Hostname: page-component-76fb5796d-qxdb6 Total loading time: 0 Render date: 2024-04-29T22:00:27.681Z Has data issue: false hasContentIssue false
  • English
  • Français

An analysis of the relationships among engagement, agitated behavior, and affect in nursing home residents with dementia

Published online by Cambridge University Press:  06 January 2012

Jiska Cohen-Mansfield ,
Maha Dakheel-Ali ,
Barbara Jensen ,
Marcia S. Marx  and
Khin Thein
Jiska Cohen-Mansfield*
Affiliation:
Innovative Aging Research, Silver Spring, MD, USA George Washington University Medical Center, Washington, DC, USA Tel-Aviv University's, Herczeg Institute on Aging and Sackler Faculty of Medicine, Tel-Aviv, Israel
Maha Dakheel-Ali
Affiliation:
Innovative Aging Research, Silver Spring, MD, USA
Barbara Jensen
Affiliation:
Innovative Aging Research, Silver Spring, MD, USA
Marcia S. Marx
Affiliation:
Innovative Aging Research, Silver Spring, MD, USA
Khin Thein
Affiliation:
Innovative Aging Research, Silver Spring, MD, USA
*
Correspondence should be addressed to: Jiska Cohen-Mansfield, Innovative Aging Research, 807 Horton Drive, Silver Spring, MD 20902, USA. Phone: +301-649-3416; Fax: +301-649-4957. Email: InnovAgingRes@gmail.com.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Affect, behavior, and cognition can be considered as basic constructs that dictate human functioning, with intricate and bi-directional relationships among them. Prior to the present study, relationships among these constructs have not been systematically examined within the context of dementia.

Methods: Sample 1 contained 185 nursing home residents with a diagnosis of dementia. Sample 2 contained 117 residents with dementia, all of whom manifested agitated behaviors. Outcome measures included stimulus engagement (assessed via the Observational Measure of Engagement), affect (measured using Lawton's Modified Behavior Stream), and agitation/problem behavior (recorded via the Agitated Behaviors Mapping Instrument). Real time direct observations were collected during both stimulus presentation and control conditions.

Results: The relationship of engagement with positive affect, represented by the variables of interest and pleasure, were high and positive. No relationship emerged for engagement with negative affect or agitated behavior. A consistent positive relationship was found between agitated behavior and negative affect, and in Sample 2, a negative relationship between agitated behavior and both pleasure and interest.

Conclusion: This is the first study to examine relationships among variables that are typically examined individually and, in doing so, has clarified the nomenclature used to describe the constructs of affect, engagement, and agitated behaviors in persons with dementia. The finding that the constructs of engagement, agitated behavior, and affect are multidimensional and that relationships among these constructs occur for some of the dimensions is important for the development of interventions and for clear communication in practice and research.

Keywords

dementianursing homesanxietyapathylong-term care
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 5 , May 2012 , pp. 742 - 752
Copyright
Copyright © International Psychogeriatric Association 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Buettner, L. and Fitzsimmons, S. (2003). Activity calendars for older adults with dementia: what you see is not what you get. American Journal of Alzheimer's Disease and Other Dementias, 18, 215–226.CrossRefGoogle ScholarPubMed
Burgio, L. D. et al. (1994). Studying disruptive vocalization and contextual factors in the nursing home using computer-assisted real-time observation. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 49, 230–239.Google ScholarPubMed
Clarke, D. E. et al. (2008). Apathy in dementia: clinical and sociodemographic correlates. Journal of Neuropsychiatry and Clinical Neuroscience, 20, 337–347.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. (2000). Nonpharmacological management of behavioral problems in persons with dementia: the TREA model. Alzheimer's Care Quarterly, 1, 22–34.Google Scholar
Cohen-Mansfield, J. (2001). Nonpharmacological interventions for inappropriate behaviors in dementia: a review, summary, and critique. American Journal of Geriatric Psychiatry, 9, 361–381.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. and Libin, A. (2005). Verbal and physical non-aggressive agitated behaviors in elderly persons with dementia: robustness of syndromes. Journal of Psychiatric Research, 39, 325–332.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. and Werner, P. (1995). Environmental influences on agitation: an integrative summary of an observational study. American Journal of Alzheimer's Care and Related Disorders Research, 10, 32–39.Google Scholar
Cohen-Mansfield, J., Marx, M. S. and Rosenthal, A. S. (1989a). A description of agitation in nursing homes. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 44, M77–M84.Google Scholar
Cohen-Mansfield, J., Werner, P. and Marx, M. S. (1989b). An observational study of agitation in agitated nursing home residents. International Psychogeriatrics, 153–165.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J., Culpepper, W. and Werner, P. (1995). The relationship between cognitive function and agitation in senior day care participants. International Journal of Geriatric Psychiatry, 10, 585–595.CrossRefGoogle Scholar
Cohen-Mansfield, J., Libin, A. and Marx, M. S. (2007). Nonpharmacological treatment of agitation: a controlled trial of systematic individualized intervention. Journals of Gerontology Series A: Biological Sciences and Medical Sciences; 62A, 908–916.CrossRefGoogle Scholar
Cohen-Mansfield, J., Dakheel-Ali, M. and Marx, M. S. (2009). Engagement in persons with dementia: the concept and its measurement. American Journal of Geriatric Psychiatry, 17, 299–307.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J., Marx, M. S., Thein, K. and Dakheel-Ali, M. (2010a). The impact of past and present preferences on stimulus engagement in nursing home residents with dementia. Aging and Mental Health, 14, 67–73.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J., Marx, M., Regier, N. G., Dakheel-Ali, M., Thein, K. and Freedman, L. (2010b). Can agitated behavior of nursing home residents with dementia be prevented with the use of standardized stimuli? Journal of American Geriatrics Society, 58, 1459–1464.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J., Marx, M. S., Thein, K. and Dakheel-Ali, M. (2011). The impact of stimuli on affect in persons with dementia. Journal of Clinical Psychiatry, 72, 480–486.CrossRefGoogle ScholarPubMed
Dwyer, M. and Byrne, G. J. A. (2000). Disruptive vocalization and depression in older nursing home residents. International Psychogeriatrics, 12, 463–471.CrossRefGoogle ScholarPubMed
Feliciano, L., Steers, M. A., Elite-Marcandonatou, A., McLane, M. and Arean, P. A. (2009). Applications of preference assessment procedures in depression and agitation management in elders with dementia. Clinical Gerontologist, 32, 239–259.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Furr, R. M. and Bacharach, V. R. (2008). Validity: Estimating and Evaluating Convergent and Discriminant Validity Evidence Psychometrics: An Introduction. Thousand Oaks, CA: Sage Publications. Available at: http://www.sagepub.com/upm-data/18479_Chapter_9.pdf.Google Scholar
Gardner, R. C. (2000). Correlation, causation, motivation, and second language acquisition. Canadian Psychology, 41, 10–24.CrossRefGoogle Scholar
Gigliotti, C. M., Jarrott, S. E. and Yorgason, J. (2004). Harvesting health: effects of three types of horticultural therapy activities for persons with dementia. Dementia, 3, 161–180.CrossRefGoogle Scholar
Larsen, J. T., McGraw, A. P. and Cacioppo, J. T. (2001). Can people feel happy and sad at the same time? Journal of Personality and Social Psychology, 81, 684–696.CrossRefGoogle ScholarPubMed
Lawton, P. M., Van Haitsma, K. and Klapper, J. (1996). Observed affect in nursing home residents with Alzheimer's disease. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 51B, 3–14.CrossRefGoogle Scholar
Lin, L. C., Yang, M. H., Kao, C. C., Wu, S. C., Tang, S. H. and Lin, J. G. (2009). Using acupressure and Montessori-based activities to decrease agitation for residents with dementia: a cross-over trial. Journal of the American Geriatrics Society, 57, 1022–1029.CrossRefGoogle ScholarPubMed
Lucero, M., Pearson, R., Hutchinson, S., Leger-Krall, S. and Rinalducci, E. (2001). Products for Alzheimer's self-stimulatory wanderers. American Journal of Alzheimer's Disease and Other Dementias, 16, 43–50.CrossRefGoogle ScholarPubMed
Morris, J. et al. (1991). MDS Resident Assessment. Natick, MA: Eliot Press.Google Scholar
Orsulic-Jeras, S., Judge, K. S. and Camp, C. J. (2000). Montessori-based activities for long-term care residents with advanced dementia: effects on engagement and affect. The Gerontologist, 40, 107–111.Google ScholarPubMed
Rabinowitz, J., Davidson, M., De Deyn, P. P., Katz, I., Brodaty, H. and Cohen‑Mansfield, J. (2005). Factor analysis of the Cohen‑Mansfield Agitation Inventory in three large samples of nursing home patients with dementia and behavioral disturbance. American Journal of Geriatric Psychiatry, 13, 991–998.CrossRefGoogle ScholarPubMed
Schreiner, A. S., Yamamoto, E. and Shiotani, H. (2005). Positive affect among nursing home residents with Alzheimer's dementia: the effect of recreational activity. Aging and Mental Health, 9, 129–134.CrossRefGoogle ScholarPubMed
Talerico, K. A., Evans, L. K. and Strumpf, N. E. (2002). Mental health correlates of aggression in nursing home residents with dementia. The Gerontologist, 42, 169–177.CrossRefGoogle ScholarPubMed
Trochim, W. M. (2006). Convergent and Discriminant Validity: The Research Methods Knowledge Base, 2nd edn. Available at: http://www.socialresearchmethods.net/kb/convdisc.php.Google Scholar