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Biomedical subjects

G R Hall

Publications and source records attributed to G R Hall.

At least 19 recordsLinked to original sources
PubMed2001

Preclinical cognitive decline in late middle-aged asymptomatic apolipoprotein E-e4/4 homozygotes: a replication study.

In a previous cross-sectional study of 100 asymptomatic individuals aged 49-69, we reported age-related decline in immediate and delayed memory that was steeper in apolipoprotein E (apoE)-e4/4 homozygotes than in members of other genetic subgroups. These findings were preliminarily based upon the statistical problem of multiple comparisons. We therefore sought to replicate these findings in a new cohort. From 1998 to 2000, 80 asymptomatic residents of Maricopa County, AZ were recruited through newspaper ads. 20 apoE-e4/4 homozygotes, 20 e3/4 heterozygotes, and 40 e4 noncarriers were matched (1:1:2) by age, gender, and years of education. All had normal neurologic and psychiatric examinations, including Folstein minimental status exam (MMSE) and Hamilton depression scale, and underwent a battery of neuropsychological tests identical to those in our previous study. The groups were well-matched for age (55.9+/-5.9 years), gender (60% women), and education (15.9+/-2.2 years), and were demographically similar to our previous cohort. Complex figure test recall was lower in e3/4 heterozygotes than noncarriers, but there was no significant difference between e4/4 homozygotes and noncarriers. There were no other significant differences in mean test scores between groups, but Wechsler adult intelligence scale-revised (WAIS-R) digit span showed a significant negative correlation with age in the e4/4 homozygote group relative to e4 noncarriers (p=0.008) as we had found in our previous study. In conclusion, we found a significant negative correlation of WAIS-R digit span with age in apoE-e4/4 homozygotes relative to e4 noncarriers in two separate cohorts, possibly reflecting an age-related effect on frontal lobe function in this genetic subgroup.

Age of Onset↗
PubMed1999

A nursing intervention to decrease depression in family caregivers of persons with dementia.

The goal of this study was to evaluate a community-based psychoeducational-nursing intervention designed to teach home caregivers to manage behavioral problems of persons with Alzheimer's disease and related dementias (ADRD) using the Progressively Lowered Stress Threshold (PLST) model, and to compare this intervention with routine information and referrals for case management, community-based services, and support groups. Previous caregiver studies have overwhelmingly pointed to the adverse effects of caregiving on the caregivers' physical and mental health, and high prevalence rates of depression among caregivers of persons with ADRD have consistently been reported. Therefore, a primary aim was to evaluate the impact of the intervention on caregivers' affective responses, especially depression. Data from both the Profile of Moods States and the Geriatric Depression Rating Scale support the effectiveness of this intervention in decreasing depression among caregivers who received the experimental training. Additional analysis of factors associated with caregiver depression are also reported. The pivotal role of psychiatric nurses in the assessment and treatment of depression among caregivers of persons with ADRD is discussed.

Adaptation, Psychological↗
PubMed1999

When traditional care falls short. Caring for people with atypical presentations of cortical dementia.

1 People with chronic dementias receive care and support with programs designed for people with Alzheimer's disease, meaning a significant minority of patients will not benefit as a result of atypical or unusual presentations of cortical decline. 2 When patients have atypical presentations of dementia, nurses must recognize the unusual symptoms, assess care needs, and develop appropriate management strategies. 3 For patients with chronic dementia, individualized care planning includes knowledge of: 1) the patient's culture; 2) their past habits, activities, and preferences; 3) their remaining abilities; 4) the regions of the brain affected, histopathology, and size of the affected area; 5) the usual trajectory for the disease type; and 6) external demands. 4 Conducting research on assessment and care of people with atypical presentations of dementia is very difficult because of their rare nature and lack of recognition by health practitioners who may diagnose the patients with Alzheimer's disease.

Aged↗
PubMed1996

Caregiver training for people with Alzheimer's based on a stress threshold model.

A caregiver training protocol for Alzheimer's disease and related disorders (ADRD) is presented for dementia management based on the progressively lowered stress threshold model. The training protocol is described using criteria for a nursing intervention including: (a) characteristics of the nursing diagnosis, (b) research base for the intervention, (c) desired patient outcomes, (d) acceptability to the patient, (e) capability of the nurse, and (f) feasibility for doing the intervention. A national study is described which is currently underway to further evaluate the effects of the training protocol.

Alzheimer Disease↗
PubMed1995

Uncovering and managing denial during the research process.

This article describes experiences of geropsychiatric nurses examining the effectiveness of the Progressively Lowered Stress Threshold Model for caregivers of persons with Alzheimer's disease and related disorders, and briefly reviews the literature on coping and denial. This research project, and those of many other psychiatric nurses, is predicated on the expectation that subjects will be able to acknowledge and report to investigators their personal and intimate responses to the challenges and everyday experiences of caregiving. Clearly, the research findings will be most valid if subjects are completely open about all aspects of their experiences, no matter how painful; yet this is often an idealized expectation. Therefore, this article also explores the concerns of geropsychiatric nurse researchers attempting to balance sensitivity to the needs of subjects and the reliability and validity of the data.

Adaptation, Psychological↗
PubMed1995

Standardized care plan. Managing Alzheimer's patients at home.

1. Family-provided care of members with Alzheimer's disease and related disorders (ADRD) is complicated by the presence of secondary behavioral symptoms, such as agitation, that lead to caregiver depression, burden, and breakdown. 2. Caregiver education to manage secondary symptoms in ADRD can be simplified by using a theoretical framework of person-environment fit, providing a selection of interventions to modify the environment to reduce demand on the dwindling resources of the demented person. 3. The Progressively Lowered Stress Threshold (PLST) model identifies six areas of stress for persons with ADRD fatigue, change of caregiver, environment or routine, demands to achieve beyond capability, multiple and competing stimuli, affective response to perceived losses, and physical stressors.

Aged↗
PubMed1995

Shining through: the humor and individuality of persons with Alzheimer's disease.

1. Elders with diminished levels of cognitive functioning are capable of providing meaningful, consistent responses that illustrate individual expressions of self. 2. The demented elder's history and experiences may provide important clues to understanding his or her current behaviors, verbalizations, and perceptions. 3. Humor may be used as a therapeutic intervention for persons with dementia and as a coping strategy for caregivers.

Aged↗
PubMed1995

Managing constipation using a research-based protocol.

Constipation, a common health problem particularly for elderly and hospitalized patients, can cause abdominal pain, discomfort, gas, headaches, nausea, anorexia, a bad taste in the mouth, and potentially adds to functional loss and length of stay. As part of a quality improvement initiative, a research-based interdisciplinary protocol was developed to prevent constipation in hospitalized immobile vascular surgery patients. Using a combination of dietary fiber, increased fluid, and hygiene measures over a 3-year period, incidence of constipation was reduced from 59% to about 9%. The incidence of impaction was eliminated and requests for laxatives and enemas were reduced from 59% to about 8%.

Clinical Nursing Research↗
PubMed1994

Chronic dementia. Challenges in feeding a patient.

1. For the SDAT/MID patient, the nurse must determine food preferences and ability to eat, meet nutritional needs, and have a basic understanding of what techniques might assist professional and family caregivers with appropriate feeding techniques. 2. Ensuring adequate nutrition requires a multidisciplinary approach. Nurses must collaborate with dietitians and other health care professionals regarding food selection, feeding techniques, and environmental management that maximize nutritional outcomes. 3. There is a need for continuing research into nutritional needs and dietary interventions for dementia patients in all stages of illness and in all settings.

Aged↗
PubMed1994

Caring for people with Alzheimer's disease using the conceptual model of progressively lowered stress threshold in the clinical setting.

Care of the people with Alzheimer's disease and related disorders (ADRD) has been fraught with controversy, often resulting in competing philosophies about what constitutes the "correct" approach. Whether developing an individualized plan of care or specialized programming, it is helpful to use a conceptual framework. The Progressively Lowered Stress Threshold (PLST) conceptual model has been used extensively for planning individualized care for patients with ADRD, developing specialized environments and programming, evaluating outcomes of interventions, and serving as the theoretical framework for nursing research. This article describes use of the PLST model in a clinical setting.

Adaptation, Psychological↗