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Biomedical subjects

Cornelia Beck

Publications and source records attributed to Cornelia Beck.

At least 19 recordsLinked to original sources
PubMed2006

Validation of a new symptom impact questionnaire for mild to moderate cognitive impairment.

BACKGROUND: Patient-reported outcomes assessment enhances the understanding of disease impact in a range of disorders. At mild levels of cognitive impairment the patient perspective on functioning, behavior and symptoms can be particularly valuable for syndrome characterization when clinical and neuropsychological findings are limited. We have evaluated the psychometric performance of the 55-item Patient-Reported Outcomes in Cognitive Impairment (PROCOG), a new patient-reported measure, to measure mild to moderate cognitive impairment symptoms and their impact from the perspective of patients with dementia of the Alzheimer's type (DAT) and mild cognitive impairment (MCI). METHODS: The sample of 75 DAT patients, 78 MCI patients and 33 cognitively intact control subjects (> 64 years) was recruited through medical centers in the U.SA. Validity was assessed through correlation to the Quality of Life--Alzheimer's Disease (QOL-AD) and Centers for Epidemiologic Studies--Depression Scale (CES-D) and neuropsychological assessments (WAIS subscales and MMSE). RESULTS: PROCOG scores for MCI patients were generally intermediate between DAT and control subjects. Internal consistency and test-retest reliability were acceptable. Correlations with the CES-D and QOL-AD were in the moderate to high range; correlations with the neuropsychological measures were low to moderate. CONCLUSIONS: The PROCOG demonstrated good to excellent psychometric properties among a sample of older adults with MCI and DAT as well as cognitively intact older adult control subjects and provides a method for collecting unique information on the patient experience of cognitive impairment. Subscales permit focused evaluation of domains relevant to the patient's experience of cognitive impairment.

Aged↗
PubMed2005

Effect of individualized social activity on sleep in nursing home residents with dementia.

OBJECTIVES: To test the efficacy of an individualized social activity intervention (ISAI) on decreasing daytime sleep, improving nighttime sleep, and lowering the day/night sleep ratio and to determine its cost. DESIGN: Pretest/posttest randomized with an experimental and control group. SETTING: Seven nursing homes. PARTICIPANTS: One hundred forty-seven residents with dementia. INTERVENTION: One to 2 hours of individualized social activities for 21 consecutive days. MEASUREMENTS: Twenty-four-hour sleep/wake patterns using an Actigraph. RESULTS: The ISAI group had significantly less daytime sleep (P=.001) and a lower day/night sleep ratio (P=.03) than the control group, after adjusting for baseline values. Because 40% of the sample slept 7 or more hours at night, a secondary analysis was conducted. When only those residents with a sleep efficiency of less than 50% (n=50) were included, the ISAI group (n=20) had less daytime sleep (P=.005), a lower day/night sleep ratio (P=.02), fell asleep faster (P=.03), and were awake less at night (P=.04) than the control group (n=30), after adjusting for baseline values. The weekly cost of the ISAI was roughly $70 per participant. Initial training and supply costs were $1,944. CONCLUSION: The ISAI provides an alternative to medications, without side effects.

Aged↗
PubMed2004

NOPPAIN: a nursing assistant-administered pain assessment instrument for use in dementia.

The Non-Communicative Patient's Pain Assessment Instrument (NOPPAIN) is a nursing assistant-administered instrument for assessing pain behaviors in patients with dementia. This study investigated the validity of the NOPPAIN. Twenty-one nursing assistants (NAs) with no prior training in using the NOPPAIN watched six videos, each portraying a bed-bound patient with severe dementia receiving personal care from a nursing assistant and responding with a different level of pain intensity. The NAs completed a NOPPAIN rating for each video. The NAs were also presented with each possible pair of videos and asked to identify the video showing the most pain. Results indicated the NAs were quite accurate in their ratings of the videos, providing excellent preliminary evidence on the use of the NOPPAIN for detecting pain in nursing home patients with dementia.

Adult↗
PubMed2004

Overview of Alzheimer's disease.

In conclusion, many researchers from multiple disciplines are addressing AD at many levels, ranging from prevention, to cellular alterations, to treatment modalities, and coping and care giving with the consequences of the ravages left by the disease. Although much has been learned in the last several decades of active research, much remains to be learned. In its current status, AD is a chronic disease without a cure, which provides ample opportunities for nursing management throughout the course progression.

Aged↗
PubMed2004

A conceptual model of pain assessment for noncommunicative persons with dementia.

PURPOSE: Our objectives are to present a conceptual model of the pain assessment process in persons with dementia and discuss methods for validating our model within this population. DESIGN AND METHODS: This conceptual work is based on an integrative review and current pain theory, pain assessment research in demented and nondemented populations, and research on the science of self-report. RESULTS: We present a multidimensional model of pain assessment that emphasizes the role of the external rater. Our model posits that a nociceptive stimulus leads to pain sensation, followed by pain perception, followed by the exhibition of external signs of pain by the patient, followed by an external rater's observation and interpretation of those external signs. Further, the model specifies the effects of nociceptive stimulus factors on pain sensation; patient-specific factors on pain perception; method-specific factors on external sign observation; and rater-specific factors on external sign interpretation. IMPLICATIONS: Pain assessment in persons with dementia must go beyond a unidimensional model of pain assessment. This multidimensional model also directly addresses the challenges of using external ratings to assess pain in persons with dementia. Finally, we present clinical recommendations for applying the model to pain assessment endeavors and research recommendations for evaluating models of pain in this population.

Dementia↗
PubMed2004

Care of individuals with Alzheimer's disease in the new millennium.

The incidence of Alzheimer's disease (AD), the leading form of dementia, is expected to increase exponentially in the next 50 years. The nursing and medical care of individuals diagnosed with AD, including the health-related challenges faced by all aging individuals, are discussed.

Activities of Daily Living↗
PubMed2003

Gender, kinship and caregiver burden: the case of community-dwelling memory impaired seniors.

BACKGROUND: This study examined whether there were gender and kinship (spouse, child, more distant relative) differences in caregiver burden. It further examined the constellation of gender and kinship by examining whether adult daughter caregivers experienced greater burden compared to wives, husbands, sons, and other more distant relatives. METHODS: The sample consisted of 305 family caregivers of memory-impaired individuals who were age 70 years or older and resided in non-institutional settings in Arkansas. A cross-sectional design was employed using validated measures to assess both the memory-impaired elders' and family caregivers' self-reported physical and memory status. RESULTS: After controlling for the age and health status characteristics of the memory-impaired elder, sociodemographic and health status characteristics of the family caregiver, and the caregiver coping response (measured by the sense of coherence), multiple regression analyses found kinship, but not gender differences in caregiver burden. Adult children experienced more caregiver burden than more distant relatives. There were no significant differences in caregiver burden between adult children and spouses. Adult daughters had greater caregiver burden scores compared to more distant relatives, but had comparable scores to wives, sons, and husbands. Other significant correlates of burden included caregiver personal characteristics (age and ethnicity) and the sense of coherence. CONCLUSIONS: The study discusses the practice implications of adult children and adult daughters' propensity to suffer burden when caring for their memory-impaired parents living in the community. It also discusses the relevance of caregiver personal characteristics and the sense of coherence as correlates of burden.

Adolescent↗
PubMed2002

Challenges to the use of nonpharmacologic interventions in nursing homes.

The Nursing Home Reform Act, part of the Omnibus Budget Reconciliation Act of 1987, stated that nursing homes should try nonpharmacologic interventions before resorting to pharmacologic agents when addressing problem behaviors among residents. Since that time, the use of pharmacologic agents has decreased, but there is little evidence to suggest that the use of nonpharmacologic interventions has increased. Psychosocial models describe problem behaviors as complex phenomena that require individualized strategies based on a resident's unique characteristics. Categories of intervention include social contact, behavior therapy, staff training, structured activities, environmental interventions, and a combination of therapies. This article discusses internal barriers to the use of nonpharmacologic interventions based on the Porras stream organization model: organizing arrangements, social factors, technology, and physical setting. Also, external barriers related to the regulatory, legal, and economic sectors are discussed. The authors offer recommendations for overcoming these barriers.

Aged↗
PubMed2002

Integrating health services research into nursing doctoral programs: the evolution of nursing research.

Traditionally, nursing research has focused on the effect of an intervention on selected patients without considering the influence of the system of care and its myriad characteristics. Health services research (HSR) focuses on organization and financing of health services; access to health care; quality of care; clinical evaluation and outcomes research; informatics and clinical decision making; practitioner, patient, and consumer behavior; health professions workforce; health policy formulation and analyses; and health care model and service use. Doctoral students can benefit from HSR's broad perspective if it is included in existing nursing curricula. Ultimately, HSR could help the nursing profession achieve the capacity to develop health policy and new systems of health care for the 21st century.

Education, Nursing, Graduate↗
PubMed2001

Will a healthy lifestyle help prevent Alzheimer's disease?

Alzheimer's disease (AD) appears to resemble other chronic diseases, whereby a myriad of interconnected factors, including those associated with lifestyle, are involved in disease development. In this paper, we examine accepted and proposed risk factors for AD and explore health behaviors, including diet, exercise, prevention of injury, and cognitive stimulation, that may help prevent AD. Adherence to a healthy lifestyle may directly protect against AD or may prevent diseases associated with AD, such as vascular disease and diabetes. A healthy lifestyle to prevent AD may be important throughout life rather than after disease manifestation and may be particularly relevant if other factors, such as genetic predisposition, also increase risk of AD. If changes in lifestyle can help prevent AD by reducing modifiable risk factors, this knowledge can aid individuals who wish to take action to protect themselves and their families from the disease.

Aged↗
PubMedDate not supplied

Demographic and sleep characteristics in cognitively impaired nursing home residents with and without severe sleep/wake pattern inefficiency.

This study determined the differences in demographic and sleep characteristics in cognitively impaired nursing home residents with and without severe sleep/wake pattern inefficiency. Identification of characteristics associated with severe sleep/wake pattern inefficiency will allow health care providers to make the best cost effective use of finite resources because they can target interventions towards those most likely to need them. This article reports the baseline characteristics of the total sample, compares the demographic and sleep characteristics of the subgroups with and without severe sleep/wake pattern inefficiency, and reviews related literature.

Activities of Daily Living↗
PubMedDate not supplied

Surrogate decision-making and related issues.

This article discusses the role of surrogate decision-makers for persons who are cognitively impaired and cannot give informed consent. Questions raised follow. Is surrogate consent in research analogous to proxy consent in health care? What are some issues in surrogate consent? How does the risk-benefit ratio affect the consent process? What are the investigator's responsibilities regarding surrogate consent? Issues discussed include advance directives, durable power of attorney, legally authorized representatives, substituted judgment, double informed consent, responsibilities of surrogates, and barriers to informed consent. The article ends with recommendations to clarify state and national laws, change research designs, and establish a national mechanism for reviewing promising research that is usually prohibited.

Advance Directives↗
PubMedDate not supplied

Time and economic cost of constipation care in nursing homes.

OBJECTIVE: Chronic constipation is a common disorder among residents in long-term care; yet the cost to the nursing home of constipation-related care is not known. The objective of this study was to quantify the nursing staff and supply-related cost of constipation care to nursing homes from the perspective of the nursing home. DESIGN: Prospective, observational time-and-motion design. SETTING: Two United States nursing homes. PARTICIPANTS: A total of 59 nursing home residents with chronic constipation and nursing staff providing constipation care to them. MEASUREMENTS: Actual time to complete constipation care-related tasks was measured via stopwatch by trained observers, and the number and professional level (eg, staff nurse, CNA) of staff performing each task was recorded. Frequency of constipation care task data was obtained through 60-day retrospective medical chart review for each subject. Nurse wage rate data was obtained from the Nursing Home Salary and Benefits Report, a US-based national source. Resident and nursing home descriptive information was also collected. RESULTS: The average cost per task occurrence ranged from 0.72 US dollars for enema administration to 1.74 US dollars for oral medication administration. Average nursing staff costs per subject per year were 1577 US dollars for oral medication administration, 215 US dollars for dietary supplement administration, 39 US dollars for constipation assessment, 17 US dollars for suppository administration, and 6 US dollars for enema administration. Based on estimates of frequency of occurrence, the total annual labor and supply cost per long-term care resident with constipation was 2253 US dollars. CONCLUSION: Nursing staff performance of constipation care-related tasks is time consuming and costly in the long-term care setting.

Journal Article↗