Behaviour Of Older People Research Articles

The impact of residential respite care on the behaviour of older people with dementia: literature review

Aim. The aim of this review was to examine the impact of residential respite care on the behaviour displayed by older people with dementia. Background. Relocation of older people with dementia to a different care setting could have a negative impact on their behaviour. If such a response is anticipated, a short-term admission to a residential aged care facility for respite care would appear to be futile for the older person and their home caregiver. Therefore, it is important to know what the outcomes of residential respite care are in relation to behaviour for older people with dementia. Methods. A literature search was undertaken and papers emerged from a range of disciplines. The search terms 'respite'; 'respite care'; 'residential respite care'; 'short-stay', 'short-term', 'overnight stays/admissions', 'behav*' and various combinations of these terms were used to find relevant publications in English from Ageline, CINAHL, Medline and, Psychinfo databases dating from 1966. Other key publications were located when searching through the reference lists of retrieved publications. A limited body of literature on residential respite care for older people with dementia was revealed. Results. Six studies were identified, which met the criteria of residential respite care as the intervention and behaviour as an outcome. Conclusions. The studies had a variety of methodological limitations and produced contradictory findings. The strength of the studies was the reporting of outcomes for respite recipients who are usually overlooked in the outcomes for respite research. Relevance to clinical practice. Residential respite care has great anecdotal support but more empirical and evaluative research is needed on outcomes for the respite recipients.

Work Behavior of Older People with Disabilities in the Era of the Americans with Disabilities Act

This paper explores the correlation between the implementation of the Americans with Disabilities Act (ADA) and the employment participation of people with disabilities. First, it discusses the methodological difficulties in measuring the ADA's impacts. Second, it describes a longitudinal study using Health and Retirement Survey data exploring changes in employment rates and odds of employment during the 1990s for older working-age people with disabilities. The findings show that while older people with disabilities had slightly lower employment rates than older people without disabilities during the 1990s, the odds that older people with disabilities would be employed has increased since the passage of the ADA.

The impact of residential respite care on the behavior of older people

The aim of this study was to examine the impact of residential respite care on disruptive behavior displayed by older people, particularly those with dementia. A quasi-experimental, repeated-measures, single-group design was used. The participants were a consecutive series of 100 older people with a mean age of 81.8 years (range 66-96 years) who had been booked for a respite admission to one of several residential aged care facilities in a provincial Australian city. A diagnosis of dementia was reported for 29% of the sample. Disruptive behaviors were rated before and after the period of respite by home caregivers (N = 100) and during the period of respite by nurses (N = 25) using the Dementia Behavior Disturbance Scale (DBDS). Age, male gender and the presence of dementia were all significantly related to the frequency of reported disruptive behaviors. Residential respite care was associated with a significant reduction in the frequency of reported disruptive behaviors in older people (Wald chi2 = 28.28, p < 0.0001). However, this improvement in behavior did not persist into the post-respite period. The deteriorating behavioral trajectory that was evident prior to respite care continued following the period of respite care. Residential respite care was associated with a temporary diminution in the frequency of reported disruptive behaviors in older people. This finding should be reassuring both for family carers considering placing a relative in residential respite care and for health workers considering whether to recommend such a course of action.

Use of preferred music to decrease agitated behaviours in older people with dementia: a review of the literature

This paper reviews study findings of preferred music on agitated behaviours for older people with dementia and provides implications for future research and practice. Music has been suggested as a feasible and less costly intervention to manage agitated behaviours in older people with dementia. However, no review of the literature focusing on study findings of preferred music on agitated behaviours in older people with dementia had been reported. A review was undertaken using electronic databases with specified search terms for the period of 1993-2005. The references listed in the publications selected were also searched for additional studies. Eight research-based articles met the inclusion criteria and were included in the review. The preferred music intervention demonstrated positive outcomes in reducing the occurrence of some types of agitated behaviours in older people with dementia. The findings from these studies were relatively consistent in finding improvement in agitated behaviours although the findings in one study did not reach statistical significance. The small sample sizes and some variations in the application of the preferred music intervention mean that caution is needed in drawing conclusions from these studies. This review highlights that preferred music has positive effects on decreasing agitated behaviours in older people with dementia; however, the methodological limitations indicate the need for further research. Findings from the review highlight the beneficial outcomes of preferred music in reducing agitated behaviours for older people with dementia. The incorporation of preferred music has the potential to provide a therapeutic approach to the care of older people with dementia.

Organising services for influenza vaccination for older people.

To follow up a trial of home-administered influenza vaccination of older people to explore reasons for their immunisation behaviour, including their views on the organisation of services. Follow-up of original trial using analysis of records of 1865 older people and semi-structured interviews of 25 older people. A once-off home visit does not appear to result in sustained changes in immunisation behaviour. Older people's behaviour appears to be largely explained by their beliefs about immunisation; the organisation of services may exert only small effects. Older people can be characterised as belonging to one of four groups in their orientation towards influenza vaccination: the 'faithful', who are keen to have vaccination; the 'converts', who have been persuaded of the benefits of vaccination and are likely to self-initiate appointments for vaccination; the 'easy-going', who require prompting for vaccination; and the 'sceptics', who perceive influenza vaccination to be ineffective or to be irrelevant for them because of their perceived inherent resistance to influenza. The last group sees vaccination as a form of interference and may be resistant to home visits to administer the vaccine. Targets for immunising older people require more debate because of the delicate balance between achieving herd immunity and preserving autonomy and choice for older people.

Aggressive behaviour in older people: a review of the issues

The occurrence of aggressive behaviour in health care is increasing, as is the risk of injury to health-care professionals following an attack from a patient. Such behaviour, which can be physical or verbal, is severely challenging and may be caused by a variety of reasons, which include mental illness and seeking attention. This article provides a review of the relevant literature regarding the possible causes of aggressive behaviour in older people. It outlines the management strategies designed to prevent this challenging behaviour, which take into consideration that the client should be able to express his or her feelings or distress.

General practitioner attitudes to discussing sexual health issues with older people

How health professionals perceive and manage later life sexual problems remains relatively unexplored and, in particular, little is known about the attitudes of GPs, who represent the first point of contact for most older people in the UK who experience sexual health concerns. This paper draws on qualitative data generated from in-depth interviews with 22 GPs working in demographically diverse primary care practices in Sheffield, UK. Analysis identified that GPs do not address sexual health proactively with older people and that, within primary care, sexual health is equated with younger people and not seen as a ‘legitimate’ topic for discussion with this age group. However, it was apparent that many beliefs held about the sexual attitudes and behaviours of older people were based on stereotyped views of ageing and sexuality, rather than personal experience of individual patients. The discussion considers the implications of these findings for primary care, particularly in relation to education and training.

POOLE’S ALGORITHM: NURSING MANAGEMENT OF DISTURBED BEHAVIOUR IN OLDER PEOPLE - THE EVIDENCE

Disturbed behaviour in older people is a challenging and complex clinical problem. Accurate nursing assessment and management are key elements for good outcomes. The literature shows that nurses do not consistently understand this clinical syndrome and appropriate education is needed. In recognition of limited time frames and of theories of learning, an algorithm has been developed detailing, in order of priority, the management of aggression, delirium, depression or other mental disorders and dementia, plus an outline of supportive communication and care techniques. Three separate packages, each comprising a booklet of lecture notes and resources plus a matching poster are available. Each of these relates particularly to the needs of older people in aged care facilities, acute care or the community.

Health status and functional capacity in a group of successfully ageing 65 – 85 year olds

Purpose: To examine health behaviours of older people,comparing people aged 65 – 74 years with those aged 75 – 85years. Methods: Seventy-five men (45%) and women (55%) agedbetween 65 and 85 years were recruited from a sample ofconvenience. Participants completed three questionnaireswhich documented health status, exercise patterns, levels ofphysical capacity, independence in daily living and involvementin activities. Tests of physical ability were then conductedrelated to walking, upper extremity function, ability on tramsteps, and grip strength. Results: The sampling method delivered a biased sample withmost participants rating their health as excellent or very goodfor their age. While many participants reported chronicmedical conditions, or more than one fall in the last year,the level of physical activity was strikingly high. Men weremore active than women, and physical activity declinedminimally after the age of 75. Anecdotally, the sample wasalso active in social and intellectual activities, with womeninvolved in these activities more than physical pursuits. Conclusions: The role of activity is important in the study ofsuccessful ageing. This study reported gender and age groupdifferences in the activities chosen, demonstrating that theinclusion of a cross-section of daily activities is essential in thestudy of health status and well-being.

The HealthSense Project

HealthSense is a pan-European, multi-center project generating scientific data on the relationships between sensory physiology, perceptions of flavor and texture, sensory memory, and food preferences across cultures. HealthSense studies degradation of sensory capabilities that accompany aging, and determines how such changes affect food preferences in different eating situations. In addition, food preferences are being considered alongside a study of the attitudes and behaviour of older people towards food and choice, and how older people provision their resources is being studied. The results of these studies will be published in a format to be used by dietitians and nutritionists, medical and other care providers, policy makers, the food industry, and consumer organizations who support the elderly.

Behaviour rating scales for older people with dementia: Which is the best for use by nurses?

Abstract : There is increasing awareness of the importance of disruptive behaviour in people with dementia and the need for rating scales to accurately and reliably measure this behaviour. When rating scales are to be administered by nurses, scale characteristics must take into account the limitations of the nursing role and the nature of the environment in which nurses work. This paper reviews thirty‐one rating scales that have been used to measure behaviour in dementia. From this analysis, five scales were identified as suitable for use by nurses when measuring disruptive behaviour in older people with dementia.

An exploration of help-seeking behaviour in older people with unmet needs.

Despite decades of research showing high rates of unmet need in older people, there currently is little understanding of why these needs remain unmet. This study was performed as part of a larger feasibility study of a multidisciplinary needs assessment tool in primary care. The aim of the present study was to explore patients' and carers' help-seeking behaviour and perceived barriers to meeting unmet needs. Four general practices were selected purposefully in inner city and suburban London A random sample of 1 in 20 people aged 75 years and over registered with each practice was selected for a multidisciplinary needs assessment using the 'Camberwell Assessment of Need for the Elderly' (CANE) schedule and unmet needs identified by patients and their informal carers. For each unmet need, a further semi-structured interview was used to explore the help-seeking behaviour and perceived barriers to meeting their needs. Responses were recorded verbatim contemporaneously and a thematic analysis performed on perceived barriers following completion of all interviews. A total of 55/84 (65.5%) of patients and 15/17 (88%) of carers completed the initial needs assessment. For 104 unmet needs identified by 31 patients and 11 carers, a further interview was completed on the barriers to meeting that need. Help had been sought for only 25/104 (24%) of unmet needs and it had been offered in only 19/104 (18%). In those not seeking help, withdrawal, resignation and low expectations were dominant themes. In those that had sought help, there were issues of perceived failure of service delivery and rationing, with themes of resignation and withdrawal again emerging in those declining help offered. The majority of older people and their carers do not appear to seek help for their unmet needs for a range of complex reasons, often involving issues of withdrawal, resignation and low expectations. This complexity has implications for the commissioning of services for older people.

An impact evaluation of a falls prevention program among older people

The aim of this evaluation study was to assess the impact of peer-presented education sessions on the falls-related attitude, knowledge and behaviour of older people. The evaluation was undertaken on the Bellarine Peninsula in Victoria, Australia, and adopted a non-randomised pre-test post-test design. Baseline, 3 and 12 months follow-up data were collected for 107 individuals who attended the education sessions and 116 controls, matched by age range and sex. The groups were not strictly equivalent at baseline, with the intervention group having a greater knowledge about falls and falls prevention. Analyses which controlled for baseline differences showed that those who attended the education sessions maintained a greater knowledge of factors that can prevent falls at 12 months follow-up. The intervention group also made more changes in and around their home to prevent falls by 3 and 12 months follow-up. Younger participants who reported a previous history of falls and having taken action to prevent falls were most likely to take additional action. The results can help target this type of education program and suggest that their major benefit may lie in providing those who voluntarily attend with the impetus to take the most effective preventative action.

Identifying the expectations of older food consumers

Given the many potential negative factors that influence food choice behaviour in older people, it is important to understand the problem areas of food shopping. Uses critical incident technique (CIT) to elicit consumers’ stories of dissatisfying/satisfying shopping experiences and, where dissatisfied, identifies their expectations. Volunteers from a cross‐section of locations in Scotland were interviewed, eliciting 248 incidents. Results identified eight key elements contributing to the food shopping experience with all, except social aspects, having positive and negative incidents. Argues that the factors influencing the food shopping experience are much wider than previous research indicates and that, given the breadth of dissatisfaction across the elements, older consumers are lacking “power” within the marketplace. Expectations indicate that some consumers feel they do not have the ability to exercise any alternative to overcome their dissatisfaction.

Researching the sexual behaviour of older people: a methodological challenge

Although it is known that older people are diagnosed with sexually transmitted diseases (STDs), including HIV (PHLS, 1998) and attend genitourinary medicine (GUM) clinics (Gott et al. 1998, Gott et al. 1998, Rogstad and Bigneil 1991, Openeye 1991, Kohiyar 1983), little is known about the sexual health of older people who do not present at health care services. This paper discusses methodological issues pertinent to designing such a study and presents the example of a two-phase postal questionnaire survey based upon the electoral register which elicited a satisfactory response rate from an older sample. This indicates that the perceived difficulties of researching sexual health issues with older populations may have been over-estimated.

MANAGEMENT OF SUICIDAL BEHAVIOR IN THE ELDERLY

Suicidal behavior in older people is more often lethal than in any other age group. Social isolation, losses and physical illness, a past history of suicide attempts, and psychiatric illness are risk factors with implications for prevention of late life suicide. Preliminary indications are that community outreach to elders at risk and educational programs for primary care providers on the identification and treatment of late life depression are effective at lowering suicide rates.

Challenging behaviour in older people: nurses' attitudes.

An investigation was undertaken to look at nurses' attitudes to challenging behaviour in hospitalised older adults. It was predicted that nurses would make internal rather than external or medical attributions for challenging behaviour and that negative emotions towards the patient would result in negative responses, for example, reprimanding the patient. Findings revealed that nurses did not make significantly more internal rather than external or medical attributions, and that no significant differences were associated with age or grade (p > 0.05). A correlation coefficient showed that negative emotions were associated with an internal attribution style (r = .40, p < 0.005). A simple regression analysis revealed that negative behaviour could be significantly predicted from negative emotion (f = 10.68, p < 0.01). The research concludes that efforts should be made to reduce negative effect via staff training and that further research should focus upon staff and patient interactions within real life settings.

Introduction: The Uses and Evaluation of Qualitative Research

If ever there was an area of inquiry that should be approached from the perspective of interpretive social science, this is one. It is apparent even to the most casual observer that aging has multiple biological, psycho- logical, and sociological components; that neither the behavior of older people nor the status of older people can be understood otherwise; and that the primary need is for explication of contexts and for multiplicity of methods. It should also be apparent that attention to change over time is fundamental in lay disciplinary approaches to the study of aging, whether it be change in the individual or historical change in social, economic, and political institutions. (p. 294)

Psychosexual Dysfunction in the Elderly

The area of psychosexual dysfunction in the elderly has been relatively ignored and very little research has been conducted into the aetiology, assessment, and treatment of such disorders. Many negative attitudes have been held traditionally relating to the sexual behaviour of older people, and this may account for the reluctance of many elderly clients to seek help, and for the lack of attention paid by helping professionals. The number of referrals for sex therapy from older persons is now beginning to increase, and evidence confirms that the majority of healthy older persons remain sexually active and sexually capable throughout their later years. Although there is a marked lack of empirical research, case studies suggest that cognitive-behavioural approaches offer promise in the treatment of psychosexual dysfunction in the elderly. Factors are discussed that relate specifically to older clients in the application of a cognitive-behavioural approach to assessment and therapy.