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This qualitative study explored the impact of pain and discomfort on the lives of cognitively impaired older adults and their caregivers from the caregiver perspective. Forty-three individuals of age 19+, who identified themselves as primary caregiver to a chronically or seriously ill older adult (age 50+) with cognitive impairment, such as Alzheimer’s Disease and Related Dementia, were recruited at various community settings. Individual, face-to-face interviews were conducted to ask participants how they thought their care-recipient’s pain and discomfort affected the care-recipient’s and the caregiver’s life respectively. Inductive, thematic analysis of interview transcripts revealed several key themes: compromised mobility, limited social interaction or activities, and depressive symptoms in both care-recipients and caregivers; aggravated cognitive decline in care-recipients; and poorer physical health in caregivers. Participants wanted more information on the disease trajectory and available services, particularly home-based therapies and social activities for care-recipients, which provides future program/practice implications.

Cognitive decline in older adults represents a major challenge since cognitive impairment is found in 10% of those ≥ 65 and 50% ≥ 85. Thus it is increasingly important to understand the impact of aging on cognitive health. We performed a battery of tests to assess cognition in 6 month-old (n=12) and 24 month-old (n=8) C57BL/6J mice, equivalent to 30 and 70 year old humans, respectively, and also assessed protein markers in cortex for mitochondrial health and cognition. We found that aged mice displayed fewer spontaneous alternations in the T maze test (p=0.034) and lower recognition of novel objects (p=0.022). In addition, aged mice showed prolonged escape time in the Barnes maze (p=0.035), all of which taken together suggest reduced capacity for learning and recall. Aged mice also exhibited diminished nest building (p

An increasing number of family caregivers face challenges of advance care planning (ACP) for their cognitively impaired older adults. The purpose of this study was to understand service providers’ views of ACP knowledge and needs among such family caregivers. Purposive sampling was used to recruit 10 service providers who serve older adults and their family caregivers in community settings of West Alabama. Individual, face-to-face interviews were conducted guided by a semi-structured questionnaire, asking about their experiences with and views of family caregivers’ ACP for their older adults. Thematic analysis of the qualitative data revealed several findings: family caregivers’ lack of knowledge about ACP and end-of-life care, discomfort in end-of-life discussions, uncertainty about their older adult’s end-of-life preferences, frustration with the surrogate decision-making role, family conflicts in ACP process, and logistical barriers to access ACP resources. Tailored services should be developed to address these barriers to promote ACP among this population.

Background Cognitive stimulation therapy (CST), a 14-session themed groupwork for people with cognitive impairment, shows effectiveness in maintaining cognitive functioning, quality of life and communication. However, its mechanism of optimizing individual cognitive benefits is little known. Engagement, a state of being occupied by meaningful external stimuli, may be an overlooked link. Individual constructive engagement is defined as the verbal or motor individual behavior exhibited for the meaningful purposed activities. Objective To investigate the individual experience of engagement in CST and its effect on cognitive benefits. Methods A total of 108 participants were recruited from 8 community centers, 2 daycare centers and 2 residential care units in Hong Kong. Trained assessors not involved in CST delivery conducted the pre-and-post assessments using Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog). Trained raters observed each participant’s engagement under six 5-minute observation windows in total during CST sessions by time sampling using the adapted Myers Institute Engagement Scale. Results Paired t-test shows significant improvement in ADAS-Cog (Pretest: M=22.71, SD=12.63; Posttest: M=19.06, SD=10.93; MD=3.65, SD=7.38, t=5.138, p

Resistiveness to care generally occurs when an individual with cognitive impairment interferes with caregivers’ attempts to provide care, and commonly occurs during personal care interactions such as bathing, toileting, and oral care. The purpose of this study was to test the reliability and validity of the Resistiveness to Care Scale (Mahoney et al., 1999) using a Rasch Measurement Model among a larger group of nursing home residents with moderate to severe dementia. This was a descriptive study using baseline data from 261 residents participating in an ongoing trial testing a Function and Behavior Focused Care intervention for cognitively impaired nursing home residents (FBFC). The average age of the residents was 84.64 (SD=9.60) and the majority were female (N=198, 74%), white (N=161, 61%), and not married (N=185, 69%). The mean MMSE was 7.23 (SD=5.10). There was sufficient evidence of internal consistency with findings similar to the original scale development which was done with a non-independent sample of 68 residents younger residents (mean age of 72) providing 232 observations in which the alpha coefficient was .82. Psychometric testing using Rasch analysis supported the validity of the measure. The findings from this study provide new support for the reliability and validity of the Resistiveness to Care Scale for use with older adults with dementia in nursing home settings. Future work with the measure may benefit, however, from the addition of items that are easier to endorse or express with regard to resistiveness to care.

Purpose: The purpose of the study was to develop a short and a screening version of the Zarit Burden Interview (ZBI) that would be suitable across diagnostic groups of cognitively impaired older adults, and that could be used for cross-sectional, longitudinal, and intervention studies. Design and Methods: We used data from 413 caregivers of cognitively impaired older adults referred to a memory clinic. We collected information on caregiver burden with the 22-item ZBI, and information about dependence in activities of daily living (ADLs) and the frequency of problem behaviors among care recipients. We used factor analysis and item‐total correlations to reduce the number of items while taking into consideration diagnosis and change scores. Results: We produced a 12item version (short) and a 4-item version (screening) of the ZBI. Correlations between the short and the full version ranged from 0.92 to 0.97, and from 0.83 to 0.93 for the screening version. Correlations between the three versions and ADL and problem behaviors were similar. We further investigated the behavior of the short version with a two-way analysis of variance and found that it produced identical results to the full version. Implications: The short and screening versions of the ZBI produced results comparable to those of the full version. Reducing the number of items did not affect the properties of the ZBI, and it may lead to easier administration of the instrument.

The purpose of this study was to determine the effect on clinical outcomes for newly admitted nursing home residents when advanced practice gerontological nurses (APNs) worked with staff to implement scientifically based protocols for incontinence, pressure ulcers, depression, and aggressive behavior. Use of APNs in this manner differs from the usual way APNs have been used in nursing homes, in which their primary focus has been to augment the physician's role. The APN treatment was randomly assigned to two nursing homes and usual care was assigned to a third. Trajectories from admission to 6 months revealed that residents with APN input into their care (n = 86) experienced significantly greater improvement or less decline in incontinence, pressure ulcers, and aggressive behavior, and they had higher mean composite trajectory scores compared with residents receiving usual care (n = 111). Significantly less deterioration in affect was noted in cognitively impaired residents in the treatment group. Findings suggest that APNs can be effective links between current scientific knowledge about clinical problems and nursing home staff.

We examined the effects of informal and formal community care on the 6-year risk of nursing home use in a representative sample of disabled elders. Increased risk was associated with receiving formal community services and with caregiver burnout. There was a modest reduction in risk of using a nursing home among those receiving greater amounts of informal care. Elders with male caregivers were at over twice the risk of using a nursing home than those with female caregivers, while those who lived with their primary caregiver were at reduced risk. Increasing amount of formal services was associated with reduced risk of nursing home use for cognitively impaired older persons. Formal community services did not buffer the effects of severity of disability on nursing home use. Supplementing informal services with formal care was associated with greater risk of using a nursing home. Future research should move beyond testing global hypotheses regarding the protective effects of informal and formal community care and examine the impact of specific types of community care for specific subgroups of older persons on subsequent nursing home use.

Nursing homes that have both special care units (SCUs) and traditional units were examined to determine the factors that cause homes to place cognitively impaired residents on the specialized units. Wandering, other problem behaviors, and Medicaid status were not significant predictors of placement. Logistic regression results indicated that functional status was the critical placement factor.

Using a database from the Oregon Medicaid program, we examined the differences in the potential insurance coverage of demented persons by using different formulations of ADL (activities of daily living) dependencies in which the definition of dependency did or did not include the need for supervision. For those with clear dementia, 81-88% of the persons with significant behavioral problems were correctly identified when a cut score of three or more ADLs was used; this percentage was even higher for two or more ADLs. This approach was not as effective in correctly discriminating those who had no behavioral problems.

We have examined a group of cognitively impaired elderly people who already showed some increase in indices of sleep-disordered breathing and applied standard criteria for dementia to them. This resulted in a subgroup of truly demented subjects who showed significantly more abnormal breathing during sleep than either normal subjects or those whose cognitive impairment may not have been due to a dementing illness.

The 1981-1982 National Long-Term Care Channeling Demonstration Project data revealed that the mean annual cost per capita for home and institutional care for cognitively impaired persons was +18,500. The equivalent figure for cognitively intact persons was +16,650. Cognitively impaired persons used nursing homes at twice the rate of cognitively intact persons. Use differences for other health services were slight. A pre- and post-nursing home admission analysis indicated that for the cognitively impaired the annual cost of community care was +11,700, whereas the cost of nursing home care was +22,300.

This study was designed to compare changes in performance on selected measures from the Halstead-Reitan neuropsychological test battery over a 5 to 6 year interval for normotensive and medically treated, uncomplicated essential hypertensive adults. Mean performance level was poorer for hypertensive than for normotensive groups on an average impairment index and a number of the individual impairment rating scores, but no Time of measurement X Blood pressure interactions were observed. There was no evidence of improvement or decline for normotensive or hypertensive adults and no evidence suggesting that the hypertensive group could be characterized as "cognitively impaired" in an absolute or clinical sense.