Potentially reversible resident factors associated with rejection of care behaviors.
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.
Ishii
Shinya
S
Geriatrics Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA. sishii@mednet.ucla.edu
Streim
Joel E
JE
Saliba
Debra
D
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