Validation of the Korean version of the Summated Xerostomia Inventory among older adults residing in nursing homes.

BACKGROUND: Xerostomia is commonly experienced by older individuals. We sought to develop and evaluate the reliability and validity of the Korean version of the Summated Xerostomia Inventory (K-SXI) among older adults residing in long-term care facilities (LTCFs) in Korea. METHODS: In this secondary data analysis study using cross-sectional data, a cross-cultural adaptation process was conducted for the Korean version before data collection. Data collection was conducted from July 2021 to January 2022, targeting 544 older adults in 16 LTCFs. Data analysis included intraclass correlation coefficient (ICC) for test-retest reliability, and Cronbach's α for internal consistency reliability. Exploratory and confirmatory factor analyses were used to verify construct and convergent validity. Test-retest analysis was performed 6 weeks after baseline. Convergent and concurrent validities were assessed with age group and the xerostomia standard single question, respectively. RESULTS: A total of 544 older adults participated in this study. The mean of total K-SXI score was 11.70 (standard deviation, 4.96) points. The ICC value was calculated to be 0.90, and Cronbach's α of K-SXI was 0.92. Exploratory factor analysis revealed a single factor, explaining 74.8% of the total variance, however, some goodness-of-fit indices of the single factor model were found to be unsuitable in confirmatory factor analysis. The convergent and concurrent validity were supported. CONCLUSION: The present study provides evidence supporting the validity and reliability of the K-SXI for measuring xerostomia in institutionalized older adults in Korea.

Change in functional disability and its trends among older adults in Korea over 2008-2020: a 4-year follow-up cohort study.

BACKGROUND: The prevalence of functional disabilities, including difficulties in performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs), increased significantly in recent years and burdened the healthcare system. METHODS: We analysed data from Korean Longitudinal Study of Aging (KLOSA) surveys, including participants aged 65 or older at baseline (2008), and participated in all 4-year follow-up periods in 2012, 2016, and 2020. A 4-year follow-up cohort study was applied to specify the change in functional disability and its trend over time among older adults. The generalized estimation equation (GEE) model was used to verify the uptrend of functional disability. Logistic regression analyses were applied to examine the influence of demographic and health parameters on the change in functional disability. RESULTS: The prevalence of ADL disability was 2.24% at baseline, increased to 3.10% after four years, 6.42% after eight years, and reached 11.12% after 12 years, five times higher than that at baseline. For IADL disability, they were 10.67%, 10.61%, 18.18%, and 25.57%, respectively. The uptrend of ADL disability in persons aged 65-74 (1.77% at baseline, increased to 7.65% in 2020, 12-year change of 5.88%) was slower than in those aged 75 or older (4.22% at baseline, increased to 25.90% in 2020, 12-year change of 21.68%). IADL disability were consistent with this. The high ADL/IADL disability rate was also present among persons with poor health status, physical inactivity, depression, dementia, and multiple chronic diseases. The relative risk of ADL/IADL disability in persons with a history of functional disability was significantly higher than in those without historical disabilities. CONCLUSION: The study verified the change in functional disability and its upward trend over time by older adults' demographic and health parameters. Functional disability was relatively flat tending to increase slowly during the early years but increased rapidly in the following years. Factors that strongly influenced the change in prevalence and the uptrend of functional disability were advanced age, living alone, being underweight or obese, poor health status, physical inactivity, depression, dementia, having multiple chronic diseases, and especially having a historical disability.

Life Experiences of Older Men Living Alone With Depression.

As the percentage of older adults living alone increases, social interest has been drawn to this physically, financially, and socially vulnerable group. The purpose of the current study was to gain a deeper understanding of the life experiences of older men with depression who live alone. Eight community-dwelling men aged ≥65 years who lived alone in Korea and had depression were enrolled in this study. Data were collected via individual in-depth interviews and analyzed using thematic analysis. Four themes emerged from analysis: Life Trapped in the Traditional Masculine Ideology, Weakening Mind and Body, Lost and Helpless, and Beginning of Communication With the World. Results of this study will be helpful in developing more effective depression intervention programs for older men living alone by increasing community health care professionals' understanding and sensitivity. [Journal of Psychosocial Nursing and Mental Health Services, 60(2), 33-40.].

Behavioral and Physiological Pain Responses in Brain-Injured Patients Who Are Unable to Communicate in the Intensive Care Unit.

BACKGROUND: Assessing pain of critically ill patients with brain injuries who are unable to communicate is a challenge. Current behavioral scales are limited in accurate pain assessments for this population. AIMS: This study sought to investigate the behavioral and physiological responses induced by routine painful procedures in patients with brain injuries who are unable to communicate. METHODS: Using a repeated-measure within-subject observational study design, 12 participants admitted to an intensive care unit were observed before, during, and 15 minutes after a nonnociceptive (noninvasive blood pressure measurement) procedure and three nociceptive (suctioning, turning, and trapezius pinch) procedures. During each assessment, patients' behavioral and physiological responses were observed using video cameras and bedside monitors. RESULTS: In the overall behavioral responses to the nociceptive procedures, clenched teeth with tense jaw, frowning, orbit tightening, closing of eyes, eye movement, fixation-staring, flushing, flexion withdrawal of arm, flexion withdrawal of leg, muscle rigidity, twitching, and coughing were more frequently observed during procedures than before and after procedures (p < .01). Regarding physiological responses, significant increases in systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and respiratory rate were identified across assessments (p < .001). CONCLUSIONS: The findings can be used as a basis for pain assessment and the development of pain assessment tools for brain-injured patients who are unable to communicate. However, since physiological responses may be influenced by various factors besides pain, physiological changes may be used as a sign of the need for pain assessment rather than being used alone as a basis for pain assessment.

The predictive relationship between factors related to fear of falling and mortality among community-dwelling older adults in Korea: analysis of the Korean longitudinal study of aging from 2006 to 2014.

OBJECTIVES: This study was conducted to identify the predictive relationship between factors related to fear of falling (FOF) and mortality among community-dwelling older adults in Korea. METHOD: Data were obtained from the Korean Longitudinal Study of Aging (KLoSA). Hierarchical Cox proportional hazards regression analyses were conducted to identify factors related to FOF and correlations of these factors with mortality. RESULTS: During the eight-year follow-up period, 964 participants (23.5%) died. Death was more likely to occur in males (hazard ratio [HR], 2.55; 95% confidence interval [95% CI], 2.17-3.00), those 75 years old or older (HR, 2.76; 95% CI, 2.40-3.17), those without education (HR, 1.27; 95% CI, 1.05-1.52), and those living without a spouse (HR, 1.30; 95% CI, 1.11-1.51). Those afraid of falling (HR, 1.41; 95% CI, 1.17-1.70), limiting their activities due to FOF (HR, 1.40; 95% CI, 1.21-1.62), showing symptoms of depression (HR, 1.34; 95% CI, 1.16-1.54), and having low life satisfaction (HR, 1.34; 95% CI, 1.13-1.59) were also more likely to experience decreased lifespans. CONCLUSION: These results suggest that early management and prevention of factors related to FOF should be an effective approach to reducing mortality in older adults.

A systematic review and meta-analysis on the effect of reminiscence therapy for people with dementia.

BACKGROUND: The main objective of this study was to conduct a meta-analysis to identify the effects of reminiscence therapy in people with dementia (PWD). METHODS: A systematic search of randomized controlled trials (RCTs) was conducted using bibliographic databases. A total of 157 original published studies were identified in the search, and 24 complete articles were included in the final review to check for the level of evidence. Two of the study authors independently assessed the quality of the included studies using the "Risk of Bias" (ROB) tool developed by the Cochrane Collaboration. Depression, quality of life, and behavioral and psychological symptoms of dementia (BPSD) were selected to measure the effect of reminiscence therapy. To determine the effects of reminiscence therapy on these variables, each individual study was analyzed using Comprehensive Meta-Analysis Software® (Biostat, Englewood, NJ, USA). RESULTS: The overall effect size was presented using standardized mean differences (SMDs) and 95% confidence intervals. Cohen's d effect size for depression was -0.541 (95% CI: -0.847 to -0.234, Z = -3.730, p<0.001), indicating that depression was significantly reduced in the reminiscence group compared to the control group. Increased quality of life and decreased BPSD were also found in the reminiscence group compared to the control group. CONCLUSION: Reminiscence therapy has a moderate effect on depression and can be broadly used to decrease depression as an alternative to antipsychotics, which can have harmful side effects and high cost.

Predictors of subjective age in community-dwelling older adults in Korea.

Subjective age, or felt age, is highly related to one's actual health and survival. This study was conducted to explore subjective age in community-dwelling older adults in Korea, and to identify predictors of subjective age. Participants were 616 Korean older adults who were living in the community. A multiple regression analysis with a stepwise method was conducted to analyse subjective age. On average, the participants felt 7.8 per cent younger than their actual age. A multiple regression analysis revealed that less severe depression, having better perceived health, having no visual impairment, having higher handgrip strength, and living in a metropolitan area were associated with younger subjective age. Further studies are needed to determine the factors associated with subjective age in older adults. Based on this study, conceptual analyses of subjective age or longitudinal studies to determine the factors affecting subjective age are advisable.

Fear of falling and its predictors among community-living older adults in Korea.

OBJECTIVES: To explore the prevalence and predicting factors of fear of falling (FOF) among community-living older adults in Korea. METHODS: Secondary data analysis of the 2011 Korean National Elderly Living Conditions and Welfare Desire Survey was used. Logistic regression analysis was conducted to examine the predictors of FOF. RESULTS: In total, 75.6% of older adults with normal cognition have FOF. Factors associated with an increased risk of FOF in older adults are previous experience with falling (OR = 3.734, 95% CI = 2.996-4.655), limitations in the performance of exercise involving lower extremities (OR = 2.428, 95% CI = 2.063-2.858), being female (OR = 2.335, 95% CI = 2.023-2.694), having more than three chronic diseases (OR = 1.994, 95% CI = 1.625-2.446), limitations in instrumental activities of daily living (IADLs) (OR = 1.745, 95% CI = 1.230-2.477), limitations in the performance of exercise involving upper extremities (OR = 1.646, 95% CI = 1.357-1.997), living without a spouse (OR = 1.626, 95% CI = 1.357-1.948), having poor self-rated health (OR = 1.571, 95% CI = 1.356-1.821), limitations in muscle strength (OR = 1.455, 95% CI = 1.150-1.841), age (≥75 years) (OR = 1.320, 95% CI = 1.150-1.516), lower levels of education (0-6 years) (OR = 1.231, 95% CI = 1.075-1.409), and life satisfaction (OR = 1.104, 95% CI = 1.065-1.114). CONCLUSION: A multidimensional construct of general characteristics, physical, and psychosocial variables act as risk factors for FOF. Preventive intervention should be developed to decrease the FOF among Korean older adults.

Predictors of Depression Among Community-Dwelling Older Women Living Alone in Korea.

This study examined the prevalence and predicting factors of depression among community-dwelling older women living alone in Korea. Of the 2054 older women living alone in this study, 42.9% (881) were experiencing depression. Factors associated with a higher prevalence of depression were overall difficulty with living alone, taking more than six medications, limitations of instrumental activities of daily living, limitations of muscle strength, limitations of exercise performance in upper extremities, trouble with hearing, and perceptions of poor health status. These results provide a basis for designing preventive interventional programs to decrease depression among older women living alone in Korea.

Changes in instrumental activities daily living limitations and their associated factors according to gender in community-residing older adults: A longitudinal cohort study.

BACKGROUND: Increases in dependence among older adults cause increases in care needs and social care burden. Instrumental activities of daily living (IADL) are often used to assess the independence of older adults residing in communities. Various factors affect IADL limitations, but few studies confirm gender differences in IADL limitations in older adults. This study explored the changes in incidence of IADL limitations across 14 years and identified the factors associated with IADL limitations according to gender among older adults in Korea. METHOD: This study uses secondary data analysis with 2006-2020 data from the Korean Longitudinal Study of Aging (KLoSA), a longitudinal cohort study. Among the total 10,254 participants, 1,230 adults aged 65 years and over who met the criteria were included in the final analysis. For each IADL item, a limitation was defined when the response was partial or complete dependence. Multivariate logistic regression was performed to identify the factors (in 2006) associated with IADL limitations in 2020. RESULTS: The mean age of the participants at baseline was 69.64 years (SD 3.93), and 61.0% of participants were female. Total scores for IADL limitations increased gradually across 14 years in all participants, and observed changes were statistically significant. The top three ranked items of IADL limitations differed according to gender in 2020: the top limitations in men were preparing meals, laundry, and using public transportation, and the top limitations in women were using public transportation, going out, and handling money. Factors associated with total IADL limitations were grip strength in men and age, dementia, fear of fall, and grip strength in women. Factors associated with the top three ranked items of IADL limitations differed according to gender. CONCLUSION: The incidence of IADL limitations gradually increased in all participants over a 14-year period. In older adults in Korea, gender differences were confirmed in the factors associated with IADL limitations, as well as in the main limited activities. To minimize IADL limitations in community-residing older adults, it is necessary to plan tailored interventions.

The moderating effect of care time on care-related characteristics and caregiver burden: differences between formal and informal caregivers of dependent older adults.

Objective: This study examined differences in care burden between formal and informal caregivers of dependent older adults according to care-related characteristics, and whether care time had a moderating effect on the relationship between care-related characteristics and caregiver burden. Methods: Participants were formal (n = 520) and informal caregivers (n = 142) of dependent older adults in South Korea. Caregiver burden was measured using the Korean version of the Zarit Burden Interview. Data were analyzed using hierarchical regression with interaction terms and moderation analysis. Results: Caregiver burden was higher for informal caregivers than formal caregivers. Factors associated with an increased risk of caregiver burden in both formal and informal caregiver of dependent older adults were caregivers' stress, physical strain, and care time. Care time significantly moderated the relationship between care attitude and care burden only among formal caregivers. When formal caregivers' care time was 1 standard deviation higher than the mean value, care attitude was significantly associated with care burden (bsimple = -0.903, SE = 0.106, p < 0.001). Conclusion: The caregiver burden of dependent older adults can be reduced by providing interventions to attenuate the effects of modifiable risk factors that were identified in this study. And to weaken the relationship between care attitude and burden of formal caregivers who have long care hours, a positive social atmosphere for care should be provided in addition to education. To realize sustainable care, policy considerations that reflect the results of this study will help solve the problem of formal and informal caregiver burden of dependent older adults.

Malnutrition as a major related factor of frailty among older adults residing in long-term care facilities in Korea.

OBJECTIVES: The objectives of this study were 1) to investigate the prevalence and co-existence of frailty and malnutrition and 2) to identify factors related to frailty (including malnutrition) according to the level of frailty. METHODS: Data collection was conducted from July 11, 2021, to January 23, 2022, in 558 older adults residing in 16 long-term care facilities (LTCFs) in Korea. The FRAIL-NH and Mini-Nutritional Assessment short form were used to measure frailty and nutrition, respectively. The data analysis included descriptive statistics and a multivariate logistic regression. RESULTS: The mean age of the participants was 83.68 (± 7.39) years. Among 558 participants, 37 (6.6%), 274 (49.1%), and 247 (44.3%) were robust, prefrail, and frail, respectively. At the same time, 75.8% were categorized as having malnutrition status (malnourished: 18.1%; risk of malnutrition: 57.7%), and 40.9% had co-existing malnutrition and frailty. In the multivariate analysis, malnutrition was identified as the major frailty-related factor. Compared with a normal nutritional status, the incidence of frailty in the malnutrition group was 10.35 times (95% CI: 3.78-28.36) higher than the incidence of robustness and 4.80 times (95% CI: 2.69-8.59) higher than the incidence of prefrail. CONCLUSION: The prevalence of frailty and malnutrition, and their co-existence, among older adults residing in LTCFs was high. Malnutrition is a major factor that increases the incidence of frailty. Therefore, active interventions are needed to improve the nutritional status of this population.

Factors Associated With Functional Limitations in Daily Living Among Older Adults in Korea: A Cross-Sectional Study.

Objective: This paper assesses the relationship between demographics, health parameters, and functional limitations among older adults in Korea, including limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Methods: We analyzed data from the Korean Longitudinal Study of Aging survey in 2020 and included only participants aged 65 and older. Multinomial logistic regression models were conducted to evaluate the factors that predicted functional limitations. Results: The prevalence of at least one ADL and IADL limitations were 6.14% (severe 1.94% and moderate 4.20%) and 15.49% (severe 3.11% and moderate 12.38%), respectively. People aged 85 and older had high rates of severe disability with 7.37% for ADLs and 12.06% for IADLs. High rates also occurred among people with low education, underweight, physical inactivity, depression, and three or more chronic diseases. Conclusion: Factors associated with functional limitations were age, educational status, body mass index, physical activity, depression, and chronic diseases. To prevent and improve functional limitations in the older populations, active and applicable interventions should be considered for modifiable factors such as physical activity, depression, and abnormal weight.

[Influence of Self-care on Burnout in Primary Family Caregiver of Person with Dementia].

PURPOSE: The purpose of this study was to identify the influence of self-care on burnout experienced by primary family caregivers of persons with dementia. METHODS: The subjects of the study were 156 primary family caregivers of persons with dementia at home in Korea. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation coefficient, and hierarchical multiple regression using IBM SPSS Statistics ver. 24.0 for Windows. RESULTS: The mean scores for self-care and burnout were 42.35 and 61.60, respectively. Self-care, subjective health status, living with a person with dementia, and behavioral and psychological symptoms of dementia were significant factors affecting burnout in family caregivers. Self-care was identified as the strongest factor affecting burnout, explaining 13.9% of burnout with controlling factors in caregivers and care receivers. CONCLUSION: To prevent burnout in primary family caregivers of persons with dementia, self-care of family caregivers should be emphasized. In nursing education, family caregivers should be recognized and approached as nursing clients who are responsible for taking care of their health. In nursing practice and research, digital self-care or self-care improvement intervention programs should be designed to help family caregivers, and further studies on self-care centered on health of family caregivers should be conducted.

Falls among Koreans 45 years of age and older: incidence and risk factors.

AIM: The aim of the study was to determine the incidence of falls according to age and risk factors among Korean adults 45 years of age and older. BACKGROUND: Falling is a known critical incident that results in injuries and limits the daily activities of older adults. METHOD: The 2006 Korean Longitudinal Study of Aging, a publicly available database, was used for this study, which was conducted in 2006 with a total of 10,254 respondents. The variables used in this study were selected from the demographic and health sections of the larger study. FINDINGS: The overall incidence of any type of fall was 4.0%, and the incidence of injurious falls tended to increase with increasing age; however, people below 65 years of age had a greater proportion of injurious falls than any of the older adult groups. All types of falls were more likely to occur among older adults and those with arthritis, visual deficits, cognitive impairments and depression. In addition, older age, visual deficits, weak grip, cognitive impairment and depression were key risk factors for falls requiring treatment and those resulting in difficulties in activities of daily living. Falls resulting in hip fractures occurred more frequently among women, people with visual deficits and those with depression. CONCLUSION: Future assessments of the incidence and risk factors for falls and studies of fall interventions should begin with younger age groups, namely those 45 years of age and older.

Effect of 16-week Kouk-Sun-Do exercise on physical fitness, emotional state, and immunoglobulin A in community-dwelling elders in Korea.

The purpose of this study was to determine the effects of 16-week Kouk-Sun-Do (KSD) exercise on physical fitness, emotional state, and immunoglobulin A (IgA) in community-dwelling elders in Korea. A total of 19 elders in the intervention group and 20 elders in the control group participated. The KSD exercise with low-intensity exercise was performed over a 45-minute session, three times a week for a 16-week period. The results show the effectiveness of KSD exercise on the physical fitness, emotional state, and IgA, and KSD can be identified as a feasible type of low-intensity exercise for elders. The findings suggest the need to determine clinical significance of KSD for patients in specific clinical settings; nurses with training in KSD can play a key role in implementing movement-based nursing interventions for specific health outcomes.

Predictive Factors of Mortality in Older Adult Residents of Long-Term Care Facilities.

BACKGROUND: Various factors affect the mortality of older adult residents of long-term care facilities. To provide adequate nursing care for older adults, it is necessary to understand the factors that affect their risk of mortality. PURPOSE: This study was designed to (a) evaluate the 24-month survival rate and (b) identify the underlying cause of death in various dimensions, including cognitive, psychological, and physical function; nutritional status; and chronic disease. METHODS: A longitudinal study was carried out between 2011 and 2013 at seven long-term care facilities. The participants comprised 276 residents who were all older than 65 years old. Baseline measurements included cognitive function (Mini-Mental State Examination for Dementia Screening), psychological function (Cornell Scale for Depression in Dementia), physical function (Barthel Index), nutritional status (Mini Nutritional Assessment, mid-arm circumference, and calf circumference), and chronic disease status (hypertension, diabetes mellitus, chronic respiratory disease, heart disease, and urinary incontinence). Data analysis included univariate and multivariate logistic regression to identify the main factors affecting mortality. RESULTS: In 2011 (baseline), the mean age of the participants was 80.46 years (SD = 7.08) and most were female (73.6%). At the 24-month follow-up, 94 (34.1%) of the participants had died. The major factors affecting mortality were as follows: cognitive dysfunction (OR = 3.12, 95% CI [1.41, 6.90]), mid-arm circumference (< 22.5 cm; OR = 2.32, 95% CI [1.35, 3.96]), and urinary incontinence (OR = 2.04, 95% CI [1.16, 3.61]). CONCLUSIONS: According to the findings, special attention is needed at the end of life to improve the quality of life of older adults with cognitive dysfunction, malnutrition (low mid-arm circumference), and urinary incontinence who reside in long-term care facilities.

Reliability and validity of the Korean version of the way-finding effectiveness scale for persons with dementia.

AIMS AND OBJECTIVES: To evaluate the psychometric properties of the Korean version of the Way-finding Effectiveness Scale (WES) for Korean persons with dementia (PWDs). DESIGN: A descriptive, cross-sectional survey method was used. METHODS: Data were collected with a non-probability sampling strategy using structured format face-to-face interviews. A convenience sample of 83 community-dwelling PWDs and their family caregivers were recruited. The participants were PWDs who were over 60 years of age, had been medically diagnosed with dementia or showed signs and symptoms of dementia, had a Mini Mental State Examination (MMSE) score of less than 24 of 30 and were independent in walking. RESULTS: Internal consistency for the 29-item KWES was 0.93 and exceeded 0.70 for the four subscales (complex way-finding goals, CWG; analytic strategy, AS; global strategy, GS; and simple way-finding goals, SWG). The intercorrelations for total KWES and subscales demonstrated a high to moderate relationship ranging from 0.84 (total and CWG) to 0.24 (AS and SWG). Pearson correlations between each subscale scores of the KWES and K-MMSE demonstrated significant, moderate relationships ranging from 0.41 (CWG and K-MSE) to 0.28 (AS and K-MMSE). Differences in current and prior behaviour of KWES were significant for the total (t = -21.00, p < 0.001) and subscales (t = -28.33--9.33, p < 0.001). CONCLUSION: Acceptable reliabilities and validities support the conclusion that the KWES is a valid and reliable instrument for examining way-finding effectiveness for Korean PWDs. RELEVANCE TO CLINICAL PRACTICE: The KWES will contribute to the development of understanding of way-finding ability for community-dwelling PWDs in both research and clinical practices.

Relationship between familiar environment and wandering behaviour among Korean elders with dementia.

AIM: To explore the relationship between wandering behaviour and familiar environment in community-residing persons with dementia in Korea. BACKGROUND: Numerous non-pharmacological interventions have been developed to decrease behavioural symptoms and to increase the quality of life among persons with dementia. Although the concept of familiarity is very important and environmental interventions using the concept should have been developed for persons with dementia, no study examining even the direct relationship between familiar environment and wandering has yet been published. DESIGN: A descriptive, cross-sectional survey design. METHODS: A convenience sample was gathered of 77 non-institutionalised, community-dwelling persons with dementia and their family caregivers in Seoul and Wonju, South Korea. Descriptive statics, Pearson's correlations, t-tests, and multiple regressions were used in the data analysis. RESULTS: The mean age of persons with dementia was 76.9 years (SD 8.0) and their mean cognitive level score using the Mini-Mental State Examination was 13.51 (SD 6.10). Most persons with dementia (71.4%) had been diagnosed with known types of dementia such as Alzheimer's disease, multiple infarct dementia, mixed type or Parkinson's disease with dementia. A familiar feeling with the environment was associated with cognitive impairment (r = 0.32, p < 0.01) and physical dependency in activities of daily living (r = -0.38, p <0.01). In addition, a familiar feeling with the environment (r = -0.56, p < 0.001) and physical dependency in activities of daily living (r = 0.56, p < 0.001) were strongly related to wandering behaviour. Familiarity and physical dependency in activities of daily living were the significant predictors for overall wandering and they explained 45% of the total variance. Cognitive impairment was the only significant predictor on the subscale of spatial disorientation. CONCLUSIONS: It was found that a familiar feeling with the environment was an important factor affecting persons with dementia's cognitive and functional abilities as well as specific features of wandering. However, future research using a more reliable method is necessary to confirm the findings obtained in this study. RELEVANCE TO CLINICAL PRACTICE: This study suggested that providing persons with dementia with a familiar feeling in daily clinical practice through establishment of familiar physical as well as psychosocial environment may have benefit to decrease wandering behaviour.

Are wandering and physically nonaggressive agitation equivalent?

OBJECTIVE: The authors examined equivalence of wandering and physically nonaggressive agitation (PNA) as concepts. DESIGN: A cross-sectional correlational design was used. SETTING: Participants were recruited from 22 nursing homes and 6 assisted living facilities in two states. PARTICIPANTS: Ambulatory residents meeting DSM-IV criteria for dementia (N = 181) were studied. MEASUREMENTS: Video-tapes for up to twelve 20-minute observations per participant were coded for wandering using an empirically derived taxonomy of ambulation patterns. Separate raters coded the same tapes for six PNA behaviors on the agitation behavior mapping instrument. RESULTS: Most participants (73.5%) wandered; all showed PNA behaviors. Factor analyses yielded an one-factor solution for wandering (explained variance = 43.66%) and a two-factor solution for PNA (explained variance = 53.45%). Overall wandering correlated significantly with PNA Factor 1 (df =179, r = 0.68, p <0.001) and Factor 2, but at a lower value (df = 179, r = 0.26, p <0.01). CONCLUSION: Findings depict wandering and PNA as overlapping, but nonequivalent phenomena. Evidence supporting construct validity of wandering was more robust than that for PNA. Results have implications for accuracy in scientific and clinical detection and labeling of wandering and agitation.