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.

Abstract

Introduction 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. Methods We recruited 17 nurses at a single nursing home who were caring for 15 MND patients of which 10 were female and 5 male patients. The study lasted for 6 weeks. For inter-observer reliability testing: We administered CWCS-R to a nursing home patient's nurse on first and second shift, once a week for the duration of 6 weeks. For validity testing: We administered Resistiveness to Care Scale (RTC) to the same patient's nurse on first and second shift, at the beginning of the study to test for external validity against CWCS-R. The integer of 1 was given to each yes on 13 item Resistiveness to Care Scale and were summed up at the end for each patient at the beginning of the study. Results Total 17 nurses enrolled in the study. Two nurses left after one month and 14 of the 15 nurses contributed a cooperation scale rating on at least one patient at least one point in time. 100% nurses were women (16 African American and 2 White). All nurses worked at the same nursing home for 6 months or more with mean work months was 81.5 months, median work months was 65 months with standard deviation (SD) 75.76 months. Mean age for nurse was 48?years, median was 47?years, and SD was 13. The patients included 10 women and 5 men. Mean for patients age was 88?years, median was 88?years and SD was 9?years. The mean (Mini Mental Status Examination) MMSE score was 7, and median MMSE score was 2, and SD was 8.3. All were white patients. 100% of patients were diagnoses with a MND. Inter-rater agreement Cooperation scores were 41.3 +/- 7.0 on first shift of week one, and 43.4 +/- 6.6 on second shift of week one (p= n.s). The median cooperation score across both shifts was 44. Using the median score of 44 as an indicator of which patients exhibited high versus low cooperation with care, a high degree of agreement was seen between the first and second shifts at week 1 (kappa=0.70; p Conclusions Our study shows that CWCS-R for MND patients, is both reliable and valid. More studies are needed to replicate these results of CWCS -R and to compare the level of cooperation with the care against the cost of care for MND patients in nursing home setting. This research was funded by: Coop Study was not funded by any source.