Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA.
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Gerontologist. 2022 Feb 9;62(2):169-180. doi: 10.1093/geront/gnab059.
Assisted living (AL) residents with dementia commonly exhibit behavioral expressions (BEs), yet no study has examined how AL staff perceive and respond to BEs in terms of the "ABC" model of antecedents, behaviors, and consequences, or how perceptions relate to organizational characteristics. Understanding staff perceptions may inform interventions.
A convergent, mixed methods design was used in a study of health care supervisors from 250 AL communities in 7 states who reported 366 cases of resident BEs (one successful and one unsuccessful case). Qualitative analysis identified antecedents, BEs, staff responses, resident outcomes, and disposition (aging in place or discharge). Content analysis identified themes and compared case types. Descriptive statistics examined organizational characteristics associated with identifying antecedents.
One quarter of cases recognized antecedents; slightly more were identified in successful (28%) compared to unsuccessful cases (20%); staff in dementia-only and smaller communities identified antecedents more often. Combativeness and anxiety were the most frequently reported BEs. The majority of both types of cases reported staff responses. Medication management was enacted as a response in 40% of cases compared to psychiatric assessment in 33% of cases.
Staff training is indicated to increase AL staff recognition of antecedents; doing so might reduce the use of antipsychotic medications. Psychiatric assessment plays an important role in dementia care in AL and warrants further examination. Results could be helpful for applied behavioral researchers interested in developing ways to improve the identification of antecedents of BEs of persons with dementia.
患有痴呆症的辅助生活（AL）居民通常会表现出行为表达（BE），但尚无研究根据前因、行为和后果的“ABC”模型来考察 AL 工作人员如何感知和应对 BE，也没有研究感知与组织特征之间的关系。了解工作人员的看法可能有助于干预。
本研究采用了一种收敛性混合方法设计，研究对象为来自 7 个州的 250 个 AL 社区的医疗保健主管人员，他们报告了 366 例居民 BE 病例（一个成功案例和一个不成功案例）。定性分析确定了前因、BE、工作人员的反应、居民的结果以及处置方式（原地老龄化或出院）。内容分析确定了主题并比较了案例类型。描述性统计检验了与识别前因相关的组织特征。
四分之一的病例识别出了前因；在成功案例（28%）中比不成功案例（20%）中更多地识别出了前因；在仅患有痴呆症和规模较小的社区中，工作人员更经常识别出前因。挑衅和焦虑是报告最多的 BE。两种类型的病例中，大多数都报告了工作人员的反应。在 40%的病例中采取了药物管理措施，而在 33%的病例中则采取了精神科评估措施。
需要对工作人员进行培训，以提高 AL 工作人员对前因的识别能力；这样做可能会减少抗精神病药物的使用。精神科评估在 AL 中的痴呆症护理中起着重要作用，值得进一步研究。对于有兴趣开发改善痴呆症患者行为前因识别方法的应用行为研究人员来说，研究结果可能会有所帮助。
