Exploring nurses' difficulties and strategies when caring for patients with dementia in a neurological ward.

Nurses in neurological wards face numerous challenges when caring for patients with dementia, particularly those who also present other acute illnesses. However, studies focusing on this area are limited. This study aimed to explore the difficulties and strategies in caring for patients with dementia among nurses working in a neurological ward. A qualitative descriptive design was adopted. Twelve nurses from a neurology ward participated in individual semi-structured interviews. The data collected through these interviews were subjected to qualitative content analysis. Two main themes emerged from the analysis: (i) various shortcomings and concerns, which include subthemes: insufficient support, worry about patient safety, inadequate care ability of the caregiver, and insufficient self-competence, and (ii) unique clinical strategies, which include subthemes: cooperate with the caregiver, improve self-competence in dementia care, and employ meticulous resorts. The findings highlighted the nurses' dedication to minimizing patient risks and utilizing available resources as well as stakeholders to provide optimal care. To enhance patient care quality, it is essential to support nurses by addressing care-related barriers, offering continuous education, and establishing care pathways.

Exploring the Difficulties and Strategies of Family Caregivers in Caring for Patients With Dementia in Acute Care Wards.

BACKGROUND: Providing appropriate care to patients with dementia in acute care settings can be a challenge for healthcare professionals. A key factor is working closely with family caregivers. PURPOSE: This study aims to explore the difficulties and strategies involved in caring for patients with dementia who have been admitted to an acute care ward from the perspective of family caregivers. METHODS: Exploratory research was conducted using a qualitative data collection approach. Data were collected by means of in-depth interviews carried out with participants. Semistructured interviews were conducted with nine participants. Content analysis was performed to analyze the data. RESULTS: A number of themes and subthemes were identified based on the primary research purposes. The first theme is "vicious cycle due to multiple factors," with the following subthemes: (a) communication disturbance, (b) endless worries, (c) inadequate care skills of paid caregivers, and (d) physical and psychological exhaustion. The second theme is "do everything," with the following subthemes: (a) management of the behavioral and psychological symptoms of dementia, (b) constant accompaniment of the patient, and (c) seeking sources of support. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results may be used to help healthcare professionals better anticipate the difficulties faced by family caregivers while providing assistance to patients with dementia and understand the related strategies they use. Acute care wards should consider the specific needs of family caregivers to ensure patients with dementia receive adequate care from the relevant parties in the ecological care chain during the care process.

Development and psychometric properties of a friendly dietary function assessment scale for home-dwelling people with dementia.

BACKGROUND: Mealtime difficulties related to cognitive functioning negatively impact a patient's life during the various stages of dementia, and they typically cause a burden and stress on family caregivers. Most people with dementia live at home alone or are cared for by informal caregivers, typically their spouses or other family members. However, no suitable screening tools for home-dwelling patients with dementia have been developed, nor have measurements focused on executive and self-eating functions. This study aimed to develop and evaluate the psychometric properties of the Dietary Function Assessment Scale (DFAS) for community-dwelling persons with dementia. METHODS: A mixed-method design was used to develop the instrument. Methods included a comprehensive literature review to identify the item pool and an expert panel to assess the initial item pool. We performed convenience sampling of 190 home-dwelling people with dementia for psychometrical evaluation. The psychometric properties tests included item and factor analyses, criterion-related validity testing, internal consistency reliability testing, and defining the optimal cut-off values. The study was conducted from 2018 to 2019. RESULTS: Items were generated based on an extensive literature review and pre-existing scales related to mealtime and executive functions in persons with dementia. The S-CVI/Ave of the DFAS was 0.89. A Principal Component factor analysis demonstrated seven items, with a two-factor structure accounting for 56.94% of the total variance. The two extracted factors were Self-eating ability and Dietary executive function. The confirmatory factor analysis indicated a good model fit. The criterion-related validity was adequate (r = -0.528, p < 0.01). The reliability of Cronbach's alpha internal consistency was 0.74, and McDonald's Omega coefficient was 0.80; the optimal cut-off value of 13 points with an AUC of 0.74 was established to determine poor dietary functioning in persons with dementia. CONCLUSION: The DFAS was simple, user-friendly, and a valid and reliable instrument to assess dietary functioning in community-dwelling persons with dementia. This short scale can be helpful for caretakers, who can use it to identify the dietary needs of home-dwelling persons with dementia and improve their care and eating experience.

Effectiveness of aroma-Tea Tree Oil and Eucalyptus oil in alleviating COVID-19 vaccine discomfort side effects.

CONTEXT: Aromatherapy is considered a mild and non-invasive complementary treatment to relieve post-vaccination discomforts. There have been no studies that examine the use of aroma-Tea Tree oil and Eucalyptus oil to relieve the discomfort side effects related to COVID-19 vaccines. OBJECTIVE: This study examined the use of two aroma-essential oils to relieve discomfort side effects of COVID-19 vaccination. DESIGN: The study used experimental design to match two groups of participants. SETTING: The participants' home. PARTICIPANTS: Adults who had not yet been vaccinated against COVID-19 but were planning to receive it were recruited. The current study included 87 control participants matched to 83 experimental participants. INTERVENTION: The participants in the experimental group used Tea tree and Eucalyptus while the control group did not. MAIN OUTCOME MEASURES: A questionnaire was used to collect data on the topical and systematic symptoms related to COVID-19 vaccines. Both groups were asked to complete the online questionnaire and report their health status 24 h (T1) and 48 h (T2) after vaccination. RESULTS: The results revealed a statistically significant difference between the groups in swelling, injection side pain, lump, fever, and muscle ache (p = .05, 0.04, <0.00, 0.02, 0.02, respectively) for T1; but for T2, a significant difference between the two groups was found only in lump and fever (p = .05, 0.03). Aroma-Tea Tree oil and Eucalyptus oil may be recognized and accepted by more people worldwide to provide a safe and healthy option not only for post-vaccination care but also to relieve pain, fever, and skin lumps associated with other diseases or conditions.

A Feasibility Evaluation of the Need-Centered Watch-Assess-Need Intervention-Think Education and Training Program for Behavioral and Psychological Symptoms of Dementia.

BACKGROUND: Despite the high prevalence of dementia among residents living in long-term care facilities in Taiwan, most care providers in these facilities have not received adequate training to deal with the behavioral and psychological symptoms of dementia (BPSD). An original care and management model for BPSD has been developed, and model-based recommendations for an education and training program have been made. However, empirical testing has not yet been conducted to determine the efficacy of this program. PURPOSE: This study was designed to evaluate the feasibility of using the Watch-Assess-Need intervention-Think (WANT) education and training program for BPSD in long-term care settings. METHODS: A mixed-method design was used. Twenty care providers and 20 corresponding care receivers (residents with dementia) from a nursing home in southern Taiwan were enrolled. Data were collected using a variety of measurement tools, including the Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia, Attitude towards Dementia Care Scale, and Dementia Behavior Disturbance Self-efficacy Scale. Qualitative data, including care-provider perspectives on the efficacy of the WANT education and training program, were also collected. Repeated measures were conducted on the results of quantitative data analysis, whereas content analysis was performed on the results of qualitative data analysis. RESULTS: Findings indicate that the program relieves agitated behavior (p = .01), alleviates depression in those with dementia (p < .001), and enhances care-provider attitudes toward dementia care (p = .01). However, no significant improvement was found in self-efficacy among the care providers (p = .11). In terms of qualitative outcomes, care providers indicated they perceived improved self-efficacy in managing BPSD, improved ability to view problems from a more need-centered perspective, improved attitudes toward dementia and patients' BPSD, and decreased care burden and stress. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The study found the WANT education and training program to be feasible in clinical practice. Because of this program's simple and easy-to-remember characteristics, it is recommended that it be vigorously promoted to care providers in both long-term institutional and home care settings to help them effectively address the BPSD.

Relationship between Walking Activity and Sleep Quality among Community-Dwelling Older Adults.

PURPOSE: To explore the relationship between walking activity and sleep quality among elderly. DESIGN: A cross-sectional, correlation study with purposive sampling was conducted on participants with a walking habit but not regular moderate-intensity exercise. METHODS: Data were collected by structured questionnaires, including the Walking Activity Questionnaire and the Pittsburgh Sleep Quality Index. FINDINGS: The total walking time per week and frequency of walking per day were significant predictors of sleep quality. CONCLUSIONS: Walking can help older community-dwelling adults improve their sleep quality. CLINICAL EVIDENCE: Walking more than once per day and total walking time per week ≥210 minutes were associated with good sleep quality.

New insight into chronic pruritus' characteristics and association with the demographic characteristics and sleep of community-dwelling older adults in Taiwan.

This study aimed to understand the characteristics of chronic pruritus (CP), its correlations with sleep quality and demographic characteristics, and its impacts on sleep of older adults. This study used convenience sampling to recruit adults aged 65 or older and living at home. The prevalence rate of CP in older adults was 25.8%. Most subjects with CP reported mild pruritus on 1-2 anatomical parts, especially the lower extremities. Overall, the five domains of CP were correlated with the seven components of sleep quality (r > .14; p > .05) except for sleep disturbance. The global itchy scores were significantly different between different sexes, educational attainments, and marital statuses (p<.05-.001). CP, sex, and the number of comorbid diseases significantly contributed to global sleep quality (ß = .26, -.19, .15, respectively; .000 ≤ p ≤ .011). This study provides new insight into the correlations of CP with marital status and educational attainment.

Development of an educational protocol for ergonomic risk assessment of working postures to enhance the competence of occupational health nurses.

AIM: To develop a protocol and provide a valid, evidence-based procedure for identifying the ergonomic risk of working postures by occupational health nurses. BACKGROUND: Although ergonomic risk assessment tools have been used for the early detection of risky working postures, their operational procedures and validations do not target the competence of occupational nursing personnel. DESIGN: This study developed and validated an educational protocol, comprised of 13 procedures in five stages. First, the number of work tasks in the workplace is determined. Second, the working postures are confirmed. Third, the raters are trained to use the assessment tools. Fourth, high-risk postures are identified and categorized. Fifth, the inter-rater reliability of the tool is reported. The content of the protocol is validated by experts, with a validity value of 0.87. DATA SOURCES: The protocol was created through review of literature published from 1991 to 2021, protocol development (between 2018 to 2020) and expert validation (2020). CONCLUSION: The protocol can be applied to educate occupational health nurses and increase their competence in detecting workers' ergonomic risks. It can be used as a reference in occupational health nursing education to evaluate work tasks and detect risky postures.

[Getting Lost in People With Dementia: A Scoping Review].

BACKGROUND: Many people with dementia suffer from getting lost, which not only impacts their daily lives but also affects their caregivers and the general public. The concept of getting lost in dementia has not been clarified in the literature. PURPOSE: This scoping review was designed to provide a deeper understanding of the overall phenomenon of getting lost in people with dementia, with the results intended to provide caregivers with more complete information and enlightening research and practice related to dementia getting lost. METHODS: A systematic review method was used, and articles were retrieved from electronic databases including PubMed, Embase, Airiti Library, Cochrane Library, and Gray literature. Specific keywords, MeSH terms, and Emtree terms were used to search for articles on dementia and getting lost. A total of 10,523 articles published from 2011-2020 that matched the search criteria were extracted. After screening the topics and deleting repetitions, 64 articles were selected for further analysis. These articles were classified and integrated based on the six-step literature review method proposed by Arksey and O'Malley. RESULTS: The key findings of the review included: (1) The concept of getting lost in dementia is diverse and inseparable from wandering; (2) More than half of the assessment tools related to getting lost in dementia include the concept of wandering; (3) The factors identified as affecting getting lost in dementia include the patient's personal traits, disease factors, care factors, and environmental factors; (4) Getting lost in dementia negatively affects patients as well as their caregivers and the general public; (5) Most of the articles in this review were quantitative studies and were conducted in Western countries. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The scoping review approach may assist care providers to fully understand the phenomenon of getting lost in dementia, clarify its causes and consequences, and identify the limitations in the literature. The findings may be referenced in the creation of healthcare policies promoting related preventive measures and care plans as well as used to guide future academic research.

Exploring dementia care competence of nurses working in acute care settings.

AIMS AND OBJECTIVES: To examine the current status of dementia care competence of nurses working in acute care settings as well as the relationship between competence and demographic attributes. BACKGROUND: Most people with dementia are older individuals when they are admitted to unfamiliar acute care settings for treatment, and they are prone to displaying BPSD. If nurses working in acute care settings are not sufficiently competent in dementia care, providing proper patient care is difficult. DESIGN: The study used a one-sample descriptive-correlation design. METHODS: This study enrolled nurses at two medical centres in southern Taiwan as the research participants and performed a stratified random sampling according to the units where they served. The Dementia Care Competence Scale was used for data collection. An independent samples t test, ANOVA and Pearson's product-moment correlation were performed for data analysis (See STROBE). RESULTS: A total of 308 valid questionnaires were collected. The results showed that dementia care competence of nurses working in acute care settings was moderate. In particular, they had insufficient knowledge of the special needs related to dementia and lacked the skills and patience necessary for identifying, preventing and managing BPSD. Additionally, although the nurses tended to have a positive attitude, they seldom communicated with people with dementia. This study also found that dementia care competence was better in nurses who were older, who had more seniority, who had taken care of people with dementia for a longer period of time and who had received training in dementia care. CONCLUSIONS: Dementia care training topics for nurses working in acute care settings should include palliative care for dementia, skills for managing behavioural and psychological symptoms of dementia and communication techniques for improving person-centred care. Nurses should also be encouraged to maintain a warm, friendly attitude when providing patient care. RELEVANCE TO CLINICAL PRACTICE: Continuing education in managing behavioural and psychological symptoms of dementia is necessary for currently practicing acute care nursing staff and should be developed according to the staff's educational background and needs.

Using a Socio-Environmental Approach to Explore the Determinants for Meeting the Recommended Physical Activity among Adults at Risk of Diabetes in Rural Indonesia.

Moderate-to-vigorous physical activity (PA) is recommended to mitigate the risk of diabetes. This study explored the PA of adults at risk for diabetes in rural Indonesia and determined the requirements for meeting the recommended PA level. In total, 842 adults were screened using a diabetes risk test in a rural health centre; among them, 342 were at risk of diabetes. The level of PA was assessed using the International Physical Activity Questionnaire, whereas the associated factors underlying the three domains -individual, support, and environment-were determined by the Influences on Physical Activity Instrument. The data analysis included a three-step multiple linear regression (MLR) and logistic regression (LR). Overall, 40.6% of the participants met the recommended PA. According to the MLR analysis, among males, individuals who gave PA a higher priority and had enough time to perform PA were predicted to have a higher activity energy expenditure (MET-minutes per week). According to the LR analysis, men were more likely to meet the recommended PA, and people who gave PA a lower priority and had less access to space for PA were less likely to meet the recommended PA level. Strategies for promoting PA in rural Indonesia include focusing on women, people who prioritize PA less, and those who have less time and space in which to be physically active.

Sensitivity and Specificity of the Saint Louis University Mental Status Examination to Detect Mild Cognitive Impairment and Dementia in Chinese Population.

INTRODUCTION: The Saint Louis University Mental Status (SLUMS) examination is a common screening instrument to detect mild cognitive impairment (MCI) in Western countries. However, further work is needed to identify optimal SLUMS cutoff scores for screening MCI and dementia in Chinese populations. OBJECTIVE: The aim of this study was to evaluate the utility and diagnostic accuracy of the SLUMS examination in the diagnosis of dementia and MCI in Chinese population. METHODS: A cross-sectional multicenter design was conducted. Patients were recruited from the outpatient department of our neurology and psychiatric clinics. The establishment of the gold standard for the SLUMS-Chinese version (SLUMS-C) to detect MCI and dementia was based on the clinical criteria of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) and related neuropsychological testing conducted by 3 certified dementia specialists. The consistency of the diagnosis process and administering SLUMS-C were established prior to the beginning of the study. Data were analyzed, and sensitivity, specificity, and areas under the curve (AUCs) were calculated. RESULTS: A total of 367 subjects were recruited. The SLUMS-C did not show satisfactory AUCs for the preliminary detection of normal cognitive status and MCI by different educational levels (all AUC 0.32-0.54). However, the SLUMS-C showed acceptable AUCs for the preliminary detection of dementia by different educational levels (all AUC 0.78-0.81). An educational level of senior high school showed the best cutoff, sensitivity, and specificity. The SLUMS-C scores to detect dementia for individuals with at least high school education and less than high school education were <24 and 22, respectively. CONCLUSIONS: Our results indicate that the SLUMS-C could be a beneficial and convenient screening instrument to detect dementia in Chinese population. After community screening, a comprehensive clinical evaluation including cognitive assessment, functional status, corroborative history, and imaging confirmation is needed.

Development and psychometric testing of a dementia care competence scale for nurses working in acute care setting.

BACKGROUND: Nurses often have difficulty to deal with dementia-related problematic behaviours, resulting in the prolonged hospitalisation of patients, which further waste medical resources and affect care quality, patient safety and nurses' job satisfaction. It is imperative to improve the dementia care competence of nurses working in acute care. Prior to educational interventions to promote dementia care, using an instrument to evaluate dementia care competence of nurses is needed. PURPOSE: The purpose of this study was to develop and test the psychometric properties of a scale suitable for the investigation of dementia care competence of nurses working in acute care setting. METHODS: The instrumental development design adapted Iceberg Theory as the theoretical foundation was used to develop a scale through three stages: Item development, Content validity and Psychometric testing of the scale. Stratified random sampling was used to enrol subjects from two medical centres in southern Taiwan. The Content Validity Index (CVI), categorical principal components analysis (CATPCA), Cronbach's α coefficient test and the intra-class correlation coefficient test were used to analyse the data. RESULTS: This study enrolled a total of 308 subjects. The CVI of the entire scale reached .97. Through the CATPCA, resulting 33 items in total with the Knowledge subscale consists of 13 items (range = 0-13), the Attitude subscale consists of 11 items (range = 11-55) and the Skills subscale consists of 9 items (range = 0-9). The final Cronbach's alpha coefficient for the Knowledge subscale was .88; for the Attitude subscale was .94; and for the Skills subscale was .85. The test-retest reliability after 2 weeks reached .818. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: This scale has good reliability, validity and theoretical support. It can be used to understand the current status and predicaments of dementia care faced by healthcare personnel working in acute care setting, as well as the educational training intervention required to be implemented. Hopefully, nurses' ability to deal with problematic behaviours of dementia can be improved.

Effects of the biopsychosocial functional activity program on cognitive function for community older adults with mild cognitive impairment: A cluster-randomized controlled trial.

Early preventive interventions may delay the onset of dementia for people with mild cognitive impairment. This study was designed to examine the effects of the biopsychosocial functional activity program on the cognitive function of community middle to older adults with mild cognitive impairment. A cluster-randomized controlled trial was conducted. The experimental group received a 12-month biopsychosocial functional activity program intervention that contained two phases. The first phase was a 6-week teaching program followed by a second-phase home follow-up phase. The measurement was carried out at baseline, 6 months and 12 months after the biopsychosocial functional activity program. The measurement tool was the Chinese version of the Saint Louis University Mental Status Examination. The Generalized Estimating Equations statistical approach was used to analyze the data. The experimental group showed significant short-term and continuous improvement in overall cognitive function in the immediate- and short-term memory domain while the domain of attention and executive function showed improvement on the 12-month measurement compared to the control group. Yet, there was no significant improvement overall and in the three domains of cognitive function for the control group. The findings may become references for advancing the dementia prevention program for communities as well as the national policies for dementia prevention programs.

[Development and Psychometric Validation of a Tool for Assessing the Care Needs of Families of Patients With Dementia].

BACKGROUND: The rapid aging of the global population has sharply increased the prevalence of dementia. Most people with dementia (PwD) live at home and are cared for by family caregivers. The complicated care needs of PwD and family caregivers necessitate the provision of comprehensive and transdisciplinary assessment and service support. PURPOSE: The purpose of this study was to construct the contents of the "Assessment Tool for Family Care Needs of People with Dementia" using a transdisciplinary perspective and to establish the reliability and validity of this tool. METHODS: Based on a literature review and clinical experience, the preliminary items of the assessment tool were drawn up and pilot tests of the case were conducted in the Clinic for Dementia Care. The transdisciplinary research team discussed the pilot tests and verified the preliminary items, and then experts were invited to assess the content validity of the assessment tool. Next, quota sampling was conducted in accordance with the national proportion of the severity of dementia and the questionnaire surveys were administered in an outpatient department of neurology at a medical center in southern Taiwan. Two hundred dyads of PwD and their family caregivers participated in the survey. Reliability and validity analysis of the data were completed. RESULTS: The assessment tool contains 21 items of demographic data and 31 items in the eight subscales of "language and communication", "activities of daily living", "sleep", "activity arrangements", "nutrition and diet", "behavioral and psychological symptoms of dementia", "care stress", and "obtaining resources". The overall content validity of the assessment tool was .99 and the Cronbach's alpha of each subscale ranged between .625 and .905. The concurrent validities of the "activities of daily living" subscale and the "behavioral and psychological symptoms of dementia" subscale were, respectively, correlated with the Barthel Index (r = -.889, p < .001) and the Neuropsychiatric Inventory Questionnaire (r = .750, p < .001). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The assessment tool was assessed as having satisfactory validity and reliability. Moreover, the tool was clear and concise, and was able to be completed quickly by the caregivers. Transdisciplinary professionals involved in dementia care may use this assessment tool in outpatient departments, centers for integrated dementia care, and discharge preparation services to acquire information related to family care needs. The results of the assessment tool may be used as a reference in developing appropriate transdisciplinary care plans to improve the quality of care and quality of life of families of patients with dementia.

[Social Impacts of International Nursing Education].

The objective of international nursing education in Taiwan is to prepare nursing elites to improve the quality of global healthcare. Nurses are on the frontlines in terms of helping the public through increasingly frequent climate-change disasters, helping care for the rising populations of older adults and patients with chronic diseases, and dealing with the emergence of new infectious diseases. Advancing the knowledge and capabilities of global nursing elites is imperative. The main purpose of nursing education is to educate future nursing leaders. This paper describes the internationalization of nursing education in the Department of Nursing at National Cheng Kung University as well as the process of establishing the Asia-Pacific Nursing Education Alliance to highlight the international characteristics of nursing education, the related global social influence, and the pursuit of sustainable development goals.

[Factors Influencing "Face" in People With Dementia: A Systematic Review of the Literature].

BACKGROUND: Face (self-esteem) is an issue that involves socially endowed status, identity roles, and self-image management and maintenance. People with dementia and their family members often experience social isolation due to diminished self-image, which affects disease progression. Better understanding the factors that influence the self-image of people with dementia may promote the ability of caregivers to maintain self-image and promote public understanding and empathy toward people with dementia. PURPOSE: The aim of this study was to explore the factors influencing self-image in people with dementia using a systematic review of the literature. METHODS: A systematic review was used. Articles were retrieved from electronic databases including PubMed, CINAHL, Airiti Library, and Cochrane Library. The following keywords and MeSH terms were used to search for articles on dementia, face, self-esteem, respect, and self-concept. A total of 3,050 articles published prior to September 2018 that matched the search criteria were extracted. After screening the topics, deleting repetitions, and doing critical appraisals, eight articles were selected for analysis. Research quality was appraised using the Joanna Briggs Institute and the Melnyk and Fineout-Overholt for Evidence-Based Medicine Level of Evidence. RESULTS: Two themes related to the factors influencing self-image in people with dementia were extracted from the selected articles. The first theme was "loss of self-identity". As people with dementia gradually lose their cognitive function and memory ability, they are increasingly incapable of handling and managing their current role tasks. The second theme was "negative public perception". The public believes that people with dementia are at risk to others and that their behaviors are unpredictable, resulting in the deprivation of the rights to which people with dementia are entitled. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Because of disease progression, people with dementia gradually lose their self-identity and become unable to perform their life-role tasks. This is accompanied by negative perceptions of the disease among the public, which, in turn, damages the self-image of people with dementia and their families. The results of this review may provide a reference for caregivers planning future person-centered care approaches for people with dementia. In addition, these results may help facilitate the establishment of a more friendly environment for people with dementia in both public and private spaces.

Development of a Screening Scale for Community-dwelling Older Adults with Multiple Care Needs.

Objectives: To develop a screening scale for community-dwelling older adults with multiple care needs.Methods: A modified Delphi was employed; 10 experts were invited to evaluate the relevancy, clarity, and suitability of the scale. A descriptive evaluation survey was tested on the screening scale users who were community volunteers to evaluate the clarity, relevance, and usefulness of the scale using a 10-point rating system. Confirmatory factor analysis was applied to determine the suitability of the factorial structure of the HCOASS. The internal consistency was examined using Kuder-Richardson Formula 20. A suitable cutoff point was developed using receiver operating characteristic analysis.Results: In the first round of the modified Delphi, the item-level content validity index (I-CVI) on the content relevance, item clarity, and suitability of the scale were all higher than .90, .80, and .80, respectively. In the second round, the scores for content relevancy, item clarity, and suitability were all 1.0. Community volunteers rated highly on the scale. The result of the confirmatory factor analysis indicated a good fit. The internal consistency reliability was satisfactory. The area under curve (AUC), sensitivity, and specificity for cutoff score of 6/7 were .91, 88%, and 81%, respectively.Conclusions: The screening scale demonstrated adequate reliability, content validity, and discriminant validity.Clinical Implications: The screening scale would serve as a reference for community volunteers in the identification of community-dwelling older adults with multiple care needs.

Effects of walking on sundown syndrome in community-dwelling people with Alzheimer's disease.

BACKGROUND: Sundown syndrome is an important care issue for people with dementia (PwD) and for family caregivers. Walking is a safe and simple physical activity for most PwD, yet no research has explored the effects of different long-term walking periods on sundown syndrome. OBJECTIVES: This study aimed to determine the effects of walking on sundown syndrome, and to identify whether different walking time periods would show different effects on sundown syndrome in community-dwelling people with Alzheimer's disease. METHODS: A quasi-experimental designed study with repeated measurements was conducted. Sixty PwD were recruited and assigned to either the control group or the morning or afternoon walking group according to their caregiver's preference. The participants in the two walking groups completed an average of 120-min walking per week, accompanied by their caregivers. Forty-six achieved the 6-month intervention. Four measurements were taken, one at the pretest and one at weeks 8, 16 and 24. The Chinese version of the Cohen-Mansfield Agitation Inventory, community form (C-CMAI) was used to assess the severity of the sundown syndrome. The generalised estimating equation (GEE) was applied for the longitudinal data analysis. RESULTS: There was a significant change across the study period (p = .048) in the morning walking group, indicating that the score for sundown syndrome decreased when PwD walked in the morning. Considering group effects, compared to the control group, the C-CMAI scores significantly decreased after 16 weeks of walking in the afternoon walking group (p = .001) and after 24 weeks in both the morning and afternoon walking groups (p = .001), indicating that after PwD had walked for 16 weeks, sundown syndrome ameliorated in the afternoon group and continually decreased after 24 weeks in both the morning and afternoon groups. However, there was no significant group difference between the morning and afternoon walking groups during the 24-week walking intervention. CONCLUSIONS: The results indicated that both morning walking and afternoon walking are beneficial for ameliorating the symptoms of sundown syndrome; however, walking in the afternoon may have a faster effect on the symptoms than walking in the morning. Walking is a safe, simple, feasible and effective intervention to benefit individuals with sundown syndrome. IMPLICATIONS FOR PRACTICE: Regularly walking for 30 min a day, four times a week, is beneficial to alleviate sundown syndrome among PwD living in the community. Either morning or afternoon walking is effective for decreasing sundown syndrome, and the longer the walking time, the greater the impact on sundown syndrome.

Effects of Group Reminiscence Therapy on Agitated Behavior and Quality of Life in Taiwanese Older Adults With Dementia.

The purpose of the current study was to evaluate short- and long-term effects of group reminiscence on agitated symptoms and quality of life (QOL) for individuals with dementia. A quasi-experimental study using a repeated-measures design was conducted in 43 residents with dementia. Participants received a 50-minute group reminiscence therapy session once per week for 10 weeks. Outcomes were measured 1 week before, 1 week after, and at 3 months postintervention. Results showed no significant difference on the overall agitated behavior of participants. However, verbally aggressive behavior decreased significantly (p = 0.025), whereas intentional falling (p = 0.025), hoarding (p = 0.021), and akathisia (p = 0.027) significantly decreased in the short term. Participation in group reminiscence therapy significantly improved QOL (p < 0.001) across time periods for individuals with dementia. The findings provide information for professional and nonprofessional caregivers of individuals with specific agitated behaviors to improve their QOL. [Journal of Psychosocial Nursing and Mental Health Services, 57(8), 30-36.].