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A Model of Agitated Behavioral Symptoms in Persons with Alzheimer Disease

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A Model of Agitated Behavioral Symptoms in Persons with Alzheimer Disease Wayne State University Wayne State University Dissertations January 2020 A Model Of Agitated Behavioral Symptoms In Persons With Alzheimer Disease Katherine Kero Wayne State University Follow this and additional works at: https://digitalcommons.wayne.edu/oa_dissertations Part of the Nursing Commons Recommended Citation Kero, Katherine, "A Model Of Agitated Behavioral Symptoms In Persons With Alzheimer Disease" (2020). Wayne State University Dissertations. 2439. https://digitalcommons.wayne.edu/oa_dissertations/2439 This Open Access Dissertation is brought to you for free and open access by DigitalCommons@WayneState. It has been accepted for inclusion in Wayne State University Dissertations by an authorized administrator of DigitalCommons@WayneState. A MODEL OF AGITATED BEHAVIORAL SYMPTOMS IN PERSONS WITH ALZHEIMER DISEASE by KATHERINE KERO DISSERTATION Submitted to the Graduate School of Wayne State University, Detroit, Michigan in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY 2020 MAJOR: NURSING Approved By: _________________________________________ Advisor Date _________________________________________ _________________________________________ _________________________________________ © COPYRIGHT BY KATHERINE KERO 2020 All Rights Reserved DEDICATION This dissertation is dedicated to everyone who suffers from age-related degenerative diseases, and to those who care for and about these individuals. Your battle is unique, but you are not alone. This work was completed with the remembrance of my grandmother Pearl who suffered from Parkinson’s disease, and with thoughts of my grandmother Betty who suffers from dementia. They are both amazing women who continue to give me inspiration and courage. ii ACKNOWLEDGMENTS I acknowledge with gratitude my advisor and committee chair Debra Schutte, Ph.D, RN, for her patience, guidance, and support throughout my entire doctoral education. She encouraged my ideas, motivated my progress, and provides a stellar example of excellence in nursing, research, and academics. I am thankful for her generosity in sharing her previously collected research data to be analyzed in this dissertation. I express my immense gratitude and admiration for Margaret Campbell, Ph.D, RN FPCN. Her mentorship and encouragement prompted me to begin my Ph.D studies, and her enthusiasm for nursing research continues to inspire me. I thank and acknowledge Hossein Yarandi, PhD for his calm and patient approach to statistics. I learned so much from his statistics courses and from working through the analysis of this dissertation research data, and I appreciate his suggestions about suggest all available options for data analysis. I acknowledge and extend my heartfelt appreciation to Joy Ernst, PhD for lending her attentive perspective on the needs of older adults. She asks thought provoking questions, and helped me think more deeply about the issues faced by older adults. I also thank her for generously sharing her time to collaborate with me on our publication summarizing social services for older adults. I acknowledge the continual support of April Hazard Vallerand, PhD, RN, FAAN, for her caring guidance. She has always been a dependable person to ask for assistance with academic or administrative matters, as well as topics of work life balance. She is a fierce advocate for all PhD nursing students. iii I would like to extend a special thank you to Elizabeth McQuillen, PhD for her kindness and assistance through my PhD experience. Thank you for taking so much time to work with me, to answer my questions, and to support my progress. She has a great talent for making statistical analyses seem more approachable, and is meticulous in her attention to detail. I also acknowledge and appreciate the support of my family. I would not have achieved this goal without their help and sacrifices. Thank you my parents Andrew and Julie, who have always believed in me, supported me, and pushed me to do all that I can do. Thank you to my husband Chris for your love, empathy, and support though this challenging process and all aspects of the exciting adventure we are taking together. Thank you to my son Victor for sharing some of our time together with my investment into this dissertation. I hope that you learn from my example the value of hard work, perseverance, and above all, a concern for the needs of the vulnerable. iv TABLE OF CONTENTS DEDICATION ................................................................................................................................ ii ACKNOWLEDGMENTS ............................................................................................................. iii List of Tables ................................................................................................................................. ix List of Figures ................................................................................................................................ xi CHAPTER 1: INTRODUCTION ................................................................................................... 1 Background and Significance ..................................................................................................... 1 Shifting Demographics ........................................................................................................... 1 Alzheimer Disease .................................................................................................................. 2 Agitation ................................................................................................................................. 4 Statement of Problem .................................................................................................................. 7 Relevance to Nursing Knowledge .............................................................................................. 8 Statement of Purpose ................................................................................................................ 10 Specific Aims and Hypotheses ................................................................................................. 10 Aim 1: ................................................................................................................................... 10 Aim 2: ................................................................................................................................... 11 Aim 3: ................................................................................................................................... 11 Summary ................................................................................................................................... 12 CHAPTER 2: LITERATURE REVIEW AND THEORETICAL FRAMEWORK ..................... 13 Alzheimer Disease Overview ................................................................................................... 13 Neuropathology of Alzheimer Disease ................................................................................. 13 Proposed Etiologies of AD ................................................................................................... 17 v State of the Science: Agitation in Alzheimer Disease .............................................................. 18 Risk Factors for Agitation ..................................................................................................... 19 Associated Outcomes ............................................................................................................ 27 Gaps in the Literature................................................................................................................ 31 Conceptual Challenges.......................................................................................................... 33 Nursing Theory: The Theory of Unpleasant Symptoms ........................................................... 39 The Theory of Unpleasant Symptoms .................................................................................. 40 Variables within Theory of Unpleasant Symptoms Framework........................................... 44 Chapter 2 Conclusion ................................................................................................................ 47 CHAPTER 3: METHODS ............................................................................................................ 49 Methods..................................................................................................................................... 49 Study Design ......................................................................................................................... 49 Setting ................................................................................................................................... 49 Sample................................................................................................................................... 50 Procedures ............................................................................................................................. 50 Measures ................................................................................................................................... 51 Data Analysis ............................................................................................................................ 73 Data Management ................................................................................................................
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