Two research teams determined the feasibility of saliva collection for cortisol measurement in nursing home residents with advanced dementia. Study aims were to: (a) determine if sufficient saliva could be obtained for assay and (b) examine whether cortisol values exhibited range and variability for meaningful interpretation. Useable samples were consistent across sites, suggesting that saliva collection for cortisol assay is a viable method in this setting. Cortisol values showed range and variability. More than half of the residents showed the normal adult pattern of high morning levels decreasing throughout the day. A third of the participants demonstrated an increase in the evening cortisol levels, while the remaining profiles were flat, suggesting hypothalamic-pituitary-adrenal (HPA) dysregulation in this population.

Individuals with dementia living in nursing homes may be exposed to non-therapeutic levels of sound. There is insufficient research examining the relationship between sound levels, personal space, and agitation in people with dementia. Using an observational designed study, 53 participants from four southeastern Wisconsin nursing homes were observed; data on sound levels, space, and agitation levels were obtained. Sound was a significant predictor of agitation. The accumulation of sound predicted agitated behavior and explained 16% of the variance, F (5, 47) = 4.520, p < 0.002, and adjusted R 2 = 0.253. The findings suggest agitation may be a clue that sound in the environment is causing stress for residents with dementia.

The Serial Trial Intervention (STI) is a decision support tool to address the problem of under assessment and treatment of pain and other unmet needs of people with dementia. This study compared the effectiveness of the 5-step and 9-step versions of the STI using a two-group repeated measures quasi-experimental design with randomization of 12 matched nursing homes. The sample consisted of 125 residents with moderate to severe dementia. Both the 5 and 9-step STIs significantly decreased discomfort and agitation from pre to posttest (effect sizes .45 to .90). The 9-step version was more effective for comorbid burden and increased cortisol slope (effect sizes .5 and .49). Process variables were all statistically significantly improved using the 9-step STI. Nurse time was not different between the two groups. The clinical decision support rules embedded in the STI, particularly the 9-step version, helped nurses change practice and improved resident outcomes.

Noise in nursing homes remains problematic despite attempts to create homelike environments. The purpose of this study was to examine nursing home sound levels. Eight nursing units in four not-for-profit nursing homes were studied. The findings of this study show sound levels ranged from 24 to 89.6 dBA, with averages of 52.91 to 59.46 dBA. Twenty-six percent of the sound was created by staff talking, while only 3% was directed at or included the residents. Findings suggest mealtime has the potential to create louder sounds, and staff talking may contribute significantly to overall sound levels.

Nurses are in the best position to advocate for the patient and the management of their chronic illness. Educating nurses on the philosophy of palliative care and improving their comfort level in assessing the need for palliative care will overcome barriers to consultation.