Staff Perceptions of Implementing a Person-Centered Communication Tool in the Nursing Home Setting: PAL Cards.

PURPOSE: To understand direct care workers' perceptions of the impact of implementing a person-centered communication tool, Preference for Activity and Leisure (PAL) Cards, into care. METHOD: PAL Cards provide at-a-glance information about a nursing home (NH) resident's background and important preferences for activities and leisure. As a quality improvement project, 11 NHs implemented use of PAL Cards in their communities and provided feedback (N = 91 feedback forms received) on their perceptions of impact of PAL Cards on care communication and delivery. RESULTS: A variety of NH staff members, across disciplines, were a part of PAL Card implementation. The majority of staff (84%) perceived that PAL Cards helped them start a conversation with a resident and 64% indicated that PAL Cards helped them provide care for a resident. CONCLUSION: PAL Cards are an effective tool for communicating information about NH residents' preferences to staff. [Journal of Gerontological Nursing, 50(8), 5-10.].

Preference Consistency: Veteran and Non-Veteran Nursing Home Resident Self-Reported Preferences for Everyday Living.

Understanding patient preferences is core to person-centered care. The consistency of everyday preference reporting was assessed comparing responses of Veteran (VA) and non-VA nursing home (NH) residents on the Preferences for Everyday Living Inventory (PELI) at baseline and 5 to 7 days later. Non-VA NH residents demonstrated higher perfect agreement than VA residents (66% vs. 56%, respectively) and higher acceptable agreement (95% vs. 88%, respectively). Multiple regression analyses examined significant predictors of reliability using demographics, cognitive functional variables, and interviewer ratings. In the VA group, higher perfect agreement was associated with residents who were less likely to have hearing deficits, better cognition, and better interviewer ratings related to energy, attention, and comprehension. In the non-VA group, higher perfect agreement was associated with residents who were younger and more independent with walking. Overall, higher agreement was associated with being female, non-VA, and having better cognition. Implications for future research and clinical practice are highlighted. [Journal of Gerontological Nursing, 46(3), 15-25.].

Determinants of behavioral and psychological symptoms of dementia: A scoping review of the evidence.

BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are prevalent in people with neurodegenerative diseases. PURPOSE: In this scoping review the Kales, Gitlin and Lykestos framework is used to answer the question: What high quality evidence exists for the patient, caregiver and environmental determinants of five specific BPSD: aggression, agitation, apathy, depression and psychosis? METHOD: An a priori review protocol was developed; 692 of 6013 articles retrieved in the search were deemed eligible for review. Gough's Weight of Evidence Framework and the Cochrane Collaboration's tool for assessing risk of bias were used. The findings from 56 high quality/low bias articles are summarized. DISCUSSION: Each symptom had its own set of determinants, but many were common across several symptoms: neurodegeneration, type of dementia, severity of cognitive impairments, and declining functional abilities, and to a lesser extent, caregiver burden and communication. CONCLUSION: Research and policy implications are relevant to the National Plan to Address Alzheimer's Disease.

Assessing neuropsychiatric symptoms in people with dementia: a systematic review of measures.

BACKGROUND: Neuropsychiatric symptoms (NPS) occur in people with dementia throughout disease course and across etiologies. NPS are associated with significant morbidities and hastened disease processes. Nevertheless, people with dementia are not systematically assessed for NPS in clinical settings. We review existing NPS measures for clinical and/or research purposes, and identify measurement gaps. METHODS: We conducted a computerized search of peer-reviewed published studies of measures (January 1, 1980-December 1, 2013) using multiple search terms. Measures selected for review were in English, had adequate psychometric properties, and were developed for or used with people with dementia. Papers describing measures were evaluated by three coders along seven characteristics: behavioral domains, number of items, method of administration, response categories, targeted population, setting, and psychometric properties. RESULTS: Overall, 2,233 papers were identified through search terms, and 36 papers from manual searches of references. From 2,269 papers, 85 measures were identified of which 45 (52.9%) had adequate psychometric properties and were developed or used with dementia populations. Of these, 16 (35.6%) were general measures that included a wide range of behaviors; 29 (64.4%) targeted specific behaviors (e.g. agitation). Measures differed widely as to behaviors assessed and measurement properties. CONCLUSIONS: A robust set of diverse measures exists for assessing NPS in different settings. No measures identify risk factors for behaviors or enable an evaluation of the context in which behaviors occur. To improve clinical efforts, research is needed to evaluate concordance of behavioral ratings between formal and informal caregivers, and to develop and test measures that can identify known risks for behaviors and the circumstances under which behaviors occur.

How Do We Achieve Person-Centered Care across Health Care Settings? Expanding Ideological Perspectives into Practice to Advance Person-Centered Care.

Person or patient-centered care (PCC) is touted as the gold standard in geriatric medical care across care settings. However, despite more than 3 decades of research and practice initiatives, it remains a challenge to consistently implement PCC that fully places the individual at the center of care planning and the delivery process. The lack of universal implementation of PCC, we argue, may be in large part due to the use of multiple terms and ideologies leading to an inability to coordinate efforts across medical settings. This article reviews recent ideological PCC movements ("What Matters to You," the Age Friendly Health Systems 4 Ms/5 Ms, "Whole Health," Patient Priorities Care, and Medicare/Medicaid person-centered care initiatives), provides a discussion of how these ideologies are implemented in a nursing home setting through preference-based care and provides implications for coordinated integration of PCC across all care settings now and into the future. We argue for the need to draw on known information and validated methodologies for assessing and implementing PCC to collectively move beyond an ideological representation of the concept into an integrated model of PCC for all older adults receiving care.

Cognitive Interviewing: Revising the Preferences for Everyday Living Inventory for Use In the Nursing Home.

A valid tool is needed to assess preferences that are relevant and important to nursing home (NH) residents. Originally developed for older adults receiving home care services, the authors adapted the Preferences for Everyday Living Inventory (PELI) for use with NH residents. Content validity was initially established using a panel of experts in long-term care. PELI items were cognitively interviewed with 31 Veteran and 39 non-Veteran participants (N = 70). Responses from cognitive interviewing guided substantial revisions of the PELI (>25% of items) to include language that NH residents use and understand, reducing potential measurement error and ensuring the preferences assessed are relevant to NH residents. Future work will further adapt the PELI for use with more diverse groups and health care settings, and assess its psychometric properties. Using the PELI will help move clinical teams closer to the goal of providing person-centered care informed by individual preferences.

A randomized controlled trial for an individualized positive psychosocial intervention for the affective and behavioral symptoms of dementia in nursing home residents.

OBJECTIVES: This randomized controlled study tested the effectiveness of individualized activities, led by certified nursing assistants (CNAs), to increase positive and reduce negative affect and behavior among nursing home residents with dementia. METHOD: Nursing home residents with mild to advanced dementia (N = 180) were randomly assigned to usual care (UC, n = 93) or 1 of 2 experimental conditions. Residents in the attention control group (AC, N = 43) participated in standardized one-to-one activities with their CNAs. Individualized Positive Psychosocial Intervention (IPPI) participants (n = 44) received a CNA-led activity matched to their interests and ability. Outcomes were residents' positive and negative affect and verbal and nonverbal behavior. RESULTS: The IPPI and AC groups experienced similar benefits-more pleasure, alertness, engagement, positive touch, and positive verbal behavior-compared with UC. The AC group displayed more anger, uncooperativeness, and very negative verbal behavior than UC or IPPI. DISCUSSION: This study demonstrates the value of individualized activities for nursing home residents with dementia. In a stringent test, residents were happier and less angry during a customized intervention compared with a standardized intervention. Even brief individualized CNA-led activities bring pleasure to nursing home residents and constitute an effective strategy to enhance positive affect and engagement in persons with dementia.

Resident-to-resident aggression in nursing homes: results from a qualitative event reconstruction study.

PURPOSE: Despite its prevalence and negative consequences, research on elder abuse has rarely considered resident-to-resident aggression (RRA) in nursing homes. This study employed a qualitative event reconstruction methodology to identify the major forms of RRA that occur in nursing homes. DESIGN AND METHODS: Events of RRA were identified within a 2-week period in all units (n = 53) in nursing homes located in New York City. Narrative reconstructions were created for each event based on information from residents and staff who were involved as well as other sources. The event reconstructions were analyzed using qualitative methods to identify common features of RRA events. RESULTS: Analysis of the 122 event reconstructions identified 13 major forms of RRA, grouped under five themes. The resulting framework demonstrated the heterogeneity of types of RRA, the importance of considering personal, environmental, and triggering factors, and the potential emotional and physical harm to residents. IMPLICATIONS: These results suggest the need for person-centered and environmental interventions to reduce RRA, as well as for further research on the topic.