Development and Initial Evaluation of Web-Based Cognitive Behavioral Therapy for Insomnia in Rural Family Caregivers of People With Dementia (NiteCAPP): Mixed Methods Study.

Background: Informal caregivers of people with dementia frequently experience chronic insomnia, contributing to stress and poor health outcomes. Rural caregivers are particularly vulnerable but have limited access to cognitive behavioral therapy for insomnia (CBT-I), a recommended frontline treatment for chronic insomnia. Web-based delivery promises to improve insomnia, particularly for rural caregivers who have limited access to traditional in-person treatments.

Impact of Web-Based Cognitive Behavioral Therapy for Insomnia on Stress, Health, Mood, Cognitive, Inflammatory, and Neurodegenerative Outcomes in Rural Dementia Caregivers: Protocol for the NiteCAPP CARES and NiteCAPP SHARES Randomized Controlled Trial.

Background: Chronic insomnia affects up to 63% of family dementia caregivers. Research suggests that chronic insomnia prompts changes in central stress processing that have downstream negative effects on health and mood, as well as on cognitive, inflammatory, and neurodegenerative functioning. We hypothesize that cognitive behavioral therapy for insomnia (CBT-I) will reverse those downstream effects by improving insomnia and restoring healthy central stress processing.

Using Telehealth to Deliver Cognitive Behavioral Treatment of Insomnia to a Caregiver of a Person With Alzheimer's Disease.

Cognitive behavioral therapy for Insomnia (CBT-I) is the gold standard treatment for insomnia. There is limited access to qualified providers to deliver CBT-I; moreover, there are patient populations who struggle with access to insomnia care due to limited time and resources. This includes caregivers for persons with Alzheimer's disease, for whom sleep disturbance is a common concern.

A research proposal testing a new model of ambulation activity among long-term care residents with dementia/cognitive impairment: the study protocol of a prospective longitudinal natural history study.

Background: Excessive and patterned ambulation is associated with falls, urinary tract infections, co-occurring delirium and other acute events among long-term care residents with cognitive impairment/dementia. This study will test a predictive longitudinal data model that may lead to the preservation of function of this vulnerable population.

Methods/design: This is a single group, longitudinal study with natural observations.

Patterns of Disruptive Feeding Behaviors in Infants With Neonatal Abstinence Syndrome.

Background: Severe irritability in infants with neonatal abstinence syndrome often impacts their ability to feed successfully, which challenges a mother's ability to demonstrate this most basic parenting skill. There is little empiric evidence to guide recommendations for practice in this population.

Purpose: Describe the infant behaviors that disrupt feeding in infants with neonatal abstinence syndrome.

Characteristics of and Barriers to Functional Status Assessment in Assisted Living.

The most commonly used functional status (FS) instruments were examined to determine the validity, reliability, sensitivity, and specificity to change and feasibility in residents in an assisted living facility (ALF). Twenty-six ALF residents were assessed weekly for up to 8 months using six instruments. Group and single-subject analyses were used to examine associations between instruments and acute events.

Changes in Sleep Predict Changes in Affect in Older Caregivers of Individuals with Alzheimer's Dementia: A Multilevel Model Approach.

Objectives: Understanding predictors of older dementia caregivers' mood could provide insight into potential treatments which may delay institutionalization of their care recipient. Research with older noncaregivers has shown that nights characterized by better subjective sleep were associated with days characterized by higher positive and lower negative affect, and vice versa. Examining daily relationships is important, as sleep and affect are state-like behaviors that fluctuate within individuals, across time.

Depression in informal caregivers of persons with dementia.

Background: Worldwide, there are more than 35 million individuals diagnosed with Alzheimer's disease. Many of these individuals are cared for at home by unpaid caregivers who often report high levels of depressive symptoms and depression. The majority of studies conducted to predict which caregivers are at risk for depression have examined non-modifiable risk factors.

Nurse entrepreneurs, arise!: improving lives of older adults by bringing your ideas to market.

Many functions that nurses carry out require the use of various technologies, yet nurses are rarely involved in the development and/or testing of technology. The purpose of this article is to provide an introduction to the world of technology development to help nurses understand how to become involved in this endeavor. An illustration of a newly developed technology will be used to further clarify the steps.

Missing incidents in community-dwelling people with dementia: understanding how these dangerous events differ from dementia-related ‘wandering’ is critical to assessment, intervention, and prevention.

At every stage of dementia, people with the condition are at risk for both missing incidents, in which they are unattended and unable to navigate a safe return to their caregiver, and "wandering," a term often used to describe repetitive locomotion with patterns such as lapping or pacing. By understanding the differences between these two phenomena, nurses can teach caregivers how to anticipate and prevent missing incidents, which are not necessarily related to wandering. The authors differentiate missing incidents from wandering, describe personal characteristics that may influence the outcomes in missing incidents, and suggest strategies for preventing and responding to missing incidents.

Missing drivers with dementia: antecedents and recovery.

Objectives: To determine the circumstances under which persons with dementia become lost while driving, how missing drivers are found, and how Silver Alert notifications are instrumental in those discoveries.

Design: A retrospective, descriptive study.

Setting: Retrospective record review.

Midlife women: symptoms associated with menopausal transition and early postmenopause and quality of life.

Objective: The objectives of this study were to examine the effects of symptoms associated with the menopausal transition and early postmenopause on quality of life and to determine if there is a clustering of symptoms that has a larger effect on quality of life than individual symptoms.

Methods: This study used data from a cross-sectional study on women aged 45 to 60 years. Descriptive statistics and regression analyses were used to analyze the data.

Nighttime activity in individuals with dementia: understanding the problem and identifying solutions.

Sleep disturbances may occur in more than 50% of individuals with dementia, and nighttime activity can lead to unsafe situations and serious consequences for both the person and his or her caregivers. Nighttime awakenings expose individuals with dementia to two major dangers: falls and unattended home exits. This article is a review of the current research on the causes of sleep disturbances and interventions for nighttime activity in individuals with dementia living at home.

Day-to-day variability in nap duration predicts medical morbidity in older adults.

Objective: The objectives for the present study were to (a) examine within-person variability of nap duration and (b) assess how variability in nap duration is related to the number of health conditions in a sample of older adults. For highly variable behaviors such as sleep, it is important to consider fluctuations within the person instead of solely comparing averages of behaviors across persons.

Method: Data were drawn from a previous study examining sleep in 103 community-dwelling older adults.

The informal caregivers' perception of wandering.

Although the term wandering is routinely used by clinicians, researchers, and informal caregivers (ICs), the meaning of this term varies depending on the source of the definition and the context in which it is used. The purpose of this study was to examine the terms ICs used to describe different scenarios that have been identified in literature as "wandering," determine their perception of risk, and compare their definitions of wandering with the perspectives of researchers. Structured interviews were conducted with 128 ICs of older adults with dementia.

Persons with dementia missing in the community: is it wandering or something unique?

Background: At some point in the disease process many persons with dementia (PWD) will have a missing incident and be unable to safely return to their care setting. In previous research studies, researchers have begun to question whether this phenomenon should continue to be called wandering since the antecedents and characteristics of a missing incident are dissimilar to accepted definitions of wandering in dementia. The purpose of this study was to confirm previous findings regarding the antecedents and characteristics of missing incidents, understand the differences between those found dead and alive, and compare the characteristics of a missing incident to that of wandering.

Behavioral symptoms of dementia: a dyadic effect of caregivers' stress process?

This study used multilevel modeling to evaluate a newly revised model in which dementia caregivers' stress process variables-perceived stress and emotional-behavioral responses-were posited as predictors of behavioral symptoms of dementia (BSD) within community-based dyads. Secondary analyses were conducted on data from a primary two-group (experimental and control) trial, in which experimental participants received a home monitoring system for managing nighttime activity in individuals with dementia. Models indicated that caregivers' trajectories did not differ significantly between groups over time; however, the time-by-group interaction of BSD approached significance.

Sleep in dementia caregivers and the effect of a nighttime monitoring system.

Purpose: The purpose of this study was to determine if a nighttime home monitoring system, designed to track the movements of a care recipient with dementia, would relieve worry and improve sleep in caregivers of persons with dementia.

Design And Methods: In this controlled clinical trial, 49 dementia caregivers were followed for up to 1 year. Sleep was measured for 7-day intervals at nine points in time using actigraphy and a sleep diary.

Improving caregivers' well-being by using technology to manage nighttime activity in persons with dementia.

This article reports the qualitative arm of a mixed-methods study designed to test an in-home nighttime monitoring system (NMS) that tracks the nighttime activity of persons with dementia. Fourteen caregiver interviews were analyzed using grounded theory/full conceptual description methods to determine the issues associated with providing care at night and to explore the benefits of using the NMS. Caregivers not using the NMS experienced sleep disruption, overwhelming worry, and loss of personal space, leading to decreased energy and changes in mood.

Reducing dangerous nighttime events in persons with dementia by using a nighttime monitoring system.

Background: Nighttime activity, a common occurrence in persons with dementia, increases the risk for injury and unattended home exits and impairs the sleep patterns of caregivers. Technology is needed that will alert caregivers of nighttime activity in persons with dementia to help prevent injuries and unattended exits.

Methods: As part of a product development grant, a controlled pilot study was conducted to test the effectiveness of a new night monitoring system designed for informal caregivers to use in the home.

Injuries and unattended home exits in persons with dementia: a 12-month prospective study.

Persons with dementia are at particular risk for injuries and unattended home exits. The purposes of this study were to prospectively describe the characteristics and determine the hazard rates of unattended home exits and injuries. A total of 9 times over 12 months, data were collected from 53 caregivers of persons with dementia about persons with dementia unattended home exits or injuries.

Sleep pattern differences between older adult dementia caregivers and older adult noncaregivers using objective and subjective measures.

Study Objectives: Informal caregivers of persons with dementia often complain about poor quality sleep; however, studies on caregivers have mixed results when examining sleep values. The purpose of this study was to describe the sleep patterns in a subset of dementia caregivers who provide care during the night, and compare those patterns to noncaregiving adults.

Methods: Data from a study on dementia caregivers and from a study of sleep in older adults were used.

Expanding participation in Alzheimer's association Safe Return by improving enrollment.

Every adult with a diagnosis of progressive dementia is at risk for wandering away or becoming lost. Those with dementia may not have the capacity to remember crucial contact information or recognize an unsafe situation, so enrollment in a program like Alzheimer's Association Safe Return is crucial. One facility-level enrollment plan at the James A.

Sleep and affect in older adults: using multilevel modeling to examine daily associations.

The main objective of the present study was to examine daily associations (intraindividual variability or IIV) between sleep and affect in older adults. Greater understanding of these associations is important, because both sleep and affect represent modifiable behaviors that can have a major influence on older adults' health and well-being. We collected sleep diaries, actigraphy, and affect data concurrently for 14 days in 103 community-dwelling older adults.

Sleep hygiene practices in two community dwelling samples of older adults.

Study Objectives: Common sleep hygiene practices were examined in 2 community-based samples of older adults to determine which practices differentiated 4 sleep subgroups: noncomplainers without insomnia symptoms, complainers without insomnia symptoms, noncomplainers with insomnia symptoms, and complainers with insomnia symptoms.

Design: Two weeks of sleep diaries provided napping and bed/out-of-bed time variability data. A retrospective questionnaire provided data on caffeine, cigarette, and alcohol usage.