The purpose of this study was (1) To develop strategies that can be used to identify pain in elderly nursing home residents; (2) to explore a pain assessment model that includes age, cognition, communication, depression, function, and pain; (3) to understand the distribution of pain among groups defined by age, gender, cognition, communication, depression, function and pain; (4) to predict pain based on measurements of variables in the model; (5) to evaluate the usefulness of functional status as a predictor for pain. The design was descriptive and correlational. The setting was a 200 bed nursing home in western Massachusetts. Subjects were 111 nursing home residents (mean age 78), who were Caucasian, and predominantly female (77.5%). They were impaired in cognition (54%), communication (61%), and function (82%). They experienced moderate to severe depression (28%) and moderate to severe pain (42%). The instrument was the Minimum Data for Nursing Home Resident Assessment and Care Screening (MDS 2.0).

Agitated behavior is a widespread problem that adversely affects the health of nursing home residents and increases the cost of their care. Agitated nursing home residents are more likely to be physically or chemically restrained, to fall and to have a lower quality of life. Current strategies to reduce agitated behavior tend to be costly. This dissertation research examined a relatively inexpensive intervention to reduce the agitated behavior of cognitively impaired nursing home residents. The specific aim was to compare the effect of calming music or hand massage or a combination of calming music and hand massage on the level and type of agitated behavior over time. This four group, repeated measures design used the Progressively Lowered Stress Threshold model (Hall & Buckwalter, 1987) to test the effect of exposure to calming music and hand massage on agitation. This model proposes that in the context of agitation, the stress response can be altered and functionally adaptive behavior achieved by modifying environmental demands and controlling for factors that correlate with the perception of stress. Power calculations indicated that a sample size of 68 would be adequate to detect significant results. Subjects were randomly assigned to one of four intervention groups: (1) calming music, (2)hand massage, (3) calming music and hand massage simultaneously, or (4) control. Level of agitation was assessed during each of four ten minute observation periods, immediately before the intervention, during the intervention, immediately after the intervention, and at 60 minutes. Each of the experimental interventions produced a reduction in agitation that was greater than that achieved in the absence of any intervention. The benefit was sustained and increased over time. The level of increased benefit over tune was similar in each of the experimental intervention groups. When syndromes of agitated behaviors were examined separately, there were differential levels of reduction of physically aggressive, physically non-aggressive and verbally agitated behaviors. Results of this study provide information on an easily administered intervention that can improve the quality of life for nursing home residents and potentially decrease the cost of their care.