Purpose The aim of this study was to systematically review the literature on the effects of mobile health applications in older adults with dementia or Mild Cognitive Impairment (MCI) and to quantify the effect size of these interventions through meta-analysis. Methods A systematic review and meta-analysis was conducted, with a total of seven databases searched on April 18, 2023. The risk of bias was evaluated using the Revised Cochrane Risk of Bias and the Risk of Bias in Non-randomized Studies of Interventions tools. Effect sizes were calculated using Hedges’ g within a random effects model, and subgroup analyses were also performed. Results A total of 10 studies were included in the systematic review, and six studies were included in the meta-analysis. Intervention groups exhibited a statistically significant improvement in cognitive function (Hedges’ g=0.33, 95% Confidence Interval [CI]=0.09~0.56, p=.007). Subgroup analyses revealed that older adults with MCI (Hedges’ g=0.41, 95% CI=0.12~0.69, p=.006) and interventions lasting more than 4 weeks (Hedges’ g=0.47, 95% CI=0.09~0.85, p=.016) demonstrated a significant cognitive improvement. Conclusion The results of this study indicate that mobile health applications may represent a suitable approach for improving cognitive function in older adults with MCI, emphasizing the need for at least a four-week intervention. These findings underscore the potential of mobile health interventions as a practical option for cognitive improvement in the early stages of cognitive decline.
Purpose This study aimed to identify factors influencing performance of pain assessment and pain intervention for dementia patients among long-term care hospital nurses. Methods In this descriptive study, participants were 106 nurses working in seven long-term care hospitals. Data were collected from August 13 to August 30, 2019. Nurses’ performance of pain assessment and pain intervention, attitude toward dementia, empathy, and knowledge about dementia-related pain were measured through self-reported questionnaires. Results The factors influencing performance of pain assessment were a total clinical career of 5 to 9 years (β=.29, p=.013) and a total clinical career of more than 15 years (β=.31, p=.013), which together explained 15.9% of the variance in the model. The factor influencing performance of pain intervention was attitude toward dementia (β=.31, p=.018), and explained 8.7% of the variance in the model. Empathy and knowledge about dementia-related pain were not found to be significant factors in either of the models. Conclusion The study findings suggest that a specialized education program for nurses with short clinical careers should be developed. Additionally, when designing the education program, it is recommended that varied content that can induce psychological and emotional attitude changes be included, as well as knowledge-oriented content. Finally, the more effective the pain assessment for dementia patients, the more appropriate the pain intervention and its performance will be. Thus, it is necessary to provide systematic training to enhance the pain assessment skills through a case study-based approach.
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Purpose The purpose of this study was to investigate caring self-efficacy and social support, and their mediating effects on the relationship between caring burden and caring behavior in family caregivers of elderly with dementia in the community-dwelling. Methods A sample of 210 participants was used in a cross-sectional study. Data were collected from July 15th to November 22nd, 2019 through structured questionnaires and analyzed using descriptive statistics, multiple linear regression analysis, and the bootstrapping method with SPSS/WIN 25.0 and PROCESS macro program. Results The mean score for caring behavior was 3.14±0.81 (range 1~5). Caring behavior was significantly associated with caring burden (r=-.54, p<.001), caring self-efficacy (r=.68, p<.001), and social support (r=.69, p<.001). Using Baron and Kenny's approach and PROCESS macro model 4, caring behavior was found to be directly affected by caring burden (β=-.55, p<.001). Caring self-efficacy (β=-.36, p<.001) and social support (β=-.34, p<.001) were directly affected by caring burden. The partial mediating effects of caring self-efficacy (β =-.18, p=.007, 95% confidence interval -0.44~-0.14) and social support (β=-.23, p<.001, 95% confidence interval -0.38~-0.13) on the impact of caring burden on caring behavior were confirmed. Conclusion The impact of caring burden on caring behavior was mediated by caring self-efficacy and social support in family caregivers of elderly with dementia in the community-dwelling. The results suggest that caring self-efficacy and social support need to be considered in developing nursing interventions to reduce caring burden and improve caring behavior for family caregivers of elderly with dementia.
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PURPOSE The purpose of this study was to investigate the effect of Family Resilience Reinforcement Program (FRRP) for family caregivers of the elderly with dementia on the family resilience, caregiver burden, family adaptation, perceived health status and depression. METHODS FRRP was implemented for 60 minutes each time, once a week, for 8 weeks. According to 3 factors of Walsh's Family resilience theory, FRRP was organized and specified as redefining 'belief system' in 1 to 2 sessions, figuring out one's own 'organizational pattern' in 3 to 5 sessions, enhancing 'communication process' in 6 to 8 sessions. A total of 46 family caregivers were assigned into either the experimental group with FRRP or the control group. Data were collected from February 18 to April 12, 2013 at the dementia support centers, and the data of 36 participants were finally analyzed. RESULTS The experimental group reported statistically significant differences in family resilience (p=.002), caregiver burden (p=.012), family adaptation (p<.001), and perceived health status (p=.002) compared to those in the control group. No significant difference was found between the two groups in depression. CONCLUSION In the light of these results, FRRP is considered to decrease caregiver burden and to influence family resilience, family adaptation and perceived health status positively. The developed FRRP is considered to be an efficient nursing intervention for strengthening family resilience of the given population. It warrants future research expanding the range of target population to those caregivers of the patients with other chronic conditions.
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PURPOSE The purpose of this study was to investigate the levels of burden, family resilience and adaptation of caregivers of elderly patients with dementia, and further to identify factors influencing their adaptation. METHODS A cross-sectional descriptive study was designed. Data were collected from questionnaires distributed to 131 family caregivers of elderly patients who visited at the Centers for Dementia in Seoul during 2012~2013. The data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation analysis, and stepwise multiple regression. RESULTS The average age of the care giving subjects was 63.58, and 31.3% were male, and 41.2% were the spouses. Statistically significant relationships were found between burden and adaptation (r=-.38, p<.001), and between family resilience and adaptation (r=.52, p<.001), and between burden and family resilience (r=-.35, p=.001). Thirty percent of adaptation was explained by burden and family resilience. The most influencing factor to adaptation was family resilience which explained about 27% of the variance. CONCLUSION The results of the study clearly indicate that family resilience explains better than burden on adaptation of family caregivers. Thus, to develop more effective nursing intervention for family caregivers of elderly patients with dementia, it would be necessary to integrate family resilience in the programs. 27% is not that much and I wonder if we have to do more work to identify the factors that influence care giving.
PURPOSE This study was to explore family member's caregiving stress and satisfaction of care for patients with dementia in long term care facilities and day care centers. METHODS: The subjects were 129 family members of elders with dementia from ten long term care facilities and eight day care centers in Daegu and Kyungsangbukdo. Data were collected from August to October, 2007. The instruments were self administered questionnaires and included. The Family Perceptions of Caregiving Role (FPCR) and the Family Perceptions of Care Tool (FPCT) which were developed by Maas and Buckwalter (1990) and translated by Park (2002). RESULTS: Family member's care giving stress in day care centers were higher than that of long term care facilities (t=-2.89, p=.005) especially in the categories of captivity (t=-3.27, p=.001), guilty (t=-2.93, p=.004), and loss (t=-2.44, p=.016). Family member's satisfaction of care in day care centers was higher than that of long term care facilities (t=-3.21, p=.002) in the (use - categories or measures since you are referring to the instrument and delete aspects) aspects of effective management (t=-3.69, p=.000) and activity (t=-2.00, p=.045). CONCLUSION: The results of this study showed that family members' perceptions toward their care giving roles and satisfaction of care differ whether the facilities are long term care or day care centers. This study provides baseline data that could be used for improving the quality of long term care services.
PURPOSE This correlational study was to examine the relationships between dementia knowledge, attitude, self-efficacy and preventive behavior of low income middled-aged women. METHODS The subjects for this study were 125 low income middle aged women living in I city. The data were collected using the questionnaires for dementia knowledge, attitude, self-efficacy and preventive behavior. The data analysis was done by descriptive statistics, t-test, ANOVA, Pearson product moment correlation and stepwise multiple regression analysis. RESULTS The mean of dementia knowledge was 13.96 out of 20, attitude was 43.98 out of 60, self-efficacy was 54.07 out of 75 and preventive behavior was 25.98 out of 36. The positive correlations were revealed between dementia knowledge (r=.458, p=.000), attitude (r=.498, p=.000), self-efficacy (r=.573, p=.000) and preventive behavior. The influencing factors for dementia preventive behavior were self-efficacy, belief in Buddhism and attitude which accounted for 42.5% of the total variance. CONCLUSION Dementia knowledge, attitude and self-efficacy were identified as variables that correlate dementia preventive behavior. Also, self-efficacy is the most influential factor affecting dementia preventive behavior. On the basis of these results, it is necessary for nurses to consider using dementia knowledge and mode of efficacy expectation in order to improve dementia preventive behavior.
PURPOSE We aimed to describe and compare the cognitive function, anxiety, and quality of life for the demented elderly in day care centers or nursing homes. METHODS We selected 44 subjects from day care centers and 63 subjects from nursing homes by performing convenience sampling. The Korean version of Mini Mental Status Examination was used for measuring cognitive status; Rating Anxiety in Dementia, for assessing anxiety; Korean Version of Quality of Life-Alzheimer's Disease, for assessing the quality of life. The data were collected from May to June 2008 and analyzed by SPSS WIN 14.0. RESULTS 1) The cognitive function of the subjects in the day care center was higher than that of the subjects in the nursing home. Anxiety in the subjects in the nursing home was higher than that in the subjects in the day care center. 2) The cognitive function and quality of life of the subjects in the day care center showed statistically significant correlation 3) The anxiety and quality of life of the subjects in the nursing home showed statistically significant correlation. CONCLUSIONS Nursing interventions that improve the quality of life of the demented elderly should be considered and applied according to the degree of cognitive function and anxiety.
PURPOSE The purpose of the study was to describe nonverbal behaviors of nurses in communication with patients with dementia in an elderly care institution in Korea. METHODS Conversation analysis was utilized to analyze the data which were collected using video camera to capture non-verbal as well as verbal behaviors. A total of 66 episodes of everyday conversations were analyzed using seven nonverbal categories: affirmative head nodding; illustrative gestures; patient-directed eye gaze; smiling and/or laughing; forward leaning; affective touch; and instrumental touch. RESULTS Among seven categories, patient-directed eye gaze(94%) was the most frequently utilized among nurses followed by affirmative head nodding(67%) and forward leaning(67%), while smiling was the least used(32%). Affective touch was identified in 39 episodes(59%). Among them, the most frequently touched area was hand or handshaking(59%) followed by shoulder or back, arm, and face. There were wide differences among nurses in terms of using affective touch, ranging from 0% to 98%. Nonverbal behaviors were more frequently identified in effective episodes than in ineffective episodes. CONCLUSION Actively utilizing effective nonverbal behaviors may help geriatric nurses in promoting communication and in establishing rapport with patients with dementia.
PURPOSE The objectives of this study were to examine the difference between scores assigned by dementia patients and their caregivers to the patients' anxiety, depression, and quality of life. METHODS After obtaining Institutional Review Board(IRB) approval, face-to-face interview with the patients and their caregivers respectively was conducted by trained graduate-level nursing students from December 2007 to February 2008. Patients' anxiety, depression, and quality of life were measured by patients and their caregivers. The data obtained were analyzed using the SPSS/WIN 14.0 program, which was used for frequency, percentage, mean , standard deviation, t-test, and Pearson's correlation. RESULTS Significant relationships were reported between the depression rated by patients and that rated by their caregivers(r = .37, p = .019). In addition, there was no difference between the quality of life rated by patients and that rated by their caregivers(t = -7.11, p = .479). However, there was no significant relationship between the anxiety rated by patients and that rated by their caregivers(r = .21, p = .195). CONCLUSION There were no differences on level of depression and quality of life of dementia patients measured by dementia patients and caregivers, However, dementia patients' anxiety level has discrepancy between them.
PURPOSE This study is to examine how dementia day care service affects fatigue, depression and life satisfaction of caregiver. METHODS: The study was conducted using a convenient sampling method from 6 Dementia Day Care Center in Incheon. Thirty nine primary caregivers answered the questionnaires. Pre-test was done before demented elders start using the dementia day care center and post-test was done five months after. Data were analyzed by using descriptive statistics and paired t-test. RESULTS: There was a significant difference in caregivers' fatigue level after using dementia day care service(t=2.188, p=.035). Results of subcategories were as follows; There was a significant difference in caregivers' physical fatigue level(t=2.270, p=.029) and psychological fatigue level(t=2.277, p=.029) after using dementia day care service. However, there was not significant difference in caregivers' neurological fatigue level(t=1.312, p=.197). There was a significant difference in caregivers' depression level(t=3.066, p=.004) and life satisfaction(t=-2.131, p=.040) after using dementia day care service. CONCLUSION: The results indicated that dementia day care service is helpful for family with demented elders. Therefore it is necessary to expand dementia day care center in terms of its size and numbers in order to support increasing number of demented elders and their families.
PURPOSE The purpose of this study was to determine the relationship between assessed pain, functional status, and emotional status in elderly women with dementia. METHODS The method was a descriptive correlational design. Subjects were sampled from 75 elderly women with dementia who were resident in nursing home. and their pain, functional status(physical function, cognitive function), emotional status(depression, agitation) were measured. The collected data were analyzed for correlations between pain and functional status and for emotional status using the SPSS 11.0 statistical program. RESULTS The pain degree of the aged women in dementia were as follows; between 0 and 27 points, average 4.04 points, which was a possible point extent. Looking at the grades in detail items, the wry face expression was shown highest, an average of 0.84 points. The relation with cognitive function was(r=-.259, p<.025) a minus relation. And the relation with physical function was (r=.406, p<.001) a plus one. The relation with depression was (r=.462, p<.001), plus one. And (r=.592, p<.001) a plus relation was found with agitation. CONCLUSION Pain is associated with impaired functional and emotional status. Major efforts are needed to improve nursing assessment and management of pain in this cognitive impaired population.
PURPOSE The research aims to identify the roles of nurses at dementia clinics or geriatric hospitals to set their tasks. METHODS This research has been conducted through literature review and focus group methodology. The field survey has been done for 195 nurses at 36 hospitals for the aged and dementia clinics from Oct. 9 to Oct. 28, 2006. RESULTS The nurses were identified to play eight roles as clinical specialists, educators, researchers, counselors, consultants, collaborators, leaders, managers, and advocators. They were also known to implement 27 nursing tasks and 104 nursing activities. CONCLUSION The findings of this research could provide a foundation for the nursing care work as well as become a practice guideline for the nurses, at these hospitals, to implement versatile roles and tasks.
PURPOSE The objective of this study was to define the predictors of health related quality of life(HRQoL) of women caregivers of the demented elderly patients. METHODS The subjects of this study were 140 pairs of patients with dementia and their caregivers. The characteristics of dementia patients and caregivers, Barthel index and SF-36 were measured in this study. T-test, ANOVA, Pearson correlation coefficient, and stepwise multiple regression were used for data analysis. RESULTS The health related quality of life(HRQoL) score of women caregivers was 288.35+/-66.10 for norm based scoring. HRQoL of women caregivers was correlated with patients' ADL, severity of dementia, caregivers' age, burden, and family support. The major factors that affected the physical components of women caregivers of patients with dementia was the age of the caregiver, burden, and ADL which explained 36.0% of HRQoL. The main predictors of women caregivers' emotional state was the caregiver's burden. CONCLUSION Patients' support systems must be implemented to improve the physical HRQoL of caregivers. A caregivers' burden relief program needs to be prepared to increase their emotional HRQoL and further studies and efforts will be needed to evaluate those effects.
PURPOSE Behavioral symptoms in dementia (BSD) are one of the most disturbing behaviors to caregivers and a major reason for nursing home placement. Behavioral symptoms are often treated with psychotropic drugs (PD), however, the effect of such drugs for the frail elderly dementia patient is not certain because of their critical adverse effects. Theoretical model applicable to nursing practice for BSD in nursing homes, which is essential in guiding and evaluating such interventions, is absent. This article presents the process of developing a theoretical model of BSD in nursing homes. METHOD Using Walker and Avants' theory synthesis method, three behavior models and two system models were incorporated into the proposed model to provide the theoretical and analytical explanation of the relationships between PD usage, its determinants, and BSD. RESULTS Resident variables and nursing home variables related to the two focal concepts (i.e., PD usage and BSD) were identified. Resident variables include demographical characteristics such as age and gender, and dementia-compromised functions such as cognitive and functional impairment. Nursing home variables include facility characteristics such as ownership type and size, and physical and psychosocial environment. CONCLUSION The proposed model suggests that fulfillment of resident unmet needs through improvement of physical and psychosocial environment may produce better health outcomes of nursing home residents with BSD. Assessment and intervening environmental triggers of such behaviors are also suggested to be prior to the PD usage.
PURPOSE The purpose of this study was to identify the level of knowledge about dementia and to find the related factors in middle-aged adults. METHOD The research design was a descriptive study by using a constructive self-report questionnaire with 34 items. Data were collected from 397 middle-aged adults using structured questionnaire. Data analysis was done by SPSS/WIN Programs using frequency, range from minimum to maximum, percentage, mean, SD, chi-square-test, t-test, ANOVA, and Duncan's Multiple Range test. RESULTS The rate of correct answer of middle-aged adults was 68.7%, showing the mid-level of knowledge about dementia. There were significant differences according to age, education, marital status, job, income, information and information sources for dementia in middle-aged adults. CONCLUSION These results indicate that Korean middle-aged adults need more education and counseling on dementia. Further studies are needed to overcome regionalism in sampling of this study and to develop standard measuring tools for the level of knowledge about dementia.
PURPOSE The purpose of this study was to develop and evaluate e-EBPP(Evidence-based Practice Protocol) system for nursing care for patients with dementia to facilitate the best evidence-based decision in their dementia care settings. METHOD: The system was developed based on system development life cycle and software prototyping using the following 5 processes: Analysis, Planning, Developing, Program Operation, and Final Evaluation. RESULT: The system consisted of modules for evidence-based nursing and protocol, guide for developing protocol, tool for saving, revising, and deleting the protocol, interface tool among users, and tool for evaluating users' satisfaction of the system. On the main page, there were 7 menu bars that consisted of Introduction of site, EBN info, Dementia info, Evidence Based Practice Protocol, Protocol Bank, Community, and Site Link. In the operation of the system, HTML, JavaScript, and Flash were utilized and the content consisted of text content, interactive content, animation, and quiz. CONCLUSION: This system can support nurses' best and cost-effective clinical decision using sharable standardized protocols consisting of the best evidence in dementia care. In addition, it can be utilized as an e-learning program for nurses and nursing students to learn use of evidence based information.
PURPOSE The purposes of this study were to examine the effects of recreational therapy (60 minutes * 3times/week * 6weeks) on dementia behavior & affection, and activity of daily living of senile people with dementia. METHODS: The subjects were 27 senile people with dementia, 16 experimental group, 11 control group, admitted at K hospital in Chungnam province in quasi-experimental study. The recreational therapy program was developed, based on the recreational program for senile welfare made by athletics science research institute in Chungnam National University(1997). It consisted of rhythm game, ball play, and beanbag game. The data were collected through questionnaires from May 1st to June 10th 2003 and were analyzed using descriptive statistics, chi2-test, Fisher' exact test, and Man Whitney U test. RESULT: The dementia behavior and affection score was significantly different between the two groups (U=32.5, p=.005). The ADL score was significantly different between the two groups (U=12.0, p=.000). There were significant decrease in dementia behavior & affection, and improvement in ADL in the experimental group compared to the control group. CONCLUSION: Recreational therapy intervention was proved effect in decreasing dementia behavior & affection and promoting ADL of senile people with dementia. We recommended re-test in containing a communicating variable.
PURPOSE The purpose of this study was to examine the effect of use of a horticultural program on the cognitive function, activities of daily living, and hand grip strength of institutionalized dementia patients. METHOD: Twenty three study participants completed a five week protocol comprised of one week of baseline and four weeks of treatment. The study design was a one group repeated measurement study. For the first and fifth week of the study period, data was collected with 3 instruments: Korean Version of Hasegawa Dementia Scale (HDS-K), Katz's ADL index, hand grip strength. Data analysis was conducted by SPSS version 10.0. RESULTS: Total HDS-K score(p=.000), Activities of daily living(p=.013) and hand grip strength(p=.001) was significantly improved after treatment compared to the baseline. CONCLUSION: The horticultural program was effective for improving cognitive function, ADL and hand grip strength of the dementia patients. Repeated studies utilizing a control group are needed, using various durations, plants and processes, to confirm these results and to standardize the horticultural program protocol.
PURPOSE This study was to observe the effects of music therapy on the cognitive function, behavior, and emotions of elderly dementia patients, and to seek musical mediation for them. This study was conducted with patients in the Dementia Sanitarium in C City from March 13 to April 17. METHOD The design of research was a nonequivalent control group non-synchronized design and the subjects were 25 patients-15 of whom were in the experimental group with 10 in the control group.
The music therapy consisted of favorite music listening in the morning, favorite music group singing activity after lunch, and relaxing music listening after dinner. The schedule was followed 6 days a week for 2 weeks for a total of thirty-six session. The effect of music therapy was measured by MMSE-K and the behavior and emotion measuring equipment which had been derived by the researcher. The verification of the effects is that the score of cognitive function, behavior, and emotions of the experimental and the control group which were measured after the therapy had been applied was analyzed by descriptive statistics and t-test using SPSS WIN program. RESULT 1)The degree of cognitive function of the experimental group which was received the music therapy is 11.53+/-5.37 which is a little higher than the control group which is 11.20+/-6.32, but it is not significant statistically (t= .14, p= .887). The first hypothesis which had assumed the recepients would have had a higher cognitive function level than the other was rejected. 2) Behavior score of the experimental group that received the music therapy is 68.90+/-7.86 which is higher than the control group which is 66.40+/-11.13, but it is not significant statistically(t= .61, p= .548). The second hypothesis which had assumed the recepients would have had a higher behavior level than the other was rejected. 3)Emotions score of the experimental group that received the music therapy is 42.13+/-5.04 which is higher than the control group which is 35.20+/-6.12, and it is significant statistically(t=3..09, p= .009). The third hypothesis which assumed the recepients would have had a higher emotion level was supported. CONCLUSION music therapy which is composed of listening to music and group singing activity is an effective strategy for improvement of the emotions of the dementia elderly. But, the effect of music therapy on the cognitive function and behavior of elderly dementia patients is not significant statistically.
The purpose of this study was to develop and validate the scale to measure dementia patient's caregiver burden of Korea. In the first phase of the study, 15 caregivers of dementia patients were interviewed to provide narrative data from which items were developed. Initially 65 items were generated from the interview data of 15 caregivers. Content validity was judged by two separate panels of experts with 27 professionals and 30 family caregivers. These items were analyzed through the Index of Content Validity and 33 items were selected which met .80 or more of the CVI. This preliminary FCBSD-K was tested with 207 adult caregivers for reliability and construct validity including item analysis and orthogonal(Varimax) factor analysis. Eight items were deleted because of high or low item-item correlation. The result of the second factor analysis produced six factors that coincided with the conceptual framework posed for the scale developed. The six factors were labeled as 'physio social factor' 'emotional factor' 'family cultural factor' 'role obligation' 'guilt feeling' and 'financial & supportive system factor'. The alpha coefficient relating to internal consistency was .9264 for reliability. In conclusion, cultural factor is related to dementia patient's caregiver burden and FCBSD-K was useful in assessing the dementia patient's caregiver burden in Korea.
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