Prevalence of Behavioral Symptoms: Comparison of the Minimum Data Set Assessments with Research Instruments

Abstract

Objective-To examine the total and domain-specific prevalence of verbally and physically abusive, socially inappropriate, and care-resistive behaviors according to the Minimum Data Set (MDS) compared with research instruments in nursing home residents with severe dementia.Design, Setting, and Methods-As part of a longitudinal observational study, MDS behavioral symptoms data were compared with corresponding items from the Ryden Aggression Scale and the Cohen-Mansfield Agitation Inventory for 15 nursing home residents with severe dementia. McNemar's test was used to compare the difference in the proportion of subjects who experienced any symptoms, as well as specific symptoms in several domains, according to the MDS and the research instruments. Additionally, temporal fluctuations in behavioral symptoms were descriptively and graphically summarized.Results-The MDS significantly underestimated both the total proportion of subjects experiencing any behavioral symptoms (P = .016), as well as the proportion of subjects experiencing verbally abusive symptoms (P < .002), physically abusive symptoms (P = .008), or socially inappropriate behaviors (P = .016) compared with corresponding items from the research instruments. Moreover, these behaviors exhibited considerable temporal instability, suggesting that the systematic daily collection of measures of behavioral disturbances is imperative during the week in which the MDS assessment is to be completed.Discussion-Albeit from a small study sample, our findings call into question the validity of the MDS behavioral symptom items as they are currently recorded, and suggest that a simple intervention of twice daily completion of a behavioral symptoms checklist containing the MDS items during the week of the assessment may significantly improve the accuracy of the recorded data. KeywordsNursing home aggression; MDS validity; behavioral outcome measurement Copyright © 2008 6 Assessments are required on admission, quarterly, annually, at discharge, and whenever there is a significant change in the resident's status. Since its implementation in nursing homes in 1991, the role of the MDS has expanded beyond scheduled assessments to identify care problems and tailor individualized care plans. It now also functions as a case-mix-based prospective reimbursement mechanism for Medicare and Medicaid, and as an indicator of the quality of care provided by LTC institutions. 7 Thus, the reliability and validity of the MDS as an assessment instrument are of paramount importance.Section E4 ("Behavioral Symptoms") of the MDS describes as its intent: "the assessment of the frequency, and alterability of behavioral symptoms in the last seven days that cause distress to the resident, or are distressing or disruptive to facility residents or staff members, even if staff and other residents appear to have adjusted to them." 6 The coding for the 5 specific items comprising Section E4 focuses on the resident's actions rather than his or her intent. Sources of information may include a rev...

The Impact of Culture Change on Elders’ Behavioral Symptoms: A Longitudinal Study

“…The mean agitation scores in this study were somewhat lower than those found by Rabinowitz et al 32 and Cohen-Mansfield, 36 most likely because the present study included cognitively intact as well as impaired elders, whereas most studies that have used the CMAI in the nursing home setting include only individuals with dementia and/or preexisting behavioral symptoms. 2,36,37 To better examine the full potential of the impact of culture change on behavioral symptoms, future studies could include larger samples of elders with a greater range of behavioral symptom frequency. This would also allow for an examination of the preventive effects of culture change in addition to the lessening of existing behaviors.…”

Victim or Initiator?: Certified Nursing Assistants’ Perceptions of Resident Characteristics that Contribute to Resident-to-Resident Violence in Nursing Homes

“…Rosen and colleagues (2008) also cited impatience with physical limitations or barriers to mobility as factors preceding RRV. Bharucha and colleagues (2008) also identified frustration with a physical limitation as an antecedent to RRV in the initiators.…”

“…To date, only six studies have been identified that explore the phenomenon (Allin, et al, 2003; Shinoda-Tagawa, et al, 2004; Lachs, Bachman, Williams, O’Leary, 2007; Bharucha, et al, 2008; Rosen, et al, 2008; Sifford, Beck, Green, & McSweeney, [in review]). (See Table 1).…”

“…Recent studies have shown that approximately 36% of nursing home violence is between residents (Allin, et al, 2003; Bharucha, et al, 2008). Resident-to-resident violence (RRV) is defined as the delivery of noxious stimuli by one resident to others that is clearly not accidental (Patel & Hope, 1992).…”

“…Studies suggest that RRV is very likely under-reported (Allin, et al, 2003; Bharucha, et al, 2008), and results in physical, psychological, and resource utilization consequences for all parties involved. The consequences include physical harm, emotional harm, the use of interventions known to be detrimental to the care of the older people (such as physical and chemical restraints), and the use of resources (nursing time, law enforcement resources) spent reacting to violence that could be better spent implementing proactive strategies for its prediction and prevention.…”