Failure to identify behavioral symptoms of people with dementia and the need for follow-up physical assessment.

This descriptively designed study examined the sensitivity and specificity of staff nurses' identification of behavior change in nursing home residents with dementia. Behavior changes and whether further physical assessment was indicated were described and compared with judgments made by one expert advanced practice nurse. The convenience sample included 155 residents and 38 staff nurses from 11 nursing homes. Verbal symptoms and body part cues were the most prevalent behaviors, regardless of the assessor. Sensitivity, or probability of identifying a real behavior change, was generally low for the staff nurses, ranging from 35% to 65% for the different types of behaviors, while specificity was high at more than 95%. Additional assessment was believed to be needed for 51% of residents by the staff nurse and for 73% of residents by the expert. This study found that staff nurses are under-identifying behavior changes and the need for additional physical assessment.