Sensitivity and specificity of proposed Richards-Campbell Sleep Questionnaire cut-off scores for good quality sleep during an ICU stay.

BACKGROUND: The 5-visual analogue scale Richards-Campbell Sleep Questionnaire subjective sleep measure is widely used in intensive care. A cut-off score indicative of good quality sleep has not been established and is required to guide the categorisation of individual patient and unit wide sleep quality. DESIGN AND METHODS: The aim was to determine the global Richards-Campbell Sleep Questionnaire cut-off score for good to very good sleep during an intensive care unit stay in non-ventilated patients. The study was a secondary (cohort) retrospective analysis of patient self-report data (n = 32) from an interventional study testing a sleep promotion bundle. The Standards for Reporting Diagnostic Accuracy studies statement were used to report the study. The study was conducted in two mixed adult 12 and 20-bed ICUs of a tertiary referral hospital in a metropolitan area. In the morning, eligible patients were administered the Richards-Campbell Sleep Questionnaire together with a 5-category item Likert scale in which patients rated their nocturnal sleep quality as 'very poor', 'poor', 'fair', 'good' and 'very good'. Receiver Operator Curve analysis was performed. RESULTS: Thirty-seven per cent (n = 32) of the total sample of 84 adult intensive care patients were females. The median age was 61.5 (51, 72) years. Self-reported median global Richards-Campbell Sleep Questionnaire score was 54.4 (30.1, 77.1) mm. A global score of ≥63.4 mm was the optimal cut-off for self-reported 'good sleep' (sensitivity: 87%, specificity: 81% and area under the curve: 0.896). CONCLUSIONS: Although the study requires replication in ventilated patients and other ICU settings, the cut-off score (63 mm) could be used to guide the categorisation of individual patient and unit wide sleep quality.

Investigating the construct and concurrent validity of the Richards-Campbell Sleep Questionnaire with intensive care unit patients and home sleepers.

BACKGROUND: Sleep is vital to our wellbeing. Critically ill patients are vulnerable with effects of sleep deprivation including weakened immune function, decreased glucose tolerance, and increased sympathetic activity. Intensive care unit (ICU) patients' sleep evaluation is difficult and often not reliable. The most commonly used instrument for assessing ICU patients' perspective of their sleep, Richards-Campbell Sleep Questionnaire (RCSQ), has not been reported to have undergone known-group construct validity testing or concurrent validity testing with the criterion measure of feeling refreshed. OBJECTIVES: The aim of the study was to explore the construct validity of the RCSQ with known-groups technique and concurrent validity with the criterion measure of feeling refreshed on awakening. METHODS: A cross-sectional descriptive survey study using the RCSQ was conducted on people sleeping at home (n = 114) over seven nights. The results were compared with the RCSQ sleep scores of nonintubated alert oriented adult ICU patients (n = 114). Home sleepers were also asked to rate how refreshed they felt on awakening. The study was executed and reported in accordance with the STROBE checklist for observational studies. FINDINGS: RCSQ construct validity was supported because home sleepers' and ICU sleepers' sleep evaluations differed significantly. Home sleepers rated their sleep significantly better than ICU patients in all five sleep domains of the RCSQ. Concurrent validity was supported because the item "feeling refreshed on awakening" correlated strongly with all sleep domains. CONCLUSIONS: Sleep quality may be accurately measured using the RCSQ in alert people both in the ICU and at home. This study has added to the validity discussion around the RCSQ. The RCSQ can be used for sleep evaluation in ICUs to promote wellbeing and recovery.

Enhancing sleep quality for nursing home residents with dementia: a pragmatic randomized controlled trial of an evidence-based frontline huddling program.

BACKGROUND: Disturbed sleep places older adults at higher risk for frailty, morbidity, and even mortality. Yet, nursing home routines frequently disturb residents' sleep through use of noise, light, or efforts to reduce incontinence. Nursing home residents with Alzheimer's disease and or related dementias-almost two-thirds of long-stay nursing home residents-are likely to be particularly affected by sleep disturbance. Addressing these issues, this study protocol implements an evidence-based intervention to improve sleep: a nursing home frontline staff huddling program known as LOCK. The LOCK program is derived from evidence supporting strengths-based learning, systematic observation, relationship-based teamwork, and efficiency. METHODS: This study protocol outlines a NIH Stage III, real-world hybrid efficacy-effectiveness pragmatic trial of the LOCK sleep intervention. Over two phases, in a total of 27 non-VA nursing homes from 3 corporations, the study will (1) refine the LOCK program to focus on sleep for residents with dementia, (2) test the impact of the LOCK sleep intervention for nursing home residents with dementia, and (3) evaluate the intervention's sustainability. Phase 1 (1 year; n = 3 nursing homes; 1 per corporation) will refine the intervention and train-the-trainer protocol and pilot-tests all study methods. Phase 2 (4 years; n = 24 nursing homes; 8 per corporation) will use the refined intervention to conduct a wedge-design randomized, controlled, clinical trial. Phase 2 results will measure the LOCK sleep intervention's impact on sleep (primary outcome) and on psychotropic medication use, pain and analgesic medication use, and activities of daily living decline (secondary outcomes). Findings will point to inter-facility variation in the program's implementation and sustainability. DISCUSSION: This is the first study to our knowledge that applies a dementia sleep intervention to systematically address known barriers to nursing home quality improvement efforts. This innovative study has future potential to address clinical issues beyond sleep (safety, infection control) and expand to other settings (assisted living, inpatient mental health). The study's strong team, careful consideration of design challenges, and resulting rigorous, pragmatic approach will ensure success of this promising intervention for nursing home residents with dementia. TRIAL REGISTRATION: NCT04533815 , ClinicalTrials.gov , August 20, 2020.

One Year of Continuous Positive Airway Pressure Adherence Improves Cognition in Older Adults With Mild Apnea and Mild Cognitive Impairment.

BACKGROUND: Mild cognitive impairment frequently represents a predementia stage of Alzheimer's disease. Although obstructive sleep apnea is increasingly recognized as a common comorbidity of mild cognitive impairment, most apnea research has focused on middle-aged adults with moderate-to-severe obstructive sleep apnea. Mild obstructive sleep apnea, defined as 5-14 apneas or hypopneas per hour slept, is common in older adults. Little is known about the effect on cognition of adherence to continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea in older adults with mild obstructive sleep apnea and mild cognitive impairment. OBJECTIVE: The objective of this study was to explore the effect of CPAP adherence on cognition in older adults with mild obstructive sleep apnea and mild cognitive impairment. METHODS: We conducted a secondary analysis of data from Memories 1, a 1-year quasiexperimental clinical trial on the effect of CPAP adherence in older adults with mild cognitive impairment and obstructive sleep apnea. Those with mild obstructive sleep apnea were divided into two groups based on their CPAP adherence over 1 year: (a) CPAP adherent group (mild cognitive impairment + CPAP) with an average CPAP use of ≥4 hours per night and (b) CPAP nonadherent group (mild cognitive impairment - CPAP) with an average CPAP use of <4 hours per night. Individuals currently using CPAP were not eligible. A CPAP adherence intervention was provided for all participants, and an attention control intervention was provided for participants who chose to discontinue CPAP use during the 1-year follow-up. Descriptive baseline analyses, paired t tests for within-group changes, and general linear and logistic regression models for between-group changes were conducted. RESULTS: Those in the mild cognitive impairment + CPAP group compared to the mild cognitive impairment - CPAP group demonstrated a significant improvement in psychomotor/cognitive processing speed, measured by the Digit Symbol Coding Test. Eight participants improved on the Clinical Dementia Rating Scale, whereas six worsened or were unchanged. Twelve participants rated themselves as improved on the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change Scale, whereas three reported their status as worsened or unchanged. The mild cognitive impairment + CPAP group had greater than an eightfold increased odds of improving on the Clinical Dementia Rating and greater than a ninefold increased odds of improving on the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change Scale, compared to the mild cognitive impairment - CPAP group. DISCUSSION: CPAP adherence may be a promising intervention for slowing cognitive decline in older adults with mild obstructive sleep apnea and mild cognitive impairment. A larger, adequately powered study is needed.

A Tailored Intervention for PAP Adherence: The SCIP-PA Trial.

OBJECTIVE/BACKGROUND: Positive airway pressure (PAP) is highly efficacious treatment but nonadherence is prevalent with little improvement over the last 15 years. Tailored interventions show promise for promoting adherence to other treatments. The study objective was to examine feasibility and acceptability of a tailored intervention to promote PAP adherence. PARTICIPANTS: The convenience sample met inclusion criteria: newly diagnosed OSA; treatment-naïve; ≥ 18 years. EXCLUSION CRITERIA: previous obstructive sleep apnea (OSA) diagnosis and treatment; new psychiatric diagnosis; use of oxygen/bilevel PAP; secondary sleep disorder. Adults (n = 118) were randomized to tailored intervention (TI; n = 61) or usual care (UC; n = 57); application of a priori exclusion criteria resulted in 30 participants per assignment who were middle-aged (51.3 ± 11.1 years) adults (70% male) with severe OSA (apnea hypopnea index [AHI], 35.9 ± 25.2). METHODS: Randomized, double-blind, single-site pilot controlled trial. A multiphased tailored intervention targeting social cognitive perceptions of OSA-PAP treatment was delivered at four intervals. Descriptive analysis, group differences, and self-efficacy change scores by t-test, and thematic analysis of acceptability data are reported. RESULTS: One-week PAP use among TI was 35 min greater than UC condition (p = 0.20; Cohen's d = 0.336). Treatment use decreased at 1 month and 3 months (NS). Per-protocol delivery of face-to-face intervention delivery was 100% but lower for telephone intervention delivery. Personalized approach was valued by participants. CONCLUSIONS: A tailored intervention approach is acceptable to participants and feasibly implemented in a clinical sleep center setting. The intervention effect size at 1 week is consistent with other educational PAP adherence interventions but was not sustained; further pilot testing is warranted to address pilot RCT limitations.

Resistance training does not alter same-day sleep architecture in institutionalized older adults.

Sleep disturbance is a common symptom in institutionalized older adults that reduces their quality of life and may contribute to progression of cognitive impairment. While we found that a 7-week combination of resistance training, walking and social activity significantly improved sleep in institutionalized older adults compared with a usual care control group, no one to our knowledge has determined the acute effects of resistance training on same-day sleep in this population. Given the effort required to promote exercise adherence in institutionalized older adults and to obtain a positive training effect, understanding of the acute effects of resistance training on same-day sleep architecture should be elucidated, especially with respect to unintended consequences. This secondary data analysis assessed if resistance training altered the same-day sleep architecture in institutionalized older adults. Forty-three participants (age 81.5 ± 8.1 years, male = 17, female = 26) had two attended overnight polysomnography tests in their rooms for sleep architecture analysis; one polysomnography with same-day resistance training, one without any resistance training. Resistance training consisted of chest and leg press exercises (three sets, eight repetitions, 80% predicted one-repetition maximum). There were no significant changes in sleep architecture between either polysomnography nights; sleep efficiency (P = 0.71), time in non-rapid eye movement stages (P = 0.50), time in rapid eye movement stages (P = 0.14), time awake (P = 0.56), time until sleep onset (P = 0.47), total sleep stage shifts (P = 0.65) or rapid eye movement sleep stage latency (P = 0.57). Our results show no acute same-day effects of resistance training on sleep architecture in institutionalized older adults. Clinical Trial Registration ClinicalTrials.gov Identifier: NCT00888706.

Impact of Alzheimer disease patients' sleep disturbances on their caregivers.

Sleep disturbance symptoms are common in persons living with Alzheimer disease (AD). However little is known about the impact of sleep disturbance symptoms in patients living with AD on caregiver burden and quality of life (QOL). The aims of this study were to determine the prevalence of symptoms of disturbed sleep in patients with AD, identify the care-recipient sleep disturbance symptoms that predict caregiver burden and QoL, and determine how care-recipient sleep disturbance symptoms compare to other caregiver and patient characteristics when predicting caregiver QoL. Caregiver burden was assessed using the Screen for Caregiver Burden. Sixty percent of the care-recipients had at least one sleep symptom. In 130 caregiver/patient dyads, nocturnal awakenings, nocturnal wandering, and snoring predicted caregiver burden. Multivariate modeling demonstrated that caregiver burden, caregiver physical and mental health, and caregiver depression were predictors of overall caregiver QoL. Treating disturbed sleep in care-recipients and caregiver mental health symptoms could have important public health impact by improving the lives of the caregiving dyad.

The reliability of the German version of the Richards Campbell Sleep Questionnaire.

BACKGROUND: The assessment of sleep quality in critically ill patients is a relevant factor of high-quality care. Despite the fact that sleep disturbances and insufficient sleep management contain an increased risk of severe morbidity for these patients, a translated and applicable instrument to evaluate sleep is not available for German-speaking intensive care settings. AIM: This study aimed to translate the Richards Campbell Sleep Questionnaire (RCSQ), a simple and validated instrument eligible for measuring sleep quality in critically ill patients, and subsequently to evaluate the internal consistency of the German version of the RCSQ. Furthermore, it also aimed to inquire into the perception of sleep in a sample of critically ill patients. METHODS: The RCSQ was translated following established methodological standards. Data were collected cross-sectionally in a sample of 51 patients at 3 intensive care units at a university hospital in Germany. RESULTS: The German version of the RCSQ showed an overall internal consistency (Cronbach's alpha) of 0·88. The mean of the RSCQ in the sample was 47·00 (SD ± 27·57). Depth of sleep was rated the lowest and falling asleep again the highest of the RCSQ sleep items. CONCLUSION: The study demonstrated very good internal consistency of the German version of the RCSQ, allowing for its application in practice and research in German-speaking countries. Quality of sleep perception was generally low in this sample, emphasizing the need for enhanced care concepts regarding the sleep management of critically ill patients. Relevance to clinical practice Assessment of self-perception of sleep is crucial in order to plan an individually tailored care process.

Description of the moderate brain injured patient and predictors of discharge to rehabilitation.

OBJECTIVE: To describe patients with moderate traumatic brain injury (TBI) treated and discharged at levels I and II trauma centers in the United States; and to describe the predictors of discharge to rehabilitation after acute care. DESIGN: Retrospective, cross-sectional, descriptive study. SETTING: Trauma centers. PARTICIPANTS: Patients with moderate TBI (N=2087; age range, 18-64 y) as reported in the 2010 National Sample Project. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Discharge destination (rehabilitation vs home with no services). RESULTS: Multivariate logistic regression models revealed that demographic, clinical, and financial characteristics influenced the likelihood of being discharged to rehabilitation. Increased age, increased severity, Medicare use, longer length of stay, and trauma center locations in the Midwest and Northeast all increased the likelihood of discharge to rehabilitation. CONCLUSIONS: The decision to discharge a person with moderate TBI from acute care to rehabilitation appears to be based on factors other than just clinical need. These findings should be considered in creating more equitable access to postacute rehabilitation services for patients with moderate TBI because they risk long-term physical and cognitive problems and have the potential for productive lives with treatment.

Risk assessment for CPAP nonadherence in adults with newly diagnosed obstructive sleep apnea: preliminary testing of the Index for Nonadherence to PAP (I-NAP).

PURPOSE: Identification of risk for continuous positive airway pressure therapy (CPAP) nonadherence prior to home treatment is an opportunity to deliver targeted adherence interventions. Study objectives included the following: (1) test a risk screening questionnaire to prospectively identify CPAP nonadherence risk among adults with newly diagnosed obstructive sleep apnea (OSA), (2) reduce the questionnaire to a minimum item set that effectively identifies 1-month CPAP nonadherence, and (3) examine the diagnostic utility of the screening index. METHODS: A prospective, longitudinal study at two clinical sleep centers in the USA included adults with newly diagnosed OSA (n=97; AHI≥5 events/h) by polysomnogram (PSG) consecutively recruited to participate. After baseline participant and OSA characteristics were collected, a risk screening questionnaire was administered immediately following CPAP titration polysomnogram. One-month objective CPAP use was collected. RESULTS: Predominantly, white (87%), males (55%), and females (45%) with obesity (BMI 38.3 kg/m2; SD 9.3) and severe OSA (AHI 36.8; SD 19.7) were included. One-month CPAP use was 4.25 h/night (SD 2.35). Nineteen questionnaire items (I-NAP) reliably identified nonadherers defined at <4 h/night CPAP use (Wald X2[8]=34.67, p<0.0001) with ROC AUC 0.83 (95% CI 0.74-0.91). Optimal score cut point for the I-NAP screening questionnaire were determined to maximize sensitivity (87%) while maintaining specificity>60% (63%). CONCLUSION: A risk screening questionnaire employed immediately after titration PSG may reliably identify CPAP nonadherers and permit the delivery of targeted interventions to prevent or reduce nonadherence. This novel approach may enhance cost-effectiveness of care and permit appropriate allocation of resources for CPAP adherence.

The relationship between sleep and physical function in community-dwelling adults: a pilot study.

More than 50% of community-dwelling adults have sleep complaints. Because aging is associated with decline in physical function, coexistent sleep difficulties may exacerbate functional decline. This pilot study explored the relationships between sleep, age, chronic disease burden, and physical function among 50 community-dwelling older adults. Findings revealed significant relationships between total sleep time and preclinical disability (r = -0.33, P ≤ .05) and mobility difficulty (r = -0.36, P ≤ .05). A regression analysis showed that total sleep time was significantly associated with mobility difficulty and preclinical disability, even after controlling for chronic disease burden. These findings suggest that total sleep time may be a catalyst for functional decline.

New graduate nurse transition programs and clinical leadership skills in novice RNs.

OBJECTIVE: The objective of this study was to determine predictors of clinical leadership skill (CLS) for RNs with 24 months of clinical experience or less. BACKGROUND: New graduate nurse transition programs (NGNTPs) have been proposed as a strategy to increase CLS. CLS is associated with positive patient outcomes. METHOD: Method used was hierarchical regression modeling to evaluate predictors of CLS among individual characteristics of RNs and characteristics of NGNTPs. RESULTS: Perceived overall quality of an NGNTP was the strongest predictor of CLS (R = 0.041, P < .01). Clinical experience and NGNTP characteristics accounted for 6.9% of the variance in CLS and 12.6% of the variance among RNs with assigned mentors (P < .01). RNs participating in NGNTPs for more than 24 weeks were 21 times more likely to remain employed within the organization when compared with NGNTPs of 12 weeks or less, a significant cost-benefit to the organization. CONCLUSION: Although perceived overall quality of a NGNTP was the strongest predictor of CLS, much of the variance in CLS remains unexplained.

Sleep deprivation and error in nurses who work the night shift.

OBJECTIVE: The aim of this study was to investigate the relationship between sleep deprivation and occupational and patient care errors among staff nurses who work the night shift. BACKGROUND: Whereas the aviation and trucking industries report that sleep deprivation increases errors, few studies have examined sleep deprivation association with occupational and patient care errors among nurses. METHODS: A cross-sectional correlational design was used to evaluate relationships between sleep deprivation and occupational and patient care errors in 289 hospital night shift nurses. RESULTS: More than half (56%) of the sample reported being sleep deprived. Sleep-deprived nurses made more patient care errors. Testing for associations with occupational errors was not feasible because of the low number of occupational errors reported. CONCLUSION: Interventions to increase the quality and quantity of sleep among hospital night shift nurses are needed. Improved sleep among night shift nurses will reduce the impact of sleep deprivation on patient care errors.

Association of Religious Service Attendance and Neuropsychiatric Symptoms, Cognitive Function, and Sleep Disturbances in All-Cause Dementia.

Commonly reported in dementia, neuropsychiatric symptoms (NPS), cognitive decline, and sleep disturbances indicate dementia progression. With the growing dementia burden, identifying protective factors that may slow dementia progression is increasingly essential. Religion and spirituality are associated with better mental and physical health, yet few studies have been reported in older adults with dementia. This study examines associations between religious service attendance and symptoms of dementia progression. Using data from the Health and Retirement Study in 2000, 2006, and 2008 and the sub-study, Aging, Demographics, and Memory Study in 2001-2003, 2006-2007, and 2008-2009, we examined the association of religious attendance with neuropsychiatric symptoms, cognitive function, and sleep disturbances among U.S. older adults aged 70 years and older with all-cause dementia (N = 72) using Spearman's partial Rho correlation controlling for social interaction. Significant associations were identified for religious attendance and NPS (rs (97) = -0.124, 95% CI [-0.129, -0.119], p < 0.0005); cognitive function, rs (97) = -0.018, 95% CI [-0.023, -0.013], p < 0.001); and sleep disturbances, rs (97) = -0.275, 95% CI [-0.280, -0.271], p < 0.0005). Beyond adjusting for social interaction, increased religious attendance was associated with lower NPS, better cognitive function, and fewer sleep disturbances. Clinical trials and longitudinal studies with a larger sample size examining religion and spirituality factors with dementia progression are warranted.

Religion, Spirituality, and Coping During the Pandemic: Perspectives of Dementia Caregivers.

Religious and spiritual (R/S) practices support individuals during difficult situations. The COVID-19 social distancing restrictions may have limited access to R/S practices for older adults with Alzheimer's disease related dementia (ADRD) and their caregivers, affecting coping and well-being. This qualitative study explored the impact of social distancing on R/S practices and coping in ADRD-caregiver dyads from the perspective of caregivers. Interviews were conducted with 11 family caregivers of older adults with ADRD residing in nursing homes (n = 4) or private homes (n = 7). Caregivers continued individual and started virtual R/S practices which improved their ability to cope. However, organized R/S practices were unavailable for those with ADRD, but they used prayer and read religious texts which noticeably improved their mood. Healthcare professionals' sharing of individual and community R/S resources available for ADRD-caregiver dyads could decrease anxiety and agitation, while improving their ability to cope with increased isolation.

Predictors of Adherence to Continuous Positive Airway Pressure in Older Adults With Apnea and Amnestic Mild Cognitive Impairment.

BACKGROUND: Almost 60% of adults with amnestic mild cognitive impairment (aMCI) have obstructive sleep apnea (OSA). Treatment with continuous positive airway pressure (CPAP) may delay cognitive decline, but CPAP adherence is often suboptimal. In this study, we report predictors of CPAP adherence in older adults with aMCI who have increased odds of progressing to dementia, particularly due to Alzheimer's disease. METHODS: The data are from Memories 2, "Changing the Trajectory of Mild Cognitive Impairment with CPAP Treatment of Obstructive Sleep Apnea." Participants had moderate to severe OSA, were CPAP naïve, and received a telehealth CPAP adherence intervention. Linear and logistic regression models examined predictors. RESULTS: The 174 participants (mean age 67.08 years, 80 female, 38 Black persons) had a mean apnea-hypopnea index of 34.78, and 73.6% were adherent, defined as an average of ≥4 hours of CPAP use per night. Only 18 (47.4%) Black persons were CPAP adherent. In linear models, White race, moderate OSA, and participation in the tailored CPAP adherence intervention were significantly associated with higher CPAP use at 3 months. In logistic models, White persons had 9.94 times the odds of adhering to CPAP compared to Black persons. Age, sex, ethnicity, education, body mass index, nighttime sleep duration, daytime sleepiness, and cognitive status were not significant predictors. CONCLUSIONS: Older patients with aMCI have high CPAP adherence, suggesting that age and cognitive impairment should not be a barrier to prescribing CPAP. Research is needed to improve adherence in Black patients, perhaps through culturally tailored interventions.

Exercise and social activity improve everyday function in long-term care residents.

OBJECTIVES: This study examined the effects of high-intensity resistance strength training and walking (E), individualized social activity (SA), and resistance training and walking combined with social activity (ESA) on everyday function in long-term care (LTC) residents and explored the relationship between change in everyday function and change in sleep. DESIGN: The study used data from The Effect of Activities and Exercise on Sleep, a randomized controlled trial. SETTING: Residential LTC facilities. PARTICIPANTS: A total of 119 participants who had measures of everyday function and sleep at baseline and postintervention. INTERVENTIONS: The E group exercised 5 days a week. The SA group was involved in social activities 5 days a week. The ESA group received both E and SA interventions. The usual care (UC) control group participated in usual activities. MEASUREMENTS: Everyday function was measured by the Nursing Home Physical Performance Test. Nighttime sleep was measured by attended polysomnography. RESULTS: The UC and SA groups showed a decline in everyday function, whereas the E and ESA groups showed improvement. There were statistically significant differences between the groups, with pairwise comparisons showing significant improvements in the ESA group over the SA group (95% confidence interval, -3.94 to -0.97) and the UC group (95% confidence interval, -3.69 to -0.64). No relationship was found between change in everyday function and change in sleep. CONCLUSION: Seven weeks of high-intensity resistance strength training and walking, combined with individualized social activities (ESA), improved everyday function among LTC residents, independent of change in sleep.

The management of sleep and circadian disturbance in patients with dementia.

Sleep and circadian disturbances are common among patients with dementia. Symptomatic manifestations vary according to dementia subtype, with one commonly shared pattern--the irregular sleep-wake rhythm (ISWR), a circadian disorder characterized by an absence of the sleepwake cycle's circadian synchronization. Hypothesized mechanisms of circadian rhythm disturbance include suprachiasmatic nucleus (SCN) circadian pacemaker damage, pineal gland and melatonin secretion alterations, and reduced zeitbeigers and decreased input to the SCN. Management options include prescribed sleep/wake scheduling, light therapy, melatonin, physical and social activity, and mixed modality. The mixed-modality approach is the most effective method in treating ISWR. Pharmacologic interventions are controversial, with no evidence supporting their effectiveness while associated with multiple side effects. They should be used with caution and only be considered as short-term therapy. All treatment strategies should be individualized to achieve the best outcomes.

Geropsychiatric Nursing Leadership in Long-Term Care.

Geropsychiatric nursing (GPN) leaders in long-term care settings have a 25-year tradition of innovation that has strikingly improved mental health and quality of life for older adult residents. The impact of the Coronavirus disease of 2019 (COVID-19) on the mental health of older adult residents and today's evolving health care systems requires additional GPN leaders well-prepared to advocate, plan, and deliver care for this vulnerable population. In this article, the authors discuss GPN leadership in the context of its history, the role of professional organizations, and educational competencies. A leadership exemplar is provided as well as recommendations for clinical practice and research.

Measures of religion and spirituality in dementia: An integrative review.

Introduction: Literature on the association of religion and spirituality (R/S) and health is growing. However, it is unclear how R/S affects outcomes and is assessed in persons with dementia (PWDs). In this integrative review, we evaluate published R/S measures and synthesize R/S findings for PWDs. Methods: We searched five databases (ATLA Religion, CINAHL, PsychInfo, PubMed, SocIndex) and identified 14 of 1043 studies for review. We assess the studies' information, quality, measures, and results. Results: We identified 17 measures for R/S: six were adapted for use with PWDs and only two were validated for PWDs; most studies reported only measures' reliability, with Cronbach's alpha. The studies' findings support significant positive associations between R/S and cognitive function and negative associations between R/S and depression and behavioral expressions. Discussion: The two validated scales indicated acceptable validity with overall good reliability. Nevertheless, diverse samples and rigorous study designs are needed to improve R/S measures and to examine associations over time for PWDs. Highlights: Few scales for measuring religion and spirituality (R/S) have been validated in persons with dementia (PWD); additional testing is needed.Most R/S measures only reported scale reliability with Cronbach's alpha.Studies supported positive associations between R/S and health yet few studies exist. conducted.Only one spiritual intervention, spiritual reminiscence, was found for PWD.More rigorous R/S studies are needed to examine health outcomes in dementia.