Behavioral rhythm, sleep, and mood disturbances in newly admitted nursing home residents.

Older adults entering a nursing home face many physical and psychosocial challenges, all at a point in life when their bodies may be least equipped to handle such adversity. Data for the present study were collected for 186 incoming residents from 6 nursing homes over the course of 1 year. Fifty-six participants were interviewed at the earliest possible time point following admission and rest-activity data were collected via actigraphy for 1 week, after which participants were interviewed a second time. Newly admitted residents in this sample were functionally dependent, highly medicated, and diagnosed with many conditions associated with sleep and/or mood disturbances. Sleep disorders appear to be underreported or underdiagnosed on the Minimum Data Set (MDS) which documented only 5.9% of patients with sleep-related diagnoses. A large number of residents, 63%, reported sleep disturbances consistent with clinical sleep pathology. The MDS indicated that 7.4% were prescribed hypnotics but this figure is deceiving in regard to medication use for sleep. Medication administration records showed 35% used sleep-related medications, and 39% of patients reported using medications to sleep. Consistent with other studies, these nursing home residents received inadequate bright light exposure with an average of 11 minutes at or above 1000 lux per day and none above 2000 lux. Approximately 35% were diagnosed with depression on the MDS. Self-reports showed approximately 29% with mild and 32% with moderate to moderately severe depression. A primary aim of this study was to identify sleep timing changes during the transition to the nursing home because adjustment to this type of change can be difficult for older adults. The average change in sleep timing fell between 1 and 2 hours, with a range from 0 to 6½ hours. As expected, participants preferred morning activity which is consistent with other studies of older adults and may reflect an age-related advance of the endogenous circadian rhythm. On average, all chronotypes experienced advances in sleep timing which is consistent with our hypothesis that the early morning routine typical of nursing homes would require residents to modify their sleep routines. Greater evening preference predicted a larger advance in sleep timing. Sleep phase changes are an important concern, particularly in light of the widespread rest-activity rhythm disturbances found in this setting and this study confirmed that rest-activity rhythms are disturbed in incoming nursing home residents. Another aim was to investigate the role of social rhythms, or the frequency and regularity of a daily routine, during this transition. A unique pattern of relationships was found among rest-activity rhythms, social rhythms, sleep and mood in the presence of certain types of sleep timing changes. This was not identified or explained based on the hypothesized model proposed in this study. Future studies should further evaluate these relationships based on a more nuanced model that accounts for the type (bed- versus wake-time) and direction (advance versus delay) of sleep timing change

An Application of the UTAUT Model for Understanding Student Perceptions Using Course Management Software

Blackboard® is a Web-based tool that is becoming an important and popular course management software application in higher education. Moreover, Blackboard® has been predicted to be the future of all types of distance learning. It provides a number of learning tools, including an online discussion board, course content management, a course calendar, information announcement, electronic mail, reviews, auto-marked quizzes and exams, navigation tools, access control, grade maintenance and distribution, student progress tracking, etc. Blackboard® benefits include a high level of interactivity, a greater level of learner enthusiasm, and a high level of satisfaction. This paper describes student perceptions in terms of applying the Unified Theory of Acceptance and Use of Technology (UTAUT) model. The UTAUT model consolidates previous TAM related studies. However, in this study mixed support for this model was found in terms of the reliability of the scale items representing the UTAUT constructs and the hypothesized relationships. Although students tend to agree that Blackboard® is a good idea and use it frequently, most of software’s features are not being used to their fullest capability

Power, empowerment, and person-centred care: using ethnography to examine the everyday practice of unregistered dementia care staff

The social positioning and treatment of persons with dementia reflects dominant biomedical discourses of progressive and inevitable loss of insight, capacity, and personality. Proponents of person-centred care, by contrast, suggest that such loss can be mitigated within environments that preserve rather than undermine personhood. In formal organisational settings, person-centred approaches place particular responsibility on ‘empowered’ direct-care staff to translate these principles into practice. These staff provide the majority of hands-on care, but with limited training, recognition, or remuneration. Working within a Foucauldian understanding of power, this paper examines the complex ways that dementia care staff engage with their own ‘dis/empowerment’ in everyday practice. The findings, which are drawn from ethnographic studies of three National Health Service (NHS) wards and one private care home in England, are presented as a narrative exploration of carers’ general experience of powerlessness, their inversion of this marginalised subject positioning, and the related possibilities for action. The paper concludes with a discussion of how Foucault’s understanding of power may help define and enhance efforts to empower direct-care staff to provide person-centred care in formal dementia care settings

Effects of participation in an aging game simulation activity on the attitudes of allied health students toward older adults

The Aging Game simulation activity was designed to improve medical students’ attitudes toward older adults. This study was conducted to determine if the Aging Game, adapted for use with allied health students, could yield positive results in the students’ levels of anxiety about aging and attitudes toward aging. The modified Aging Game was implemented at a large Midwestern university with 156 students from three allied health areas – nutrition and dietetics, physical therapy, and long-term care administration. All students actively engaged in the simulation activity and completed pre- and posttest questionnaires containing the Anxiety about Aging Scale (AAS) and the Aging Semantic Differential (ASD) measures. Results indicated most students had low anxiety about aging and positive attitudes toward older adults both before and after the Aging Game activity. Changes in the students’ pre- and posttest scores on AAS and/or ASD measures were mixed, with small differences in average scores. The demographics of the sample group for this study may partially explain the effects the simulation experience had on these allied health students. That some students took on a more negative attitude toward older adults after the simulation could be attributed to a more realistic view of the difficulties and challenges of aging. Also, the shortened timeframe of the Aging Game simulation may have affected the students’ reactions to the activity. Future activities to complement the simulation, such as reflective writing and interaction with older adults, may improve the impact of the Aging Game on the attitudes of allied health students