Evidence supporting nutritional interventions for persons in early stage Alzheimer's disease (AD).

The purpose of this paper is to grade research evidence supporting nutritional interventions for persons with early stage dementias and to report the recommendations of a consensus panel. Thirty four studies were reviewed in the areas of dietary restriction, antioxidants, and Mediterranean diet with strong support from epidemiological studies found in all three areas. The body of evidence to support nutritional interventions in the prevention and treatment of AD is growing and has potential as a treatment modality following translational studies.

High prevalence of central nervous system medications in community-dwelling older adults with dementia over a three-year period.

Few recent studies have investigated the prevalence and outcomes for central nervous system (CNS)-active medication use in older persons with dementia (PWD) who live in the community. Thus, the purpose of this study was to describe the health outcomes and patterns of use of CNS-active drugs in PWD living in the community. Using a retrospective study design from a southeastern managed care organization (MCO), claims data were collected for three years on all identified cases with dementia and included age, gender, medical diagnoses for each claim (International Classification of Disease [ICD-9 code]) and prescription drugs (National Drug Code [NDC]). Individuals (N = 960) were selected who were continuously enrolled and had prescription drug coverage. Over 79% of PWD in this sample were on a CNS-active medication during the three-year period and 35% were on a benzodiazepine. The highest number of drug-related problems (DRPs) within 45 days after receiving a CNS drug prescription were for syncope, fatigue, altered level of consciousness, delirium, constipation, falls and fractures. This study illustrates the need to further examine inappropriate CNS-active medication use in PWD and to test non-pharmacologic therapies for the clinical problems that initiate their use in PWD.

Toward holistic theory-based intervention for dementia behavior.

Four million Americans suffer from some form of dementia. Over 50% of these individuals exhibit behaviors that are perceived as "disturbing" by family and caregivers. The Need-driven Dementia-compromised Behavior Model was developed by a group of nurse researchers to study and understand these behaviors. The model changes the view of dementia behaviors as "disturbing" to that of behavior as signifying potentially understandable needs. This article reviews the model and demonstrates how interventions derived from the model can be used to respond to dementia behaviors in a holistic fashion.

The relation of premorbid factors to aggressive physical behavior in dementia.

Aggressive physical behaviour (APB) is common in persons with dementia and often leads to negative consequences such as use of restraints and staff member burnout. For the past several years, a group of nurse researchers has collaborated to develop a model that views dementia behaviors as need-driven but dementia-compromised. The model posits that background variables of the demented person interact with proximal (or current situational) variables to produce APB. The purpose of this study was to test a part of that model by addressing the question: Which premorbid factors predict APB in a sample of 84 demented institutionalized elders? This was a cross-sectional descriptive study that obtained measures of the following characteristics of residents: (1) aggressive behavior as assessed by nursing home staff members using the Ryden Aggression Scale, (2) premorbid personality traits as assessed by a member of the resident's family using the NEO Five Factor Inventory and (3) history of psychosocial stress as assessed by a member of the residents' family using the modified Social Readjustment Rating Scale. Of the sample of 84 residents, 44% exhibited physical aggression. Background factors in the model were not predictive of aggressive behavior in late-stage dementia, although the relation between premorbid neuroticism and physical aggression was in the predicted direction.

Life-span perspective of personality in dementia.

PURPOSE: To propose an alternative view of personality change in dementia by presenting existing evidence for the continuity of personality. SIGNIFICANCE: As the population continues to age, dementing illnesses will account for a greater proportion of morbidity and mortality; the care of these people will have a significant effect on the health care system. ORGANIZING FRAMEWORK: Life-span perspective of personality continuity. SCOPE METHOD: Review of current literature on personality in dementia using Medline, 1980-1994; CINAHL, 1990-1994; and Psych Lit., 1980-1994. FINDINGS: Although there are systematic shifts in personality with dementia, individuals tend to maintain their unique pattern of premorbid personality traits. CONCLUSIONS: The personalities of dementia patients seem to reflect adaptive patterns that served them in the past. IMPLICATIONS: Use of a life-span perspective can enhance individualized care for demented patients and advance theory development.

Everyday functioning in Alzheimer's disease: contribution of neuropsychological testing.

COGNITIVE AND BEHAVIORAL problems associated with Alzheimer's disease are variable and complex; consequently, each patient should be managed by an advanced practice nurse (APN) so that everyday functioning is maximized and excess disabilities are prevented. Neuropsychological testing is sensitive to neuropathological conditions and holds promise for assisting APNs in the care of the Alzheimer's patient by pinpointing areas of cognitive and behavioral impairment. In this article, an overview is given of the essentials of a neuropsychological assessment for the Alzheimer's patient as performed by the neuropsychologist. Use of assessment results by the APN for designing interventions that compensate for losses but which preserve remaining abilities is discussed.

Disturbing behaviors in demented elders: a concept synthesis.

This article describes the use of concept synthesis, as defined by Walker and Avant, to extract meaningful syndromes of disturbing behaviors as they are manifested in demented elders. The process resulted in the identification of five distinct behavioral clusterings: Aggressive Psychomotor Behavior, Nonaggressive Psychomotor Behavior, Verbally Aggressive Behavior, Passive Behavior and Functionally Impaired Behavior. These synthesized concepts are an initial attempt at clarifying nursing perspective on disturbing behaviors in dementia.

Contextual factors associated with disturbing behaviors in institutionalized elders.

Data from a longitudinal clinical trial funded by the National Institute of Aging, testing the effects of staff education and consultation on restraint reduction in nursing homes, were used to examine disturbing behaviors in institutionalized elders and to identify related environmental and personal characteristics. Subjects were 586 residents from three well-matched nursing homes. Kayser-Jone's (1989) model on environment and quality of life in long-term care institutions served as the organizing framework. Data on disturbing behaviors from the Psychogeriatric Dependency Rating Scale were factor analyzed. Three factors, Agitated Psychomotor Behaviors, Aggressive Interpersonal Communication, and Expressive Difficulty, emerged from the principal factor analysis and accounted for 35% of the variance. The Kayser-Jones model partially explained Agitated Psychomotor Behavior (R2 = .22). A model comparison approach indicated that the addition of an organizational variable, staff mix, significantly increased the amount of variance explained over and above that contributed by the personal variables.

The clinical importance of environmental lighting to the elderly.

1. Nurses need to be aware of the effects of artificial lights on the aged because the aged spend a greater amount of time under these lights than do younger people. 2. Although the aged require more light than younger people to see, bright lights may cause glare. The use of indirect lighting is recommended to reduce problems with glare. 3. The aged see best under artificial lighting that simulates natural sunlight. 4. Nurses who work in institutional settings should be sensitive to the need for individualized light-dark cycles.

Restlessness in the elderly: a concept analysis.

The concept of restlessness has been explored and a definition proposed. The behavior has been described within the framework of Activation Theory, and several approaches to measurement have been suggested. It remains for nursing researchers to test the adequacy of this analysis, to support or reject the antecedents, and to propose interventions which are philosophically congruent.