The Minimum Data Set Agitated and Reactive Behavior Scale: Measuring Behaviors in Nursing Home Residents With Dementia
The Minimum Data Set Agitated and Reactive Behavior Scale: Measuring Behaviors in Nursing Home Residents With Dementia
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DOI：
10.1016/j.jamda.2019.08.030
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发表时间：
2019-12-01
影响因子：
7.6
通讯作者：
Mor, Vincent
中科院分区：
文献类型：
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作者：
McCreedy, Ellen;Ogarek, Jessica A.;Mor, Vincent
目标：目前正在疗养院（NH）测试旨在控制痴呆症患者的激越和攻击行为而不使用抗精神病药物的干预措施。研究人员和临床医生需要一种能够捕捉居民行为严重程度的措施。我们测试了激动和反应行为量表 (ARBS) 的内部一致性和结构有效性，该量表是使用强制性 NH 评估数据创建的。设计：横断面。设置和参与者：2016 年全国 15,326 个医疗保险和医疗补助服务中心认证的 NH 样本。分析样本包括 489,854 名新入院居民和 765,367 名长期居住居民（在新罕布什尔州居住至少 90 天）。所有参与者都有痴呆症诊断。方法：最小数据集 (MDS)，版本 3.0。 ARBS 是对 (1) 针对他人的身体行为症状的综合衡量； (2)针对他人的言语行为症状； （三）其他不针对他人的行为症状； (4) 拒绝护理。用于建立结构效度的变量包括认知障碍程度、控制激越和攻击行为的药物使用，以及与激越和攻击行为相关的同时发生的病症（例如精神分裂症、抑郁症或谵妄）。 结果：本报告有 3 个重要发现：（1）在全国患有痴呆症的 NH 居民中，ARBS 评分具有足够的内部一致性（α = .64-.71）； (2) 根据 MDS 评估，只有 18% 的新入院痴呆症居民和 21% 的长期住院居民在上周表现出任何烦躁或攻击性行为； (3) ARBS 表现出良好的结构效度；它随着认知障碍、相关药物治疗以及同时出现的精神疾病和症状而增加。讨论：全国现有的 MDS 数据可能大大低估了新罕布什尔州痴呆症居民中激越和攻击性行为的患病率。结论和启示：对新罕布什尔州痴呆症居民进行非药物干预管理行为的实用试验的研究人员应考虑到现有 MDS 数据中可能未检测到这些行为。 (C) 2019 AMDA - 急性后和长期护理医学协会。
Objectives: Interventions aimed at managing agitated and aggressive behaviors in dementia without the use of antipsychotics are currently being tested in nursing homes (NHs). Researchers and clinicians require a measure that can capture the severity of residents' behaviors. We test the internal consistency and construct validity of the Agitated and Reactive Behavior Scale (ARBS), a measure created using data from mandatory NH assessments.Design: Cross-sectional.Setting and Participants: The 2016 national sample of 15,326 Centers for Medicare and Medicaid Servicescertified NHs. The analytic sample included 489,854 new admissions and 765,367 long-stay residents (at least 90 days in NH). All participants have a dementia diagnosis.Methods: Minimum Data Set (MDS), version 3.0. The ARBS is a composite measure of (1) physical behavioral symptoms directed at other people; (2) verbal behavioral symptoms directed at other people; (3) other behavioral symptoms not directed at other people; and (4) rejection of care. Variables used to establish construct validity included degree of cognitive impairment, use of medications for managing agitation and aggression, and co-occurring conditions associated with agitated and aggressive behaviors (eg, schizophrenia, depression, or delirium).Results: This report has 3 important findings: (1) the ARBS score has borderline-adequate internal consistency (alpha = .64-.71) in the national population NH residents with dementia; (2) only 18% of new admissions and 21% of long-stay residents with dementia evidence any agitated or aggressive behaviors in the last week, as rated in the MDS assessment; and (3) the ARBS demonstrates good construct validity; it increases with cognitive impairment, treatment with relevant medications, and co-occurring psychiatric conditions and symptoms.Discussion: Nationally available MDS data may significantly underestimate the prevalence of agitated and aggressive behaviors among NH residents with dementia.Conclusions and Implications: Researchers conducting pragmatic trials of non-pharmaceutical interventions to manage behaviors in NH residents with dementia should consider the likely underdetection of these behaviors in the available MDS data. (C) 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.