Toward holistic theory-based intervention for dementia behavior.

Four million Americans suffer from some form of dementia. Over 50% of these individuals exhibit behaviors that are perceived as "disturbing" by family and caregivers. The Need-driven Dementia-compromised Behavior Model was developed by a group of nurse researchers to study and understand these behaviors. The model changes the view of dementia behaviors as "disturbing" to that of behavior as signifying potentially understandable needs. This article reviews the model and demonstrates how interventions derived from the model can be used to respond to dementia behaviors in a holistic fashion.

A Nightingale-based model for dementia care and its relevance for Korean nursing.

This article addresses the synchrony between a Western middle-range theory of care for persons with dementia and traditional Korean nursing care. The Western theory is called a need-driven, dementia-compromised behavior model and is heavily influenced by the assessment categories outlined in Nightingale's work. This model is presented as congruent with Nightingale's work and then viewed from the perspective of traditional Korean nursing. Several congruencies and a few incongruencies are found between these Western and Eastern views, and suggestions are made for greater consistency between these views.

The plight of the elderly in managed care systems.

Are we in danger of knowing the cost of everything and the value of nothing? The historical values of nursing such as compassion, patient advocacy, tolerance for others, and providing help for the less able all appear to be in danger of being cast out and replaced by an extreme view of cost-effectiveness. Are elders to be seen as a commodity to be used and discarded when they displease those who are currently fit and powerful? Is nursing's emerging view one that advocates for insurance companies? This is a troubling idea, because nursing's social contract with society was and is based on other historical values. Surely the early values of insurance to share the risk and provide humane care will serve to influence our obligation to senior citizens. Recently, a Wall Street Journal article suggested the need for public disclosure to oversee the quality of managed care. It is hoped that a spectrum of societal values will be used to judge the quality of such care for older populations.

Life-span perspective of personality in dementia.

PURPOSE: To propose an alternative view of personality change in dementia by presenting existing evidence for the continuity of personality. SIGNIFICANCE: As the population continues to age, dementing illnesses will account for a greater proportion of morbidity and mortality; the care of these people will have a significant effect on the health care system. ORGANIZING FRAMEWORK: Life-span perspective of personality continuity. SCOPE METHOD: Review of current literature on personality in dementia using Medline, 1980-1994; CINAHL, 1990-1994; and Psych Lit., 1980-1994. FINDINGS: Although there are systematic shifts in personality with dementia, individuals tend to maintain their unique pattern of premorbid personality traits. CONCLUSIONS: The personalities of dementia patients seem to reflect adaptive patterns that served them in the past. IMPLICATIONS: Use of a life-span perspective can enhance individualized care for demented patients and advance theory development.

Behavioral analysis and nursing interventions for reducing disruptive behaviors of patients with dementia.

In this study, two cases were used to examine the potential of behavioral analysis as an intervention to decrease disruptive behaviors of institutionalized individuals with dementia. Behavioral modeling was used to teach the principles of behavioral analysis. The nurses observed a behavior change plan implemented by the investigator, revised the plan based on behavioral analysis techniques, and subsequently implemented the revised behavioral strategies. The patients' disruptive behaviors decreased markedly when the behavioral intervention was implemented. Patients resumed disruptive behaviors when care was provided without the behavioral plan. The findings suggest the need to address interventions in nursing research, education, and practice that use behavioral analysis to reduce disruptive behaviors in individuals with dementia.

Interdisciplinary team training in geriatrics: reaching out to small and medium-size communities.

Since 1989, six teams in the state of Michigan have been involved in a team training program designed to promote the development of geriatric services in small to medium-size communities. The program was enthusiastically received by participants, but after 18 months, only half of the teams had implemented clinical services for older adults. Monitoring the progress of the teams over 18 months and analyzing the activities of two teams revealed that financially stable and supportive sponsoring agencies and the community were critical factors in the implementation of interdisciplinary clinical services in geriatrics. Future team training programs trying to promote the development of geriatric services in small to medium-size communities should try to address these issues through community organization interventions.