TESTING VALIDITY AND RELIABILITY OF COOPERATION WITH CARE SCALE - R IN NURSING HOME MAJOR NEUROCOGNITIVE DISORDER PATIENTS SMITA U. VARSHNEY, M.D., WILLIAM V. MCCALL, M.D.

Currently 1.7 million individuals reside in 15,600 nursing homes in US (www.cdc.gov). These individuals often have difficulty adjusting to their new environment. They may refuse daily care, meals, and medications. Resistance-to-care behavior was reported in 9% of dementia patients in US studies and 96.9% in a Norwegian study (Konno R 2012). A definition of rejection of care and a conceptual framework of rejection of care incorporating 7 components was proposed by Ishii S. 2012). Increased caregiver stress can cause both physical and psychological injury to caregivers (Cody SJ 2001). Informant distress related to patients behavioral and psychological symptoms of dementia (BPSD) rather than symptoms themselves, were noted to be associated with higher healthcare utilization and costs (Maust D. 2017). Increased mortality and death rate are associated with use of antipsychotic medications (Tampi R 2017). Different interventions have been reported to decrease resistance to care behaviors including Music therapeutic caregiving (Hammer L 2011), simulated presence therapy (Woods p 1995), Family-generated videotapes Cohen-Mansfield J 1997), video simulated presence(VSP) (O'Conner C 2012). AlzhaTV displayed family videos to dementia patients to reorient, reassure, encourage to cooperate with care, showed decrease in NPI-NH (Neuropsychiatric inventory – Nursing home) scores by 85% by day 90 (Varshney S 2018). Noncooperation with healthcare workers to overall daily care, medications, and treatments is a major factor in increased cost of care for dementia patients in nursing homes. A Resistiveness to Care scale was developed by (Mahoney EK 1999) to measure a wide range of resistive behaviors. Some strategies can be implemented to improve cooperation. However, our literature search didn't find any study/scale to assess co-operation with care that would help compare outcomes of different studies that used different interventions to improve cooperation with care. We created and tested a scale to measure cooperation with the care (Varshney S 2018) then revised to add frequency component to obtain a comprehensive assessment on cooperation with the care. We applied Cooperation with Care Scale – Revised (CWCS-R) to nurses taking care of 15 nursing home dementia patients, in a systematic approach to test its validity and reliability.