Haesook Kim

To Nap or Not to Nap Excessive Daytime Napping Is Associated With Elevated Evening Cortisol in Nursing Home Residents With Dementia

Background: Alterations in the sleep–wake cycle, including daytime napping, are consistently reported in persons with dementia (PWD). A dysregulation in the hypothalamic–pituitary–adrenal (HPA) axis, indexed by elevated evening cortisol, may offer one explanation for these alterations. Alternatively, excessive daytime sleeping may alter cortisol rhythm and increase intraindividual variability, potentially contributing to increased environmental reactivity and behavioral symptoms. The purpose of this substudy (N = 12) was to examine the association between daytime napping and basal cortisol diurnal rhythm in nursing home residents with dementia. Method: In this within-individual longitudinal design, saliva samples were obtained daily for 5 consecutive days upon waking and 30–45 min, 6 hr, and 12 hr after waking to obtain a cortisol diurnal rhythm. Behavior and sleep–wake state (nap/no nap) were observed and recorded every 20 min for 12 hr per day for 5 days. Results: Participants were categorized as high nappers (HNs) or low nappers (LNs). There was a significant difference in evening cortisol levels (t = −2.38, p = .032) and continence (t = 3.37, p = .007) between groups, with HNs exhibiting higher evening cortisol levels. There were no other significant differences in resident characteristics between the two groups. Conclusions: These data suggest a link between excessive daytime napping and elevated evening cortisol in PWD consistent with findings in children. Elevated evening cortisol is an indication of a dysregulation in the HPA axis. These preliminary data support a close association between the sleep–wake cycle and HPA-axis regulation in PWD.

Apolipoprotein ε4 status is associated with behavioral symptoms in nursing home residents with dementia

BACKGROUND While the relationship of apolipoprotein E (APOE) to behavioral symptoms of dementia (BSD) has been studied in community-dwelling persons with AD, it has received limited attention within the nursing home (NH) population. The aim of this study was to examine the association between APOE genotype and BSD in NH residents using direct observation. METHODS Thirty-six participants, aged 71-102 years, were compared using a non-randomized two-group design with continuous measures. APOE genotype was obtained by buccal swab. BSD, including restlessness, escape restraint, tapping and banging, searching and wandering, pacing and walking, and vocalization, were measured using the Modified Agitated Behavior Rating Scale. Participants were observed every 20 minutes for 12 hours per day for five days. Each participants mean behavior scores were compared according to the presence or absence of the APOE epsilon4 allele. RESULTS Resident characteristics included a mean MMSE of 10.44 indicating moderate to severe dementia and a mean of 3.44 medical co-morbidities. Fifty-six percent of the participants had one epsilon4 allele. A significant difference was found between APOE epsilon4+/4- and mean behavioral scores (F(1,31)) = 4.40, p = 0.04). Restlessness was significantly inversely correlated with MMSE (r = -0.367, p = 0.03), but not APOE genotype. There was no significant correlation between proxy reporting and direct observation (r = 0.257, p = 0.13). CONCLUSION Findings indicate that the presence of the APOE epsilon4+ genotype increases the risk for BSD in NH residents with dementia. Direct observation proved a more accurate estimate of BSD than proxy report.

Morning Cortisol in Relation to Behavioral Symptoms of Nursing Home Residents With Dementia

Behavioral symptoms of dementia (BSD) are a significant challenge for elders, their caregivers, and clinicians, with a prevalence ranging between 66% and 98%. Although several studies have examined BSD type and frequency, few studies have examined a possible neuroendocrine basis of BSD. The purpose of this study was to examine the association between morning cortisol levels and BSD in nursing home (NH) residents. Method: Using a within-subject longitudinal design, saliva was collected four times daily for 5 days to obtain basal cortisol levels from 30 NH residents, aged 80 to 102. Behavior was observed every 20 min for 12 hr/day for 5 days. Mixed-model analysis was used to test the association between morning cortisol (MC) and BSD. To examine the association between MC and BSD across time, participants were divided into low (LM) and high morning (HM) cortisol groups. Results: A significant inverse association between mean overall BSD and morning cortisol (F = 12.71, p = .000) was found. A significant inverse association between low and high morning cortisol and behavior variability across time (F = 15.36. p = .000) was found. The LM group exhibited significantly more behavioral variability across the day than the HM cortisol group. There was a significant group difference between two co-occurring behaviors, vocalization, and restlessness (F = 19.59, p = .000). Conclusion: Although preliminary, these results suggest an association between morning cortisol and BSD. Low morning cortisol, potentially indicating HPA axis dysregulation, may increase vulnerability to BSD.

Developing and proposing the ethno-cultural gerontological nursing model.

By 2050, for the first time in U.S. history, almost half of elders will be from ethnic minority groups. To meet the needs of this rapidly diversifying population, nurses need to be able to marry transcultural nursing knowledge with gerontological nursing knowledge. The purpose of this article is to propose a new theoretical model for explaining health outcomes and health responses for older individuals in unique ethno-cultural groups and to discuss implications and applications of the model to transcultural gerontological nursing practice and research. The discussion will include (1) an overview of currently available theoretical knowledge in the area, (2) a description of the theory development process, (3) presentation of the proposed ethno-cultural gerontological nursing theoretical model, and (4) discussion of how this model can enhance nursing’s contributions to reducing health disparities. This model is presented not as a finished product but as a basis for future discussion and refinement.

Older Latinos Applying the Ethnocultural Gerontological Nursing Model

Latinos/Hispanics are the largest and fastest growing ethnic minority group in the United States. By mid-century, older Hispanics may account for almost 20% of the older cohort. Yet while health disparities have garnered increased attention, little is known about older Hispanics and their overall health, social, and economic needs. This article presents an innovative Ethnocultural Gerontological Nursing Model that can serve as an overarching framework for exploring various salient macro- and micro-level factors that affect the lives of Latino elders, their families, and the communities that support them. By utilizing a life span perspective, the Ethnocultural Gerontological Nursing Model and attached questionnaire can assist nurses and other health providers in gaining a fuller assessment of older Latinos in order that we may improve our understanding and development of health service, program, and policy changes that address the needs of older Latinos and the nurses who care for them and their families.

The Development of Direct-Care Staff Social Interaction Coding Schemas for Nursing Home Residents with Dementia

Two social interaction coding schemas were developed to measure the dementia competent (DSI) and culturally competent (CSI) social interaction of direct-care staff for persons with dementia in a Korean American nursing home. A pilot study was conducted to assess: feasibility, content validity, inter-rater reliability and the ease of use of both schemas. An expert panel evaluated the content validity of the DSI/CSI. Two research assistants (RAs) simultaneously observed and recorded direct-care staff social interaction encounter during care activities. Twenty-three morning care activities were recorded over a 3-day period. The Index of Content Validity score for the DSI and the CSI was .88 and .80, respectively. Cohens Kappa ranged from 0.73 to 0.83 for the DSI and 0.69 to 0.82 for the CSI, indicating good to very good inter-rater reliability. RA interviews noted that schemas were easy to use and feasible.

Elder Mistreatment in U.S. Residential Care Facilities: The Scope of the Problem

Many in the United States believe elder mistreatment in long-term care is serious and widespread, but until recently few studies focused on the problem. This study was designed to describe the scope of mistreatment in assisted living facilities (ALFs) in Arizona during a 3-year period. Findings showed that receiving citations for elder mistreatment was relatively rare. However, analysis of narrative reports from only 7% of facilities showed 598 allegations of mistreatment in complaint investigations, of which 372 (62.2%) were substantiated and given citations for something other than mistreatment. Results show that elder mistreatment in ALFs is seriously underidentified, even by state inspectors.

Nursing Assistants’ Communication Styles in Korean American Older Adults With Dementia A Review of the Literature

As ethnic diversity increases in the United States with the anticipated increase in dementia, it is critical to understand the implications of dementia and culturally appropriate communication for ethnic minority older adults with dementia. Utilizing the Ethno-Cultural Gerontological Nursing model and the Progressively Lowered Stress Threshold model, this article describes the relationship between nursing assistants’ communication style and behavioral symptoms of dementia, focused on Korean American older adults with dementia residing in nursing homes. The discussion includes reviewing currently available studies, nursing implications, and suggestions for future studies.