Use of Body Sensors to Examine Nocturnal Agitation, Sleep, and Urinary Incontinence in Individuals With Alzheimer's Disease.

Nighttime agitation, sleep disturbances, and urinary incontinence (UI) occur frequently in individuals with dementia and can add additional burden to family caregivers, although the co-occurrence of these symptoms is not well understood. The purpose of the current study was to determine the feasibility and acceptability of using passive body sensors in community-dwelling individuals with Alzheimer's disease (AD) by family caregivers and the correlates among these distressing symptoms. A single-group, descriptive design with convenience sampling of participants with AD and their family caregivers was undertaken to address the study aims. Results showed that using body sensors was feasible and acceptable and that patterns of nocturnal agitation, sleep, and UI could be determined and were correlated in study participants. Using data from body sensors may be useful to develop and implement targeted, individualized interventions to lessen these distressing symptoms and decrease caregiver burden. Further study in this field is warranted. [Journal of Gerontological Nursing, 44(8), 19-26.].

Developing the Person-Environment Apathy Rating for persons with dementia.

OBJECTIVES: To develop the Person-Environment Apathy Rating (PEAR) scale that measures environmental stimulation and apathy in persons with dementia and to evaluate its psychometrics. METHOD: The PEAR scale consists of the PEAR-Environment subscale and PEAR-Apathy subscales. The items were developed via literature review, field testing, expert review, and pilot testing. The construct validity and reliability were examined through video observation. The parent study enrolled 185 institutionalized residents with dementia. For this study, 96 videos were selected from 24 participants. The PEAR-Environment subscale was validated using the Ambiance Scale and the Crowding Index. The PEAR-Apathy subscale was validated using the Neuropsychiatric Inventory (NPI)-Apathy, Passivity in Dementia Scale (PDS), and NPI-Depression. RESULTS: The PEAR-Environment subscale and PEAR-Apathy subscales each consists of six items rated on a 1-4 scale. For validity, the Crowding Index slightly, yet significantly, correlated with the PEAR-Environment subscale total score and three of the individual scores. Ambiance Scale scores, both engaging and soothing, did not correlate with the PEAR-Environment subscale. The PEAR-Apathy highly correlated with the PDS and NPI-Apathy and moderately correlated with the NPI-Depression, suggesting good convergent validity and moderate discriminant validity. For reliability, both environment and apathy subscales demonstrated excellent internal consistency. Although facial expression and eye contact showed moderate inter-rater reliability, all other items showed good to excellent inter-rater and intra-rater reliability. CONCLUSION: This study has successfully developed the PEAR scale and established its psychometrics based on the compatible scales available. The PEAR scale is the first scale that concurrently assesses apathy and environmental stimulation, and is recommended for use in persons with dementia.

Expanding the role of long-term care social workers: assessment and intervention related to urinary incontinence.

Urinary incontinence (UI) is a common and stigmatizing problem faced by long-term care (LTC) residents. It is typically addressed by medical professionals, with social work rarely involved. The purpose of this article is to illustrate how social workers can address the psychosocial implications of UI while working with residents and their family members as part of an interdisciplinary team. Using a case example and the NASW objectives for LTC, recommendations on how the role of the LTC social workers can be expanded to better address both the needs of residents, families, and the larger LTC system are provided.

Promoting continence in individuals with dementia.

Urinary incontinence (UI) is common in individuals with dementia as the disease progresses. The primary reasons for incontinence are often not related to pathology in the urinary system but are frequently attributed to losses associated with dementia. This article discusses the scope of the problem of UI in individuals with dementia, possible causes, and assessment methods, as well as interventions that can achieve improved outcomes.

Aging issues: nursing imperatives for healthcare reform.

The people of the United States sent a clear message in November 2008 that they wanted a change in the nation's priorities, including healthcare. The question is whether healthcare reform will extend to the care of older adults, especially in the face of complex needs in the last years of their lives. This article addresses this question by examining the demographics of the older adult population, the eldercare workforce, and the current inadequate patchwork of financing. Some aging issues, such as chronic care, are being addressed in the broad context of healthcare reform, whereas health information technology and others remain marginal. The window of opportunity for a clear and coherent voice in a reformed/reshaped healthcare system is narrow. Now is the time for the "trusted" profession to advocate for meaningful change that will meet the current and future needs of older adults. The article concludes with strategies and Web-based resources for nurses to bring aging issues to the healthcare reform debate at both the national and local levels.

The relationship between RN job satisfaction and accountability.

The purpose of this descriptive correlational secondary data analysis is to describe the relationship between job satisfaction and accountability among registered nurses with clinical responsibilities employed by a rural health care network in the Midwest. The response rate from the primary study is 39%, with 337 RN respondents. The sample for this secondary analysis is 299. The instruments used to measure accountability and job satisfaction are the Specht and Ramler Accountability Index-Individual Referent and the McCloskey-Mueller Satisfaction Scale (MMSS). The results indicate that accountability is perceived to be relatively high and job satisfaction is moderate. Accountability and job satisfaction are significantly correlated at a moderate level. The correlations between the subscales of the MMSS and accountability are all statistically significant but low. The subscales with the highest correlations (e.g., control and responsibility, praise and recognition, professional opportunities, scheduling) provide direction for nurse administrators about important target areas for improvement.

Effect of individualized music on agitation in individuals with dementia who live at home.

This pilot study investigated the effect of individualized music on agitation in individuals with dementia who live at home. Fifteen individuals listened to their preferred music for 30 minutes prior to peak agitation time, two times per week for 2 weeks, followed by no music intervention for 2 weeks. The process was repeated once. The findings showed that mean agitation levels were significantly lower while listening to music than before listening to the music. The findings of this pilot study suggest the importance of music intervention for individuals with dementia who live at home.

Needs of people with early-stage Alzheimer's disease: reviewing the evidence.

The focus of this literature search was on the needs of older adults with Alzheimer's disease (AD). Very little research has been published directly related to the concept of needs, so concepts were identified by implicitly pulling them from the foci of articles. Identified articles were written outside the framework of the person with AD-from the perspective of the providers and caregivers. To get the person's perspective, the search was expanded to find"self-identified" needs of the person with AD and by widening the medical subject heading terms. The collection of work found indicated retained awareness of the person with AD well into the disease process and that this awareness is not recognized by professionals or caregivers. The result is that older adults with AD are not consulted in determining their needs or having a voice in their plan of care. Also identified were the needs for early diagnosis, to be heard, for information and knowledge, for safety, health promotion, and emotional and cognitive support.

Partnering for care: the evidence and the expert.

Evidence supports the maintenance of self-awareness in individuals with Alzheimer's disease (AD) and the individuals' ability to identify their own needs. The need for individualized, person-centered programming may be met only if the perceptions of the individuals with AD are taken into account and valued. There is strong support for individuals with AD to be involved in developing their plan of care. Plans should include supportive and educational programs, individualized to the person's self-identified needs. Plans must also take into account preserved self-awareness and address preservation of self-esteem, maintenance of abilities, management of behavioral symptoms including depression, and health promotion. Second author Richard Taylor, who has dementia, noted the absence of discussion on this joint planning in most of the AD literature. As he says, it omits the most important person, the person with dementia.

Nonpharmacological Strategies for Patients With Early-Stage Dementia or Mild Cognitive Impairment: A 10-Year Update.

As the incidence and prevalence of early-stage Alzheimer's disease and mild cognitive impairment increases worldwide, gerontological researchers continue to examine the efficacy and effectiveness of strategies to help patients and caregivers live with the disease. Although pharmacological treatments remain the focus of much of the research, nonpharmacological strategies and approaches to care continue to gain ground as effective means of improving the health-related quality of life for this patient population. The current commentary summarizes the state of the science based on a series of integrative and systematic reviews undertaken by the International Dementia Scholars Collaborative as a 10-year update to a previous white paper. Selected topics from this previous white paper (e.g., support groups, nutrition, exercise, cognitive training, falls) as well as new topics (e.g., mind-body, advance care planning, driving safety) are discussed, and recommendations for future research are provided. [Res Gerontol Nurs. 2017; 10(1):5-11.].

Effects of Support Groups for Individuals with Early-Stage Dementia and Mild Cognitive Impairment: An Integrative Review.

Support groups have demonstrated promising outcomes for individuals with mild cognitive impairment (MCI) and early-stage dementia (ESD) in previous literature reviews. However, evidence has not been updated since 2007. The current review aimed to update current evidence on the use and effects of support groups for individuals with MCI and ESD and their care partners. A literature search was conducted in seven databases and 18 eligible research articles were retrieved. Support groups showed positive impacts on participant acceptance of cognitive impairment; performance and satisfaction of meaningful activity; resilience; self-help; and care partner coping self-efficacy, perceived support, and preparation and task effectiveness. Findings also revealed that support groups were well accepted by participants and care partners. Few studies included ethnic diversity, limiting the generalizability of findings. Further large-scale studies are needed to confirm the effects of support groups for individuals with MCI and ESD in all populations. [Res Gerontol Nurs. 2017; 10(1):35-51.].

Staff Nurse Decisional Involvement in the United States and Turkey.

The purpose of this descriptive comparative study is to compare the levels of decisional involvement of staff nurses between one Midwestern health care system in the United States with a nongovernmental University hospital in Turkey. The Decisional Involvement Scale was used for data collection. U.S. ( n = 163) and Turkey ( n = 50) staff nurses were included in the study. Both samples preferred more decisional involvement than they currently experienced. However, Turkish nurses experienced and preferred lower levels of decisional involvement than the U.S. SAMPLE: Shared governance structures may be a strategy used to enhance staff nurse decisional involvement.

How Do We Promote Health?: From the Words of African American Older Adults With Dementia and Their Family Members.

As population diversity increases, understanding what health promotion means to ethnically diverse older adults and their family members aids in the design of health programming. This understanding is particularly relevant for the African American population who experience a high prevalence of Alzheimer's disease and related dementias (ADRD). The purpose of the current study was to describe family members' definition of health, health promotion activities (HPAs), barriers to HPAs, and the perceived effectiveness of HPAs for African American older adults with ADRD. A qualitative descriptive design was used to collect data from African American family caregivers (n = 26) and care recipients (n = 18). Transcripts, journals, and field notes were reviewed using inductive content analysis. Common health promotion activities included taking care of self, positive attitude on life, social engagement, spiritual and religious activity, stimulation and active movement, and financial stability. This research informs person-centered care strategies for African American families caring for older adults with ADRD. [Res Gerontol Nurs. 2016; 9(6):278-287.].

HomeSafe: Supportive assistance for elderly individuals through a nurse-managed plan.

A lack of quality, cost-effective alternatives to nursing home care for community-dwelling older adults exists. The evidence suggests that case management provides quality care in a cost-efficient manner to help older adults remain at home safely and as independently as possible. This article describes HomeSafe, a nurse-managed membership plan that assists older individuals to enhance their health and quality of life, and to age in place in their homes and communities. HomeSafe serves as an innovative model of care and a teaching site for undergraduate and graduate nursing students and nursing faculty at The University of Iowa.

Interventions for residents with dementia and their family and staff caregivers: evaluating the effectiveness of measures of outcomes in long-term care.

This article describes six instruments developed for programs of research testing nursing interventions for individuals with dementia in Special Care Units and their family and staff caregivers. The Functional Abilities Checklist measures the functional abilities of residents with dementia. The Family Perceptions of Care Tool assesses family member satisfaction with care of the institutionalized relative with dementia. The Family Perceptions of Caregiving Role instrument evaluates stress experienced by family members of individuals with dementia related to their caregiving roles in long-term care settings. The Caregiver Stress Inventory and Staff Perceptions of Caregiving Role tools measure staff stress related to caring for residents with dementia. Finally, the Attitudes About Families Checklist assesses general staff attitudes about families of residents with dementia. Each instrument and its psychometric properties are described. The advantages of these instruments for research and clinical use with individuals with dementia are discussed.

9 myths of incontinence in older adults: both clinicians and the over-65 set need to know more.

Despite progress made in the research into and treatment of urinary incontinence, its incidence is rising among older adults. Many reasons for this disturbing finding have been posed: clinicians' insufficient knowledge of urinary incontinence, the reluctance of patients to discuss it, and inadequately individualized care. Common misconceptions of bladder health in older adults are explored to address these concerns and help prepare nurses in all settings to provide care that prevents and treats incontinence.

Correlates among nocturnal agitation, sleep, and urinary incontinence in dementia.

Family caregivers of elders with dementia often face the challenging behaviors of nighttime agitation, sleep disturbances, and urinary incontinence. To date, no study has examined the interrelationships of these behaviors in community-dwelling persons. This single group, descriptive study employs wireless body sensors to objectively collect data on nighttime agitation, sleep, and urinary incontinence in patients with dementia in their homes over a 5- to 7-day period. The aims are to (1) examine the feasibility and acceptability of the use of body sensors in community-dwelling persons with dementia; (2) describe patterns of nocturnal agitation, sleep continuity and duration, and nighttime urinary incontinence; and (3) examine the relationships among nocturnal agitation, sleep continuity and duration, and nighttime urinary incontinence. Data collection is in early stages and is still in progress. Challenges and advantages from preliminary data collection are reported.