Journal of Gerontological Nursing

Feature Article 

Patterns of New Physical Problems Emerging in Long-Term Care Residents With Dementia

Christine R. Kovach, PhD, RN, FAAN, FGSA; Julie Ellis, PhD, RN, GCNS-BC; Crystal-Rae Evans, RN, BSN

Abstract

Individuals receiving skilled nursing care have multiple comorbid conditions that impact comfort and resource use. The current study describes variations in the trajectories of new physical problems emerging over 8 weeks and the predictive value for future health and behavior in a sample of 72 residents with dementia. Residents had two to 37 new physical problems occurring over 8 weeks. Sixty-five percent of the sample had five or more new problems and were identified by three unstable trajectories. Common problems, illnesses, and symptoms accounted for 28.2% of the variance in subsequent new physical problems (p < 0.001) and 25.7% of the variance in subsequent agitation (p < 0.001). This study found more new problems than earlier studies that only examined new acute illness. Findings suggest a higher intensity of need for skilled assessment and treatment than may be available in many long-term care organizations. [Journal of Gerontological Nursing, 43(8), 25–32.]

Abstract

Individuals receiving skilled nursing care have multiple comorbid conditions that impact comfort and resource use. The current study describes variations in the trajectories of new physical problems emerging over 8 weeks and the predictive value for future health and behavior in a sample of 72 residents with dementia. Residents had two to 37 new physical problems occurring over 8 weeks. Sixty-five percent of the sample had five or more new problems and were identified by three unstable trajectories. Common problems, illnesses, and symptoms accounted for 28.2% of the variance in subsequent new physical problems (p < 0.001) and 25.7% of the variance in subsequent agitation (p < 0.001). This study found more new problems than earlier studies that only examined new acute illness. Findings suggest a higher intensity of need for skilled assessment and treatment than may be available in many long-term care organizations. [Journal of Gerontological Nursing, 43(8), 25–32.]

New physical problems commonly emerge in nursing home residents. One study reported 1.5 new acute illnesses per year per resident, and another study reported 149 new physical problems in 61 residents over a 6-week period (Hung, Liu, & Boockvar, 2010; Kovach, Logan, Simpson, & Reynolds, 2010). The burden of new physical problems is important because of the potential for cumulative or cascading effects and the associated increase in health care demand and costs.

Due to cognitive and communication deficits, residents with dementia have difficulty reporting physical symptoms and have been found to have a high rate of undetected acute illness (Kovach, Logan, Joosse, & Noonan, 2012; Zwakhalen, Hamers, & Berger, 2006). Thirty-six percent of a community-dwelling sample had an acute illness based on blood and urine samples, with urinary tract infection, hyperglycemia, and anemia being the most prevalent (Boockvar, Brodie, & Lachs, 2000). A study in long-term care found delays of 4 to 29 days between the start of symptoms to diagnosis, with a median of 4 days (Kovach et al., 2010).

Little research is available on the possible predictive value of illness or physical symptoms in one time period for determining likely future problems and health care use. A nursing home study of 200 residents found that 32.3% of residents developed an acute illness in the next 20 days following nonspecific symptoms. Lethargy, weakness, and decreased appetite were the most predictive of acute illness during this time period (Hodgson, Gitlin, Winter, & Czekanski, 2011). Another study found that weakness, not saying hello, agitation, self-reported symptoms, and decreased food intake preceded acute illness and were observed by nursing assistants 5 days before obvious symptoms of acute illness (Boockvar & Lachs, 2003). Estimates from one study were that 67% of hospitalizations of nursing home residents were potentially avoidable and the costs of avoidable hospitalization in nursing home residents were estimated to be as high as $4 billion per year (Ouslander et al., 2010).

Understanding comorbid problems of residents with dementia may have important implications for long-term care organizations and the delivery of care. Little empirical work has been performed to describe the emergence of new physical problems and determine whether different temporal patterns of onset are evident. Differentiating among expected trajectories and related needs could inform the intensity of assessments conducted and help target and shape prevention and treatment strategies. Although it is known that agitation in individuals with dementia correlates with symptoms and illness, it is less clear whether symptoms or illnesses create a cumulative physical burden that is associated with the later development of agitation. The current article presents a secondary study with the following aims:

  1. Describe the new physical problems emerging over 8 weeks in a sample of nursing home residents with dementia.

  2. Describe variations in the trajectories of how new physical problems emerge.

  3. Determine whether new physical problems occurring in 1 month can predict new physical problems or agitation occurring in the subsequent month.

The primary study determined feasibility for end users and obtained pilot data on effectiveness of a protocol to assist nurses to track responses to new treatments and stop or alter ineffective treatments (Kovach, Hekel, & Rababa, 2015).

Method

Setting and Participants

Two not-for-profit nursing homes in the upper Midwest with 108 and 160 certified beds, respectively, were chosen by convenience. All 78 participants came from eight units that were either designated as memory care units or the majority of those residing on the unit had dementia. The only inclusion criteria was that the participant had documented dementia. Six cases were excluded because the residents died before 8 weeks of information were collected.

The majority of residents were female (n = 52, 72%) and were not independently ambulatory (n = 70, 97%). Average participant age was 88.03 years (SD = 6.86 years), and the average length of stay was 27.45 months (SD = 25.33 months). Active diagnoses listed in the Minimum Data Set (MDS; Centers for Medicare & Medicaid Services [CMS], 2015) are those diagnoses that affect residents' functional status and drive the current plan of care. Residents had an average of 10.67 (SD = 3.91) active diagnoses. Cognitive information was available in the MDS for 71 of 72 residents. Of the 48 residents able to participate in the Brief Interview for Mental Status (BIMS; range = 0 to 15), the mean for scores recorded in the MDS by staff in the previous quarter was 8.75 (SD = 5.09). For the remaining 23 residents, evaluation was performed by staff report of cognitive ability. The C 1000 item of the MDS rates the staff member's perception of the resident's cognitive skills for daily decision making. According to the C 1000 item, 11 of 23 residents assessed by staff report were moderately cognitively impaired and 12 were severely impaired (CMS, 2015).

Measurement and Analysis

The primary study compared two different forms for nurses to use to evaluate treatment effectiveness (Kovach et al., 2015). Both forms had the same requirement for daily documentation of each new problem over 8 weeks. The space and layout for documenting the new problems on the two versions of the forms were the same in size and layout. The new problems listed were not analyzed in the primary study. Nurse managers on the eight units completed the forms. The daily forms were cross-checked by a trained research assistant with the nurses' reports and resident medical records twice weekly to investigate and resolve discrepancies. Hence, the new physical problems and agitation variables coded for the current study came from documentation on the daily forms, resident medical records, or the nurses' reports to the research assistant.

Data were coded for quantitative analyses and entered into SPSS 22. Definitions used for coding variables are based on standard statements of meaning used in gerontology literature and are provided in Table 1. All data were coded by two researchers (C.R.K. and other), and interrater reliability for coding the variables on 20 forms was 0.88.

Definitions of Variables Coded and Used in Analyses

Table 1:

Definitions of Variables Coded and Used in Analyses

To address Aim 1, a list was created of all new problems recorded on daily forms that occurred for each resident for each of the 8 weeks of data collection. Problems coded as physical problems included any new illness, symptom, or common physical problem. Physical problems were described with frequencies, means, and standard deviations. In addition, sums were used to provide an overview of the most and least frequent symptoms and problems emerging in body systems.

To address Aim 2, three variables were calculated and are defined in Table 1: (a) the total number of new problems; (b) the problem-free duration; and (c) the number of spikes. Frequency distributions were examined to delineate spikes and dichotomize the number of new problems and duration a resident was free from new problems. Six or more new problems over 8 weeks was considered a high number of new problems (67th percentile or higher) and five or less new problems (33rd percentile or lower) was considered a low number of new problems. Likewise, residents who had ≥5 weeks with no new problems were considered to have a relatively long problem-free duration (67th percentile) and those with ≤4 weeks with no new problems were considered to have a short problem-free duration (33rd percentile). Spikes in new problems were defined as weeks in which four or more problems occurred (95th percentile or higher). Results are described with frequencies, percentages, and line graphs.

To address Aim 3, hierarchical regression analyses were performed to determine the relative contribution of new physical problems occurring in 1 month in predicting new physical problems or agitation in the subsequent month. After truncating one outlier, data were not severely skewed, relationships were linear, and there was no evidence of multicollinearity. Spikes, physical problems in 1 month, and problem-free duration were examined as predictors.

Because the number of new physical problems in 1 month was a statistically significant predictor, there was an interest in determining whether the specific types of problems were more or less predictive of physical or behavioral problems occurring in subsequent weeks. Hence, new symptoms, illnesses, and common problems occurring in Weeks 1 to 4 were included as independent variables in hierarchical regression models predicting new physical problems and new agitation occurring in the subsequent month.

Results

Aim 1: Description of Problems

Residents had an average of 9.3 (SD = 6.21; range = 2 to 37) new physical problems occurring over 8 weeks. As seen in Table 2, 72 residents had 668 new problems. Skin and gastrointestinal problems were frequent and represented 40.9% (n = 273) of problems. Problems involving the respiratory and cardiovascular systems were also numerous (16.5% ([n = 110] of new problems). There were 28 instances of new weight loss and 26 reports of new fatigue.

New Physical Problems of Nursing Home Residents with Dementia Emerging Over 8 Weeks (N = 668 Problems, N = 72 Residents)

Table 2:

New Physical Problems of Nursing Home Residents with Dementia Emerging Over 8 Weeks (N = 668 Problems, N = 72 Residents)

Residents averaged 3.53 (SD = 1.84; range = 0 to 7) weeks with no new problems. No residents were free of new problems for the entire 8 weeks. Thirty-nine percent of the sample (n = 28) had a spike in new problems of four or more in 1 week and nine residents had ≥2 weeks with a spike in new problems. The number of problems occurring in 1 week ranged from 0 to 12, with spikes ranging from four to 12 new problems occurring in 1 week.

Aim 2: Differences in Patterns of New Problems Emerging

Using the criteria for delineating spikes and dichotomizing a high and low number of new problems, and problem-free duration, clustering of individual trajectories revealed that 25 (35%) residents were considered stable as defined by five or less new problems over 8 weeks. A total of 65% (n = 47) of the sample had five or more new problems and were identified by three unstable trajectories: unstable with no spikes, unstable with spikes, and fluctuating. The Figure provides exemplars. There were 22 (30%) residents who were unstable with spikes, as defined by a high frequency of problems, short problem-free duration, and the presence of spikes. Fifteen (21%) additional residents were unstable but had no weeks with a spike in problem frequency. Ten (14%) residents had a fluctuating pattern with a high problem frequency but a long duration that was problem free.

The four patterns of new physical problems emerging over 8 weeks.

Figure.

The four patterns of new physical problems emerging over 8 weeks.

Aim 3: Predicting New Physical Problems and Agitation

Spikes, new physical problems, and the problem-free duration predicted 23.6% of the variance in new physical problems and new agitation occurring in the subsequent month. Both models were statistically significant (F(3,68) = 6.983, p < 0.001 and F(3,68) = 6.998, p < 0.001), but only the new physical problem betas were significant predictors (β = 0.390, p = 0.048; and β = 0.400, p = 0.003).

Table 3 shows that the variables common problems, illnesses, and symptoms accounted for 28.2% of the variance in subsequent new physical problems (p < 0.001). When entered into the model alone (Step 1), symptoms predicted 10.3% of the variance (p = 0.006). At Step 2, symptoms and illnesses accounted for 15% of the variance, a change of 4.6%, which was not statistically significant (p = 0.057). Step 3 of the model showed that 13.2% of the variance in subsequent new physical problems was uniquely accounted for by the common problems in the previous month (p = 0.001). Even after controlling for symptoms and illnesses, common problems was the strongest predictor of new physical problems. Bivariate correlations showed that common problems in the previous month statistically significantly correlated with common problems (r = 0.527, p < 0.001) and new symptoms of unclear etiology in the subsequent month (r = 0.283, p = 0.016). Symptoms in Weeks 1 to 4 statistically significantly correlated with new symptoms of unclear etiology in the subsequent month (r = 0.351, p = 0.003). Illnesses were not significantly associated with common problems, symptoms, or illnesses in the subsequent month.

Summary of Hierarchical Regression Analysis with Number of New Physical Problems in Weeks 5–8 as Criterion (N = 72 Residents)

Table 3:

Summary of Hierarchical Regression Analysis with Number of New Physical Problems in Weeks 5–8 as Criterion (N = 72 Residents)

Table 4 shows the regression results predicting new agitation. The variables common problems, illnesses, and symptoms accounted for 25.7% of the variance in subsequent agitation (p < 0.001). When variables were examined individually, symptoms was the only statistically significant predictor of subsequent agitation. The correlation between symptoms in Weeks 1 to 4 and agitation in the subsequent month was 0.570 (p < 0.001).

Summary of Hierarchical Regression Analysis with Agitation in Weeks 5–8 as Criterion (N = 72 Residents)

Table 4:

Summary of Hierarchical Regression Analysis with Agitation in Weeks 5–8 as Criterion (N = 72 Residents)

Discussion

More new problems were found in the current sample than previously reported in studies that only examined new acute illness (Boockvar et al., 2000; Hung et al., 2010). Similar to previous studies, skin and gastrointestinal issues were found to be the most frequent types of new physical problems (Kovach et al., 2010). The current study provides a more comprehensive view of the overall burden from new physical problems and symptoms occurring in older adults with dementia residing in long-term care. Findings suggest a higher intensity of physical needs that require a higher quality of assessment skills than may be available in many long-term care organizations.

The frequency of new problems and differences in the patterns of how these problems emerged over a relatively short time period suggests instability and variability in physiological health that has not been previously identified. The possible existence of different pathways of decline may have important implications for health care delivery. Researching illness and time-to-death trajectories is a common strategy for improving understanding of the illness experience, changing care needs, and determining resource and staffing needs (Gerstorf, Ram, Lindenberger, & Smith, 2013; Kaul et al., 2011). Trajectories of decline in functional ability of individuals with dementia has been broadly studied to inform care needs during different stages of decline. More research is needed to determine whether problems such as breakdown of skin in multiple areas or new symptoms of unknown etiology signal a declining trajectory overall, or, if treated aggressively, can reverse or delay a trajectory of decline. Future research should also examine how the variability in physical problems emerging may impact care needs, functional abilities, and other outcomes.

Common problems that occurred in 1 month were predictive of common problems and new symptoms in the subsequent month. The authors acknowledge that this finding could simply indicate that certain individuals tend to have a fairly stable pattern of either a high or low number of common new problems. Other than work done to reduce recurrent falls and some infections, little research has been devoted to preventing recurrent common problems or determining the effect on cost and quality of life outcomes (Alvarez Barbosa et al., 2016; Vu, Weintraub, & Rubenstein, 2006). Future research should aim to understand the recurrence of common physical problems and develop and test the efficacy of prevention and treatment modalities. Because this population is particularly susceptible to adverse drug effects, early identification of problems and conservative use of drug treatments are recommended (Andersen, Viitanen, Halvorsen, Straume, & Engstad, 2011). Early recognition and treatment of symptoms, new problems, and exacerbations of existing conditions is a potential strategy for decreasing the severity of problems, preventing hospitalization, and reducing overall costs. Early treatment could also help improve comfort and quality of life by decreasing the burdens associated with multiple co-morbid conditions.

Many studies have shown that behavioral agitation is a common symptom in individuals with dementia who have physical symptoms (Savva et al., 2009; Scherder et al., 2005). The current study is the first to show that physical problems occurring in one time period were strongly predictive of behaviors in a subsequent time period. Limited longitudinal data on the determinants of behavioral symptoms, such as agitation, are available. Findings from this study may be useful to practitioners in recognizing the association of new physical problems to increased behavioral symptoms. The need for skilled assessment in long-term care settings is apparent. Longitudinal studies on the interrelationship between physical problems and behaviors associated with dementia are warranted.

Limitations

Limitations of the current study include examining a time period of only 8 weeks in duration and a limited sample from two similar high-quality nursing homes. Causal claims cannot be made based on a single correlational study. Measurement error may have occurred if certified nursing assistants did not communicate changes in residents' condition to the nurse manager. The problems considered in this study related to physical well-being. The functional and social declines that parallel cognitive losses have been mapped. Psychological and social trajectories may also potentially be important and better understood through trajectory analyses.

Conclusion

Findings from the current study suggest that, in addition to needing custodial care, individuals with dementia living in nursing homes develop many new physical problems that require skilled assessment and intervention. Research is warranted to understand patterns of symptoms and problems occurring over a longer period of time. Understanding the stability of trajectories will help determine whether a trajectory perspective can inform the intensity of assessments conducted and target and shape prevention and treatment strategies.

References

  • Alvarez Barbosa, F., Del Pozo-Cruz, B., Del Pozo-Cruz, J., Alfonso-Rosa, R.M., Corrales, B.S. & Rogers, M.E. (2016). Factors associated with the risk of falls of nursing home residents aged 80 or older. Rehabilitation Nursing, 41, 16–25. doi:10.1002/rnj.229 [CrossRef]
  • Andersen, F., Viitanen, M., Halvorsen, D.S., Straume, B. & Engstad, T.A. (2011). Co-morbidity and drug treatment in Alzheimer's disease: A cross sectional study of participants in the dementia study in northern Norway. BMC Geriatrics, 11, 58. doi:10.1186/1471-2318-11-58 [CrossRef]
  • Boockvar, K., Brodie, H.D. & Lachs, M. (2000). Nursing assistants detect behavior changes in nursing home residents that precede acute illness: Development and validation of an illness warning instrument. Journal of the American Geriatrics Society, 48, 1086–1091. doi:10.1111/j.1532-5415.2000.tb04784.x [CrossRef]
  • Boockvar, K.S. & Lachs, M.S. (2003). Predictive values of nonspecific symptoms for acute illness in nursing home residents. Journal of the American Geriatrics Society, 51, 1111–1115. doi:10.1046/j.1532-5415.2003.51360.x [CrossRef]
  • Centers for Medicare & Medicaid Services. (2015). Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual Section C: Cognitive patterns. Retrieved from http://www.aanac.org/docs/mds-3.0-rai-users-manual/11118_mds_3-0_chapter_3_-_section_c_v1-12.pdf?sfvrsn=6
  • Gerstorf, D., Ram, N., Lindenberger, U. & Smith, J. (2013). Age and time-to-death trajectories of change in indicators of cognitive, sensory, physical, health, social, and self-related functions. Developmental Psychology, 49, 1805–1821. doi:10.1037/a0031340 [CrossRef]
  • Hodgson, N.A., Gitlin, L.N., Winter, L. & Czekanski, K. (2011). Undiagnosed illness and neuropsychiatric behaviors in community-residing older adults with dementia. Alzheimer's Disease & Associated Disorders, 25, 109–115. doi:10.1097/WAD.0b013e3181f8520a [CrossRef]
  • Hung, W.A., Liu, S. & Boockvar, K.S. (2010). A prospective study of symptoms, function, and medication use during acute illness in nursing home residents: Design, rationale and cohort description. BMC Geriatrics, 10, 47–54. doi:10.1186/1471-2318-10-47 [CrossRef]
  • Kaul, P., McAlister, F.A., Ezekowitz, J.A., Bakal, J.A., Curtis, L.H., Quan, H. & Armstrong, P.W. (2011). Resource use in the last 6 months of life among patients with heart failure in Canada. Archives of Internal Medicine, 171, 211–217. doi:10.1001/archinternmed.2010.365 [CrossRef]
  • Kovach, C.R., Hekel, B. & Rababa, M. (2015). Feasibility testing of a protocol to stop ineffective drug and non-drug treatments. Western Journal of Nursing Research, 37, 1404–1422. doi:10.1177/0193945915599070 [CrossRef]
  • Kovach, C.R., Logan, B.R., Joosse, L.L. & Noonan, P.E. (2012). Failure to identify behavioral symptoms of people with dementia and the need for follow-up physical assessment. Research in Gerontological Nursing, 5, 89–93. doi:10.3928/19404921-20110503-01 [CrossRef]
  • Kovach, C.R., Logan, B.R., Simpson, M.R. & Reynolds, S. (2010). Factors associated with time to identify physical problems of nursing home residents with dementia. American Journal of Alzheimer's Disease & Other Dementias, 25, 317–323. doi:10.1177/1533317510363471 [CrossRef]
  • Ouslander, J.G., Lamb, G., Perloe, M., Givens, J.H., Kluge, L., Rutland, A. & Saliba, D. (2010). Potentially avoidable hospitalizations of nursing home residents: Frequency, causes, and costs. Journal of the American Geriatrics Society, 58, 627–635. doi:10.1111/j.1532-5415.2010.02768.x [CrossRef]
  • Savva, G.M., Zaccai, J., Matthews, F.E., Davidson, J.E., Mckeith, I. & Brayne, C. (2009). Prevalence, correlates and course of behavioural and psychological symptoms of dementia in the population. British Journal of Psychiatry, 194, 212–219. doi:10.1192/bjp.bp.108.049619 [CrossRef]
  • Scherder, E., Oosterman, J., Swaab, D., Herr, K., Ooms, M., Ribbe, M. & Benedetti, F. (2005). Recent developments in pain in dementia. BMJ, 330, 461–464. doi:10.1136/bmj.330.7489.461 [CrossRef]
  • Vu, M.Q., Weintraub, N. & Rubenstein, L.Z. (2006). Falls in the nursing home: Are they preventable?Journal of the American Medical Directors Association, 5, 401–406. doi:10.1097/01.JAM.0000144553.45330.AD [CrossRef]
  • Zwakhalen, S.M., Hamers, J.P. & Berger, M.P. (2006). The psychometric quality and clinical usefulness of three pain assessment tools for elderly people with dementia. Pain, 126, 210–220. doi:10.1016/j.pain.2006.06.029 [CrossRef]

Definitions of Variables Coded and Used in Analyses

VariableDefinition
Aim 1
New physical problemsAn illness, symptom, or common problem that emerges after the first data collection point.

A new illness included acute illnesses (i.e., a new physical sickness with a precipitous onset) and exacerbations of chronic illnesses (i.e., a noted worsening or increase in the severity of a chronic physical illness or its signs and symptoms).

A new symptom included subjective reports of changes in the body or its functions or objective signs of a physical change that was not clearly tied to an identified illness of the resident.

A common problem is a physical disruption that is frequently seen in nursing home populations, treated within the nursing home, and not considered life-threatening (e.g., constipation, minor skin problems, osteoarthritic pain).

Aim 2
Total number of new problemsA sum of new physical problems in Weeks 1 to 8 for each resident.
Problem-free durationThe number of weeks that had 0 new problems emerge.
SpikeThe number of weeks in which four or more new problems emerged.
Aim 3
Physical problems in 1 month (independent variable)A sum of new physical problems in Weeks 1 to 4 for each resident.
Subsequent physical problems (dependent variable)A sum of new physical problems in Weeks 5 to 8 for each resident.
Subsequent agitation (dependent variable)A sum of new agitation events in Weeks 5 to 8 for each resident. Agitation was defined as any reference to new verbal, vocal, or motor behavior that did not result directly from needs and also included references to new aggression, anxious behavior, or resistance to care.
Aim 3a
Physical illness in 1 month (independent variable)A sum of new acute illnesses and exacerbations of chronic illnesses in Weeks 1 to 4 for each resident.
Symptoms in 1 month (independent variable)A sum of symptoms in Weeks 1 to 4 for each resident.
Common problems in 1 month (independent variable)A sum of common problems in Weeks 1 to 4 for each resident.

New Physical Problems of Nursing Home Residents with Dementia Emerging Over 8 Weeks (N = 668 Problems, N = 72 Residents)

ProblemTotal (n, %)
Integument160 (24)
Gastrointestinal113 (16.9)
Respiratory58 (8.7)
Cardiovascular52 (7.8)
Endocrine/electrolyte/hematic49 (7.3)
Musculoskeletal37 (5.5)
Eye, ear, nose, and throat32 (4.8)
Genitourinary31 (4.6)
Weight loss28 (4.2)
Fatigue26 (3.9)
Pain unspecified23 (3.4)
Decreased appetite17 (2.5)
Change in condition unspecified12 (1.8)
Neurological11 (1.6)
Other10 (1.5)
Increased temperature9 (1.3)

Summary of Hierarchical Regression Analysis with Number of New Physical Problems in Weeks 5–8 as Criterion (N = 72 Residents)

Step and Predictor Variables from Weeks 1 to 4R2ΔR2βtp Value
Step 1
  Symptoms0.1030.103*0.5432.8430.006*
Step 2
  Symptoms0.4802.5250.014*
  Illnesses0.1500.0460.9531.9320.057
Step 3
  Symptoms0.3882.1280.033*
  Illnesses0.9182.0090.049*
  Common problems0.2820.132*3.5370.001*
F(3,68) = 8.887, p < 0.001

Summary of Hierarchical Regression Analysis with Agitation in Weeks 5–8 as Criterion (N = 72 Residents)

Step and Predictor Variables from Weeks 1 to 4R2ΔR2βtp Value
Step 1
  Common problems0.0000.0000.0220.1270.899
Step 2
  Common problems0.0100.0550.956
  Illnesses0.0340.0340.4851.5510.126
Step 3
  Common problems−0.093−0.5980.552
  Illnesses0.2750.9810.330
  Symptoms0.2570.223*0.4934.524<0.001*
F(3,68) = 7.856, p < 0.001
Authors

Dr. Kovach is Jewish Home and Care Center Research Professor in Aging, Dr. Ellis is Assistant Professor, and Ms. Evans is Research Associate, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin.

The authors have disclosed no potential conflicts of interest, financial or otherwise. Funding is acknowledged from the Jewish Home Foundation, Retirement Research Foundation, and Bader Philanthropies to support this project.

Address correspondence to Christine R. Kovach, PhD, RN, FAAN, FGSA, Jewish Home and Care Center Research Professor in Aging, University of Wisconsin-Milwaukee, 1921 East Hartford Avenue, Milwaukee, WI 53201; e-mail: ckovach@uwm.edu.

Received: August 24, 2016
Accepted: January 16, 2017
Posted Online: April 11, 2017

10.3928/00989134-20170310-01

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