The DOI matches its Crossref record; 29 of the 32 references it cites were found in a registry or an index; 1 of the 18 sources its claims cite were checked for support.
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
19 Own result · 14 Own interpretation · 8 No full text of the sources · 4 Own method · 2 Not checked yet · 2 No basis given · 1 Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § 3.4 Unmet needs in relation to the type of agitation manifested · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § 4. Discussion · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 3. Results > 3.1 The perceptions of unmet needs contributing to behavior problems, and the level of confidence in the determination of unmet needs
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Moreover, each study participant was rated as having at least one unmet need.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 3. Results > 3.4 Unmet needs in relation to the type of agitation manifested
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 3. Results > 3.4 Unmet needs in relation to the type of agitation manifested
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- 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.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 3. Results > 3.1 The perceptions of unmet needs contributing to behavior problems, and the level of confidence in the determination of unmet needs
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 3. Results > 3.1 The perceptions of unmet needs contributing to behavior problems, and the level of confidence in the determination of unmet needs
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 3. Results > 3.4 Unmet needs in relation to the type of agitation manifested
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 3. Results > 3.1 The perceptions of unmet needs contributing to behavior problems, and the level of confidence in the determination of unmet needs
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Based on results and independent ratings of pain, the authors estimate notable under detection of discomfort and pain by both types of informants.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > Abstract
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Probably not a substantial claim. 14
- It may state two separate claims as one. 21
Every source the paper cites for this claim was checked and supports it.
In the paper
“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.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 2. Methods > 2.3 Measurements
What the sources say
- Supportedcites Cohen-Mansfield et al., 1989 source
The citation supports the historical reliability figure, not the citing study’s current 96% or ICC of 0.90. The source paper’s Methods section states that interobserver agreement for each agitated behavior averaged 0.93. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- 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
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 4. Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 3. Results > 3.4 Unmet needs in relation to the type of agitation manifested
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 3. Results > 3.1 The perceptions of unmet needs contributing to behavior problems, and the level of confidence in the determination of unmet needs
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 3. Results > 3.3 Unmet needs in relation to residents’ background information
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The agreement rate between RAs and NAs averaged 86% for all types of needs, and kappas averaged .25.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 3. Results > 3.2 A comparison of RAs and NAs determination of unmet needs
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Similarly, there was considerable overlap between the categories of pain and discomfort, yet the ratings were different.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 4. Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the average rating of confidence was identical for both RAs and NAs (mean=3.78).”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 3. Results > 3.1 The perceptions of unmet needs contributing to behavior problems, and the level of confidence in the determination of unmet needs
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 4. Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 3. Results > 3.3 Unmet needs in relation to residents’ background information
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 4. Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Significant relationships between discomfort and specific types of verbal agitation were found, but not with the category as a whole.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 4. Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 1. Introduction
What the sources say
- Not checked — no full text of the sourcecites Cohen-Mansfield and Werner, 1995 source
- Not matchedcites Cohen-Mansfield, 2000b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“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).”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 1. Introduction
What the sources say
- Not checked — no full text of the sourcecites Hancock et al., 2006 source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > Abstract
What the sources say
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Also stated in: § 1. Introduction · plain
In the paper
“Persons with dementia often exhibit inappropriate behaviors, which increases their suffering as well as the burden of caregivers (Cohen-Mansfield, 2001).”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 1. Introduction
What the sources say
- Not checked — no full text of the sourcecites Cohen-Mansfield, 2001 source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Consequently, agitated behaviors, such as pacing may act to alleviate boredom or repetitious vocalizations may be used to communicate the need.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 1. Introduction
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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).”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 4. Discussion
What the sources say
- Not checked — no full text of the sourcecites Schölzel-Dorenbos et al., 2010 source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 4. Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.
- Rests on an assumption: Unmet needs are an internal construct that cannot be assessed by self-report.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 4. Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 3. Results > 3.2 A comparison of RAs and NAs determination of unmet needs
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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).”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 4. Discussion
What the sources say
- Not checked — no full text of the sourcecites Schölzel-Dorenbos et al., 2010 source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 4. Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 2. Methods
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The specific nature of the identified discomfort needs make these particularly amenable to improvement efforts.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 4. Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“This has been shown to pose a barrier to quality of care (Trinkoff et al., 2013; Lerner et al., 2014).”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 4. Discussion
What the sources say
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This study can therefore be seen as a template for developing such programs.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 4. Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
- Rests on an assumption: This is the first paper to delineate the unmet needs of agitated nursing home residents with dementia.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Inter- rater agreement evaluations averaged 88% per emotional mode, with a range of 70%–99%, and an average ICC of 0.91.”
§ Which unmet needs contribute to behavior problems in persons with advanced dementia? > 2. Methods > 2.3 Measurements
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
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?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredIn the citing paper
“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.
Citations
Cites
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975) · Journal of Psychiatric Research · doi:10.1016/0022-3956(75)90026-6 · Cited by 88,282 · cited 7×
“…direct care of the resident judged him/her to have a life expectancy of less than 3 months due to obvious causes; (b) The resident had an accompanying diagnosis of bipolar disorder or schizophrenia; and (c) A score of 25 or higher on the Mini-Mental State Examination (MMSE; Folstein et al., 1975).”
BackgroundMethodInfluentialHirono, N., Mori, E., Ikejiri, Y., Imamura, T., Shimomura, T., Hashimoto, M., Yamashita, H., & Ikeda, M. (1997) · PubMed · Cited by 21,012
Kok, J. S., Berg, I. J., & Scherder, E. J. A. (2013) · Dementia and Geriatric Cognitive Disorders Extra · doi:10.1159/000353441 · Cited by 20,589
Older Adults' Reasons for Using Technology while Aging in Place
Peek, S. T. M., Luijkx, K. G., Rijnaard, M. D., Nieboer, M. E., van der Voort, C. S., Aarts, S., van Hoof, J., Vrijhoef, H. J., & Wouters, E. (2015) · Gerontology · doi:10.1159/000430949 · Cited by 19,852
Sensitivity and False Alarm Rate of a Fall Sensor in Long-Term Fall Detection in the Elderly
Kangas, M., Korpelainen, R., Vikman, I., Nyberg, L., & Jämsä, T. J. (2014) · Gerontology · doi:10.1159/000362720 · Cited by 19,007
Cohen-Mansfield, J. (2001) · The American Journal of Geriatric Psychiatry · doi:10.1097/00019442-200111000-00005 · Cited by 593
Self-citationObserved Affect in Nursing Home Residents with Alzheimer's Disease
Lawton, M. P., Van Haitsma, K., & Klapper, J. (1996) · The Journals of Gerontology Series B: Psychological Sciences and Social Sciences · doi:10.1093/geronb/51b.1.p3 · Cited by 401 · cited 1×
“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×
“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×
“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.”
ResultSelf-citationKolanowski, A., Litaker, M., Buettner, L., Moeller, J., & Costa, Jr. (2011) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2011.03449.x · Cited by 199 · cited 2×
“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
Cohen-Mansfield, J., Werner, P., & Marx, M. S. (1989) · International Psychogeriatrics · doi:10.1017/s1041610289000165 · Cited by 163 · cited 5×
“Direct observations were recorded via the Agitated Behaviors Mapping Instrument (ABMI; Cohen-Mansfield et al., 1989).”
MethodInfluentialSelf-citationEnvironmental influences on agitation: an integrative summary of an observational study
Cohen-Mansfield, J., & Werner, P. (1995) · American Journal of Alzheimer's Care and Related Disorders & Research · doi:10.1177/153331759501000108 · Cited by 136 · cited 10×
“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…”
BackgroundInfluentialSelf-citationCohen-Mansfield, J., Thein, K., Marx, M. S., Dakheel-Ali, M., & Freedman, L. (2012) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.12m07918 · Cited by 129 · cited 4×
“, 2013), observations (Cohen-Mansfield et al., 2012), and trial and error protocols.”
BackgroundInfluentialSelf-citationSchölzel-Dorenbos, C. J. M., Meeuwsen, E. J., & Olde Rikkert, M. G. M. (2010) · Aging & Mental Health · doi:10.1080/13607860903046495 · Cited by 124 · cited 2×
“…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×
“…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×
“…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×
“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×
“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
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×
“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×
“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×
“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
Self-citationNonpharmacological management of behavioral problems in persons with dementia: the TREA model.
Cohen‐Mansfield, J. (2000) · Alzheimer's care quarterly · Cited by 46
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×
“…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×
“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×
“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×
“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×
“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
Cited by
Sorted by citations
Donovan, N. J., & Blazer, D. (2020) · The American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2020.08.005 · Cited by 739
“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
“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
“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
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
“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).”
Background
Metadata
- 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 › Medicine › Geriatrics and Gerontology › 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.
A language model drew the claims from the paper on 2026-09-28, under version 3 of the claim definition (prompt extract-v3).
A second model labelled each claim on 2026-09-28 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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