Encopresis: a medical and family approach.

Bowel control is an important developmental milestone for children. Failure to achieve or loss of bowel control by five years of age threatens both physical and mental health. Most children are successful at achieving bowel control by age four, but up to 3% of the pediatric population suffer from encopresis. Three in-depth case studies were reviewed, including the causes, symptoms, and treatment of this condition, one of which is presented in this article. Results indicate that treatment was successful when a combined approach using medical and behavioral strategies within the context of a developmental model was used. These results can be used by pediatric nurses, nurse practitioners, and pediatricians to assure more children will be identified and obtain the support they need for successful treatment of this complex condition.

Institutional placement of persons with dementia: what predicts occurrence and timing?

The decision to place an individual with dementia in an institutional care facility is often one of the most difficult judgments made in families. The purpose of this study was to determine the key variables that affect the occurrence and timing of institutional placement for families caring for an individual with dementia. The results of this study indicated that the most salient variables affecting the occurrence and timing of institutional placement for persons with dementia were the caregivers' depression scores and the care recipients' behavior change scores over time. These results indicate the need to screen for behavior change in the person with dementia and symptoms of depression in the caregivers to help families predict the need for institutional placement.

Behavioral change in persons with dementia: relationships with mental and physical health of caregivers.

The purpose of this study was to examine the effects that changes in behavioral and psychological symptoms of dementia of persons with Alzheimer's disease have on their caregivers' mental health and physical health. The research design was a prospective, longitudinal follow-up study conducted in a major medical center and in participants' homes. Longitudinal analysis linking change in behavior to caregiver outcomes was based on 64 cases. Care recipients were assessed at the time of diagnosis with the Mini-Mental State Examination (MMSE). To provide information on the care recipient's behaviors, caregivers participated in an interview with the Modified Neuropsychiatric Inventory at diagnosis and at follow-up. Caregivers also completed a battery of established instruments to measure stress appraisal, mental health, and perceptions of their physical health at follow-up. Results showed that increases in problem behaviors among persons living with dementia, along with residence status, were significant predictors of caregivers' mental health and also their physical health. However, these relationships were mediated through stress appraisal. Variables such as MMSE score of the person with dementia, number of years caregiving, relationship status, and education level were not significant predictors of caregivers' health when behavior change was in the model.