The Columbia Behavior Scale for Dementia: Validity and Reliability in Long-Term Care Settings

Abstract Numerous neuropsychiatric inventories have been created for behavioral and psychological symptoms of dementia (BPSD). These inventories are seldom used in long-term care (LTC) settings due to questionable psychometrics, lengthy administration, and reliance on knowledgeable informants. The Columbia Behavior Scale for Dementia (CBS) is a rapidly administered BPSD rating tool that was developed for LTC residents. The 11-item CBS can be completed in less <5 minutes independently, with nursing staff, or in conjunction with interdisciplinary care teams. LTC residents (N = 350) participated in a validation study in Maryland, USA (M age = 78.38, SD = 10.82). Internal consistency (⍺ = 0.75) and inter-rater reliability (r = 0.99) for the CBS were strong. CBS scores were not biased by informant type (p > 0.05): GNAs/CNSs (40.69%), nurses (36.10%), other facility staff (23.21%). Diagnostic validity was confirmed by significantly higher CBS scores (p < 0.001; large effect, d = .63) for LTC residents with dementia (n = 197, M = 4.63, SD = 4.58) versus those without dementia (n = 145, M = 2.17, SD = 2.87). Higher CBS scores were significantly associated with greater impairment on cognitive instruments (r range = -0.25, -.36) and increased mood dysfunction (r range = 0.20, 0.26), indicating convergent validity. Principal components analysis produced three CBS factors, psychosis, aggression, and non-aggressive motor disinhibition, which significantly identified LTC residents with greater odds for antipsychotic use. Results will be discussed in terms of right-sizing antipsychotic utilization, improving nonpharmacological behavior management, and enhancing the dementia literacy of nursing staff.

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The Mood-5 (M5): A New Scale for Detecting COVID-19 Psychological Burden in Post-acute and Long-term Care Residents (Preprint)

10.2196/preprints.26340 ◽

2020 ◽

Author(s):

William E Mansbach ◽

Ryan A Mace ◽

Melissa A Tanner

Keyword(s):

Convergent Validity ◽

Long Term Care ◽

Psychological Symptoms ◽

Demographic Variables ◽

Self Assessment ◽

Term Care ◽

Psychological Burden ◽

Virtual Visits ◽

Novel Coronavirus

BACKGROUND Older adults are at high risk for developing serious somatic and psychological symptoms from the 2019 novel coronavirus (COVID-19). Available instruments may not be sensitive to concerns about COVID-19 in post-acute and long-term care (PA/LTC) and have unknown utility for telehealth. OBJECTIVE We investigated the psychometric properties of the Mood-5 Scale (M5) as a rapid self-assessment of COVID-19 psychological burden in PA/LTC residents. METHODS Residents (N = 131, age ≥ 50) in 20 Maryland, USA PA/LTC settings were evaluated in-person or via telehealth (33%) during a four-week COVID-19 period (05/11/2020 – 06/05/2020). COVID psychological burden was rated by psychologists who independently reviewed clinical documentation. Psychometric analyses were performed on the M5 in relation to psychological tests, COVID-19 psychological burden, and diagnostic data collected during the evaluation. RESULTS The M5 demonstrated acceptable internal consistency (???? = .77). M5 scores were not confounded by demographic variables or telehealth administration (ps > 0.08). Convergent validity for the M5 was established via positive associations with anxiety (r = 0.56, p < 0.001) and depressive (r = 0.49, p < 0.001) symptoms. A M5 cutoff of 3 demonstrated strong sensitivity (.92) and adequate specificity (.75) for identifying COVID-19 psychological distress in PA/LTC residents (AUC = .89, PPV = .79, NPV = .91). CONCLUSIONS The M5 is a reliable and valid mood self-assessment that can identify residents with significant psychological burden associated with COVID-19. It can be completed in less than one minute and is appropriate for in-person and virtual visits.

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OP48 Nursing Requirements In Long-Term Care: A Health Technology Assessment

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462319001132 ◽

2019 ◽

Vol 35 (S1) ◽

pp. 11-12

Author(s):

Paula Corabian ◽

Charles Yan ◽

Susan Armijo-Olivo ◽

Bing Guo

Keyword(s):

Nursing Care ◽

Nursing Staff ◽

Real World ◽

Research Evidence ◽

Long Term Care ◽

Staff Time ◽

Term Care ◽

Policy Makers ◽

The Relationship

IntroductionThe objectives of this study were to systematically review published research on the relationship between nursing staff coverage, care hours, and quality of care (QoC) in long-term care (LTC) facilities; and to conduct a real world evidence (RWE) analysis using Alberta real world data (RWD) to inform policy makers on whether any amendments could be made to current regulations.MethodsA systematic review (SR) of research evidence published between January 2000 and May 2018 on the relationship between nursing staff coverage, care hours, and QoC in LTC facilities was conducted. Panel data regressions using available RWD from Alberta, Canada, were performed to assess associations between nursing care hours and LTC outcomes. Outcomes of interest included quality indicators related to resident outcomes, hospital admissions, emergency room visits and family satisfaction. Nursing care hours considered in SR and RWE analysis included those provided by registered nurses (RNs) and licensed practical nurses (LPNs).ResultsThe SR found inconsistent and poor quality evidence relevant to the questions of interest, indicating a great uncertainty about the association between nursing staff time and type of coverage and QoC. Although some positive indications were suggested, major weaknesses of reviewed studies limited interpretation of SR results. RWE analysis found that impact of care hours on LTC outcomes was heterogeneous, dependent on outcome measurements. There was evidence that total staff, RN, and LPN hours had positive effects on some resident outcomes and magnitude of effect differed for different nursing staff.ConclusionsNo definitive conclusion could be drawn on whether changing nursing staff time or nursing staff coverage models would affect residents’ outcomes based on the research evidence gathered in the SR. RWE analysis helped to fill a gap in the available published literature and allowed policy makers to better understand the impact of revising current regulations based on actual outcomes.

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An instrument for measuring staff's knowledge of behavior management principles (KBMQ) as applied to geropsychiatric clients in long-term care settings

Journal of Behavior Therapy and Experimental Psychiatry ◽

10.1016/s0005-7916(97)00021-9 ◽

1997 ◽

Vol 28 (3) ◽

pp. 213-220 ◽

Cited By ~ 3

Author(s):

Charles E. Blair ◽

Estena F. Eldridge

Keyword(s):

Behavior Management ◽

Long Term Care ◽

Term Care

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Hearing Screening for Residents in Long-Term Care Homes Who Live with Dementia: A Scoping Review

Journal of Alzheimer s Disease ◽

10.3233/jad-215087 ◽

2021 ◽

pp. 1-24

Author(s):

Fiona Höbler ◽

Katherine S. McGilton ◽

Walter Wittich ◽

Kate Dupuis ◽

Marilyn Reed ◽

...

Keyword(s):

Older Adults ◽

Hearing Loss ◽

Nursing Staff ◽

Scoping Review ◽

Pure Tone ◽

Long Term Care ◽

Pure Tone Audiometry ◽

Care Homes ◽

Term Care

Background: Hearing loss is highly prevalent in older adults, particularly among those living with dementia and residing in long-term care homes (LTCHs). Sensory declines can have deleterious effects on functioning and contribute to frailty, but the hearing needs of residents are often unrecognized or unaddressed. Objective: To identify valid and reliable screening measures that are effective for the identification of hearing loss and are suitable for use by nursing staff providing care to residents with dementia in LTCHs. Methods: Electronic databases (Embase, Medline, PsycINFO, CENTRAL, and CINAHL) were searched using comprehensive search strategies, and a stepwise approach based on Arksey & O’Malley’s scoping review and appraisal process was followed. Results: There were 193 scientific papers included in the review. Pure-tone audiometry was the most frequently reported measure to test hearing in older adults living with dementia. However, measures including self- or other-reports and questionnaires, review of medical records, otoscopy, and the whisper test were found to be most suitable for use by nurses working with older adults living with dementia in LTCHs. Conclusion: Although frequently used, the suitability of pure-tone audiometry for use by nursing staff in LTCHs is limited, as standardized audiometry presents challenges for many residents, and specific training is needed to successfully adapt test administration procedures and interpret results. The whisper test was considered to be more suitable for use by staff in LTCH; however, it yields a limited characterization of hearing loss. There remains an urgent need to develop new approaches to screen hearing in LTCHs.

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Longitudinal associations of nursing staff turnover with patient outcomes in long-term care hospitals in Korea

Journal of Nursing Management ◽

10.1111/jonm.12576 ◽

2018 ◽

Vol 26 (5) ◽

pp. 518-524 ◽

Cited By ~ 13

Author(s):

Yoonseo Kim ◽

Kihye Han

Keyword(s):

Patient Outcomes ◽

Nursing Staff ◽

Long Term Care ◽

Staff Turnover ◽

Term Care ◽

Longitudinal Associations

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Psychometric Evaluation of the Korean Version of the Personhood in Dementia Questionnaire Using Rasch Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16234834 ◽

2019 ◽

Vol 16 (23) ◽

pp. 4834 ◽

Cited By ~ 1

Author(s):

Da Eun Kim ◽

Young Ko ◽

Paulette V. Hunter ◽

Ju Young Yoon

Keyword(s):

Convergent Validity ◽

Rasch Analysis ◽

Long Term Care ◽

Internal Consistency Reliability ◽

World Health ◽

Term Care ◽

Korean Version ◽

Item Fit ◽

Group Validity

There is an increasing awareness of the need to promote behaviors consistent with the understanding that individuals with dementia deserve adequate respect. Person-centered attitudes on the part of a care facility’s staff can affect care practices and relationships with residents. This study examined the psychometric properties of the Korean version of the Personhood in Dementia Questionnaire (KPDQ), which measures staff’s person-centered attitudes toward individuals with dementia. The KPDQ was translated and adapted based on commonly used guidelines from the World Health Organization. For psychometric testing, the data obtained from a total of 269 participants in 13 long-term care facilities were analyzed. Factor analysis, item fit, convergent validity, and known-group validity were examined. Reliability and differential item functioning (DIF) based on Rasch analysis were also assessed. The KPDQ consists of 20 items with three subscales (“agency”, “respect for personhood” and “psychosocial engagement”). Item fit statistics indicated that each item fits well with the underlying construct. The KPDQ demonstrated satisfactory convergent validity, known-group validity and internal consistency reliability. There was no DIF by subgroup according to age or educational status. Results indicated that the KPDQ is a reliable and valid tool for measuring long-term care staff’s beliefs about personhood.

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