scholarly journals Perspectives of Family Caregivers Confronted With Care-Resistant Behavior From Persons With Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 253-253
Author(s):  
Rita Jablonski ◽  
Vicki Winstead ◽  
David Geldmacher
Keyword(s):  
Nurse Practitioner ◽  
Community Dwelling ◽  
Behavioral Symptoms ◽  
Community Resources ◽  
Targeted Interventions ◽  
Manage Care ◽  
Coaching Strategies ◽  
Online Coaching ◽  
Coaching Training ◽  
Person With Dementia

Abstract Problem: Care-resistant behavior is often bundled with other behavioral symptoms of dementia, but it is a unique behavior requiring targeted interventions. Purpose: To describe the experiences of caregivers receiving online coaching to manage care-resistant behaviors exhibited by persons with dementia. Design: Qualitative. Sample & Procedure: 20 caregivers (12 female, 8 male) were recruited from Memory Disorders and Geriatrics clinics to participate in 6 weeks of online coaching sessions delivered by a doctorally prepared nurse practitioner. Coaching sessions were recorded and transcribed. NVivo12 software was used to manage the thematic analyses. Results: Caregivers followed a general trajectory. They initially reported feelings of anger, frustration, and guilt. They believed that the person with dementia was purposefully “being stubborn and mean.” As the coaching sessions progressed, these negative emotions and the attributions of intent altered. By the conclusion of the six weeks, caregivers expressed feelings of success and ingenuity in applying coaching strategies. Conclusion: Online coaching is an effective way to individualize strategies that enable the caregiver to manage and reduce care-resistant behavior. Implications: The use of a doctorally-prepared nurse practitioner to deliver coaching, while effective, is not sustainable. Next steps include developing a coaching training program that could be embedded into existing community resources for community-dwelling caregivers. Limitations: Participants were limited to referrals from two clinics in the same institution.

scholarly journals BESI: Behavioral and Environmental Sensing and Intervention for Dementia Caregiver Empowerment—Phases 1 and 2

2020 ◽  
Vol 35 ◽  
pp. 153331752090668 ◽  
Author(s):  
Azziza Bankole ◽  
Martha S. Anderson ◽  
Nutta Homdee ◽  
Ridwan Alam ◽  
Ashley Lofton ◽  
...  
Keyword(s):  
Phase 1 ◽  
Care Facility ◽  
Community Dwelling ◽  
Ethnographic Study ◽  
Environmental Sensing ◽  
Dementia Caregiver ◽  
Home Based ◽  
Person With Dementia ◽  
Design And Methods ◽  
The Relationship

Background and Objectives: Caregiver burden associated with dementia-related agitation is one of the commonest reasons a community-dwelling person with dementia (PWD) transitions to a care facility. Behavioral and Environmental Sensing and Intervention for Dementia Caregiver Empowerment (BESI) is a system of body-worn and in-home sensors developed to provide continuous, noninvasive agitation assessment and environmental context monitoring to detect early signs of agitation and its environmental triggers. Research Design and Methods: This mixed methods, remote ethnographic study is explored in a 3-phase, multiyear plan. In Phase 1, we developed and refined the BESI system and completed usability studies. Validation of the system and the development of dyad-specific models of the relationship between agitation and the environment occurred in Phase 2. Results: Phases 1 and 2 results facilitated targeted changes in BESI, thus improving its overall usability for the final phase of the study, when real-time notifications and interventions will be implemented. Conclusion: Our results show a valid relationship between the presence of dementia related agitation and environmental factors and that persons with dementia and their caregivers prefer a home-based monitoring system like BESI.

Accelerated sarcopenia and outcomes in older adults with cancer: The Health ABC Study.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11526-11526
Author(s):  
Grant Richard Williams ◽  
Yanjun Chen ◽  
Kelly Kenzik ◽  
Andrew Michael McDonald ◽  
Shlomit S. Shachar ◽  
...  
Keyword(s):  
Older Adults ◽  
Body Composition ◽  
Cancer Diagnosis ◽  
Cox Regression ◽  
Community Dwelling ◽  
Mixed Effect ◽  
Prospective Longitudinal Study ◽  
Targeted Interventions ◽  
Prospective Longitudinal ◽  
Time Varying Covariates

11526 Background: Progressive loss of muscle mass and strength (sarcopenia) is a well-known phenomenon of aging; however, little is known about the contribution of a cancer diagnosis to sarcopenia and its subsequent impact on disability. Using a prospective cohort of older adults from pre- to post-cancer diagnosis and a similarly-followed non-cancer cohort, we examined the trajectory of sarcopenia measures and their association with overall survival (OS) and major disability among those with cancer. Methods: The Health, Aging, and Body Composition (Health ABC) Study is a prospective longitudinal study where 3,075 community-dwelling older adults (70-79y) underwent 6 annual assessments of body composition and were followed for development of sentinel events (cancer, disability, death). Appendicular lean mass (ALM [kg]) was a sum of DXA-based lean tissue of all extremities. Hand grip strength (HGS [kg]) was averaged from 2 trials per hand. Gait speed (GS) was evaluated over a 20m course. We used linear mixed effect models to compare the change in ALM, HGS, and GS between individuals who subsequently developed cancer and those who did not, adjusting for age, race, gender, enrollment site. Among patients with cancer, we used multivariable cox regression for time from cancer diagnosis to mortality and major disability (cane/walker, inability to walk 0.25 mile/climb 10 steps, assistance with activities of daily living) treating sarcopenia measures as time-varying covariates. Results: Mean age at enrollment was 75y; 52% female; 42% black; 515 new cancers (prostate: 23%, colorectal: 15%, lung: 13%, breast: 11%). Compared with non-cancer controls, we found significantly steeper declines in HGS ( p= 0.03) and GS ( p< 0.001), and a trend in ALM ( p= 0.07) prior to cancer diagnosis; and a significantly steeper decline in ALM ( p< 0.001), but no difference in HGS ( p= 0.6) or GS ( p= 0.4) after cancer diagnosis. Slow GS was associated with a 44% increase in mortality ( p= 0.02) and a 70% increase in disability ( p= 0.02), but not ALM or HGS. Conclusions: Accelerated loss in sarcopenia measures both prior to and after a cancer diagnosis, and association with disability and mortality in older adults with cancer, present opportunities for targeted interventions.

Assessment of Behavioral Symptoms in Community-Dwelling Dementia Patients

1997 ◽  
Vol 5 (1) ◽  
pp. 26-30
Author(s):  
Myron F. Weiner ◽  
Brent Williams ◽  
Richard C. Risser
Keyword(s):  
Community Dwelling ◽  
Behavioral Symptoms ◽  
Dementia Patients

The effects of a multi-component dyadic intervention on the psychological distress of family caregivers providing care to people with dementia: a randomized controlled trial

2015 ◽  
Vol 27 (12) ◽  
pp. 2031-2044 ◽  
Author(s):  
Anna-Eva Prick ◽  
Jacomine de Lange ◽  
Jos Twisk ◽  
Anne Margriet Pot
Keyword(s):  
Randomized Controlled Trial ◽  
Physical Exercise ◽  
Family Caregivers ◽  
Controlled Trial ◽  
Skills Training ◽  
Community Dwelling ◽  
Randomized Controlled ◽  
People With Dementia ◽  
The Us ◽  
Person With Dementia

ABSTRACTBackground:Earlier research showed that multi-component dyadic interventions – including a combination of intervention strategies and addressing both the person with dementia and caregiver – have a beneficial impact on the mental and physical health of people with dementia and their family caregivers. A randomized controlled trial (RCT) of a multi-component dyadic intervention, which is a translated and adapted version of an intervention that has been shown to be effective in the US by Teri et al. (2003), was performed. The effects on caregivers’ mood (primary outcome), burden, general health, and salivary cortisol levels (secondary outcomes) were studied.Methods:Community-dwelling people with dementia and their family caregivers (N = 111 dyads) were randomly assigned. The experimental group received eight home visits during three months, combining physical exercise and support (psycho-education, communication skills training, and planning of pleasant activities). Both the physical exercise and support component were directed at both the person with dementia and the caregiver. The comparison group received monthly information bulletins and phone calls. There were three measurements at baseline (prior to the intervention), at three months, and at six months into the intervention. Data were analyzed with Generalized Estimating Equations (GEE) based on an intention-to-treat analysis of all available data.Results:All analyses showed no benefits of the intervention over time on any of the outcomes.Conclusion:The negative results might be explained by the translation and adaptation of the intervention that has been shown to be effective in the US: the intervention was shortened and did not include cognitive reframing. However, only the health effects on people with dementia and not on caregivers were studied in the US. Several other factors might also have played a role, which are important for future studies to take into account. These are: the usual health care in the country or region of implementation; the wishes and needs of participants for specific intervention components; the room for improvement regarding these components; the inclusion of positive outcome measures, such as pleasure, and the quality of the relationship.

scholarly journals Preliminary Estimates of Change in Physical Function After Targeted Kyphosis Exercise Intervention in Older Adults With Low Function: A Secondary Analysis of The SCOR Trial

2020 ◽  
Author(s):  
Amy Gladin ◽  
Wendy Katzman ◽  
Yoshimi Fukuoka ◽  
Neeta Parimi ◽  
Shirley Wong ◽  
...  
Keyword(s):  
Older Adults ◽  
Adverse Events ◽  
Physical Function ◽  
High Intensity ◽  
Exercise Intervention ◽  
Secondary Analysis ◽  
Community Dwelling ◽  
Spinal Curvature ◽  
Targeted Interventions ◽  
Function Group

Abstract Background: Hyperkyphosis is common in older adults and associated with low physical function and reduced health related quality of life (HrQol). Improved kyphosis has been previously established in kyphosis-targeted interventions in randomized controlled trials in older adults with hyperkyphosis however evidence for improved physical function is conflicting. Few studies have investigated change in physical function after a targeted kyphosis intervention in older adults with low physical function. The primary aim in this descriptive study was to explore change in physical function after a progressive high intensity 3-month targeted kyphosis exercise and posture training intervention in older adults with low physical function and hyperkyphosis. Secondary aims were to explore change in HrQol, spinal strength and spinal curvature, and adherence and safety of the intervention in older adults with low physical function and hyperkyphosis.Methods: In this secondary analysis of the Specialized Center of Research (SCOR) Kyphosis randomized trial, 101 community dwelling older men and women with hyperkyphosis who completed the intervention were divided into a low function group (LFG) and high function group (HFG). Baseline characteristics were compared between LFG and HFG. Physical function, HrQol, spinal strength and spinal curvature (kyphosis and lordosis) pre/post intervention change scores were explored within and between groups. Adherence and adverse events were examined in the LFG and HFG. Results:Twenty-six (26%) older adults were LFG, mean SPPB 9.62 (SD=1.17) points. At baseline, the LFG was older than HFG (p=0.005), endorsed more pain, (p=0.060), had worse physical function and HrQol (p≤0.001), and comparable kyphosis (p=0.640). SPPB increased 0.62 (95% CI: -0.20 to 1.44) points in the LFG and decreased 0.04 (95%CI: -0.28 to 0.19) points in the HFG, p=0.020. Gait speed improved 0.04 (95%CI: -0.02 to 0.10) m/s in the LFG. Kyphosis improved equally in both groups. Adherence was similar and there were no adverse events in the LFG or HFG. Conclusions:Older adults with low physical function and hyperkyphosis may improve physical function after a kyphosis targeted intervention. Older adults with low physical function may safely participate in targeted high-intensity kyphosis exercise and posture training. This observation needs to be confirmed in larger adequately powered studies. Clinicaltrials.gov dentifier: NCT01766674

scholarly journals Differential associations of functional and cognitive health outcomes with pre-frailty and frailty states in community-dwelling older adults

2018 ◽  
Vol 25 (8) ◽  
pp. 1057-1063 ◽  
Author(s):  
Caitlin Sleight ◽  
Roee Holtzer
Keyword(s):  
Older Adults ◽  
New York ◽  
Health Outcomes ◽  
Verbal Memory ◽  
Community Dwelling ◽  
Functional Health ◽  
Targeted Interventions ◽  
Health Decline ◽  
Age Related ◽  
Perceived Difficulty

This study examined associations of pre-frailty and frailty states with cognitive and functional health outcomes among community-residing older adults ( N = 457) in the Bronx, New York. Results: older adults who met criteria for frailty demonstrated poorer performance in attention, verbal memory, and overall global cognitive functioning compared to healthy controls. Moreover, pre-frail and frail older adults had significantly worse health outcomes including greater perceived difficulty with lower and upper extremity functioning and perceived limitations in completing daily activities, suggesting the need for targeted interventions in the community that may ameliorate age-related health decline.

scholarly journals An Examination of Lower Extremity Function and Its Correlates in Older African American and White Men

2015 ◽  
Vol 25 (3) ◽  
pp. 271 ◽  
Author(s):  
Olivio J. Clay, PhD ◽  
Roland J. Thorpe, Jr., PhD ◽  
Larrell L. Wilkinson, PhD ◽  
Eric P. Plaisance, PhD ◽  
Michael Crowe, PhD ◽  
...  
Keyword(s):  
African American ◽  
Lower Extremity ◽  
Racial Differences ◽  
African American Men ◽  
White Men ◽  
Community Dwelling ◽  
Potential Range ◽  
Lower Extremity Function ◽  
Targeted Interventions ◽  
Extremity Function

<p><strong>Objective: </strong>Maintaining functional status and reducing/eliminating health disparities in late life are key priorities. Older African Americans have been found to have worse lower extremity functioning than Whites, but little is known about potential differences in correlates between African American and White men. The goal of this investigation was to examine measures that could explain this racial difference and to identify race-specific correlates of lower extremity function.</p><p><strong>Methods: </strong>Data were analyzed for a sample of community-dwelling men. Linear regres­sion models examined demographics, medical conditions, health behaviors, and perceived discrimination and mental health as correlates of an objective measure of lower extremity function, the Short Physi­cal Performance Battery (SPPB). Scores on the SPPB have a potential range of 0 to 12 with higher scores corresponding to better functioning.</p><p><strong>Results: </strong>The mean age of all men was 74.9 years (SD=6.5), and the sample was 50% African American and 53% rural. African American men had scores on the SPPB that were significantly lower than White men after adjusting for age, rural residence, marital status, education, and income dif­ficulty (<em>P</em>&lt;.01). Racial differences in cognitive functioning accounted for approximately 41% of the race effect on physical function. Additional models stratified by race revealed a pattern of similar correlates of the SPPB among African American and White men.</p><p><strong>Conclusions: </strong>The results of this investigation can be helpful for researchers and clinicians to aid in identifying older men who are at-risk for poor lower extremity function and in planning targeted interventions to help reduce disparities. <em>Ethn Dis.</em>2015;25(3):271- 278.</p>

scholarly journals 0609 Sleep Phenotypes in Middle-Aged and Older Hispanics/Latinos. Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A233-A233
Author(s):  
B Wu ◽  
W Tarraf ◽  
D M Wallace ◽  
A Stickel ◽  
N Schneiderman ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Sleep Duration ◽  
Latent Class ◽  
Rating Scale ◽  
Community Dwelling ◽  
Health Study ◽  
Apnea Hypopnea Index ◽  
Middle Aged ◽  
Targeted Interventions ◽  
Percent Time

Abstract Introduction Identifying sleep phenotypes in the diverse and understudied US Hispanic/Latino population is critical to developing interventions and mitigating distal clinical outcomes (e.g. dementias). Methods Using latent class analyses (LCA), we identify empirically derived and clinically meaningful sleep phenotypes using data on community dwelling middle-aged/older adults (ages ≥45-years) from the HCHS/SOL (2008-2011) - Investigation of Neurocognitive Aging (n=6,377). Sleep variables used included Apnea/Hypopnea Index (AHI), percent time SpO2&lt;90%, Epworth Sleepiness Scale (ESS), Women’s Health Initiative Insomnia Rating Scale (WHIIRS), self-reported average sleep duration, restless legs symptoms, napping frequency, and sleep quality. Results Mean (M) age was 56.4±8.1 years, and 54.7% were female. Average AHI, ESS, WHIIRS, and sleep duration were 8.7±13.1, 6.0±5.0, 7.6±5.5, and 7.8±1.4, respectively, and 25.8% had zero percent time SpO2 &lt;90%. Fit statistics indicated that a four-class solution provided the best data fit. The derived classes, adjusting for age, sex, income, and acculturation, corresponded with four clinically meaningful groups: (1) 28.8% were asymptomatic [(M) AHI=0.8; (M) ESS=5.6; (M)WHIIRS=7.6; (M) sleep duration=7.8; 0% SpO2&lt;90%=74.1%], (2) 25.7 % were asymptomatic mild sleep apnea [(M) AHI=6.2; (M) ESS=3.8; (M) WHIIRS=2.9; (M) sleep duration=7.8; 0% SpO2&lt;90%=8.8%], (3) 19.4% were symptomatic sleep apnea [(M) AHI=25.6; (M) ESS=8.5; (M) WHIIRS=7.2; (M) sleep duration=7.7; 0% SpO2&lt;90%= 0.5%], and (4) 26.1% were insomnia [(M) AHI=5.7; (M) ESS=6.7; (M) WHIIRS=13.0; (M) sleep duration=7.8; 0% SpO2&lt;90%=10.3%]. Classification into groups 3 and 4 were primarily driven by elevated AHI and WHIIRS scores, respectively. The distribution of scores in the derived groups suggest variations relative to current clinical thresholds. Conclusion We identified 4-groups using LCA in a community-based sample of diverse U.S. Hispanic/Latino adults. Better characterization of sleep phenotypes for Hispanics/Latinos can help in developing targeted interventions studies and ameliorate health disparities. Support 5R01AG048642-05; R21AG056952; R21HL140437.

scholarly journals Memantine Therapy of Behavioral Symptoms in Community-Dwelling Patients with Moderate to Severe Alzheimer’s Disease

2009 ◽  
Vol 27 (2) ◽  
pp. 164-172 ◽  
Author(s):  
George T. Grossberg ◽  
Vojislav Pejović ◽  
Michael L. Miller ◽  
Stephen M. Graham
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Community Dwelling ◽  
Behavioral Symptoms

scholarly journals Who Cares for Whom and Is That important? A Typology of Dementia Care Dyads and Health-Related Support Measures

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 757-758
Author(s):  
Karin Wolf-Ostermann ◽  
Henrik Wiegelmann ◽  
Liane Schirra-Weirich ◽  
Lisa-Marie Verhaert ◽  
Werner Brannath ◽  
...  
Keyword(s):  
Latent Class ◽  
Decisive Role ◽  
Dementia Care ◽  
Community Dwelling ◽  
Living Situation ◽  
Disease Characteristics ◽  
Home Based ◽  
Care And Support ◽  
Health Related ◽  
Person With Dementia

Abstract In Germany, about 70% of all care-dependent persons are community dwelling. In dementia care arrangements you will commonly find a primary informal caregiver (IC) taking on the decisive role in providing care and support for the person with dementia (PwD). This study aimed to develop a typology of dyads based on typical characteristics of the PwD, the IC and their relationship and to gain a better understanding of home-based dementia care arrangements. A latent class analysis was used to detect different dyad types based on personal, social, care and disease characteristics of 551 dyads of CGs and PwD living at home. A 6-class model was identified. The classes could be differentiated based on IC-PwD key characteristics (gender, age, relationship, living situation, occupation). There are significant differences with regard to observed outcomes. The verification of different types of dyads strengthens the need to develop tailored dyad-centred interventions in dementia care

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