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Purpose: With the nationwide expansion of local dementia centers (LDCs) after the National Responsibility for Dementia System, the number of tailored dementia case management (TDCM) programs increased significantly, but qualitative improvement in TDCM is still a remaining task. The purpose of this study was to explore the current practice of the TDCM in LDCs and suggest directions for future program improvement. Methods: A focus group interview was conducted with seven hands-on workers who had experience in TDCM at the LDCs. Participants (mean age=40 years old) were nurses, social workers, and occupational therapists with an average of 9.1 years of working experience in TDCM. Data were analyzed using qualitative content analysis. Results: The results were summarized into three core themes and fourteen sub-themes. The three core themes were ‘Job Characteristics of TDCM’, ‘Barriers to the effective operation of TDCM’, and ‘Improvement plans for successful TDCM’. Conclusion: To establish the function and role of TDCM within the domestic dementia management system, we propose five areas for improvement: 1) Developing a standardized TDCM manual; 2) Quantitative and qualitative expansion of case manager working capacity; 3) Activating a multidisciplinary team approach; 4) Forming a collaborative network between related organizations and local community councils; 5) Active promotion of TDCM.

Purpose: This study aimed to evaluate the validity and reliability of the Korean version of the Behavioral Management Skill (K-BMS) for family caregivers of people with Alzheimer’s dementia (AD) and other types of dementia (non-AD).Methods: 258 family caregivers of people with AD and 201 family caregivers of people with non-AD were included to examine the K-BMS’s reliability and validity by psychometric tests. Item analysis, construct validity with exploratory and confirmatory factor analysis, the known-groups method, concurrent validity test with correlations testing among a visual analogue scale (VAS), single general item (SGI), and Zarit Burden Interview (ZBI), and internal consistency reliability were conducted for the psychometric tests.Results: The exploratory and confirmatory factor analysis yielded a two-factor model with 11 items. Results supported that the K-BMS was an appropriate model for both AD and non-AD groups with good convergent validity. Construct validity and reliability were established using the known-groups method and Cronbach’s ⍺. The concurrent validity was established with a VAS (AD: r=.22, p

Purpose: This study aimed to identify characteristics and preferences related to the use of virtual reality(VR) devices for the education of families of persons with dementia.Methods: Using a descriptive study design, an online survey was conducted for families of persons with dementia (N=136, mean age=48.14±10.4 years). Descriptive statistics, Pearson's x2 test, and Fisher's exact test were calculated using SPSS 25.0.Results: Most families of persons with dementia used electronic devices proficiently at least to some extent (n=117, 86%). It was found that they were willing to use the VR-based education program with a certain degree of inconvenience (n=133, 97.8%). When participating in VR-based education programs, the most preferred device was open VR (n=77, 56.6%) followed by closed VR (n=42, 30.9%). The preferred training time for all four devices was around 20 minutes. There was a statistically significant difference between proficiency in electronic device use and gender (x2=9.11, p=.045), age (x2=19.83, p=.004), and educational background (x2=18.46, p=.007), whereas only gender (x2=12.17, p=.006) was a significant factor for a willingness to be inconvenienced to get educated using VR devices. In the case of the preferred interaction method, only gender (x2=10.08, p=.033) had a statistically significant difference.Conclusion: Families of persons with dementia had a positive intention to use VR-based education programs, regardless of age and educational background, even with the inconvenience. The results of this study are expected to be used as basic data for the production of VR-based education programs in the future.

Behavioral and psychological symptoms of dementia (BPSD) are symptoms of dementia that family caregivers find difficult to manage. Competence in managing BPSD differs according to individual family caregiver. The current study investigated the competence in managing BPSD, focusing on family caregivers who were recognized as managing them well. Twenty-four Korean family caregivers (83% female, mean age = 67 years) living with persons with dementia (PWD) were interviewed. Four themes were derived from the content analysis: Entering and Looking into the World of PWD , Keeping Daily Life in Harmony With BPSD , Becoming an Expert in BPSD , and Balancing Between Caregiving and Myself . Family caregivers minimized the impact of BPSD and maintained life balance. As a result, they were able to continue a harmonious life with PWD. [ Research in Gerontological Nursing, 15 (3), 141–150.]

Purpose: This paper aimed to clarify the meaning of personhood communication with persons with dementia, by identifying its attributes.Methods: Walker and Avant’s concept analysis method was employed. A literature review was performed using salient medical and health databases such as PubMed, Embase, and CINAHL between 1988 to June 2020. The literature review employed keywords such as “personhood”, “communication”, and “dementia”.Results: Personhood communication with persons with dementia is defined as providing social interaction based on their residual capacities, with adjustments being made in light of their remaining communication abilities, attentiveness to their emotions and respect for their individuality being shown, and decision-making rights being maintained.Conclusion: At the core of personhood communication is respect for persons with dementia and the goal of enabling them to be valid members of society. Further research is needed on the development of educational programs that impart the attributes of personhood communication with persons with dementia.

Purpose: This study aimed to develop the examination objectives based on nursing competency of the Korean Nursing Licensing Examination.Methods: This is a validity study to develop the examination objectives based on nursing competency. Data were collected in December 2021. We reviewed the literature related to changing nurse roles and on the learning objectives for the Korea Medical Licensing Examination and other health personnel licensing examinations. Thereafter, we created a draft of the nursing problems list for examination objectives based on the literature review, and the content validity was evaluated by experts. A final draft of the examination objectives is presented and discussed.Results: A total of 4 domains, 12 classes, and 85 nursing problems for the Korean Nursing Liscensing Examination were developed. They included the essentials of objectives, related factors, evaluation goals, related activity statements, related clients, related settings, and specific outcomes.Conclusion: This study developed a draft of the examination objectives based on clinical competency that were related to the clinical situations of nurses and comprised appropriate test items for the licensing examination. Above results may be able to provide fundamental data for item development that reflects future nursing practices.

Objectives People with life-limiting diseases such as dementia are living longer. How to improve the quality of life of those living with dementia is an important challenge for society. Continuity maintenance in older adulthood is a psychosocial adaptation strategy by searching for preference and familiarity, making a sense of connection, and creating coherence. Continuity maintenance is a useful concept for effective dementia care, which could bring psychosocial benefits. This review investigates effective ways of continuity maintenance for people with dementia (PWD). Study design A rapid realist review (RRR) of a comprehensive range of databases was conducted. Methods Realist review methodology provides an explanatory analysis of what works for whom, in what circumstances, and is characterized by its focus on strategies/interventions, contexts, mechanisms, and outcomes. A literature search was conducted using four databases, and articles discussing potential interventions to maintain continuity in PWD were included. Data were extracted on key variables related to contextual factors, mechanisms, and outcomes. Results Four key themes emerged: (1) maintaining personal identity, (2) maintaining social identity, (3) keeping a familiar environment, and (4) sustaining daily activities. It is hypothesized that these four factors combine and interact to maintain continuity and ultimately lead to psychosocial benefits. Conclusions Maintenance of identity, environment, and activities is central to continuity for PWD. The resulting model and program theories respond to the need for a coherent approach to continuity maintenance. Using the foundations created by this RRR, nursing homes may psychosocially improve PWD through maintaining continuity.

Aim This study aimed to identify the attributes of "family caregiver competence in managing behavioral psychological symptoms of dementia". Methods Six electronic databases were searched for studies published between January 1990 and June 2017 with the key words "dementia", "behavioral psychological symptoms of dementia", "caregiver", "coping (managing)", and "competence". From the final fully reviewed 26 articles, descriptions related to family caregiver's dealing with behavioral psychological symptoms of dementia were extracted first. Then, based on Walker and Avant's concept synthesis, the concept of "family caregiver competence in managing behavioral psychological symptoms of dementia" was explored. Results Four attributes, namely "Judging", "Empathizing", "Adjusting", and "Reflecting", comprised of ten categories were identified as constituting the concept of family caregiver competence in managing the behavioral psychological symptoms of dementia. As a meta competence, "reflecting" may play a significant role in improving family caregiver competence by interacting with the other dimensions of competence in managing symptoms. Conclusions Based on the suggested conceptual model, education or training programs could be developed to improve family caregiver competence in managing behavioral psychological symptoms of dementia. To refine the attributes found in this study, field studies including observations of and interviews with family caregivers need to be conducted. Studies exploring the associations between these attributes are also of value.

Families' caring competence plays a key role in caring for the elderly with dementia. In particular, the management of the behavioural and psychological symptoms of dementia is different from the management of other symptoms of dementia. However, there is no tool for evaluating family caregiver competence for managing the behavioural and psychological symptoms of dementia.This study aimed to develop a competence scale in managing the behavioural and psychological symptoms of dementia for family caregivers and to evaluate its psychometric properties.An instrument development and cross-sectional validation study was conducted.Twenty-one local dementia centres in Seoul, Korea.A total of 460 community-dwelling family caregivers of people living with dementia (mean age = 69.82 ± 11.08, female = 78.7%, spouse = 65.7%) participated in the study.This study was conducted in two steps: (1) instrument development and (2) psychometric tests (N = 460). After item generation and the evaluation of content validity and face validity, a total of 39 preliminary items were tested. For the psychometric tests, item analysis using the corrected item-to-total correlations and construct validity with exploratory and confirmatory factor analysis were performed. Using measurement tools of the Behaviour Management Skill, a Visual Analogue Scale, and a general question of the scale developed in this study, the concurrent validity was examined by calculating Pearson's correlation coefficient. Reliability was evaluated with Cronbach's α, test reliability with the standard error of measurement, and test-retest reliability with the intraclass correlation coefficient.The exploratory and confirmatory factor analyses yielded a six-factor solution with 28 items. The six factors were 'person-centred attitude', 'introspection for improvement', 'symptom occurrence analysis', 'application of various strategies', 'awareness of symptoms' and 'caring for one's own mind and body'. The concurrent validity was established. The reliability was demonstrated to be acceptable (Cronbach's α = 0.922, ICC = 0.781).The competence scale in managing the behavioural and psychological symptoms of dementia for family caregivers was found to be a valid and reliable instrument. The scale is potentially useful for promoting better dementia care in both research and clinical practice settings by enabling the identification of needs to be improved for family caregivers in coping with dementia symptoms.

Purpose: This study was done to develop competencies and core curriculum for gerontological nursing education in programs towards a Bachelor of Science in Nursing (BSN). Methods: From June 2015 to January 2016, competencies and core curriculum from gerontological nursing education in foreign countries were analyzed using a literature review, along with an analysis of the current gerontological nursing curriculum in Korean BSN programs. Competencies and core curriculum of undergraduate nursing education for gerontological nursing were determined through expert panel discussions in the Korean Gerontological Nursing Society. Results: Data were collected from 30 BSN programs in Seoul, Kyunggido, Kangwondo, Chungchungdo, Kyungsangdo, and Jeollado. Compared with the core curriculum for gerontological nursing recommended by the National Gerontological Nursing Association, there were deficiencies in legal/ethical issues, administrative issues, nursing research in gerontological nursing, and care and service delivery. From the data and panel discussion, 13 competencies and core curriculum including 6 contents, 32 programs, and 197 learning objectives were found to be important. Conclusion: Use of the recommended curriculum from this study can address deficiencies in baccalaureate gerontological nursing education, but it is also necessary to develop textbooks based on the recommended 13 competencies and core curriculum including 6 contents, 32 programs, and 197 learning objectives.

Purpose This article aims to define the concept of maintenance of continuity in older adulthood (MCOA) and assist nurses to better understand the concept of MCOA. Methods The method by Walker and Avant was used for this concept analysis. Findings In the literature, MCOA is defined as a psychosocial adaptation strategy by searching for preference and familiarity, making a sense of connection, and creating coherence. Conclusions MCOA has potential to improve psychosocial adjustment to difficult life transitions as a coping mechanism. Implication for nursing practice Insights about MCOA in nursing may contribute to improved patient care outcomes by assisting nurses to understand the elderly's experience during age-related challenges from a life course perspective.

Aim To evaluate the nutritional status of older adults with dementia who were living in long-term care settings. Methods As a secondary analysis, this study used the data from the Nationwide Survey on Dementia Care in Korea that was conducted between December 1, 2010, and August 31, 2011, which surveyed 3472 older adults with dementia, aged ≥60 years (mean age: 81.24 years), who were residing in 248 randomly selected long-term care settings in South Korea. Twenty-three different variables that related to the participants' demographics, diseases, and functional and nutritional characteristics were selected. The nutritional status was assessed by using the Mini Nutritional Assessment (MNA). Descriptive statistics, an ANOVA, and a chi-squared test were used to analyze the data. Results The mean MNA score of the participants was 17.90. The malnutrition rate was 38.4% (n = 1333), with 54.7% (n = 1900) of the participants at risk for malnutrition. The largest population with malnutrition resided in long-term care hospitals (47.9%), followed by nursing homes (34.1%), and group homes (25.9%). Being older and female, while exhibiting higher cognitive impairment, more neuropsychiatric symptoms, higher functional dependency, and a higher number of disabilities, were associated with poor nutritional status. Conclusion The nutritional status of older adults with dementia who were living in long-term care settings in South Korea was poor and associated with multiple factors. Paying special attention to recognizing, assessing, preventing, and treating malnutrition in this population is necessary.

Purpose: The aim of this study was to evaluate the possibility for clinical use of delirium assessment tools, the Nursing Delirium Screening Scale (Nu-DESC) and the Delirium Observation Screening Scale (DOS), for postoperative neurosurgery patients. Methods: A sample of 100 elderly patients post neurosurgery was recruited from a neurosurgery ward in a university hospital located in Seoul, South Korea. Nurses (n=28) on the neurosurgery ward were asked to assess the participants using the Nu-DESC and the DOS. Based on the diagnosis of delirium made by a neuropsychiatrist, validity of the tools was evaluated. A questionnaire about ease of use of the tool was completed by the nurses. Results: As for the reliability of the tools, Cronbach's ⍺ was .79, and .95 for the Nu-DESC and the DOS, respectively. Both of the tools showed high levels of sensitivity and specificity. As for ease of use in the clinical setting, the Nu-DESC (mean=39.2±4.82) had a higher (t=2.77, p=.01) score than the DOS (mean=37.39±5.97). Conclusion: Findings of this study confirmed that both the Nu-DESC and the DOS were highly reliable and valid tools to detect delirium in postoperative older neurosurgery patients, but the Nu-DESC was easier to use.

Aims and objectives To explore the degree of eating ability in people with dementia and identify what factors affect their eating ability. Background Appropriate food consumption is important to human life. Although eating difficulties are common among people with dementia, little is known about what factors might influence their eating ability. Design Descriptive, cross-sectional study. Methods A total of 149 people with dementia residing in nursing facilities in Seoul or the Gyeonggi area of Korea were evaluated using the Korean Mini-Mental State Examination, Korean Activities of Daily Living Scale and Eating Behaviour Scale. Data were analysed using descriptive statistics, one-way analysis of variance, Pearson correlation coefficient and multiple regression analysis. Results The participants showed a moderate level of dependency with respect to eating ability and were most dependent on the use of utensils. There were significant differences in eating ability according to general characteristics such as duration of residence, duration of illness, degree of visual impairment, eating place, and diet type. The eating ability of the participants was significantly correlated with cognitive function and physical function. Cognitive function, physical function, duration of illness, eating place (living room or dining room), and diet type (soft or liquid) significantly predicted eating ability in people with dementia. Conclusions The findings of this study suggest that it is necessary to thoroughly assess the eating ability of people with dementia and to develop appropriate training programs to maintain or improve their remaining eating ability. The creation of a pleasurable physical and social environment for eating might also be helpful. Relevance to clinical practice These findings would be able to serve a useful basis in the development of materials for nursing intervention programs for people with dementia during mealtimes by improving the techniques and care qualities of nursing caregivers.

To evaluate the nutritional status of older adults with dementia who were living in long-term care settings.As a secondary analysis, this study used the data from the Nationwide Survey on Dementia Care in Korea that was conducted between December 1, 2010, and August 31, 2011, which surveyed 3472 older adults with dementia, aged ≥60 years (mean age: 81.24 years), who were residing in 248 randomly selected long-term care settings in South Korea. Twenty-three different variables that related to the participants' demographics, diseases, and functional and nutritional characteristics were selected. The nutritional status was assessed by using the Mini Nutritional Assessment (MNA). Descriptive statistics, an ANOVA, and a chi-squared test were used to analyze the data.The mean MNA score of the participants was 17.90. The malnutrition rate was 38.4% (n = 1333), with 54.7% (n = 1900) of the participants at risk for malnutrition. The largest population with malnutrition resided in long-term care hospitals (47.9%), followed by nursing homes (34.1%), and group homes (25.9%). Being older and female, while exhibiting higher cognitive impairment, more neuropsychiatric symptoms, higher functional dependency, and a higher number of disabilities, were associated with poor nutritional status.The nutritional status of older adults with dementia who were living in long-term care settings in South Korea was poor and associated with multiple factors. Paying special attention to recognizing, assessing, preventing, and treating malnutrition in this population is necessary.

Purpose The aim of this study was to determine the effect of domain-specific life satisfaction on the risk of depressive symptoms in late adulthood and old age. Methods A cross-sectional descriptive survey was conducted using stratified data from the Korean Longitudinal Study of Aging (KLoSA). The respondents completed the Korean version CES-D and domain-specific life satisfaction. Results In both groups, satisfaction with health and economic status were significant predictors of depressive symptoms. In the old age group, depressive symptoms were also predicted by satisfaction with the relationships with one's spouse and with one's children. Conclusion Life satisfaction was a crucial predictive factor for depressive symptoms in late adulthood and old age.

The purpose of this study was to identify family caregivers’ experiences in managing the behavioral and psychological symptoms of dementia (BPSD) with particular focus on their interpersonal interactions with patient with dementia. Data were collected through focus-group interviews with 15 family caregivers from three local dementia-support centers located in Seoul. Data were analyzed using content analysis. Three main themes were identified through data analysis: triggers of BPSD, family caregiver’s actions in response to BPSD and patient’s reactions, and the effect of BPSD on family caregivers. Findings demonstrated that BPSD depended on the complex interplay of family caregivers and patients, including their interaction style. This information could help nurses when counseling and educating family caregivers to improve or modify their attitudes and approaches to behavioral symptoms of patients.

This study aimed to explore relationships of premorbid personality and behavioral responses to stress with wandering behavior of persons with dementia in long-term care facilities. Ambulatory residents ( N = 108) with dementia were selected from 21 long-term care facilities. The Mini-Mental State Examination, the NEO Five-Factor Personality Inventory, the Behavioral Responses to Stress Scale, and the Revised Algase Wandering Scale—Nursing Home Version (RAWS-NH) were used as data collection tools. When the MMSE and age were controlled, regression analyses revealed that premorbid extroversion and premorbid negative verbalization stress response were significant negative predictors for the overall RAWS-NH and some subscales.

The purpose of the study was to test a staged causal model as a theoretical base to explain the burden of family caregivers of community-dwelling self-ambulatory persons with dementia (PWDs) in Korea. The model contained three stages including antecedents (Stage 1), behavior (Stage 2), and outcome (Stage 3). The antecedents were variables of the PWDs (e.g., cognitive impairment and activities of daily living [ADL] dependency of the PWDs) and caregiver variables (e.g., age, gender of caregiver, and the relationship of caregiver to PWD). Stage 2 focused on wandering behavior. In Stage 3, the outcome variable was caregiver burden. A total of 83 noninstitutionalized, community-dwelling elders with dementia and their family caregivers participated. The instruments used in this study were the Korean version of Mini Mental State Examination, K-PADL (Korean-Physical Activities of Daily Living), Korean-Revised Algase Wandering Scale-Community Version, and K-CWOB (Caregiver Worry, Overload, and Role Captivity Scale-Korean) Korean versions of standardized Western instruments. Results indicate that cognitive impairment and ADL dependency had an indirect influence on caregiver burden through wandering behavior. In addition, caregiver age had a direct impact on caregiver burden. The findings of this study suggest that further refinement of the underlying model is warranted.

Purpose: To determine the predictors of agreement with writing advance directives (ADs) among older Korean adults. Design: This was a secondary analysis of a study that compared the differences in knowledge, experience, and preference about ADs between community and facility-dwelling older adults. Data were collected through self-reported questionnaires. In this study, after 25 cases were excluded from the original sample (N = 181) for incomplete data, a sample of 156 was analyzed using multiple logistic regression analysis. Results: Older adults’ experiences with having thought about life-sustaining treatments, odds ratio (OR) = 4.02, 95% confidence interval (CI) [1.56, 10.38], agreements with legalization of ADs, OR = 4.68, 95% CI [1.69, 12.96], and wishes to obtain information about medical status, OR = 3.78, 95% CI [1.66, 8.64], were identified as the predictors of agreement with writing ADs. Implications for Practice: Discussion channels and educational programs about ADs should be developed for olde...

Behavioral and psychological symptoms of dementia (BPSD) are sources of psychological distress for caregivers who take care of people with dementia. The purpose of this study was to examine the association between BPSD and the burden on formal caregivers of nursing homes in South Korea. Results showed that the total severity score of BPSD had a statistically significant positive correlation with the total distress score. Agitation/Aggression was the most distressing symptom for registered nurses and care workers. These findings suggest that there is a need for improved treatments for BPSD, to help mitigate its burden on formal caregivers.

Wandering, a challenging behavior associated with dementia, affects many residents of long-term care facilities and can result in elopement, injury, and death. Most studies of wandering have taken place in nursing homes (NH). Expansion of the long-term care sector over the last 2 decades has resulted in a surge in options such as assisted living facilities (ALF). This study compared wandering behavior of residents (N= 108) in 21 long-term care facilities (15 NH, 6 ALF). Staff used the Revised Algase Wandering Scale-Nursing Home Version (RAWS-NH) to quantify wandering. While there were some differences in demographic variables (i.e., race, motor ability) between NH and ALF participants, no significant differences were found in either RAWS-NH overall or any of the 6 subscale scores. This suggests that the expression of wandering is similar in long-term care residents across all dimensions of the RAWS-NH regardless of facility type. Findings are of concern for those involved in the safe management and protection of residents at risk for wandering, particularly in long-term care facilities with underregulated staffing and training requirements.

The purpose of this multiple case design study (n = 3) with an embedded experiment was to determine the effect of the systematic use of a behavioral nursing intervention on the mealtime behavior of nursing home residents with probable Alzheimer's disease. It was hypothesized that the systematic behavioral intervention would increase time spent seated during the meal and proportion of food consumed while decreasing the frequency of table-leaving events during mealtime. The intervention was designed to impact the proximal factors of physiological need and social interaction from the Need-Driven Behavior Model. Results demonstrate that all cases were able to sit at the table longer and eat more food during the intervention, while body weight for all cases remained stable throughout the study. Two of the three cases left the table fewer times during the intervention. There were no statistically significant changes in proportion of fluids consumed in any case.

This study examined the psychometric properties of an expanded version of the Algase Wandering Scale (Version 2) (AWS-V2) in a cross-cultural sample. A cross-sectional survey design was used. Study subjects were 172 English-speaking persons with dementia (PWD) from long-term care facilities in the USA, Canada, and Australia. Two or more facility staff rated each subject on the AWS-V2. Demographic and cognitive data (MMSE) were also obtained. Staff provided information on their own knowledge of the subject and of dementia. Separate factor analyses on data from two samples of raters each explained greater than 66% of the variance in AWS-V2 scores and validated four (persistent walking, navigational deficit, eloping behavior, and shadowing) of five factors in the original scale. Items added to create the AWS-V2 strengthened the shadowing subscale, failed to improve the routinized walking subscale, and added a factor, attention shifting as compared to the original AWS. Evidence for validity was found in significant correlations and ANOVAs between the AWS-V2 and most subscales with a single item indicator of wandering and with the MMSE. Evidence of reliability was shown by internal consistency of the AWS-V2 (0.87, 0.88) and its subscales (range 0.88 to 0.66), with Kappa for individual items (17 of 27 greater than 0.4), and ANOVAs comparing ratings across rater groups (nurses, nurse aids, and other staff). Analyses support validity and reliability of the AWS-V2 overall and for persistent walking, spatial disorientation, and eloping behavior subscales. The AWS-V2 and its subscales are an appropriate way to measure wandering as conceptualized within the Need-driven Dementia-compromised Behavior Model in studies of English-speaking subjects. Suggestions for further strengthening the scale and for extending its use to clinical applications are described.

The aim of this study was to evaluate the relationship of wandering and wayfinding and validate the Revised Algase Wandering Scale – Community Version (RAWS-CV) using a community sample of persons with dementia. Adult caregivers (n = 266) completed the RAWS-CV and the Wayfinding Effectiveness Scale (WES). Four aspects of wandering were confirmed (persistent walking, repetitive walking, spatial disorientation, eloping behavior), and two new aspects were also validated (negative outcomes, mealtime impulsivity). The spatial disorientation subscale of the RAWS-CV had significant (p < 0.01) negative correlations with all WES subscales. The global strategies and simple wayfinding goals subscales of the WES correlated significantly with all RAWS-CV subscales except repetitive walking and mealtime impulsivity. ANOVAs comparing wayfinding at 4 levels of wandering revealed differences only for the simple wayfinding goals subscale. Studies examining the relationship of wandering and wayfinding at various levels of cognitive impairment are suggested to further understand these phenomena.

Objective: Because studies of crowding in long-term care settings are lacking, the authors sought to: (1) generate initial estimates of crowding in nursing homes and assisted living facilities; and (2) evaluate two operational approaches to its measurement. Background: Reactions to density and proximity are complex. Greater density intensifies people's reaction to a situation in the direction (positive or negative) that they would react if the situation were to occur under less dense conditions. People with dementia are especially reactive to the environment. Methods: Using a cross-sectional correlational design in nursing homes and assisted living facilities involving 185 participants, multiple observations ( N = 6,455) of crowding and other environmental variables were made. Crowding, location, and sound were measured three times per observation; ambiance was measured once. Data analyses consisted of descriptive statistics, t-tests, and one-way analysis of variance. Results: Crowding estimates were higher for nursing homes and in dining and activity rooms. Crowding also varied across settings and locations by time of day. Overall, the interaction of location and time affected crowding significantly ( N = 5,559, df [47, 511], F = 105.69, p < .0001); effects were greater within location-by-hour than between location-by-hour, but the effect explained slightly less variance in Long-Term Care Crowding Index (LTC-CI) estimates (47.41%) than location alone. Crowding had small, direct, and highly significant correlations with sound and with the engaging subscale for ambiance; a similar, though inverse, correlation was seen with the soothing subscale for ambiance. Conclusions: Crowding fluctuates consistent with routine activities such as meals in long-term care settings. Furthermore, a relationship between crowding and other physical characteristics of the environment was found. The LTC-CI is likely to be more sensitive than simple people counts when seeking to evaluate the effects of crowding on the behavior of elders—particularly those with dementia—in long-term care settings. aging in place.

Aim. To explore the relationship between wandering behaviour and familiar environment in community-residing persons with dementia in Korea. Background. Numerous non-pharmacological interventions have been developed to decrease behavioural symptoms and to increase the quality of life among persons with dementia. Although the concept of familiarity is very important and environmental interventions using the concept should have been developed for persons with dementia, no study examining even the direct relationship between familiar environment and wandering has yet been published. Design. A descriptive, cross-sectional survey design. Methods. A convenience sample was gathered of 77 non-institutionalised, community-dwelling persons with dementia and their family caregivers in Seoul and Wonju, South Korea. Descriptive statics, Pearson’s correlations, t-tests, and multiple regressions were used in the data analysis. Results. The mean age of persons with dementia was 76·9 years (SD 8·0) and their mean cognitive level score using the Mini-Mental State Examination was 13·51 (SD 6·10). Most persons with dementia (71·4%) had been diagnosed with known types of dementia such as Alzheimer’s disease, multiple infarct dementia, mixed type or Parkinson’s disease with dementia. A familiar feeling with the environment was associated with cognitive impairment (r = 0·32, p

Despite being identified as a significant clinical phenomenon, wandering of persons with dementia (PWDs) has not been studied in Korea. As an initial trial, various factors chosen from the literature for their predictive relationships to wandering of Korean PWDs were evaluated in this study.A total of 160 PWDs residing in 14 long-term care facilities participated in this study. The Mini-Mental State Exam (MMSE), Physical Activities of Daily Living (PADL) and Korean-translated Revised Algase Wandering Scale (Nursing Home version) (KRAWS-NH) were used to assess participants' degree of cognitive impairment, functional ability and wandering behaviour on six dimensions: persistent walking (PW), specific patterns (SP), spatial disorientation (SD), escape behaviour (EB), attention shift (AS) and negative outcomes (NO). Demographic, personal and environmental data were also collected.The MMSE score was a significant negative predictor for KRAWS-NH overall and subscales except for EB; while age, PADL and history of falls were positive predictors for SD and NO. Total number of residents in a room was a significant negative predictor for EB and AS.Different factors found in PWDs may contribute to different aspects of wandering behaviour. Further studies on factors influencing multiple facets of wandering in various cultural settings are warranted.

Background and Purpose Wandering is one of the most common behavioral and psychological symptoms of dementia, and associated with some of the adverse outcomes in dementia, such as getting lost or even death. The etiology of wandering is not yet clearly known. As depression and wandering are both very common among the patients with dementia, this study examined the relationship between the depression and wandering among the community dwelling patients with dementia. Methods Fifty community dwelling patients diagnosed with dementia were included in this study if they had primary family caregiver, older than age 18 in Seoul, South Korea. The Geriatric Depression Scale, Korean Version (GDS-K), Korean Version of the Mini-Mental State Examination (K-MMSE) and Korean Version of Revised Algase Wandering Scale-Community Version (K-RAWS-CV) were used to measure the severity of depression, cognitive function and wandering. Results Thirty percents of the patients showed wandering. Mean score of GDS-K was significantly higher in wanderers than non-wanderers. Severity of depression was significantly correlated with the total score of K-RAWS-CV and subscales of persistent walking, repetitive walking, eloping behavior, and mealtime impulsivity in whole sample. K-MMSE score also was related to wandering behavior. The prevalence odds ratio for wandering in depressed patients compared with undepressed group was 8.386 (95% confidence interval: 1.978–35.561). Conclusions This study implicates that not only cognitive impairment but also psychosocial aspects should be considered in wandering patients with dementia and suggests assessing the depression in patients would be helpful in identifying the causes of wandering.

This study evaluates three versions of the Wayfinding Effectiveness Scale (WES), developed to differentiate problems of wayfinding and wandering behavior of community-residing elders with dementia (EWD), in 266 dyads (EWD and caregiver) recruited from Alzheimer's Association chapters. Factor analyses yield a five-factor solution (explained variance = 62.6%): complex wayfinding goals, analytic strategies, global strategies, simple wayfinding goals, and being stimulus bound. Overall, internal consistencies are high: WES (.94-.95), and subscales are stable across all versions. Testretest reliability is acceptable for the overall WES and two subscales (complex and simple wayfinding goals) for the care recipient current behavior version. Construct validity is supported by the pattern of correlations among subscales and analyses of variance (ANOVAs) showing significant differences among the care recipient (current vs. prior behavior) and caregiver versions overall and for all subscales. Results support the WES as a valid and reliable measure of wayfinding effectiveness in persons with dementia.

The purpose of this study was to examine the psychometric properties of a Korean translated version of the Revised Algase Wandering Scale, community version (K-RAWS-CV) among persons with dementia in Korea. A cross-sectional survey design was used. After established equivalence of the instrument using back-translation and a field test, 69 community dwelling family caregivers described the wandering behavior of their family members with dementia. The overall mean of the K-RAWS-CV was 1.73 (SD=0.61, range=1-3.87). Means of each subscale ranged from 1.44 (meal-time impulsivity, MI) to 2.04 (escape behavior, EB). The reliability alpha for the overall scale was 0.96 with reliabilities for subscales ranging from 0.82 (negative outcome, NO) to 0.93 (persistent walking, PW). The correlation between the overall K-RAWS-CV and each subscale ranged from 0.52 (overall and NO) to 0.82 (overall and PW) with a mean value of 0.66. Pearson's correlations between the level of cognitive impairment and each subscale of the K-RAWS-CV demonstrated significant, moderate relationships ranging from -0.24 (MI, RW, and MMSE) to -0.39 (PW, EB and MMSE). Mean differences between wanderers and non-wanderers were statistically significant for the K-RAWS-CV overall and all subscale except for MI. Results support the validity and reliability of the K-RAWS-CV overall and the six subscales.

Although wandering in dementia is seen in various cultures, cross-cultural comparisons have not been reported. We examined wandering in residents of long-term care settings (LTCs) in three English-speaking countries (n= 96, America;n= 42, Canada;n= 13, Australia) using the Algase Wandering Scale—Version 2 (AWS-V2). Participants differed by country on age and medical diagnosis. The Americans were significantly older; the Canadians had a greater rate of Alzheimer’s disease (AD). In one-way ANOVAs, AWS-V2 ratings from nurse aides revealed significant differences in the AWS-V2 and three subscales (spatial disorientation, attention shifting, eloping behavior), but not for two others (persistent walking, shadowing). Where significant, Canadians had consistently lower ratings than others. Post-hoc analyses by age of participants failed to reveal significant differences. However, participants with AD had significantly lower AWS-V2 scores than those with mixed-type dementia. Lower MMSE score predicted higher AWS-V2, spatial disorientation, and eloping behavior. Post-hoc analyses of respondent characteristics revealed no significant differences on AWS-V2 or subscales by frequency of attending dementia classes and level of experience with dementia. Thus the nature of wandering in these three countries is not substantially different. However, variations in care environments may contribute to differences in attention shifting. Further, limited sample size, particularly among Australians and Canadians, make findings tentative.

Purpose: The purpose of this study was to explore characteristics of eating behavior according to level of functional status of elders with dementia (EWD), and to examine feeding time, change in food intake and body mass index (BMI) according to eating behavior. Methods: Participants were 149 EWD residing in long-term care facilities located in Seoul or Gyeonggi province and evaluated using the Mini-Mental State Exam-Korean version, Korean version-Activities of Daily Living, and Eating Behavior Scale (EBS). Feeding time, change in food intake, and BMI were also measured. Data were analyzed using SPSS 17.0, specifically descriptive statistics, ANOVA, and Chi-square test. Results: Participants" mean EBS score was 10.43±6.01 and half of them (54.4%) needed moderate or total assistance while eating. The EBS score was significantly lower for elders with severe dementia compared to those with mild or moderate dementia; and elders with severe ADL dependence compared to those with mild or moderate ADL dependence. Lower EBS scores were related to longer feeding time, a greater the rate of participants with decreased food intake and ‘underweight" BMI. Conclusion: Nursing intervention programs which are designed for EWD are needed to maintain functional eating skills and prevent negative consequences in this population.

Purpose: This study investigated various factors relatied to wandering behavior of Korean elders with dementia (KED). Methods: A sample of 160 ambulatory residents with dementia from 14 long term care facilities was used to examine demographic, individual, cognitive, physical health, and environmental characteristics by comparing wanderers (N=108) to nonwanders (N=52). Subjects were evaluated by Korean versions of the Mini-mental State Exam (K-MMSE), the Physical and Instrumental Activities of Daily Living (K-PIADL), and the Revised Algase Wandering Scale Nursing Home version (KRAWS-NH) along its six dimensions. Demographic and environmental data were also obtained. Independent sample ttests, Chi-square test, Fisher’ Exact tests, and ANCOVAs were used to examine differences between wanderers and nonwanders. Results: Wanderers were significantly (p