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Alzheimer's disease or a related dementia (ADRD) disproportionately affects women with two-thirds of individuals with ADRD comprised of women. This study examined gender-related differences in the quality of staff-patient interactions and depressive symptoms among hospitalized older patients living with dementia. This secondary analysis utilized baseline data of 140 hospitalized older patients with dementia who participated in the final cohort of a randomized controlled trial (ClinicalTrials.gov identifier: NCT03046121) implementing Family centered Function-focused Care (Fam-FFC). On average, the participants (male = 46.1%, female = 52.9%) were 81.43 years old (

The current study aimed to test the feasibility and preliminary efficacy of the Promoting Positive Care Interactions (PPCI) intervention designed to establish positive care interactions between staff and residents in assisted living (AL) using an online approach. PPCI was implemented in one AL community using a single group pre-/posttest design; 17 care staff were recruited from the memory care unit. Delivery, receipt, and enactment of the PPCI were assessed for feasibility. Change in staff outcomes and facility outcomes were examined for preliminary efficacy. The four steps of the PPCI were implemented as intended with 100% staff exposure to education and considerable staff engagement in weekly mentoring sessions. Although there was an improvement in AL environment and policy, no significant changes were observed in staff outcomes. Future testing of the PPCI should include a longer timeline and explore a hybrid model that includes online education and in-person mentoring and coaching of staff to improve care interactions. [ Journal of Gerontological Nursing, 48 (8), 17–25.]

Background. Quality staff-resident communication is crucial to promote outcomes in nursing home residents with dementia requiring assistance during mealtimes. Better understanding of staff-resident language characteristics in mealtime interactions help promote effective communication, yet evidence is limited. This study aimed to examine factors associated with language characteristics in staff-resident mealtime interactions.Methods. This was a secondary analysis of 160 mealtime videos involving 36 staff and 27 residents with dementia (53 unique staff-resident dyads) in 9 nursing homes. We examined the associations of speaker (resident vs. staff), utterance quality (negative vs. positive), intervention (pre- vs. post-communication intervention), and resident dementia stage and comorbidities with expression length (number of words in each utterance) and addressing partner by name (whether staff or resident named their partner in each utterance), respectively.Results. Staff (utterance n = 2990, 99.1% positive, mean = 4.3 words per utterance) predominated conversations and had more positive, longer utterances than residents (utterance n = 890, 86.7% positive, mean = 2.6 words per utterance). As residents progressed from moderately-severe to severe dementia, both residents and staff produced shorter utterances (z=-2.66, p = .009). Staff (18%) named residents more often than residents (2.0%; z = 8.14, p Conclusions. Staff-resident communication was primarily positive, staff-initiated, and resident-oriented. Utterance quality and dementia stage were associated with staff-resident language characteristics. Staff play a critical role in mealtime care communication and should continue to initiate resident-oriented interactions using simple, short expressions to accommodate resident declining language abilities, particularly those with severe dementia. Staff should practice addressing residents by their names more frequently to promote individualized, targeted, person-centered mealtime care. Future work may further examine staff-resident language characteristics at word and other levels using more diverse samples.

Care interactions are essential to understand and respond to resident needs in assisted living (AL). The factors that influence care interactions in AL have not been directly examined. In this study, we explored the factors associated with the quality of care interactions in AL. It was hypothesized that resident functional status, agitation, depression, and resistiveness to care as well as facility size and ownership would be significantly associated with the quality of care interactions in AL after controlling for resident demographics (age, gender, marital status), comorbidities, and cognition. To test the hypothesis, we utilized baseline data including 379 residents from the second and third cohorts recruited in a randomized trial titled ‘Dissemination and Implementation of Function Focused Care for Assisted Living Using the Evidence Integration Triangle’. Regression analysis was performed using a stepwise method. The care interactions were mostly positive (mean=6.3; range = 0-7). Resident agitation and facility ownership were significantly associated with care interactions and accounted for 8.2% of the variance. Increased resident agitation was associated with negative or neutral interaction while for-profit ownership was associated with positive interactions. To promote positive care interactions, staff should be educated about strategies to minimize resident agitation (e.g., calm posture and respectful listening) and encouraged to engage with residents using resident-centered care and communication approach. Findings also suggest the need to work towards optimizing care interactions in nonprofit stings. Future research could further explore the impact of facility-level factors (e.g., staffing ratios, staff longevity, and job satisfaction) on care interactions.

Nursing homes (NHs) are challenged to consistently deliver person-centered care (PCC), or care based on residents' values and preferences. NH staff associate certain resident preferences with risk. However, there are limited evidence-based person-centered risk management strategies to assist NH staff with risky resident preferences. The purpose of the current study was to explore NH staff perceptions of health and safety outcomes associated with honoring NH residents' risky preferences to inform intervention development. This descriptive, qualitative study used sequential focus groups and content analysis, revealing that nursing staff perceive negative and positive outcomes for staff and residents when seeking to honor residents' risky preferences. This finding is supported by three themes: Potential Harms to Staff , Potential Harms to Residents , and Positive Shared Outcomes . These results contribute a set of nurse-driven quality of life and quality of care outcomes for NH staff and residents associated with PCC delivery in NHs. [ Research in Gerontological Nursing, 15 (6), 271–281.]

This study examined the associations between cognition and depressive symptoms, function, and pain among hospitalized older patients with dementia. We utilized baseline data of 461 hospitalized older patients with dementia who participated in an intervention study implementing Family-centered Function-focused Care (Fam-FFC) and conducted stepwise linear regression. On average, the participants (males = 189; 41% and females = 272; 59%) were 81.64 years old (Standard Deviation, SD = 8.38). There was a statistically significant association of cognition with depressive symptoms (b = −0.184, p < .001), functional status (b = 1.324, p < .001), and pain (b = −0.045, p < .001) when controlling for covariates. This study utilized a large sample of a relatively underrepresented population, hospitalized older adults with dementia, and addressed a topic with great clinical significance. Specific focus on testing and implementing best practices or interventions to support the clinical outcomes, and the cognitive function of hospitalized older adults with dementia is warranted in both practice and research.

While the incidence of dementia is generally higher in women compared to men, gender differences in interactions and well-being in dementia is still unclear. This study examined gender differences in interactions and well-being among hospitalized patients living with dementia. A total of 140 hospitalized patients (53% female and 47% male) were included in the analysis. On average, the participants were 81.43 years old (SD= 8.29), had positive interactions with staff based on higher scores on Quality of Interaction Schedule, QUIS (5.81, SD= 1.36), and fair emotional well-being based on lower scores on Cornell Scale for Depression in Dementia, CSDD (7.79, SD= 5.59). Although men seemed to have more positive interactions (male=6.07, SD=1.13; female=5.59, SD=1.51) and greater wellbeing (male=7.52, SD=4.77; female=8.03, SD=6.25) than women, there were no statistically significant gender differences observed in linear models with appropriate covariates. Future work should continue to explore gender differences in interactions and well-being.

Background: Positive and effective staff–resident interactions are imperative to adequately assess and meet the needs of cognitively impaired residents in nursing homes and optimize their quality of life. Purpose: The purpose of this study was to quantify, describe, and analyze the interaction between staff and cognitively impaired residents in nursing homes, using the Quality of Interaction Schedule (QuIS). Specifically, the following aims were addressed— Aim 1: To quantify and describe the quality of interactions between staff and cognitively impaired residents in nursing homes. Aim 2: To analyze whether the quality of staff–resident interactions vary by resident cognitive status (moderate vs severe) and interaction characteristics (interaction location, interaction situation, interpersonal distance, type of staff, and resident level of participation). Method: This descriptive analysis utilized baseline data from the first 2 cohorts in a randomized clinical trial including 341 residents from 35 nursing homes. Results: Five hundred fifty-six staff–resident interactions were evaluated; majority were positive (n = 466, 83.8%) and the remaining were either neutral (n = 60, 10.8%) or negative (n = 30, 5.4%). The quality of interactions varied by interaction location, interpersonal distance, and resident participation. Conclusion: This study provides some current descriptive information about the quality of staff-resident interactions in nursing homes and the interaction characteristics that might impact these interactions. Future research should focus on decreasing the negative/neutral interactions and explore staff characteristics (e.g., gender, level of experience) and facility factors (e.g., size, ownership) that might influence the quality of interactions.

Background and PurposeThe Cohen-Mansfield Agitation Inventory (CMAI) is a widely used measure of agitation. The purpose of this study was to test the internal consistency, reliability, and validity of short-form CMAI in a sample of nursing home residents with cognitive impairment and examine if it is invariant across gender.MethodsThis study utilized baseline data from a randomized trial including 553 residents from 55 nursing homes. Data was analyzed using structural equation modeling.ResultsConfirmatory factory analysis supported the three-factor structure including aggressive (α = .794), physically nonaggressive (α = .617), and verbally agitated (α = .718) behaviors. Invariance testing confirmed that the shortened measure is invariant across gender.ConclusionsFindings provide validity evidence of short-form CMAI to assess agitation and gender differences in agitation in nursing home population.

Background and PurposeThe purpose of this study was to test the reliability and validity of the Quality of Interaction Survey (QuIS) using a quantification scoring approach.MethodsBaseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) study was used.ResultsA total of 553 residents participated. There was evidence of inter-rater reliability with Kappa scores of .86 to 1.00 and internal consistency based on the Rasch analysis (item reliability of .98). There was some support for validity based on item fit and hypothesis testing as resistiveness to care was significantly associated with total QuIS scores.ConclusionThis study supports the use of the quantified QuIS to evaluate the quality of interactions over time and to test interventions to improve interactions.

Background: The Cohen-Mansfield Agitation Inventory (CMAI), available in both long and short versions, is a widely used measure to assess and evaluate agitation among older adults. There has been less psychometric testing of the short-form CMAI particularly with regard to the factor structure of this shorter measure. Purpose: The purpose of this study was to test the internal consistency, reliability and validity of short-form CMAI in a sample of nursing home residents and examine if it is invariant across gender. Specifically, it was hypothesized that consistent with the long form CMAI, the short-form CMAI would have three factors with acceptable internal consistency and item reliability. In addition, it was hypothesized that there would be no difference in factor structure and factor means across gender. Methods: This study utilized baseline data from a randomized trial including 553 residents from 55 nursing homes. Data was analyzed using structural equation modeling. Results: Confirmatory factory analysis supported the three-factor structure of short-form CMAI including aggressive (α= 0.794), physically non-aggressive (α= 0.617), and verbally agitated (α= 0.718) behaviors; three items loading on physically non-aggressive behaviors had R2 close to 0.3 suggesting low reliability. Invariance testing confirmed that the shortened measure is invariant across gender. Conclusions: Short-form CMAI is a valid and reliable scale to assess agitation and gender differences in agitation in nursing home population. However, it could benefit from rewording the items with low reliability or, merging them with other similar items. Future work could also consider a four-factor structure for this shortened measure.

Staff-resident interaction is an integral part of daily life of nursing home residents and has an influence on residents’ well-being. However, less is known about the factors that influence these interactions. The purpose of this study was to describe the quality of interaction between staff and residents with dementia in nursing homes, and explore the factors associated with ‘positive’ and ‘negative/neutral’ interactions. This cross-sectional analysis utilized baseline data from the first two cohorts in a randomized clinical trial, EIT-4-BPSD, including 338 residents from 35 nursing homes. Generalized linear mixed model (GLMM) was used to explore the factors associated with interactions. It was hypothesized that the resident factors (age, gender, race, marital status, cognition, comorbidities, depressive symptoms, agitation, functional status) and facility factors (facility ownership, facility size, RN hours, LPN hours, CNA hours, and star rating) would be associated with staff-resident interactions. The staff-resident interactions were mostly positive. Overall, the models for ‘positive interactions’ and ‘negative/neutral interactions’ correctly classified 82.8% and 85.3% of the cases respectively. Both ‘positive’ and ‘negative/neutral’ interactions were significantly associated with marital status, and profit status of the facility. Being married and living in a not for profit facility was associated with lower odds of positive interaction and higher odds of negative/neutral interaction. There is some evidence that marital status influences staff-resident interactions and that profit status of facilities are associated with staff resident interactions. Future studies could explore staff factors such as consistent assignment, job satisfaction, staff characteristics, and training.