Correlates of disruptive behavior in severely cognitively impaired nursing home residents.

This article provides information about correlates of "disruptive behaviors" among nursing home residents with dementia. We used averages of multiple observations for a wide range of behaviors (n = 45) across 11 months to gather this information. We placed behaviors into four separate categories: physically aggressive, physically non-aggressive, vocally agitated, and vocally aggressive. Then, we tested associations between these categories and demographic, cognitive, and health variables. Cognitive status and selected demographic variables were associated with the behavior categories; adding health variables did not improve prediction. Lower cognitive status was associated with more disruptive behaviors. Our findings suggest that cognitive status, but not health variables, predicts disruptive behavior among nursing home residents with dementia.

Confusion.

The term confusion describes a plethora of possible cognitive deficits and behavioral manifestations. A subjective assessment of confusion must be followed by an objective systematic evaluation to develop the cognitive-behavior profile. Because of age-associated physiologic and pathologic changes, elderly patients are at high risk for developing acute confusion. The management of confusion presents a challenge to nursing. Nursing can play a significant role in the prevention and the early detection of acute confusion. Preventing or identifying confusion early will decrease the physical and psychological stress of the patient as well as decrease the cost of hospitalization by shortening length of stay. Additional research is needed to determine the efficacy of present nursing activities and to identify new approaches for management.

Family caregiver stress: clinical assessment and management.

This intervention study compares the effectiveness of two approaches on caregiving stress reduction. Caregivers' psychobiological symptom experience and coping were profiled over time by identifying the types of stress-related symptoms most frequently experienced. Following pretesting (and selected matching procedures) using family functioning, coping, stress and mental status instruments, random assignment of caregivers was made to one of four groups: educative/didactic, psychotherapeutic/support, placebo, or control. Patients were tested at the end of eight weekly 2-hour sessions and again at 1-, 3-, 6-, and 12-month intervals after treatment. Although both the educative and psychotherapeutic groups were effective interventions for the reduction of strain, the psychotherapeutic/support group was the most effective over time, both at posttest and at the 3-month intervals. Neither group intervention was more effective than the control groups in reducing other types of stress, including anxiety, somatization, or depression. The psychobiological symptoms experienced by caregivers peaked at crisis periods in the caregiving trajectory, or when multiple demands were made of the caregiver during any one point in time.