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.

Noticing Acute Changes in Health in Long-Term Care Residents.

Purpose: Early signs of acute conditions and increased fall risk often go unrecognized in patients in long-term care facilities. The aim of this study was to examine how healthcare staff identify and act on changes in health status in this patient population.

Design: A qualitative study design was used for this study.

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.

Characteristics of Nursing Home Resident Movement Patterns: Results from the TEAM-UP Trial.

Objective: To determine movement patterns of nursing home residents, specifically those with dementia or obesity, to improve repositioning approaches to pressure injury (PrI) prevention.

Methods: A descriptive exploratory study was conducted using secondary data from the Turn Everyone And Move for Ulcer Prevention (TEAM-UP) clinical trial examining PrI prevention repositioning intervals. K-means cluster analysis used the average of each resident's multiple days' observations of four summary mean daily variables to create homogeneous movement pattern clusters.

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.

To Turn or Not to Turn: Exploring Nurses' Decision-Making Processes Concerning Regular Turning of Nursing Home Residents.

: Nursing home (NH) residents are at high-risk for pressure injuries (PrIs), and those living with Alzheimer's Disease and Related Dementias (ADRD) are at even greater risk. Understanding how nursing staff approach repositioning remains critical. : As part of an ongoing clinical trial, this mixed-method prospective, exploratory, descriptive study examined repositioning efforts for PrI prevention.

Cognitive Function and Sleep in Caregivers of Persons Living with Dementia.

Poor sleep is prevalent among caregivers of persons living with dementia and increases their risk for cognitive impairment and decline. In this cross-sectional, correlational study, we compared the cognitive function scores of caregivers with poor sleep with the demographically adjusted normed scores of the National Institutes of Health Toolbox Cognition Battery. Caregivers completed a 14-day sleep diary.

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.

CE: Original Research: New Acute Symptoms in Older Adults with Cognitive Impairment: What Should Family Caregivers Do?

Unlabelled: : Background: When older adults with cognitive impairment develop new physical or behavioral symptoms, their family caregivers face a difficult decision: whether and when to seek professional medical care. Most family caregivers lack formal training in assessment and may have difficulty making such decisions. The Veterans Health Administration's home-based primary care (HBPC) program, which is widely available, offers community-dwelling frail veterans and their family caregivers guidance, with the goal of reducing hospitalization and institutionalization in long-term care facilities.

Wandering Behaviors and Activities of Daily Living Among Older Adults With Cognitive Impairment.

Purpose: The aim of the study was to examine the characteristics of wandering associated with preserved versus worsened activities of daily living (ADL) function.

Design: Longitudinal prospective design. Twenty-two cognitively impaired residents of an assisted living facility with over 450 observations were followed up to 8 months.

The Physical and Cognitive Performance Test for Residents in Assisted Living Facilities.

Objectives: To develop and evaluate the psychometric properties of a new performance-based instrument (Physical and Cognitive Performance Test for Assisted Living Facilities (PCPT ALF)) designed to assess the physical and cognitive skills associated with performance of activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

Design: There were three stages in this study: development of instrument items and validity testing, a feasibility pilot study, and a cross-sectional trial to establish construct and criterion validity and reliability.

Setting: One 116-bed assisted living facility (ALF).

Intraindividual Changes in Ambulation Associated With Falls in a Population of Vulnerable Older Adults in Long-Term Care.

Objective: To examine how intraindividual changes in ambulation characteristics may be used to predict falls.

Design: Longitudinal study design.

Setting: Assisted living facility.

Enhancing the Communication of Suddenly Speechless Critical Care Patients.

Background: Sudden speechlessness is common in critically ill patients who are intubated or have had surgery for head and neck cancer. Sudden inability to speak poses challenges for hospitalized patients because strategies to facilitate communication are often limited and unreliable.

Objective: To determine the impact of a technology-based communication intervention on patients' perception of communication difficulty, satisfaction with communication methods, and frustration with communication.

Sleep and Cognition in Community-Dwelling Older Adults: A Review of Literature.

Changes in sleep and cognition occur with advancing age. While both may occur independently of each other, it is possible that alterations in sleep parameters may increase the risk of age-related cognitive changes. This review aimed to understand the relationship between sleep parameters (sleep latency, wake after sleep onset, sleep efficiency, sleep duration, general sleep complaints) and cognition in community-dwelling adults aged 60 years and older without sleep disorders.

Field Evaluations of Tracking/Locating Technologies for Prevention of Missing Incidents.

Background: Persons with dementia are at risk of a missing incident, which is defined as an instance in which a demented person's whereabouts are unknown to the caregiver and the individual is not in an expected location. Since it is critical to determine the missing person's location as quickly as possible, we evaluated whether commercially available tracking technologies can assist in a rapid recovery.

Methods: This study examined 7 commercially available tracking devices: 3 radio frequency (RF) based and 4 global positioning system (GPS) based, employing realistic tracking scenarios.

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.

The Concept of Missing Incidents in Persons with Dementia.

Behavioral symptoms of dementia often present the greatest challenge for informal caregivers. One behavior, that is a constant concern for caregivers, is the person with dementia leaving a designated area such that their whereabouts become unknown to the caregiver or a missing incident. Based on an extensive literature review and published findings of their own research, members of the International Consortium on Wandering and Missing Incidents constructed a preliminary missing incidents model.

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.

Nurses' experiences of communicating with hospitalized, suddenly speechless patients.

We used a qualitative focus group design to explore the experiences and challenges of nurses who work with hospitalized patients experiencing the sudden inability to verbalize their needs, also known as sudden speechlessness. In response to open-ended questions in facilitated focus groups, 18 nurses discussed issues around the care and communication needs of suddenly speechless (SS) patients. Nurses identified multiple, commonly occurring communication challenges when caring for SS patients.

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.

Sleep discrepancy, sleep complaint, and poor sleep among older adults.

Objectives: Discrepancy between self-report- and actigraphy-measured sleep, often considered an artifact of measurement error, has been well documented among insomnia patients. Sleep problems are common among older adults, and this discrepancy may represent meaningful sleep-related phenomenon, which could have clinical and research significance.

Method: Sleep discrepancy was examined in 4 groups of older adults (N = 152, mean age = 71.

Development of a communication intervention to assist hospitalized suddenly speechless patients.

Healthcare staff face significant challenges while caring for hospitalized patients experiencing sudden inability to verbalize their needs (sudden speechlessness). Familiar methods of communication such as non-verbal strategies are limited and often fail to assist suddenly speechless patients (SS) communicate their needs. Consequently, strategies tailored to the needs of hospitalized speechless patients are necessary, and must consider factors intrinsic to the patients and the complexities of the acute care environment.

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.