Seventy to ninety percent of all persons with Alzheimer's Disease (AD) receive care in their homes. For the millions of family caregivers for persons with AD in the U.S., nighttime agitation, sleep disturbances, and urinary incontinence in their care recipients add additional burden to these already burdened caregivers. These disturbances are often reported by caregivers as being the """"""""tipping point"""""""" for seeking institutional care for their loved ones. While each of these disturbances are recognized independently in persons with AD, no research, to date, has studied the interrelationships of these challenging behaviors in community-dwelling persons. Effective interventions can be developed and tested once these relationships are better understood. We believe that a primary reason for limited research in this area is related to the resource-intensiveness of collecting these data using conventional methods (i.e., direct observations). Wireless, body sensor networks hold promise as innovative, reliable, and valid means to collect these data.
Three specific aims will guide this study: (1) examine the feasibility and acceptability of the use of boy sensors in community-dwelling persons with AD and in their family caregivers;(2) describe patterns of nocturnal agitation, sleep continuity and duration, and nighttime urinary incontinence in community-dwelling persons with AD;and (3) examine the relationships among nocturnal agitation, sleep continuity and duration, and nighttime urinary incontinence (timing, frequency) in persons with AD. We will use a single-group, descriptive design with AD participants and their caregivers (N = 50). Data collection will take place over 5 weeknights in participants'home environments. To measure the feasibility and acceptability of these body sensor systems, we will query family caregivers using a semi-structured interview and questionnaire regarding their satisfaction and ease of enactment with the study components (use of body sensors;alarming systems). This will allow for collection of data concerning the immediate experience of the caregiver, while providing the study team with valuable information upon which to make any needed adjustments prior to our conducting a larger scale study. Wireless, body sensor systems will be used with persons with AD in their natural home settings to collect objective data on nighttime agitation (restlessness, physical and verbal agitation), sleep (sleep onset latency, frequency of nighttime awakenings, wake after sleep onset, and total sleep time), and urinary incontinence (timing, frequency). Data analysis will examine the relationships in terms of timing and duration between incontinence and agitation and the subsequent effects on sleep. Results from this study will provide us with the necessary data to develop and test interventions to decrease or eliminate these problematic disturbances in persons with AD, and to influence positively the daily lives of family caregivers.

Public Health Relevance

Family caregivers provide the majority of care in their homes to the 5.5 to 7 million persons with Alzheimer's Disease (AD) in the United States. The distressing symptoms of nighttime agitation, sleep disturbances, and urinary incontinence are difficult for caregivers to manage, and the presence of these oftentimes leads to institutionalization of care recipients. The proposed study may identify the relationship between these symptoms that can be used to develop interventions to assist family caregivers in handling these distressing symptoms, and may lead to significant cost savings and increases in quality of life for persons with AD and their family caregivers, and, ultimately, to decreased institutionalization rates for persons with AD.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1-NRCS-G (08))
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Tully, Lois
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University of Virginia
Schools of Nursing
United States
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Rose, Karen; Specht, Janet; Forch, Windy (2015) Correlates among nocturnal agitation, sleep, and urinary incontinence in dementia. Am J Alzheimers Dis Other Demen 30:78-84