Non-pharmacological interventions for managing dementia-related sleep problems within community dwelling pairs: A mixed-method approach.

Dementia-related sleep problems can be complex and challenging. Environmental interventions which resynchronise the sleep/wake cycle have been trialled with promising results for people with dementia in institutionalised settings. However, there is less research concerning community-dwelling people with dementia and their family carers. This study involved a five-week feasibility study including timed light therapy, exercise and sleep education. Sleep and physical and mental functioning were measured at the beginning and end of the trial using objective measures, standardised questionnaires and structured participant feedback. Of 15 community-dwelling pairs who participated, nine completed the trial. The case studies presented here reveal that it is feasible for this population to use non-pharmacological interventions, with positive outcomes. However, there are also issues that can mask benefits or prevent compliance. The options for treating dementia are limited. Environmental interventions may help manage dementia-related sleep problems and further trials would be worthwhile to improve compliance and evaluate effectiveness.

Understanding the sleep problems of people with dementia and their family caregivers.

Sleep disturbances are common with dementia and can adversely affect waking function. However, the perspectives of people with dementia and their family caregivers concerning their sleep are under-researched. We conducted three focus groups with 12 community-dwelling pairs (a person with dementia and their family caregiver). Discussions addressed sleep disturbances, coping strategies, and beliefs and attitudes surrounding sleep. Thematic analysis indicated that dementia-related sleep disturbances were common, including confused awakenings and dementia-related behaviors at night, changes to sleep timing, and nightmares. Common issues for caregivers included being woken at night, having problems getting back to sleep, trips to the bathroom, and daytime sleepiness. Participants often normalized their sleeping problems and had developed a number of coping strategies. These findings highlight the impact that sleep disturbances can have on people living with dementia. Their experiences and beliefs need to be considered for developing effective interventions to improve sleep, waking function, and wellbeing.

Validating a measure of children's monitoring-blunting coping styles in dental situations.

The monitoring-blunting theory of coping suggests that when faced with a threatening situation, individuals can respond by either monitoring or avoiding (blunting) threatening information. The current study sought to validate a scale of children's preferences for monitoring or blunting in dental situations (the Monitoring Blunting Dental Scale or MBDS). The psychometric characteristics of the scale were assessed in a sample of 240 New Zealand children aged 11-13. Reliability was adequate for both monitoring (α = 0.74) and blunting (α = 0.76) subscale scores. Convergent validity was indicated by strong correlations (>0.6) between the measure's subscales and those of a related scale, although discriminant validity with respect to dental anxiety was problematic for the blunting subscale. Exploratory factor analysis supported a two-factor monitoring-blunting model, although confirmatory factor analysis indicated reasonable but imperfect fit for this model, SBχ²(251) = 510.7, p < 0.001, RMSEA = 0.066. We reflect on conceptual issues which may underlie the difficulties experienced here and elsewhere in developing psychometrically sound measures of Miller's blunting construct and suggest that the monitoring subscale of the study scale may be most useful to other researchers.

Assessing children's dental anxiety in New Zealand.

OBJECTIVES: To investigate the reliability and validity of computerized anxiety assessment with New Zealand children, and to explore children's preferences for the method of anxiety assessment. DESIGN: A validation study including test-retest reliability, and mean anxiety scores for items on the computerised Smiley Faces Program-Revised scale (SFP-R), together with qualitative data on children's preferences following two computer assessments and a pen-and-paper assessment using the Modified Children's Dental Anxiety Scale. PARTICIPANTS: 206 children ranging in age from five to 13 years and from from three primary schools (one each of high, medium and low decile ranking). Approximately one-third (33%) were European, one-quarter M&ori or Polynesian, and 38% were Asian. RESULTS: Estimates of internal consistency, (calculated using Cronbach's alpha), demonstrated an acceptable level of reliability for the SFP-R (alpha = 0.75). Test-retest data from the sub-sample of children across a two-week period showed a strong correlation (r = 0.75, p < 0.001). The SFP-R was found to significantly correlate with the MCDAS demonstrating concurrent validity (r = 0.67, p < 0.01). The mean anxiety score for all children was 19.9 (SD = 6.1). A two-way analysis of variance was employed to test for the effect of gender and age on total dental anxiety scores. There was no main effect for gender (F(1, 195) = 0.017, p > 0.05) or age group (F(3, 195) = 1.527, p > 0.05) and no interaction between the two factors. Children rated themselves most anxious when faced with the drill (mean = 4.5, SD = 1.7). 'Happy' faces were chosen some of the time for all of the items, even for the invasive procedures. CONCLUSIONS: The SFP-R demonstrated good reliability and validity with New Zealand children and data indicated that it is a stable measure over time. It demonstrated concurrent validity, as evidenced by the moderately strong correlation with the MCDAS. Mean scores and frequency data suggest that, as there is still a significant proportion of children with very high overall anxiety scores, dental anxiety should be formally assessed and managed in NZ children. Children's preferences were for the computerised assessment of dental anxiety, supporting the continued development of Dental Jungle, the New Zealand dental anxiety intervention program.