title: Predictors of need-driven behaviors in nursing home residents with dementia and associated certified nursing assistant burden.
abstract: OBJECTIVE
  We examined predictors of staff-reported need-driven behaviors and resistiveness to care in nursing home residents with dementia and predictors of certified nursing assistant (CNA) burden related to both constructs. Background and proximal factors from the need-driven dementia-compromised behavior model [Algase, D.L., Beck, C., Kolanowski, A., Whall, A., Berent, S., Richards, K., et al. (1996). Need-driven dementia-compromised behavior: An alternative view of disruptive behavior. American Journal of Alzheimer's Disease, 5, 10-19] were examined as potential predictors of need-driven behaviors (NDBs) and resistiveness to care and CNA burden.
  
  
  METHODS
  We used secondary data analysis of prospective data from 10 nursing homes in Birmingham, Alabama. One-hundred and sixty-one residents (83.43 +/- 8.56 years) with mini mental state examination (MMSE) score = 6.41 (+/- 6.66) were assessed via chart review, resident surveys, and surveys of CNAs.
  
  
  RESULTS
  Multiple regression models revealed that cognitive functioning, activities of daily living functioning, race, gender, and CNA-reported weekly resident pain intensity were associated with resident NDBs. Regression models also revealed that weekly pain intensity and medical comorbidity were associated with CNA burden associated with the resident NDBs. However, we were unable to explain a significant amount of variance in the resistiveness to care or CNA burden associated with resistiveness to care.
  
  
  CONCLUSIONS
  Results underscore the role of pain in both resident NDBs and associated CNA burden. Future research should focus on predictors of resident resistiveness to care and the relation of pain assessment and management practices to CNA burden. Moreover, interventions to improve resident care should seek to include CNAs in institutional pain assessment and management processes.
authors.affiliation: Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL 35487-0348, USA. misti.j.norton@gmail.com
authors.forename: Misti J
authors.initials: MJ
authors.lastname: Norton
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Allen
authors.forename: A Lynn
authors.initials: AL
authors.lastname: Snow
authors.forename: J Michael
authors.initials: JM
authors.lastname: Hardin
authors.forename: Louis D
authors.initials: LD
authors.lastname: Burgio
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000407:Alabama; D000488:Allied Health Personnel; D003071:Cognition; D017281:Cost of Illness; D003704:Dementia / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D009735:Nursing Homes; D009740:Nursing Staff; D010146:Pain; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011446:Prospective Studies; D011595:Psychomotor Agitation; D012920:Social Behavior Disorders; D000078329:Workforce