Characteristics of older people with cognitive impairment attending emergency departments: A descriptive study.

Objective: The objective of this paper is to describe the profile of older people with cognitive impairment (CI) presenting to emergency departments (EDs).

Methods: This was a multi-centre (n=8) observational study of a convenience sample of older (≥70y) ED patients (n=579). Participants were prospectively assessed for CI and surveyed for the duration of their ED stay (n=191).

Process quality indicators targeting cognitive impairment to support quality of care for older people with cognitive impairment in emergency departments.

Objectives: The objective of this study was to develop process quality indicators (PQIs) to support the improvement of care services for older people with cognitive impairment in emergency departments (ED).

Methods: A structured research approach was taken for the development of PQIs for the care of older people with cognitive impairment in EDs, including combining available evidence with expert opinion (phase 1), a field study (phase 2), and formal voting (phase 3). A systematic review of the literature identified ED processes targeting the specific care needs of older people with cognitive impairment.

Structural quality indicators to support quality of care for older people with cognitive impairment in emergency departments.

Objectives: The purpose of this study was to identify the structural quality of care domains and to establish a set of structural quality indicators (SQIs) for the assessment of care of older people with cognitive impairment in emergency departments (EDs).

Methods: A structured approach to SQI development was undertaken including: 1) a comprehensive search of peer-reviewed and gray literature focusing on identification of evidence-based interventions targeting structure of care of older patients with cognitive impairment and existing SQIs; 2) a consultative process engaging experts in the care of older people and epidemiologic methods (i.e.

An evidence-based program to improve analgesic practice and pain outcomes in residential aged care facilities.

Pain is common in individuals living in residential aged care facilities (RACFs), and a number of obstacles have been identified as recurring barriers to adequate pain management. To address this, the Australian Pain Society developed 27 recommendations for comprehensive good practice in the identification, assessment, and management of pain. This study reviewed preexisting pain management practice at five Australian RACFs and identified changes needed to implement the recommendations and then implemented an evidence-based program that aimed to facilitate better pain management.

Appraisal of the quality of care of older adults with cognitive impairment in the emergency department.

The medical records of 273 patients 75 years and older were reviewed to evaluate quality of emergency department (ED) care through the use of quality indicators. One hundred fifty records contained evidence of an attempt to carry out a cognitive assessment. Documented evidence of cognitive impairment (CI) was reported in 54 cases.

Wandering and the physical environment.

Background/rationale: Guided by the need-driven dementia-compromised behavior (NDB) model, this study examined influences of the physical environment on wandering behavior.

Methods: Using a descriptive, cross-sectional design, 122 wanderers from 28 long-term care (LTC) facilities were videotaped 10 to 12 times; data on wandering, light, sound, temperature and humidity levels, location, ambiance, and crowding were obtained. Associations between environmental variables and wandering were evaluated with chi-square and t tests; the model was evaluated using logistic regression.

Empirical derivation and validation of a wandering typology.

Objectives: To develop and validate a wandering typology.

Design: Cross-sectional, correlational descriptive design.

Setting: Twenty-two nursing homes and six assisted living facilities.

A framework for managing wandering and preventing elopement.

Purpose Of The Study: A framework aids choice of interventions to manage wandering and prevent elopement in consideration of associated risks and mobility needs of wanderers.

Design And Methods: A literature review, together with research results, published wandering tools, clinical reports, author clinical experience, and consensus-based judgments was used to build a decision-making framework.

Results: Referencing a published definition of wandering and originating a clinical description of problematic wandering, authors introduce a framework comprising (1) wandering and related behaviors; (2) goals of wandering-specific care, (3) interpersonally, technologically, and policy-mediated wandering interventions, and (4) estimates of relative frequencies of wandering behaviors, magnitudes of elopement risk, and restrictiveness of strategies.

Are wandering and physically nonaggressive agitation equivalent?

Objective: The authors examined equivalence of wandering and physically nonaggressive agitation (PNA) as concepts.

Design: A cross-sectional correlational design was used.

Setting: Participants were recruited from 22 nursing homes and 6 assisted living facilities in two states.

The concept of vulnerability and the protection of human subjects of research.

This article provides an overview of the concept of vulnerability through the lens of the U.S. federal regulations for the protection of human subjects of research.

Initial psychometrics of the ambiance scale: a tool to study person-environment interaction in dementia.

Our purpose was to evaluate the psychometric properties of the Ambiance Scale (AS), a new instrument that assesses the capacity of long-term care environments for generating affective and behavioural responses in people with dementia. Within the context of three parent studies of dementia-related behaviour in long-term care settings, we conducted a cross-sectional correlational study by creating two separate samples of ratings from among all those available. Factor analysis revealed a two-factor structure (engaging, soothing) for the AS.

A comparison of wandering behavior in nursing homes and assisted living facilities.

Wandering, a challenging behavior associated with dementia, affects many residents of long-term care facilities and can result in elopement, injury, and death. Most studies of wandering have taken place in nursing homes (NH). Expansion of the long-term care sector over the last 2 decades has resulted in a surge in options such as assisted living facilities (ALF).

Comparison of U.S., Canadian, and Australian participants' performance on the Algase Wandering Scale-Version 2 (AWS-V2).

Although wandering in dementia is seen in various cultures, cross-cultural comparisons have not been reported. We examined wandering in residents of long-term care settings (LTCs) in three English-speaking countries (n = 96, America; n = 42, Canada; n = 13, Australia) using the Algase Wandering Scale-Version 2 (AWS-V2). Participants differed by country on age and medical diagnosis.

Biomechanical activity devices to index wandering behavior in dementia.

Valid and reliable measures of wandering are needed to study this troubling behavior. Although researchers have used various perspectives, definitions, and approaches to study wandering, spontaneous ambulation is a key characteristic across all views. Biomechanical activity devices for capturing movement provide one way to index wandering.