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Dementia caregiving involves a challenging and complex process, especially for immigrant families. Using a qualitative method, this study provides an in-depth exploration of caregiving experiences among Korean American caregivers of people living with dementia. Based on various sampling strategies, 16 Korean American caregivers of family members/relatives with dementia were recruited in the greater Los Angeles area. Guided by the stress process model and the constant comparative method, themes and subthemes were derived and categorized into four domains: (1) background/context; (2) perception/appraisal; (3) resources/coping, and (4) caregiver burden/reward. Findings suggest that intervention efforts should focus on educating and training dementia caregivers.

Objectives: Language accommodation is indispensable in making evidence-based interventions available and accessible to ethnic minorities with limited English proficiency. As part of the larger effort to culturally adapt the Savvy Caregiver Program for Korean American dementia caregivers, we first conducted linguistic adaptation, and the present study reports the preliminary findings on participants' changes in depressive Symptoms., Methods: The linguistically adapted program was delivered to two small groups of Korean American dementia caregivers (total n  = 13) by two Savvy-certified Korean-speaking trainers. Participants' depressive symptoms were assessed at three time points (pre-intervention, immediate post-intervention, and 6-month follow-up)., Results: Following the intervention, participants exhibited lowered depressive symptoms ( t  = 8.64, p  < .001, Cohen's d  = .89). This benefit was sustained at 6-month follow-up., Conclusions: Findings suggest that the therapeutic benefit of the Savvy Caregiver Program could potentially be shared with linguistic minorities when delivered in their native language., Clinical Implications: Although limited in its scope and nature, the pilot study with linguistic adaptation sheds light on efforts to close the gap in the evidence-based intervention delivery.

Subsidized senior housing helps many socioeconomically disadvantaged older adults pursue independent living and aging in place. However, cognitive impairment or dementia poses a critical challenge to many residents' ability to live independently and safely. Focusing on Korean American dementia caregivers, a group known to be vulnerable to caregiving burden but understudied, we explored the safety of persons with dementia in senior housing from the perspectives of caregivers. Qualitative data from nine caregivers whose care recipients were current or former residents of subsidized senior housing in Los Angeles were analyzed by the constant comparative method. Major concerns emerged were: (1) fire risks, (2) wandering, (3) physical injury (e.g., self-harm, falls), and (4) potential neglect. Caregivers also mentioned errors in the self-administration of medications, potential financial exploitation, and interpersonal conflicts. These concerns provide implications for services and programs for the safety of persons with dementia who live in senior housing.

Background: Little research has been conducted on telehealth-based interventions in older adults. There has been no study of the use of telehealth-based online chair yoga (CY) to improve physical activity and manage dementia symptoms and socialisation for older adults with dementia who are socially isolated., Objectives: The study identified benefits, challenges and facilitators in participating in remotely supervised online CY from the perspective of older adults with dementia and their caregivers, including what would help them to participate in online interventions., Methods: In a qualitative descriptive design, four online focus groups (two pre-intervention and two post-intervention) conducted via videoconference explored the benefits, challenges and facilitators in participating in a remotely supervised twice-weekly, 8-week online CY intervention. A total of 17 participants (eight people with dementia and nine family caregivers) attended the focus groups. The data were subjected to thematic analysis., Results: Thematic analysis of data identified three themes from the perspectives of older adults with dementia and their caregivers: (a) benefits (e.g. sleep and relaxation, emotional regulation, flexibility, muscle strength, convenience, caregiver-participant connection), (b) challenges (e.g. technological setup) and (c) lessons learned (e.g. inclusion of caregiver, yoga instructor, visual cues, socialisation, safety). The online intervention was beneficial to participants, who reported that they wanted to continue home-based online CY practice., Conclusion: Convenience was the major advantage for the participant to continue to practice online CY. The online intervention offered virtual socialisation, which could be significant for motivating older adults to continue the CY program., Implications for Practice: Gerontological nurses could add CY as a nonpharmacological component of a treatment plan and monitor older adults' progress during the online intervention. The home-based online CY intervention should be prioritised to promote health and wellness in socially isolated older adults with dementia., (© 2022 John Wiley & Sons Ltd.)

Background: Limited English proficiency (LEP) of dementia caregivers poses a critical barrier to these caregivers' access to evidence-based interventions. In an effort to make such interventions available and accessible to dementia caregivers with LEP, in the present study we use Barrera and colleagues' (2011) three-step model of cultural adaptation: (1) information gathering, (2) preliminary adaptation, and (3) full adaptation. Selecting Korean Americans as a target group and the Savvy Caregiver Program (SCP) as a target intervention, we demonstrate the sequential process of cultural adaption and report the outcomes on feasibility and acceptability., Methods: Preliminary adaptation with linguistic attunement was conducted by translating the SCP manual into Korean and certifying two lay individuals who were bilingual in English and Korean as Savvy trainers. The 6-week online SCP program was delivered by the two trainers in Korean with six to seven caregiver participants per trainer (N = 13). Feasibility and acceptability of the SCP for both caregiver participants and trainers were assessed using mixed methods, and their data then informed full adaptation., Results: Findings not only showed the initial efficacy of the linguistically attuned SCP but also suggested areas for further modification. Data-driven assessment yielded a list of recommended changes for full adaptation, which was reviewed by the SCP developer to ensure fidelity and by community and research partners to confirm contextual and cultural relevance., Conclusions: The adopted changes are broadly summarized as representing logistical, technical, and cultural issues. Given our refined set of educational materials and implementation guidelines, we discuss future directions for research and development., (© 2022. The Author(s).)

Background: and Purpose: Social isolation and caregiver burden call for an innovative way to deliver a chair yoga (CY) intervention to older adults with dementia who cannot travel to a community center. During a remotely supervised CY session, the yoga instructor can monitor each participant's pose and correct poses to optimize efficacy of CY and reduce chances of injury. This study assessed the feasibility of a remotely supervised online CY intervention for older adults with dementia and explored the relationship between CY and clinical outcomes: pain interference, mobility, risk of falling, sleep disturbance, autonomic reactivity, and loneliness., Methods: Using a one-group pretest/posttest design, a home-based CY intervention was delivered remotely to 10 older adults with dementia twice weekly in 60-minute sessions for 8 weeks. Psychosocial and physiological (i.e., cardiac) data were collected remotely at baseline, mid-intervention, and post-intervention., Results: The results indicated that remotely supervised online CY is a feasible approach for managing physical and psychological symptoms in socially isolated older adults with dementia, based on retention (70%) and adherence (87.5%), with no injury or other adverse events. While there were no significant findings for pain interference, mobility, sleep, or social loneliness longitudinally, emotional loneliness showed a significant increase, F(1.838, 11.029) = 6.293, p = .016, η 2  = 0.512, from baseline to post-intervention. Although participants were socially connected to other participants via a videoconferencing platform, emotional loneliness increased during the pandemic period., Conclusion: A home-based remotely supervised online CY is a feasible approach for socially isolated older adults with dementia who are unable to travel to a facility., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Introduction: More than 50 million people worldwide are living with dementia in 2020, and this number is expected to double every 20 years. Physical exercise is a growing field in non-pharmacological interventions for dementia care. Due to public health measures during the COVID-19 pandemic, more people have considered adapting to technology-based exercise via digital devices. This scoping review will explore evidence relating to the use of technology-based group exercise by people with dementia or mild cognitive impairment., Methods and Analysis: This review will follow the Joanna Briggs Institute scoping review methodology to review literature published between June and December 2021. This review is designed to identify existing types of technology-based group exercise interventions for people with dementia. The review will provide a synthesis of current evidence on the outcome and impacts of technology-based group exercise. The context of this review will include homes, assisted living facilities and memory care services but exclude hospitals. The review will include a three-step search strategy: (a) identify keywords from MEDLINE and Embase, (b) search using the identified keywords in databases (MEDLINE/PubMed, CINAHL, Web of Science, Embase, Cochrane Library, PsychInfo and Google) and (c) review references from included studies to identify additional studies. Only studies in English will be included. Four researchers will independently assess titles and abstracts and then review the full text of the selected articles, applying the inclusion criteria. The extracted data will be presented in tables and summarised narratively., Ethics and Dissemination: Scoping review data will be collected from publicly available articles; research ethics approval is not required. The findings will be disseminated to healthcare practitioners and the public through a peer-reviewed publication and conference presentations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This study assessed the feasibility of conducting 3 nonpharmacological interventions with older adults in dementia, exploring the effects of chair yoga (CY), compared to music intervention (MI) and chair-based exercise (CBE) in this population. Using a cluster randomized controlled trial (RCT), 3 community sites were randomly assigned 1:1:1 to CY, MI, or CBE. Participants attended twice-weekly 45-minute sessions for 12 weeks. Thirty-one participants were enrolled; 27 safely completed the interventions and final data collection (retention rate of 87%). Linear mixed modeling was performed to examine baseline and longitudinal group differences. The CY group improved significantly in quality of life compared to the MI group (CY mean = 35.6, standard deviation [SD] = 3.8; MI mean = 29.9, SD = 5.3, P = .010). However, no significant group differences were observed in physical function, behavioral, or psychological symptoms (eg, for mini-PPT: slope time = 0.01, standard error [SE] = 0.3, P = .984 in the CBE group; slope time = -0.1, SE = 0.3, P = .869 in the MI group; slope time = -0.3, SE = 0.3, P = .361 in the CY group) over the 12-week intervention period. Overall, this pilot study is notable as the first cluster RCT of a range of nonpharmacological interventions to examine the feasibility of such interventions in older adults, most with moderate-to-severe dementia. Future clinical trials should be conducted to examine the effects of nonpharmacological interventions for older adults with dementia on health outcomes.

The current qualitative research explored perceived effects of three nonpharmacological interventions (chair yoga [CY], participatory music intervention [MI], and chair-based exercise [CBE]) in managing symptoms in older adults with Alzheimer's disease or dementia with Lewy bodies from family caregivers' perspectives. Three focus groups were conducted following completion of the 12-week interventions. Constant comparative analysis determined whether each intervention had perceived effects on symptoms, based on caregivers' perspectives. Three major themes emerged: (a) Changes in Cognitive Symptoms, (b) Changes in Physical Function, and (c) Changes in Mood, Behavioral Symptoms, and Sleep Disturbance. Results can be integrated into treatment plans for older adults with dementia. Future research should focus on CY or CBE with support from caregivers to manage dementia symptoms and compare CY or CBE practiced with caregivers against CBE or CY practiced solely by participants with dementia. [Journal of Gerontological Nursing, 46(1), 37-46.]., (Copyright 2020, SLACK Incorporated.)

Objective: Pain assessment for nonverbal older adults with cognitive impairments or dementia presents many challenges, and it is important to determine which scales are most useful in assessing pain among this population. Method: In this review 11 observational scales for assessment of pain in older adults with dementia or cognitive impairments are evaluated in four areas: pain indicators, reliability, validity, and clinical utility of the measure. Results: Results indicate that various scales are available for assessing pain in cognitively impaired or demented older adults who are unable to report their pain, but future research should focus on further psychometric evaluations. Conclusions: Implications include that social workers should be trained as raters of pain assessment methods. (Contains 2 tables.)

Background: Neuropsychiatric symptoms (NPS) are prevalent among persons with Alzheimer's disease and related dementias (ADRD). However, there are limited safe and effective nonpharmacological treatments for controlling NPS. Transcranial direct current stimulation (tDCS) is a promising noninvasive and safe treatment. Materials and Methods: This study investigated the effects of remotely supervised tDCS in managing NPS in older adults with mild to moderate ADRD. Forty older adults diagnosed with early-stage ADRD were randomly assigned in a 1:1 ratio to receive home-based active tDCS (n = 20) or sham tDCS (n = 20). Results: Results showed a significantly greater improvement in the following NPS: scratching (P = 0.052, Hedges' g = −0.60 [confidence interval {CI}: −1.24, 0.04], Cliff's δ = −0.41 [CI: −0.67, −0.06]), nighttime behaviors (P = 0.041; Hedges' g = −0.62 [CI: −1.26, 0.03]; Cliff's δ = −0.41 [CI: −0.67, −0.06], and appetite/eating changes (P = 0.010; Hedges' g = −0.78 [CI: −1.43, −0.13]; Cliff's δ = −0.41 [CI: — 0.56, −0.10]). Conclusion: This study shows promising initial results for using home-based, remotely supervised tDCS to manage NPS, such as nighttime behaviors, changes in eating and appetite, and scratching. Larger studies with more participants are needed to explore various tDCS doses and their long-term effects on NPS. [ABSTRACT FROM AUTHOR]

Given the significant role of culture and place in dementia caregiving, we conducted a qualitative study with Korean American family caregivers of persons with dementia. Guided by the sociocultural model of dementia caregivers' service use, we explored the categories of care decisions, caregiving situations, and formal service use within the context of culture and place. Data from in-depth interviews with 16 Korean American dementia caregivers living in the greater Los Angeles area were analyzed using the constant comparison method. Across the three conceptual categories, we derived eight themes: (1) personal motivation; (2) family context; (3) attitude toward formal care; (4) strains; (5) rewards; (6) language and geographic region; (7) knowledge and awareness; and (8) social support and cultural stigma. Our findings demonstrate not only varied experiences in care decisions, caregiving situations, and formal service use but also their interconnectedness. Supporting the influential role of culture and place in dementia caregiving, the findings include positive and negative elements within each domain and provide implications for programs and services to respond to identified needs and barriers. [ABSTRACT FROM AUTHOR]

Although transcranial direct current stimulation (tDCS) is emerging as a convenient pain relief modality for several chronic pain conditions, its feasibility, acceptability, and preliminary efficacy on pain in patients with Alzheimer's disease and related dementias (ADRD) have not been investigated. The purpose of this pilot study was to assess the feasibility, acceptability, and preliminary efficacy of 5, 20-min home-based tDCS sessions on chronic pain in older adults with ADRD. We randomly assigned 40 participants to active (n = 20) or sham (n = 20) tDCS. Clinical pain intensity was assessed using a numeric rating scale (NRS) with patients and a proxy measure (MOBID-2) with caregivers. We observed significant reductions of pain intensity for patients in the active tDCS group as reflected by both pain measures (NRS: Cohen's d = 0.69, p-value = 0.02); MOBID-2: Cohen's d = 1.12, p-value = 0.001). Moreover, we found home-based tDCS was feasible and acceptable intervention approach for pain in ADRD. These findings suggest the need for large-scale randomized controlled studies with larger samples and extended versions of tDCS to relieve chronic pain on the long-term for individuals with ADRD. [ABSTRACT FROM AUTHOR]

Background: Pre-loss grief increases as dementia advances. Caregivers who experience pre-loss grief face risks to their own physical and psychological health.Objective: The study examined factors associated with pre-loss grief in caregivers of older adults with dementia with Lewy bodies (DLB) to determine whether overall caregiver experiences differ based on the stages of DLB in care recipients. The study also compared pre-loss grief in caregivers of DLB patients with that in caregivers of patients with Alzheimer's disease (AD) and other dementias.Method: Using a cross-sectional design, 714 caregivers of older adults with dementia (488 DLB, 81 AD, 145 other dementias) completed an online survey on pre-loss grief. Multivariate linear regression identified risk factors associated with pre-loss grief and analysis of variance examined whether pre-loss grief in caregivers differed significantly based on type of dementia or stage of DLB.Results: Being the caregiver of a spouse, lower level of caregiver well-being, lower psychological well-being of the caregiver, and higher level of burden were associated (p < 0.005) with increased pre-loss grief in caregivers of older adults with DLB. There was no significant difference in caregiver burden, well-being, or depression according to the various stages of DLB (mild, moderate, severe, deceased) in the care recipients. There was no significant difference in pre-loss grief in caregivers of DLB care recipients compared to caregivers of patients with other dementias.Conclusion: Assessment of DLB caregivers and appropriate interventions should be conducted to reduce their burden and emotional distress to decrease the incidence of pre-loss grief. [ABSTRACT FROM AUTHOR]

This comprehensive literature review analyzed relevant studies on the effects of exercise interventions for older adults with dementia. An extensive search of databases was conducted to identify relevant studies. Among the 64 reviewed studies, the highest number focused on Alzheimer's disease, following by mixed dementia; none of the studies included older adults with Lewy body dementia or frontotemporal dementia. Methodological quality and risk of bias were evaluated based on Downs & Black's Quality Index. A variety of exercise interventions have been shown to be beneficial for functional outcomes but there were mixed findings regarding the effects of exercise on cognitive function, behavioral and psychological symptoms, and overall quality of life. Not all high-frequency or longer-duration physical exercise interventions were associated with significant effects on cognitive function but positive outcomes of exercise intervention on cognitive ability were often accompanied by improvement in activities of daily living. More clinical trials are needed to determine how to motivate older adults with dementia to engage regularly in exercise and how group and individually tailored exercise programs may improve physical function and minimize behavioral and psychological symptoms associated with dementia. [ABSTRACT FROM AUTHOR]