Karen Rose

Predictors of caregiver burden in caregivers of individuals with dementia.

AIMS This article is a report on a study of the multidimensional predictors of caregiver burden in caregivers of individuals with dementia using nationally representative data. BACKGROUND Caregiver burden affects the health of both caregivers and their care-recipients. Although previous studies identified various predictors of caregiver burden, these predictors have not been confirmed in nationally representative population. METHODS Data for this secondary analysis was provided by the National Alliance for Caregiving, American Association of Retired Persons. The data were collected through a telephone survey of randomly selected adults in seven states in 2003 (weight adjusted n = 302). Descriptive statistics, inter-correlation analysis and a hierarchical multiple regression analysis were performed. RESULTS/FINDINGS Disease-related factors were the most significant predictors, explaining 16% of caregiver burden; these were followed by caregiver socio-demographical factors and caregiving-related factors (F = 21·28, P < 0·01). Significant individual predictors were impairment of activities of daily living or instrumental activities of daily living, the number of hours of caregiving, use of coping strategies, co-residence, spousal status and caregiver gender (P < 0·05). CONCLUSION Impaired function in care-recipients predicts caregiver burden, and also interacts with demographical- and caregiving-related factors. Thus, it will be beneficial to both care-recipients and caregivers to target nursing interventions and community services to improve the functional abilities of individuals with dementia.

Evidence supporting nutritional interventions for persons in early stage Alzheimer's disease (AD)

The purpose of this paper is to grade research evidence supporting nutritional interventions for persons with early stage dementias and to report the recommendations of a consensus panel. Thirty four studies were reviewed in the areas of dietary restriction, antioxidants, and Mediterranean diet with strong support from epidemiological studies found in all three areas. The body of evidence to support nutritional interventions in the prevention and treatment of AD is growing and has potential as a treatment modality following translational studies.

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.

Cognitive Training for Early-Stage Alzheimer's Disease and Dementia

The purpose of this article is to critically review and synthesize the literature on the effects of nonpharmacological cognitive training on dementia symptoms in early-stage Alzheimers disease (AD) and related dementia. Electronic databases MEDLINE (PubMed), CINAHL, PsycInfo, and the Cochrane Library were searched using the keywords cognition, reality orientation, Alzheimers disease, psychosocial factors, cognitive therapy, brain plasticity, enriched environments, and memory training. The findings support that cognitive training improves cognition, activities of daily living, and decision making. Interventions are more effective if they are structured and focus on specific known losses related to the AD pathological process and a persons residual ability, or are combined with cognitive-enhancing medications. Nursing implications are also discussed.

The Effects of Meditation on Perceived Stress and Related Indices of Psychological Status and Sympathetic Activation in Persons with Alzheimer's Disease and Their Caregivers: A Pilot Study

Objective. To investigate the effects of an 8-week meditation program on perceived stress, sleep, mood, and related outcomes in adults with cognitive impairment and their caregivers. Methods. Community-dwelling adults with a diagnosis of mild cognitive impairment or early-stage Alzheimers disease, together with their live-in caregivers, were enrolled in the study. After a brief training, participants were asked to meditate for 11 minutes, twice daily for 8 weeks. Major outcomes included measures of perceived stress (Perceived Stress Scale), sleep (General Sleep Disturbance Scale), mood (Profile of Mood States), memory functioning (Memory Functioning Questionnaire), and blood pressure. Participants were assessed pre- and post-intervention. Results. Ten participants (5 of 6 dyads) completed the study. Treatment effects did not vary by participant status; analyses were thus pooled across participants. Adherence was good (meditation sessions completed/week: X = 11.4 ± 1.1). Participants demonstrated improvement in all major outcomes, including perceived stress (P < 0.001), mood (overall, P = 0.07; depression, P = 0.01), sleep (P < 0.04), retrospective memory function (P = 0.04), and blood pressure (systolic, P = 0.004; diastolic, P = 0.065). Conclusions. Findings of this exploratory trial suggest that an 8-week meditation program may offer an acceptable and effective intervention for reducing perceived stress and improving certain domains of sleep, mood, and memory in adults with cognitive impairment and their caregivers.

Sleep disturbances and nocturnal agitation behaviors in older adults with dementia.

STUDY OBJECTIVES To examine nighttime sleep patterns of persons with dementia showing nocturnal agitation behaviors and to determine whether restless legs syndrome (RLS), periodic limb movements in sleep (PLMS), and obstructive sleep apnea (OSA) are associated with nocturnal agitation behaviors. DESIGN Cross-sectional. SETTING General community. PARTICIPANTS 59 participants with geriatrician-diagnosed dementia. Participants ages ranged from 66 to 88 years (mean age 79.1; SD 6.0). Mean Mini Mental State Examination (MMSE) score was 20.1 (SD 6.6). MMSE was used to measure baseline cognitive function and not for the diagnosis of dementia. INTERVENTIONS None. MEASUREMENTS AND RESULTS Sleep was measured by 2 nights of in-home, attended, portable polysomnography (PSG). Nocturnal agitation was measured over 3 additional nights using the Cohen-Mansfield Agitation Inventory modified for direct observations. Two experts independently and via consensus identified probable RLS. Total sleep time in participants was 5.6 h (SD 1.8 h). Mean periodic limb movements in sleep index (PLMI) was 15.29, and a high percentage (49%) had moderate to severe obstructive sleep apnea. Probable RLS was present in 24% of participants. Those with more severe cognitive impairment had longer sleep latency. Severe cognitive impairment, low apnea hypopnea index (AHI), and probable RLS were associated with nocturnal agitation behaviors (R(2) = 0.35, F(3,55) = 9.40, P < 0.001). CONCLUSIONS It appears that probable RLS is associated with nocturnal agitation behaviors in persons with dementia, while OSA and PLMS are not. Further investigation is warranted to determine if treatment of RLS impacts nocturnal agitation behaviors in persons with dementia.

Sleep disturbances in dementia.

Approximately one quarter of adults with dementia experience sleep disturbances. The purpose of this article is to (a) describe and define sleep disturbances in individuals with dementia, (b) describe techniques to assess for sleep disturbances in individuals with dementia, and (c) provide nursing interventions to improve sleep in this patient population. Typical presentations of sleep disturbances in individuals with dementia are described, along with medications that may interfere with sleep. Suggestions for nursing measures that can be implemented to enhance sleep are also presented. Nurses have numerous nonpharmacological options to assist with the regulation of sleep-wake rhythms in individuals with dementia.

Effects of Cranial Electrical Stimulation on Sleep Disturbances, Depressive Symptoms, and Caregiving Appraisal in Spousal Caregivers of Persons with Alzheimer’s Disease

PURPOSE The purpose of this work was to investigate the effects of cranial electrical stimulation (CES) on sleep disturbances, depressive symptoms, and caregiving appraisal. METHODS Thirty-eight participants were randomly assigned to receive active CES or sham CES for 4 weeks. RESULTS Both intervention groups demonstrated improvement in study measures from baseline scores. A trend toward statistically significant differences in daily sleep disturbances was found between the groups. No differences in depressive symptoms and caregiving appraisal were found between the groups. CONCLUSIONS These findings did not fully support the efficacy of the short-term use of active CES versus sham CES to improve sleep disturbances, depressive symptoms, or caregiving appraisal.

Sleep Disturbances in Family Caregivers: An Overview of the State of the Science

Sleep disturbance is a prevalent and complex issue within the family caregiver population that affects the overall health of the caregivers themselves and their care recipients. However, there is limited evidence to support the efficacy of current practice and a lack of consensus regarding the optimal treatment protocol. This article will provide an overview of sleep research in family caregivers. It explores current trends in sleep research and identifies relevant conceptual and methodological issues, suggesting implications for further research and highlighting the need to improve sleep quality in the caregiver population.

Expanded Review Criteria: The Case of Nonpharmacological Interventions in Dementia

This paper challenges the assumptions underlying many reviews and offers alternative criteria for examining evidence for nonpharmacological interventions. We evaluated 27 reviews examining interventions for persons with dementia as they relate to the issues of selection based on randomized controlled trial (RCT) design. Reviews were described by type of intervention, level of cognitive function, and criteria for inclusion. Of the 27 reviews, 46% required RCTs for inclusion and most had stringent inclusion criteria. This resulted in poor utilization of the literature and low ecological validity. Eliminating most of the available data poses a critical problem to clinical and research development. Studies meeting strict methodological criteria may not generalize to the greater population or may exclude sub-populations and interventions. Limitations of double-blind RCTs and potential design solutions are set forth based on appropriate populations, problems, interventions, and settings characteristics.