS Face-to-face interviews were completed with 86 inpatients with schizophrenia in a psychiatric hospital (mean age = 54, 55% female). Self-esteem was assessed using Rosenbergs Self Esteem Scale. Self-stigma was assessed using an adapted version of the Internalized Stigma of Mental Health (ISMI) scale. Information regarding socio-demographic characteristics and psychiatric history and symptomatology was collected. RESULTS Self-stigma was moderate with only 20-33% of the participants reporting high levels of stigmatization. Older participants reported lower levels of self-stigma than younger participants. A relatively strong association between self-stigma and self-esteem was found. CONCLUSIONS The findings point to the complexity of the association between self-stigma, self-esteem and age in people with schizophrenia. This study stresses the importance of clinicians taking the issue of self-stigma into consideration when treating young and old patients with schizophrenia.

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.

Individualized Care Alternatives Used in the Process of Removing Physical Restraints in the Nursing Home

To describe the individualized care alternatives used during the process of removing physical restraints in a nursing home.

Early onset dementia: clinical and social aspects.

BACKGROUND Increasing efforts are being devoted to the study of early onset dementia (EOD), namely dementia in persons under the age of 65. Until recently, it was assumed that dementia occurs primarily among people aged 65 and over. However, since the number of persons with EOD is increasing, its importance as a clinical and social problem is rising accordingly. The aim of the present paper is to summarize research in this area. METHODS We reviewed the research published to date on EOD, and divided the current body of knowledge into several main sections. RESULTS The first section focuses on clinical aspects and summarizes findings regarding prevalence, causes, symptoms, diagnosis, and management of persons with EOD. The second section focuses on social aspects related to the cost of care for young people with the disease, the challenges faced by individuals and caregivers, and the services available for this population. Finally, conclusions and future directions are suggested. CONCLUSIONS Research on EOD is still in its early stages. There is an urgent need to expand research that will lead to more effective diagnosis and management of EOD as well as to the allocation of funds and the development of appropriate services suitable for the unique needs of young people with dementia.