Which unmet needs contribute to behavior problems in persons with advanced dementia?
Open accessAbstract
The Unmet Needs Model states that problem behaviors of people with dementia result from unmet needs stemming from a decreased ability to communicate those needs and to provide for oneself. The purpose of this study is to describe the unmet needs of persons with dementia exhibiting behavior problems. Eighty-nine residents from 6 Maryland nursing homes with dementia were assessed by research assistants and nursing assistants for their unmet needs using multiple assessment tools. Three unmet needs per resident were identified on average, with informants rating boredom/sensory deprivation, loneliness/need for social interaction, and need for meaningful activity as the most prevalent needs. Discomfort was associated with higher levels of verbally agitated behaviors (e.g., complaining). Based on results and independent ratings of pain, the authors estimate notable under detection of discomfort and pain by both types of informants. The study demonstrates methodologies for uncovering unmet needs among persons with dementia and highlights the importance of developing programs that address those unmet needs, especially social and activity needs of nursing home residents. The detection of pain, and possibly that of discomfort, may require a different methodology.
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Claims the paper makes
1 of 18 cited sources checked · 1 supported · 0 flagged
- Findingown data
Residents with discomfort as an unmet need showed more verbally agitated behaviors, including complaining.
“Discomfort was associated with higher levels of verbally agitated behaviors (e.g., complaining).”
- Also stated in: § 3.4 Unmet needs in relation to the type of agitation manifested · plain
“Discomfort was related to better cognitive function (MMSE, z=2.56, p=.01), greater pain (PAINE, z=2.07, p=.039), higher levels of negative affect at baseline (z=1.96, p=.05), higher levels of manifesting verbally agitated behaviors of constant requests for attention (z=1.93. p=.027, one-tailed), complaining (z=2.92, p=.004), and screaming (z=2.28, p=.02).”
Quote in the paperSubstantial claim - Also stated in: § 3.4 Unmet needs in relation to the type of agitation manifested · plain
- Findingown data
Among 89 nursing home residents with dementia, an average of about three unmet needs per resident were identified.
“Three unmet needs per resident were identified on average, with informants rating boredom/sensory deprivation, loneliness/need for social interaction, and need for meaningful activity as the most prevalent needs.”
- Also stated in: § 4. Discussion · plain
“This is the first paper to delineate the unmet needs of agitated NH residents with dementia, revealing an average of 3 unmet needs per resident.”
Quote in the paperSubstantial claim - Also stated in: § 4. Discussion · plain
- Findingown data
NAs reported an average of 2.6 unmet needs per participant.
“RAs reported an average of 2.9 unmet needs per participant (range 0–7, s.d.=1.3) and NAs reported an average of 2.6 unmet needs per participant (range 0–6, s.d.=1.4).”
Quote in the paperNot a substantial claim - Findingown data
Each study participant was rated as having at least one unmet need.
“Moreover, each study participant was rated as having at least one unmet need.”
Quote in the paperNot a substantial claim - Findingown data
In revised estimates, over half of residents had unmet needs for loneliness/social contact, boredom, meaningful activity, pain, and discomfort.
“The following unmet needs were found for over half of the residents: loneliness/need for social contact, boredom, need for meaningful activity, pain, and discomfort. Moreover, each study participant was rated as having at least one unmet need.”
Quote in the paperSubstantial claim- Rests on an assumption: The RA, unlike overextended nursing staff, was able to give undivided attention to a resident's response to social and activity opportunities.
- Findingown data
RAs reported an average of 2.9 unmet needs per participant.
“RAs reported an average of 2.9 unmet needs per participant (range 0–7, s.d.=1.3) and NAs reported an average of 2.6 unmet needs per participant (range 0–6, s.d.=1.4).”
Quote in the paperNot a substantial claim - Findingown data
Discomfort was noted as an unmet need for about one third of the sample.
“Discomfort was noted as an unmet need for about one third of the sample and included many types of needs including the need to use the bathroom (most commonly) and uncomfortable seating positions (Table 1).”
Quote in the paperNot a substantial claim - Findingown data
Boredom/sensory deprivation need showed a non-significant trend toward higher physical nonaggressive behaviors.
“Participants who were rated as having an unmet need which is related to boredom and sensory deprivation displayed somewhat higher levels of physical nonaggressive behaviors (mean ranks of 47.1 for those rated as having the need and 39.9 for those rated as not having it, z=1.20, p=.11, one-tailed). However, this difference did not reach statistical significance.”
Quote in the paperNot a substantial claim - Findingown data
The need for meaningful activity was noted for around half of the sample by both RAs and NAs.
“The most common needs were loneliness/need for social contact and boredom/sensory deprivation, noted for about two thirds of the sample by RAs and for approximately half by NAs, followed by the need for a meaningful activity, which was noted for around half the sample by both sources.”
Quote in the paperNot a substantial claim - Interpretationown data
The authors estimate that both RAs and NAs under-detected discomfort and pain among residents.
“Based on results and independent ratings of pain, the authors estimate notable under detection of discomfort and pain by both types of informants.”
Quote in the paperSubstantial claim - Interpretationown data
Detecting pain, and perhaps discomfort, may need a different method.
“The detection of pain, and possibly that of discomfort, may require a different methodology.”
Quote in the paperSubstantial claim - Premisecitation
Unmet needs form the basis for nonpharmacologic interventions for dementia.
“Indeed, they form the basis for nonpharmacologic interventions for dementia (Bédard et al., 2011; Kolanowski et al., 2011; Cohen-Mansfield et al., 2012).”
Quote in the paperSubstantial claim0 of 3 sources checked - Interpretationown data
Informants found boredom and meaningful activity to be different needs.
“Cross tabulating ratings for both of these unmet needs shows that RAs identified only one or the other of these needs, rather than both, 39% of the time; the corresponding rate for NAs was 66% indicating that informants found these two needs to be different.”
Quote in the paperSubstantial claim - Interpretationown data
The modest agreement between RAs and NAs indicates difficulty in determining unmet needs in a population with severe cognitive impairment.
“The modest agreement between RAs and NAs regarding the determination of unmet needs attests to the difficulty of determining such needs in a population with a severe cognitive impairment.”
Quote in the paperSubstantial claim - Interpretationreasoning
The RA and NA ratings of unmet needs may underestimate residents' true needs.
“Upon reviewing the analyses described above, it became clear that the ratings of unmet needs by RAs and by NAs may actually represent an underestimation of the residents’ true needs, which led to reinterpreting the results and developing improved estimates for the prevalence of unmet needs.”
Quote in the paperSubstantial claim - Study design and conductown data
Validity of the TUNA was supported by significant associations between unmet needs and independently derived measures of the same needs or behaviors.
“Validity of the TUNA was examined by analyzing relationships between unmet needs and independently derived measures of the same needs or behaviors.”
Quote in the paperSubstantial claim - Interpretationown data
Discomfort was underdetected among participants with severe cognitive decline.
“Discomfort was also significantly related to better cognitive function, suggesting that discomfort was under detected among participants with a severe cognitive decline.”
Quote in the paperSubstantial claim - Study design and conductown data
Test-retest reliability of TUNA for 41 NAs over mean 14 days had agreement rate 85%.
“Test–retest reliability was obtained for 41 NAs who completed the TUNA twice (with a mean of 14 days between TUNA administrations), resulting in an agreement rate of 85%.”
Quote in the paperNot a substantial claim - Interpretationreasoning
The non-significant relationship between boredom and physical agitation is most likely due to too small sample size.
“The fact that one relationship, that between boredom and physical agitation, emerged as a trend rather than a statistically significant result is most likely due to too small of a sample size.”
Quote in the paperNot a substantial claim - Premisecitation
The PAINE is superior to other assessments for detecting pain in this population.
“For this reason, the PAINE data was used for the estimate rather than the reports of RAs or NAs, as this assessment has been shown to be superior to others for the detection of pain in this population (Cohen-Mansfield and Lipson, 2008).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Cohen-Mansfield and Lipson, 2008 source
- Interpretationown data
Raters in this study were likely subject to the same bias found in most studies of pain in dementia: residents who can express pain are likely identified, while those who cannot remain underdiagnosed.
“Regarding pain, the finding that pain was significantly related to cognitive function led us to believe that the raters of the present study were subject to the same bias found in most studies of pain in persons with dementia; that is, those who can express pain are likely to be identified, whereas those who cannot express pain remain under diagnosed (Cohen-Mansfield, 2005; Cohen-Mansfield and Lip”
Quote in the paperSubstantial claim0 of 2 sources checked
- Classified as probably not a substantial claim. 14
- May combine two claims. 21
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataInter-rater reliability for agitated behaviors in the current study averaged 96% with ICC 0.90.
“Inter-rater reliabilities regarding agitated behaviors previously averaged 0.93 (Cohen-Mansfield et al., 1989) and currently averaged 96% with Intra-Class Correlation (ICC) of 0.90.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Cohen-Mansfield et al., 1989 source
May combine two claims.
Findingown dataBoredom/sensory deprivation, loneliness/need for social interaction, and need for meaningful activity were the most prevalent unmet needs according to informants.
“Three unmet needs per resident were identified on average, with informants rating boredom/sensory deprivation, loneliness/need for social interaction, and need for meaningful activity as the most prevalent needs.”
- Also stated in: § 3.1 The perceptions of unmet needs contributing to behavior problems, and the level of confidence in the determination of unmet needs · plain
“The most common needs were loneliness/need for social contact and boredom/sensory deprivation, noted for about two thirds of the sample by RAs and for approximately half by NAs, followed by the need for a meaningful activity, which was noted for around half the sample by both sources.”
Quote in the paperSubstantial claim- Also stated in: § 3.1 The perceptions of unmet needs contributing to behavior problems, and the level of confidence in the determination of unmet needs · plain
May combine two claims.
Findingown dataRAs identified only one of boredom or meaningful activity needs rather than both 39% of the time; NAs did so 66% of the time.
“Cross tabulating ratings for both of these unmet needs shows that RAs identified only one or the other of these needs, rather than both, 39% of the time; the corresponding rate for NAs was 66% indicating that informants found these two needs to be different.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataRA-rated loneliness need was associated with higher verbal agitation but not physical agitation.
“Participants who were rated by RAs as having a loneliness need had significantly higher ratings of verbal agitation (Mann-Whitney test, z=1.70, p=.045, one-tailed – used based on the hypothesis) than those not designated as having this need, but there was no difference between the groups in physical agitation.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataRAs reported loneliness/social contact and boredom/sensory deprivation for about two thirds of residents, while NAs reported these for about half.
“The most common needs were loneliness/need for social contact and boredom/sensory deprivation, noted for about two thirds of the sample by RAs and for approximately half by NAs, followed by the need for a meaningful activity, which was noted for around half the sample by both sources.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataRA-rated anxiety/need for relaxation was associated with higher verbal agitation and higher negative affect.
“Residents rated as having anxiety/need for relaxation by the RA had significantly higher ratings of verbal agitation (z=2.04, p=.041), and negative affect (z=2. 60, p=.009).”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataAgreement between RAs and NAs averaged 86% for all types of needs, with kappas averaging .25.
“The agreement rate between RAs and NAs averaged 86% for all types of needs, and kappas averaged .25.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingnone givenThere was considerable overlap between the categories of pain and discomfort, yet the ratings were different.
“Similarly, there was considerable overlap between the categories of pain and discomfort, yet the ratings were different.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataAverage confidence in unmet need ratings was 3.78 on a 1-5 scale for both RAs and NAs.
“the average rating of confidence was identical for both RAs and NAs (mean=3.78).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe relationships between loneliness and verbal agitation and between pain and verbal agitation were supported by the findings.
“In regard to the hypotheses relating to the 4th research question pertaining to the relationship between unmet needs and type of agitation, the relationships between loneliness and verbal agitation and between pain and verbal agitation were supported by the findings.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataRA designation of pain as an unmet need was associated with better cognitive function, higher baseline negative affect, and higher PAINE scores.
“RA’s designation of the unmet need of pain was associated with significantly better cognitive function as tapped by the MMSE (z=2.16, p=.03), significantly higher levels of negative affect at baseline (z=2.21, p=.027), and higher scores on the PAINE (z=1.76. p=.039, one-tailed; one-tailed tests used to examine one sided hypotheses).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
FindingreasoningA pilot study suggested combining the categories of boredom and need for sensory stimulation because differentiation between them was difficult.
“That pilot tackled problems of categorizing unmet needs in order to develop categories and suggested, for example, combining the categories of boredom and need for sensory stimulation, since differentiation between these proved difficult.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataSignificant relationships between discomfort and specific types of verbal agitation were found, but not with the category as a whole.
“Significant relationships between discomfort and specific types of verbal agitation were found, but not with the category as a whole.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
PremisecitationUnder the Unmet Needs Model, problem behaviors arise from an imbalance among lifelong habits and personality, current physical and mental states, and suboptimal environmental conditions.
“According to the Unmet Needs Model, problem behaviors result from an imbalance in the interaction between lifelong habits and personality, current physical and mental states, and less than optimal environmental conditions (Figure 1).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Cohen-Mansfield and Werner, 1995 source
- cites Cohen-Mansfield, 2000b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationDementia reduces a person's ability to meet needs because communication becomes harder and self-care capacity declines.
“The Unmet Needs Model (Cohen-Mansfield and Werner, 1995; Cohen-Mansfield, 2000b) postulates that the dementia process results in a decreased ability to meet one’s needs because of an increasing difficulty in communicating these needs, and a decreased ability to provide for oneself (Hancock et al., 2006).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hancock et al., 2006 source
Classified as probably not a substantial claim.
PremisecitationAccording to the Unmet Needs Model, problem behaviors in dementia result from unmet needs caused by reduced ability to communicate needs and care for oneself.
“The Unmet Needs Model states that problem behaviors of people with dementia result from unmet needs stemming from a decreased ability to communicate those needs and to provide for oneself.”
- Also stated in: § 1. Introduction · plain
“The Unmet Needs Model (Cohen-Mansfield and Werner, 1995; Cohen-Mansfield, 2000b) postulates that the dementia process results in a decreased ability to meet one’s needs because of an increasing difficulty in communicating these needs, and a decreased ability to provide for oneself (Hancock et al., 2006).”
Quote in the paperSubstantial claim0 of 3 sources checked- Also stated in: § 1. Introduction · plain
Classified as probably not a substantial claim. May combine two claims.
PremisecitationPeople with dementia often show inappropriate behaviors, which add to their suffering and to caregiver burden.
“Persons with dementia often exhibit inappropriate behaviors, which increases their suffering as well as the burden of caregivers (Cohen-Mansfield, 2001).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Cohen-Mansfield, 2001 source
May combine two claims.
InterpretationreasoningAgitated behaviors such as pacing may serve to relieve boredom, and repetitive vocalizations may serve to communicate an unmet need.
“Consequently, agitated behaviors, such as pacing may act to alleviate boredom or repetitious vocalizations may be used to communicate the need.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationPrevious findings show persons with dementia have needs for being useful/giving meaning to life, enjoyment of activities, and social contact, rated as important to quality of life.
“This finding corroborates previous findings in persons with dementia of a need for being useful/giving meaning to life, enjoyment of activities, and social contact, which have been rated as psychological domains judged to be important to the quality of life of persons with dementia (see Schölzel-Dorenbos et al., 2010).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Schölzel-Dorenbos et al., 2010 source
Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.
Interpretationnone givenDetermination of unmet needs is a basis for developing intervention and prevention programs to meet those needs, leading to improvement in quality of life of NH residents with dementia.
“The determination of unmet needs is a basis for developing intervention and prevention programs to meet those needs, thereby leading to improvement in the quality of life of NH residents with dementia.”
Quote in the paperNot a substantial claim- Rests on an assumption: Unmet needs are an internal construct that cannot be assessed by self-report.
May combine two claims.
InterpretationreasoningThe modest agreement likely stems from different perspectives: RAs focused on social and activity needs, while NAs were more concerned with physical needs and had more information of that type.
“We believe this result stems from the different perspectives of these informants. Whereas the RAs focused on social and activity needs and their fulfillment, the NAs were more concerned with physical needs and often had more information of this type (e.g., constipation as an unmet need) to draw from when completing the TUNA.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningThe pattern of high overall agreement and low kappa suggests agreement is high when most residents lack a need, but low when identifying which residents have a specific unmet need.
“Based on our examination of the results, this indicates high agreement when most of the residents do not exhibit the need, but much lower agreement when determining which residents actually experience a specific unmet need.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationActivities interpreted as meaningful by residents relate to their past values, beliefs, interests, routines, and psychological needs, and are experienced as enjoyable.
“Activities interpreted as meaningful by residents relate to their past values, beliefs, interests and routines, and psychological needs and are experienced as enjoyable (Schölzel-Dorenbos et al., 2010).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Schölzel-Dorenbos et al., 2010 source
Probably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningStaff turnover is likely to affect nursing assistants' ability to provide a thorough evaluation of unmet needs via the TUNA.
“It is likely to affect nursing assistants’ ability to provide a thorough evaluation of unmet needs via the TUNA and should therefore be taken into account in future research.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataThe study was approved by an Institutional Review Board and informed consent was obtained.
“The study was approved by the Institutional Review Board of the Charles E. Smith Life Communities and participants or closest relatives signed an informed consent.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
Interpretationnone givenThe specific nature of the identified discomfort needs makes them particularly amenable to improvement efforts.
“The specific nature of the identified discomfort needs make these particularly amenable to improvement efforts.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationStaff turnover poses a barrier to quality of care.
“This has been shown to pose a barrier to quality of care (Trinkoff et al., 2013; Lerner et al., 2014).”
Quote in the paperNot a substantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningThe study can be seen as a template for developing programs addressing unmet needs.
“This study can therefore be seen as a template for developing such programs.”
Quote in the paperNot a substantial claim- Rests on an assumption: This is the first paper to delineate the unmet needs of agitated nursing home residents with dementia.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataInter-rater agreement for affect averaged 88% per emotional mode, range 70-99%, average ICC 0.91.
“Inter- rater agreement evaluations averaged 88% per emotional mode, with a range of 70%–99%, and an average ICC of 0.91.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
Direct observations are more objective and accurate than other forms of assessment.
“Direct observations were chosen because these are more objective and more accurate than other forms of assessment.”
The paper relies on this without support.
Unmet needs are an internal construct that cannot be assessed by self-report.
“Unmet needs represent an internal construct that cannot be assessed by self-report, yet is crucial for proper treatment.”
The paper relies on this without support.
The RA, unlike overextended nursing staff, was able to give undivided attention to a resident's response to social and activity opportunities.
“For social and activity needs, we chose to use only the RA’s evaluation since the RA, unlike the overextended nursing staff, was able to give undivided attention to a resident’s response to social/activity opportunities”
The paper relies on this without support.
This is the first paper to delineate the unmet needs of agitated nursing home residents with dementia.
“This is the first paper to delineate the unmet needs of agitated NH residents with dementia”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
DAD may be influenced by, or may facilitate, challenging behavior in the care recipient.
“DAD may be influenced by, or may facilitate, challenging behavior in the care recipient (Cohen-Mansfield et al., Citation2015; Feast et al., Citation2016).”
From How do care-related beliefs contribute to depression and anxiety in family caregivers of people with dementia? Testing a cognitive vulnerability-stress model. (2025) · cites this paper as Cohen-Mansfield et al., 2015
The Introduction says that challenging behaviors increase caregiver burden and that caregivers’ responses to unmet needs can contribute to agitation. It does not discuss DAD specifically or establish that DAD facilitates challenging behavior in the care recipient. (LLM, conf=0.76)
Experimental — accuracy not yet measuredPain and discomfort may cause difficulties in communication and self-management and contribute to behavioral and psychological symptoms of dementia.
“Since pain and discomfort may cause difficulties in communication and self-management, and contribute to BPSD, these factors should be carefully searched and treated (111, 112).”
From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [112]
Statistics recomputed
Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.
- Consistentz = 2.16reported p = .03 · recomputed p = .031
“(z=2.16, p = .03”
- Consistentz = 2.21reported p = .027 · recomputed p = .027
“(z=2.21, p = .027”
- Consistentz = 2.04reported p = .041 · recomputed p = .041
“(z=2.04, p = .041”
- Consistentz = 1.7reported p = .045 · recomputed p = .089
“z=1.70, p = .045”
The paper states a one-tailed test
- Consistentz = 2.56reported p = .01 · recomputed p = .010
“z=2.56, p = .01”
- Consistentz = 2.07reported p = .039 · recomputed p = .038
“z=2.07, p = .039”
- Consistentz = 1.96reported p = .05 · recomputed p = .050
“(z=1.96, p = .05”
- Consistentz = 2.92reported p = .004 · recomputed p = .004
“(z=2.92, p = .004”
- Consistentz = 2.28reported p = .02 · recomputed p = .023
“(z=2.28, p = .02”
- Consistentz = 1.2reported p = .11 · recomputed p = .230
“z=1.20, p = .11”
The paper states a one-tailed test
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Self-check results appear here once an independent check has confirmed them.
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Older Adults' Reasons for Using Technology while Aging in Place
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Self-citationObserved Affect in Nursing Home Residents with Alzheimer's Disease
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“Affect—Evaluation of positive and negative affect was based on direct observation and assessed via Lawton’s Modified Behavior Stream (LMBS; Lawton et al., 1996).”
MethodThe needs of older people with dementia in residential care
Hancock, G. A., Woods, B., Challis, D., & Orrell, M. (2006) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.1421 · Cited by 269 · cited 2× · see citing works
“The Unmet Needs Model (Cohen-Mansfield and Werner, 1995; Cohen-Mansfield, 2000b) postulates that the dementia process results in a decreased ability to meet one’s needs because of an increasing difficulty in communicating these needs, and a decreased ability to provide for oneself (Hancock et al., 2006).”
BackgroundEngagement in persons with dementia: the concept and its measurement
Cohen-Mansfield, J., Dakheel-Ali, M., & Marx, M. (2009) · The American journal of geriatric psychiatry · doi:10.1097/jgp.0b013e31818f3a52 · Cited by 252 · cited 1× · see citing works
“For instance, while one would expect that boredom would be rather close to the need for meaningful activities, as has been found in other studies (Cohen-Mansfield, 2001; Cohen-Mansfield et al., 2009; Kolanowski et al., 2011), data from this study suggest otherwise.”
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“For instance, while one would expect that boredom would be rather close to the need for meaningful activities, as has been found in other studies (Cohen-Mansfield, 2001; Cohen-Mansfield et al., 2009; Kolanowski et al., 2011), data from this study suggest otherwise.”
BackgroundResultAn observational study of agitation in agitated nursing home residents
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“Direct observations were recorded via the Agitated Behaviors Mapping Instrument (ABMI; Cohen-Mansfield et al., 1989).”
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“Specifically, those manifesting verbal\vocal behaviors were more likely to be displayed by persons who were rated as having pain, discomfort or being alone, whereas physically nonaggressive behaviors were more likely under normal environmental conditions when the people with dementia were not engaged with any activity…”
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“, 2013), observations (Cohen-Mansfield et al., 2012), and trial and error protocols.”
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“…previous findings in persons with dementia of a need for being useful/giving meaning to life, enjoyment of activities, and social contact, which have been rated as psychological domains judged to be important to the quality of life of persons with dementia (see Schölzel-Dorenbos et al., 2010).”
BackgroundPain and Depression in the Nursing Home: Corroborating Results
Cohen‐Mansfield, J., & Marx, M. S. (1993) · Journal of Gerontology · doi:10.1093/geronj/48.2.p96 · Cited by 107 · cited 1× · see citing works
“…designation by the research assistant of pain relief as an unmet need will correlate positively with ratings of pain (assessed via the PAINE), and to negative affect (Cohen-Mansfield and Marx, 1993). b. Unmet needs due to anxiety will be positively related to observed negative affect at baseline.”
BackgroundSelf-citationMedical Correlates of Agitation in Nursing Home Residents
Cohen‐Mansfield, J., Billig, N., Lipson, S., Rosenthal, A. S., & Pawlson, G. (2009) · Gerontology · doi:10.1159/000213191 · Cited by 94 · cited 4× · see citing works
“…or being alone, whereas physically nonaggressive behaviors were more likely under normal environmental conditions when the people with dementia were not engaged with any activity (Cohen-Mansfield et al., 1990; Cohen-Mansfield and Werner, 1995; Sloane et al., 1997; Cohen-Mansfield, 2000a).”
BackgroundInfluentialSelf-citationAre nursing home survey deficiencies higher in facilities with greater staff turnover
Lerner, N. B., Johantgen, M., Trinkoff, A. M., Storr, C. L., & Han, K. (2014) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2013.09.003 · Cited by 92 · cited 1× · see citing works
“This has been shown to pose a barrier to quality of care (Trinkoff et al., 2013; Lerner et al., 2014).”
BackgroundPain in cognitively impaired nursing home residents: how well are physicians diagnosing it?
Cohen‐Mansfield, J., & Lipson, S. (2002) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2002.50258.x · Cited by 92 · cited 2× · see citing works
“A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript (Cohen-Mansfield, 2005; Cohen-Mansfield and Lipson, 2002).”
BackgroundSelf-citationTheoretical frameworks for behavioral problems in dementia.
Cohen‐Mansfield, J. (2000) · Alzheimer's care quarterly · Cited by 92 · see citing works
Self-citationInformed Consent for Research in a Nursing Home: Processes and Issues
Cohen‐Mansfield, J., Kerin, P., Pawlson, G., Lipson, S., & Holdridge, K. (1988) · The Gerontologist · doi:10.1093/geront/28.3.355 · Cited by 91 · cited 1× · see citing works
“For all study participants, informed consent was provided by the attorney in fact or the closest family member (Cohen-Mansfield et al., 1988).”
BackgroundSelf-citationTurnover, Staffing, Skill Mix, and Resident Outcomes in a National Sample of US Nursing Homes
Trinkoff, A. M., Han, K., Storr, C. L., Lerner, N., Johantgen, M., & Gartrell, K. (2013) · JONA: The Journal of Nursing Administration · doi:10.1097/nna.0000000000000004 · Cited by 79 · cited 1× · see citing works
“This has been shown to pose a barrier to quality of care (Trinkoff et al., 2013; Lerner et al., 2014).”
BackgroundPain Assessment in Noncommunicative Elderly Persons—PAINE
Cohen‐Mansfield, J. (2006) · Clinical Journal of Pain · doi:10.1097/01.ajp.0000210899.83096.0b · Cited by 70 · cited 1× · see citing works
“Pain was assessed by the Pain Assessment In Elderly Persons (PAINE), consisting of a list of pain symptoms rated by direct caregivers (Cohen-Mansfield, 2006).”
MethodSelf-citationThe utility of pain assessment for analgesic use in persons with dementia
Cohen-Mansfield, J., & Lipson, S. (2008) · Pain · doi:10.1016/j.pain.2007.03.023 · Cited by 62 · see citing works
Self-citationNonpharmacological management of behavioral problems in persons with dementia: the TREA model.
Cohen‐Mansfield, J. (2000) · Alzheimer's care quarterly · Cited by 46 · see citing works
Self-citationManagement of the Patient With Disruptive Vocalization
WILSON, N. L., Sloane, P. D., Davidson, S., et al. (1997) · The Gerontologist · doi:10.1093/geront/37.5.675 · Cited by 43 · cited 4× · see citing works
“…or being alone, whereas physically nonaggressive behaviors were more likely under normal environmental conditions when the people with dementia were not engaged with any activity (Cohen-Mansfield et al., 1990; Cohen-Mansfield and Werner, 1995; Sloane et al., 1997; Cohen-Mansfield, 2000a).”
BackgroundInfluentialBédard, A., Landreville, P., Voyer, P., Verreault, R., & Vézina, J. (2011) · Aging & Mental Health · doi:10.1080/13607863.2011.569480 · Cited by 43 · cited 1× · see citing works
“Indeed, they form the basis for nonpharmacologic interventions for dementia (Bédard et al., 2011; Kolanowski et al., 2011; Cohen-Mansfield et al., 2012).”
BackgroundNursing staff members assessments of pain in cognitively impaired nursing home residents
Cohen-Mansfield, J. (2005) · Pain Management Nursing · doi:10.1016/j.pmn.2005.05.002 · Cited by 32 · cited 2× · see citing works
“A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript (Cohen-Mansfield, 2005; Cohen-Mansfield and Lipson, 2002).”
BackgroundSelf-citationCare needs assessment of older Chinese individuals with dementia of Hong Kong
Chung, J. C. C. (2006) · Aging & Mental Health · doi:10.1080/13607860600650532 · Cited by 30 · cited 1× · see citing works
“Accordingly, this finding demonstrates the value of the subjective assessment of unmet needs and reinforces the need to use multiple informants (Chung, 2006) (such as activity therapists, social workers, relatives and NAs) who focus on different aspects of needs.”
BackgroundSources of Discomfort in Persons With Dementia
Cohen‐Mansfield, J., Thein, K., Marx, M. S., et al. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.6483 · Cited by 17 · cited 3× · see citing works
“Discomfort was ascertained either by observation (see Cohen-Mansfield et al., 2013), through interpretation of the participant’s verbal behavior, or via other means, such as the impact of intervention.”
BackgroundSelf-citation
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Donovan, N. J., & Blazer, D. (2020) · The American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2020.08.005 · Cited by 739 · see citing works
“Risk factors for SI/Lin older adults also include cognitive deficits and dementia.(31,32) Societal factors, such as availability of public transportation, may also contribute to SI/L.”
Zucchella, C., Sinforiani, E., Tamburin, S., Federico, A., Mantovani, E., Bernini, S., Casale, R., & Bartolo, M. (2018) · Frontiers in Neurology · doi:10.3389/fneur.2018.01058 · Cited by 297 · see citing works
“Since pain and discomfort may cause difficulties in communication and self-management, and contribute to BPSD, these factors should be carefully searched and treated (111, 112).”
BackgroundOlsen, C., Pedersen, I., Bergland, A., Enders‐Slegers, M., Jøranson, N., Calogiuri, G., & Ihlebæk, C. (2016) · BMC Geriatrics · doi:10.1186/s12877-016-0312-4 · Cited by 220 · see citing works
“Several studies of institutionalized PWDs have shown that the residents’ needs for meaningful activities are often unmet [15, 17, 61].”
Backgroundvan der Roest, H. G., Prins, M., van der Velden, C., Steinmetz, S., Stolte, E., van Tilburg, T. G., & de Vries, D. H. (2020) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2020.09.007 · Cited by 185 · see citing works
Olsen, C., Pedersen, I., Bergland, A., Enders‐Slegers, M., Patil, G., & Ihlebæk, C. (2016) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4436 · Cited by 156 · see citing works
“It is possible that the AAA intervention might have been of particular value for this group, as patients with severe dementia have been found to have a high prevalence of unmet needs regarding meaningful activities and social contact (Cohen-Mansfield et al., 2015).”
BackgroundAgitation and Dementia: Prevention and Treatment Strategies in Acute and Chronic Conditions
Carrarini, C., Russo, M., Dono, F., Barbone, F., Rispoli, M. G., Ferri, L., Pietro, M. D., Digiovanni, A., Ajdinaj, P., Speranza, R., et al. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.644317 · Cited by 164 · see citing works
“Nonetheless, cognitively impaired patients may experience difficulties communicating feelings of discomfort, pain, and loneliness, thereby making the assessment difficult (80).”
BackgroundPalliative Care in Advanced Dementia
Eisenmann, Y., Golla, H., Schmidt, H., Voltz, R., & Perrar, K. M. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00699 · Cited by 146 · see citing works
“Neuropsychiatric symptoms were associated with lower quality of life and unmet needs as pain and social needs were associated with verbally agitated behavioral symptoms (95).”
Backgroundde Boer, B., Hamers, J. P. H., Zwakhalen, S. M. G., Tan, F. E. S., Beerens, H. C., & Verbeek, H. (2016) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2016.10.013 · Cited by 137 · see citing works
Unmet care needs of older people: A scoping review
Kohanová, D., Stolt, M., Scott, P. A., Papastavrou, E., Suhonen, R., & CA15208, O. B. O. T. R. C. A. (2020) · Nursing Ethics · doi:10.1177/0969733020948112 · Cited by 123 · see citing works
“) Sensory deprivation (Cohen-Mansfield et al.(18)) Vision care (Clark and Dellasega,(51) Ferreira et al.”
BackgroundMethodInfluentialHome is where the future is: The BrightFocus Foundation consensus panel on dementia care
Samus, Q. M., Black, B. S., Bovenkamp, D. E., Buckley, M. J., Callahan, C. M., Davis, K. C., Gitlin, L. N., Hodgson, N. A., Johnston, D. M., Kales, H. C., et al. (2017) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2017.10.006 · Cited by 102 · see citing works
Shiells, K. R., Pivodic, L., Holmerová, I., & den Block, L. V. (2019) · Aging & Mental Health · doi:10.1080/13607863.2019.1625303 · Cited by 82 · see citing works
Patel, R., & McKinnon, B. J. (2018) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2018.01.001 · Cited by 84 · see citing works
Hjetland, G. J., Pallesen, S., Thun, E., Kolberg, E., Nordhus, I. H., & Flo, E. (2020) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2020.101310 · Cited by 74 · see citing works
Jakob, A., & Collier, L. (2017) · Design for Health · doi:10.1080/24735132.2017.1296274 · Cited by 80 · see citing works
Keszycki, R. M., Fisher, D. W., & Dong, H.-X. (2019) · Frontiers in Pharmacology · doi:10.3389/fphar.2019.01109 · Cited by 62 · see citing works
Olsen, C., Pedersen, I., Bergland, A., Enders-Slegers, M.-J., & Ihlebæk, C. (2016) · Geriatric Nursing · doi:10.1016/j.gerinurse.2016.04.002 · Cited by 71 · see citing works
“Based on previous research on AAIs and PWDs’ need for meaningful activities (39), research on the effect of AAIs on the physical outcome ‘balance’ would be of great interest.”
MethodThe Experience of Relations in Persons with Dementia: A Systematic Meta-Synthesis
Eriksen, S., Helvik, A., Juvet, L. K., Skovdahl, K., Førsund, L. H., & Grov, E. K. (2016) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000452404 · Cited by 63 · see citing works
Hearing Loss Treatment in Older Adults With Cognitive Impairment: A Systematic Review
Mamo, S. K., Reed, N. S., Price, C. L., Occhipinti, D., Pletnikova, A., Lin, F. R., & Oh, E. S. (2018) · Journal of Speech Language and Hearing Research · doi:10.1044/2018_jslhr-h-18-0077 · Cited by 63 · see citing works
Froggatt, K. A., Best, A., Bunn, F., Burnside, G., Coast, J., Dunleavy, L., Goodman, C. M., Hardwick, B., Jackson, C., Kinley, J., et al. (2020) · Health Technology Assessment · doi:10.3310/hta24060 · Cited by 63 · see citing works
“holding a doll) because the intervention combines one-to-one social interaction with sensory stimulation.(116)”
BackgroundElectroconvulsive Therapy for Agitation and Aggression in Dementia: A Systematic Review
van den Berg, J. F., Kruithof, H. C., Kok, R., Verwijk, E., & Spaans, H. (2017) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2017.09.023 · Cited by 62 · see citing works
Song, J., & Oh, Y. (2015) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2015.06.004 · Cited by 60 · see citing works
Ferreira, A. R., Dias, C. C., & Fernandes, L. (2016) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2016.00072 · Cited by 55 · see citing works
“…et al., 2003; Hancock et al., 2006), unmet needs were prevalent across these three nursing homes, and clustered in particular domains, namely the psychosocial, such as daytime activities, company and psychological distress (Martin et al., 2002; Hancock et al., 2006; Cohen-Mansfield et al., 2015).”
BackgroundResultHelvik, A., Selbæk, G., Benth, J. Š., Røen, I., & Bergh, S. (2018) · PLoS ONE · doi:10.1371/journal.pone.0206147 · Cited by 59 · see citing works
Optimal nonpharmacological management of agitation in Alzheimer’s disease: challenges and solutions
Millán-Calentí, J. C., Lorenzo‐López, L., Alonso-Búa, B., de Labra, C., González‐Abraldes, I., & Maseda, A. (2016) · Clinical Interventions in Aging · doi:10.2147/cia.s69484 · Cited by 58 · see citing works
“10 Pharmacological interventions have been traditionally used in the treatment of agitation, but many studies have documented adverse effects of sedative and antipsychotic drugs, such as worsening cognitive function, higher cerebro-vascular side effects, longer hospitalizations, and increased…”
Using dolls for therapeutic purposes: A study on nursing home residents with severe dementia
Cantarella, A., Borella, E., Faggian, S., et al. (2018) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4872 · Cited by 57 · see citing works
“The idea behind the use of a doll vs a hand warmer stemmed from the need to see whether the possible beneficial effects of the DT (as described in previous works) relate to the anthropomorphic characteristics of dolls per se and therefore to their eliciting behaviors that echo previous nurturing experiences (mothering…”
BackgroundEcopsychosocial Interventions in Cognitive Decline and Dementia
Zeisel, J., Reisberg, ., Whitehouse, P. J., Woods, B. T., & Verheul, A. (2016) · American Journal of Alzheimer s Disease & Other Dementias® · doi:10.1177/1533317516650806 · Cited by 53 · see citing works
“a nonspecific and inexact label limit financial resources for research? Does such a label make it unnecessarily difficult to acquire and compare potentially significant research data and evidence? Does using a negative label limit access to treatments that might provide those with dementia and their partners a higher…”
BackgroundBunn, F., Lynch, J. K., Goodman, C. M., Sharpe, R., Walshe, C., Preston, N. J., & Froggatt, K. A. (2018) · BMC Geriatrics · doi:10.1186/s12877-018-0995-9 · Cited by 51 · see citing works
“holding a doll) because the intervention combines one-to-one social interaction with sensory stimulation [109].”
BackgroundRapaport, P., Livingston, G., Hamilton, O. K., Turner, R., Stringer, A., Robertson, S., & Cooper, C. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-022260 · Cited by 51 · see citing works
Motealleh, P., Moyle, W., Jones, C., & Dupré, K. (2019) · Health & Place · doi:10.1016/j.healthplace.2019.102148 · Cited by 50 · see citing works
Engagement in elderly persons with dementia attending animal-assisted group activity
Olsen, C., Pedersen, I., Bergland, A., Enders‐Slegers, M., & Ihlebæk, C. (2016) · Dementia · doi:10.1177/1471301216667320 · Cited by 48 · see citing works
Littlejohn, J. L., Bowen, M. A., Constantinidou, F., Dawes, P., Dickinson, C., Heyn, P. C., Hooper, E., Hopper, T. L., Hubbard, I., Langenbahn, D. M., et al. (2021) · Gerontology · doi:10.1159/000515892 · Cited by 50 · see citing works
“Sensory deprivation is associated with boredom and is classified as one of the most common unmet needs for PwD in care settings [39], where residents with Littlejohn et al.”
BackgroundMartin, L. S., Gillies, L., Coker, E., Pizzacalla, A., Montemuro, M., Suva, G., & McLelland, V. C. (2016) · American Journal of Alzheimer s Disease & Other Dementias® · doi:10.1177/1533317516668574 · Cited by 49 · see citing works
“Despite these constraints, the post-GPA intervention group described applying a more person-centered process that reflected the dementia-specific communication strategies aligned with best practice competencies published in the literature—strategies that, until now, have been reported almost exclusively in studies con…”
MethodFamily Ties and Older Adult Well-Being: Incorporating Social Networks and Proximity
Patterson, S., & Margolis, R. (2023) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbad139 · Cited by 51 · see citing works
Appel, L., Appel, E., Kisonas, E., Lewis-Fung, S. E., Pardini, S., Rosenberg, J., Appel, J., & Smith, C. (2023) · Journal of Medical Internet Research · doi:10.2196/51758 · Cited by 42 · see citing works
“…include the use of physical presence and therapeutic touch, recreational or social activities, behavioral interventions, individual and group psychological or psychosocial interventions, environmental interventions, daily routines, music-based therapies [33,34], or combinations of these [35,36].”
Dodd, K., Watchman, K., Janicki, M. P., Coppus, A. M. W., Gaertner, C., Fortea, J., Santos, F. H., Keller, S. M., & Strydom, A. (2017) · Aging & Mental Health · doi:10.1080/13607863.2017.1373065 · Cited by 39 · see citing works
Cohen‐Mansfield, J. (2018) · International Psychogeriatrics · doi:10.1017/s104161021800039x · Cited by 39 · see citing works
“Given that the most common needs pertain to loneliness, boredom, pain, and discomfort (Cohen-Mansfield et al., 2015), nonpharmacological interventions span a very wide range of actual interventions, of which the papers here mention visual arts (Windle et al.”
BackgroundSelf-citationde Bruin, S. R., Buist, Y., Hassink, J., & Vaandrager, L. (2019) · Ageing and Society · doi:10.1017/s0144686x19001168 · Cited by 40 · see citing works
Ashrafizadeh, H., Gheibizadeh, M., Rassouli, M., Hajibabaee, F., & Rostami, S. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.699959 · Cited by 39 · see citing works
Predictors of unmet needs in Chilean older people with dementia: a cross-sectional study
Tapia Muñoz, T., Slachevsky, A., León-Campos, M. O., Madrid, M., Caqueo-Urízar, A., Rohde, G. C., & Miranda-Castillo, C. (2019) · BMC Geriatrics · doi:10.1186/s12877-019-1131-1 · Cited by 35 · see citing works
Melander, C., Martinsson, J., & Gustafsson, S. R. (2017) · Dementia and Geriatric Cognitive Disorders Extra · doi:10.1159/000484890 · Cited by 34 · see citing works
Gibbor, L., Forde, L., Yates, L., Orfanos, S., Komodromos, C., Page, H., Harvey, K., & Spector, A. E. (2020) · Aging & Mental Health · doi:10.1080/13607863.2020.1747048 · Cited by 32 · see citing works
Hung, L., Au-Yeung, A., Helmer, C., Ip, A., Elijah, L., Wilkins-Ho, M., & Chaudhury, H. (2018) · Contemporary Nurse: health care across the lifespan · doi:10.1080/10376178.2018.1505436 · Cited by 33 · see citing works
Measuring Effects of Nondrug Interventions on Behaviors: Music & Memory Pilot Study
McCreedy, E. M., Yang, X., Baier, R. R., Rudolph, J. L., Thomas, K. S., & Mor, V. (2019) · Journal of the American Geriatrics Society · doi:10.1111/jgs.16069 · Cited by 37 · see citing works
de Bruin, S. R., Pedersen, I., Eriksen, S., et al. (2020) · Journal of Healthcare Leadership · doi:10.2147/jhl.s202988 · Cited by 33 · see citing works
Cheung, D. S. K., Lai, C. K. Y., Wong, F. K. Y., & Leung, M. C. P. (2018) · Dementia · doi:10.1177/1471301218800195 · Cited by 33 · see citing works
Hakvoort, L., & Tönjes, D. (2022) · Nordic Journal of Music Therapy · doi:10.1080/08098131.2022.2070925 · Cited by 30 · see citing works
Ellingsen‐Dalskau, L. H., de Boer, B., & Pedersen, I. (2020) · Health & Social Care in the Community · doi:10.1111/hsc.13113 · Cited by 26 · see citing works
Cabote, C., Salamonson, Y., Trajkovski, S., Maneze, D., & Montayre, J. (2023) · Journal of Clinical Nursing · doi:10.1111/jocn.16617 · Cited by 28 · see citing works
Implementing Montessori Methods for Dementia: A Scoping Review
Hitzig, S. L., & Sheppard, C. L. (2017) · The Gerontologist · doi:10.1093/geront/gnw147 · Cited by 27 · see citing works
“A recent study found that the three most common unmet needs in people with dementia were boredom/sensory deprivation, loneliness/need for social interaction, and need for meaningful activity (Cohen-Mansfield et al., 2015).”
BackgroundAarskog, N. K., Hunskår, I., & Bruvik, F. K. (2019) · Physical & Occupational Therapy In Geriatrics · doi:10.1080/02703181.2019.1613466 · Cited by 25 · see citing works
“Hence, nonpharmacological treatment can be considered in order to relieve BPSDs.(2,7,11) There are numerous non-pharmacological treatment options that have been shown to improve quality of life and reduce BPSDs in individuals with dementia, one of which is animal-assisted intervention (AAI).”
BackgroundSensory Design for Dementia Care – The Benefits of Textiles
Jakob, A., & Collier, L. (2017) · Journal of Textile Design Research and Practice · doi:10.1080/20511787.2018.1449078 · Cited by 26 · see citing works
“The process of cognitive decline impacts a person’s ability and capacity to cope with and adjust to their environment, to take part in everyday activities and personal care, to interact with others and to meet their own needs (Cohen-Mansfield et al. 2015).”
BackgroundInfluentialVery frequent physical aggression and vocalizations in nursing home residents with dementia
Veldwijk-Rouwenhorst, A. E., Zuidema, S. U., Smalbrugge, M., Bor, H. H. J., Wetzels, R. B., Gerritsen, D. L., & Koopmans, R. T. C. M. (2020) · Aging & Mental Health · doi:10.1080/13607863.2020.1786799 · Cited by 24 · see citing works
Macaulay, S. (2018) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2017.11.009 · Cited by 24 · see citing works
Jones, C., Liu, F., Murfield, J., & Moyle, W. (2020) · Geriatric Nursing · doi:10.1016/j.gerinurse.2020.06.001 · Cited by 23 · see citing works
Toward Quantification of Agitation in People With Dementia Using Multimodal Sensing
Davidoff, H., den Bulcke, L. V., Vandenbulcke, M., et al. (2022) · Innovation in Aging · doi:10.1093/geroni/igac064 · Cited by 23 · see citing works
Leroi, I., Wolski, L., Charalambous, A. P., Constantinidou, F., David, R., Dawes, P., Hann, M., Himmelsbach, I., Miah, J., Payne, M., et al. (2021) · Disability and Rehabilitation · doi:10.1080/09638288.2021.1923071 · Cited by 23 · see citing works
O'Donnell, E. A., Holland, C., & Swarbrick, C. (2022) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2022.104260 · Cited by 22 · see citing works
Tang, S., & Chow, A. Y. M. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.06.001 · Cited by 21 · see citing works
Implementation effectiveness of psychosocial and environmental care practices in assisted living
Miller, H. V., Ward, K., & Zimmerman, S. I. (2020) · Geriatric Nursing · doi:10.1016/j.gerinurse.2020.09.003 · Cited by 21 · see citing works
Room for improvement: An online survey of allied health professionals’ dementia knowledge
Lawler, K., Kitsos, A. R., Bindoff, A. D., Callisaya, M. L., Eccleston, C. E. A., & Doherty, K. (2020) · Australian Journal on Ageing · doi:10.1111/ajag.12886 · Cited by 21 · see citing works
Adlbrecht, L., Nemeth, T., Frommlet, F., Bartholomeyczik, S., & Mayer, H. (2021) · Scandinavian Journal of Caring Sciences · doi:10.1111/scs.13017 · Cited by 22 · see citing works
“Activities and social interactions are amongst the most prevalent unmet needs of persons with dementia which have a negative impact on their physical, cognitive and psychosocial wellbeing [9,10].”
BackgroundMotealleh, P., Moyle, W., Jones, C., & Dupré, K. (2021) · HERD Health Environments Research & Design Journal · doi:10.1177/19375867211063489 · Cited by 23 · see citing works
“These unmet needs are often due to unacceptable environmental conditions, including excessive or insufficient levels of stimulation in the environment and limited opportunities for engagement or socialization with others (Cohen-Mansfield et al., 2015).”
BackgroundInfluentialFake bus stops for persons with dementia? On truth and benevolent lies in public health
Lorey, P. (2019) · Israel Journal of Health Policy Research · doi:10.1186/s13584-019-0301-0 · Cited by 21 · see citing works
Revisiting the Role of Physicians in Assisted Living and Residential Care Settings
Dys, S., Smith, L., Tunalilar, O., & Carder, P. (2020) · Gerontology and Geriatric Medicine · doi:10.1177/2333721420979840 · Cited by 20 · see citing works
Michelet, M., Selbaek, G., Strand, B. H., Lund, A., Engedal, K., Bieber, A., Gonçalves-Pereira, M., Hopper, L., Irving, K., Jelley, H., et al. (2022) · Aging & Mental Health · doi:10.1080/13607863.2021.1910792 · Cited by 19 · see citing works
Malhotra, C., Vishwanath, P., Yong, J. R., Østbye, T., Seow, D. C. C., Yap, P. L. K., Tan, L. L., Tham, W. Y., Vaingankar, J. A., Foo, J., et al. (2020) · Journal of Alzheimer s Disease · doi:10.3233/jad-190897 · Cited by 19 · see citing works
Yan, Z., Traynor, V., Alananzeh, I. M., Drury, P., & Chang, H. (2023) · Dementia · doi:10.1177/14713012231173817 · Cited by 20 · see citing works
“A study by Cohen-Mansfield et al. (2015) identified the top three unmet needs of individuals with dementia in residential aged care to be loneliness/need for social interaction, boredom/sensory deprivation, and need for meaningful activities.”
BackgroundMcCreedy, E. M., Gutman, R., Baier, R. R., Rudolph, J. L., Thomas, K. S., Dvorchak, F., Uth, R., Ogarek, J. A., & Mor, V. (2021) · Trials · doi:10.1186/s13063-021-05620-y · Cited by 19 · see citing works
Enhancing Communication in Adults with Dementia and Age-Related Hearing Loss
Oh, E. S., Lin, F. R., & Mamo, S. K. (2017) · Seminars in Hearing · doi:10.1055/s-0037-1601573 · Cited by 19 · see citing works
The Validity of the Norwegian Version of the Cognitive Function Instrument
Michelet, M., Engedal, K., Selbæk, G., Lund, A. D., Bjørkløf, G. H., Horndalsveen, P. O., & Bergh, S. (2018) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000493463 · Cited by 18 · see citing works
Ferreira, A. R., Simões, M. R., Moreira, E., Guedes, J. M., & Fernandes, L. P. N. S. (2019) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2019.103919 · Cited by 18 · see citing works
The Rights of Persons With Dementia and Their Meanings
Cohen‐Mansfield, J. (2021) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2021.03.007 · Cited by 18 · see citing works
Self-citationLin, R. S. Y., Yu, D. S. F., Chau, P. H., Li, P. W., & Ismail, Z. (2022) · Journal of Geriatric Psychiatry and Neurology · doi:10.1177/08919887221093363 · Cited by 17 · see citing works
“The behaviors denoted by the non-homogenous items are the resultant actions used by people with dementia to fulfill their needs without awareness and acknowledgment of social norms.(65) For example, undressing in public can be seen as highly inappropriate, when in fact, it can result from physical discomfort.”
BackgroundBjörk, S., Lövheim, H., Lindkvist, M., Wimo, A. B., & Edvardsson, D. (2017) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4714 · Cited by 17 · see citing works
“Agitation and depression were previously shown to relate negatively with a proxy-rated QoL (Beerens et al., 2013), and in a recent study, agitated behaviors were associated with discomfort, unmet social needs, or boredom (Cohen-Mansfield et al., 2015).”
BackgroundA Longitudinal Study of Functional Unmet Need Among People with Dementia
Read, S., Hu, B., Wittenberg, R., Brimblecombe, N., Robinson, L. A., & Banerjee, S. (2021) · Journal of Alzheimer s Disease · doi:10.3233/jad-210724 · Cited by 16 · see citing works
Burley, C. V., Casey, A., Chenoweth, L., & Brodaty, H. (2022) · International Psychogeriatrics · doi:10.1017/s1041610222000849 · Cited by 17 · see citing works
Pain in persons with dementia and the direct and indirect impacts on caregiver burden
Regier, N. G., Taylor, J. L. W., Szanton, S. L., Parmelee, P. A., Perrin, N., Liu, M., Jenkins, E., Hodgson, N. A., & Gitlin, L. N. (2021) · Geriatric Nursing · doi:10.1016/j.gerinurse.2021.01.007 · Cited by 16 · see citing works
Self-citationIsraeli nursing home staff perspectives on challenges to quality care for residents with dementia
Cohen-Mansfield, J., & Meschiany, G. (2022) · Geriatric Nursing · doi:10.1016/j.gerinurse.2021.12.012 · Cited by 15 · see citing works
Self-citationMelander, C., Kikhia, B., Olsson, M. B., Wälivaara, B., & Sävenstedt, S. (2018) · Dementia and Geriatric Cognitive Disorders Extra · doi:10.1159/000493339 · Cited by 15 · see citing works
Lin, R. S. Y., Yu, D. S. F., Li, P. W. C., & Masika, G. M. (2020) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5460 · Cited by 14 · see citing works
“NPS are a product of unmet needs due to the increasing difficulties in expressing ones' needs.(82) Considering that the daily functioning of people at earlier disease stages is mostly intact,(83) their NPS manifestations are more stress‐provoking as described by the PLST model than need‐driven as stated by the unmet n…”
BackgroundPerceived Unmet Need and Need-Related Distress of People Living With Dementia
Minyo, M. J., & Judge, K. S. (2022) · Gerontology and Geriatric Medicine · doi:10.1177/23337214221092886 · Cited by 14 · see citing works
“For example, behavioral expressions have been shown to be associated with unmet needs (Cohen-Mansfield et al., 2015; Hancock et al., 2006; Martyr et al., 2018), such that behavioral expressions arise as an attempt to communicate an unmet need (Algase et al., 1996; CohenMansfield et al., 2015).”
BackgroundSmaling, H. J. A., Francke, A. L., Achterberg, W. P., et al. (2022) · Journal of Palliative Care · doi:10.1177/08258597221129739 · Cited by 14 · see citing works
“A lack of activities contributes to challenging behavior in people with advanced dementia, stemming from unmet needs such as boredom, sensory deprivation, and need for social interaction.(5,6) Offering tailored, meaningful activities can improve persons with dementia’s quality of life.”
BackgroundModerate dementia: relational social engagement (RSE) during family visits
Walmsley, B. D., & McCormack, L. (2017) · Aging & Mental Health · doi:10.1080/13607863.2017.1326462 · Cited by 14 · see citing works
“However, if speech and facial expressiveness diminish during the moderate stage of dementia, individuals find it difficult to satisfy their engagement needs (Cohen-Mansfield, 2000; CohenMansfield & Werner, 1995; Cohen-Mansfield et al., 2015; Miller, 2015).”
Impacto psicológico de las demencias en las familias: propuesta de un modelo integrador
Losada‐Baltar, A., González, M. M., Vara‐García, C., Gallego‐Alberto, L., Moreno, R. R., & Rodríguez, J. O. (2017) · Clínica Contemporánea · doi:10.5093/cc2017a4 · Cited by 13 · see citing works
Telenius, E. W., Eriksen, S., & Rokstad, A. M. M. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-035886 · Cited by 14 · see citing works
Molvik, I., Kjelvik, G., Selbæk, G., & Rokstad, A. M. M. (2024) · BMC Geriatrics · doi:10.1186/s12877-024-04665-3 · Cited by 14 · see citing works
“Discovering and addressing the needs of people with dementia are critical endeav-ours, because unmet needs can reduce quality of life, increase discontent, and drive a sense of despair [11–13].”
BackgroundKoh, W. Q., Hoel, V., Casey, D., & Toomey, E. C. (2022) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2022.09.010 · Cited by 14 · see citing works
Hyun, K. T., & 박수현 (2016) · Korean Journal of Health Psychology · doi:10.17315/kjhp.2016.21.1.004 · Cited by 13 · see citing works
Staehler, M., Benson, C., Block, L., Roberts, T. J., & Gilmore‐Bykovskyi, A. L. (2022) · The Gerontologist · doi:10.1093/geront/gnac012 · Cited by 12 · see citing works
Gebhard, D., & Frank, J. I. (2024) · BMC Geriatrics · doi:10.1186/s12877-024-05641-7 · Cited by 12 · see citing works
Douglas, N., & MacPherson, M. K. (2021) · American Journal of Speech-Language Pathology · doi:10.1044/2020_ajslp-20-00065 · Cited by 12 · see citing works
Kang, B., Pan, W., Karel, M. J., & McConnell, E. S. (2021) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2021.03.032 · Cited by 13 · see citing works
Gaspar, P. M., & Westberg, K. (2020) · Journal of Gerontological Nursing · doi:10.3928/00989134-20200409-01 · Cited by 12 · see citing works
Abdullah, J. M., Courtney‐Pratt, H., Doherty, K., & Andrews, S. (2023) · Dementia · doi:10.1177/14713012231198952 · Cited by 11 · see citing works
Keller, M. S., Guevara, N., Guerrero, J.-A., Mays, A. M., McCleskey, S. G., Reyes, C. E. S., & Sarkisian, C. A. (2024) · BMC Geriatrics · doi:10.1186/s12877-024-05323-4 · Cited by 11 · see citing works
“Moreover, many behavioral symptoms of dementia may be related to an inability to express unmet needs, such as hunger, thirst, loneliness/social isolation, boredom, and lack of physical activity [4].”
BackgroundCrandall, J. M., Coatsworth‐Puspoky, R., Schlegel, K., Beker, L., McLelland, V. C., & Martin, L. S. (2022) · Dementia · doi:10.1177/14713012211070148 · Cited by 12 · see citing works
“…generally occur in response to a person’s unmet needs and there is a movement to discourage pathologizing of human behaviour (Alzheimer Society of Canada, 2019; Behavioural Supports Ontario, 2020; Bourgeois & Hickey, 2009; Cohen-Mansfield et al., 2015; Dupuis et al., 2012; Dupuis & Luh, 2005).”
BackgroundAesthetics and dementia: exploring the role of everyday aesthetics in dementia care settings
Fleetwood-Smith, R., Tischler, V., & Robson, D. (2022) · Design for Health · doi:10.1080/24735132.2022.2074207 · Cited by 11 · see citing works
“Sensory experience, in the context of dementia, is particularly important as people with the condition are at risk of sensory deprivation and can become increasingly reliant on sensory cues due to difficulties with language and communication as the condition progresses (Cohen-Mansfield et al. 2015).”
BackgroundKratzer, A., Diehl, K., Gefeller, O., Meyer, S., & Graessel, E. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-03695-z · Cited by 12 · see citing works
“Therefore the MAKS-s intervention (where s stands for severe dementia) was adapted to the special needs of PWSDs, following the ‘unmet needs model’ by Cohen-Mansfield and colleagues [16].”
BackgroundMethodWalsh, B., Dahlke, S., O’Rourke, H., & Hunter, K. F. (2022) · Journal of Clinical Nursing · doi:10.1111/jocn.15477 · Cited by 11 · see citing works
Kang, B., Karel, M. J., Corazzini, K., & McConnell, E. S. (2021) · Journal of Advanced Nursing · doi:10.1111/jan.14864 · Cited by 12 · see citing works
- Authors
- Cohen-Mansfield, J., Dakheel-Ali, M., Marx, M. S., Thein, K., & Regier, N. G.
- ORCID
- Regier, Natalie G.
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2015-07
- Volume
- 228
- Issue
- 1
- Pages
- 59-64
- ISSN
- 0165-1781 (ISSN-L)
- PMC
- PMC4451402
- OpenAlex
- W1988292497
- Semantic Scholar
- cc1a9c2635510a9c9875de4eaa550a367b18d87a
- Cited by
- 287
- References
- 32
- Citations by year
- 2026: 27 · 2025: 26 · 2024: 31 · 2023: 28 · 2022: 33 · 2021: 36 · 2020: 36 · 2019: 14 · 2018: 23 · 2017: 14 · 2016: 16 · 2015: 3
- FWCI
- 15.14
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (2 R01 AG010172- 10A2)
- Minerva-Stiftung Foundation (31583295000, 80539)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- dementia, unmet needs, behavioral problems, nursing home residents, boredom, sensory deprivation, loneliness, social interaction, meaningful activities, verbal agitation, pain detection, discomfort, informant ratings
- MeSH terms
- Problem Behavior, Aged, Aged, 80 and over, Dementia, Female, Health Services Needs and Demand, Homes for the Aged, Humans, Male, Maryland, Nursing Homes, Pain, Psychomotor Agitation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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