Temporal patterns of negative and positive behavior among nursing home residents with Alzheimer's disease

Although clinical observations suggest a late-day peak in disruptive behavior in persons with dementia, results from studies of temporal patterns of behavior are equivocal. This study used direct observation methods and systematic time sampling to examine temporal patterns of negative and positive behavior in 177 residents of 2 long-term care facilities with clinically diagnosed Alzheimer's disease (AD). The authors found small statistically significant diurnal variation in both negative and positive behavior, characterized by a curvilinear pattern with a single peak. This pattern was unaffected by seasonal differences in length of day, severity of cognitive impairment, level of behavior, or sleep disturbances. Time when behavior peaked differed by type of behavior and by facility, and there was substantial heterogeneity in behavior patterns.     

Childhood depression and conduct disorder: II. An analysis of family interaction patterns in the home.

Few researchers have assessed family interaction patterns associated with childhood depression, especially using observations in natural settings. We directly sampled the interaction patterns of families with depressed, conduct-disordered, mixed depressed-conduct-disordered, and comparison children ages 7-14 years in their homes during the evening meal. Observational measures were taken of positive and aversive behaviors and affect expression for both parents, the referred children, and their siblings. Results replicated previous research showing that conduct-disordered children express high levels of aversive behavior and anger and are part of a family system marked by conflict and aggression. The depressed children were exposed to maternal aversiveness but did not show any evidence of elevated levels of anger or aversiveness in their own behavior. Surprisingly, this was also true for the mixed-disorder children. High levels of depression in both groups of depressed children were associated with low levels of conflict and anger in family members. Overall, siblings showed very similar patterns of behavior, and were exposed to similar patterns of parental behavior, as the referred children. Results are discussed in terms of family models that emphasize the function of aggression and depression in the maintenance of child psychopathology.     

Direct assessment of quality of care in a geriatric nursing home

Direct observation was used to examine multiple aspects of care provided in a proprietary nursing home. The samples were taken at random intervals, 7 days per week for 5 weeks, across several categories of environmental and resident conditions as well as staff and resident activity. Results showed a high degee of compliance with predefined standards (based on current federal regulations) for environmental and resident conditions. Overall distributions of resident and staff activity showed results similar to those found in previous studies, with residents spending most of their time engaged in nonsocial activity and staff spending the majority of their time engaged in nonresident work. When data were analyzed across areas of the facility, times of day, and weekdays versus weekends, some differences were noted. Weekend versus weekday comparisons showed higher resident:staff ratios on weekends and more resident inactivity, but no significant differences in environmental or resident conditions. In addition, more frequent resident care, resident interaction, and resident activity were observed in Medicare units than in non-Medicare units. Results are discussed in terms of federal requirements for monitoring the quality of care in nursing homes and the potential use of time sampling expressly for this purpose.     

Social stress and community psychology

Two questions that embarrass community psychologists are: "What do community psychologists do?" "What's the difference between community psychology and clinical psychology?" A conceptual model is proposed to help to find answers to these questions. The model describes a process whereby psychosocial stress leads to psychopathology. The argument is developed that the apparently disparate activities of community psychologists are uniformly directed at undermining the stress process but, given the complexity of this process, vary because they tackle it at different points.     

Mortality of geriatric and younger patients with schizophrenia in the community

Little is known about the differences in mortality among non-institutionalized geriatric and younger patients with schizophrenia. In this study long-term mortality and suicidal behavior of all the geriatric (age > or = 65 years), middle-age (age 41-64 years), and young (age 15-40 years) subjects with schizophrenia living in a Chinese rural community were compared. A 10 year follow-up investigation among a 1994 cohort (n = 510) of patients with schizophrenia was conducted in Xinjin County, Chengdu, China. Compared with young subjects, geriatric subjects with schizophrenia were more likely to be female, have more previous physical illness, never accepted treatment, and practice religious (p < or = 0.01). There were no significant differences of suicide attempts among the three groups. Young subjects had a higher rate of suicide (1,033.8 per 100,000 person-years), and geriatric subjects had a higher rate of deaths due to other causes (accident and natural causes) (4,314.2 per 100,000 person-years). Standardized mortality ratios for both suicide and deaths due to other causes were highest in young subjects and the lowest in geriatric subjects. Patients with schizophrenia in all age groups had a marked increase in mortality and suicide. Specific intervention strategies for decreasing mortality and suicide should be developed for patients with schizophrenia in different age groups.     

Autonomy for nursing home residents: the role of regulations

The importance of autonomy and choice to nursing home residents' well-being has been well established. This paper examines the complex role of regulation as it affects the autonomy of nursing home residents. Nonstandardized interviews with residents, family members, nursing staff members, and administrators were conducted at three nursing homes in suburban Maryland. These anecdotal interviews identified the most problematic areas where regulations enforce barriers to autonomy and control. These areas include: scheduling of activities of daily living, food portions, physical environment, and documentation. Suggestions for possible improvements are discussed.     

Family interaction patterns and childhood depression

Rehm's (1977) self-control model for depression and Bandura's (1977) concept that children internalize external controls placed upon them are united to predict family interaction patterns that may contribute to the etiology or maintenance of depression in children. Families of depressed, nondepressed, and nonclinic children were compared on rates of, and criteria for, parental and self-reinforcement. Mother-father-child interactions were sequentially coded to reveal that mothers of depressed and nonclinic children both set very high criteria for rewarding their children, compared to mothers of clinic/nondepressed children. However, mothers of depressed children rewarded their depressed children at much lower rates than mothers of either clinic/nondepressed or nonclinic children. These factors, taken together, are discussed in terms of their possible etiological role in childhood depression.     

Family decision-making for nursing home residents: Legal mechanisms and ethical underpinnings

Families frequently act as substitute decisionmakers for their older members who suffer from diminished mental capacity to make and express their own medical choices. Substitute decisionmaking takes on particular ethical and legal urgency within the nursing home environment, especially when choices concern potential medical treatment near the end of the nursing home resident's life. This article examines current legal mechanisms in the United States that enable a family to make substitute medical decisions, the ethical underpinnings of those mechanisms, and specific ethical and legal considerations implicated by their application to the nursing home setting. The article offers advice to nursing home professionals, including physicians, in working with families as substitute decisionmakers.     

Evaluations by staff, residents, and community seniors of patronizing speech in the nursing home: impact of passive, assertive, or humorous responses

Two studies tested the impact of alternative communication in accommodation strategies. Nursing home staff and residents (and community-residing seniors in Study 2) rated nurse-resident conversational scenarios in which a resident responded passively, directly assertively, or humorously (indirectly assertively) to a patronizing nurse. The nurse then either maintained a patronizing manner or accommodated with a more respectful speech style. Even though all groups devalued the nurse who maintained a patronizing speech style, nursing home residents predictably showed the most acceptance. The directly assertive response by the resident elicited more devaluation of the nonaccommodating nurse than did either passive or humorous responses, but also the least favorable ratings of the resident. Ratings of the humorous response in Study 2 suggested that humor could be a good compromise response style for allowing the receiver of patronizing speech to express opposition to a request, yet still maintain an appearance of competence and politeness.     

The effect of gambling activities on happiness levels of nursing home residents

The current study evaluated the effect of participating in simulated gambling activities on happiness levels of 3 nursing home residents. A 4‐component analysis was used to measure objective responses associated with happiness during baseline, varying durations of engagement in simulated gambling activities, and 2 follow‐up periods. Results indicated that all residents exhibited a higher percentage of happiness levels while engaged in simulated gambling activities compared with baseline. Follow‐up assessment took place 10 min and 30 min following the intervention; no lasting effects were observed.     

Measuring the person-centeredness of caregivers working with nursing home residents with dementia

There is increasing interest in promoting person-centered caregiving within gerontology. However, few observational instruments have been developed to measure person-centered caregiving behaviors. In the present study, two innovative coding instruments—the Person-Centered Behavior Inventory (PCBI) and the Global Behavior Scale (GBS)—were used to test the hypothesis that caregivers’ person-centeredness would be negatively correlated with residents’ resistiveness to care. The study hypothesis was based on the need-driven dementia-compromised theory of behavior. It was expected that person-centered caregiving would better meet residents’ needs and be associated with less resistiveness to care. This hypothesis was tested by coding 70 videotaped interactions between 54 caregivers and 20 residents diagnosed with dementia. Resistiveness to care was measured by behaviorally coding residents’ resistive behaviors based on the Resistiveness to Care scale. The study hypothesis was supported when the GBS was used to measure person-centeredness, but not when the PCBI was used. The findings provide preliminary support for the predictive and construct validity of the GBS and the PCBI.     

Paths to community empowerment: Organizing at home

This study examines how low-income minority communities build on their strengths to improve material conditions and how these actions lead to further empowerment at the individual and group level, and increase engagement with civic life. Based on earlier qualitative research, low-income limited equity housing co-ops were chosen as research. Using quantitative questionnaire data, a path model was tested in which variables were organized into four levels.Level One: Attributes of the person and the context were conceptualized asexogenous variables leading to activities first at the co-op level.Level Two:co-op activities were thought to affect living conditions in the building and evaluations of co-op ownership, which comprisedLevel Three,quality of life in the building. All preceding levels were thought to influenceempowerment, as measured atLevel Four through an attitudinal measure of empowerment, and reported participation in civic activities in the broader community. The model, which emphasizes the collective and material nature of empowerment in addition to the psychological, seems justified by the data. It is especially significant that the aggregate measure of perceived participation of others predicted building quality, and that the aggregate measure of building quality went on to influence empowerment and voting behavior. Personal participation in building activities also proved a good predictor of empowerment, indicating that empowerment operates at both the individual and the group level. Furthermore, increased empowerment at the level of attitude did influence civic activities, in conjunction with personal characteristics and perceived neighborhood qualities. (Tests of causality in the opposite direction were not significant.) Our findings confirm the importance of all three components of empowerment, as articulated by Zimmerman and his colleagues (1992), that is, empowerment at the psychological, interactional, and behavioral level. It extends the conceptualization by introducing the group level of analysis. We thank the Robert F. Wagner Sr. Center for Urban Public Policy at the City University of New York Graduate School and University Center and the Fund for the City of New York for early support and the Edna McConnell Clark Foundation for current support. We acknowledge the invaluable participation in the original project of Heléne Clark, Eric Glunt, Bill Roane, and April Tyler. We also thank the anonymous reviewers and the editor for their helpful and extremely thorough comments and suggestions.     

Twenty-four-hour sleep-wake patterns in a nursing home population

Sleep-activity patterns were objectively recorded over a 24-hr period in 19 elderly nursing home residents. On average, both sleep and wake times were observed during every hour of the 24 recorded hours; however, the sleep pattern of the residents was fragmented so that they rarely experienced even a single hour of consolidated time spent sleeping. It is hypothesized that several independent factors, including compensation for lost sleep, increased total time in bed, weakening of social constraints, and deterioration of the circadian sleep-wake rhythm, are interacting to produce this increase in sleep fragmentation.     

Social communication patterns of attention-deficit-disordered boys

This study was designed to compare the social communication patterns of attention-deficit-disordered (ADD) and normal boys. This was accomplished by employing a TV Talk Show social role-playing procedure in which the task required different strategies for the roles of host and guest. Groups of ADD and normal elementary-age boys were formed, and each boy was paired with a normal classmate. Measures of communication competence were coded from videotapes made of subject and partner social interactions while performing both roles. Results indicated that the ADD boys, in contrast to the control group, failed to modulate their social communication behaviors as task demands shifted. Additionally, the behavior of the ADD boys resulted in their normal partners' altering their response patterns in order to maintain the equilibrium in the dyadic interaction. These results suggest that the social behavior of ADD children is relatively independent of environmental requirements and may contribute to the inappropriate responding of others.