Medicine and Health Sciences Commons^™

The Association Between Cognitive Dysfunctions And Cardiovascular Disease Of Minority And Lgbtq+ Communities In The United States, Nathan G. De Shields

Walden Dissertations and Doctoral Studies

Dementia, the loss of cognitive acuity is an umbrella term of neuro-degenerative symptoms that impact an estimated 6.5 million Americans, and amid heart disease, cancers, and emerging viruses, such as COVID-19, has reportedly increased in prevalence. A cross-sectional study of secondary data from the National Health and Nutrition Examination Survey (NHANES) was conducted to analyze minority and non-heterosexual experiences of health risks found higher in prior studies of distress rates in LGBTQ+ adults. The socio-ecological framework was used to interpret the competing ecologies of social health determinants in natural and social settings. Literature reviews on cognitive dysfunction and other vascular …

Exploring Barriers To Accessing Funding For Individuals With Dementia Who Reside In Long-Term Care Facilities, Gwendolyn Cox Smith

Walden Dissertations and Doctoral Studies

AbstractMedicare and Medicaid are the most used funding sources for long term care (LTC); however, they are insufficient to pay for all social activities needed by individuals with dementia who reside in LTC facilities in the United States. Barriers in accessing funding to provide social activities for these individuals were explored though the theoretical lens of a logic model related to funding. A qualitative exploratory case study design was used to find not only the barriers of accessing funding but also the type of available funding and the eligibility criteria for receiving funds for social activities for those with dementia …

Occupational Therapists’ Perspectives On Using The Physical Environment In Skilled Nursing Facilities, Jennie L. Digrado

Walden Dissertations and Doctoral Studies

Occupational therapists (OTs) are among the health care professionals who assist individuals with neurocognitive disorders (NCDs) to engage in self-care and leisure skills in a skilled nursing facility (SNF) environment. Although the SNF environment has been researched, a gap exists regarding how OTs use the built environment to help clients with a NCD engage in self-care and leisure-related activities. The purpose of this qualitative case study was to understand how OTs use the physical environment in a SNF to help individuals with a NCD engage in self-care and leisure related activities. The conceptual framework that guided this study was the …

The Motivations And Work-Life Balance Of Paid Home-Based Caregivers Of Clients Experiencing Dementia, Cheraire Lyons

Walden Dissertations and Doctoral Studies

With an expected increase in demand for professional caregivers for the growing older adult and aging population, caregivers need balance in their lives so they can provide quality patient care. The purpose of this qualitative multiple case study was to explore what motivates paid, professional home-based caregivers of clients with dementia to maintain their work–life balance. The caregiver ambition framework was the guide for exploring home-based caregivers’ work life issues along with caregivers’ motivations for work–life enrichment. Interview data were collected from five interviews that were analyzed first manually by exploring the transcribed interviews for commonly seen words and phrases. …

A Clinical Practice Guideline For Managing Behavioral Problems In Persons With Dementia, Ken J. Brinker

Walden Dissertations and Doctoral Studies

AbstractAs the baby boom generation ages, the demand for effective nursing care for patients diagnosed with dementia has greatly increased. The challenges associated with dementia include a patient’s inability to focus, pay attention, and follow conversations. Patients often become forgetful, angry, frustrated, and aggressive with family members and caregivers. The medical providers and administrators at a long-term care facility needed assistance in developing a clinical practice guideline for managing behaviors demonstrated by patients with dementia. The project question centered on the identification of current evidence supporting a clinical practice guideline for nursing practice for unpredictable behaviors demonstrated by residents diagnosed …

Occupational Therapists’ Perspectives On Using The Physical Environment In Skilled Nursing Facilities, Jennie L. Digrado

Walden Dissertations and Doctoral Studies

Occupational therapists (OTs) are among the health care professionals who assist individuals with neurocognitive disorders (NCDs) to engage in self-care and leisure skills in a skilled nursing facility (SNF) environment. Although the SNF environment has been researched, a gap exists regarding how OTs use the built environment to help clients with a NCD engage in self-care and leisure-related activities. The purpose of this qualitative case study was to understand how OTs use the physical environment in a SNF to help individuals with a NCD engage in self-care and leisure related activities. The conceptual framework that guided this study was the …

Exploring Barriers To Accessing Funding For Individuals With Dementia Who Reside In Long-Term Care Facilities, Gwendolyn Cox Smith

Walden Dissertations and Doctoral Studies

AbstractMedicare and Medicaid are the most used funding sources for long term care (LTC); however, they are insufficient to pay for all social activities needed by individuals with dementia who reside in LTC facilities in the United States. Barriers in accessing funding to provide social activities for these individuals were explored though the theoretical lens of a logic model related to funding. A qualitative exploratory case study design was used to find not only the barriers of accessing funding but also the type of available funding and the eligibility criteria for receiving funds for social activities for those with dementia …

Cognition, Neurocognitive Disorder, Psychotropic Group Of Medication, And Fall Among Canadians Aged 65+ Years, Victoria Elaki Momoh

Walden Dissertations and Doctoral Studies

Despite the high incidence of fall among the elderly in residential care, this problem has been minimally explored and reported. This study examined the association between (cognitive performance, dementia, four groups of psychotropic medication-hypnotics, antidepressants, antianxiety medication, and antipsychotics) and fall among Canadian elderly in residential care. A multi–variate logistic regression was used for the analysis. The Social Cognitive Theory was used to interpret the findings of an analysis on 180,231 Canadian residents from 2018–2019. Cognitive performance at intact level (OR=1.114, p<0.001), cognitive performance at moderate level (OR=1.192, p<0.001), dementia diagnosis (OR=1.075, p<0.001), antipsychotics (OR=2.571, p<0.001), antidepressants (OR =1.486, p<0.001) and antianxiety prescription (OR=3.284, p<0.001) increased the odds ratio of fall. However, cognitive performance at severe level (OR=0.898, p<0.001), no dementia diagnosis (OR=0.001, p<0.001) and hypnotics prescription (OR=0.389, p<0.001) decreased the odds ratio of fall. Findings indicate that cognitive performance at the intact and moderate levels, antianxiety, antipsychotic and antidepressant medications and dementia were strong predictors of fall among the elderly in residential care in Canada. A limitation of the study was that the dataset used captured data from 7 out of 13 Canadian provinces and territories therefore, limiting external validity. The potential positive social change impact of this study is that it would guide caregivers, enhance fall prevention practices and decrease fall occurrence in this population.

Staff Education For Identifying, Assessing And Managing Pain In Patients With Dementia, Nadia S. Handspike

Walden Dissertations and Doctoral Studies

Pain is a common symptom in healthcare settings, especially among patients with Alzheimer's Disease (AD). AD patients have cognitive and communication impairment making it difficult or impossible for them to communicate their pain to their caregivers or healthcare practitioners. The purpose of this project was to implement a staff education program for healthcare professionals on evidence-based practices for assessing, recognizing, and managing pain in patients with AD. The practice-focused question explored if a staff education program on identification, assessment, and management of pain in patients with AD improves the staff's knowledge, skills, and attitude towards timely and effective pain assessment …

Developing Innovative Practices Through Third-Space Partnerships: Reflections On Project Dare (Dementia Knowledge, Art, Research And Education), Corinne A. Green, Michelle J. Eady Dr, Pippa Burns, Jessica Baker, Jennine Primmer, Penelope Harris, Carinya Barkley, Victoria Traynor

Journal of Educational Research and Practice

Partnerships between schools, universities, and community organizations have mutual benefits for all involved. These partnerships value the contributions of all participants and capitalize on the expertise and knowledge that each brings. This reflective paper details a collaborative third-space partnership between a university, a primary school, and a community organization. The partnership facilitated the design, development, and implementation of a unique program called Project DARE (Dementia knowledge, Art, Research, and Education). A research-based evaluation of the Project DARE feasibility study can be found elsewhere (Burns et al., 2020). The aim of this paper is to reflect upon the formation of the …

Increasing Staff Knowledge Regarding The Use Of Nonpharmacological Interventions With Long-Term Care Residents Diagnosed With Dementia, Larissa Latrice Anderson

Walden Dissertations and Doctoral Studies

Dementia is an umbrella term that describes a clinical syndrome of progressive cognitive decline. The prevalence of a dementia diagnosis increases with age, making it a common occurrence within the older population. In long-term care facilities, where 5% of the older population reside, antipsychotic medications are the first line of defense and the choice of treatment among patients diagnosed with dementia. Recently, the Center for Medicare and Medicaid Services (CMS) announced a new goal of decreasing antipsychotic medication usage by 15% by the end of 2019. Guided by Watson’s Theory of Caring, this project was conducted to determine if an …

Non-Pharmacological Interventions For Residents With Dementia, Jared Bielanski

Walden Dissertations and Doctoral Studies

The use of antipsychotic medications in persons with dementia has been shown to increase mortality in long-term care (LTC) patients. National guidelines recommend the use of nonpharmacological interventions when possible for LTC residents with dementia. Nurses who work in a local LTC facility are not regularly trained in effective nonpharmacological interventions and lack the knowledge to provide care for patients with dementia. To provide safe and effective alternative interventions to antipsychotic medication use, nurses and direct care staff must have current, evidence-based education available to them about alternative practices. The purpose of this staff education project, guided by Calista Roy’s …

Development Of Practice Guidelines Based On Need-Driven Dementia-Compromised Behavior Model, Amy Marie Nolan

Walden Dissertations and Doctoral Studies

People with dementia, who experience cognitive decline, memory loss, and reasoning difficulties, often exhibit compromised behaviors such as agitation or aggressive behavior that impact negatively upon the person’s quality of life and increase safety risks. The purpose of this project was to develop an evidence-based clinical practice guideline (CPG) to improve the use of effective evidence-based interventions by staff in a skilled long-term care nursing facility to manage the compromised behavior of residents with dementia. The Need-Driven Behavioral Model, which suggests that compromised behaviors occur when patient attempts to accomplish a goal or express a need, provided the framework CPG …

Reducing Antipsychotic Medication Use In Long-Term Care Settings, Martha Ofeibea Agbeli

Walden Dissertations and Doctoral Studies

The prescription rate of antipsychotics in patients with dementia varies between 20% and 50% for the common and troubling neuropsychiatric symptoms experienced by patients with dementia. The use of these antipsychotic medications has been linked with increased risk of morbidity and mortality due to associated Parkinsonism, over sedation, gait disturbances, cognitive decline, and cardiovascular adverse events. The purpose of this project was to assess whether development of an evidence-based clinical practice guideline (CPG) for a long-term care facility would increase awareness about issues that govern the safe use of antipsychotic medications. The conceptual framework for the project was Watson's model …

Coping Methods Of Caregivers Dealing With Patients Suffering From Geriatric Dementia, Blessing Baridakara Deemua

Walden Dissertations and Doctoral Studies

Dementia is a neurological disorder primarily diagnosed in the geriatric population. A problem for paid caregivers of patients diagnosed with stage-4 dementia is that they may experience caregiving stress while rendering care. However, there was no research that described the lived experiences of paid caregivers. Caregiving stress can be accompanied by behaviors or comorbid conditions and specific symptoms of stress can have a differential wellness impact. This phenomenological study explored the lived experiences of paid caregivers of patients with dementia through Vroom's expectancy theory. Data were gathered through interpretative interviews from a sample of 10 to 15 purposefully selected nursing …

Staff Education Intervention To Enhance Care Planning For Older Adults, Mozhgan Peiravi

Walden Dissertations and Doctoral Studies

The increased prevalence of cognitive deterioration has increased the challenges of caring for older adults. This study's project site offers a psychiatric program for older adults with customized care for complex geriatric mental health patients. Clinical assessment and care management are often overlooked in geriatric mental health patients diagnosed with behavioral and psychological symptoms of dementia (BPSD). The purpose of this project was to deliver an education program developed from the Staff Training in Assisted Living Residences-Veterans Administration, P.I.E.C.E.S model and the Castle framework to 42 nursing and allied health staff of the project site. The project question explored whether …

Experiences Of Formal Caregivers Providing Dementia Care To American Indians, Damon Grew Peter Syphers, C.J. Schumaker, Ronald P. Hudak

Journal of Sustainable Social Change

Alzheimer’s disease (AD) is a significant public health concern for all elders in the United States. It is a particular concern for the American Indian (AI) population, which is one of the fastest aging populations in the United States and the smallest, most underrecognized, and most culturally diverse group in the country. A formal caregiver understanding of AD in the AI population is scarce. This phenomenological study was designed to discern what is known about AD in the AI population by exploring the cultural beliefs and experiences of formal caregivers who provide care for AI dementia patients. Specifically, this study …

Unmet Support Needs Of Informal Caregivers Of Older Adults, Julie Ann Smith Hinders

Walden Dissertations and Doctoral Studies

Due to projected growth of the 65-and-older population and concerns of an impending care gap, reliance on informal caregivers is expected to increase. Improving support for informal caregivers is viewed as a national priority, yet research related to the unmet support needs of informal caregivers is limited. The purpose of this cross-sectional correlational study was to examine predictive relationships between contextual factors (caregiving relationship and type of illness) and environmental factors (rurality) and the unmet support needs (classes, service access, support groups, counseling, and respite) of informal caregivers of older adults. The theoretical framework was Bronfenbrenner's ecological systems theory. Archival …

A Nursing Education Program To Decrease Use Of Psychotropics Among Dementia Patients, Tami Felicia Blackmon

Walden Dissertations and Doctoral Studies

Dementia, a clinical condition that affects the psychological ability of patients, is distinguished by a significant overall decline in cognitive function that results in distorted perception. Guiding nursing practice in the long-term care (LTC) setting to decrease the unnecessary use of psychotropics is critical because doing so relates to the patients' quality of life and safety. In the LTC facility that served as the practicum site for this study, there was an observed overuse of psychotropic medications in the care of patients with dementia. The practice-focused question guiding this project asked whether a nursing staff development program would decrease the …

Nonpharmacological Behavioral Interventions For Patients With Dementia: An Integrative Literature Review, Michelle Monique Spears

Walden Dissertations and Doctoral Studies

The use of antipsychotic medications in older adults with dementia increases risk of

mortality; therefore, it is critical that nurses use nonpharmacological interventions in dementia care. The nurses' role is integral to implementation of treatment strategies to dementia patients and efforts to improve care in patients with dementia using a nonpharmacological approach are necessary. Therefore, guidelines outlining nonpharmacologic dementia care management will enable nurses to provide a wider spectrum of care to dementia patients. The purpose of this project was to make recommendations for the development and implementation of interdisciplinary practice guidelines to standardize care in the organizational setting. An …

The Impact Of Depakote On Agitation And Short-Term Memory In Nursing Home Dementia Residents, Kristin E. Fazzolari-Pleace

Walden Dissertations and Doctoral Studies

Researchers have linked dementia to common psychiatric symptoms such as agitation and aggression, known as behavioral and psychological symptoms of dementia (BPSD). To treat residents manifesting BPSD, nursing homes (NHs) use psychoactive medications. However, research is limited and inconsistent regarding the impact of Depakote treatment on agitation and short-term memory (STM) in NH residents who have dementia. The purpose of this nonexperimental quantitative study was to evaluate for 1 year the impact of Depakote treatment on agitation and STM in NH residents as measured by each resident's Minimum Data Set (MDS). Moncrieff and Cohen's drug-centered theory served as the theoretical …

Use Of Antipsychotic Medications In Individuals With Alzheimer's Disease In Nursing Facilities, Michelle M. Dionne-Vahalik

Walden Dissertations and Doctoral Studies

Patients with Alzheimer's disease or other types of dementia often require long-term care in nursing facilities (NF) where they may display out-of-character behaviors complicating their care. While antipsychotic medications are sometimes prescribed for NF residents, their use is considered inappropriate for the control of dementia behaviors. The Centers for Medicare and Medicaid Services have rated Texas the worst state in the country for the inappropriate use of antipsychotic medications for NF residents with dementia. This project was guided by the star model of knowledge transformation with the goal to reduce inappropriate use of antipsychotic medications through NF staff education. The …

African American Women Caring For Loved Ones With Alzheimer's Disease And Dementia, Lisa M. Forbes

Walden Dissertations and Doctoral Studies

Abstract

In 2016, a dramatic shift occurred in demographics in the United States because the oldest people in the baby boomer generation, which consists of people born between 1946 and 1964, reached age 65. The larger aging population and longer lifespans have produced an increased need for care and services. There are an estimated 5.4 million Americans of varying ages living with a diagnosis of dementia or Alzheimer's disease. Diagnoses of Alzheimer's disease are more prevalent among African Americans than other ethnicities. With little research found on culturally appropriate interventions for specific ethnic groups, a more detailed review of the …

A Causal Layered Analysis Of Assistive Technology For The Cognitively Impaired Elderly, Dariusz J. Ropiak

Walden Dissertations and Doctoral Studies

Assistive technology may delay cognitively impaired elders' need for long-term institutionalization, and the promote independence. Its use is on the rise, yet the gap between the needs of the cognitive impaired elderly and what developers of the assistive technologies design, manufacture, and implement, remains to be filled. Using Inayatullah's 6-pillar approach, as the guide to the future of assistive technology, the purpose of this qualitative study was to explore how assistive technologies may fulfill the daily functional needs of the cognitively impaired elderly with Alzheimer's or other dementia by 2037. Data were collected from a focus group of 10 seniors …

Facilitating Environmental Enrichment In Senior Care Activities With Professional Development, Celia Mary Ross

Walden Dissertations and Doctoral Studies

There is little known about the current state of professional development and continuing education practices for empowering activity professionals to better enhance environmental enrichment in long term care. The purpose of this qualitative study was to explore the activity professional's perceived role and best strategies for professional development to enrich the long-term care environment. The study used social cognitive theory as its theoretical framework to develop research questions focused on the views of activity professionals concerning professional development and continuing education to support care for long-term care residents. Using a narrative approach, 9 activity professionals were recruited through networking at …

Using Music Intervention To Reduce Anxiety And Agitation For Dementia Residents In Long Term Setting, Sonia Brown

Walden Dissertations and Doctoral Studies

Abstract

Dementia is one of the degenerative conditions that present in old age with a decline in cognitive function resulting in changes in personality and the ability to carry out activities of daily living and social functions. Dementia is usually associated with behavioral disturbances that include anxiety and agitation that pose a challenge for family members or caregivers in an alternate home or care-related facility. The purpose of this project was to design and implement a quality improvement program to evaluate music therapy intervention for residents in a long-term care who have dementia. The aim was to evaluate if music …

Enhancing Nurses' Assessment Of Pain Management In Dementia Patients, Norma Jean Boone

Walden Dissertations and Doctoral Studies

Chronic pain contributes to morbidity, mortality, and disability in millions of people. Prevalence rates for pain are as high as 83% among the 5.2 million older adults living with a diagnosis of dementia. The purpose of the quality improvement project was to assess nurses' knowledge of pain assessment and management in a 45-bed Veterans Health Administration long-term care facility serving older adults with dementia. Knowles' adult learning theory served as the theoretical framework and the knowledge to action model supported the translation of evidence into practice. A convenience sample of 27 licensed and unlicensed nursing staff answered the 16-question, 5-point …

Evaluating Nurses' Self-Efficacy In Caring For Patients With Dementia, Wendy Hopkins

Walden Dissertations and Doctoral Studies

In 2011, 5 million Americans had dementia and this number is predicted to increase. As the number of people with dementia increases, the need for quality nursing care, education, and treatment for patients with dementia increases. To address the need, nurses not only must be prepared with the knowledge, skills, and abilities to care for patients with dementia, but they must also have the self-efficacy to provide quality care. The practice focused question guiding the project was to determine the level of self-efficacy for caring for dementia patients among long-term care nursing staff. Using Bandura's social cognitive theory, the purpose …

Dementia Caregive Module And Pamphlet, Shawen Denise Ransby

Walden Dissertations and Doctoral Studies

Dementia care is an immediate and growing issue that affects everyone. People are living longer increasing the likelihood that they may be diagnosed with dementia. Friends and family are become caregivers but are often unprepared for the role. The purpose of this project was to develop a 15-minute dementia care module to assist caregivers with the home care of dementia patients. A pamphlet was created to reinforce the module information and to provide a quick reference for dementia support. The self-efficacy theory, along with the review of best practice guidelines and evidence from literature, informed the development of the module. …

Improving The Experiences Of Informal And Formal Alzheimer's Disease And Dementias Caregivers, Roxroy Anthony Reid

Walden Dissertations and Doctoral Studies

Informal and formal caregivers of persons with Alzheimer's disease and related dementias (ADRD) encounter a more difficult and unique set of challenges than do caregivers of individuals with general disabilities. If adequate caregiver supports are not provided, caregivers may experience increased strain as the disease progresses, increasing the likelihood of unnecessary institutionalization of their care recipients and increasing the cost to the public. Using rational choice theory and political systems theory, the purpose of this study was to differentiate between the phenomenological experiences of formal and informal caregivers of ADRD patients. The overall research was a qualitative design that used …