title: Potentially reversible resident factors associated with rejection of care behaviors.
abstract: OBJECTIVE
  To identify the potentially modifiable resident-level factors associated with rejection of care in nursing home (NH) residents.
  
  
  METHODS
  Secondary analysis of a 3.0 national field test to revise the Minimum Data Set (MDS).
  
  
  METHODS
  Seventy-one NHs in eight states.
  
  
  METHODS
  Three thousand two hundred thirty NH residents scheduled for MDS assessments from September 2006 through February 2007.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Geriatrics Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA. sishii@mednet.ucla.edu
authors.forename: Shinya
authors.initials: S
authors.lastname: Ishii
authors.forename: Joel E
authors.initials: JE
authors.lastname: Streim
authors.forename: Debra
authors.initials: D
authors.lastname: Saliba
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression; D001294:Attitude to Health; D003072:Cognition Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D003704:Dementia / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D009735:Nursing Homes; D012111:Residence Characteristics; D012189:Retrospective Studies; D012307:Risk Factors; D016312:Treatment Refusal / Q000523:psychology*; D014481:United States / Q000453:epidemiology