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1.
Gerontologist ; 2022 Apr 14.
Artículo en Inglés | MEDLINE | ID: mdl-35421236

RESUMEN

An optimum focus in any care situation is creating and sustaining environments that facilitate an ongoing sense of "being in place" for all involved. Using this rationale, we propose a Situational Model of Care (SMC) for exploring dynamic relationships among aging persons receiving care, the convoy of persons offering this care and support, and the place where this occurs, as evolving situations throughout the course of a disease. The model is grounded in extant literature and illustrated through a case study derived from in-home observations and interviews. Emphasizing an underlying goal of fostering a sense of being in place as a desirable outcome facilitates situationally nuanced directions in research and clinical care.

2.
Gerontol Geriatr Med ; 8: 23337214211068290, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35024382

RESUMEN

Mild cognitive impairment (MCI) or dementia often leads to behavioral and psychiatric symptoms of dementia (BPSD). Sensory processing abnormalities may be associated with BPSD. The purpose of this study was to explore relationships among sensory processing, behavior, and environmental features within the homes of people with MCI or dementia. This project used mixed methods to assess participants' sensory processing, care partner perspectives on behaviors, and in situ observations of the home environment. Nine participants with cognitive impairment (MCI n = 8, early dementia = 1) and their care partners were included. Seven participants with cognitive impairment were reported to have abnormal sensory processing. Findings suggest that unique environmental adaptations, tailored to personal and sensory preferences for each participant, were associated with a decreased level of behavioral disruption during the observation periods. Implementing sensory-based approaches to maximize environment adaptation may be beneficial in reducing disruptive behaviors for adults with cognitive impairment.

3.
Am J Occup Ther ; 76(1)2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-34990510

RESUMEN

IMPORTANCE: Practitioners need to be familiar with, and involved in, managing quality-related adverse events in postacute care. OBJECTIVE: To determine interventions within the scope of occupational therapy that address preventable adverse events in adult postacute inpatient and home health settings. DATA SOURCES: Articles published from January 1995 through 2019 identified through searches of MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane databases. Study Selection and Data Collection: Articles were collected, evaluated, and analyzed by two independent reviewers. They were assessed and synthesized with a goal of informing clinical practice. FINDINGS: Twenty-four articles were included in the review. Of the 10 Centers for Medicare & Medicaid Services preventable adverse events, 6 were addressed: diabetes management (n = 2), dysphagia (n = 5), infection control (n = 1), pressure ulcers (n = 6), falls (n = 5), and discharge management (n = 5). There was strong strength of evidence that exercise programs should, when appropriate, be implemented in both inpatient and home health settings to decrease the risk of falls. There was moderate strength of evidence that practitioners could consider implementing a facility wide evidence-based pressure ulcer program; providing multidisciplinary rehabilitation and swallow strengthening exercises for dysphagia; implementing a multidisciplinary, multicomponent falls program; and using a manualized depression intervention in home health to decrease hospital readmission. CONCLUSIONS AND RELEVANCE: The review highlights the importance of preventable adverse events and of occupational therapy practitioners acknowledging and managing these events to enhance health outcomes and to control health care costs. What This Article Adds: Many interventions typically performed by occupational therapy practitioners address preventable adverse events. The review highlights the importance of practitioners being aware of this category of impairment or injury.


Asunto(s)
Terapia Ocupacional , Adulto , Anciano , Humanos , Pacientes Internos , Medicare , Readmisión del Paciente , Atención Subaguda , Estados Unidos
4.
Aging Ment Health ; 26(3): 586-594, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-33222510

RESUMEN

BACKGROUND: Similarities exist in behavioral expression of autism spectrum disorder (ASD) and Alzheimer's disease and related dementias (ADRD). The purpose of this study was to assess presence of behavioral and psychiatric symptoms of dementia (BPSD) and ASD-like behaviors in adults with ADRD. METHODS: Using a cross-sectional design, data from University of Kentucky Alzheimer's Disease Center participant cohort were used. Hierarchical linear regression was used to assess (1) the relationship between ASD-like behaviors (measured by the Gilliam Autism Rating Scale-Second Edition, GARS-2) and BPSD measured by the Neuropsychiatric Inventory (NPI), and (2) the relationship between ASD-like behaviors and dementia severity (measured by the Clinical Dementia Rating [CDR] sum of boxes), when controlling for BPSD. RESULTS: Complete data were available for 142 participants. Using α of 0.05, analyses identified ASD behaviors were significantly associated with BPSD severity ratings (r = 0.47; p < 0.001) and dementia severity (r = 0.46; p < 0.001). GARS-2 explained 6.1% (p < 0.001) of variance in CDR sum of boxes when controlling for NPI and other covariates. DISCUSSION: There is significant overlap in behaviors characteristic of ASD and BPSD as assessed by the NPI and GARS-2, despite the use of these instruments in disparate developmental vs. aging settings. ASD behaviors appear to not be solely present in early childhood as a manifestation of ASD but are also present in older adults with neurodegenerative cognitive impairment. Such associations warrant additional research into causation, assessment, and behavioral interventions to further enable new therapeutic approaches targeting ASD behaviors across the lifespan.


Asunto(s)
Enfermedad de Alzheimer , Trastorno del Espectro Autista , Demencia , Anciano , Enfermedad de Alzheimer/psicología , Trastorno del Espectro Autista/complicaciones , Trastorno del Espectro Autista/epidemiología , Síntomas Conductuales , Preescolar , Estudios Transversales , Demencia/psicología , Humanos , Escalas de Valoración Psiquiátrica
5.
J Patient Saf ; 18(2): e503-e507, 2022 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-34009869

RESUMEN

INTRODUCTION: Falls in persons with dementia are associated with increased mortality. Occupational therapy (OT) is a rehabilitation discipline, which has, among its goals, the promotion of safety and fall prevention in older adults and those with dementia. The purpose of this study was to evaluate root cause analysis (RCA) data to identify causes of falls with adverse events in patients with dementia who were referred to or receiving OT services within the Veterans Health Administration (VHA). METHODS: This study used retrospective review of RCAs within the National Center for Patient Safety database for the VHA. The RCA database was searched using these terms: falls with adverse events, dementia, and OT. Descriptive statistical analysis of demographic information, location, occurrence of orthopedic fracture, and mortality was used. All root causes were qualitatively categorized using thematic analysis of determined causes. RESULTS: Eighty RCAs were included in analysis. Mean age of veterans included was 80 years; 96% were male; 76% resulted in hip fracture; and 20% died as a result of the fall. Occupational therapy evaluations occurred within 7 days of admission to VHA and falls most frequently occurred within 4 days of OT evaluation. Most common causes included inappropriate or lack of equipment (21%), need for falls/rehabilitation assessment (20%), compliance/training to fall protocol of all staff (19%), and behavior/medical status (17%). CONCLUSIONS: Earlier identification for OT evaluation need may improve access to services, and use of proper equipment to decrease frequency of falls may improve patient safety for older adults with dementia.


Asunto(s)
Demencia , Terapia Ocupacional , Veteranos , Anciano , Anciano de 80 o más Años , Demencia/complicaciones , Humanos , Masculino , Estudios Retrospectivos , Análisis de Causa Raíz , Estados Unidos , United States Department of Veterans Affairs
6.
J Appl Gerontol ; 40(8): 814-817, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-33648357

RESUMEN

Social distancing guidelines during COVID can be isolating, especially for older adults, with potential for poor health outcomes. Technology offers opportunities for remote connection, yet, older adults' use of and perspectives on technology during this time remain largely unknown. The purpose of this study was to gain insight into older adults' technology use and preferences to inform the development of a technology training intervention to support older adult well-being. Semi-structured interviews were conducted with 30 older adults. Interviews were analyzed using an iterative, constant comparison approach. Findings were consistent with Socioemotional Selectivity Theory; respondents were primarily interested in technology to support emotionally meaningful goals. Participants indicated limited interest in technology training, referencing diminished future time perspectives to explain disinterest. Findings suggest that efforts to encourage older adults' expanded technology adoption should highlight how use supports emotionally meaningful goals and provide low-effort, timely training, tied to specific and clear applications.


Asunto(s)
COVID-19 , Distanciamiento Físico , Anciano , Humanos , SARS-CoV-2
7.
Clin Gerontol ; 44(3): 345-353, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33583362

RESUMEN

Objectives: This study sought to explore changes in longitudinal cognitive status in relation to baseline measures of intimacy and sexuality in cognitively intact, married older adults.Methods: Baseline intimacy and sexuality survey data from 155, cognitively intact, married, older adults were collected using a novel survey instrument that explored the domains of: 1) romance with one's partner, 2) sexual satisfaction, 3) beliefs about sexuality, and 4) social support and emotional intimacy. These data were analyzed in relation to change in cognitive status over a 10-year follow-up period using binary logistic regression modeling. Exploratory factor analysis was used to assess the shared variance of survey items attributable to intimacy and sexuality without specification of an a priori hypothesis regarding the association of intimacy and sexuality with future change in cognitive status.Results: Over the 10-year study period, 33.5% (n = 52) of individuals developed cognitive impairment. Participants with greater sexual satisfaction scores at baseline were statistically less likely to convert from cognitively intact to mild cognitive impairment or dementia in the future (p = .01). The domains of romance with one's partner, beliefs about sexuality, and social support/emotional intimacy were not predictive of future longitudinal changes in cognitive status.Conclusions: Sexual satisfaction is associated with longitudinal cognitive outcomes in cognitively intact, married, older adults.Clinical implications: Clinicians should routinely assess for sexual satisfaction among older adults and refer to appropriate providers, such as couples or sex therapists, when appropriate.


Asunto(s)
Disfunción Cognitiva , Orgasmo , Anciano , Humanos , Conducta Sexual , Parejas Sexuales , Sexualidad
8.
Alzheimers Dement ; 17 Suppl 7: e052397, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-35109453

RESUMEN

BACKGROUND: Previous research has shown that up to one-third of patients diagnosed with mild cognitive impairment (MCI) demonstrate resistance to acceptance of the diagnosis, which may contribute to reduced engagement in clinical research activities including interventional trials. METHOD: This study explored researchers' experiences to recruit 18 dyads from a U.S. Alzheimer's Research Center to participate in a nine-month duration, pilot, platform trial of biopsychosocial interventions for persons with MCI and their study partner. Thirty-nine individuals with MCI met the inclusion criteria for the study. The MCI-study partner dyads were contacted by mail and phone solicitation for recruitment. Thematic analysis of recruitment case notes was used to track the number of telephone contacts, reasons for interest/disinterest in participation, and questions about the study. RESULT: Whereas many participants with MCI were interested and willing to enroll (92.3%), frequently study partners were not willing to enroll (53.8%). Study partners primarily consisted of male spouses with a mean age of 67. Study partners reported reasons for disinterest including being unavailable to participate in research sessions (due to availability or geographical distance) and lack of knowledge on MCI or the benefit of research involvement. Further data on the characteristics of study partners in regards to their willingness to engage in research will be presented. CONCLUSION: Recruiting persons with MCI and their study partners for clinical trials research may require specialized communication messaging and strategies for dyad engagement. Strategies should target study partners by promoting the opportunities and potential benefits of MCI clinical trials while considering challenges to involvement due to availability (e.g., weekend meetings, remote offerings, and attempting to lessen the burden of research engagement), rather than focusing recruitment efforts solely on the participant. Further studies exploring strategies to educate and engage study partners to enhance recruitment into MCI research is warranted.

9.
Alzheimers Dement ; 17 Suppl 7: e054696, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-35109455

RESUMEN

BACKGROUND: Older adults are at greater risk for morbidity and mortality associated with COVID-19. Spatial distancing and sequestering practices are recommended to limit viral exposure. Older adults adopting these practices are at increased risk of social isolation and adverse health outcomes. Remote technologies offer various platforms for satisfying socialization and healthcare needs while sequestering. Understanding how older adults are using technology has implications for wellbeing during a pandemic. METHOD: Researchers attempted to contact all participants enrolled in the University of Kentucky Alzheimer's Disease Research Center longitudinal study via telephone to survey technology use (n = 706). Participants were contacted directly, except for demented participants, whose primary caregivers were contacted to respond on their behalf, when possible. Participants and caregivers gave their assent verbally to complete the voluntary survey, the procedures of which were approved by the IRB. The surveys consisted of validated instruments to gauge the extent of use of and comfort with technology. Spearman correlations, chi-square tests, and t-tests were used to explore data. RESULT: Ultimately, 384 participants were reached and 332 consented to participate. Most reported reliable home internet access (91.5%) and some internet use (90.6%). Recent feelings of loneliness were not related to any technology-related variables (all ps > 0.29) other than decreasing with greater willingness to use telehealth (Rho = -0.11, p = 0.06). Those who reported a lack of comfort with technology (n = 76) were less likely to text messaging (67% vs 78%) and social media (56% vs 69%), ps ≤ 0.06, but felt socially connected using technology at similar levels (82% vs 75%), p = 0.22. Nearly 70% of this group reported they would use technology more with training. Across all participants, willingness to use telehealth was not related to frequency of frustration with tech (Rho = 0, p = 0.99). CONCLUSION: The results suggest that some older adults' use of technology is limited by familiarity. Lack of familiarity does not appear to create a barrier to using telehealth nor does frustration with technology appear to limit telehealth use. The findings have implications for supporting older adults sequestered during a pandemic but potentially more broadly.

10.
Alzheimers Dement ; 17 Suppl 7: e053263, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-35109459

RESUMEN

BACKGROUND: Recognition of the impact of primary sensory impairment on cognitive status and decline in the aging population has spurred research in this area. Most prior studies have focused on primary sensory function, with few studying the potential impact of central nervous system sensory processing and modulation in relation to cognitive status. METHOD: This study sought to evaluate sensory processing abnormalities rather than primary sensory deficits in community-residing older adults through administration of the Adult Sensory Profile (ASP), a 60-item, norm-referenced assessment evaluating central nervous system sensory processing. The ASP items assess six sensory modalities: taste/smell, movement, visual, touch, auditory, and activity level. Participants ranked items based on their likelihood to engage in activities within each group. Responses were tabulated into four processing categories (sensation avoiding, sensory sensitivity, sensation seeking, and low registration) and compared with age-cohort normative data. Identification of more than one category outside of normative results was indicative of sensory processing abnormalities compared to same-aged peers. Participants were categorized based on the ASP as normal (<2 categories outside of normal range) or abnormal (2-4 categories outside of normal range). Chi-square tests compared cognitively normal participants to those with cognitive impairment. RESULT: Seventeen participants completed the ASP. Eight were cognitively normal at the time of completion and nine were diagnosed with cognitive impairment. Of those with normal cognition, two were considered to have abnormal sensory processing (25%). Of those with cognitive impairment, seven were considered abnormal (78%), indicating a significant difference in global sensory processing between groups (x2 =4.73, p=0.029). CONCLUSION: Global sensory processing abnormalities were more frequent in those diagnosed with cognitive impairment compared to those that remained cognitively intact. It is likely that cortical neurodegeneration in sensory association areas is responsible for the increased prevalence of sensory processing abnormalities seen in the older adults with cognitive impairment in this study. Abnormal sensory processing abilities could contribute to increased behavioral and psychiatric symptoms, similar to that seen in children with severe sensory processing disorders. Larger studies are needed to confirm these results and investigate the relationship between impaired sensory processing and behavioral symptoms in dementia.

11.
Alzheimers Dement ; 17 Suppl 7: e052225, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-35109618

RESUMEN

BACKGROUND: Receiving a diagnosis of mild cognitive impairment (MCI) may lead to experiences of emotional turmoil stemming from a perceived lack of clarity around diagnosis and prognosis. Previous research has identified several maladaptive behaviors resulting from the diagnosis of MCI that may be targeted for intervention in order to help those with a new diagnosis of MCI best adapt behaviors to maintain functional abilities. METHOD: A platform-based MCI trial cohort of individuals, newly diagnosed with MCI from a U.S. Alzheimer's Disease Research Center, was used to pilot a multicomponent interdisciplinary intervention targeting adaptive behavioral responses to the diagnosis of MCI. Thematic analysis was employed with fifteen focus groups across three study groups of 14 participants. After engaging with each of the platform-based MCI trial components, participants' and their study partner's perceptions of each intervention's acceptability, satisfaction, and compliance across the multicomponent interdisciplinary intervention were assessed. RESULTS: Themes that emerged from the data included a preference towards education, learning new information, and skill development. Both persons with MCI and study partners favored intervention components that were novel to them. They also reported higher satisfaction with activities facilitated by a professional (e.g., social worker, physical therapist, or pharmacist) as opposed to intervention activities that were self-directed. Participants with MCI and their study partners reported those with impairment's challenges utilizing technology independently, requiring assistance in setting up online medical portals, using wearable exercise trackers and automated pillboxes that represented technology-dependent components of the intervention. CONCLUSION: These data suggest that persons, newly diagnosed with MCI, are interested in adaptive, biopsychosocial interventions for persons with MCI. Acceptability, satisfaction, and compliance may be increased when individuals are engaging in learning novel information and skills that are led and supported by professionals. Assistance with and or training in the use of technology-based interventions may be needed to maximize the impact of such approaches. Further studies exploring the impact on the cognitive and functional decline that may be mediated by adaptive behavioral interventions in persons newly diagnosed with MCI are warranted.

13.
Alzheimers Dement (N Y) ; 6(1): e12045, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32775600

RESUMEN

Coronavirus disease 19 (COVID-19) has dramatically altered everyday life, including the field of Alzheimer's disease (AD) research. This perspective article explores some of the ways in which COVID-19 has already impacted the field, anticipates some of the long-lasting effects, and explores strategies for addressing current and future needs. Areas of impact include study integrity, regulatory and industry issues, and participant engagement. Proposed strategies for addressing these challenges include analytic methods to deal with large degrees of missing data and development of patient-centered, user-friendly, remote data collection tools and assessments. We also highlight the importance of maintaining participant well-being as a first and constant priority.

14.
Alzheimer Dis Assoc Disord ; 34(1): 66-71, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31517641

RESUMEN

INTRODUCTION: Autism spectrum disorder (ASD) represents a heterogenous cluster of clinical phenotypes that are classically diagnosed by the time of adolescence. The possibility of late-life emergence of ASD has been poorly explored. METHODS: To more fully characterize the possibility of late-life emergence of behaviors characteristic of ASD in mild cognitive impairment and AD, we surveyed caregivers of 142 older persons with cognitive impairment from the University of Kentucky Alzheimer's Disease Center Longitudinal Cohort using the Gilliam Autism Rating Scale-2. RESULTS: Participants with high autism index ratings (autism "possible/very likely," n=23) reported significantly (statistically and clinically) younger age at the onset of cognitive impairment than those who scored in the autism "unlikely" range (n=119): 71.14±10.9 vs. 76.65±8.25 (P=0.034). In addition, those in the autism "possible/very likely" group demonstrated advanced severity of cognitive impairment, indicated by the Clinical Dementia Rating Scale Sum of Boxes scores. DISCUSSION: Data demonstrate that ASD behaviors may seem de novo of degenerative dementia and such behaviors are more prevalent in those with early onset dementia. Further work elucidating a connection between ASD and dementia could shed light on subclinical forms of ASD, identify areas of shared neuroanatomic involvement between ASD and dementias, and provide valuable insights that might hasten the development of therapeutic strategies.


Asunto(s)
Edad de Inicio , Trastorno del Espectro Autista/diagnóstico , Disfunción Cognitiva/complicaciones , Demencia/complicaciones , Anciano , Trastorno del Espectro Autista/clasificación , Cuidadores , Estudios de Cohortes , Femenino , Humanos , Estudios Longitudinales , Masculino , Fenotipo , Problema de Conducta/psicología , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios
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