Publications by authors named "Kenneth C Pike"

38 Publications

Open-loop Audio-Visual Stimulation for sleep promotion in older adults with comorbid insomnia and osteoarthritis pain: results of a pilot randomized controlled trial.

Sleep Med 2021 06 3;82:37-42. Epub 2021 Apr 3.

Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States.

Osteoarthritis is commonly comorbid with insomnia in older adults. While cognitivebehavioral therapy for insomnia is the recommended first-line treatment for insomnia, alternative efficacious non-pharmacological options are needed. This study examined sleep and pain in 30 community-dwelling older adults with comorbid insomnia and osteoarthritis pain randomized to two weeks of 30 min of bedtime active (n = 15, mean age 66.7 ± 5.2) or placebo control (n = 15, mean age 68.9 ± 5.0) Audiovisual Stimulation (AVS). After AVS use, improvements in sleep, pain, and depression were reported for both groups but between-group comparisons were non-significant. A posthoc analysis examined the effects of AVS in the 11 subjects who reported sleep latency complaints (≥30 min). No significant group differences were found for this small sleep latency subsample; however, the pre-post effect sizes (ES) of active AVS versus placebo were greatly increased for the subsample relative to the total sample for sleep (ES = 0.41 versus 0.18 for the Insomnia Severity Index, and 0.60 versus 0.03 for the Pittsburgh Sleep Quality Index, respectively). A similar enhanced effect pattern was found for pain (ES = 0.41 versus 0.15 for the Brief Pain Inventory). Study findings suggest that the 30-min AVS program may have potential to improve sleep in older adults with sleep onset but not sleep maintenance difficulty. Despite study limitations of a small sample size and lack of follow-up, results offer valuable insights into the functionality of AVS treatment. Future research should focus on subjects with sleep onset complaints, who are most likely to receive benefit from this treatment modality.
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http://dx.doi.org/10.1016/j.sleep.2021.03.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8196909PMC
June 2021

Serotonin transporter gene polymorphisms and depressive symptoms in patients with chronic obstructive pulmonary disease.

Expert Rev Respir Med 2021 May 29;15(5):681-687. Epub 2020 Dec 29.

VA Puget Sound, University of Washington, Seattle, WA, USA.

: We examined the relationship between polymorphisms in the promoter region of the serotonin transport (SERT) gene (5-HTTLPR, short 'S' and long 'L' alleles) and in intron 2 variable number tandem repeat (STin2VNTR, 9, 10, or 12-repeat alleles) with depression or anxiety in patients with COPD.: 302 patients with moderate to severe COPD participated in SERT study. History and number of prior depressive episodes were measured using the Structured Clinical Interview for Depression; Hospital Anxiety Depression Scale (HAD) depression ≥8 or a Patient Health Questionnaire-9 (PHQ-9) >,10.: 240 (80%) male sample had a mean age of 68.0 years. Current depression was 22% (HAD) or 21% (PHQ-9), anxiety was 25% (HAD), and suicidal ideation (6%). 5-HTTLPR or STin2 VNTR genotypes were not associated with current depressive or anxiety symptoms. The mean number of prior depressive episodes was higher for patients with the 5-HTTLPR genotype S/S or S/L compared with L/L (4.4 ± 6.1; 5.3 ± 6.8; 4.0 ± 6.1, p < 0.001) and with STin2VNTR high-risk genotype (9/12 or 12/12), medium risk (9/10 or 10/12) compared to low risk (10/10) genotypes (5.1 ± 6.8; 4.9 ± 6.7; 2.7 ± 4.5, p < 0.001).: SERT 5-HTTLPR and STin2-VNTR polymorphisms were not associated with current depressive and anxiety symptoms, but the high-risk STin2-VNTR genotypes and S/L were associated with the number of prior depressive episodes.
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http://dx.doi.org/10.1080/17476348.2021.1865159DOI Listing
May 2021

Frailty in Chronic Obstructive Pulmonary Disease and Risk of Exacerbations and Hospitalizations.

Int J Chron Obstruct Pulmon Dis 2020 11;15:1967-1976. Epub 2020 Aug 11.

Department of Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.

Background: Frailty is a complex clinical syndrome associated with vulnerability to adverse health outcomes. While frailty is thought to be common in chronic obstructive pulmonary disease (COPD), the relationship between frailty and COPD-related outcomes such as risk of acute exacerbations of COPD (AE-COPD) and hospitalizations is unclear.

Purpose: To examine the association between physical frailty and risk of acute exacerbations, hospitalizations, and mortality in patients with COPD.

Methods: A longitudinal analysis of data from a cohort of 280 participants was performed. Baseline frailty measures included exhaustion, weakness, low activity, slowness, and undernutrition. Outcome measures included AE-COPD, hospitalizations, and mortality over 2 years. Negative binomial regression and Cox proportional hazard modeling were used.

Results: Sixty-two percent of the study population met criteria for pre-frail and 23% were frail. In adjusted analyses, the frailty syndrome was not associated with COPD exacerbations. However, among the individual components of the frailty syndrome, weakness measured by handgrip strength was associated with increased risk of COPD exacerbations (IRR 1.46, 95% CI 1.09-1.97). The frailty phenotype was not associated with all-cause hospitalizations but was associated with increased risk of non-COPD-related hospitalizations.

Conclusion: This longitudinal cohort study shows that a high proportion of patients with COPD are pre-frail or frail. The frailty phenotype was associated with an increased risk of non-COPD hospitalizations but not with all-cause hospitalizations or COPD exacerbations. Among the individual frailty components, low handgrip strength was associated with increased risk of COPD exacerbations over a 2-year period. Measuring handgrip strength may identify COPD patients who could benefit from programs to reduce COPD exacerbations.
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http://dx.doi.org/10.2147/COPD.S245505DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429100PMC
June 2021

Indirect effect of sleep on abdominal pain through daytime dysfunction in adults with irritable bowel syndrome.

J Clin Sleep Med 2020 10;16(10):1701-1710

Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington.

Study Objectives: Sleep deficiency, psychological distress, daytime dysfunction, and abdominal pain are common in adults with irritable bowel syndrome. Prior research on individuals with chronic pain has identified the indirect effect of sleep on pain through psychological distress or daytime dysfunction; however, this effect is less clear in irritable bowel syndrome. The purpose of this study was to examine potential indirect effects of sleep on abdominal pain symptoms simultaneously through psychological distress and daytime dysfunction in adults with irritable bowel syndrome.

Methods: Daily symptoms of nighttime sleep complaints (sleep quality and refreshment), psychological distress, daytime dysfunction (fatigue, sleepiness, and difficulty concentrating), and abdominal pain were collected in baseline assessments from 2 randomized controlled trials of 332 adults (mean age 42 years and 85% female) with irritable bowel syndrome. Structural equation modeling was used to examine the global relationships among nighttime sleep complaints, psychological distress, daytime dysfunction, and abdominal pain.

Results: The structural equation modeling analyses found a strong indirect effect of poor sleep on abdominal pain via daytime dysfunction but not psychological distress. More than 95% of the total effect of nighttime sleep complaints on abdominal pain was indirect.

Conclusions: These findings suggest that the primary impact of nighttime sleep complaints on abdominal pain is indirect. The indirect effect appears primarily through daytime dysfunction. Such understanding provides a potential avenue to optimize personalized and hybrid behavioral interventions for adults with irritable bowel syndrome through addressing daytime dysfunction and sleep behaviors. Additional study integrating symptoms with biological markers is warranted to explore the underlying mechanisms accounting for these symptoms.

Clinical Trial Registration: Registry: ClinicalTrials.gov. Name: Nursing Management of Irritable Bowel Syndrome: Improving Outcomes, Nursing Management of IBS: Improving Outcomes. URLs: https://clinicaltrials.gov/ct2/show/NCT00167635, https://clinicaltrials.gov/ct2/show/NCT00907790. Identifiers: NCT00167635, NCT00907790.
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http://dx.doi.org/10.5664/jcsm.8658DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954013PMC
October 2020

Serum IgG Levels and Risk of COPD Hospitalization: A Pooled Meta-analysis.

Chest 2020 10 19;158(4):1420-1430. Epub 2020 May 19.

Department of Medicine, University of Maryland, Baltimore, MD.

Background: Hypogammaglobulinemia (serum IgG levels < 7.0 g/L) has been associated with increased risk of COPD exacerbations but has not yet been shown to predict hospitalizations.

Research Question: To determine the relationship between hypogammaglobulinemia and the risk of hospitalization in patients with COPD.

Study Design And Methods: Serum IgG levels were measured on baseline samples from four COPD cohorts (n = 2,259): Azithromycin for Prevention of AECOPD (MACRO, n = 976); Simvastatin in the Prevention of AECOPD (STATCOPE, n = 653), Long-Term Oxygen Treatment Trial (LOTT, n = 354), and COPD Activity: Serotonin Transporter, Cytokines and Depression (CASCADE, n = 276). IgG levels were determined by immunonephelometry (MACRO; STATCOPE) or mass spectrometry (LOTT; CASCADE). The effect of hypogammaglobulinemia on COPD hospitalization risk was evaluated using cumulative incidence functions for this outcome and deaths (competing risk). Fine-Gray models were performed to obtain adjusted subdistribution hazard ratios (SHR) related to IgG levels for each study and then combined using a meta-analysis. Rates of COPD hospitalizations per person-year were compared according to IgG status.

Results: The overall frequency of hypogammaglobulinemia was 28.4%. Higher incidence estimates of COPD hospitalizations were observed among participants with low IgG levels compared with those with normal levels (Gray's test, P < .001); pooled SHR (meta-analysis) was 1.29 (95% CI, 1.06-1.56, P = .01). Among patients with prior COPD admissions (n = 757), the pooled SHR increased to 1.58 (95% CI, 1.20-2.07, P < .01). The risk of COPD admissions, however, was similar between IgG groups in patients with no prior hospitalizations: pooled SHR = 1.15 (95% CI, 0.86-1.52, P =.34). The hypogammaglobulinemia group also showed significantly higher rates of COPD hospitalizations per person-year: 0.48 ± 2.01 vs 0.29 ± 0.83, P < .001.

Interpretation: Hypogammaglobulinemia is associated with a higher risk of COPD hospital admissions.
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http://dx.doi.org/10.1016/j.chest.2020.04.058DOI Listing
October 2020

Cognition, Health, and Social Support of Formerly Homeless Older Adults in Permanent Supportive Housing.

Innov Aging 2020 1;4(1):igz049. Epub 2020 Jan 1.

Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle.

Background And Objectives: Formerly homeless older adults residing in Permanent Supportive Housing (PSH) represent an invisible subsector of two distinct, yet related populations: the homeless population and the elderly population. Little research is focused on the complex health concerns facing this aging population within the homelessness response system. Of particular concern is the identification and support of individuals with cognitive impairment and co-occurring chronic conditions. We collaborated with a leading housing services provider to develop a systematic screening system for case managers to capture the cognitive, physical, and psychosocial health of older adults served within homeless housing programs.

Research Design And Methods: PSH residents aged ≥50 years in four sites screened as being without cognitive impairment on the Mini-Cog were enrolled. A brief demographic survey and selected PROMIS measures were used to characterize participants' demographics, cognition, global physical and mental health, physical functioning, self-efficacy for social interactions, and instrumental support. PSH case managers were trained to recruit participants and collect data. PROMIS scales were scored using the Health Measures Scoring Service. Descriptive statistics, correlations, and one sample -tests were performed.

Results: Fifty-three residents (mean age = 60.8 years, range 50-76 years) participated. The majority self-identified as male and were military veterans; 60% reported having a history of two or more episodes of homelessness. All PROMIS scores were significantly ( < .05) lower than reference U.S. population means, with global mental health and cognition having the lowest scores.

Discussion And Implications: Self-reported cognitive functioning and global mental health were residents' greatest concerns. Strengthening housing case manager capacity to assess residents' cognitive and health status could increase support for older adults in PSH. It is feasible to train PSH staff to conduct structured interviews to identify resident cognitive and health needs to help support this "invisible" population to successfully age in place.
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http://dx.doi.org/10.1093/geroni/igz049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7207261PMC
January 2020

Sleep intervention for children with asthma and their parents (SKIP Study): a novel web-based shared management pilot study.

J Clin Sleep Med 2020 06;16(6):925-936

Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington.

Study Objectives: The objective of this study was to describe the feasibility, acceptability, and preliminary efficacy of a novel Sleep Intervention for Kids and Parents (SKIP). Parent and child primary sleep outcomes were total sleep time, wake after sleep onset (WASO), sleep efficiency (SE), and bedtime range.

Methods: Children 6-11 years of age with asthma and 1 parent, both with behavioral sleep disturbance, enrolled in this single-group pilot. The 8-week shared management intervention included weekly online educational modules, goal setting, and progress reporting. Feasibility was measured by the number of dyads who were eligible, enrolled, and retained. Acceptability was measured by survey and semistructured interview. Total sleep time, WASO, SE, and bedtime range were measured by actigraphy at baseline, after the intervention, and 12-week follow-up. Mixed-effects regression models were used to determine change in sleep outcomes from baseline.

Results: Thirty-three of 39 eligible dyads enrolled; of 29 dyads that started the intervention, 25 (86%) completed all study visits. SKIP was acceptable for 61% of children and 92% of parents. Compared with baseline, at follow-up, children had significantly improved WASO (-37 minutes; 95% confidence interval [CI], -44.5 to -29.7; P < .001), SE (5.4%; 95% CI, 4.2-6.5; P < .001), and bedtime range (-35.2 minutes; 95% CI, -42.9 to -27.5; P < .001). Parents also had significantly improved WASO (-13.9 minutes; 95% CI, -19.5 to -8.2; P < .001), SE (2.7%; 95% CI, 1.7-.7; P < .001), and bedtime range (-35.3 minutes; 95% CI, -51.0 to -19.7; P < .001).

Conclusions: SKIP was feasible, acceptable, and we observed improved child and parent sleep outcomes except total sleep time. Following refinements, further testing of SKIP in a controlled clinical trial is warranted. Clinical Trial Registration: Registry: ClinicalTrials.gov; Name: Sleep Intervention for Kids and Parents: A Self-Management Pilot Study; URL: https://www.clinicaltrials.gov/ct2/show/study/NCT03144531; Identifier: NCT03144531.
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http://dx.doi.org/10.5664/jcsm.8374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849662PMC
June 2020

Telephone interventions for co-morbid insomnia and osteoarthritis pain: The OsteoArthritis and Therapy for Sleep (OATS) randomized trial design.

Contemp Clin Trials 2019 12 13;87:105851. Epub 2019 Oct 13.

Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States of America.

The OsteoArthritis and Therapy for Sleep (OATS) study is a population-based randomized controlled trial of cognitive behavioral therapy for insomnia (CBTI) with four innovative methodological aims. These are to: (1) Enroll representative participants across Washington state, including those from medically underserved communities; (2) Enroll persons with persistent insomnia and chronic osteoarthritis (OA) pain; (3) Test a scalable CBT-I intervention; and (4) Evaluate patient-reported outcomes (insomnia, pain severity, fatigue, depression) and cost-effectiveness over one year. This paper describes progress towards achieving these aims. The target population was persons age 60+ who had received OA care within the Kaiser Permanente Washington (KPW) health care system. We employed a two-phase screening via mail survey and telephone follow-up, with a 3-week interval between screens to exclude persons with spontaneous improvement in sleep or pain symptoms. Participants were randomized to a 6-session telephone-delivered CBT-I intervention or a 6-session telephone education only control condition (EOC). Blinded outcome assessments (completed online or on mailed paper forms) included primary and secondary sleep and pain outcome measures and quality of life measures. We obtained healthcare utilization from administrative claims data. Intent to treat analyses, including all participants randomized when they scheduled the first telephone session, will be conducted to compare CBT-I and EOC outcomes. The trial will be the largest experimental evaluation of telephone CBT-I to date, and the first to evaluate its cost-effectiveness. Trial registration: ClinicalTrials.gov identifier: NCT02946957.
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http://dx.doi.org/10.1016/j.cct.2019.105851DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886712PMC
December 2019

A pilot study of mindful body awareness training as an adjunct to office-based medication treatment of opioid use disorder.

J Subst Abuse Treat 2020 01 23;108:123-128. Epub 2019 May 23.

Department of Medicine, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98195, USA.

The purpose of this study was to pilot-test a mind-body intervention called Mindful Awareness in Body-oriented Therapy (MABT) as an adjunct to buprenorphine for individuals with opioid use disorder (OUD). MABT, a manualized 8 week protocol, teaches interoceptive awareness skills to promote self-care and emotion regulation. A small study was designed to assess MABT recruitment and retention feasibility, and intervention acceptability, among this population. Individuals were recruited from two office-based programs providing buprenorphine treatment within a large urban community medical center. Participants were randomized to receive either treatment as usual (TAU), or TAU plus MABT. Assessments administered at baseline and 10-week follow-up included validated self-report health questionnaires and a process measure, the Multidimensional Assessment of Interoceptive Awareness, to examine interoceptive awareness skills. An additional survey and exit interview for those in the MABT study arm were administered to assess intervention satisfaction. Results showed the ability to recruit and enroll 10 participants within two-weeks, and no loss to follow-up. The MABT study group showed an increase in interoceptive awareness skills from baseline to follow-up, whereas the control group did not. Responses to the satisfaction questionnaire and exit interview were positive, indicating skills learned, satisfaction with the interventionists, and overall perceived benefit of the intervention. In summary, study results demonstrated recruitment and retention feasibility, and high intervention acceptability. This pilot study suggests preliminary feasibility of successfully implementing a larger study of MABT as an adjunct to office-based medication treatment for opioid use disorder.
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http://dx.doi.org/10.1016/j.jsat.2019.05.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6874727PMC
January 2020

Open-Loop Audiovisual Stimulation Induces Delta EEG Activity in Older Adults With Osteoarthritis Pain and Insomnia.

Biol Res Nurs 2019 05 12;21(3):307-317. Epub 2019 Mar 12.

3 School of Medicine, University of Washington, Seattle, WA, USA.

Objective: People with chronic insomnia tend to have cortical hyperarousal marked by excessive beta-/gamma-frequency brain activity during both wake and sleep. Currently, treatment options for managing hyperarousal are limited. Open-loop audiovisual stimulation (AVS) may be such a treatment. The purpose of this study was to provide a mechanistic foundation for future AVS research in sleep promotion by examining quantitative electroencephalogram (QEEG) responses to an AVS sleep-induction program.

Method: Sixteen older adults with both chronic insomnia and osteoarthritis pain were randomly assigned to either active- or placebo-control AVS. Electroencephalogram (EEG) was collected during baseline (5 min, eyes closed/resting) and throughout 30 min of AVS.

Results: Findings showed significantly elevated mean baseline gamma (35-45 Hz) power in both groups compared to an age- and gender-matched, noninsomnia normative database, supporting cortical hyperarousal. After 30 min of exposure to AVS, the active group showed significantly increased delta power compared to the placebo-control group, providing the first controlled evidence that active AVS induction increases delta QEEG activity in insomnia patients and that these changes are immediate. In the active group, brain locations that showed the most delta induction (Cz, Fp, O1, and O2) were associated with the sensory-thalamic pathway, consistent with the sensory stimulation provided by the active AVS program.

Conclusions: Findings demonstrate that delta induction, which can promote sleep, is achievable using a 30-min open-loop AVS program. The potential for AVS treatment of insomnia in the general population remains to be demonstrated in well-designed clinical trials.
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http://dx.doi.org/10.1177/1099800419833781DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6700899PMC
May 2019

Translating an Evidence-based Multicomponent Intervention for Older Adults With Dementia and Caregivers.

Gerontologist 2020 04;60(3):548-557

Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle.

Background And Objectives: Effective community-based programs to maintain health and well-being of adults with dementia are needed. This article describes the translation, implementation, and effectiveness of a multicomponent exercise plus behavioral/psychosocial intervention (Reducing Disability in Alzheimer's Disease-NorthWest [RDAD-NW]) conducted by staff in regional Area Agencies on Aging (AAAs).

Research Design And Methods: Staggered multiple baseline design was used; 10 AAAs, 20 case managers, and 255 community-residing persons with dementia (PWDs), and family caregivers were enrolled. RDAD-NW was conducted in-home over 6 weeks with aerobic/endurance, strength, and balance/flexibility exercises, dementia education, training to increase pleasant events, and activator-behavior-consequence problem-solving approach. Outcomes included case manager treatment fidelity, and caregiver/PWD physical activity, restricted activity days, physical functioning, quality of life, and affect.

Results: RDAD-NW was successfully translated and implemented by AAA agency staff through their usual service provision mechanisms. Staff responded positively and delivered the program with a high degree of fidelity. Caregiver/PWD dyads also responded favorably engaging in both exercise and behavioral/psychosocial portions of the program. A total of 207 dyads (81%) completed the intervention and 140 (55%) completed the 13-month follow-up. PWD physical activity increased significantly pre- to posttreatment (p < .001, ES = .54), and 13 months (p < .01, ES = .21). Quality of life of PWD increased significantly pre- to posttreatment (p < .001, ES = .29); caregiver depression improved pre- to posttreatment (p = .01, ES = -.18).

Discussion And Implications: RDAD-NW was successfully translated and implemented by AAA case managers and resulted in increased physical activity and improved behavioral and emotional outcomes of caregiver/PWDs. Results support continued dissemination and implementation of RDAD-NW.

Clinical Trials Registration: NCT01708304.
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http://dx.doi.org/10.1093/geront/gny122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7117621PMC
April 2020

Psychological and Autonomic Correlates of Emotion Dysregulation among Women in Substance Use Disorder Treatment.

Subst Use Misuse 2019 1;54(1):110-119. Epub 2018 Oct 1.

c Department of Psychosocial and Community Health Nursing , University of Washington , Seattle , Washington , USA.

Background: Emotion regulation is increasingly recognized as important for the prevention and treatment of substance use disorder (SUD). However, there is an identified lack of physiological indexes of emotion dysregulation in SUD treatment studies, critically needed to better understand the link between emotion regulation capacity (measured physiologically) and self-report health outcomes among individuals in SUD treatment.

Objective: To examine the association between respiratory sinus arrhythmia (RSA) and self-report health outcomes among women in SUD treatment.

Methods: This is a cross-sectional study based on baseline data from 217 women enrolled in a randomized control trial to study a mind-body intervention as an adjunct to SUD treatment. All participants were enrolled in community-based outpatient treatment. Participants were administered questionnaires to examine sample characteristics, mental health symptoms, and interoceptive awareness and mindfulness skills. RSA data was gathered as an index of emotion dysregulation. Descriptive statistics, bivariate correlations, and regression were used in the analyses.

Results: Findings highlight the extensive trauma histories, low SES, and the high symptoms of distress in this sample. RSA was only significantly correlated with interoceptive awareness after controlling for age and BMI. Measures of symptomatic distress and mindfulness were not correlated with RSA. Conclusions/Importance: Results provide the first evidence of RSA as an index of interoceptive awareness in this population. The inclusion of biomarkers such as RSA in SUD clinical studies may help identify individuals that are in need of targeted treatments that include interoceptive awareness training focused on improving emotion regulation.
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http://dx.doi.org/10.1080/10826084.2018.1508297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6379107PMC
December 2019

Exploring the Challenges that Family Caregivers Faced When Caring for Hospice Patients with Heart Failure.

J Soc Work End Life Palliat Care 2018 Apr-Sep;14(2-3):162-176. Epub 2018 Jun 1.

d Department of Family and Community Medicine , School of Medicine, University of Missouri , Columbia , Missouri , USA.

Although patients with heart disease comprise the second largest diagnostic group in hospice care, the challenges faced by family caregivers of hospice patients with heart failure are poorly understood and often go unaddressed. This study explored the challenges and needs of family caregivers of adults with advanced heart failure receiving hospice care in the home. The baseline quantitative and qualitative data from 28 family caregivers' participation in a large-scale hospice clinical trial of a problem-solving therapy intervention were analyzed. The quantitative data showed that family caregivers were mildly anxious and had worse financial and physical quality of life than their social and emotional quality of life. The qualitative data showed that caregiver challenges were related to patient care and symptom management, inadequate social support, communication issues, and financial concerns. The results provide insight to hospice social workers and researchers to develop practical tools that can be used in routine care to evaluate family caregivers' needs comprehensively.
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http://dx.doi.org/10.1080/15524256.2018.1461168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6274608PMC
December 2019

Effect of symptoms on physical performance in COPD.

Heart Lung 2018 Mar - Apr;47(2):149-156. Epub 2018 Feb 1.

VA Puget Sound Health Care Center, Seattle, WA, USA.

Background: Chronic obstructive pulmonary disease (COPD) patients experience multiple symptoms including dyspnea, anxiety, depression, and fatigue, which are highly correlated with each other. Together, those symptoms may contribute to impaired physical performance.

Objectives: The purpose of this study was to examine interrelationships among dyspnea, anxiety, depressive symptoms, and fatigue as contributing factors to physical performance in COPD.

Methods: This study used baseline data of 282 COPD patients from a longitudinal observational study to explore the relationship between depression, inflammation, and functional status. Data analyses included confirmatory factor analyses and structural equation modeling.

Results: Dyspnea, anxiety and depression had direct effects on fatigue, and both dyspnea and anxiety had direct effects on physical performance. Higher levels of dyspnea were significantly associated with impaired physical performance whereas higher levels of anxiety were significantly associated with enhanced physical performance.

Conclusion: Dyspnea was the strongest predictor of impaired physical performance in patients with COPD.
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http://dx.doi.org/10.1016/j.hrtlng.2017.12.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857230PMC
December 2018

Limbic and Basal Ganglia Neuroanatomical Correlates of Gait and Executive Function: Older Adults With Mild Cognitive Impairment and Intact Cognition.

Am J Phys Med Rehabil 2018 04;97(4):229-235

From the Department of Rehabilitation Medicine, University of Washington, Seattle, Washington (ELM, VEK); Department of Radiology, University of Washington, Seattle, Washington (KEW, TJG); Integrated Brain Imaging Center, University of Washington, Seattle, Washington (KEW, TJG); and Psychosocial and Community Health, University of Washington, Seattle, Washington (RGL, SMM, KCP, LT).

Objective: This study aimed to examine differences in spatiotemporal gait parameters between older adults with amnestic mild cognitive impairment and normal cognition and to examine limbic and basal ganglia neural correlates of gait and executive function in older adults without dementia.

Design: This was a cross-sectional study of 46 community-dwelling older adults, ages 70-95 yrs, with amnestic mild cognitive impairment (n = 23) and normal cognition (n = 23). Structural magnetic resonance imaging was used to attain volumetric measures of limbic and basal ganglia structures. Quantitative motion analysis was used to measure spatiotemporal parameters of gait. The Trail Making Test was used to assess executive function.

Results: During fast-paced walking, older adults with amnestic mild cognitive impairment demonstrated significantly slower gait speed and shorter stride length compared with older adults with normal cognition. Stride length was positively correlated with hippocampal, anterior cingulate, and nucleus accumbens volumes (P < 0.05). Executive function was positively correlated with hippocampal, anterior cingulate, and posterior cingulate volumes (P < 0.05).

Conclusions: Compared with older adults with normal cognition, those with amnestic mild cognitive impairment demonstrated slower gait speed and shorter stride length, during fast-paced walking, and lower executive function. Hippocampal and anterior cingulate volumes demonstrated moderate positive correlation with both gait and executive function, after adjusting for age.

To Claim Cme Credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) discuss gait performance and cognitive function in older adults with amnestic mild cognitive impairment versus normal cognition, (2) discuss neurocorrelates of gait and executive function in older adults without dementia, and (3) recognize the importance of assessing gait speed and cognitive function in the clinical management of older adults at risk for dementia.

Level: Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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http://dx.doi.org/10.1097/PHM.0000000000000881DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375079PMC
April 2018

Training Area Agencies on Aging Case Managers to Improve Physical Function, Mood, and Behavior in Persons With Dementia and Caregivers: Examples from the RDAD-Northwest Study.

J Gerontol Soc Work 2018 01 6;61(1):45-60. Epub 2017 Dec 6.

a Department of Psychosocial and Community Health , University of Washington , Seattle WA , USA.

The Reducing Disability in Alzheimer's Disease (RDAD) program has been shown to be an effective tool for teaching caregivers strategies to improve mood, behavior, and physical function in persons with dementia. This paper describes how RDAD has been translated and implemented for use by Area Agencies on Aging (AAA) case managers across Washington and Oregon. Modifications to the original RDAD program as part of its community translation included decreasing the number of in-person sessions while preserving all educational content; involving caregivers in exercise activities for themselves as well as acting as exercise coaches for care-receivers; and enrolling persons with cognitive impairment due to mixed etiologies. This paper describes these changes and their rationale, the challenges faced by community agencies recruiting for and delivering evidence-based programs, and illustrates the actual RDAD implementation process through several brief case examples. Case examples also illustrate how RDAD-Northwest can be useful with care-receivers with a range of cognitive impairment severity, family caregiving situations, and levels of mood and behavioral challenges.
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http://dx.doi.org/10.1080/01634372.2017.1400486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5939562PMC
January 2018

Pain Management Concerns From the Hospice Family Caregivers' Perspective.

Am J Hosp Palliat Care 2018 Apr 6;35(4):601-611. Epub 2017 Sep 6.

5 Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA.

Background: Pain management is a challenging task for family caregivers in home hospice care. However, there are limited studies that examine the challenges regarding pain management in hospice care from family caregivers' perspectives.

Objectives: To identify the challenges related to pain management faced by family caregivers in hospice care and to examine the validity of an existing framework that outlines pain management challenges for hospice family caregivers.

Design: We conducted a theory-driven, deductive content analysis of secondary data obtained from hospice family caregivers' interviews from a randomized clinical trial.

Setting/participants: We included baseline interviews of 15 hospice caregivers of patients from hospice agencies in the States of Washington. The majority of the participants were white and female caregivers. They were spouse/partner or adult child living with the patient.

Results: The study identified 5 out of the 6 major themes in the original framework and confirmed that hospice family caregivers face a variety of challenges: caregiver-centric issues, caregiver's medication skills and knowledge, communication and teamwork, organizational skill, and patient-centric issues. A couple of the subthemes in the original framework were not present in our findings. We also expanded the original framework by adding 1 subtheme and revised 2 definitions in the original framework.

Conclusion: The study provided an investigation on hospice family caregivers' difficulties in pain management. The results can inform health-care providers and researchers of family caregivers' challenges and provide insights for future designs of educational tools targeting pain management strategies, so that family caregivers can perform pain management effectively at home.
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http://dx.doi.org/10.1177/1049909117729477DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322198PMC
April 2018

Differential predictors of nighttime and daytime sleep complaints in older adults with comorbid insomnia and osteoarthritis pain.

J Psychosom Res 2017 09 1;100:22-28. Epub 2017 Jul 1.

Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.

Objectives: Osteoarthritis (OA) is extremely common in older adults, affecting 50% of people aged 65 or older, and more than half of older adults with OA complain of significantly disturbed sleep. This study compared predictors of nighttime sleep complaints and daytime sleep-related consequences as measured by the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) in older adults with comorbid OA pain and insomnia.

Methods: A secondary analysis of baseline data from a large longitudinal randomized controlled trial. Multivariate regression analyses were performed to test two sets of predictive models.

Results: 367 older adults (mean age 72.9±8.2years; female 78.5%) with OA and insomnia were included in this analysis. In Model 1, fatigue and depression predicted daytime sleep-related consequences for both ISI and PSQI. When measures of sleep and pain beliefs/attitudes were added (Model 2), fatigue, and sleep and pain beliefs/attitudes predicted nighttime sleep complaints for both ISI and PSQI; depression was no longer a significant predictor of ISI daytime consequences, but remained in the model for PSQI daytime consequences.

Conclusions: This study found both similarities and differences in factors predicting nighttime sleep complaints and daytime sleep-related consequences. Individual beliefs/attitudes about sleep and pain were stronger predictors of sleep difficulties than were depression and pain. Fatigue was the strongest and most consistent predictor associated with both nighttime sleep complaints and daytime sleep-related consequences regardless of the scale used to measure these concepts.
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http://dx.doi.org/10.1016/j.jpsychores.2017.06.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5599170PMC
September 2017

Congruence between polysomnography obstructive sleep apnea and the pediatric sleep questionnaire: fatigue and health-related quality of life in juvenile idiopathic arthritis.

Qual Life Res 2017 03 16;26(3):779-788. Epub 2016 Dec 16.

Division of Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.

Purpose: To examine the congruence between polysomnography obstructive apnea hypopnea index (OAHI) and parent-reported obstructive sleep apnea (OSA) symptoms in 6- to 11-year-old children with juvenile idiopathic arthritis (JIA) and controls; and to compare fatigue and quality of life in JIA and control children based on OAHI and OSA symptoms.

Methods: Sixty-eight children with JIA and 75 controls and a parent participated. Children underwent one night of polysomnography in a sleep laboratory. Parents completed the sleep-related breathing disorders scale-pediatric sleep questionnaire (PSQ), and both children and parents completed the Pediatric Quality of Life Generic Core Scale and the Multidimensional Fatigue Scale.

Results: In JIA, 86% who met the OAHI clinical criteria for OSA (≥1.5) were above the PSQ OSA symptom cut-off score with a sensitivity of 0.86 and a specificity of 0.28. In the control group, 63% who met the OAHI clinical criteria for OSA were above the PSQ OSA symptom cut-off score, with a sensitivity of 0.63 and a specificity of 0.42. All children above both the clinical criteria for OAHI and OSA symptom cut-off score had the most impaired quality of life and greater fatigue compared to those below both the clinical criteria for OAHI and the OSA symptom cut-off score.

Conclusion: Children who meet clinical criteria for OSA and also scored high on a parent-reported screening tool for OSA symptoms had the most impaired quality of life and more fatigue. The PSQ has potential to identify children at risk for OSA.
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http://dx.doi.org/10.1007/s11136-016-1475-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310971PMC
March 2017

Symptom profiles and inflammatory markers in moderate to severe COPD.

BMC Pulm Med 2016 12 3;16(1):173. Epub 2016 Dec 3.

University of Washington & Puget Sound Veterans Administration, Seattle, USA.

Background: Physical and psychological symptoms are the hallmark of patients' subjective perception of their illness. The purpose of this analysis was to determine if patients with COPD have distinctive symptom profiles and to examine the association of symptom profiles with systemic biomarkers of inflammation.

Methods: We conducted latent class analyses of three physical (dyspnea, fatigue, and pain) and two psychological symptoms (depression and anxiety) in 302 patients with moderate to severe COPD using baseline data from a longitudinal observational study of depression in COPD. Systemic inflammatory markers included IL1, IL8, IL10, IL12, IL13, INF, GM-CSF, TNF-α (levels >75centile was considered high); and CRP (levels >3 mg/L was considered high). Multinominal logistic regression models were used to examine the association between symptom classes and inflammation while adjusting for key socio-demographic and disease characteristics.

Results: We found that a 4-class model best fit the data: 1) low physical and psychological symptoms (26%, Low-Phys/Low-Psych), 2) low physical but moderate psychological symptoms (18%, Low-Phys/Mod Psych), 3) high physical but moderate psychological symptoms (25%, High-Phys/Mod Psych), and 4) high physical and psychological symptoms (30%, High-Phys/High Psych). Unadjusted analyses showed associations between symptom class with high levels of IL7, IL-8 (p ≤ .10) and CRP (p < .01). In the adjusted model, those with a high CRP level were less likely to be in the High-Phys/Mod-Psych class compared to the Low-Phys/Low-Psych (OR: 0.41, 95%CI 0.19, 0.90) and Low-Phys/Mod-Psych classes (OR: 0.35, 95%CI 0.16, 0.78); elevated CRP was associated with in increased odds of being in the High-Phys/High-Psych compared to the High-Phys/Mod-Psych class (OR: 2.22, 95%CI 1.08, 4.58). Younger age, having at least a college education, oxygen use and depression history were more prominent predictors of membership in the higher symptom classes.

Conclusions: Patients with COPD can be classified into four distinct symptom classes based on five commonly co-occurring physical and psychological symptoms. Systemic biomarkers of inflammation were not associated with symptom class. Additional work to test the reliability of these symptom classes, their biological drivers and their validity for prognostication and tailoring therapy in larger and more diverse samples is needed.

Trial Registration: Clinicaltrials.gov, NCT01074515 .
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http://dx.doi.org/10.1186/s12890-016-0330-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5135800PMC
December 2016

Failure to Redose Antibiotic Prophylaxis in Long Surgery Increases Risk of Surgical Site Infection.

Surg Infect (Larchmt) 2017 May/Jun;18(4):474-484. Epub 2016 Dec 2.

5 Department of Psychosocial Nursing and Community Health, School of Nursing, University of Washington , Seattle, Washington.

Background: Antibiotic prophylaxis is a key component of the prevention of surgical site infection (SSI). Failure to manage antibiotic prophylaxis effectively may increase the risk of SSI. This study aimed to examine the effects of antibiotic prophylaxis on SSI risk.

Methods: A retrospective cohort study was conducted among patients having general surgery between May 2012 and June 2015 at the University of Washington Medical Center. Peri-operative data extracted from hospital databases included patient and operation characteristics, intra-operative medication and fluid administration, and survival outcome. The effects of antibiotic prophylaxis and potential factors on SSI risk were estimated using multiple logistic regression and were expressed as risk ratios (RRs).

Results: A total of 4,078 patients were eligible for analysis. Of these, 180 had an SSI. Mortality rates within and after 30 days were 0.8% and 0.3%, respectively. Improper antibiotic redosing increased the risk of SSI (RR 4.61; 95% confidence interval [CI] 1.33-15.91). Other risk factors were in-patient status (RR 4.05; 95% CI 1.69-9.66), smoking (RR 1.63; 95% CI 1.03-2.55), emergency surgery (RR 1.97; 95% CI 1.26-3.08), colectomy (RR 3.31; 95% CI 1.19-9.23), pancreatectomy (RR 4.52; 95% CI 1.53-13.39), proctectomy (RR 5.02; 95% CI 1.72-14.67), small bowel surgery (RR 6.16; 95% CI 2.13-17.79), intra-operative blood transfusion >500 mL (RR 2.76; 95% CI 1.45-5.26), and multiple procedures (RR 1.40; 95% CI 1.01-1.95).

Conclusions: These data demonstrate that failure to redose prophylactic antibiotic during long operations increases the risk of SSI. Strengthening a collaborative surgical quality improvement program may help to eradicate this risk.
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http://dx.doi.org/10.1089/sur.2016.164DOI Listing
October 2017

Associations of cognition with physical functioning and health-related quality of life among COPD patients.

Respir Med 2016 05 10;114:46-52. Epub 2016 Mar 10.

Health Services Research & Development, Center of Innovation VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, USA; Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA.

Background: Neurocognitive impairment has been described in COPD patients, but little is known about its relationship with physical functioning and health-related quality of life (HRQL) in this chronically ill patient group.

Methods: 301 stable COPD patients completed the Trail Making Test (TMT-A: psychomotor speed and TMT-B: executive control); 198 patients completed the Memory Impairment Screen (MIS). Standardization of TMT-A and TMT-B scores to a normative population yielded classifications of normal, borderline, or impaired cognitive status. Using multivariable regression, we examined the relationship between the TMT-A, TMT-B, and MIS with physical functioning (physical activity, 6-min walk test, and grip strength) and health-related quality of life (HRQL) measured with the Chronic Respiratory Questionnaire and the SF-36.

Results: Nearly 30% of patients had either borderline or impaired cognition on the TMT-A or TMT-B. Adjusted models indicated that those with either borderline or impaired cognitive functioning had weaker grip strength (TMT-A borderline: β = -2.9, P < 0.05; TMT-B borderline: β = -3.0, P < 0.05; TMT-B impaired: β = -2.5, P < 0.05) and lower scores on the mental health component summary score (MCS-SF-36 HRQOL) measure (TMT-A impaired: β = -4.7, P < 0.01). No adjusted significant associations were found for other physical functioning measures or the other HRQL measures. Impaired memory showed a significant association only with the MCS scale.

Conclusions: Cognitive function was not associated with most standard indicators of physical function or most measures of HRQL in COPD patients. Both TMT-A and TMT-B were associated with weaker grip strength, and the TMT-A and MIS with poorer mental health.
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http://dx.doi.org/10.1016/j.rmed.2016.03.005DOI Listing
May 2016

Gender Differences in Caregiving at End of Life: Implications for Hospice Teams.

J Palliat Med 2015 Dec 20;18(12):1048-53. Epub 2015 Oct 20.

6 School of Social Work, University of Missouri , Columbia, Missouri.

Background: Researchers have identified important gender differences in the experience of caring for a family member or friend living with advanced disease; however, trends suggest that these differences may be diminishing over time in response to changing gender roles. In addition, while many studies have found caregiving experiences and outcomes to be poorer among female caregivers, noteworthy exceptions exist.

Objective: The primary aim of this exploratory study was to determine how, if at all, current day caregiving at end of life varies by gender.

Methods: We conducted a secondary analysis of data from a multisite randomized controlled trial of a family caregiving intervention performed between 2010 and 2014. We compared female and male hospice family caregivers on baseline variables using χ(2) tests for association of categorical variables and t-tests for continuous variables. Our sample included 289 family caregivers of individuals receiving services from one of two hospice agencies located in the northwestern United States. Demographic data and other categorical variables of interest were provided via caregiver self-report using an instrument created specifically for this study. Reaction to caregiving and caregiving burden were measured using the Caregiver Reaction Assessment (CRA).

Results: As it related to caregiving, females had significantly lower self-esteem and more negative impact on their schedule, health, and family support than males. No gender differences were detected with regard to the impact of caregiving on individuals' finances.

Conclusions: Despite changing social expectations, pronounced gender differences persist in caregiving at the end of life.
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http://dx.doi.org/10.1089/jpm.2015.0214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4677542PMC
December 2015

Adopting Evidence-Based Caregiver Training Programs in the Real World: Outcomes and Lessons Learned From the STAR-C Oregon Translation Study.

J Appl Gerontol 2017 05 13;36(5):519-536. Epub 2015 Apr 13.

1 University of Washington, Seattle, USA.

Objectives: This article describes the translation and evaluation of STAR-Community Consultants program (STAR-C), an evidence-based dementia caregiver training program, within the Oregon Department of Human Services.

Method: Staff from two regional Area Agencies on Aging (AAAs) were trained to implement all aspects of STAR-C, including screening, recruitment of caregiver/care-receiver dyads, and treatment delivery. Mailed assessments of caregiver depression, burden, and care-receiver mood, behavior, and quality of life were collected at pre-treatment, post-treatment, and 6-month follow-up.

Results: One hundred fifty-one dyads entered the program; 96 completed the 8-week intervention. Significant positive post-treatment effects were obtained for caregiver depression, burden, and reactivity to behavior problems, and care-receiver depression and quality of life. At 6-month follow-up, improvements in caregiver reactivity and care-receiver depression were maintained. Caregivers reported high levels of satisfaction with the program.

Discussion: STAR-C was successfully and effectively implemented by participating AAAs. Recommendations for replication, including training, recruitment, and assessment procedures are provided.
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http://dx.doi.org/10.1177/0733464815581483DOI Listing
May 2017

Unique characteristics of informal hospice cancer caregiving.

Support Care Cancer 2015 Jul 30;23(7):2121-8. Epub 2014 Dec 30.

Department of Family and Community Medicine, School of Medicine, University of Missouri, MA306 Medical Sciences Building, DC032.00, Columbia, MO, 65212, USA,

Purpose: The purpose of this study was to describe the unique characteristics of informal hospice cancer caregiving.

Methods: Researchers conducted a secondary analysis of data drawn from a randomized clinical trial of an informal hospice caregiving intervention (N = 348). Demographic characteristics and measures of the informal caregiving experience of hospice patients and their informal caregivers were compared based on the patient's diagnosis using chi-square tests for association of categorical variables and t tests for continuous variables.

Results: Informal caregivers of cancer patients differed from their non-cancer counterparts in a number of respects including patient age, caregiver age, patient residence, relationship between patient and caregiver, amount and duration of care provided, likelihood to incur out-of-pocket expenses related to patient care, caregiver problem-solving style, and impact on caregiver daily schedule. There were no statistically significant differences between cancer and non-cancer caregivers in terms of gender, race, employment status, anxiety, and quality of life.

Conclusions: While cancer and non-cancer caregivers are similar in many respects, a number of unique features characterize the informal hospice cancer caregiving experience. Attention to these unique features will allow hospice providers to tailor supportive care interventions to better address cancer caregivers' needs.
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http://dx.doi.org/10.1007/s00520-014-2570-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4449794PMC
July 2015

Memory Care and Wellness Services: Efficacy of Specialized Dementia Care in Adult Day Services.

Gerontologist 2016 Apr 10;56(2):318-25. Epub 2014 Mar 10.

Washington Department of Social and Health Services, Aging and Long-Term Support Administration, Olympia.

Purpose Of The Study: This investigation evaluated participant and caregiver outcomes of a program of specialized dementia adult day services (ADS; Memory Care and Wellness Services: MCWS).

Design And Methods: One hundred eighty-seven participant-caregiver dyads were enrolled in a quasiexperimental research investigation; 162 attended MCWS and 25 were comparison dyads that met eligibility criteria but did not have access to ADS within their communities. The objectives of this investigation were to evaluate whether MCWS improved quality of life, mood, behavior, or functional status for participants with dementia and whether caregivers experienced decreased stress, burden, or depression, compared with comparison dyads.

Results: No significant differences were seen between MCWS and comparison dyads at 3 months. However, after 6 months, MCWS participants exhibited significantly fewer depressive behaviors (p < .05) and a trend toward fewer total behavior problems (p < .10) than comparison participants, and MCWS caregivers exhibited significantly less distress over behavior problems (total behavior problems, memory problems, depressive problems, all p < .05) than comparison caregivers.

Implications: Although modest, outcomes represent a reversal of the typical direction of change in both behavior problems and caregiver distress, despite the progression of cognitive and functional impairment. Caregivers were highly satisfied with the services. The MCWS program provides a model of a community-based dementia ADS and results provide support for further development of the program.
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http://dx.doi.org/10.1093/geront/gnu012DOI Listing
April 2016

Anxiety among informal hospice caregivers: an exploratory study.

Palliat Support Care 2015 Jun 13;13(3):567-73. Epub 2014 Feb 13.

Curtis W. & Ann H. Long Department of Family and Community Medicine,University of Missouri,Columbia,Missouri.

Objective: This study examined the prevalence of clinically significant anxiety among informal hospice caregivers and identified the characteristics of caregivers who experienced anxiety of this severity.

Method: An exploratory secondary data analysis pooled from three separate studies of informal hospice caregivers (N = 433) was conducted. Researchers employed descriptive statistics to calculate anxiety prevalence and utilized logistic regression to model the associations between the covariates (i.e., caregiver characteristics) and anxiety.

Results: Overall, 31% of informal hospice caregivers reported moderate or higher levels of anxiety. Caregivers associated with the research site in the Northwest were less likely to be anxious than those in the Southeast [χ2(3, N = 433) = 7.07, p = 0.029], and employed caregivers were less likely to be anxious than unemployed caregivers (OR = 0.56, 95% CI = 0.33, 0.96). The likelihood of being anxious decreased with increasing physical quality of life (OR = 0.77, 95% CI = 0.69, 0.85), and younger female caregivers were more likely to be anxious than male caregivers and older females (OR = 0.95, CI = 0.91, 0.99).

Significance Of Results: A noteworthy number of informal hospice caregivers experience clinically significant levels of anxiety. Increased efforts to screen and address anxiety in this population are recommended.
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http://dx.doi.org/10.1017/S1478951513001193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4133335PMC
June 2015

Anxiety among informal hospice caregivers: an exploratory study.

Palliat Support Care 2015 Jun 13;13(3):567-73. Epub 2014 Feb 13.

Curtis W. & Ann H. Long Department of Family and Community Medicine,University of Missouri,Columbia,Missouri.

Objective: This study examined the prevalence of clinically significant anxiety among informal hospice caregivers and identified the characteristics of caregivers who experienced anxiety of this severity.

Method: An exploratory secondary data analysis pooled from three separate studies of informal hospice caregivers (N = 433) was conducted. Researchers employed descriptive statistics to calculate anxiety prevalence and utilized logistic regression to model the associations between the covariates (i.e., caregiver characteristics) and anxiety.

Results: Overall, 31% of informal hospice caregivers reported moderate or higher levels of anxiety. Caregivers associated with the research site in the Northwest were less likely to be anxious than those in the Southeast [χ2(3, N = 433) = 7.07, p = 0.029], and employed caregivers were less likely to be anxious than unemployed caregivers (OR = 0.56, 95% CI = 0.33, 0.96). The likelihood of being anxious decreased with increasing physical quality of life (OR = 0.77, 95% CI = 0.69, 0.85), and younger female caregivers were more likely to be anxious than male caregivers and older females (OR = 0.95, CI = 0.91, 0.99).

Significance Of Results: A noteworthy number of informal hospice caregivers experience clinically significant levels of anxiety. Increased efforts to screen and address anxiety in this population are recommended.
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http://dx.doi.org/10.1017/S1478951513001193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4133335PMC
June 2015

Development and evaluation of a sleep education program for older adults with dementia living in adult family homes.

Am J Geriatr Psychiatry 2012 Jun;20(6):494-504

Department of Psychosocial and Community Health, University of Washington, Seattle, WA 98115, USA.

Objectives: To investigate the feasibility of implementing a Sleep Education Program (SEP) for improving sleep in adult family home (AFH) residents with dementia, and the relative efficacy of SEP compared with usual care control in a pilot randomized controlled trial.

Participants: Thirty-seven AFH staff-caregivers and 47 residents with comorbid dementia and sleep disturbances.

Intervention: SEP consisted of four training sessions with staff-caregivers to develop and implement individualized resident behavioral sleep plans.

Measurements: Treatment fidelity to the SEP was assessed following the National Institutes of Health (NIH) Behavior Change Consortium model utilizing trainer observations and staff-caregiver reports. Resident sleep was assessed by wrist actigraphy at baseline, 1-month posttreatment, and 6-month follow-up. Caregiver reports of resident daytime sleepiness, depression, and disruptive behaviors were also collected.

Results: Each key area of treatment fidelity (SEP delivery, receipt, enactment) was identified, measured, and yielded significant outcomes. Staff-caregivers learned how to identify sleep scheduling, daily activity, and environmental factors that could contribute to nocturnal disturbances and developed and implemented strategies for modifying these factors. SEP decreased the frequency and disturbance level of target resident nocturnal behaviors and improved actigraphically measured sleep percent and total sleep time over the 6-month follow-up period compared with the control condition.

Conclusion: Results suggest behavioral interventions to improve sleep are feasible to implement in adult family homes and merit further investigation as a promising intervention for use with AFH residents with dementia.
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http://dx.doi.org/10.1097/JGP.0b013e318248ae79DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358539PMC
June 2012

Increasing walking and bright light exposure to improve sleep in community-dwelling persons with Alzheimer's disease: results of a randomized, controlled trial.

J Am Geriatr Soc 2011 Aug 28;59(8):1393-402. Epub 2011 Jul 28.

Department of Psychosocial and Community Health, University of Washington, Seattle, Washington, USA.

Objectives: To test the effects of walking, light exposure, and a combination intervention (walking, light, and sleep education) on the sleep of persons with Alzheimer's disease (AD).

Design: Randomized, controlled trial with blinded assessors.

Setting: Independent community living.

Participants: One hundred thirty-two people with AD and their in-home caregivers.

Interventions: Participants were randomly assigned to one of three active treatments (walking, light, combination treatment) or contact control and received three or six in-home visits.

Measurements: Primary outcomes were participant total wake time based on wrist actigraphy and caregiver ratings of participant sleep quality on the Sleep Disorders Inventory (SDI). Secondary sleep outcomes included additional actigraphic measurements of sleep percentage, number of awakenings, and total sleep time.

Results: Participants in walking (P=.05), light (P=.04), and combination treatment (P=.01) had significantly greater improvements in total wake time at posttest (effect size 0.51-0.63) than controls but no significant improvement on the SDI. Moderate effect size improvements in actigraphic sleep percentage were also observed in active treatment participants. There were no significant differences between the active treatment groups and no group differences for any sleep outcomes at 6 months. Participants with better adherence (4 d/wk) to walking and light exposure recommendations had significantly less total wake time (P=.006) and better sleep efficiency (P=.005) at posttest than those with poorer adherence.

Conclusion: Walking, light exposure, and their combination are potentially effective treatments for improving sleep in community-dwelling persons with AD, but consistent adherence to treatment recommendations is required.
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http://dx.doi.org/10.1111/j.1532-5415.2011.03519.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3158242PMC
August 2011