Background Fatigue is a symptom experienced by 40%–74% of older individuals in the United States. Despite its significance, clinicians face challenges helping individuals to manage or reduce fatigue levels. Some management issues are attributable to the ambiguity around the risk factors, consequences, and the effect of fatigue management strategies. Methods A literature review was conducted using four databases to identify themes in relation to risk factors, consequences, and management strategies from research studies about fatigue in older individuals with chronic diseases. Results Findings on fatigue risk factors, such as age, body mass index, and marital status, were contradictory. There was a positive association between fatigue and comorbidities, depression, and anxiety and a negative relationship between fatigue and physical activity, sleep, educational status, and socioeconomic status. Fatigue was perceived as a state of “feebleness” and negatively impacted individuals’ quality of life. Consequences of fatigue included tiredness, sleepiness, depression, anxiety, worse sense of purpose in life, poor self-care, and an increased β-amyloid load. Predictors of worse fatigue consequences included functional health, symptom burden, subjective health, and self-acceptance. Fatigue management strategies included physical activity, rest, sleep, maintaining normal hemoglobin levels, and acetyl- l -carnitine supplementation. Conclusion This systematic review is of value to older individuals with chronic illnesses, researchers, and clinicians who strive to improve the quality of life of individuals experiencing fatigue. To prevent undesirable consequences of fatigue, older individuals should be screened for the discussed modifiable risk factors of fatigue. The inconsistencies in the studies reviewed can guide researchers to potential research areas that require further inquiry and exploration to ground future practice on best scientific evidence

Sleep disturbance in mild cognitive impairment (MCI) is associated with progression to Alzheimer’s disease (AD), more severe AD symptoms, and worse health outcomes. The aim of this review was to examine the relationship between sleep and MCI, and the effectiveness of sleep improvement interventions for older adults with MCI or AD. An integrative review was conducted using four databases, and findings were analyzed using an iterative process. Findings from 24 studies showed that alterations in sleep increased the risk of MCI and that the sleep quality of individuals with MCI or AD was poorer than healthy controls. Changes in brain anatomy were also observed in healthy older adults with sleep disturbances. Examined interventions were shown to be effective in improving sleep. Screening for sleep disturbances in individuals with MCI/AD is crucial to mitigate neurodegenerative or neurobehavioral risks in this population.

Background Supporting human dignity is the essence of delivery of care. Dignity is one’s sense of self-value that is influenced by the perceived value attributed to the individual from others. Individuals with Alzheimer’s disease and related dementias (ADRD) are at risk of violations of their dignity, due to their diminished autonomy, the alteration in their sense of self, the loss of meaningful social roles, and their limited interactions with peers and confirmation of identity. Objectives A scoping review was conducted to explore the state of art regarding the dignity of individuals with ADRD. Methods: A search was conducted using CINAHL, PubMed, Web of Science, and PsycINFO. Relevant articles were analyzed and organized based on the themes they addressed, and a narrative description of findings was presented. Results Twenty-six articles were included in the review. Findings highlighted characteristics of care that affected the dignity of these individuals. Researchers found that care was task-centered, depersonalized, and lacked a genuine connection. Individuals with ADRD experienced embarrassment, lack of freedom, and powerlessness, which contributed to feelings of being devalued, and threatened their dignity. Studies testing interventions to enhance dignity were either inconclusive, lacked rigor, or had no lasting effect. Conclusion: The dignity of individuals with ADRD may be violated during healthcare interactions. More research is needed to objectively measure the dignity of these individuals and examine the effectiveness of interventions aimed at promoting dignity.

In the United states, 60% of adults have one chronic disease and 40% have at least two chronic diseases. Fatigue is a commonly reported symptom in individuals with chronic illnesses, the prevalence of which ranges between 40-74%. It is associated with multiple risk factors and has a tremendous impact on quality of life, social functioning, mood, motivation and cognition. Despite its high prevalence, the relationship between fatigue and chronic illness has not been well explored. Accordingly, the focus of this synthesis of literature is to explore fatigue-associated factors and their relation to chronic disease. The databases searched were CINAHL, PubMed, PsychInfo and Web of Science, where the following keywords were used: “Chronic disease” OR “Chronic illness” OR “Chronic conditions”, “Fatigue”, “Elderly” OR “Older adults” OR “Seniors” OR “Geriatrics”. The synthesis resulted in four themes: understanding the concept of fatigue, factors related to fatigue, activity and fatigue, and self-management of fatigue. There were some inconsistencies in the findings among research studies which were addressed, in addition to the strengths and weaknesses of some of the fatigue measurement scales used. This literature review integrates findings about fatigue in chronic illnesses in various aspects, in the population of individuals who are of 65 age or older. The four emerged themes are of value to individuals with similar characteristics as the selected population, as well as to health care providers and researchers who may address the inconsistent findings and provide a strong evidence for best practice.

The purpose of the current study was to establish feasibility of personal sleep monitoring devices (PSMDs) as an intervention for sleep self-management in older adults. This study followed a mixed-methods experimental design based on the World Health Organization's International Classification of Functioning, Disability, and Health, and the proposed conceptual model of symptom management in a social context. Results showed an acceptable recruitment and retention rate of participants, and acceptability of PSMDs by users. Participants were able to meaningfully interpret PSMD data as evidenced by the numeracy evaluation scores, initiate sleep goals, and share their sleep data and goals with friends or relatives. Findings support extending this research protocol to a larger sample. Future studies for sleep health self-management and personally tailored interventions using personal sleep monitoring are recommended. [ Journal of Gerontological Nursing, 47 (1), 28–34.]

Chronic sleep disturbances reduce physical and mental health and affect over 8 million people age 65 years and older in the United States. There is evidence that use of a wearable Personal Self-Monitoring Device (PSMD) may improve sleep self-management in young adult populations. Feasibility of PSMD use for older individuals has not been explored and was the goal of this study. Persons age 65 years and over with self-reported sleep disturbances were recruited in a local community and were asked to wear a commercial PSMD for a 4-week period. To assess whether such an intervention may be feasible, outcomes included consent rate, study completion rate, data download interpretation, identification of a sleep self-management goal, improved knowledge about sleep, and improved sleep. Twenty-six persons (12 males and 14 females) were recruited over 3 months, out of a total of 33 expressing interest. Mean age=72, SD=4.99. Ninety-two percent of participants completed the study and reported improved awareness of sleep patterns and identified a sleep goal. Total sleep time was M=7 hours 14 minutes, SD=40 minutes; total restful sleep time was M=4 hours 33 minutes, SD=1 hour 22 minutes. In conclusion, sleep self-management with the use of a PSMD is feasible and of interest among persons in the young-old age category (65-74 years). There is potential for the use of PSMD among older people with the goal of improved sleep self-management. Future studies for sleep health self-management and interventions using personal sleep monitoring are recommended.

PurposeThe aim of this study was to examine a fatigue model for older individuals based on the theory of unpleasant symptoms.Research DesignThe research design used was a secondary data analysis of the “Patient-Reported Outcomes Measurement Information System Profiles–Health Utilities Index” data set.MethodsMultiple regression analysis and path analyses were used to examine hypothesized model paths.ResultsA number of comorbidities, pain, sleep, depression, anxiety, education, and sensory impairment were significant predictors of fatigue. Higher fatigue scores predicted lower physical, social, and cognitive performances, as well as worse perceived health and quality of life (QOL). In addition, the identified fatigue outcomes mediated the relationship between fatigue and QOL.ConclusionsFuture research should be directed toward exploring other risk factors of fatigue and examining feedback loops depicted in the theory of unpleasant symptoms.Clinical Relevance to the Practice of Rehabilitation NursingRehabilitation nurses should closely monitor and manage the identified fatigue-influencing factors to improve older individuals’ performance, perceived health, and QOL.