Potentially Reversible Resident Factors Associated with Rejection of Care Behaviors
Article first published online: 2 SEP 2010
© 2010, Copyright the Authors. Journal compilation © 2010, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 58, Issue 9, pages 1693–1700, September 2010
How to Cite
Ishii, S., Streim, J. E. and Saliba, D. (2010), Potentially Reversible Resident Factors Associated with Rejection of Care Behaviors. Journal of the American Geriatrics Society, 58: 1693–1700. doi: 10.1111/j.1532-5415.2010.03020.x
- Issue published online: 2 SEP 2010
- Article first published online: 2 SEP 2010
- rejection of care;
- nursing home;
- modifiable characteristics
OBJECTIVES: To identify the potentially modifiable resident-level factors associated with rejection of care in nursing home (NH) residents.
DESIGN: Secondary analysis of a 3.0 national field test to revise the Minimum Data Set (MDS).
SETTING: Seventy-one NHs in eight states.
PARTICIPANTS: Three thousand two hundred thirty NH residents scheduled for MDS assessments from September 2006 through February 2007.
MEASUREMENTS: The potentially mutable characteristics assessed were mood (Patient Health Questionnaire-9), delirium (Confusion Assessment Method), delusions, hallucinations or illusions, hearing impairment, vision impairment, pain severity, and infection diagnoses. Characteristics considered as covariates were cognition, communication abilities, and impairment in activities of daily living.
RESULTS: Of 3,230 residents assessed, 312 (9.7%) had demonstrated rejection of care in the preceding 5 days. In multiple regression analysis adjusted for covariates, rejection of care was associated with delusions (odds ratio (OR)=3.9; 95% confidence interval (CI)=2.5–6.0), delirium (OR=1.8, 95% CI=1.3–2.4), minor (OR=2.1, 95% CI=1.5–2.8) and major (OR=2.3, 95% CI=1.5–3.4) depression, and severe to horrible pain (OR=1.6, 95% CI=1.1–2.3). Infection diagnoses were not significant in bivariate analysis. Hallucinations or illusions, mild to moderate pain, and hearing and vision impairment were not significant in multiple regression analysis.
CONCLUSION: In this population, delirium, delusions, depression, and severe pain were associated with rejection of care, suggesting that some care rejection behaviors may resolve with appropriate interventions for the identified target conditions if the associations observed are causal.