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. Data from 53 subjects were collected at nine points in time during a 12-month period regarding injuries and unattended home exits that occurred while the caregiver slept. Nighttime activity frequently resulted in nursing home placement. RESULTS: The night monitoring system proved a reliable adjunct to assist caregivers in managing nighttime activity. A total of nine events (injuries or unattended home exits) occurred during the study, with 6 events occurring in the control group. With intent-to-treat analysis, there was no difference between the groups. However, in a secondary analysis that was based on use of the intervention, experimental subjects were 85% less likely to sustain an event than control subjects. CONCLUSIONS: When nighttime activity occurred, it resulted in severe injuries sometimes associated with subsequent nursing home placement. The night monitoring system represents a new technology that caregivers can use to assist them in preventing nighttime injuries and unattended home exits in care recipients with dementia.

Rehabilitation after treatment for jugular foramen lesions.

Swallowing problems following jugular foramen surgery are more common than is often acknowledged and affect up to a third of our patients. They have a significant effect on quality of life. We have become more proactive in this respect and anticipate these problems before they become established. In this article we present our management protocol that has evolved over the past 30 years as a result of our experience treating 134 glomus jugulare tumors. Our current protocol involves a thorough preoperative assessment of swallowing. After jugular foramen surgery, patients undergo further evaluation using fiberoptic endoscopic evaluation of swallowing (FEES), videofluoroscopy, and manometry. Those with prolonged or poorly compensated dysphagia are offered rehabilitation surgery. We describe this technique, which has proved beneficial to our patients. Guidelines for management are proposed.

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. When the NMS was used, caregivers reported improved "peace of mind." The fear and uncertainty associated with worry was alleviated by reliable alerts regarding the whereabouts of the person with dementia. Some caregivers were able to better balance needs for personal space with needs to remain in contact with the person with dementia. Generally, caregivers reported improved quality of sleep, although some caregivers reported more awakenings due to the system alerts.

Assessing penetration and aspiration: how do videofluoroscopy and fiberoptic endoscopic evaluation of swallowing compare?

OBJECTIVES/HYPOTHESIS: We aimed to investigate whether the type of dysphagia examination (fiberoptic endoscopic evaluation of swallowing [FEES] or videofluoroscopy) influences the scoring of penetration and aspiration. STUDY DESIGN: Prospective, single-blind study. METHODS: Fifteen dysphagic participants were recruited and underwent one FEES and one videofluoroscopy examination, performed and recorded simultaneously. Fifteen independent raters from 12 centers scored penetration and aspiration from recordings using the Penetration Aspiration Scale. Raters were blind to participant details, the pairing of the FEES and videofluoroscopy recordings, and the other raters' scores. Interrater and intrarater reliability were analyzed using weighted kappa. RESULTS: The Penetration Aspiration Scale scores were significantly higher for the FEES recordings than for the videofluoroscopy recordings (ANOVA P < .001). The mean difference between the FEES and videofluoroscopy penetration aspiration scores for the same swallows was 1.15 points. Interrater and intrarater reliability ranged from 0.64 to 0.79 (weighted kappa). CONCLUSIONS: Penetration aspiration is perceived to be greater (more severe) from FEES than videofluoroscopy images. The clinical implications are discussed.

Development of nurse competencies to improve dementia care.

The rapid increase in the number of elders who need dementia care and the critical need for skilled care providers prompted Florida legislators to enact legislation to improve the care of these residents. One component of the new legislation mandated dementia training for long-term care staff and led to the development of dementia care competencies that would guide a competency-based curriculum to meet the demand for training. The competencies, methods used for development, and information regarding how to access these newly developed resources are described in this article.