Ann Kolanowski's research while affiliated with William Penn University and other places

Publications (209)

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Introduction: The review described in this paper builds upon the Dementia Care Practice Recommendations (DCPR) published by the Alzheimer's Association in 2018 and addresses behavior change and the need for targeted outcome measures that evolve from person-centered frameworks and help evaluate interventions. Apathy and resistance to care (RTC) are...
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Nurse leaders are first and foremost, registered nurses. Nursing leadership is critical for improving the care and quality of life for older adults. Visionary nurse leaders collaborate, motivate, influence, and inspire the achievement of values and goals to improve the quality of life for older adults in long-term care. Professional registered nurs...
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Episodes of lucidity (ELs) in Alzheimer's disease and Alzheimer's disease‐related dementias (AD/ADRD), have garnered increasing attention as an important area of research. Efforts to study lucidity suffer from a lack of clear definitional criteria, inconsistent conceptualization, and diverse approaches to operationalizing features of these events....
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In residential care communities (CCs), implementation strategies can improve the use of person-centered approaches for residents' behavioral symptoms of distress. We examined staff perceptions of how well their organizational goals for achieving person-centered care (PCC) were met following implementation of the strategy, Evidence Integration Trian...
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Importance: The ability to rate delirium severity is key to providing optimal care for older adults, and such ratings would allow clinicians to target patients with severe delirium and monitor response to treatment, recovery time, and prognosis; assess nursing burden and staffing needs; and, ultimately, provide more appropriate patient-centered ca...
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Objective: To evaluate the effectiveness of feedback reports and feedback reports + external facilitation on completion of life-sustaining treatment (LST) note the template and durable medical orders. This quality improvement program supported the national roll-out of the Veterans Health Administration (VA) LST Decisions Initiative (LSTDI), which...
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Effective management of the perceived risks associated with delivering preference-based person-centered care (PBPCC) is historically challenging for nursing home staff. Existing research lacks the granularity needed to guide clinicians who fear negative health and safety outcomes for residents. This study examined direct-care nursing staff percepti...
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This study aimed to explore the perceptions of stakeholders (site champions, administrators, and front-line, social service, and activity staff) regarding the EIT-4-BPSD implementation strategy, including its utility, and the barriers and facilitators to implementation in real-world settings. A process evaluation included qualitative data from focu...
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Behavioral and psychological symptoms of dementia are increasingly being reconceptualized as expressions of distress and unmet needs. Measures that evaluate context are needed to increase our understanding of factors that influence these expressions. This review evaluated measures for two common behavioral states that are experienced as challenging...
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The COVID-19 pandemic has caused a health crisis for vulnerable older adults, physically and psychologically. Despite the urgent demand for clinical research for people with dementia, research activities are restricted due to the pandemic. This symposium will share the experiences of researchers conducting studies with older persons with dementia d...
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Behavioral and psychological symptoms of dementia (BPSD) include aggression, agitation, depression, anxiety, apathy and hallucinations and are exhibited by up to 90% of nursing home (NH) residents with dementia. BPSD result in negative health outcomes, functional decline, high care costs, increased risk for inappropriate use of antipsychotic medica...
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The purpose of this study was to test the reliability and validity of the Pain Assessment in Advanced Dementia (PAINAD) and particularly consider whether or not this measure was invariant when used among the Black and White residents. Baseline data from an implementation study testing that included a sample of 553 residents, 30% of who were Black,...
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Objectives The purpose of this study was to expand on prior work testing invariance on several depression measures in community-based older adults and explore the psychometric properties and evidence of invariance between racial groups based on the Cornell Scale for Depression in Dementia. Design This was a descriptive measurement study. Setting...
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Background: With the increase in Black nursing home residents, racial and ethnic disparities in quality of care have been raised. Purpose: The purpose of this study was to evaluate racial disparities in care and outcomes over 12 months. Methods: This was a secondary data analysis using data from the Evidence Integration Triangle for Behavioral...
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Background Behavioral and psychological symptoms of distress in dementia (BPSD) are major drivers of poor quality of life, caregiver burden, institutionalization, and cost of care in nursing homes. The Evidence Integration Triangle (EIT)-4-BPSD in nursing homes was a pragmatic Hybrid III trial of an implementation strategy to help staff use evidenc...
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Background: This study evaluated the association between age, sex, comorbidities, cognition, and administration of opioids with pain and the impact of all of these variables plus function, agitation, resistiveness to care, and depression on quality of life among residents in nursing home with severe dementia. Design: This was a descriptive study...
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Objectives:Emotional expressions in late-stage dementia have traditionally been studied within a deficit paradigm. Moving the narrative of the dementia trajectory from a solely negative pathological experience to one that acknowledges the potential for positive experiences aligns with international recommendations for living well with dementia. The...
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Background Federal regulations stipulate that behavioral interventions be used for behavioral and psychological symptoms of distress in dementia (BPSD). Care community staff have difficulty implementing these approaches. Purpose This study tested an implementation strategy, the Evidence Integration Triangle for BPSD (EIT-4-BPSD), for assisting sta...
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The purpose of this study was to consider gender differences in depressive symptoms, agitation, resistiveness to care, physical function, and use of psychotropic medications in older adults with moderate to severe dementia in nursing homes. Sixty-seven nursing homes and 889 residents from two states were included. The majority of the participants w...
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Person-centered care (PCC) is the standard for the delivery of long-term services and supports (LTSS). In this article, we summarize the state of the science on meaningful outcomes and workforce development and discuss what is needed to ensure that person-centered LTSS becomes a universal reality. These 2 themes are intimately related: the dementia...
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The purpose of the current study was to describe gender differences in the quality of interactions between nursing home residents with behavioral and psychological symptoms of dementia and staff. Data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) implementation study were used for the curr...
Preprint
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Background: Behavioral and psychological symptoms of distress in dementia (BPSD) are major drivers of poor quality of life, caregiver burden, institutionalization, and cost of care in nursing homes. The Evidence Integration Triangle (EIT)-4-BPSD in nursing homes was a pragmatic Hybrid III trial of an implementation strategy to help staff use eviden...
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COVID-19 has exposed the longstanding internal problems in nursing homes and the weak structures and policies that are meant to protect residents. The Centers for Medicare and Medicaid Services convened the Coronavirus Commission for Safety and Quality in NHs in April, 2020 to address this situation by recommending steps to improve infection preven...
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Editor's note: This article is by 22 nursing gerontology experts who are all advocates of nursing home reform. They are listed at the end of this article.
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After hip fracture, older adults experience poor functional outcomes including a lack of IADL recovery. Gender differences exist in risk, incidence, mortality, and complication rates; yet, analyses of predictive factors of IADL especially by gender are often not conducted. The purpose of this study was to investigate gender differences in predictiv...
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Nursing home (NH) staff perceptions of risks to residents’ health and safety is a major barrier to honoring resident preferences, the cornerstone of person-centered care delivery. This study examined direct-care nursing staff perceptions of risk (possibilities for harm or loss) associated with honoring residents’ preferences for everyday living and...
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Little literature exists examining the development and implementation of person-centered care (PCC) plans focused on behavioral and psychological symptoms of dementia (BPSD). The current study aimed to describe BPSD documented in nursing home (NH) residents' care plans, the types of approaches staff document in addressing those symptoms, and whethe...
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Background and objectives: Nursing home (NH) staff perceptions of risks to residents' health and safety is a major barrier to honoring resident preferences, the cornerstone of person-centered care delivery. This study explored direct-care nursing staff perceptions of risk (possibilities for harm or loss) associated with honoring residents' prefere...
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Positive airway pressure (PAP) associated claustrophobia is common among obstructive sleep apnea patients and plays a prominent role in low adherence and treatment failure. As there are no evidence-based interventions for PAP-associated claustrophobia, the objective of the present research is to pilot test Mindfulness-based Exposure for PAP-associa...
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Lack of identification and management of behavioral and psychological symptoms of dementia (BPSD) can negatively impact female residents. The purpose of this secondary data analysis was to explore gender differences in presentation and management of BPSD and quality of interactions between residents and staff. A total of 553 residents from 55 nursi...
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The purpose of this study was to test the reliability and validity of the Assessment of the Environment for Person-Centered Management of BPSD and the Assessment of Policies for Person-Centered Management of BPSD. The sample included 35 long term care facilities. There was evidence of reliability based on internal consistency and test-retest reliab...
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Regardless of presenting symptoms, there are concerns that BPSD is more often identified in males versus females and males are more likely to be treated with pharmacologic and non-pharmacologic interventions than females. In part this is due to the behaviors in men, specifically aggression, being more distressing for staff and more difficult to man...
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Affect balance is a concept that is measured by comparing the relative frequency of experiencing positive affect versus negative affect. A higher ratio of positive to negative affect has been associated with greater well-being, improved function and resilience. Baseline data from an ongoing pragmatic trial were used to determine the resident, staff...
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How behavioral and psychological symptoms of dementia (BPSD) are understood and managed is important to person-centered care. No knowledge tests associated with dementia specifically address staff knowledge of person-centered behavioral approaches to BPSD. The Knowledge of Person-Centered Behavioral Approaches for BPSD Test was developed by our tea...
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Person-centered care is the standard of practice in communal living sites, yet many facilities struggle to make this a reality. Both direct care staff and administrators find residents’ behavioral and psychological symptoms of dementia (BPSD) particularly challenging. Our research team is conducting a pragmatic trial, the goal of which is to help s...
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Participation in leisure activities may be cognitively protective for older adults. However, there is no comprehensive scoring system for analyzing data related to the effectiveness of leisure activity engagement on cognitive decline risk. The authors developed a component scoring system to determine the typical amount of cognitive, physical, and s...
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Our climate is changing. These changes have an impact on health, especially in vulnerable populations such as older adults. Many older adults lack the physical, cognitive, social, and economic resources to avoid and/or mitigate the effects of exposure to extreme weather events. The purpose of the current article is to help nurses understand climate...
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Purpose Our purpose was to create a content domain framework for delirium severity to inform item development for a new instrument to measure delirium severity. Methods We used an established, multi-stage instrument development process during which expert panelists discussed best approaches to measure delirium severity and identified related conte...
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Well-being is an important outcome for people with dementia. The current study is a secondary analysis of baseline data from an ongoing pragmatic trial. Affect balance, the ratio of positive to negative affect, was used as a measure of well-being, and factors related to it were examined in a sample of 325 nursing home residents. Measures of staff i...
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Objective: Delirium superimposed on dementia (DSD) is common, morbid, and costly, yet frequently undiagnosed. Our study aimed to develop a brief screening test to improve health care worker recognition of DSD. Design/setting/participants: Older hospitalized adults with dementia were prospectively enrolled from medical and surgical inpatient unit...
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Unexpected cognitive lucidity and communication in patients with severe dementias, especially around the time of death, have been observed and reported anecdotally. Here, we review what is known about this phenomenon, related phenomena that provide insight into potential mechanisms, ethical implications, and methodologic considerations for systemat...
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Aims and objectives: Five of the eight focus areas of Bowen's Feasibility Framework were utilised to assess the feasibility of implementing the Safe Walking Program (SWP) with people with severe dementia who wander in long-term care (LTC). Background: Dementia-related wandering in LTC is associated with adverse outcomes related to intensity (mal...
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Introduction Claustrophobia is common in PAP users. No systematically evaluated interventions for PAP-associated claustrophobia exist. Aim: determine effect size of mindfulness-based stress reduction for claustrophobia (MBSR-C) on claustrophobia severity, frequency and PAP use. Methods In a pilot trial we enrolled adults with OSA, PAP treatment ≤3...
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This study described current use and predictors of psychotropics among residents with moderate to severe cognitive impairment. This was a secondary data analysis using baseline data from the first 341 residents in an ongoing trial. Predictive measures included age, gender, race, depressive symptoms, agitation, resistiveness to care, depression, cog...
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The goal of this quality improvement project is to improve care planning around preferences for life-sustaining treatments (LST) and daily care to promote quality of life, autonomy, and safety for U.S. Department of Veterans Affairs (VA) Community Living Center (CLC) (i.e., nursing home) residents with dementia. The care planning process occurs thr...
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Person-centered care (PCC) has a wide range of definitions, most based on expert opinion rather than empirical analysis. The current study used an empirical concept mapping approach to identify core components of PCC used in long-term services and supports (LTSS). The aim is to help providers and researchers develop a unified set of domains that ca...
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Gaps in pain management, including discontinuity in analgesic medication prescribing, frequently complicate transitions from hospital to skilled nursing facilities (SNFs) for patients with dementia. The objective of the current study was to examine analgesic medication use and prescribing patterns in the last 48 hours of hospitalization and upon di...
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This State of the Science Commentary responds to the preliminary recommendation from the National Research Summit on Dementia Care, Services and Supports for Persons with Dementia and Their Caregivers to develop and identify a broad array of outcome measures (objective and subjective) that are meaningful to different stakeholders. Five significant...
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Challenges to measuring quality of life of residents’ with dementia include their ability to provide subjective input, evaluators’ knowledge of what is relevant, and potential biases when proxy reporting is done. The Quality of Life in Late-Stage Dementia (QUALID) was developed specifically for individuals with late-stage dementia. We tested the ps...
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Long term care (LTC) residents with dementia who engage in risky wandering experience adverse outcomes including weight loss, fatigue, injury from falls, resident to resident violence, becoming lost and death. Limited robust evidence currently informs best practice for managing risky wandering in LTC using non-pharmacological interventions. Two dif...
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Person-centered care is widely recognized as the optimal approach to caring for older individuals receiving care in long term service and support settings. One foundational element to person-centeredness is knowing and honoring an older adults’ preferences for everyday living. The Preferences for Everyday Living Inventory (PELI) is one tool designe...
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The definition of health should include a more dynamic focus on the ability of individuals to adapt and self-manage physical, mental and social well-being despite the presence of chronic conditions. In 2016 the European InterDem’s Social Health Taskforce operationalized three dimensions of Social Health for dementia: (1) having the capacity to fulf...
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One way to improve person-centered approaches for Behavioral and Psychological Symptoms of Dementia (BPSD) is through care planning. Therefore, we developed and tested the Care Plan Checklist for Evidence of Person-Centered Approaches for BPSD. A total of 137 residents from 14 settings were recruited and the Cornell Scale for Depression in Dementia...
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Longer lives often involve complex care issues to maintain the health of older adults. Dementia poses some of the more difficult complex care issues, including strategies to address psychiatric behaviors and drug burden, both in community and nursing home residents. At the same time, gerontologic interventions offer great promise for addressing the...
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The first National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers was held on October 16-17, 2017, at the National Institutes of Health. In this paper, participants from the Summit Session on Research on Care Needs and Supportive Approaches for Persons with Dementia summarize the state of the science,...
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Objectives The purpose of this study was to test the efficacy of MOUTh (Managing Oral Hygiene Using Threat Reduction), a nonpharmacologic, relationship‐based intervention vs. control on 2 primary outcomes for nursing home (NH) residents with dementia who resisted mouth care: (i) reduction in the occurrence and intensity of care‐resistant behaviours...
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Apathy is one of the most common and pervasive of the behavioral and psychological symptoms of dementia (BPSDs). Apathy has profound consequences for morbidity, mortality, and caregiver burden. Treatment of apathy has been hindered because of poor understanding of the mechanisms underlying this heterogeneous syndrome. Research has demonstrated that...
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Background/rationale: This study tested the psychometric properties of the Quality of Life in Late-Stage Dementia (QUALID) Scale using Rasch analysis. The QUALID includes 11 items with a 5-point response scale. Scores range from 11 to 55, and lower scores indicate higher quality of life (QoL). Methods: Baseline data from a randomized clinical tr...
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Behavioral and psychological symptoms of dementia (BPSD) include aggression, agitation, resistiveness to care, depression, anxiety, apathy, and hallucinations. BPSD are common in nursing home residents and can be ameliorated using person-centered approaches. Despite regulatory requirements, less than 2% of nursing homes consistently implement perso...
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The quality of dementia care rendered to individuals and families is contingent upon the quality of assessment and care planning, and the degree to which those processes are person-centered. This paper provides recommendations for assessment and care planning derived from a review of the research literature. These guidelines build upon previous rec...
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Purpose: The purpose of this study was to test the reliability and validity of the Care Plan Checklist for Evidence of Person-Centered Approaches for Behavioral and Psychological Symptoms Associated with Dementia (BPSD). Methods: This study used baseline data from the first cohort of a larger randomized clinical trial testing the implementation...
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Background: Research assistants (RAs) are critical members of all research teams. When a study involves vulnerable populations, it is particularly important to have the right team members. Aim: To describe the motivations, personal characteristics and team characteristics that promoted the job satisfaction of RAs who worked on two multi-year, ra...
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Delirium is common in post-acute care (PAC) patients with dementia; its treatment is not established. We hypothesized that cognitive activities would reduce the duration and severity of delirium and improve cognitive and physical function to a greater extent than usual care. This was an NIH-funded single-blind randomized clinical trial conducted in...
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Objective: To examine the effect of cognitive reserve (CR) on longitudinal cognitive decline and gray matter (GM) atrophy in young-onset dementia. Methods: Forty-seven patients with behavioral variant Frontotemporal Degeneration (bvFTD) were studied longitudinally on neuropsychological measures of executive function (verbal fluency) and language (c...
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Delirium is often misdiagnosed in dementia and mistreated with medications that may be continued even after hospital discharge. This paper will present results from the Early Nurse Detection of Delirium Superimposed on Dementia (END- DSD) NIH funded cluster randomized trial. We hypothesized that subjects on the END-DSD units would receive fewer psy...
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Little is understood about the use of person-centered care (PCC) for individuals with delirium superimposed on dementia (DSD), especially in the acute care setting. As part of a larger clinical trial, the purpose of the current exploratory study was to describe examples and qualitatively derived themes of nurse-facilitated PCC for hospitalized olde...
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Objectives: The objective of this study was to describe the experiences of older adults living with subjective memory impairment (SMI) and examine the extent to which SMI severity was associated with impact of SMI on daily life. Method: A mixed methods convergent design was utilized. Participants with SMI (n = 19, mean age 80.7 years) were recruite...
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Background: Behavioral and psychological symptoms of dementia (BPSD) are prevalent in people with neurodegenerative diseases. Purpose: In this scoping review the Kales, Gitlin and Lykestos framework is used to answer the question: What high quality evidence exists for the patient, caregiver and environmental determinants of five specific BPSD: a...
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Background: Social interactions that lead to positive affect are fundamental to human well-being. However, individuals with dementia are challenged to achieve positive social interaction. It is unclear how social interactions influence affect in people with dementia. This study examined the association between social interactions and affect in nurs...
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Objective/background: Positive airway pressure (PAP) is highly efficacious treatment but nonadherence is prevalent with little improvement over the last 15 years. Tailored interventions show promise for promoting adherence to other treatments. The study objective was to examine feasibility and acceptability of a tailored intervention to promote PA...
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Objective: To determine whether cognitively stimulating activities would reduce duration and severity of delirium and improve cognitive and physical function to a greater extent than usual care. Design: Single-blind randomized clinical trial. Setting: Eight post-acute care (PAC) facilities. Participants: Community-dwelling older adults with...
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Behavioral and psychological symptoms of dementia are common in nursing home residents, and the Centers for Medicare and Medicaid Services now require that nonpharmacological interventions be used as a first-line treatment. Few staff know how to implement these interventions. The purpose of this study was to pilot test an implementation strategy, E...