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Prevalence of behavioral symptoms: comparison of the minimum data set assessments with research instruments
Ashok J Bharucha1, Mihnea Vasilescu, Mary Amanda Dew
1Advanced Center in Interventions and Services Research for Late-Life Mood Disorders and the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. bharuchaaj@upmc.edu
Objective:
To examine the total and domain-specific prevalence of verbally and physically abusive, socially inappropriate, and care-resistive behaviors according to the Minimum Data Set (MDS) compared with research instruments in nursing home residents with severe dementia.
Design, Setting, And Methods:
As part of a longitudinal observational study, MDS behavioral symptoms data were compared with corresponding items from the Ryden Aggression Scale and the Cohen-Mansfield Agitation Inventory for 15 nursing home residents with severe dementia. McNemar's test was used to compare the difference in the proportion of subjects who experienced any symptoms, as well as specific symptoms in several domains, according to the MDS and the research instruments. Additionally, temporal fluctuations in behavioral symptoms were descriptively and graphically summarized.
Results:
The MDS significantly underestimated both the total proportion of subjects experiencing any behavioral symptoms (P = .016), as well as the proportion of subjects experiencing verbally abusive symptoms (P < .002), physically abusive symptoms (P = .008), or socially inappropriate behaviors (P = .016) compared with corresponding items from the research instruments. Moreover, these behaviors exhibited considerable temporal instability, suggesting that the systematic daily collection of measures of behavioral disturbances is imperative during the week in which the MDS assessment is to be completed.
Discussion:
Albeit from a small study sample, our findings call into question the validity of the MDS behavioral symptom items as they are currently recorded, and suggest that a simple intervention of twice daily completion of a behavioral symptoms checklist containing the MDS items during the week of the assessment may significantly improve the accuracy of the recorded data.
Insights
The Minimum Data Set (MDS) significantly underestimates behavioral symptoms in dementia patients compared to research tools. Daily symptom tracking during MDS assessments may improve data accuracy for nursing home residents.
Area of Science:
- Gerontology
- Dementia Care
- Clinical Assessment
Background:
- Nursing home residents with severe dementia often exhibit behavioral symptoms.
- Accurate assessment of these behaviors is crucial for appropriate care planning and intervention.
- The Minimum Data Set (MDS) is a standardized tool used for resident assessment, but its validity for behavioral symptoms is questioned.
Purpose of the Study:
- To compare the prevalence of behavioral symptoms in nursing home residents with severe dementia as measured by the MDS versus established research instruments.
- To evaluate the validity of MDS behavioral symptom items against the Ryden Aggression Scale and Cohen-Mansfield Agitation Inventory.
Main Methods:
- A longitudinal observational study compared MDS behavioral data with research instruments in 15 nursing home residents with severe dementia.
- McNemar's test was used to analyze differences in symptom prevalence.
- Temporal fluctuations in behavioral symptoms were also analyzed.
Main Results:
- The MDS significantly underestimated the total proportion of subjects experiencing any behavioral symptoms (P = .016).
- MDS data also underestimated verbally abusive (P < .002), physically abusive (P = .008), and socially inappropriate behaviors (P = .016) compared to research instruments.
- Behavioral symptoms demonstrated considerable temporal instability.
Conclusions:
- The findings question the current validity of MDS behavioral symptom items due to underestimation.
- A simple intervention, such as twice-daily completion of a behavioral symptoms checklist during the assessment week, may enhance data accuracy.
- Improved accuracy in recording behavioral disturbances is vital for effective dementia care in nursing homes.