Aims: We examined whether Dementia Care Mapping (DCM) or the VIPS practice model (VPM) is more ef... more Aims: We examined whether Dementia Care Mapping (DCM) or the VIPS practice model (VPM) is more effective than education of the nursing home staff about dementia (control group) in reducing agitation and other neuropsychiatric symptoms as well as in enhancing the quality of life among nursing home patients. Methods: A 10-month three-armed cluster-randomized controlled trial compared DCM and VPM with control. Of 624 nursing home patients with dementia, 446 completed follow-up assessments. The primary outcome was the change on the Brief Agitation Rating Scale (BARS). Secondary outcomes were changes on the 10-item version of the Neuropsychiatric Inventory Questionnaire (NPI-Q), the Cornell Scale for Depression in Dementia (CSDD) and the Quality of Life in Late-Stage Dementia (QUALID) scale. Results: Changes in the BARS score did not differ significantly between the DCM and the control group or between the VPM and the control group after 10 months. Positive differences were found for cha...
The aims of this study were to describe the pain and use of pain medication in nursing home patie... more The aims of this study were to describe the pain and use of pain medication in nursing home patients and examine which variables that were associated with pain. Inpatients (n = 307) older than 64 years from nursing homes were included. Pain was measured with a 4-point verbal rating scale in the self-reported group (SRG) and Doloplus-2 in the proxy-rated group (PRG). The mean age was 86 years (SD, 7), and more than two-thirds were female. A total of 128 (60%) patients were able to self-report their pain. Approximately 50% of the SRG reported 'pain now', and of these, nearly 50% reported moderate or severe pain intensity. Better cognitive function was associated with higher pain and receiving more potent pain medication in the SRG. The pain prevalence in the PRG was higher than in the SRG (67.5% vs 51%), but no variable was associated with proxy-rated pain. Nearly 30% in the SRG and 40% in the PRG did not receive pain medication in spite of pain. Pain is still a huge problem in the nursing homes, and more research is needed on pain management in nursing home residents.
Psychiatric symptoms and behavioral disturbances are highly prevalent in the residents of nursing... more Psychiatric symptoms and behavioral disturbances are highly prevalent in the residents of nursing homes. The Neuropsychiatric Inventory (NPI) is a commonly used scale for the assessment of such symptoms in diverse settings. We have conducted a study of the reliability and the validity of the Norwegian version of the NPI nursing home version (NPI-NH). The reliability study comprised 41 patients. We established inter-rater reliability between raters with various levels of health education using kappa statistics. Fifty patients were included in the validity study. The patients were examined by a physician, who also rated the patient's behavior using "behavioral pathology in Alzheimer's disease" (BEHAVE-AD). Subsequently, a research nurse performed a standardized interview using the NPI and the Cornell scale. Concurrent validity of the NPI and the BEHAVE-AD was analyzed. Internal consistency, as measured by Cronbach's alpha was above 0.8. Inter-rater reliability was, except for one item, between 0.85 and 1.0 across assessors with different levels of health education. All correlations between the NPI and the BEHAVE-AD were significant, ranging from 0.38 to 0.72. The weakest correlations were between items assessing affective and anxiety symptoms. The Norwegian version of the NPI-NH is a reliable and valid instrument for assessing psychiatric symptoms and behavioral disturbances in the residents of nursing homes. The investigation of depressive symptoms merits particular attention.
Agitation and aggression are prevalent in dementia and put heavy strains on caregivers. Validated... more Agitation and aggression are prevalent in dementia and put heavy strains on caregivers. Validated assessment tools measuring these symptoms are required to evaluate patients before therapy and during the follow-up period. Given the daily routine in nursing homes, abbreviated instruments are preferable. The Brief Agitation Rating Scale (BARS) is a short form of the Cohen-Mansfield Agitation Inventory. Our aim was to examine the Norwegian version of the BARS by performing a factor analysis. The data came from 1,870 nursing home patients. The primary caregivers were interviewed by research nurses using the Clinical Dementia Rating Scale, Lawton's Physical Self-Maintenance Scale and the BARS. The exploratory factor analysis of the BARS revealed 3 dimensions: physically aggressive behavior, physically nonaggressive behavior and verbal agitation. Linear regression analysis showed that reduced functioning in activities of daily living was associated with physically aggressive behavior and verbal agitation, whereas increased severity of dementia and better functioning in activities of daily living were related to physically nonaggressive behavior. In addition, verbal agitation was positively related to a higher number of drugs being taken per day. The factor analyses confirmed that the Norwegian version of the BARS measures the clinically relevant dimensions of agitation in dementia.
The aims of this study were to describe the pain and use of pain medication in nursing home patie... more The aims of this study were to describe the pain and use of pain medication in nursing home patients and examine which variables that were associated with pain. Inpatients (n = 307) older than 64 years from nursing homes were included. Pain was measured with a 4-point verbal rating scale in the self-reported group (SRG) and Doloplus-2 in the proxy-rated group (PRG). The mean age was 86 years (SD, 7), and more than two-thirds were female. A total of 128 (60%) patients were able to self-report their pain. Approximately 50% of the SRG reported 'pain now', and of these, nearly 50% reported moderate or severe pain intensity. Better cognitive function was associated with higher pain and receiving more potent pain medication in the SRG. The pain prevalence in the PRG was higher than in the SRG (67.5% vs 51%), but no variable was associated with proxy-rated pain. Nearly 30% in the SRG and 40% in the PRG did not receive pain medication in spite of pain. Pain is still a huge problem in the nursing homes, and more research is needed on pain management in nursing home residents.
Aims: We examined whether Dementia Care Mapping (DCM) or the VIPS practice model (VPM) is more ef... more Aims: We examined whether Dementia Care Mapping (DCM) or the VIPS practice model (VPM) is more effective than education of the nursing home staff about dementia (control group) in reducing agitation and other neuropsychiatric symptoms as well as in enhancing the quality of life among nursing home patients. Methods: A 10-month three-armed cluster-randomized controlled trial compared DCM and VPM with control. Of 624 nursing home patients with dementia, 446 completed follow-up assessments. The primary outcome was the change on the Brief Agitation Rating Scale (BARS). Secondary outcomes were changes on the 10-item version of the Neuropsychiatric Inventory Questionnaire (NPI-Q), the Cornell Scale for Depression in Dementia (CSDD) and the Quality of Life in Late-Stage Dementia (QUALID) scale. Results: Changes in the BARS score did not differ significantly between the DCM and the control group or between the VPM and the control group after 10 months. Positive differences were found for cha...
The aims of this study were to describe the pain and use of pain medication in nursing home patie... more The aims of this study were to describe the pain and use of pain medication in nursing home patients and examine which variables that were associated with pain. Inpatients (n = 307) older than 64 years from nursing homes were included. Pain was measured with a 4-point verbal rating scale in the self-reported group (SRG) and Doloplus-2 in the proxy-rated group (PRG). The mean age was 86 years (SD, 7), and more than two-thirds were female. A total of 128 (60%) patients were able to self-report their pain. Approximately 50% of the SRG reported 'pain now', and of these, nearly 50% reported moderate or severe pain intensity. Better cognitive function was associated with higher pain and receiving more potent pain medication in the SRG. The pain prevalence in the PRG was higher than in the SRG (67.5% vs 51%), but no variable was associated with proxy-rated pain. Nearly 30% in the SRG and 40% in the PRG did not receive pain medication in spite of pain. Pain is still a huge problem in the nursing homes, and more research is needed on pain management in nursing home residents.
Psychiatric symptoms and behavioral disturbances are highly prevalent in the residents of nursing... more Psychiatric symptoms and behavioral disturbances are highly prevalent in the residents of nursing homes. The Neuropsychiatric Inventory (NPI) is a commonly used scale for the assessment of such symptoms in diverse settings. We have conducted a study of the reliability and the validity of the Norwegian version of the NPI nursing home version (NPI-NH). The reliability study comprised 41 patients. We established inter-rater reliability between raters with various levels of health education using kappa statistics. Fifty patients were included in the validity study. The patients were examined by a physician, who also rated the patient's behavior using "behavioral pathology in Alzheimer's disease" (BEHAVE-AD). Subsequently, a research nurse performed a standardized interview using the NPI and the Cornell scale. Concurrent validity of the NPI and the BEHAVE-AD was analyzed. Internal consistency, as measured by Cronbach's alpha was above 0.8. Inter-rater reliability was, except for one item, between 0.85 and 1.0 across assessors with different levels of health education. All correlations between the NPI and the BEHAVE-AD were significant, ranging from 0.38 to 0.72. The weakest correlations were between items assessing affective and anxiety symptoms. The Norwegian version of the NPI-NH is a reliable and valid instrument for assessing psychiatric symptoms and behavioral disturbances in the residents of nursing homes. The investigation of depressive symptoms merits particular attention.
Agitation and aggression are prevalent in dementia and put heavy strains on caregivers. Validated... more Agitation and aggression are prevalent in dementia and put heavy strains on caregivers. Validated assessment tools measuring these symptoms are required to evaluate patients before therapy and during the follow-up period. Given the daily routine in nursing homes, abbreviated instruments are preferable. The Brief Agitation Rating Scale (BARS) is a short form of the Cohen-Mansfield Agitation Inventory. Our aim was to examine the Norwegian version of the BARS by performing a factor analysis. The data came from 1,870 nursing home patients. The primary caregivers were interviewed by research nurses using the Clinical Dementia Rating Scale, Lawton's Physical Self-Maintenance Scale and the BARS. The exploratory factor analysis of the BARS revealed 3 dimensions: physically aggressive behavior, physically nonaggressive behavior and verbal agitation. Linear regression analysis showed that reduced functioning in activities of daily living was associated with physically aggressive behavior and verbal agitation, whereas increased severity of dementia and better functioning in activities of daily living were related to physically nonaggressive behavior. In addition, verbal agitation was positively related to a higher number of drugs being taken per day. The factor analyses confirmed that the Norwegian version of the BARS measures the clinically relevant dimensions of agitation in dementia.
The aims of this study were to describe the pain and use of pain medication in nursing home patie... more The aims of this study were to describe the pain and use of pain medication in nursing home patients and examine which variables that were associated with pain. Inpatients (n = 307) older than 64 years from nursing homes were included. Pain was measured with a 4-point verbal rating scale in the self-reported group (SRG) and Doloplus-2 in the proxy-rated group (PRG). The mean age was 86 years (SD, 7), and more than two-thirds were female. A total of 128 (60%) patients were able to self-report their pain. Approximately 50% of the SRG reported 'pain now', and of these, nearly 50% reported moderate or severe pain intensity. Better cognitive function was associated with higher pain and receiving more potent pain medication in the SRG. The pain prevalence in the PRG was higher than in the SRG (67.5% vs 51%), but no variable was associated with proxy-rated pain. Nearly 30% in the SRG and 40% in the PRG did not receive pain medication in spite of pain. Pain is still a huge problem in the nursing homes, and more research is needed on pain management in nursing home residents.
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