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Dementia and cancer are two common chronic conditions in older adults. However, there are few studies examining the prevalence of comorbid cancer and dementia and the longitudinal impact of these comorbid conditions on health outcomes. This study investigated the prevalence and longitudinal impact on health outcomes in older adults with comorbid cancer and dementia. This is a secondary analysis, using data from the 2010 and 2016 waves of the Health and Retirement Study (HRS). The health outcomes of the study included nursing home stay, hospital stay, home care use, activities of daily living (ADL) limitations, instrumental activities of daily living (IADL), self-rated health status, mortality, and the out-of-pocket medical expenditure in older adults with cancer and dementia. Data were analyzed using descriptive statistics, logistic regression, and linear regression analyses. The results revealed that the prevalence of comorbid cancer and dementia ranged from 2.6% to 2.8% over the 6-year period. Older adults with comorbid cancer and dementia demonstrated higher likelihood of nursing home stay, ADL and IADL limitations, and mortality; but a decreased likelihood of homecare use and hospital stay compared to older adults with cancer only or dementia only (some outcomes were not significant for dementia only group). Findings point out the risk of increased functional decline and mortality in older adults with comorbid cancer and dementia. Future research is needed to explore the contributing factors of the risk and identify interventions to promote physical function and reduce mortality for this population.

Background and Objectives Behavioral and psychological symptoms of dementia (BPSD) commonly occur in persons living with dementia Bright light (BL) interventions have shown some positive impact on BPSD. Ambient lighting is a more efficient approach to delivering BL with better compliance and less staff workload than individual-based lighting interventions. Yet, its effect has not been systematically reviewed. This review synthesized research evidence on the effect of ambient BL on BPSD. Research Design and Methods This review searched literature from PubMed (Medline), CINAHL, Scopus, Web of Science, and Cochrane in February 2021. Original research testing the effect of ambient BL on BPSD in persons with dementia was included. Two reviewers independently screened, extracted data, and assessed the quality of each article. Results Nine studies were reviewed with one randomized controlled trial and eight quasi-experimental studies. The sample size ranged from 14-89 participants across care settings. While not all studies showed positive results, evidence from multiple studies revealed the positive effect of ambient BL on depressive symptoms and agitation in persons with dementia. The ambient BL that showed positive effect targeted at approximately 350-750lux, 4500-9325K, and/or CS=0.375-0.4 for 10-12 hours a day for 4 weeks or longer. Evidence on other BPSD was mixed or too limited to draw conclusions. Discussion and Implications A preponderance of evidence suggests that, when properly designed and implemented, ambient BL shows promise in reducing depressive symptoms and agitation. Future research, using more rigorous designs, is needed to further test the effect of ambient BL on BPSD with attention to lighting parameters, measurement approaches, and intervention fidelity.

Apathy and pain commonly occur in persons with dementia and significantly impact their quality of life. However, communication barriers in persons with dementia make pain assessment challenging. Apathy further complicates pain management in dementia due to decreased facial expression and verbal communication. This study aims to examine pain management in persons with dementia and apathy. This descriptive study included 13 residents with dementia and apathy from two nursing homes in Pennsylvania. Data on pain, pain-related diagnoses, and treatments were extracted from medical records. Participants’ mean age was 90 years old, and their mean apathy level was 54.6. All 13 participants had pain-related diagnoses with an average of 3.1 pain-related diagnoses (range=1-7). Four participants (30.7%) had pain reported in their medical records with osteoarthritis being the most common diagnosis (38.5%). Eight participants (61.5%) had pain-related diagnoses but did not have regular pain medication administered, and 3 of them (37.5%) had pain reported. In addition, five participants had one or more acute pain-related diagnoses, including surgery, fractures, and falls, and only 2 (40%) of them had pain reported. The average number of prescribed pain medications was 0.4 and 1.1 for regularly administered and as-needed medications, respectively. Acetaminophen was the most common administered medication. Overall, the results pointed out the potential issue that pain may be underrecognized and undermanaged in this population. More research is needed to examine the pain assessment and treatment in this population to promote pain management in persons with dementia and apathy.

Communication is fundamental for daily care activities in nursing homes (NHs). Second-by-second behavioral coding of video observations is an ideal approach to examine the interactive nature of communication but requires a reliable coding scheme. Recent studies have adapted the Peron-Centered Behavioral Inventory (PCBI) and Task-Centered Behavioral Inventory (TCBI) to analyze caregiver communication during mealtime interactions, but their use for coding general daily caregiving activities has not been widely evaluated. This pilot study adapted the PCBI and TCBI of video observations and determined their inter-rater reliability for measuring caregiver verbal communication with persons with dementia (PwD). We analyzed videos from a randomized controlled trial of an intervention to improve caregiver communication in NHs. We selected one 1-minute segment from 12 videos that included interactions of caregiver-resident dyads. One research assistant transcribed caregivers’ verbal communication and segmented the communication into utterances. Two other research assistants independently coded each utterance using the adapted PCBI and TCBI. The coding scheme was expanded by modifying the existing operational definitions, adding three new codes, and developing a coding decision guide. Residents were Caucasian (100%), mean age 86 years with dementia and resistive behaviors. The adapted PCBI and TCBI had an inter-rater reliability of Kappa=0.656 (p<.001) across the 12 videos. Overall, our adapted PCBI and TCBI showed substantial inter-rater reliability. The results support the use of our adapted PCBI and TCBI to distinguish between person-centered and task-centered communication in video observations, which, in turn, allows for sequential analysis to examine the impact of caregiver communication on PwD.