No abstract

Dementia is a clinical syndrome of cognitive deficits that involves both memory and functional impairments. While disruptions in cognition is a striking feature of dementia, it is also closely coupled with changes in functional and behavioral health of older adults. In this paper, we investigate the challenges of improving the automatic assessment of dementia, by better exploiting the emerging physiological sensors in conjunction with ambient sensors in a real field environment with IRB approval. We hypothesize that the cognitive health of older individuals can be estimated by tracking their daily activities and mental arousal states. We employ signal processing on wearable sensor data streams (e.g., Electrodermal Activity (EDA), Photoplethysmogram (PPG), accelerometer (ACC)) and machine learning algorithms to assess cognitive impairments and its correlation with functional health decline. To validate our approach, we quantify the score of machine learning, survey and observation based Activities of Daily Living (ADLs) and signal processing based mental arousal state, respectively for functional and behavioral health measures among 17 older adults living in a continuing care retirement community in Baltimore. We compare clinically observed scores with technology guided automated scores using both machine learning and statistical techniques.

Background Resistiveness to care is behavior which prevents or interferes with caregivers’ performing or assisting with activities of daily living and puts residents at risk for inappropriate use of antipsychotic drugs, other restraining interventions, social isolation and physical abuse. The purpose of this study was to establish the psychometric properties of a previously developed Resistiveness to Care measure. Procedures This was a descriptive study using baseline data from an ongoing randomized controlled trial testing a Function and Behavior Focused Care (FBFC) intervention. Residents were eligible to participate if they were 55 years of age or older, had a Mini-Mental State Exam (MMSE) score of 15 or less, were not enrolled in Hospice or admitted for subacute care. Descriptive information included age, race, gender, cognitive status and marital status. In addition to the Resistance to Care Scale, the Barthel Index, the Physical Activity Survey in Long Term Care (PAS-LTC) and the Cohen-Mansfield Agitation Inventory (CMAI) were completed. Psychometric testing was done using Rasch analysis and the Winsteps statistical program. Main Findings The participants were moderate to severely cognitively impaired (MMSE of 7.23) functionally dependent (Barthel Index 47.31, SD 27.59) and engaged in only 134.17 (SD=207.32) minutes of physical activity daily. Reliability was supported based on a Cronbach alpha of 0.84 and the DIF analysis as there was no difference in function of the items between male and female participants. Validity was supported as all items fit the measurement model based on INFIT and OUTFIT statistics. Conclusions The findings support the reliability and validity of the Resistiveness to Care Scale for use with older adults with dementia in nursing home settings. Future work with the measure may benefit from the addition of items that are easier to endorse with regard to resistiveness to care (shutting eyes or spitting out food may be useful additions).

This study used an ethnocultural approach to explore how cultural factors influenced ethnically diverse dementia caregivers' experiences and use of services. A modified thematic analysis of in-depth interviews with 15 caregivers, ranging in age from 50 to 75 years, including spouses, daughters, sons, cousins, and a friend, from three minority groups-African American, Hispanic, and South Korean caregivers-was conducted by a team of multi-lingual researchers. Caregiver stress was pervasive across all subgroups. Several themes emerged that were qualitatively different across groups, including knowledge about dementia, language barriers, religion and spirituality, and cultural differences in attitudes about caring and formal services. A two-pronged intervention model that includes a generic intervention to reduce caregiver stress along with a culturally targeted intervention tailored to a family's language, food preferences, religious practices, gender norms, and other values was recommended to more successfully reach and support these caregivers.

The purpose of this study was to examine factors that influence physical activity among residents in assisted living. This was a secondary data analysis using baseline data from a function-focused care intervention study including 171 residents from 4 assisted living facilities. Using structural equation modeling, we found that mood, satisfaction with staff and activities, and social support for exercise were directly associated with time spent in physical activity. Gender, cognition, depression, and comorbidities were indirectly associated with physical activity and accounted for 13% of the total variance in physical activity. Implications for future research and social work practice are presented.