{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T14:37:52Z","timestamp":1775918272894,"version":"3.50.1"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T00:00:00Z","timestamp":1689724800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Sigma Theta Tau International Small"},{"name":"Midwest Nursing Research Society Joseph and Jean Buckwalter Dissertation Grant"},{"name":"Barbara and Richard Csomay Gerontology Research Award"},{"DOI":"10.13039\/100000056","name":"National Institute of Nursing Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000056","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["F31NR018580"],"award-info":[{"award-number":["F31NR018580"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background and Objectives<\/jats:title>\n                  <jats:p>Rejection of care is common in hospitalized persons living with dementia. However, distinguishing between rejection of care behaviors related to care practices or other causes, such as pain or delirium, is challenging. The purpose of this study is to further understand the relationship between rejection of care and pain and delirium in hospitalized patients with dementia by identifying which rejection of care behaviors are associated with pain and delirium.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Research Design and Methods<\/jats:title>\n                  <jats:p>Care encounters between hospitalized patients with dementia (n = 16) and nursing staff (n = 53) were observed on 88 separate occasions across 35 days. Rejection of care was measured using the 13 behaviors from the Resistiveness to Care Scale. Pain and delirium severity were measured using a variety of scales including the Pain Assessment in Advanced Dementia Scale, Checklist of Nonverbal Pain Indicators, and numeric rating scale for pain severity and the Confusion Assessment Method\u2014Severity short form and Delirium Observation Screening Scale for delirium severity. Linear mixed modeling was used to determine the relationship between rejection of care behaviors and pain and delirium severity for each measure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>About 48.9% of the observations included rejection of care, 49.9% included a patient in pain, and 12.5% included a patient with delirium. Cry, push away, scream\/yell, and turn away indicated a higher pain severity across pain measures. No rejection of care behaviors were found to indicate delirium severity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion and Implications<\/jats:title>\n                  <jats:p>Certain rejection of care behaviors may be helpful in identifying pain in hospitalized patients with dementia, suggesting that caregivers should be cognizant of pain when these rejection of care behaviors are present. However, in this sample rejection of care behaviors was not found to be useful for identifying delirium severity in hospital dementia care.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/geroni\/igad076","type":"journal-article","created":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T13:23:25Z","timestamp":1689773005000},"source":"Crossref","is-referenced-by-count":4,"title":["The Relationship Between Rejection of Care Behaviors and Pain and Delirium Severity in Hospital Dementia Care"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3136-5278","authenticated-orcid":false,"given":"Clarissa","family":"Shaw","sequence":"first","affiliation":[{"name":"College of Nursing, University of Iowa , Iowa City, Iowa , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caitlin","family":"Ward","sequence":"additional","affiliation":[{"name":"School of Public Health, Division of Biostatistics, University of Minnesota , Minneapolis, Minnesota , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Williams","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Iowa , Iowa City, Iowa , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyuri","family":"Lee","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Iowa , Iowa City, Iowa , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keela","family":"Herr","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Iowa , Iowa City, Iowa , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,7,19]]},"reference":[{"issue":"1","key":"2023121214021626700_CIT0001","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1097\/01.NOR.0000310607.62624.74","article-title":"Comparison of self-reported pain and the PAINAD scale in hospitalized cognitively impaired and intact older adults after hip fracture surgery","volume":"27","author":"DeWaters","year":"2008","journal-title":"Orthopaedic Nursing"},{"issue":"1\u20132","key":"2023121214021626700_CIT0002","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.pain.2004.09.012","article-title":"Core outcome measures for chronic pain clinical trials: IMMPACT recommendations","volume":"113","author":"Dworkin","year":"2005","journal-title":"Pain"},{"issue":"3","key":"2023121214021626700_CIT0003","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1111\/j.1526-4637.2009.00787.x","article-title":"Comparing the psychometric properties of the Checklist of Nonverbal Pain Behaviors (CNPI) and the Pain Assessment in Advanced Dementia (PAIN-AD) instruments","volume":"11","author":"Ersek","year":"2010","journal-title":"Pain Medicine"},{"issue":"1","key":"2023121214021626700_CIT0004","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1053\/jpmn.2000.5831","article-title":"The Checklist of Nonverbal Pain Indicators (CNPI)","volume":"1","author":"Feldt","year":"2000","journal-title":"Pain Management Nursing"},{"issue":"1","key":"2023121214021626700_CIT0005","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.jamda.2016.08.008","article-title":"Reliability and validity of the Resistiveness to Care Scale among cognitively impaired older adults","volume":"18","author":"Galik","year":"2017","journal-title":"Journal of the American Medical Directors Association"},{"issue":"9","key":"2023121214021626700_CIT0006","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1093\/qjmed\/hcw023","article-title":"Antipsychotic prescription amongst hospitalized patients with dementia","volume":"109","author":"Gallagher","year":"2016","journal-title":"QJM"},{"key":"2023121214021626700_CIT0007","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.gerinurse.2022.02.021","article-title":"Prevalence, risk factors, and outcomes of subsyndromal delirium in older adults in hospital or long-term care settings: A systematic review and meta-analysis","volume":"45","author":"Gao","year":"2022","journal-title":"Geriatric Nursing (New York, N.Y.)"},{"key":"2023121214021626700_CIT0008","doi-asserted-by":"crossref","first-page":"104160","DOI":"10.1016\/j.ijnurstu.2021.104160","article-title":"The role of experiential knowledge in hospital nurses\u2019 management of pain-related agitation in people with dementia: An expert performance simulation study","volume":"127","author":"Graham","year":"2022","journal-title":"International Journal of Nursing Studies"},{"issue":"1 Suppl","key":"2023121214021626700_CIT0009","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/AJP.0b013e31802be869","article-title":"An interdisciplinary expert consensus statement on assessment of pain in older persons","volume":"23","author":"Hadjistavropoulos","year":"2007","journal-title":"Clinical Journal of Pain"},{"issue":"1","key":"2023121214021626700_CIT0010","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.jamda.2021.09.008","article-title":"Prevalence, risk factors, and impact of delirium on hospitalized older adults with dementia: A systematic review and meta-analysis","volume":"23","author":"Han","year":"2022","journal-title":"Journal of the American Medical Directors Association"},{"key":"2023121214021626700_CIT0011","volume-title":"The CAM-S training manual and coding guide","author":"Inouye","year":"2014"},{"issue":"8","key":"2023121214021626700_CIT0012","doi-asserted-by":"crossref","first-page":"526","DOI":"10.7326\/M13-1927","article-title":"The CAM-S: Development and validation of a new scoring system for delirium severity in 2 cohorts","volume":"160","author":"Inouye","year":"2014","journal-title":"Annals of Internal Medicine"},{"issue":"2","key":"2023121214021626700_CIT0013","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1001\/jamainternmed.2018.6975","article-title":"Assessment of instruments for measurement of delirium severity: A systematic review","volume":"179","author":"Jones","year":"2019","journal-title":"JAMA Internal Medicine"},{"issue":"3","key":"2023121214021626700_CIT0014","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.pmn.2020.11.002","article-title":"Understanding nurses\u2019 knowledge and attitudes toward pain assessment in dementia: A literature review","volume":"22","author":"Jonsdottir","year":"2021","journal-title":"Pain Management Nursing"},{"key":"2023121214021626700_CIT0015","doi-asserted-by":"crossref","first-page":"h369","DOI":"10.1136\/bmj.h369","article-title":"Assessment and management of behavioral and psychological symptoms of dementia","volume":"350","author":"Kales","year":"2015","journal-title":"BMJ"},{"key":"2023121214021626700_CIT0016","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1016\/j.jpain.2022.12.014","article-title":"A systematic review of barriers and facilitators of pain management in persons with dementia","volume":"24","author":"Liao","year":"2023","journal-title":"Journal of Pain"},{"issue":"1","key":"2023121214021626700_CIT0017","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1186\/s12913-016-1690-1","article-title":"The assessment and management of pain in patients with dementia in hospital settings: A multi-case exploratory study from a decision-making perspective","volume":"16","author":"Lichtner","year":"2016","journal-title":"BMC Health Services Research"},{"key":"2023121214021626700_CIT0018","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1186\/1471-2318-14-138","article-title":"Pain assessment for people with dementia: A systematic review of systematic reviews of pain assessment tools","volume":"14","author":"Lichtner","year":"2014","journal-title":"BMC Geriatrics"},{"key":"2023121214021626700_CIT0019","first-page":"185","article-title":"Rejection of care in dementia","volume-title":"Assessment scales for advanced dementia","author":"Mahoney","year":"2015"},{"issue":"1","key":"2023121214021626700_CIT0020","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1002\/(SICI)1098-240X(199902)22:1<27::AID-NUR4>3.0.CO;2-T","article-title":"Development and testing of the Resistiveness to Care Scale","volume":"22","author":"Mahoney","year":"1999","journal-title":"Research in Nursing and Health"},{"issue":"1","key":"2023121214021626700_CIT0021","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1159\/000341582","article-title":"Psychometric properties of the Pain Assessment in Advanced Dementia Scale compared to self-assessment of pain in elderly patients","volume":"34","author":"Mosele","year":"2012","journal-title":"Dementia and Geriatric Cognitive Disorders"},{"issue":"4","key":"2023121214021626700_CIT0022","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1016\/j.pmn.2013.08.001","article-title":"A psychometric evaluation of three pain rating scales for people with moderate to severe dementia","volume":"15","author":"Neville","year":"2014","journal-title":"Pain Management Nursing"},{"issue":"4","key":"2023121214021626700_CIT0023","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1177\/1054773820961234","article-title":"The Delirium Observation Screening Scale: A systematic review and meta-analysis of diagnostic test accuracy","volume":"30","author":"Park","year":"2021","journal-title":"Clinical Nursing Research"},{"key":"2023121214021626700_CIT0024","doi-asserted-by":"crossref","first-page":"2258","DOI":"10.1111\/jgs.17910","article-title":"Elderspeak communication and pain severity as modifiable factors to rejection of care in hospital dementia care","volume":"70","author":"Shaw","year":"2022","journal-title":"Journal of the American Geriatric Society"},{"key":"2023121214021626700_CIT0025","doi-asserted-by":"crossref","first-page":"104259","DOI":"10.1016\/j.ijnurstu.2022.104259","article-title":"Characteristics of elderspeak communication in hospital dementia care: Findings from the Nurse Talk observational study","volume":"132","author":"Shaw","year":"2022","journal-title":"International Journal of Nursing Studies"},{"key":"2023121214021626700_CIT0026","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.gerinurse.2022.11.015","article-title":"Delirium superimposed on dementia in post-acute care: Nurse documentation of symptoms and interventions","volume":"49","author":"Sillner","year":"2023","journal-title":"Geriatric Nursing (New York, N.Y.)"},{"issue":"10","key":"2023121214021626700_CIT0027","doi-asserted-by":"crossref","first-page":"3174","DOI":"10.1111\/jan.15251","article-title":"Documented nursing practices of pain assessment and management when communicating about pain in dementia care","volume":"78","author":"Tsai","year":"2022","journal-title":"Journal of Advanced Nursing"},{"issue":"1","key":"2023121214021626700_CIT0028","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/01.JAM.0000043422.31640.F7","article-title":"Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale","volume":"4","author":"Warden","year":"2003","journal-title":"Journal of the American Medical Directors Association"},{"issue":"5","key":"2023121214021626700_CIT0029","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1111\/j.1532-5415.2008.01674.x","article-title":"The Confusion Assessment Method: A systematic review of current usage","volume":"56","author":"Wei","year":"2008","journal-title":"Journal of the American Geriatrics Society"},{"key":"2023121214021626700_CIT0030","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/1471-2318-6-3","article-title":"Pain in elderly people with severe dementia: A systematic review of behavioural pain assessment tools","volume":"6","author":"Zwakhalen","year":"2006","journal-title":"BMC Geriatrics"}],"container-title":["Innovation in Aging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/innovateage\/advance-article-pdf\/doi\/10.1093\/geroni\/igad076\/50911267\/igad076.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/innovateage\/article-pdf\/7\/10\/igad076\/54338979\/igad076.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/innovateage\/article-pdf\/7\/10\/igad076\/54338979\/igad076.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,12]],"date-time":"2023-12-12T18:00:10Z","timestamp":1702404010000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/innovateage\/article\/doi\/10.1093\/geroni\/igad076\/7226390"}},"subtitle":[],"editor":[{"given":"Karl","family":"Pillemer","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2023,7,19]]},"references-count":30,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2023,12,12]]}},"URL":"https:\/\/doi.org\/10.1093\/geroni\/igad076","relation":{},"ISSN":["2399-5300"],"issn-type":[{"value":"2399-5300","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,12,1]]},"published":{"date-parts":[[2023,7,19]]},"article-number":"igad076"}}