Reliability and Validity of the Resistiveness to Care Scale Among Cognitively Impaired Older Adults

Resistiveness to care generally occurs when an individual with cognitive impairment interferes with caregivers’ attempts to provide care, and commonly occurs during personal care interactions such as bathing, toileting, and oral care. The purpose of this study was to test the reliability and validity of the Resistiveness to Care Scale (Mahoney et al., 1999) using a Rasch Measurement Model among a larger group of nursing home residents with moderate to severe dementia. This was a descriptive study using baseline data from 261 residents participating in an ongoing trial testing a Function and Behavior Focused Care intervention for cognitively impaired nursing home residents (FBFC). The average age of the residents was 84.64 (SD=9.60) and the majority were female (N=198, 74%), white (N=161, 61%), and not married (N=185, 69%). The mean MMSE was 7.23 (SD=5.10). There was sufficient evidence of internal consistency with findings similar to the original scale development which was done with a non-independent sample of 68 residents younger residents (mean age of 72) providing 232 observations in which the alpha coefficient was .82. Psychometric testing using Rasch analysis supported the validity of the measure. The findings from this study provide new support for the reliability and validity of the Resistiveness to Care Scale for use with older adults with dementia in nursing home settings. Future work with the measure may benefit, however, from the addition of items that are easier to endorse or express with regard to resistiveness to care.