Corinne W. Lambert

Strength Training, Walking, and Social Activity Improve Sleep in Nursing Home and Assisted Living Residents: Randomized Controlled Trial

OBJECTIVES: To compare the effects of physical resistance strength training and walking (E), individualized social activity (SA), and E and SA (ESA) with a usual care control group on total nocturnal sleep time in nursing home and assisted living residents.

Factors Associated with Problematic Vocalizations in Nursing Home Residents With Dementia

PURPOSE OF THE STUDY Problematic vocalizations (PVs) are the most frequent and persistent disruptive behaviors exhibited by nursing home residents with dementia. Understanding factors associated with these behaviors are important to prevent or reduce them. We used the Need-Driven Dementia-Compromised Behavior model to identify the characteristics of persons with dementia who are likely to display nonaggressive and aggressive PVs and the conditions under which these behaviors are likely to occur and persist. DESIGN AND METHODS This multisite descriptive study included 138 residents of 17 nursing homes, and approximately half had a history of PVs. Background data were gathered through interviews, chart reviews, and administration of physical and neuropsychological assessments. Proximal data were obtained from observations and videotapes. RESULTS When the 2 subscales of the Verbal Behavior Scale were used as the dependent variables, agreeableness and conscientiousness, positive affect, and discomfort were associated with nonaggressive vocalizations, and general health state (GHS), age, and negative and positive affect were associated with aggressive vocalizations. When the verbally agitated (nonaggressive) section of the Cohen-Mansfield Agitation Inventory was the dependent variable, the background factors of gender, agreeableness, GHS, and age remained predictors, as did the proximal factors of affect and discomfort. IMPLICATIONS We identified 5 background factors and 3 proximal factors as risk factors for PVs in persons with dementia, with variation between nonaggressive or aggressive PVs. These data provide direction for caregiving for persons with dementia and design of interventions to prevent or reduce PVs.

Restless Legs Syndrome Risk Factors, Behaviors, and Diagnoses in Persons With Early to Moderate Dementia and Sleep Disturbance

In this study, restless legs syndrome (RLS) risk factors, RLS-associated behaviors, and the ability to understand and answer an RLS diagnostic interview were investigated. In 23 older adults with early to moderate dementia and nighttime sleep disturbance, the most common risk factors for RLS were a periodic leg movement sleep index > 15 (54.55%), based on polysomnography, and use of selective serotonin reuptake inhibitors (SSRIs) (34.78%). The most common RLS-associated behaviors were repetitious mannerisms (56.52%) and general restlessness (34.78%), according to direct observation from research assistants. Finally, older adults with early to moderate dementia were unable to understand and reliably answer the RLS diagnostic interview. Older persons with mild to moderate dementia and sleep disturbance may require objective diagnostics to identify RLS.

Backrest position and reference level in pulmonary artery pressure measurement.

Pulmonary artery pressures obtained using two common reference levels with patients in each of three hack reef, positions were evaluated. A repeated measures factorial design was used to collect pulmonary artery systolic, diastolic, and mean pressures from 32 adult patients in critical rare units. Two way analyses or covariance yielded no differences in pulmonary artery pressures associated with reference level. With backrest elevation, only pulmonary artery diastolic pressures varied in a statistically significant way hut only with the change from 20 to 40 degrees. However, with backrest elevation, clinically significant changes were observed In two patients, The statistical findings suggest that either reference level may be used to abtain pulmonary artery pressures and that, In most cases, they tan he obtained accurately with backrest elevations of Lip to 20 degrees. The findings associated with backrest elevation must be applled with caution pending further study of those factors that contribute to such changes

Predictors of Daytime Sleep of Nursing Home Residents With Dementia

BACKGROUND: Excessive daytime sleep (EDS) in nursing home residents with dementia may lead to decline in cognitive, affective, and functional status. Yet, we know little about predictors of EDS. OBJECTIVES: Describe daytime, nighttime, and 24-hr sleep and determine predictors of daytime sleep among them. STUDY DESIGN: This cross-sectional study of 104 residents from nine nursing homes used actigraphy to measure sleep variables and multiple linear regression to analyze 10 predictor factors (age, gender, body mass index, cognitive function, functional status, comorbidity, psychiatric illness, nighttime sleep minutes, frequency of nighttime awakenings, and number of sedating medications per participant). RESULTS: In this sample, 66% of participants were female octogenarians. On average, they slept 139.0 min (SD ± 113.5) during the day, 340.6 min (SD ± 156.0) at night, and 479.6 min (SD ± 227.1) during 24 hr. Significant predictors of daytime sleep were nighttime sleep minutes (Beta = .34; p < .001), comorbidity (Beta = .24; p < .01), and gender (Beta = .21; p < .05). CONCLUSIONS: Controlling comorbidity may enhance daytime alertness.

Positioning during hemodynamic monitoring: Evaluating the research

Can pulmonary artery or right atrial pressures be obtained accurately when patients are in lateral positions? This review of the published research says probably not.

Backrest elevation and pulmonary artery pressures: Research analysis

Obtaining pulmonary artery pressure readings in the traditionally accepted flat, supine position can be uncomfortable for the patient and time consuming for the nurse. This analysis of published research suggests that some patients need not lie flat.