A conceptual model and objective scale for measuring resistiveness to care in individuals with advanced dementia of the Alzheimer type (DAT) were empirically generated from the perspective of nursing staff caregivers and through observation of residents with DAT. The resistiveness to care scale (RTC-DAT) was judged to have content validity and reduced to 13 items. Quantifiable scoring procedures and methods for rating videotapes and conducting clinical observations were developed. The RTC-DAT was tested with 68 subjects at three sites. The RTC has a range of 0-156. Initial testing provided reliability estimates of .82-.87 for internal consistency and good to excellent kappas. Criterion-related validity with observed discomfort and construct validity by factor analysis support the RTC-DAT. Measurement issues and recommendations for use in research are discussed.
Seventy-three institutionalized patients suffering from probable dementia of the Alzheimer type (DAT) were surveyed for the presence of eating difficulties. Among 71 patients fed by natural means four different groups emerged: (1) patients who fed themselves (n = 17, 23.9%), (2) patients who had to be fed but posed no other eating problem (n = 13, 18.3%), (3) patients who refused food although they were able to swallow it (n = 18, 25.4%), and (4) patients who choked on liquid and/or solid food, some of whom also refused food (n = 23, 32.4%). Patients who fed themselves were in a less advanced stage of the disease than those who did not, and their average body weight was equal to the ideal weight. The remaining three groups, ie, those with different eating problems, did not differ in mean severity of DAT, and their body weights were significantly lower. The mortality rate during 2 years following the survey was similar in all four groups of patients, although tube feeding was used in only one case. The mortality rate was also similar in patients whose body weights were 20% or more below the median weight for their age, and in patients whose relative body weight was higher. The results of this study suggest that eating difficulties occur in a majority of institutionalized DAT patients, but can be managed without resorting to tube feeding.
Alzhein. er s disease (AD) causes sleep and behavioral disturbar es which may be related to abnormalities of circadian .-hythms caused by damage ofthe suprachiasmatic nuc,'eis. Exposure to bright light may compensate for this danlage by improving synchronization, timing and amplijude ofcircadian rhythms. Three case studies, presented n this paper, demonstrate the beneficial effect oflight th rapy on sleep and one ofthe cases also suggests that .ight therapy may be effective in the treatment ofagitateoJ behavior The clinical observations also suggest a net " for increased level oflighting in long term care facili its. Introdu w-tionThe cotinection between sleep and wake behaviors is dependent upon closely synchronized biological rhythms, such as boidy temperature changes and adrenal cortex secretion. The suprachiasmatic nucleus (SCN) in the hypothala mius is the key to balancing the body's rhythms of sleep-wil..ke, core body temperature, and concentration
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.