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Impact of caregivers’ behaviors on resistiveness to care and collaboration in persons with dementia in the context of hygienic care: an interactional perspective

Published online by Cambridge University Press:  13 July 2015

Guylaine Belzil*
Affiliation:
Alphonse Desjardins Health and Social Services Centre, Site Paul-Gilbert (S48), 9330, boul. du Centre Hospitalier, Charny, QC G6X 1L6, Canada
Jean Vézina
Affiliation:
School of psychology, Pavillon Félix-Antoine-Savard (1124-A), Université Laval, Québec, QC G1V 0A6, Canada
*
Correspondence should be addressed to: Dr. Guylaine Belzil, PhD Psychologist, Alphonse Desjardins Health and Social Services Centre, Site Paul-Gilbert (S48), 9330, boul. du Centre Hospitalier, Charny, QC G6X 1L6, Canada. Phone: 418-380-8994 #182240. Email: [email protected].

Abstract

Background:

The role played by various physical and verbal behaviors of professional caregivers in the onset of resistiveness to care (RTC) and collaborative behaviors of nursing home residents with dementia was assessed in a daily hygienic care routine context.

Methods:

Two hundred and forty hygienic care routines, observed in eight nursing home residents, were analyzed with a video-assisted systematic observation methodology and a sequential statistical analysis strategy.

Results:

Caregiver and care recipient behaviors are interdependent in the hygienic care routine context. Physical instrumental behavior, neutral, negative and positive statements, positive and negative instructions, and verbal distraction emitted by caregivers are significantly and moderately associated with the onset of RTC in persons with dementia (PWD), but the strength of relationships observed depends on the care recipient's behavior prior to the caregiver's action. Positive instructions are moderately associated with the onset of collaboration in residents with preserved language abilities. However, for residents with severe language impairment, these same instructions were linked to RTC behaviors.

Conclusions:

Although antecedents to RTC can be identified, the risk that caregiver behaviors trigger resistive responses is higher when care recipients are already exhibiting RTC, and is low when no particular behavior or collaboration is shown. Antecedents to collaboration are also identified and discussed. Although different caregiver behaviors may be more or less likely to elicit resistiveness or collaboration, it is the pre-existing state of the care recipient that will determine its reaction to the caregiver's behavior. Clinical implications emerging from these influential findings are elaborated.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2015 

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References

Algase, D. L. et al. (1996). Need-driven dementia-compromised behavior: an alternative view of disruptive behavior. American Journal of Alzheimer's Disease & Other Dementias, 11, 1019.Google Scholar
Bakeman, R. and Quera, V. (1995). Analyzing interaction. Sequential analysis with SDIS and GSEQ. New York: Cambridge University Press.Google Scholar
Burgener, S. C., Jirovec, M., Murrell, L. and Barton, D. (1992). Caregiver and environmental variables related to difficult behaviors in institutionalized, demented elderly persons. Journal of Gerontology: Psychological Sciences, 47, P242P249.Google Scholar
Burgio, L. D., Butler, F. R., Roth, D. L., Hardin, J. M., Hsu, C.-C. and Ung, K. (2000). Agitation in nursing home residents: the role of gender and social context. International Psychogeriatrics, 12, 495511.Google Scholar
Cohen-Mansfield, J. and Parpura-Gill, A. (2007). Bathing: a framework for intervention focusing on psychosocial, architectural, and human factors considerations. Archives of Gerontology and Geriatrics, 45, 121135.Google Scholar
Cohen-Mansfield, J. and Werner, P. (1995). Environmental influences on agitation: an integrative summary of an observational stydy. American Journal of Alzheimer's Disease & Other Dementias, 10, 3237.Google Scholar
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 23082314.CrossRefGoogle ScholarPubMed
Desrosiers, J., Bravo, G., Hébert, R. and Dubuc, N. (1995). Reliability of the revised functional autonomy measurement system (SMAF) for epidemiological research. Age and Ageing, 24, 402406.Google Scholar
Gibson, M. C. (1997). Differentiating aggressive and resistive behaviors in long-term care. Journal of Gerontological Nursing, 23, 2128.Google Scholar
Hallberg, I. R., Holst, G., Nordmark, A. and Edberg, A. (1995). Co-operation during morning care between nurses and severely demented institutionalized patients. Clinical Nursing Research, 4, 78104.Google Scholar
Hart, B. and Wells, D. (1997). The effetcs of language used by caregivers on agitation in residents with dementia. Clinical Nurse Specialist, 11, 2023.Google Scholar
Hope, T., Keene, J., Fairburn, C. G., Jacoby, R. and McShane, R. (1999). Natural history of behavioral changes and psychiatric symptoms in Alzheimer's disease. A longitudinal study. British Journal of Clinical Psychiatry, 174, 3944.Google Scholar
Hugues, C. P., Berg, L., Danziger, W. L., Cohen, L. A. and Martin, R. L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566572.Google Scholar
Kable, A., Guest, M. and McLoed, M. (2012). Resistance to care: contributing factors and associated behaviours in healthcare facilites. Journal of Advanced Nursing, 69, 17471760.Google Scholar
Keene, J., Hope, T., Fairburn, C. G., Jacoby, R. and Gedling, K. (1999). Natural history of aggressive behavior in dementia. International Journal of Geriatric Psychiatry, 14, 541548.Google Scholar
Magai, C., Cohen, C. I. and Gomberg, D. (2002). Impact of training dementia caregivers in sensitivity to non-verbal emotion signals. International Psychogeriatrics, 14, 2538.Google Scholar
Mahoney, E. K. et al. (1999). Development and testing of the resistiveness to care scale. Research in Nursing & Health, 22, 2738.Google Scholar
Marx, M. S., Werner, P. and Cohen-Mansfield, J. (1989). Agitation and touch in the nursing home. Psychological Reports, 64, 10191026.Google Scholar
Mickus, M. A., Wagenaar, D. B., Averill, M., Colenda, C. C., Gardiner, J. and Luo, Z. (2002). Developing effective bathing strategies for reducing problematic behavior for residents with dementia: the PRIDE approach. Journal of Mental Health and Aging, 8, 3743.Google Scholar
Potkins, D. et al. (2003). Language impairment in dementia: impact of symptoms and care needs in residential homes. International Journal of Geriatric Psychiatry, 18, 10021006.Google Scholar
Potts, H. W., Richie, M. F. and Kaas, M. J. (1996). Resistance to care. Journal of Gerontological Nursing, 22, 1116.Google Scholar
Rader, J. et al. (2006). The bathing of older adults with dementia. American Journal of Nursing, 106, 4048.Google Scholar
Roth, D. L., Stevens, A. B., Burgio, L. D. and Burgio, K. L. (2002). Time-event sequential analysis of agitation in nursing home residents during personal care interactions with nursing assistants. Journal of Gerontology: Psychological Sciences and Social Sciences, 57, P461P468.Google Scholar
Saxton, J., McGonigle-Gibson, K. L., Swihart, A. A., Miller, V and Boller, F. (1990). Assessment of the severely impaired patient: description and validation of a new neuropsychological test battery. Psychological Assessment, 2, 298303.Google Scholar
Small, J. A., Gutman, G., Makela, S. and Hillhouse, B. (2003). Effectiveness of communication strategies used by caregivers of persons with Alzheimer's disease during activities of daily living. Journal of Speech, Language, and Hearing Research, 46, 353367.Google Scholar
Somboontanont, W., Sloane, P. D., Floyd, F. J., Holditch-Davis, D., Hogue, C. C. and Mitchell, C. M. (2004). Assaultive behavior in Alzheimer's disease: identifying immediate antecedents during bathing. Journal of Gerontological Nursing, 30, 2229.Google Scholar
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, 169177.Google Scholar
Volicer, L., Bass, E. A. and Luther, S. L. (2007). Agitation and resistiveness to care are two separate behavioral syndromes of dementia. Journal of the American Medical Directors Association, 8, 527532.Google Scholar
Wells, D. L., Dawson, P., Sidani, S., Craig, D. and Pringle, D. (2000). Effects of an abilities-focused program of morning care on residents who have dementia and on caregivers. Journal of the American Geriatrics Society, 48, 442–229.Google Scholar
Westerberg, K. and Strandberg, S. (2007). Showering is more than resistance: cognitive interview sequences in residential homes for elderly clients with dementia. Qualitative research in Psychology, 4, 1528.Google Scholar
Whall, A. L. et al. (2008). Factors associated with aggressive behavior among nursing home residents with dementia. The Gerontologist, 48, 721731.CrossRefGoogle ScholarPubMed
Williams, K. N. and Herman, R. E. (2011). Linking resident behavior to dementia care communication: effects of emotional tone. Behavior Therapy, 42, 4246.Google Scholar
Williams, K. N., Herman, R., Gajewski, B. and Wilson, K. (2009). Elderspeak communication: impact on dementia care. American Journal of Alzheimer's Disease & Other Dementias, 41, 1120.Google Scholar
Zeller, A., Hahn, S., Needham, I., Kok, G., Dassen, T. and Halfens, R. J. G. (2009). Aggressive behavior of nursing home residents toward caregivers: a systematic literature review. Geriatric Nursing, 30, 174187.Google Scholar