SAR-Connect: A Socially Assistive Robotic System to Support Activity and Social Engagement of Older Adults.

Multi-domain activities that incorporate physical, cognitive, and social stimuli can enhance older adults' overall health and quality of life. Several robotic platforms have been developed to provide these therapies in a quantifiable manner to complement healthcare personnel in resource-strapped long-term care settings. However, these platforms are primarily limited to one-to-one human robot interaction (HRI) and thus do not enhance social interaction. In this paper, we present a novel HRI framework and a realized platform called SAR-Connect to foster robot-mediated social interaction among older adults through carefully designed tasks that also incorporate physical and cognitive stimuli. SAR-Connect seamlessly integrates a humanoid robot with a virtual reality-based activity platform and a multimodal data acquisition module including game interaction, audio, visual and electroencephalography responses of the participants. Results from a laboratory-based user study with older adults indicates the potential of SAR-Connect that showed this system could 1) involve one or multiple older adults to perform multi-domain activities and provide dynamic guidance, 2) engage them in the robot-mediated task and foster human-human interaction, and 3) quantify their social and activity engagement from multiple sensory modalities.

Field Testing of Ro-Tri, a Robot-Mediated Triadic Interaction for Older Adults.

Older adults residing in long term care (LTC) settings commonly experience apathy, a neuropsychiatric condition with adverse consequences of increased morbidity and mortality. Activities that combine social, physical and cognitive stimuli are most effective in engaging older adults with apathy but are time consuming and require significant staff resources. We present the results from an initial pilot field study of our socially assistive robotic (SAR) system, Ro-Tri, capable of multi-modal interventions to foster social interaction between pairs of older adults. Seven paired participants attended two sessions a week for three weeks. Sessions consisted of robot-mediated triadic interactions with three types of activities repeated once over the 3 weeks. Ro-Tri gathered quantitative interaction data, head pose, vocal sound, and physiological signals to automatically evaluate older adults' activity and social engagement. Ro-Tri functioned smoothly without any technical issues. Older adults had > 90% attendance and 100% completion rate and remained engaged with the system throughout the study duration. Participants' visual attention toward the SAR system and their partners increased 7.2% and 4.7%, respectively, with their interaction effort showing an increase of 2.9%. Older adults and LTC staff had positive perceptions with the system. These initial results demonstrate Ro-Tri's ability to engage older adults, encourage social human-to-human interaction, and assess the changes using quantitative metrics. Future studies will determine SAR's impact on apathy in LTC older adults.

Socially Assistive Robots: Measuring Older Adults' Perceptions.

To address manpower shortages, health care leaders recommend technology, including robots, to facilitate and augment processes for delivery of efficient, safe care. Little is known regarding older adults' perceptions of socially assistive robots (SARs). Using the Unified Theory of Acceptance and Use Technology framework, a survey was developed and tested for capturing older adults' likelihood to use SARs. The Robot Acceptance Survey (RAS) comprises three subscales: Performance Expectancy, Effort Expectancy, and Attitude. Older adults completed the RAS pre- and post-experimental procedure with a SAR. Cronbach's alpha coefficients for the subscales ranged from 0.77 to 0.89. Subscales were sensitive to change, with more positive reactions after exposure to SAR activities. Future studies must identify robotic programming capable of providing cognitive, physical, and social assistance, as well as person-, activity-, situation-, and robot-specific factors that will influence older adults' acceptance of SARs. [Journal of Gerontological Nursing, 43(12), 35-43.].

Managing herpes zoster in older adults: Prescribing considerations.

NPs must be aware of special prescribing considerations for medication safety when managing the care of older adults with herpes zoster. Age-related physiologic changes of the body impact the pharmacokinetics and pharmacodynamics of antiviral and pain medications and can lead to potential adverse events.

A Robotic Coach Architecture for Elder Care (ROCARE) Based on Multi-User Engagement Models.

The aging population with its concomitant medical conditions, physical and cognitive impairments, at a time of strained resources, establishes the urgent need to explore advanced technologies that may enhance function and quality of life. Recently, robotic technology, especially socially assistive robotics has been investigated to address the physical, cognitive, and social needs of older adults. Most system to date have predominantly focused on one-on-one human robot interaction (HRI). In this paper, we present a multi-user engagement-based robotic coach system architecture (ROCARE). ROCARE is capable of administering both one-on-one and multi-user HRI, providing implicit and explicit channels of communication, and individualized activity management for long-term engagement. Two preliminary feasibility studies, a one-on-one interaction and a triadic interaction with two humans and a robot, were conducted and the results indicated potential usefulness and acceptance by older adults, with and without cognitive impairment.

Navigating DNP Student Needs: Faculty Advising Competencies and Effective Strategies for Development and Support.

Doctor of nursing practice (DNP) faculty advisers help students navigate academic challenges, professional development, and leadership opportunities while earning a DNP degree. Student needs during DNP education are unique from other programs and require careful advising to address common challenges. This article links student needs with advising competencies and presents strategies for faculty development and support.

Depression Training in an Assisted Living Facility: A Pilot Study.

Depression in older adults residing in assisted living facilities (ALFs) is often not recognized. ALF staff who work with residents on a daily basis are the most likely individuals to recognize residents' depressive symptoms. The purpose of the current pilot study was to determine feasibility of a 4-week training program for 15 direct care staff to recognize any depression symptoms of 32 residents. Although training significantly improved knowledge, it did not improve staff recognition of residents with positive depressive symptoms. Staff reported the training provided them a better understanding about depression and rated the training as very helpful to be able to recognize depression symptoms. Staff requested more information on ways to respond to someone who is depressed. Additional training should emphasize staff-resident communication skills for staff. Challenges included resident attrition and dwindling staff participation. Strategies to address these challenges are presented. [Journal of Psychosocial Nursing and Mental Health Services, 54(5), 25-31.].

The value of resident choice during daily care: do staff and families differ?

Allowing long-term care (LTC) residents to make choices about their daily life activities is a central tenet of resident-centered care. This study examined whether staff and family rated care episodes involving choice differently from care episodes not involving choice. Seventeen nurse aide and 15 family participants were shown paired video vignettes of care interactions. Participants were asked to rate their preferred care vignette using a standardized forced-choice questionnaire. Focus groups were held separately for staff and family members following this rating task to determine reasons for their preferences. Both staff and family rated the vignettes depicting choice as "strongly" preferred to the vignettes without choice. Reasons provided for the preference ratings during the focus group discussions related to resident well-being, sense of control, and respondents' own personal values. These findings have implications for LTC staff training related to resident-centered care to promote choice.

A controlled trial of an intervention to increase resident choice in long term care.

OBJECTIVE: The purpose of this study was to evaluate an intervention to improve staff offers of choice to nursing home residents during morning care. DESIGN: A controlled trial with a delayed intervention design. SETTING: Four community, for-profit nursing homes. PARTICIPANTS: A total of 169 long-stay nursing home residents who required staff assistance with morning care and were able to express their care preferences. INTERVENTION: Research staff held weekly training sessions with nurse aides (NAs) for 12 consecutive weeks focused on how to offer choice during four targeted morning care areas: when to get out of bed, when to get dressed/what to wear, incontinence care (changing and/or toileting), and where to dine. Training sessions consisted of brief video vignettes illustrating staff-resident interactions followed by weekly feedback about how often choice was being provided based on standardized observations of care conducted weekly by research staff. MEASUREMENTS: Research staff conducted standardized observations during a minimum of 4 consecutive morning hours per participant per week for 12 weeks of baseline and 12 weeks of intervention. RESULTS: There was a significant increase in the frequency that choice was offered for 3 of the 4 targeted morning care areas from baseline to intervention: (1) out of bed, 21% to 33% (P < .001); dressing, 20% to 32% (P < .001); incontinence care, 18% to 23%, (P < .014). Dining location (8% to 13%) was not significant. There was also a significant increase in the amount of NA staff time to provide care from baseline to intervention (8.01 ± 9.0 to 9.68 ± 9.9 minutes per person, P < .001). CONCLUSION: A staff training intervention improved the frequency with which NAs offered choice during morning care but also required more time. Despite significant improvements, choice was still offered one-third or less of the time during morning care.

Resident characteristics related to the lack of morning care provision in long-term care.

PURPOSE: The purpose of this study was to examine usual long-term care (LTC) practices related to 3 aspects of morning care and determine if there were resident characteristics related to the lack of care. DESIGN AND METHODS: Participants were 169 long-stay residents in 4 community LTC facilities who required staff assistance with either transfer out of bed, dressing, and/or incontinence care and were able to respond to structured interview questions about their morning care preferences. Trained research staff conducted standardized observations during 4 consecutive morning hours once per week per participant for 3 consecutive months during usual LTC conditions and interviewed participants about their morning care preferences using a structured interview protocol once per month during this same time period. RESULTS: Overall, 40% of the observations showed a lack of morning care provision, including any staff-resident communication about care, during the 4-hr observation period. Participants rated by staff as more physically dependent and requiring 2 staff for transfer were more likely to not receive morning care. Even when care in a particular area was absent, the majority of participants expressed a stable preference for care to remain the "same" (range of proportions was .75 to .87 for the 3 targeted care areas) and infrequently made requests for care. IMPLICATIONS: Efforts to promote resident-directed care should consider staffing issues related to missed care occurrences and resident issues related to level of dependency on staff as well as reduced expectations for care, which can lead to resident acceptance of low care frequencies.

Fatigability as a function of physical activity energy expenditure in older adults.

Increased fatigue is a predictor of morbidity and mortality in older adults. Fatigability defines a change in performance or self-reported fatigue in response to physical activity (PA). However, the relationship of fatigability to PA-related energy expenditure (PAEE) is unknown. Changes in performance, fatigue, and energy expenditure were measured simultaneously in 17 adults (11 females, 74-94 years old) performing eight standardized PA tasks with various energy expenditure requirements in a whole-room indirect calorimeter. Change in performance was objectively measured using a PA movement monitor and change in fatigue was self-reported on a seven-point scale for each task. Performance and perceived fatigability severity scores were calculated as a ratio of change in performance and fatigue, respectively, and PAEE. We found that change in both objective performance and self-reported fatigue were associated with energy expenditure (Spearman rho = -0.72 and -0.68, respectively, p < 0.001) on a task requiring relatively high level of energy expenditure. The performance and perceived fatigability severity scores were significantly correlated (rho = 0.77, p < 0.001) on this task. In summary, results of this proof of concept pilot study show that both perceived and performance fatigability severity scores are related to PAEE-induced fatigue on a task requiring relatively high level of energy expenditure. We conclude that fatigability severity is a valid measure of PAEE-induced fatigue in older adults.

Evaluation of two fatigability severity measures in elderly adults.

OBJECTIVES: To document the stability, concurrent validity, and clinical correlates of two fatigability severity measures as recommended by the American Geriatrics Society. DESIGN: Descriptive, cross-sectional. SETTING: Two independent living and one community senior centers. PARTICIPANTS: Forty-three participants, with an average age 85 ± 6. MEASUREMENTS: Perceived fatigability severity was quantified by directly asking participants to report change in energy after a standardized 10-minute walk at a self-selected pace. Performance fatigability severity was defined as a ratio of change in walking speed to total distance walked. The walk test was repeated within 2 weeks to assess stability. Total daily physical activity (PA) was measured over 7 consecutive days using a waist-worn accelerometer. Frailty was measured using the Vulnerable Elders Survey interview scale, and gait speed was measured using a standardized 25-feet walk test. RESULTS: The perceived and performance fatigability severity measures were significantly correlated (correlation coefficient (r) = 0.94, P < .001) and stable over two assessments (r = 0.82 and 0.85, P < .001). Both fatigability severity measures were significantly correlated with PA level (r = -0.42 and r = -0.44, respectively, P = .02), frailty (r = 0.47 and 0.53, respectively, P = .001) and gait speed (r = -0.45, P = .003 and r = -0.54, P = .001, respectively). CONCLUSION: The methodology described in this study permits the calculation of two highly correlated fatigability severity scores, which summarize the relationship between a person's change in self-reported tiredness or change in physical performance and concurrently measured PA. The fatigability severity scores are reproducible and correlated with clinical measures predictive of decline. The methods used to quantify fatigability severity can be implemented during a brief assessment (<15 minutes) and should be useful in the design and evaluation of interventions to increase PA in older adults at risk of functional decline.

Resident-directed long-term care: staff provision of choice during morning care.

PURPOSE: To develop an observational protocol to assess the quality of staff-resident communication relevant to choice and describe staff-resident interactions as preliminary evidence of the usefulness of the tool to assess current nursing home practices related to offering choice during morning care provision. DESIGN AND METHODS: This study included 73 long-stay residents in 2 facilities. Research staff conducted observations for 4 consecutive morning hours during targeted care activities (transfer out of bed, incontinence, dressing, and dining location). Observations were conducted weekly for 12 consecutive weeks. Staff-resident interactions were measured related to staff offers of choice and residents' responses. RESULTS: Interrater agreement was achieved for measures of staff offers of choice (kappa = .83, p < .001), type of choice provided (kappa = .75, p < .001), and resident requests related to choice (kappa = .72, p < .001). Observations over 2,766 care episodes during 4 aspects of morning care showed that staff offered residents choice during 18% of the episodes. Most observations (70%) were coded as staff offering "no choice." IMPLICATIONS: Nursing home staff can use a simplified version of this standardized observational tool to reliably measure staff-resident interactions related to choice during morning care provision as a first step toward improving resident-directed care practice.

The effect of tai chi on cognition in elders with cognitive impairment.

This one-arm pilot study investigated the effect of tai chi on cognition in elders with cognitive impairment. Although no significant difference existed between pre- and post-test performance on all cognition measures, a dose-response relationship was demonstrated between attendance and some cognition measures.

A controlled trial of an intervention to improve urinary and fecal incontinence and constipation.

OBJECTIVES: To evaluate effects of a multicomponent intervention on fecal incontinence (FI) and urinary incontinence (UI) outcomes. DESIGN: Randomized controlled trial. SETTING: Six nursing homes (NHs). PARTICIPANTS: One hundred twelve NH residents. INTERVENTION: Intervention subjects were offered toileting assistance, exercise, and choice of food and fluid snacks every 2 hours for 8 hours per day over 3 months. MEASUREMENTS: Frequency of UI and FI and rate of appropriate toileting as determined by direct checks from research staff. Anorectal assessments were completed on a subset of 29 residents. RESULTS: The intervention significantly increased physical activity, frequency of toileting, and food and fluid intake. UI improved (P=.049), as did frequency of bowel movements (P<.001) and percentage of bowel movements (P<.001) in the toilet. The frequency of FI did not change. Eighty-nine percent of subjects who underwent anorectal testing showed a dyssynergic voiding pattern, which could explain the lack of efficacy of this intervention program alone on FI. CONCLUSION: This multicomponent intervention significantly changed multiple risk factors associated with FI and increased bowel movements without decreasing FI. The dyssynergic voiding pattern and rectal hyposensitivity suggest that future interventions may have to be supplemented with bulking agents (fiber), biofeedback therapy, or both to improve bowel function.

Prevalence of constipation symptoms in fecally incontinent nursing home residents.

OBJECTIVES: To determine the prevalence of constipation symptoms and the effects of a brief toileting assistance trial on constipation in a sample of fecally incontinent nursing home (NH) residents. DESIGN: Observational study. SETTING: Five NHs. PARTICIPANTS: One hundred eleven fecally incontinent NH residents. MEASURES: Research staff measured bowel movement frequency every 2 hours for 10 days. The following week, residents were offered toileting assistance every 2 hours for 2 days to determine resident straining, time required for a bowel movement, and resident perceptions of feeling empty after a bowel movement. Constipation data were abstracted from the medical record. RESULTS: The frequency of bowel movements during usual NH care was low (mean=0.32 per person per day), and most episodes were incontinent. The frequency of bowel movements increased significantly, to 0.82 per person per day, and most episodes were continent during the 2 days that research staff provided toileting assistance. Eleven percent of residents showed evidence of straining, and 21% of the time after a continent bowel movement, residents reported not feeling empty. Five percent of participants had medical record or Minimum Data Set documentation indicative of constipation symptoms. CONCLUSION: Low rates of bowel movements during the day that are potentially indicative of constipation were immediately improved during a 2-day trial of toileting assistance in approximately 68% of the residents, although other symptoms of constipation remained in a subset of residents who increased toileting frequency.

The effect of tai chi on knee osteoarthritis pain in cognitively impaired elders: pilot study.

This article reports a pilot study of the effect of tai chi (TC), a pharmacological adjunct and mild aerobic exercise, on osteoarthritic knee pain in elders with cognitive impairment (CI). The TC program included a warm-up, 12-form Sun-style TC, and a cool-down period, for a total of 20-40 minutes per session, twice a week for 15 weeks. The results showed no significant differences in knee pain after the TC intervention in 7 elders with CI. However, more minutes of TC attendance were related to improved pain scores (Spearman's rho=.78, P < .05). Greater accuracy in TC performance was also correlated with improvements in pain scores (Spearman's rho = .70, P=.08). Of 4 elders who participated in TC practice regularly (more than 20 sessions), 3 showed clinically important improvements, but 3 elders who participated in no sessions or only a few sessions showed no improvement.

Using spirituality to cope with early-stage Alzheimer's disease.

Alzheimer's disease (AD) robs persons living with the disease of their independence and self-esteem, which can lead to depression, anxiety, and loneliness. Understanding how people with early-stage AD cope is a critical step in enhancing their adaptive abilities and ultimately improving their quality of life. This qualitative study describes how individuals with early-stage AD use spirituality to cope with the losses of self-esteem, independence, and social interaction that they face. The purposive sample for this focused ethnographic study consisted of 15 participants living at home in central Arkansas. Holding onto faith, seeking reassurance and hope, and staying connected were the global themes. Personal faith, prayer, connection to church, and family support enhanced the ability of people with early-stage AD to keep a positive attitude as they face living with AD.

Challenges in conducting qualitative research with individuals with dementia.

Qualitative research can capture the meaningful experiences and life values of individuals with dementia not reported in quantitative studies. This article shares a personal experience of the challenges faced and the lessons learned while conducting a qualitative study of 15 people with early-stage Alzheimer's disease. The purpose of this article is to discuss the issues concerning determination of capacity to consent to research, consent/assent, communication challenges, and trustworthiness of data when conducting a qualitative study of people with dementia. Understanding communication challenges related to dementia is important to develop effective communication strategies, such as simplifying the structure of questions, allowing ample time for the participant's response, using reminiscence, and redirecting the dialogue. This information will be valuable to researchers conducting qualitative studies and the resulting contributions to the body of knowledge about Alzheimer's disease.

The Feasibility of Implementing Tai Chi for Nursing Home Residents With Knee Osteoarthritis and Cognitive Impairment.

This paper addresses the feasibility of implementing Tai Chi (TC) as an intervention for nursing home residents with osteoarthritis knee and cognitive impairment (CI). Recruiting elderly residents to participate was difficult. Only 9 out of the 31 originally thought eligible meet study criteria and 8 of the 9 elders eventually completed the study. With 2 sessions per week, the elders needed 8-10 weeks to learn the complete set of TC. They could not memorize the TC sequences, but they could follow the instructor who also employed verbal and visual cueing during the intervention. Clearly, elders with CI need different teaching methods and doses of TC. Using extended TC and teaching strategies tailored to participants' physical and cognitive capacity may promote effective learning.