Evidence supporting nutritional interventions for persons in early stage Alzheimer's disease (AD).

The purpose of this paper is to grade research evidence supporting nutritional interventions for persons with early stage dementias and to report the recommendations of a consensus panel. Thirty four studies were reviewed in the areas of dietary restriction, antioxidants, and Mediterranean diet with strong support from epidemiological studies found in all three areas. The body of evidence to support nutritional interventions in the prevention and treatment of AD is growing and has potential as a treatment modality following translational studies.

Scholarship of practice for a practice profession.

At a time of shrinking resources, rapidly changing health care environments, and increased demands for solutions to pressing health issues, concerns regarding the relevance of nursing research for practice are again being raised. After the national debate surrounding definitions of scholarship across disciplines and having established respectability for past and current contributions to knowledge development, nursing may now begin to reconceptualize what constitutes scholarship in a practice profession. This article addresses two central questions related to the scholarship of nursing practice: (1) How is scholarship of practice in a practice of profession defined? and (2) What characteristics differentiate the new conceptualizations of scholarship of practice from traditional research models? The results include a delineation of scholarship of practice and a differentiation of characteristics between scholarship of practice and traditional research approaches. Implications for nursing education are also addressed.

Nursing care of cognitively impaired, institutionalized elderly.

Findings indicate the importance of many nursing staff behaviors in relation to the behaviors of demented elderly persons, especially when asking the elder to complete a care task, such as dressing. Nonverbal as well as verbal nursing staff behaviors were related to behaviors of demented elderly persons, especially smiling, eye contact, and manipulating the environment to avoid difficult encounters. The nursing staff's ability to remain relaxed and flexible when assisting with the elder's care was strongly related to the elder's ability to remain flexible, calm, and cooperative during the care procedure. Use of verbal distraction or redirection, praise, and light-hearted, playful approaches were often found to be helpful when the demented elder became upset or paranoid.

Assessing patients in the early stages of irreversible dementia. The relevance of patient perspectives.

1 Individuals with Alzheimer's dementia are able to describe their personal responses to the disease, including how the disease has affected their perceptions of self. 2 Individual-centered variables, other than those related to the disease, are associated with quality of life outcomes in individuals with Alzheimer's dementia, including the individuals' personality, age, and education level. 3 The importance of maintenance of social activities and past pleasant activities is shown by the relationships among these variables and quality of life outcomes in individuals with dementia. 4 The quality of the relationship between caregivers and individuals with dementia, including the role-stress experiences by the caregivers, is moderately to strongly associated with the individuals' level of depression, psychological well-being, and productive behaviors.

Expressions of individuality in cognitively impaired elders. Need for individual assessment and care.

1. Cognitively impaired elders uniquely express their individuality (expressed selfness) despite the effects of the dementing process. 2. Recognizing and attending to expressed selfness has implications for planning nursing care both to meet specific needs and to support existing characteristics and behaviors. 3. With the multiple losses encountered in dementia, supporting expressed selfness accessible to the individual can enhance the quality of the individual's living experience.

Caregiver religiosity and well-being in dealing with Alzheimer's dementia.

To examine the relationship among religious participation, stress, and well-being, 84 caregivers of Alzheimer's patients and 81 control subjects completed the Religiosity Scale, Life-3, and Medical Outcomes Study well-being measures. Caregivers only completed the Relative's Stress Scale. No differences were found between groups in religious practices, although caregivers indicated higher levels of clergy-visiting than the others and control subjects indicated a greater met need for contact with the church or synagogue. In contrast, control subjects show higher levels of well-being, social functioning, and mental health than caregivers. In care-givers, significant relationships were found among several religiosity variables, stress, and well-being.

Predicting quality of life in caregivers of Alzheimer's patients: the role of support from and involvement with the religious community.

Examines the differences in caregivers of Alzheimer's patients and an age-matched comparison group on the variables of religious behavior; support and contact with the religious community; number of friends; quality of life; and well-being, and the relationship among these variables for predictors of the caregivers' quality of life. Findings included lower caregiver well-being, mental health, public religious behavior, satisfaction with church/synagogue support and contact, number of friends, support from and contact with friends, and quality of life indicators compared to comparison group subjects. Concludes that religious well-being and support from friends in the church/synagogue helps to explain a significant amount of the variance in the caregivers' well-being, health perceptions, mental health, and distress within the caregiving role.

Variables related to caregiver behaviors with cognitively impaired elders in institutional settings.

The purpose of this study was to identify variables that might influence the behaviors of institutional caregivers when they interact with institutionalized, cognitively impaired elders. Independent variables included type of care situation, type of institution and nursing unit, and selected characteristics of both the caregiver and elder. The care situation was found to have a significant effect on caregiver behaviors. Caregiver characteristics of knowledge of dementia, experience in working with demented elders, and total years of education were significantly related to several caregiver behaviors. Elder characteristics of years of education, number of diagnoses, time on the nursing unit, age, self-care ability, and extent of dementia were related to several caregiver behaviors. Caregiver behaviors did not vary by the elder's gender.

Conceptualizing psychological well-being in cognitively-impaired older persons.

This article addresses a neglected area within nursing knowledge development: appropriate conceptual frameworks for guiding care of institutionalized, cognitively-impaired elders. Following a review of possible conceptual frameworks, psychological well-being, as defined by Lawton (1983), is proposed as an appropriate framework for guiding knowledge development and care of this elderly population. Two aspects of psychological well-being, positive and negative affect, may be appropriate indicators of the concept in cognitively-impaired elders. Instruments for measurement of psychological well being are also discussed. The implications of using psychological well-being as a conceptual basis for both research and nursing care are presented.

Caregiver and environmental variables related to difficult behaviors in institutionalized, demented elderly persons.

This study describes the relationship between caregiver and elder behavior in institutionalized, cognitively impaired, elderly persons. A repeated-measures design was used to observe interactive behaviors between caregivers and demented elders within three caregiving situations (dressing, toileting, and bathing) and an interpersonal contact in two long-term care facilities. During observations, the caregiver's behaviors were rated using the Interaction Behavior Measure and Health Professional's-Geriatric Patient Behavior Rating scale, whereas the elder's behaviors were rated using a modified version of the Interaction Behavior Measure. The study included 116 subjects (58 elders and 58 caregivers), with each unique caregiver/elder pair being observed in the four situations. All elder behaviors varied according to situation type, with the most difficult elder behaviors occurring during bathing. Ten of the 12 caregiver behaviors included in the analysis varied by situation type. Significant relationships were systematically found between the caregiver's relaxed and smiling behavior and the elder's calm/functional behaviors, r = .42 (dressing) to r = .46 (toileting) for caregiver relaxed behavior and r = .34 (bathing) to r = .58 (dressing) for smiling. The elder's behavior did not vary by type of nursing unit (special dementia unit or general nursing unit), or interruptions to the interaction.

Effective caregiving approaches for patients with Alzheimer's disease.

To address the need for nonpharmacologic approaches to managing difficult behaviors in patients with dementia, a repeated measures design was used to test the effectiveness of educational and behavioral intervention on behavioral and functional outcomes in home-dwelling patients with dementia and their caregivers' knowledge of dementia. Baseline and 6-month postintervention data were collected for 108 subjects (54 caregiver/patient pairs) following random assignment to an intervention or comparison group. Findings included increases in caregiver knowledge in two treatment groups and patient self-care ability in one treatment group and ratings of the most effective behavioral interventions by caregivers.