Characteristics of and Barriers to Functional Status Assessment in Assisted Living.

The most commonly used functional status (FS) instruments were examined to determine the validity, reliability, sensitivity, and specificity to change and feasibility in residents in an assisted living facility (ALF). Twenty-six ALF residents were assessed weekly for up to 8 months using six instruments. Group and single-subject analyses were used to examine associations between instruments and acute events. Two were problematic initially (Katz Index of Independence in Activities of Daily Living and hand grip) and were excluded early in the study. Of the remaining instruments, only the Barthel Index and Resident Assessment Instrument had acceptable psychometric profiles. However, these instruments were either not feasible in this environment or did not capture the full range of FS in this population. The current study's findings suggest that instruments commonly used to measure FS may be inadequate for this population and environment. These findings may be used to develop assessment methods for ALF residents that capture both the full range of FS in ALF settings as well as acute and long-term changes in functioning.

Missing incidents in community-dwelling people with dementia: understanding how these dangerous events differ from dementia-related 'wandering' is critical to assessment, intervention, and prevention.

OVERVIEW: At every stage of dementia, people with the condition are at risk for both missing incidents, in which they are unattended and unable to navigate a safe return to their caregiver, and "wandering," a term often used to describe repetitive locomotion with patterns such as lapping or pacing. By understanding the differences between these two phenomena, nurses can teach caregivers how to anticipate and prevent missing incidents, which are not necessarily related to wandering. The authors differentiate missing incidents from wandering, describe personal characteristics that may influence the outcomes in missing incidents, and suggest strategies for preventing and responding to missing incidents.

Sleep in dementia caregivers and the effect of a nighttime monitoring system.

PURPOSE: The purpose of this study was to determine if a nighttime home monitoring system, designed to track the movements of a care recipient with dementia, would relieve worry and improve sleep in caregivers of persons with dementia. DESIGN AND METHODS: In this controlled clinical trial, 49 dementia caregivers were followed for up to 1 year. Sleep was measured for 7-day intervals at nine points in time using actigraphy and a sleep diary. FINDINGS: Although the experimental caregivers generally reported that the system was "of great help" in relieving worry about nighttime activity, no significant group differences were found using multilevel modeling analyses. With regard to total sleep time, time awake after sleep onset, and sleep quality, multilevel models did not demonstrate any changes in sleep between groups, either averaged over time or for the interaction of group and time. CONCLUSIONS: Since previous analysis of our qualitative data suggested improvements in caregiver worry and sleep, problems other than night awakenings may be perpetuating the sleep problem. Future studies should include testing of multimodal sleep interventions. CLINICAL RELEVANCE: Caregivers have high amounts of unwanted wake time during the night and additional research is needed to identify effective interventions to improve their sleep.

Expanding participation in Alzheimer's association Safe Return by improving enrollment.

Every adult with a diagnosis of progressive dementia is at risk for wandering away or becoming lost. Those with dementia may not have the capacity to remember crucial contact information or recognize an unsafe situation, so enrollment in a program like Alzheimer's Association Safe Return is crucial. One facility-level enrollment plan at the James A. Haley Veterans Hospital in Florida has had a relatively high participation rate. A mailed survey was used to help evaluate that enrollment process and the results are described here. Of 262 respondents to the survey, 193 (74%) indicated the person with dementia enrolled in Safe Return. Potential enrollees need the following facilitators: perception of an unsafe situation, financial support and easy processing. Safe Return is not just focused on those who wander but is essential for all persons with dementia as these individuals can become lost in the course of normal daily activities.

A comparison study: paper-based versus web-based data collection and management.

The purpose of this pilot study was to compare the cost, accuracy, and efficiency of a web-enhanced handheld computer data collection system with those of the traditional paper-based data collection and management system and to increase awareness/knowledge of researchers on these two data collection and management methods. This is an important topic because funding resources are diminishing and high startup costs associated with automated data collection systems may give researchers pause when faced with these financial expenditures. Hence, this information will position grant writers and funders to make intelligent decisions regarding the feasibility and advantage of web-enhanced electronic data collection strategies.