Entity

Time filter

Source Type


Cohen-Mansfield J.,George Washington University | Cohen-Mansfield J.,Tel Aviv University | Jensen B.,Research Institute On Aging Of Charles E Smith Life Communities | Resnick B.,University of Maryland, Baltimore | Norris M.,Texas A&M University
Gerontologist | Year: 2012

Purpose of the study: Behavior problems are common in nursing homes. Current guidelines recommend nonpharmacological interventions (NPHIs) as first-line treatment, but pharmacological regimens (PIs) continue to be used. Given differences in background and training of those who treat behavior problems in residents, we compared attitudes of physicians (MDs), psychologists (PhDs), and nurse practitioners (NPs) concerning PI and NPHI usage as well as knowledge of NPHIs. Design and Methods: One hundred and eight MDs, 36 PhDs, and 89 NPs responded to a web-based questionnaire that captured level of agreement with statements concerning treatment of behavior symptoms and familiarity with NPHIs. Results: NPs were the most favorable toward NPHIs. MDs were significantly more favorable to the use of PIs than were PhDs, with attitudes of NPs falling in between. All felt that NPHI usage should increase and that NPHIs should be implemented before using PIs but also believed that PIs work well for behavior problems. MDs had significantly lower knowledge of NPHIs than PhDs or NPs. Overall, NPHI knowledge was similar for PhDs and NPs, although they differed on their use of specific interventions. Implications: As levels of knowledge and familiarity with NPHIs differed among providers, it is conceivable that all might benefit from training and experience with a wider range of NPHIs. Future studies might evaluate the impact of a uniform understanding of NPHI on communication and teamwork in nursing homes and examine ways to enhance a multidisciplinary approach that would allow for the tailoring and individualization that is required of successful interventions. © The Author 2011. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.


Cohen-Mansfield J.,Research Institute On Aging Of Charles E Smith Life Communities | Cohen-Mansfield J.,Tel Aviv University | Cohen-Mansfield J.,George Washington University | Marx M.S.,Research Institute On Aging Of Charles E Smith Life Communities | And 3 more authors.
American Journal of Geriatric Psychiatry | Year: 2010

OBJECTIVES: To determine which stimuli are 1) most engaging 2) most often refused by nursing home residents with dementia, and 3) most appropriate for persons who are more difficult to engage with stimuli. METHODS: Participants were 193 residents of seven Maryland nursing homes. All participants had a diagnosis of dementia. Stimulus engagement was assessed by the Observational Measure of Engagement. RESULTS: The most engaging stimuli were one-on-one socializing with a research assistant, a real baby, personalized stimuli based on the person's self-identity, a lifelike doll, a respite video, and envelopes to stamp. Refusal of stimuli was higher among those with higher levels of cognitive function and related to the stimulus'social appropriateness. Women showed more attention and had more positive attitudes for live social stimuli, simulated social stimuli, and artistic tasks than did men. Persons with comparatively higher levels of cognitive functioning were more likely to be engaged in manipulative and work tasks, whereas those with low levels of cognitive functioning spent relatively more time responding to social stimuli. The most effective stimuli did not differ for those most likely to be engaged and those least likely to be engaged. CONCLUSION: Nursing homes should consider both having engagement stimuli readily available to residents with dementia, and implementing a socialization schedule so that residents receive one-on-one interaction. Understanding the relationship among type of stimulus, cognitive function, and acceptance, attention, and attitude toward the stimuli can enable caregivers to maximize the desired benefit for persons with dementia. © 2010 American Association for Geriatric Psychiatry.


Cohen-Mansfield J.,Research Institute On Aging Of Charles E Smith Life Communities | Cohen-Mansfield J.,Tel Aviv University | Cohen-Mansfield J.,George Washington University | Thein K.,Research Institute On Aging Of Charles E Smith Life Communities | And 2 more authors.
Journal of the American Medical Directors Association | Year: 2012

Objective: Behavioral symptoms are common in persons with dementia, and nonpharmacological interventions are recommended as the first line of therapy. We describe barriers to conducting nonpharmacological interventions for behavioral symptoms. Design: A descriptive study of barriers to intervention delivery in a controlled trial. Settings: The study was conducted in six nursing homes in Maryland. Participants: Participants were 89 agitated nursing home residents with dementia. Intervention: Personalized interventions were developed using the Treatment Routes for Exploring Agitation decision tree protocol. Trained research assistants prepared and delivered the interventions. Feasibility of the interventions was determined. Measurements: Barriers to Intervention Delivery Assessment, activities of daily living, cognitive functioning, depressed affect, pain, observed agitation, and observed affect. Results: Barriers were observed for the categories of resident barriers (specifically, unwillingness to participate; resident attributes, such as unresponsive), barriers related to resident unavailability (resident asleep or eating), and external barriers (staff-related barriers, family-related barriers, environmental barriers, and system process variables). Interventions pertaining to food/drink and to 1-on-1 socializing were found to have the fewest barriers, whereas higher numbers of barriers occurred with puzzles/board games and arts and crafts activities. Moreover, when successful interventions were presented to participants after the feasibility period, we noted fewer barriers, presumably because barrier identification had been used to better tailor interventions to each participant and to the environment. Conclusion: Knowledge of barriers provides a tool by which to tailor interventions so as to anticipate or circumvent barriers, thereby maximizing intervention delivery. © 2012 American Medical Directors Association, Inc.


Cohen-Mansfield J.,Research Institute On Aging Of Charles E Smith Life Communities | Cohen-Mansfield J.,Tel Aviv University | Cohen-Mansfield J.,George Washington University | Jensen B.,Research Institute On Aging Of Charles E Smith Life Communities | And 2 more authors.
International Journal of Geriatric Psychiatry | Year: 2012

Objective To compare physicians (MDs), psychologists (PhDs), and nurse practitioners (NPs) regarding their approach to dementia-associated behavior problems in nursing home residents. Methods A web-based questionnaire solicited information about symptoms, assessment methods, suspected etiologies, and interventions with respect to the last resident treated for dementia-associated behavior problems. Results Responses were obtained from 108 MDs, 38 PhDs, and 100 NPs. All groups relied similarly on information from the nursing staff, speaking with nursing assistants, and care team meetings in assessment; NPs were more likely to consult with family members. A standard assessment instrument was used most frequently by PhDs (50%), but this generally assessed cognitive status rather than problem behaviors. PhDs most frequently noted depression in residents. Groups were similar in attributing the behavioral symptoms to dementia and to underlying medical conditions, but PhDs were more likely to indicate depression, loneliness/boredom, staff-resident communication, and insufficient activities as etiologies. Use of pharmacological and nonpharmacological interventions of MDs and NPs were similar. PhDs reported least satisfaction with treatment. Conclusion Awareness of similarities and differences in the approaches of different health professionals can facilitate interdisciplinary interaction in providing care for dementia-associated behavior problems in nursing home residents. © 2011 John Wiley & Sons, Ltd.


Cohen-Mansfield J.,Research Institute On Aging Of Charles E Smith Life Communities | Cohen-Mansfield J.,Tel Aviv University | Cohen-Mansfield J.,George Washington University | Dakheel-Ali M.,Research Institute On Aging Of Charles E Smith Life Communities | Frank J.K.,Research Institute On Aging Of Charles E Smith Life Communities
Health Promotion International | Year: 2010

Most older adults prefer to age in place and it is therefore vital to support them in maintaining a high quality of life in their place of residence. Many Naturally Occurring Retirement Communities (NORCs) have implemented services to fulfill a range of needs of their residents. Community Partners (CP) provided 58 NORC residents in six apartment buildings within two suburban neighborhoods in Maryland with health and social work services, activities and transportation services. Participants were compared with 70 residents who did not receive these services. Residents were assessed prior to initiation of services (e.g. transportation, social work and recreation) and after service usage through a membership program. Members had significantly increased satisfaction with recreational activities and social life in the community as well as significant decreases in depressed affect. Members' self-reports showed that they were more likely to get out of the house, felt less isolated, and were happier since joining CP activities. This study is unique in examining the impact of utilization of a variety of services for older persons, while comparing these individuals to a local group of community-dwelling older persons who are without NORC services. © 2010 The Author. Published by Oxford University Press. All rights reserved.

Discover hidden collaborations