Behavioral Problems in Community-Dwelling People with Dementia

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73826/1/j.1547-5069.2000.00055.x.pd

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. Rural caregivers are particularly vulnerable, but they have limited access to CBT-I; therefore, we developed an accessible digital version using community input (NiteCAPP CARES). OBJECTIVE: This trial will evaluate the acceptability, feasibility, and short-term and long-term effects of NiteCAPP CARES on the sleep and stress mechanisms underlying poor caregiver health and functioning. METHODS: Dyads (n=100) consisting of caregivers with chronic insomnia and their coresiding persons with dementia will be recruited from Columbia and surrounding areas in Missouri, United States. Participant dyads will be randomized to 4 weeks (plus 4 bimonthly booster sessions) of NiteCAPP CARES or a web-based sleep hygiene control (NiteCAPP SHARES). Participants will be assessed at baseline, after treatment, and 6- and 12-month follow-ups. The following assessments will be completed by caregivers: 1 week of actigraphy and daily diaries measuring sleep, Insomnia Severity Index, arousal (heart rate variability), inflammation (blood-derived biomarkers: interleukin-6 and C-reactive protein), neurodegeneration (blood-derived biomarkers: plasma amyloid beta [Aβ40 and Aβ42], total tau, and phosphorylated tau [p-tau181 and p-tau217]), cognition (Joggle battery, NIH Toolbox for Assessment of Neurological and Behavioral Function, and Cognitive Failures Questionnaire), stress and burden, health, and mood (depression and anxiety). Persons with dementia will complete 1 week of actigraphy at each time point. RESULTS: Recruitment procedures started in February 2022. All data are expected to be collected by 2026. Full trial results are planned to be published by 2027. Secondary analyses of baseline data will be subsequently published. CONCLUSIONS: This randomized controlled trial tests NiteCAPP CARES, a web-based CBT-I for rural caregivers. The knowledge obtained will address not only what outcomes improve but also how and why they improve and for how long, which will help us to modify NiteCAPP CARES to optimize treatment potency and support future pragmatic testing and dissemination. TRIAL REGISTRATION: ClinicalTrials.gov NCT04896775; https://clinicaltrials.gov/ct2/show/NCT04896775. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/37874

The Impact of Internal and External Resources on Functional Outcome in Chronic Illness

This study\u27s purpose was to determine if internal and or external resources could deter negative consequences of physiologic stress in chronic illness. Resource theory was used to test relationships over time among stress (physiologic), distress (functional outcome), and resources (internal—well-being; external—social network). A secondary analysis was done on data from 112 persons with end stage renal disease, collected yearly over 3 years. Physiologic stressors were strongly associated with higher levels of physical dysfunction. Resources were generally unable to reduce deleterious effects of physiologic stress on functional outcomes; functional outcomes were largely determined by preexisting levels of function

Intervening to Prevent Nighttime Injuries in Cognitively-Impaired Persons Living at Home: A Case Report

The purpose of this case report is to illustrate the use of a novel intervention used to prevent injuries in cognitively-impaired (CI) individuals living in the home who arise during the night. A home monitoring system was developed to ensure that the caregiver would be notified if the CI individual attempted to leave the home at night. This case illustrates the effectiveness of the device in a situation in which the CI individual frequently attempted to leave the home during the night hours

Intervening to Prevent Nighttime Injuries in Cognitively-Impaired Persons Living at Home: A Case Report

The purpose of this case report is to illustrate the use of a novel intervention used to prevent injuries in cognitively-impaired (CI) individuals living in the home who arise during the night. A home monitoring system was developed to ensure that the caregiver would be notified if the CI individual attempted to leave the home at night. This case illustrates the effectiveness of the device in a situation in which the CI individual frequently attempted to leave the home during the night hours

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

Nighttime Activity in Individuals with Dementia: Understanding the Problem and Identifying Solutions

Sleep disturbances may occur in more than 50% of individuals with dementia, and nighttime activity can lead to unsafe situations and serious consequences for both the person and his or her caregivers. Nighttime awakenings expose individuals with dementia to two major dangers: falls and unattended home exits. This article is a review of the current research on the causes of sleep disturbances and interventions for nighttime activity in individuals with dementia living at home

Injuries Sustained by Community-Dwelling Individuals With Dementia

As the percentage of individuals with dementia continues to increase in the American population, it is particularly important to understand and prevent conditions that may have an impact on the course of the disease. In this study, injuries that occurred in the home with a subsequent in-patient admission were studied using a medical record review. Ninety-six percent of individuals were injured as a result of a fall. The falls resulted in fractures in 61% of the subjects. Interestingly, 35% were admitted after only sustaining soft tissue injuries. Most subjects (65%) were discharged to an institutional setting instead of returning home. Clearly, fall prevention should be addressed in-depth when caring for individuals with dementia in the home to prevent early institutionalization