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1.
Geriatr Nurs ; 45: 153-159, 2022 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-35472750

RESUMO

OBJECTIVES: To identify predictors of change in older adults' satisfaction with outdoor activities ratings over the first two years of enrollment in long-term services and supports (LTSS). METHODS: Self-rated satisfaction with outdoor activities (not at all satisfied to extremely satisfied) was the primary outcome of this secondary data analysis. Mixed-effects linear regression modeling with a backward elimination process was used for analyses. RESULTS: In the final model (N = 453) older LTSS recipients at baseline had lower ratings of satisfaction with outdoor activities over time, whereas younger recipients had higher ratings over time. Those who moved into a residential facility at baseline had an increase in outdoor activity satisfaction ratings over time compared to older adults who received home and community-based services that had a decrease. DISCUSSION: LTSS clinicians can use these findings to support older adults with decision-making around enrollment into LTSS, address preferences, and develop person-centered care interventions for outdoor activity.

2.
J Am Coll Health ; : 1-8, 2022 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-35298364

RESUMO

Objectives: Racial aggression against Asians and the implementation of state-wide stay-at-home orders during the COVID-19 pandemic may have negatively impacted mental health in Asian international graduate students in the United States, yet these relationships are unknown. Therefore, this study was conducted to investigate these relationships. Participants: Data were collected from 177 participants from four universities. Methods: On-line survey was used to assess perceived racial discrimination related to the COVID-19, daily racial discrimination during the pandemic, home boundness and loneliness, and depression and anxiety. Results: Daily racial discrimination was associated with an increased risk for depression. Home boundness was related to fewer depression symptoms (B = -0.728) and fewer anxiety symptoms (B = -0.558). Higher symptoms of loneliness (B = 0.377) were related to more depression symptoms. More loneliness (B = 0.257) was related to more anxiety symptoms. Conclusions: The findings can help university stakeholders to create a guideline for the development and implementation of resource programs for Asian international graduates.

3.
J Appl Gerontol ; : 7334648221083658, 2022 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-35341367

RESUMO

While sleep disturbances are common in people living with cognitive impairment, little is known about the influence of evening light exposure on their sleep. The purpose of this study was to examine the relationship between evening light exposure in natural living environment and daytime sleepiness in community residing people living with cognitive impairment. A secondary data analysis was conducted using the baseline data of the Healthy Patterns Clinical Trial. Actiwatch Spectrum Plus was used to collect information on the average white light intensity of 4 hours before sleep for three consecutive days. Multivariate regression analyses were used. Among 173 participants, the average light intensity during evening was 80.25 ± 123.04 lux. After controlling for covariates, greater intensity of light exposure during evening was related to excessive daytime sleepiness (ß = 0.211, p = .004). The results of our study suggest exposure to light during evening may disturb sleep and subsequently influence daytime sleepiness the following day.

4.
Artigo em Inglês | MEDLINE | ID: mdl-34997619

RESUMO

OBJECTIVES: Social isolation among older adults with cognitive impairment is understudied. The purpose of this study is to examine the relationship between social isolation and anxiety in people with cognitive impairment in the United States. METHODS/DESIGN: Secondary data analyses were conducted using the National Social Life, Health, and Aging Project (NSHAP) Wave 2 (2010-2011) dataset which includes a nationally representative sample of American older adults living at home. A total of 1343 people who had probable cognitive impairment measured by a Montreal Cognitive Assessment (MoCA) score of 22 or less were selected. Anxiety was measured using the anxiety measure of Hospital Anxiety and Depression Scale (HADS-A) and social isolation was measured using Perceived Social Isolation Scale. A weighted multivariable linear regression analysis and weighted F tests were used to examine the relationship between social isolation and anxiety. RESULTS: We observed that greater social isolation was related to increased anxiety in people with cognitive impairment (coefficients = 0.7242, t = 2.51, p = 0.015), adjusting for severity of cognitive impairment, race, pain, depression, activities of daily living, and instrumental activities of daily living. Weighted F tests showed that persons with clinically significant anxiety (HADS-A ≥ 8) had higher levels of loneliness, including feeling a lack of companionship, feeling left out, and greater social isolation. CONCLUSIONS: The results of our study suggest that people with cognitive impairment can feel social isolation and it may contribute to their anxiety. Health care professionals, family, and friends of people with cognitive impairment should pay greater attention to social isolation of their loved ones.


Assuntos
Atividades Cotidianas , Disfunção Cognitiva , Idoso , Ansiedade/epidemiologia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Humanos , Solidão/psicologia , Isolamento Social/psicologia , Estados Unidos/epidemiologia
5.
J Appl Gerontol ; 41(4): 1047-1056, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34047198

RESUMO

Engaging in leisure activities that are cognitively simulating and enjoyable may be protective against cognitive decline in older adults; yet, few studies have examined this topic. We used two waves of data from the Population Study of Chinese Elderly and ran mixed-effects regression models to examine the relationship between baseline art activity attendance (including attending museum, musical arts, or both) and change in cognitive function (global, episodic memory, working memory, and executive function) among 2,703 older U.S. Chinese adults. We found that compared with older adults who did not attend any art activities, those who reported attending both art activities experienced a slower rate of change in episodic memory (estimate = -0.07; SE = 0.03; p = .01) and executive function (estimate = -0.06; SE = .03; p = .04). Our study findings point to the importance of attending art-based culture events among U.S. Chinese older adults.


Assuntos
Disfunção Cognitiva , Memória Episódica , Idoso , China , Cognição , Disfunção Cognitiva/psicologia , Humanos , Vida Independente
6.
BMC Geriatr ; 21(1): 581, 2021 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-34670502

RESUMO

BACKGROUND: People living with dementia (PLWD) and caregivers are adversely impacted by lack of meaningful activity leading to worse symptoms and impaired quality-of-life. There is a critical need to develop effective and well-tolerated treatments that mitigate clinical symptoms, engage PLWD and support caregiver wellbeing. We tested whether, compared to attention control, the Tailored Activity Program (TAP) reduced clinical symptoms and health-related events, and improved caregiver wellbeing, and if TAP activities were well-tolerated. METHODS: We conducted a single-blind randomized controlled trial among 250 dyads recruited from Baltimore-Washington DC (2012-2016) with a dementia diagnosis and clinically significant agitation/aggression. Dyads were randomized to TAP (n = 124) or attention control (n = 126), and interviewed at baseline, 3 (endpoint) and 6-months (follow-up) by interviewers masked to group allocation. TAP assessed PLWD abilities/interests, instructed caregivers in using prescribed activities, and provided dementia education and stress reduction techniques. Attention controls received disease education and home safety tips. Both groups had up to 8 home visits over 3-months. The primary outcome was frequency by severity scores for agitation/aggression subscales of Neuropsychiatric Inventory-Clinician using caregiver ratings. Secondary outcomes included number of instrumental (IADL) and activities of daily living (ADL) needing assistance, caregiver wellbeing, and confidence using activities. Health-related events (PLWD death, hospitalizations, caregiver hospitalization, depression) and perceived study benefits were captured over 6 months. PLWD tolerability of prescribed activities was examined. RESULTS: Of 250 dyads, most caregivers were female (81.2 %, n = 203), non-spouses (54.4 %, n = 136), white (59.2 %, n = 145) or African American (36.7 %, n = 90) with mean age = 65.4 (SD = 12.6). PLWD were mostly female (63.2 %, n = 158) with mean age = 81.4 (SD = 7.9), and mean MMSE = 14.3 (SD = 7.8). At 3-months, compared to controls, TAP conferred no benefit to agitation/aggression (p = 0.43, d = 0.11), but resulted in less IADL (p = 0.02, d=-0.33), and ADL (p = 0.04, d=-0.30) assistance, improved caregiver wellbeing (p = 0.01, d = 0.39), and confidence using activities (p = 0.02, d = 0.32). By 6-months, 15 PLWD in TAP had ≥ 1 health-related event versus 28 PLWD in control, demonstrating 48.8 % improvement in TAP (p = 0.03). TAP caregivers were more likely to perceive study benefits. Prescribed activities were well-tolerated. CONCLUSIONS: Although TAP did not benefit agitation/aggression, it impacted important outcomes that matter to families warranting its use in dementia care. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov # NCT01892579 at https://clinicaltrials.gov/ ; Date of clinical trial registration: 04/07/2013; Date first dyad enrolled: 15/11/2013.


Assuntos
Cuidadores , Demência , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Demência/diagnóstico , Demência/terapia , Feminino , Humanos , Masculino , Qualidade de Vida , Método Simples-Cego
7.
BMC Geriatr ; 21(1): 451, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344312

RESUMO

BACKGROUND: Sleep-wake disorders occur in most persons living with dementia and include late afternoon or evening agitation, irregular sleep-wake rhythms such as daytime hypersomnia, frequent night awakenings, and poor sleep efficiency. Sleep-wake disorders pose a great burden to family caregivers, and are the principal causes of distress, poor quality of life, and institutionalization. Regulating the sleep-wake cycle through the use of light and activity has been shown to alter core clock processes and suggests that a combination of cognitive, physical, and sensory-based activities, delivered at strategic times, may be an effective mechanism through which to reduce sleep-wake disorders. METHODS: A definitive Phase III efficacy trial of the Healthy Patterns intervention, a home-based activity intervention designed to improve sleep-wake disorders and quality of life, is being conducted using a randomized two-group parallel design of 200 people living with dementia and their caregivers (dyads). Specific components of this one-month, home-based intervention involve 4 in-home visits and includes: 1) assessing individuals' functional status and interests; 2) educating caregivers on environmental cues to promote activity and sleep; and 3) training caregivers in using timed morning, afternoon, and evening activities based on circadian needs across the day. The patient focused outcomes of interest are quality of life, measures of sleep assessed by objective and subjective indicators including actigraphy, subjective sleep quality, and the presence of neuropsychiatric symptoms. Caregiver outcomes of interest are quality of life, burden, confidence using activities, and sleep disruption. Salivary measures of cortisol and melatonin are collected to assess potential intervention mechanisms. DISCUSSION: The results from the ongoing study will provide fundamental new knowledge regarding the effects of timing activity participation based on diurnal needs and the mechanisms underlying timed interventions which can lead to a structured, replicable treatment protocol for use with this growing population of persons living with dementia. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov # NCT03682185 at https://clinicaltrials.gov/ ; Date of clinical trial registration: 24 September 2018.


Assuntos
Demência , Transtornos do Sono-Vigília , Cuidadores , Demência/diagnóstico , Demência/terapia , Humanos , Qualidade de Vida , Sono
8.
Schizophr Res ; 233: 44-51, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34225026

RESUMO

BACKGROUND: Traumatic stressful events (TSEs) are among the most studied risk factors for subsequent schizotypal symptoms. However, specificity and aggregate effects of trauma exposure on schizotypal symptoms remain unclear. This study investigates these relationships among a community-based sample of US adolescents. MATERIAL AND METHODS: A sub-sample of 426 adolescents (51.6% female) from the Philadelphia Neurodevelopmental Cohort study were selected for longitudinal follow-up based on presence (n = 209) or absence (n = 217) of psychosis spectrum symptoms (PSS). At baseline, they completed assessments of demographic, TSEs, other psychopathology (e.g., PSS, anxiety, depression, and behavioral disorder) and family history of psychopathology. Schizotypal symptom dimensions (cognitive-perceptual, interpersonal and disorganized) were evaluated approximately two years later. RESULTS: More than half of adolescents experienced at least one type of TSE. Adolescents with assaultive trauma reported about 1.5 times as many symptoms on all three schizotypal symptom dimensions, compared to adolescents with non-assaultive TSE, adjusting for demographic and family history variables. No statistical significance was found after further adjusting for other baseline psychopathology (p > 0.05). There was a significant aggregate effect of TSEs on cognitive-perceptual symptoms with small effect size (p < 0.001, Cohen's f2 = 0.034). CONCLUSIONS: We found evidence of an association between aggregate TSEs and cognitive-perceptual symptoms, but trauma type was not associated with schizotypal symptom dimensions when controlling for potential confounders. Our findings highlight the importance of considering aggregate TSE effects and potential confounds when examining associations between TSEs and schizotypy. Trauma and psychosis spectrum screening may be important in the effort to provide trauma-informed care.


Assuntos
Transtornos Psicóticos , Transtorno da Personalidade Esquizotípica , Adolescente , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Psicopatologia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/etiologia , Transtorno da Personalidade Esquizotípica/diagnóstico , Transtorno da Personalidade Esquizotípica/epidemiologia
9.
Geriatr Nurs ; 42(4): 869-879, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34090233

RESUMO

Sleep disruption is common among older adults. Non-pharmacological interventions involving music has emerged as a promising approach to address sleep disruption. The purpose of this systematic review was to examine the effects of music interventions on sleep outcomes among older adults (age ≥ 50). We searched five databases through May 2020 and found 16 eligible studies focused on two types of music interventions: music listening (n = 11) and multi-component (n = 5). We found mixed evidence in the efficacy of music interventions to improve sleep outcomes in older adults, which included sleep quality, objective and subjective sleep characteristics. Music listening interventions contained relaxing music with research teams personalizing music choice based on participants' preferences. Multi-component interventions included listening to music in addition to one other approach, such as massage, tai chi, and nature scenes. Future higher-quality studies should provide a detailed description of music interventions and tailor music selections to older adults' preferences.


Assuntos
Musicoterapia , Música , Idoso , Humanos , Sono
10.
Am J Alzheimers Dis Other Demen ; 36: 15333175211008768, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33853394

RESUMO

Little is known about the family experience of caregiving for persons living with dementia (PLWD) at home during the COVID-19 pandemic. The purpose of this study was to examine the influence of COVID-19 on concerns of current family caregivers of PLWD. Study participants were recruited from the parent study, Healthy Patterns Clinical Trial (NCT03682185). Data was collected from 34 caregivers via semi-structured telephone interviews. Over 70% of the study participants reported worrying about spreading COVID-19 to the PLWD, 41% reported they had taken on additional caregiving duties for others in their family since COVID-19, and 62% reported one or more anxiety symptoms. Dementia caregivers who reported anxiety symptoms reported lower scores on functional independence of their care recipients compared to dementia caregivers who did not report anxiety symptoms (p=0.036). Health care professionals should be alert to the concerns expressed by dementia caregivers for their well-being during this unprecedented pandemic.


Assuntos
COVID-19 , Demência , Ansiedade , Cuidadores , Demência/epidemiologia , Humanos , Pandemias , SARS-CoV-2
11.
West J Nurs Res ; : 1939459211008563, 2021 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-33870784

RESUMO

Recruitment for dementia research is challenging and costly. Using Ajzen's Theory of Planned Behavior we explored attitudes, perceived norms, and perceived behavioral control of persons living with dementia (PLWD) and their caregivers who participated in one clinical trial to better understand factors that influence dyads' decisions to enroll. We conducted semi-structured telephone interviews with 12 PLWD and 9 caregivers and utilized directed content analysis. Categories connected with positive attitudes about study enrollment were personal desires of wanting to learn and in-person meetings with knowledgeable staff. Additionally, participants said the money always helps in terms of the financial incentive. Participants reported enrolling to support another person (perceived norm). Study requirements were thought to be easy (perceived behavioral control). Participants highlighted the importance of flexible scheduling and study tasks being completed at their home. Findings can inform future recruitment efforts and should be investigated as effective recruitment methods in other clinical trials.

12.
J Prof Nurs ; 37(1): 207-211, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33674096

RESUMO

Given the complexity and rapidly changing pace of 21st-century healthcare, the need for research intensive Ph.D. prepared nurses has never been greater. Philanthropic funders and sponsors of Ph.D. nursing education have important insights into how investments in Ph.D. education have direct and positive impacts on healthcare, and consequently bring important perspectives to emerging roles for Ph.D. prepared nurses. To elicit these perspectives focused questions were posed to four leading philanthropic funders/sponsors of Ph.D. nursing education: The Rita and Alex Hillman Foundation; The Robert Wood Johnson Foundation, Sigma Theta Tau- International Honor Society of Nursing, and the Jonas Nursing & Veterans Healthcare of Jonas Philanthropies. The interviews were conducted as part of a special session from the October 2019 PhD Summit "Re-Envisioning PhD Programs of the Future". A common theme that emerged from these discussions was the compelling need to prepare research intensive Ph.D. prepared nurses with advanced skills in leadership and innovation in order to leverage the larger impact of their work on health, health care and health policy. Lessons learned from the programs supported by these sponsors can be used to refine and implement future Ph.D. programs that provide the leadership and innovation skills required of research intensive Ph.D. prepared nurses.


Assuntos
Educação de Pós-Graduação em Enfermagem , Atenção à Saúde , Política de Saúde , Humanos , Liderança , Pesquisadores
13.
Geriatr Nurs ; 42(2): 366-371, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33571930

RESUMO

OBJECTIVES: Unresolved pain is related to neuropsychiatric symptoms (NPS) in persons living with dementia (PLWD), and an increase in NPS is distressing for PLWD and their caregivers. Hence, we examined whether pain in PLWD was related to caregiver burden and whether caregiver upset with NPS mediated this relationship. METHOD: We examined, cross-sectionally, the relationships among pain in PLWD, caregiver burden, and upset with NPS. Data from 272 PLWD and their caregivers who participated in the Advancing Caregiver Training (ACT) trial were analyzed using structural equation modeling (SEM). RESULTS: Model fit was satisfactory, and caregiver upset with NPS fully mediated the association between pain in PLWD and caregiver burden. CONCLUSION: Caregiver upset with NPS helps explain the relationship between pain in PLWD and burden in their caregivers. Pain and NPS are amenable to modification, as is caregiver burden, suggesting great opportunity to impact the lives of PLWD and their caregivers.


Assuntos
Fardo do Cuidador , Demência , Cuidadores , Humanos , Dor
14.
J Psychiatr Ment Health Nurs ; 28(6): 1092-1112, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33502097

RESUMO

WHAT IS KNOWN ON THE SUBJECT?: The complexity and high prevalence of schizotypal personality disorders (SPD) pose serious challenges for mental health practice in its management, and also bring severe consequences for the patients. The identification of the specific early life factors (ELFs) that confer risk to SPD has become a major focus of clinical research on schizophrenia-spectrum disorders which aligns well with the mental health nursing's responsibility in health promotion, prevention and treatment. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Adolescents may experience certain ELFs, which contribute to the occurrence of SPD, but no systematic review has been conducted to identify ELF among them. And nursing literature addressing modifiable ELF is very limited. Two clusters of ELF and SPD in adolescents were identified: prenatal and early postnatal factors; childhood trauma and parental factors. The findings also show that more research is needed to determine the specificity and cumulative effects of ELF on the development of SPD by using rigorous and comprehensive measurements and a longitudinal design. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses, especially nurses in the primary care, should be aware of potentially modifiable ELFs and incorporate more comprehensive and valid instrument for assessing cumulative ELF and SPD. These findings may serve to inform possible future interventions for SPD, such as parent education and support to mitigate these risk factors. ABSTRACT: INTRODUCTION: Schizotypal personality disorder (SPD) affects 4% of the general population in the United States. The identification of early life factors (ELFs) that confer risk to SPD in adolescents (ages 10-24 years old) has become a major focus of clinical research on schizophrenia-spectrum disorders. AIM: This systematic review aims to determine what ELFs contribute to the onset of SPD in the adolescent population. METHODS: A systematic search of PubMed, PsycINFO, Psychiatry online, Scopus, Web of Science, EMBASE and CINAHL databases was conducted using relevant keywords. Data were extracted using a standardized form following PRISMA guidelines. RESULTS: Twenty-four studies met the criteria for inclusion. ELFs in the development of SPD were grouped into two important clusters: (a) prenatal and early postnatal factors; (b) childhood trauma and parental factors. CONCLUSION: Mental health nurses, especially nurses in primary care, should be aware of potentially modifiable ELF. Longitudinal research is needed to determine the causative roles of these ELF play in the occurrence of SPD by using rigorous measurements. IMPLICATIONS FOR PRACTICE: These findings call for awareness of the modifiable ELF for SPD and also inform possible future interventions to reduce these risks, such as parent-training or environmental enrichment programmes.


Assuntos
Esquizofrenia , Transtorno da Personalidade Esquizotípica , Adolescente , Adulto , Criança , Humanos , Fatores de Risco , Transtorno da Personalidade Esquizotípica/epidemiologia , Adulto Jovem
15.
Patient Educ Couns ; 104(4): 896-902, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33004235

RESUMO

OBJECTIVE: The study evaluated the effects of care consultation delivered through the Alzheimer's Association National Helpline - a free resource in which master's-level clinicians offer confidential support. The study compared the effectiveness of Helpline "Care Consultation" and "Care Consultation Plus" conditions on caller outcomes. METHODS: Four hundred and forty-five non-crisis callers were randomly assigned to the traditional Helpline "Care Consultation" or a "Care Consultation Plus" condition that included one additional booster call. RESULTS: While no differences were found between the two conditions, the study found that callers reported significantly improved caregiver mental health scores (27 % net improvement over baseline) and ability to manage emotions (29 % net improvement) at one week (p = .006). By one week, 70 % of callers had put action steps in place and by 1 month 80 % of callers had put action steps into place. Over 80 % of callers reported action steps were "helpful". CONCLUSION: A single call provided a measurable benefit to caregivers'mental health, ability to manage emotions and ability to engage in action planning and accessing resources. PRACTICE IMPLICATIONS: This pilot study demonstrated that the support provided via the Helpline can be effective at improving caregiver mental health and improving the ability of callers to "take action".


Assuntos
Doença de Alzheimer , Cuidadores , Doença de Alzheimer/terapia , Linhas Diretas , Humanos , Projetos Piloto , Encaminhamento e Consulta
16.
J Appl Gerontol ; 40(6): 590-597, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-32608313

RESUMO

Older adults receiving long-term services and supports (LTSS) experience barriers to outdoor activities and satisfaction ratings with such experiences are not well understood. Our study used cross-sectional data (n = 329) to (a) examine whether those new to LTSS were satisfied with their outdoor activities and (b) describe the characteristics and factors associated with satisfaction levels. Self-report of satisfaction with outdoor activities was the outcome variable. Multivariable linear regression modeling of the outcome was conducted. Fifty-nine percent were satisfied with their outdoor activities. More depressive symptoms (p < .001) and higher cognitive functioning (p = .011) were associated with lower ratings. Higher self-rated physical health (p = .009) and more independence with activities of daily living (p = .022) were associated with greater satisfaction. Findings suggest an unmet need among four in 10 new recipients of LTSS (41%) related to their outdoor activities. LTSS interdisciplinary teams can use these findings to inform their assessments, develop person-centered care plans, and address barriers.


Assuntos
Atividades Cotidianas , Moradias Assistidas , Idoso , Estudos Transversais , Humanos , Assistência de Longa Duração , Casas de Saúde , Satisfação Pessoal
17.
Alzheimers Dement ; 17 Suppl 7: e056362, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35109568

RESUMO

BACKGROUND: Irregular sleep-wake patterns are common in persons living with dementia, pose a great burden to caregivers, and are the principal causes of distress and institutionalization. A growing body of research supports the importance of activity-based interventions to reduce the frequency and intensity of sleep wake disruption, enhance personhood and dignity, and improve quality of life (QOL). METHOD: A two-arm RCT was conducted with 170 dyads of persons living at home with dementia and with symptoms of sleep-wake disruption, and their family caregiver. Specific components of the Healthy Patterns intervention include: 1) assessing health/functional status and preferences/interests; 2) educating caregivers on environmental cues to promote activity and sleep; and 3) training caregivers in using timed morning, afternoon, and evening activities based on circadian needs. Outcomes included: QOL, function, neuropsychiatric symptoms, and actigraphic and proxy-reported measures of sleep-wake patterns. RESULT: At 4 weeks, the intervention group showed significantly greater improvement than the control group in QOL (p=.01) and sleep efficiency (p=.04). CONCLUSION: Results provide new fundamental knowledge regarding the nature and timing of activities for persons with dementia. It has the potential to change how and when activities for persons with dementia are provided.

18.
Res Nurs Health ; 43(6): 557-567, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33136301

RESUMO

Sleep disruption in older adults living with Alzheimer's disease and related dementias (ADRD) is debilitating and contributes to increased institutionalization, reduced cognitive function, and accelerated disease progression. Furthermore, sleep disruption is linked to poor health outcomes in caregivers, such as decreased quality of life and increased caregiver burden. Given the potentially harmful side effects of pharmacologic treatment, nonpharmacologic approaches, such as music, may provide a safer alternative to reducing sleep disruption in this vulnerable population. A growing body of literature suggests that calming tailored music may improve sleep quality in older adults with memory loss, but its efficacy has not been demonstrated in older adults with ADRD in the community, where most older adults with ADRD live. If shown to be feasible and acceptable, tailored music interventions can then be tested for efficacy in reducing sleep disruption. This protocol details a wait-list randomized controlled trial (NCT04157244), the purpose of which is to test the feasibility, acceptability, and examine the preliminary efficacy of a tailored music listening intervention in older adults with ADRD who report sleep disruption. Music selections will be tailored to the music genre preferences of older adults with ADRD and account for known sleep-inducing properties. The feasibility of processes that is key to the success of the subsequent study will be examined. Preliminary efficacy of the intervention will be assessed using objective (actigraphy) and subjective (proxy-reported) sleep quality measures. In addition, qualitative data will be solicited, examining the acceptability and satisfaction with the intervention by individuals with ADRD.


Assuntos
Doença de Alzheimer/psicologia , Música , Transtornos do Sono-Vigília/psicologia , Idoso , Humanos , Qualidade de Vida/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
19.
BMC Geriatr ; 20(1): 463, 2020 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-33172392

RESUMO

BACKGROUND: In the US, post-acute care in skilled nursing facilities (SNFs) is common and outcomes vary greatly across facilities. Little is known about the expectations of patients and their caregivers about physician care during the hospital to SNF transition. Our objectives were to (1) describe the experiences and expectations of patients and their caregivers with SNF physicians in SNFs, and (2) identify patterns that differed between patients with vs. without cognitive impairment. METHODS: This qualitative study used grounded theory approach to analyze data collected from semi-structured interviews at five SNFs in January-August 2018. Patients admitted for short-term SNF care 5-10 days prior were eligible to participate. Thematic analysis was performed to detect recurrent themes with a focus on modifiable aspects of physician care. Analysis was stratified by patient cognitive impairment (measured by the Montreal Cognitive Assessment at the time of the interview). RESULTS: Fifty patients and six caregivers were interviewed. Major themes were: (1) patients had poor awareness of the physician in charge of their care; (2) they were dissatisfied with the frequency of interaction with the physician; and (3) participants valued the perception of receiving individualized care from the physician. Less cognitively impaired patients were more concerned about limited interactions with the physicians and were more likely to report attempts to seek out the physician. CONCLUSION: Patient and caregiver expectations of SNF physicians were not well aligned with their experiences. SNFs aiming to improve satisfaction with care may focus efforts in this area, such as facilitating frequent communication between physicians, patients and caregivers.


Assuntos
Médicos , Instituições de Cuidados Especializados de Enfermagem , Hospitais , Humanos , Motivação , Alta do Paciente , Cuidados Semi-Intensivos
20.
Int Psychogeriatr ; 32(7): 849-861, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32524932

RESUMO

OBJECTIVES: Daytime sleepiness is associated with multiple negative outcomes in older adults receiving long-term services and supports (LTSS) including reduced cognitive performance, need for greater assistance with activities of daily living and decreased social engagement. The purpose of this study was to identify predictors of change in subjective daytime sleepiness among older adults during their first 2 years of receiving LTSS. DESIGN AND SETTING: Secondary analysis of data from a prospective longitudinal study of older adults who received LTSS in their homes, assisted living communities or nursing homes interviewed at baseline and every 3 months for 24 months. PARTICIPANTS: 470 older adults (60 years and older) newly enrolled in LTSS (mean = 81, SD = 8.7; range 60-98; 71% women). MEASUREMENTS: Subjective daytime sleepiness was assessed every 3 months through 2 years using the Epworth Sleepiness Scale. Multiple validated measures were used to capture health-related quality of life characteristics of enrollees and their environment, including symptom status (Symptom Bother Scale), cognition (Mini Mental Status Exam), physical function (Basic Activities of Daily Living), physical and mental general health, quality of life (Dementia Quality of Life, D-QoL), depressive symptoms (Geriatric Depression Scale) and social support (Medical Outcomes Survey-Social Support). RESULTS: Longitudinal mixed effects modeling was used to examine the relationship between independent variables and continuous measure of daytime sleepiness. Increased feelings of belonging, subscale of the D-QoL (effect size = -0.006, 95% CI: -0.013 to -0.0001, p = 0.045) and higher number of depressive symptoms (effect size = -0.002, 95% CI: -0.004 to -0.001, p = 0.001) at baseline were associated with slower rates of increase in daytime sleepiness over time. CONCLUSIONS: Comprehensive baseline and longitudinal screening for changes in daytime sleepiness along with depression and perceived quality of life should be used to inform interventions aimed at reducing daytime sleepiness among older adults receiving LTSS.


Assuntos
Atividades Cotidianas/psicologia , Envelhecimento , Transtornos Cognitivos/psicologia , Depressão/psicologia , Distúrbios do Sono por Sonolência Excessiva/psicologia , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Moradias Assistidas , Transtornos Cognitivos/diagnóstico , Depressão/diagnóstico , Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Feminino , Humanos , Relações Interpessoais , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Casas de Saúde , Estudos Prospectivos , Comportamento Social
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