The purpose of this study was to explore perceptions of home healthcare nurses related to suffering, artificial nutrition and hydration in people with late-stage dementia, and if these perceptions influence care to people with dementia and their families. Part of a mixed-methods study, the qualitative portion examined perceptions of home healthcare nurses in a rural area in the southern United States. Seventeen home healthcare nurses participated in this study. Semistructured focus group interview questions were used. Constant comparative analysis was the method used for coding transcripts. Three themes emerged from the analysis: patient/family comfort, futility, and symbols of suffering. Although many of the nurses reported that artificial nutrition and hydration was of comfort to the patient and family because of the potential for "starving," they also felt it prolonged the patient's suffering due to the invasive procedure, need for restraints, and possibility of fluid overload. Several nurses felt that artificial nutrition and hydration gave a sense of false hope to the family that the patient would live longer. The perceptions of these home healthcare nurses influence their care to people with dementia and their families related to artificial nutrition and hydration, possibly based on experience. Their perceptions could influence family decisions regarding treatment options. Further research and education with home healthcare nurses is vital to ensure nurses are appropriately caring for patients with dementia and their families.

The progressive nature of dementia marks this disease as a terminal illness in the advanced stage, and palliative care rather than curative treatment is indicated. The use of feeding tubes to deliver artificial nutrition and hydration at end of life is often part of the plan of care for people with dementia. Current evidence, however, suggests that tube feeding in advanced dementia is not beneficial and the burdens of the procedure and the feedings themselves outweigh any benefits. Evidence also reveals that healthcare providers may lack evidence-based knowledge about artificial nutrition and hydration to adequately inform families and surrogate decision makers. This article examines the evidence regarding use of artificial nutrition and hydration for patients with end-stage dementia and offers implications for home care clinicians.

The purpose of this exploratory pilot study was two-fold: (a) to determine the reliability of the instrument to measure nurses' knowledge of artificial nutrition and hydration, and (b) to assess home healthcare nurses' knowledge of artificial nutrition and hydration. A cross-sectional design was used to administer the questionnaire to 91 home healthcare nurses in North Carolina; 33 questionnaires were returned. Results revealed an accurate answer rate of 73% and Cronbach's alpha was 0.71, indicating adequate internal consistency reliability.

Evidence has shown that exercise, a healthier diet, and smoking cessation may protect the brain, but evidence is scarce on exercise combined with cognitive training and its benefits for people with mild cognitive impairment. The aim of this study is to identify key issues with utility, effectiveness, and appeal of specific electronic applications for people with mild cognitive impairment in order to guide the design and development of a mobile application which incorporates both physical and cognitive activities, which may improve, impede or prevent cognitive decline. Sixteen participants, 65 and older, with mild cognitive impairment, assessed using the Montreal Cognitive Assessment tool, with a range of 19-25 were recruited. To assess the participants' ability to consent to the study, the MacArthur Competence Assessment Tool for Clinical Research was used. Participants were observed playing a physical activity application and cognitive training application via a tablet, on two separate occasions. A Usability Observation form was used to obtain data on facial features as well as verbal and body language while playing. A survey and focus group sessions were held to get feedback from the participants. The majority of the participants were able to use the tablets and play the physical activity and cognitive training applications. However, some of the applications had levels that were more difficult for some of the participants, but a few said parts of the applications were too easy. The investigators noted that a 'tablet stand' would have highly enhanced participation during the use of physical activity applications.