Browsing by Subject "Dementia"

Behavioral symptoms of dementia cause considerable distress for persons with dementia and their caregivers and are related to adverse outcomes that have significant social and economic impact. Thus, behavioral symptoms represent one of the most challenging aspects of dementia care. Over the past three decades, research on behavioral symptoms of dementia has laid the foundation for development of non-pharmacological interventions by identifying underlying mechanisms of symptom development. However, the research has largely overlooked how the needs of military veterans may influence development and treatment of behavioral symptoms of dementia, including those needs associated with co-occurring dementia and posttraumatic stress disorder (PTSD). This dissertation aimed to develop knowledge related to behavioral symptoms of dementia among older veterans with and without PTSD by synthesizing current understanding of neurocognitive and psychiatric comorbidities of PTSD among veterans as well as explicating relationships among background factors, proximal factors, and behavioral symptoms of dementia among veterans living in residential care using the need-driven, dementia-compromised behavior (NDB) model.

This dissertation includes a systematic review in Chapter 2 that synthesized the patterns of neurocognitive and psychiatric comorbidities of PTSD in older veterans and revealed a substantial gap in the literature with regards to understanding manifestations and treatment of behavioral symptoms of dementia among older veterans with co-occurring dementia and PTSD. The primary study of this dissertation that encompasses Chapters 3 and 4 utilized an exploratory sequential mixed methods design using secondary data derived from the evaluation dataset of the STAR-VA training program. In Chapter 3, a qualitative study, as the first phase of the mixed methods study, analyzed text data that captured the interdisciplinary care team’s observation of behavioral symptoms of dementia and their circumstances for the subsample of 33 veterans from the STAR-VA dataset. This qualitative study described how behavioral symptoms of dementia are manifested among veterans with and without PTSD in the context of personal, interpersonal/social, and environmental factors that trigger the symptoms. Findings demonstrated that behavioral symptoms of dementia are heterogeneous, with distinct clusters of triggers that are multi-level, thereby warranting an interdisciplinary, multi-level approach to developing person-centered interventions. In addition, findings from this qualitative study informed the development of the second phase of the sequential mixed methods study in Chapter 4 that aimed to test hypothesized pathways between background factors, interpersonal triggers (proximal factors), and behavioral symptoms of rejection of care and aggression and to explore the moderating effect of PTSD on the hypothesized pathways. The mixed methods approach integrated quantitative data measured by standardized scales and text data for 315 veterans derived from the STAR-VA dataset. After converting text data into categorical variables, structural equation modeling (SEM) was performed to compare the patterns of relationships among background factors, interpersonal triggers, and behavioral symptoms of rejection of care and aggression between veterans with and without PTSD. The direct effect of interpersonal triggers and the indirect effect of background factors through interpersonal triggers on rejection of care and aggression emphasizes the importance of developing and implementing psychosocial interventions that improve interpersonal relationships. The multi-group SEM revealed that the full model was not moderated by PTSD. However, the differential direct and indirect effect of background factors and interpersonal triggers as a proximal factor on the behavioral outcomes between veterans with and without PTSD suggest potential different mechanisms of behavioral outcomes between veterans depending upon whether or not PTSD is present. Evidence for the PTSD-moderated mediating effect of interpersonal triggers on the relationship between depression and rejection of care was demonstrated, suggesting the need to develop targeted interventions for veterans with dementia and PTSD who have greater depressive symptoms.

The new knowledge generated from this dissertation helps to clarify complex patterns of associations among background factors such as PTSD and proximal factors and behavioral symptoms of dementia consistent with the NDB model, strengthening the foundation for development of novel approaches to designing and implementing person-centered care for veterans with co-occurring dementia and PTSD.

Background: Family caregivers for a parent with dementia often experience negative emotional consequences. These caregivers may also be at risk for compassion fatigue, a concept that was introduced to the health care community as feelings of anger, inefficacy, apathy, and depression resulting from a caregiver's inability to cope with devastating stress. Compassion fatigue was first observed in nurses and later in other caring professionals such as social workers and psychologists and the definition was adapted to focus on prolonged exposure to suffering as one of the primary causes.

Although compassion fatigue has not been studied in family caregivers providing care at home, their experiences, particularly those of adult daughter caregivers for parents with dementia, appear to create a foundation for developing compassion fatigue. For this reason, it was important to investigate compassion fatigue in this growing population of caregivers and this dissertation explored compassion fatigue in daughter caregivers for parents with dementia. The dissertation aims were to 1) identify common themes across the literature on compassion fatigue and to apply these themes and the existing model of compassion fatigue to informal caregivers for family members with dementia, 2) analyze secondary data from Project ASSIST to substantiate a need for further study of compassion fatigue in adult daughter caregivers of a parent with dementia, 3) explore the feasibility of studying compassion fatigue in family caregivers, and 4) explore compassion fatigue and the contributing factors and potential outcomes of compassion fatigue in adult daughter caregivers for parents with dementia.

Methods: The dissertation consisted of three studies. The first study, a review of the literature addressed aim 1 of the dissertation as I applied the established model of compassion fatigue to family caregivers. The second study, a secondary analysis pilot study addressed aim 2 and aim 3 of the dissertation study. The third study of the dissertation was a qualitative study exploring the concept of compassion fatigue in daughter caregivers for parents with dementia.

Conclusions: The literature review found evidence to support the components of the established model of compassion fatigue and findings suggested additional work was needed on the concept of compassion fatigue in family caregivers. Findings from the secondary analysis provided support for more in-depth exploration of the concept of compassion fatigue in family caregivers. Findings from the larger qualitative study provided support for many of the factors related to compassion fatigue, but also suggested revisions to the established model of compassion fatigue were needed. A revised model was created based upon the findings from this dissertation.

The revised model incorporates the contributing factors and moderators of compassion fatigue found in family caregivers and the model also proposes revised characteristics and outcomes of compassion fatigue. Findings from this dissertation also suggest new areas for research, specifically with all dementia caregivers and caregivers who do not utilize formal or informal support. Additional value from this dissertation derives from the detailed explanation of previous relationship quality, empathy, and caregiving experience. This dissertation is one of a few qualitative studies on compassion fatigue to provide this level of detail and serves to anchor future research on compassion fatigue in all family caregivers.

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AbstractBackground: Chronic pain is a widespread and intricate condition that affects a substantial portion of the global population. Its impact poses both societal and economic threats, exerting physical and psychological strains and becoming a genuine long-term public health concern. Emerging evidence suggests an association between chronic pain and cognitive decline, particularly in the context of Alzheimer's disease, vascular dementia, and other dementia-like symptoms.

While the conventional approach involves considering the count of locations and severity of pain in chronic pain research and clinical practice, this method may oversimplify the complexity of chronic pain experiences. Therefore, understanding the patterns of chronic pain locations and their associations with dementia is crucial for developing tailored and effective interventions as well as preventive strategies. This study aims to identify prevalent patterns of chronic pain locations and evaluate their associations with incident dementia among middle-aged and older adults in the UK Methods: This study leveraged medical data extracted from the UK Biobank, a large-scale prospective cohort study encompassing detailed health and genetic information from over 500,000 participants across the United Kingdom. The analysis involved a total of 445,530 participants, and incident dementia records were sourced from national health registers. Chronic pain location was self-reported, with respondents choosing from eight possible options: headache, face, neck or shoulder, back, stomach or abdominal, hip, knee, or all over the body.

To identify the most prevalent patterns of chronic pain locations, the study calculated the incidence rates of all-cause dementia for the 20 most common combinations. Cox models were employed to examine the hazard of dementia for each of these 20 combinations in comparison to three groups: (i) participants without chronic pain, (ii) participants with only a single chronic pain location not included in the combination, and (iii) participants with only a single chronic pain location included in the combination.

Results: The analysis unveiled that the size of the combinations of chronic pain locations varied, ranging from 6 to 8,207 persons. The three most prevalent combinations were neck and back (5.7%), back and knee (5.4%), and neck and knee (4.5%). Chronic pain in the back, neck, and knee was each present in over half of the 20 most prevalent combinations.

Notably, chronic pain in the back, neck, and knee was commonly found either individually or simultaneously in combinations linked to higher dementia rates compared to individuals without chronic pain. Furthermore, combinations involving back, neck, and knee were associated with greater dementia rates than groups with a single pain location not included in the combination.

Conclusions: The findings of this study strongly indicate that chronic pain is not randomly distributed across body locations and that specific patterns of chronic pain locations may be linked to an elevated risk of dementia. The understanding of how different patterns of chronic pain locations relate to dementia offers fresh insights into dementia prevention strategies through effective pain relief. These results emphasize the significance of acknowledging the complexity of chronic pain experiences and their potential implications for cognitive health.

Further research is warranted to delve into the underlying mechanisms that connect chronic pain patterns to dementia. Additionally, exploring targeted interventions for dementia prevention through precise pain management would contribute to a more comprehensive understanding of the intricate relationship between chronic pain and cognitive health窗体底端

Further research is warranted to delve into the underlying mechanisms that connect chronic pain patterns to dementia. Additionally, exploring targeted interventions for dementia prevention through precise pain management would contribute to a more comprehensive understanding of the intricate relationship between chronic pain and cognitive health

Caregivers of individuals with dementia describe a wide spectrum of caregiving experiences, ranging from very negative to very positive. Previous literature acknowledges these differing experiences, but how and why they differ has rarely been investigated. Dementia caregiving can be burdensome with many psychological, physical, social and financial challenges. However, it can also be an opportunity for growth and transcendence as caregivers find meaning in caregiving. High levels of mutuality (the perception that the quality of the care relationship is positive), reportedly ameliorates negative caregiver outcomes. Thus, this dissertation consists of three studies that explore aspects of the caregiver-care recipient relationship that may enhance positive caregiving experiences.

The first study was a secondary analysis of factors related to caregivers' perceptions of care relationship mutuality over a 12 month period. Caregivers who reported high mutuality were less likely to be depressed and more likely to provide care for longer periods before deciding to institutionalize the care recipient. The second study was a secondary analysis of caregiver interviews. It revealed that caregivers who reported a positive caregiving experience described both their past and present relationship in loving terms and reported that they understood their care recipient could not reciprocate. These caregivers focused on aspects of the relationship that still existed, rather than on what they had lost. They expressed satisfaction with caregiving, were other-focused, and reported little caregiving burden. The third study was a qualitative descriptive study. Caregivers who reported finding meaning in caregiving were interviewed to explore how they were able to do so. These caregivers used strategies such as accepting the situation, deciding to care, choosing a positive attitude, focusing on the blessings of caregiving, and actively seeking care resources. They demonstrated altruistic values and the determination and discipline to live those values. They also possessed strong faith, love, and social support, and said they had derived strength from past challenges.

Clinicians and researchers should explore the quality of the caregiving relationship as a critical factor in caregiver and care recipient outcomes. Caregiver interventions should include relationship-building skills and empathy building techniques to offset adverse caregiver outcomes and enhance understanding and acceptance of changes that occur in the care recipient over time.

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BackgroundSeveral modifiable risk factors for dementia have been identified. Rising interests focus on how frailty captures heterogeneous treatment and prevention effects. This study aimed to examine the association between modifiable risk factors and all-cause dementia among middle-aged and older adults and compare population-level intervention effects across frailty status.

MethodsParticipants from UK Biobank without dementia and with available data on frailty and modifiable risk factors at baseline were included. Dementia was ascertained from inpatient records. Frailty was defined by a modified version of physical frailty phenotype and classified as non-frail, pre-frail and frail. Thirteen socioeconomic, life-style, environmental, and medical risk factors were included. We used Logistic regression to examine their association with 10-year dementia. Population intervention effects were also estimated by parametric G-computation.

ResultsOf 381, 419 eligible participants with a mean age of 56.9 years, 58.4%, 38.2%, and 3.4% were non-frail, pre-frail, and frail, respectively. Over a 10-year follow-up, 1,688 (0.76%), 1,949 (1.34%), and 378 (2.90%) dementia cases were identified among non-frail, pre-frail, and frail adults. The odds ratios for low education, physical inactivity, central obesity, hearing impairment, high NO2 exposure, and traumatic brain injury increased, but those for smoking, depression, hypertension, and diabetes decreased. Population intervention effects for single risk factors (excluding smoking and excessive alcohol use) increased with severer frailty status. For interventions achieving 100% coverage, the population intervention effect was 0.002, 0.007, and 0.022 in the non-frail, pre-frail, and frail populations, respectively. Even with intervention coverage of only 25% and 50%, the population intervention effect remained highest among the frail population.

ConclusionWe found that frailty modifies the associations between established risk factors and dementia among middle-aged and older adults. Dementia intervention effectiveness appears to be greatest among frail adults. Therefore, routine frailty evaluation should be adopted to identify those who will gain the most from personalized dementia prevention strategies.

Background: Increasing evidence suggests that early diagnosis of Alzheimer’s disease and related diseases (ADRD) offers opportunities for access to supportive services and disease management. However, most cases of ADRD are diagnosed in the later stages of the disease limiting the benefits of supportive services and increasing challenges related to the disease. This study aimed to understand facilitators and barriers to early ADRD diagnosis among Black and White individuals seeking racial differences in this process. Methods: Our sample included 21 racially diverse caregivers (n= 21) of older adults with ADRD, including Black caregivers (n=11) and White caregivers (n= 10). Semi-structured interviews were conducted individually with participants. Duke University Health System (DUHS). Data were coded for emerging themes and analyzed through the lens of the life course framework using NVIVO analysis software. Results: Facilitators and barriers along the diagnosis process were shaped by the individual, family/caregiver, and interactions with the healthcare system. Racial differences were particularly evident regarding family/caregiver's lower knowledge about ADRD, care approach offered to the care recipient, and prevalent negative interactions with the healthcare system among Black caregivers. Conclusions: The diagnosis process pathways were lengthy, characterized by caregivers' persistence, challenges to receiving an adequate cognitive assessment, and limited access to supportive services. Black caregivers experienced a more prolonged process, lower knowledge about ADRD, and challenging interactions with the healthcare system.

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