Factors Associated With Sleep Quality in Hospitalized Persons With Dementia.

BACKGROUND: Factors associated with sleep quality have not been well examined in hospitalized older persons with dementia, who are at high risk for impaired sleep. The aim was to identify factors associated with sleep quality among hospitalized persons with dementia. METHODS: This secondary analysis used baseline data from a cluster randomized trial. Factors examined included delirium severity, pain, depression, behavioral and psychological symptoms of dementia (BPSD), and daytime physical activity. Multiple stepwise linear regressions evaluated factors related to dimensions of sleep quality (sleep duration, efficiency, latency, and fragmentation; measured by the MotionWatch 8). RESULTS: Increased daytime physical activity was associated with higher sleep duration [ß=0.164; 95% confidence interval (CI), 0.111-0.717; P=0.008; 7.7% variance] and sleep efficiency (ß=0.158; 95% CI, 0.020-0.147; P=0.010; 5.4% variance), and less sleep fragmentation (ß=-0.223; 95% CI, -0.251 to -0.077; P<0.001; 10.4% variance). Higher BPSD was significantly associated with prolonged sleep latency (ß=0.130; 95% CI, 0.098-2.748; P=0.035; 3.7% variance). CONCLUSION: Results suggest the need to encourage daytime physical activity and reduce or manage BPSD to improve sleep quality among hospitalized persons with dementia.

Physical Activity in Hospitalized Persons With Dementia: Feasibility and Validity of the MotionWatch 8.

Persons with dementia are at high risk for hospital-acquired disability, associated with low physical activity during hospitalizations. To determine the effectiveness of efforts to increase physical activity, a valid and reliable measurement approach is required. Data from an ongoing cluster randomized clinical trial examined the feasibility and validity of the MotionWatch 8 (MW8) triaxial actigraphy device. The sample included 321 participants of which 259 (81%) were willing to wear the MW8 for 24 hr. Regression analysis revealed that time in low activity, ß = 0.17, t(255) = 2.9, p = .004, and time in moderate activity, ß = 0.14, t(255) = 2.4, p = .017, measured by the MW8, were associated with participants' physical function. Engagement in moderate physical activity was associated with return to baseline function at discharge (Wald χ2 = 4.10, df = 1, p = .043). The study provides preliminary support for the feasibility and validity of the MW8 in hospitalized persons with dementia.

Disparities in Physical and Psychological Symptoms in Hospitalized African American and White Persons with Dementia.

Objectives: This study examined differences in physical function, delirium, depressive symptoms, and behavioral and psychological symptoms of dementia (BPSD) in hospitalized African American and white older adults with dementia. Methods: This secondary data analysis using baseline data from an ongoing trial testing family-centered function-focused care included African American (n = 159) and white persons (n =135) with dementia. Results: A multivariate analysis of covariance showed that controlling for relevant demographic and health characteristics, African Americans with dementia had lower physical function, more delirium, and more depressive symptoms upon admission than white participants. There were no significant differences in BPSD between African American and white persons. Discussion: To our knowledge, this is the first study to examine racial differences in admission symptoms of hospitalized persons with dementia. While the findings are preliminary, they can be used to inform the design of future research, including identifying the causes of disparities.

Pain Incidence, Treatment, and Associated Symptoms in Hospitalized Persons with Dementia.

BACKGROUND: Moderate to severe pain has been frequently reported in hospitalized older adults. Pain in hospitalized persons with dementia within the context of other common symptoms, functional decline, delirium, and behavioral and psychological symptoms of dementia (BPSD), has received little attention. AIMS: Describe the incidence of pain, the pharmacologic management of pain, and the association of pain with physical function, delirium, and BPSD in hospitalized persons with dementia. DESIGN: Descriptive, cross-sectional study. SETTING: Six medical units in three hospitals. PARTICIPANTS: Baseline data from 299 hospitalized persons with dementia enrolled in the Family-centered Function-focused Care (Fam-FFC) cluster randomized trial. METHODS: Descriptive analyses of pain used the Pain Assessment in Advanced Dementia (PAINAD) scale and the use of medication for pain management. Linear regression analyses tested relationships between pain and:1) physical function (Barthel Index), 2) delirium severity (Confusion Assessment Method Severity Short Form) and 3) BPSD severity (Neuropsychiatric Inventory- Questionnaire). RESULTS: The majority of the sample was female (61.9%), non-Hispanic (98%), and Black (53.2%), with a mean age of 81.58 (SD=8.54).Of the 299 patients, 166 (56%) received pain medication. Of the 108 individuals who demonstrated pain, 40% (n=43) did not receive pain medication. When controlling for age, gender, cognition, and comorbidities, pain was significantly associated with function, delirium severity, and BPSD severity. CONCLUSIONS: Results suggest that pain may be undertreated in hospitalized persons with dementia, and should be considered upon admission to optimize function, decrease delirium, and prevent or decrease BPSD.