PubMed Health⌕ Search

Biomedical subjects

A C Hurley

Publications and source records attributed to A C Hurley.

At least 19 recordsLinked to original sources
PubMed2000

Advance directives and dementia.

Since the 1990 Patient Self-Determination Act, increasing numbers of adults are completing advance directives (ADs), but unfortunately many adults seen in a dementia evaluation program have not completed an AD. This article discusses the issue of individuals with dementia completing ADs. Situational factors that frame this issue are the stage of dementia, degree of certainty of an individual's wishes for end-of-life care, the decision-making act required by care providers, and the degree of contentment or distress experienced by an individual with dementia. Several investigators have demonstrated successful completion of ADs by individuals with mild and moderate dementia. A nurse's knowledge about the stages of dementia is essential to helping an individual through the AD decision-making process. Nurses caring for individuals with dementia should assess decision-making context; recognize the emotions of family, friends, and staff; understand the substance and logic of AD requests; and support individuals and their decisions.

Advance Directives↗
PubMed1999

Development and testing of the Resistiveness to Care Scale.

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.

Activities of Daily Living↗
PubMed1997

Physical status and complications in patients with Alzheimer disease: implications for outcome studies.

Physical illnesses commonly coexist with dementia of the Alzheimer type (DAT). Their presence complicates DAT research because it represents a confounding variable. Furthermore, some illnesses or their symptoms also may be used as outcome measures. The conditions that frequently occur in subjects with DAT include neurological complications, intercurrent infections, and malnutrition. This review summarizes data regarding the connections among these conditions and DAT.

Alzheimer Disease↗
PubMed1996

Effect of fever-management strategy on the progression of dementia of the Alzheimer type.

This study was undertaken to determine if the progression of dementia of the Alzheimer type (DAT) is accelerated by an intercurrent infection and if management strategy (aggressive or palliative care) would modify this effect. A prospective cohort study compared the progression of DAT in patients in three 25-bed dementia special care units that provide a hospice option for care. There were three groups of patients, as follows: (a) developed a fever and received aggressive care (FAC, n = 30), (b) developed a fever and received palliative care (FPC, n = 19), and (c) did not develop a fever (NF, n = 46). The presence of a fever episode did not have an effect of its own on DAT progression. Over a 3-month period, DAT severity increased in most patients, but more so in FAC patients. Thus aggressive medical treatment of infections did not affect the underlying disease process and was associated with an acceleration of the progression of severity of DAT. Providing palliative care is recommended because it prevents patients from undergoing invasive diagnostic workups and treatments, does not accelerate the progression of DAT, and conserves scarce health care resources.

Activities of Daily Living↗
PubMed1995

Reaching consensus: the process of recommending treatment decisions for Alzheimer's patients.

Observational and interview data obtained from nurse caregivers and family members of patients with late-stage Alzheimer's disease were analyzed to explicate the nursing role in advance proxy planning. A four-phase model, Achieving Consensus: Decision Making to Determine Treatment Options for Patients with Alzheimer's Disease, was developed. Patient decline, family coping, professional development of nursing staff, and nursing unit philosophy were community characteristics found to be important antecedents to the process of reaching consensus. Achieving consensus constructs included interactive process components of patient, family, and staff adjustment, caring, and knowing. Timing and trust were influential catalysts to family and staff readiness factors for achieving consensus. Outcomes were the advice provided by staff and the family conference where treatment options were determined. Consequences included the advance proxy plan and patient care.

Adaptation, Psychological↗
PubMed1994

Measurement of severity in advanced Alzheimer's disease.

BACKGROUND: In late stages of dementia of the Alzheimer type (DAT), most scales measuring only cognitive or functional deficits lose their sensitivity to detect further disease progression. METHODS: By combining ratings of cognitive (speech, eye contact) and functional deficits (dressing, eating, ambulation) with occurrence of pathological symptoms (sleep-wake cycle disturbance, muscle rigidity/contractures), a scale was developed (BANS-S) which does not lose its sensitivity until the patient reaches a vegetative state. BANS-S was tested on three Special Care Dementia Units. RESULTS: Data from 74 patients with the clinical diagnosis of DAT indicated that BANS-S has good reliability and reproducibility. BANS-S scores correlated with scores of Mini-Mental State Examination, Katz ADL, Test for Severe Impairment, and Language Assessment. In 25 patients with the diagnosis of DAT confirmed by autopsy, BANS-S scores determined within 3 months of death correlated with density of neurofibrillary tangles in CA2 and CA3 areas of the hippocampus. CONCLUSION: BANS-S may be a useful tool for the evaluation of different treatment strategies in severe DAT and for the correlation of clinical and pathological findings.

Aged↗
PubMed1993

Palliative fever management in Alzheimer patients. quality plus fiscal responsibility.

Aggressive medical treatment of infections does not affect the progressive course of dementia of the Alzheimer type (DAT) and has limited effect on the mortality rate. Utilization of health care resources and discomfort during a fever episode were compared in three differing treatment conditions: in 18 patients in a dementia special care unit (DSCU) who received palliative management, 26 patients in a DSCU who were treated aggressively, and 17 DAT patients in traditional long-term care units who were treated aggressively. Both groups of patients in the DSCU had lower discomfort scores, lower utilization of high-cost health care resources, and higher utilization of analgesics and narcotics. A nursing model of care incorporating hospice concepts into the DSCU is suggested.

Aged↗
PubMed1993

Is hospice care appropriate for Alzheimer patients?

Hospice care can benefit late-stage Alzheimer's patients, but caregivers and families must first be aware of the complications and treatment difficulties that often accompany Alzheimer's disease. From this awareness they can determine whether and when hospice care is appropriate for their patients or loved ones.

Aged↗
PubMed1992

Assessment of discomfort in advanced Alzheimer patients.

An objective scale for measuring discomfort in noncommunicative patients with advanced Alzheimer's disease was empirically generated from the perspectives of nursing staff practicing on special care Alzheimer units and was judged to have content validity. On the basis of a pilot test, the discomfort scale was reduced to nine items. Quantifiable scoring procedures and a rater training program were developed. The scale (DS-DAT) was tested longitudinally for 6 months with 82 subjects at two sites. Psychometric properties, measurement issues, and recommendations for use in practice and research are discussed.

Alzheimer Disease↗
PubMedDate not supplied

Past, present, and future directions for Alzheimer research.

To understand the current thinking and future research directions in Alzheimer disease (AD), it is essential to examine the breadth of research into AD. AD was identified as a distinct disease process early in this century and research into its etiology and treatment has a short, but active, history. This paper emphasizes past, present, and future biomedical research for the goal of stimulating research to solve some of the unanswered questions to ultimately help the victims of Alzheimer disease. The "hot" topics today for biomedical researchers include early diagnosis, presymptomatic markers, the role of presenilins, amyloid, protein precursor processing, and continued exploration for genetic and environmental risk factors.

Aged↗
PubMedDate not supplied

Assessment of behavioral symptom management in demented individuals.

This article is intended to stimulate interdisciplinary research by social, behavioral, and biomedical researchers to solve some of the problems for persons with Alzheimer disease who suffer from behavioral symptoms. We identify the need for using conceptually based measures that have adequate reliability and validity to operationalize indicators of psychological well-being, suggest instruments to assess mood, engagement, agitation, resistiveness and comfort, and pose research questions to explore responses to active involvement (individual or group), passive involvement, lack of activity, aversive activity (related to activities of daily living), and limitation of activity (restraints) in persons with dementia. Answers to the research questions posed in this article will lead to expanded knowledge and can redefine how we give care to those in need.

Aged↗