Factors associated with the quality of life of persons with young-onset dementia: A systematic literature review.

This review examines factors associated with quality of life (QoL) in persons with young-onset dementia (YOD). Studies investigating and analysing factors related to QoL in persons with YOD were included. Databases searched included PubMed, CINAHL, Web of Science, EMBASE, and SCOPUS. Due to inconsistent outcome variables across studies, synthesis without meta-analysis was used for data integration. Methodological quality was assessed, and results were synthesised. Eleven studies were included in this review, identifying different factors influencing QoL in persons with YOD, which could be categorised into six groups. Behavioural and psychiatric factors showed the highest significant findings ratio (SFR), as determined by the ratio of 'studies finding significance' to the 'total number of studies addressing the factor'. Following in terms of SFR were care-related and physical factors. Demographic and dementia-characteristic factors had the lowest SFR. Among single factors, depressive symptoms, and neuropsychiatric symptoms, both included in behavioural and psychiatric factors, had the highest SFR. This systematic review highlights the importance of behavioural and psychiatric elements in QoL in persons with young onset and points to depressive symptoms and neuropsychiatric symptoms as potential therapeutic targets. However, as research on QoL in persons with YOD continues to expand, the inclusion of methods such as meta-analysis may be beneficial.

Non-pharmacological interventions for people living with young-onset dementia and their carers: A scoping review focussing on the support of participants' needs.

WHAT IS KNOWN ON THE SUBJECT?: Young-onset dementia (YOD) refers to a phenomenon in which dementia symptoms appear under age 65. Diagnosing YOD is difficult and its progression is fast. Furthermore, it limits the socio-economic careers of people living with YOD, regardless of their needs. People living with YOD and their carers have unstable occupational status and their dependents also have to face a high burden of care. They claim that existing social support for dementia is limited to the elderly and is not suitable for them. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The characteristics of non-pharmacological intervention studies for people living with YOD and/or their carers so far, and an analysis of the needs supported via the applied interventions. A theoretical basis and direction for the interventions to be studied in the future. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Research and intervention development should focus more on the needs of people living with YOD. In addition, it is necessary to understand and reflect on carers who directly care for people living with YOD. A multidisciplinary programme that supports wide area of the needs should be developed. ABSTRACT: INTRODUCTION: Young-onset dementia (YOD) is a highly influential disease that exerts force on the normal life of those who still have to continue social life. Research has been lacking in spite of its seriousness, which accounts for about 9% of all dementia cases. AIM: This study aimed to examine non-pharmacological interventions for people living with YOD and/or their carers, and to analyse how those interventions support their needs. METHOD: A scoping review methodology was utilized to search the studies examining interventions for people living with YOD and/or their carers, and in English or Korean. The information was extracted, summarized and analysed in CANE categories. RESULTS: Sixteen studies were included in the review. Five types of interventions were drawn. 'Memory' was the most covered part of the needs by the interventions. DISCUSSION: This study found that interventions currently do not match the needs of people living with YOD and their carers. Multidisciplinary research would be eligible to cover the subjects' wide range of the needs as much as possible. IMPLICATIONS FOR PRACTICE: We suggest the development of a specialized needs assessment tool and specialized interventions for people living with young-onset dementia and their carers.

Virtual Reality-Based Education Program for Managing Behavioral and Psychological Symptoms of Dementia: Development and Feasibility Test.

This study aims to develop a virtual reality-based education program for managing behavioral and psychological symptoms of dementia for family carers of persons living with dementia and investigate the feasibility for users. The program was developed through literature review, interviews with family carers, surveys, and expert content validity assessment. User feasibility was evaluated quantitatively through a questionnaire on usefulness, ease of use, and satisfaction, and qualitatively through participant interviews. The program was produced in two parts, Type 1 and Type 2, consisting of three and six episodes, respectively. Participants showed a high level of satisfaction with overall program scores of 4.28 ± 0.66 and 4.34 ± 0.41 for the two evaluations. Participants also expressed that both programs were helpful, Type 1 for achieving changes in attitude associated with more understanding of persons living with dementia and Type 2 for acquiring coping methods through communication training. Use of the virtual reality device was not inconvenient and was identified as helpful due to the high immersion experience. Results of this study confirmed that family carers had no resistance to education using new technologies such as virtual reality devices and that virtual reality-based education could be effective for training family carers.

Development of examination objectives based on nursing competency for the Korean Nursing Licensing Examination: a validity study

PURPOSE: This study aimed to develop the examination objectives based on nursing competency of the Korean Nursing Licensing Examination. METHODS: This is a validity study to develop the examination objectives based on nursing competency. Data were collected in December 2021. We reviewed the literature related to changing nurse roles and on the learning objectives for the Korea Medical Licensing Examination and other health personnel licensing examinations. Thereafter, we created a draft of the nursing problems list for examination objectives based on the literature review, and the content validity was evaluated by experts. A final draft of the examination objectives is presented and discussed. RESULTS: A total of 4 domains, 12 classes, and 85 nursing problems for the Korean Nursing Licensing Examination were developed. They included the essentials of objectives, related factors, evaluation goals, related activity statements, related clients, related settings, and specific outcomes. CONCLUSION: This study developed a draft of the examination objectives based on clinical competency that were related to the clinical situations of nurses and comprised appropriate test items for the licensing examination. Above results may be able to provide fundamental data for item development that reflects future nursing practices.

The Competence Scale in Managing Behavioral and Psychological Symptoms of Dementia (CS-MBPSD) for family caregivers: Instrument development and cross-sectional validation study.

BACKGROUND: Families' caring competence plays a key role in caring for the elderly with dementia. In particular, the management of the behavioural and psychological symptoms of dementia is different from the management of other symptoms of dementia. However, there is no tool for evaluating family caregiver competence for managing the behavioural and psychological symptoms of dementia. OBJECTIVE: This study aimed to develop a competence scale in managing the behavioural and psychological symptoms of dementia for family caregivers and to evaluate its psychometric properties. DESIGN: An instrument development and cross-sectional validation study was conducted. SETTINGS: Twenty-one local dementia centres in Seoul, Korea. PARTICIPANTS: A total of 460 community-dwelling family caregivers of people living with dementia (mean age = 69.82 ± 11.08, female = 78.7%, spouse = 65.7%) participated in the study. METHODS: This study was conducted in two steps: (1) instrument development and (2) psychometric tests (N = 460). After item generation and the evaluation of content validity and face validity, a total of 39 preliminary items were tested. For the psychometric tests, item analysis using the corrected item-to-total correlations and construct validity with exploratory and confirmatory factor analysis were performed. Using measurement tools of the Behaviour Management Skill, a Visual Analogue Scale, and a general question of the scale developed in this study, the concurrent validity was examined by calculating Pearson's correlation coefficient. Reliability was evaluated with Cronbach's α, test reliability with the standard error of measurement, and test-retest reliability with the intraclass correlation coefficient. RESULTS: The exploratory and confirmatory factor analyses yielded a six-factor solution with 28 items. The six factors were 'person-centred attitude', 'introspection for improvement', 'symptom occurrence analysis', 'application of various strategies', 'awareness of symptoms' and 'caring for one's own mind and body'. The concurrent validity was established. The reliability was demonstrated to be acceptable (Cronbach's α = 0.922, ICC = 0.781). CONCLUSIONS: The competence scale in managing the behavioural and psychological symptoms of dementia for family caregivers was found to be a valid and reliable instrument. The scale is potentially useful for promoting better dementia care in both research and clinical practice settings by enabling the identification of needs to be improved for family caregivers in coping with dementia symptoms.

Korean Family Caregivers' Experiences With Managing Behavioral and Psychological Symptoms of Dementia: Keeping Harmony in Daily Life.

Behavioral and psychological symptoms of dementia (BPSD) are symptoms of dementia that family caregivers find difficult to manage. Competence in managing BPSD differs according to individual family caregiver. The current study investigated the competence in managing BPSD, focusing on family caregivers who were recognized as managing them well. Twenty-four Korean family caregivers (83% female, mean age = 67 years) living with persons with dementia (PWD) were interviewed. Four themes were derived from the content analysis: Entering and Looking into the World of PWD, Keeping Daily Life in Harmony With BPSD, Becoming an Expert in BPSD, and Balancing Between Caregiving and Myself. Family caregivers minimized the impact of BPSD and maintained life balance. As a result, they were able to continue a harmonious life with PWD. [Research in Gerontological Nursing, 15(3), 141-150.].

Family caregiver competence in managing behavioral and psychological symptoms of dementia: A concept synthesis.

AIM: This study aimed to identify the attributes of "family caregiver competence in managing behavioral psychological symptoms of dementia". METHODS: Six electronic databases were searched for studies published between January 1990 and June 2017 with the key words "dementia", "behavioral psychological symptoms of dementia", "caregiver", "coping (managing)", and "competence". From the final fully reviewed 26 articles, descriptions related to family caregiver's dealing with behavioral psychological symptoms of dementia were extracted first. Then, based on Walker and Avant's concept synthesis, the concept of "family caregiver competence in managing behavioral psychological symptoms of dementia" was explored. RESULTS: Four attributes, namely "Judging", "Empathizing", "Adjusting", and "Reflecting", comprised of ten categories were identified as constituting the concept of family caregiver competence in managing the behavioral psychological symptoms of dementia. As a meta competence, "reflecting" may play a significant role in improving family caregiver competence by interacting with the other dimensions of competence in managing symptoms. CONCLUSIONS: Based on the suggested conceptual model, education or training programs could be developed to improve family caregiver competence in managing behavioral psychological symptoms of dementia. To refine the attributes found in this study, field studies including observations of and interviews with family caregivers need to be conducted. Studies exploring the associations between these attributes are also of value.

Maintenance of Continuity in Older Adulthood: Concept Analysis.

PURPOSE: This article aims to define the concept of maintenance of continuity in older adulthood (MCOA) and assist nurses to better understand the concept of MCOA. METHODS: The method by Walker and Avant was used for this concept analysis. FINDINGS: In the literature, MCOA is defined as a psychosocial adaptation strategy by searching for preference and familiarity, making a sense of connection, and creating coherence. CONCLUSIONS: MCOA has potential to improve psychosocial adjustment to difficult life transitions as a coping mechanism. IMPLICATION FOR NURSING PRACTICE: Insights about MCOA in nursing may contribute to improved patient care outcomes by assisting nurses to understand the elderly's experience during age-related challenges from a life course perspective.

National study of the nutritional status of Korean older adults with dementia who are living in long-term care settings.

AIM: To evaluate the nutritional status of older adults with dementia who were living in long-term care settings. METHODS: As a secondary analysis, this study used the data from the Nationwide Survey on Dementia Care in Korea that was conducted between December 1, 2010, and August 31, 2011, which surveyed 3472 older adults with dementia, aged ≥60 years (mean age: 81.24 years), who were residing in 248 randomly selected long-term care settings in South Korea. Twenty-three different variables that related to the participants' demographics, diseases, and functional and nutritional characteristics were selected. The nutritional status was assessed by using the Mini Nutritional Assessment (MNA). Descriptive statistics, an ANOVA, and a chi-squared test were used to analyze the data. RESULTS: The mean MNA score of the participants was 17.90. The malnutrition rate was 38.4% (n = 1333), with 54.7% (n = 1900) of the participants at risk for malnutrition. The largest population with malnutrition resided in long-term care hospitals (47.9%), followed by nursing homes (34.1%), and group homes (25.9%). Being older and female, while exhibiting higher cognitive impairment, more neuropsychiatric symptoms, higher functional dependency, and a higher number of disabilities, were associated with poor nutritional status. CONCLUSION: The nutritional status of older adults with dementia who were living in long-term care settings in South Korea was poor and associated with multiple factors. Paying special attention to recognizing, assessing, preventing, and treating malnutrition in this population is necessary.

Patient and Caregiver Interplay in Behavioral and Psychological Symptoms of Dementia: Family Caregiver's Experience.

The purpose of this study was to identify family caregivers' experiences in managing the behavioral and psychological symptoms of dementia (BPSD) with particular focus on their interpersonal interactions with patient with dementia. Data were collected through focus-group interviews with 15 family caregivers from three local dementia-support centers located in Seoul. Data were analyzed using content analysis. Three main themes were identified through data analysis: triggers of BPSD, family caregiver's actions in response to BPSD and patient's reactions, and the effect of BPSD on family caregivers. Findings demonstrated that BPSD depended on the complex interplay of family caregivers and patients, including their interaction style. This information could help nurses when counseling and educating family caregivers to improve or modify their attitudes and approaches to behavioral symptoms of patients.

A Relationship between Depression and Wandering in Community-Dwelling Elders with Dementia.

BACKGROUND AND PURPOSE: Wandering is one of the most common behavioral and psychological symptoms of dementia, and associated with some of the adverse outcomes in dementia, such as getting lost or even death. The etiology of wandering is not yet clearly known. As depression and wandering are both very common among the patients with dementia, this study examined the relationship between the depression and wandering among the community dwelling patients with dementia. METHODS: Fifty community dwelling patients diagnosed with dementia were included in this study if they had primary family caregiver, older than age 18 in Seoul, South Korea. The Geriatric Depression Scale, Korean Version (GDS-K), Korean Version of the Mini-Mental State Examination (K-MMSE) and Korean Version of Revised Algase Wandering Scale-Community Version (K-RAWS-CV) were used to measure the severity of depression, cognitive function and wandering. RESULTS: Thirty percents of the patients showed wandering. Mean score of GDS-K was significantly higher in wanderers than non-wanderers. Severity of depression was significantly correlated with the total score of K-RAWS-CV and subscales of persistent walking, repetitive walking, eloping behavior, and mealtime impulsivity in whole sample. K-MMSE score also was related to wandering behavior. The prevalence odds ratio for wandering in depressed patients compared with undepressed group was 8.386 (95% confidence interval: 1.978-35.561). CONCLUSIONS: This study implicates that not only cognitive impairment but also psychosocial aspects should be considered in wandering patients with dementia and suggests assessing the depression in patients would be helpful in identifying the causes of wandering.

Predictors of Agreement With Writing Advance Directives Among Older Korean Adults.

PURPOSE: To determine the predictors of agreement with writing advance directives (ADs) among older Korean adults. DESIGN: This was a secondary analysis of a study that compared the differences in knowledge, experience, and preference about ADs between community and facility-dwelling older adults. Data were collected through self-reported questionnaires. In this study, after 25 cases were excluded from the original sample (N = 181) for incomplete data, a sample of 156 was analyzed using multiple logistic regression analysis. RESULTS: Older adults' experiences with having thought about life-sustaining treatments, odds ratio (OR) = 4.02, 95% confidence interval (CI) [1.56, 10.38], agreements with legalization of ADs, OR = 4.68, 95% CI [1.69, 12.96], and wishes to obtain information about medical status, OR = 3.78, 95% CI [1.66, 8.64], were identified as the predictors of agreement with writing ADs. IMPLICATIONS FOR PRACTICE: Discussion channels and educational programs about ADs should be developed for older Korean adults.

The Association Between the Burden on Formal Caregivers and Behavioral and Psychological Symptoms of Dementia (BPSD) in Korean Elderly in Nursing Homes.

Behavioral and psychological symptoms of dementia (BPSD) are sources of psychological distress for caregivers who take care of people with dementia. The purpose of this study was to examine the association between BPSD and the burden on formal caregivers of nursing homes in South Korea. Results showed that the total severity score of BPSD had a statistically significant positive correlation with the total distress score. Agitation/Aggression was the most distressing symptom for registered nurses and care workers. These findings suggest that there is a need for improved treatments for BPSD, to help mitigate its burden on formal caregivers.

Factors influencing the degree of eating ability among people with dementia.

AIMS AND OBJECTIVES: To explore the degree of eating ability in people with dementia and identify what factors affect their eating ability. BACKGROUND: Appropriate food consumption is important to human life. Although eating difficulties are common among people with dementia, little is known about what factors might influence their eating ability. DESIGN: Descriptive, cross-sectional study. METHODS: A total of 149 people with dementia residing in nursing facilities in Seoul or the Gyeonggi area of Korea were evaluated using the Korean Mini-Mental State Examination, Korean Activities of Daily Living Scale and Eating Behaviour Scale. Data were analysed using descriptive statistics, one-way analysis of variance, Pearson correlation coefficient and multiple regression analysis. RESULTS: The participants showed a moderate level of dependency with respect to eating ability and were most dependent on the use of utensils. There were significant differences in eating ability according to general characteristics such as duration of residence, duration of illness, degree of visual impairment, eating place, and diet type. The eating ability of the participants was significantly correlated with cognitive function and physical function. Cognitive function, physical function, duration of illness, eating place (living room or dining room), and diet type (soft or liquid) significantly predicted eating ability in people with dementia. CONCLUSIONS: The findings of this study suggest that it is necessary to thoroughly assess the eating ability of people with dementia and to develop appropriate training programs to maintain or improve their remaining eating ability. The creation of a pleasurable physical and social environment for eating might also be helpful. RELEVANCE TO CLINICAL PRACTICE: These findings would be able to serve a useful basis in the development of materials for nursing intervention programs for people with dementia during mealtimes by improving the techniques and care qualities of nursing caregivers.

Effect of domain-specific life satisfaction on depressive symptoms in late adulthood and old age: results of a cross-sectional descriptive survey.

PURPOSE: The aim of this study was to determine the effect of domain-specific life satisfaction on the risk of depressive symptoms in late adulthood and old age. METHODS: A cross-sectional descriptive survey was conducted using stratified data from the Korean Longitudinal Study of Aging (KLoSA). The respondents completed the Korean version CES-D and domain-specific life satisfaction. RESULTS: In both groups, satisfaction with health and economic status were significant predictors of depressive symptoms. In the old age group, depressive symptoms were also predicted by satisfaction with the relationships with one's spouse and with one's children. CONCLUSION: Life satisfaction was a crucial predictive factor for depressive symptoms in late adulthood and old age.

[Characteristics of eating behavior in elders with dementia residing in long-term care facilities].

PURPOSE: The purpose of this study was to explore characteristics of eating behavior according to level of functional status of elders with dementia (EWD), and to examine feeding time, change in food intake and body mass index (BMI) according to eating behavior. METHODS: Participants were 149 EWD residing in long-term care facilities located in Seoul or Gyeonggi province and evaluated using the Mini-Mental State Exam-Korean version, Korean version-Activities of Daily Living, and Eating Behavior Scale (EBS). Feeding time, change in food intake, and BMI were also measured. Data were analyzed using SPSS 17.0, specifically descriptive statistics, ANOVA, and Chi-square test. RESULTS: Participants' mean EBS score was 10.43±6.01 and half of them (54.4%) needed moderate or total assistance while eating. The EBS score was significantly lower for elders with severe dementia compared to those with mild or moderate dementia; and elders with severe ADL dependence compared to those with mild or moderate ADL dependence. Lower EBS scores were related to longer feeding time, a greater the rate of participants with decreased food intake and 'underweight' BMI. CONCLUSION: Nursing intervention programs which are designed for EWD are needed to maintain functional eating skills and prevent negative consequences in this population.

Estimates of crowding in long-term care: comparing two approaches.

OBJECTIVE: Because studies of crowding in long-term care settings are lacking, the authors sought to: (1) generate initial estimates of crowding in nursing homes and assisted living facilities; and (2) evaluate two operational approaches to its measurement. BACKGROUND: Reactions to density and proximity are complex. Greater density intensifies people's reaction to a situation in the direction (positive or negative) that they would react if the situation were to occur under less dense conditions. People with dementia are especially reactive to the environment. METHODS: Using a cross-sectional correlational design in nursing homes and assisted living facilities involving 185 participants, multiple observations (N = 6,455) of crowding and other environmental variables were made. Crowding, location, and sound were measured three times per observation; ambiance was measured once. Data analyses consisted of descriptive statistics, t-tests, and one-way analysis of variance. RESULTS: Crowding estimates were higher for nursing homes and in dining and activity rooms. Crowding also varied across settings and locations by time of day. Overall, the interaction of location and time affected crowding significantly (N = 5,559, df [47, 511], F = 105.69, p < .0001); effects were greater within location-by-hour than between location-by-hour, but the effect explained slightly less variance in Long-Term Care Crowding Index (LTC-CI) estimates (47.41%) than location alone. Crowding had small, direct, and highly significant correlations with sound and with the engaging subscale for ambiance; a similar, though inverse, correlation was seen with the soothing subscale for ambiance. CONCLUSIONS: Crowding fluctuates consistent with routine activities such as meals in long-term care settings. Furthermore, a relationship between crowding and other physical characteristics of the environment was found. The LTC-CI is likely to be more sensitive than simple people counts when seeking to evaluate the effects of crowding on the behavior of elders-particularly those with dementia-in long-term care settings. aging in place.

Relationship between familiar environment and wandering behaviour among Korean elders with dementia.

AIM: To explore the relationship between wandering behaviour and familiar environment in community-residing persons with dementia in Korea. BACKGROUND: Numerous non-pharmacological interventions have been developed to decrease behavioural symptoms and to increase the quality of life among persons with dementia. Although the concept of familiarity is very important and environmental interventions using the concept should have been developed for persons with dementia, no study examining even the direct relationship between familiar environment and wandering has yet been published. DESIGN: A descriptive, cross-sectional survey design. METHODS: A convenience sample was gathered of 77 non-institutionalised, community-dwelling persons with dementia and their family caregivers in Seoul and Wonju, South Korea. Descriptive statics, Pearson's correlations, t-tests, and multiple regressions were used in the data analysis. RESULTS: The mean age of persons with dementia was 76.9 years (SD 8.0) and their mean cognitive level score using the Mini-Mental State Examination was 13.51 (SD 6.10). Most persons with dementia (71.4%) had been diagnosed with known types of dementia such as Alzheimer's disease, multiple infarct dementia, mixed type or Parkinson's disease with dementia. A familiar feeling with the environment was associated with cognitive impairment (r = 0.32, p < 0.01) and physical dependency in activities of daily living (r = -0.38, p <0.01). In addition, a familiar feeling with the environment (r = -0.56, p < 0.001) and physical dependency in activities of daily living (r = 0.56, p < 0.001) were strongly related to wandering behaviour. Familiarity and physical dependency in activities of daily living were the significant predictors for overall wandering and they explained 45% of the total variance. Cognitive impairment was the only significant predictor on the subscale of spatial disorientation. CONCLUSIONS: It was found that a familiar feeling with the environment was an important factor affecting persons with dementia's cognitive and functional abilities as well as specific features of wandering. However, future research using a more reliable method is necessary to confirm the findings obtained in this study. RELEVANCE TO CLINICAL PRACTICE: This study suggested that providing persons with dementia with a familiar feeling in daily clinical practice through establishment of familiar physical as well as psychosocial environment may have benefit to decrease wandering behaviour.

Premorbid characteristics and wandering behavior in persons with dementia.

This study aimed to explore relationships of premorbid personality and behavioral responses to stress with wandering behavior of persons with dementia in long-term care facilities. Ambulatory residents (N = 108) with dementia were selected from 21 long-term care facilities. The Mini-Mental State Examination, the NEO Five-Factor Personality Inventory, the Behavioral Responses to Stress Scale, and the Revised Algase Wandering Scale-Nursing Home Version (RAWS-NH) were used as data collection tools. When the MMSE and age were controlled, regression analyses revealed that premorbid extroversion and premorbid negative verbalization stress response were significant negative predictors for the overall RAWS-NH and some subscales.

Wandering behaviour of persons with dementia in Korea: investigation of related factors.

OBJECTIVES: Despite being identified as a significant clinical phenomenon, wandering of persons with dementia (PWDs) has not been studied in Korea. As an initial trial, various factors chosen from the literature for their predictive relationships to wandering of Korean PWDs were evaluated in this study. METHOD: A total of 160 PWDs residing in 14 long-term care facilities participated in this study. The Mini-Mental State Exam (MMSE), Physical Activities of Daily Living (PADL) and Korean-translated Revised Algase Wandering Scale (Nursing Home version) (KRAWS-NH) were used to assess participants' degree of cognitive impairment, functional ability and wandering behaviour on six dimensions: persistent walking (PW), specific patterns (SP), spatial disorientation (SD), escape behaviour (EB), attention shift (AS) and negative outcomes (NO). Demographic, personal and environmental data were also collected. RESULTS: The MMSE score was a significant negative predictor for KRAWS-NH overall and subscales except for EB; while age, PADL and history of falls were positive predictors for SD and NO. Total number of residents in a room was a significant negative predictor for EB and AS. CONCLUSION: Different factors found in PWDs may contribute to different aspects of wandering behaviour. Further studies on factors influencing multiple facets of wandering in various cultural settings are warranted.