Recent Research Publications and Funding

Background: Depression is a common yet often unrecognized consequence of stroke, affecting between 20-50% of all survivors. Reported underlying factors affecting depression in acute and chronic stroke include: functional disability, lesion location, time since stroke, female gender, age, cognitive impairment, history of major depression, low social support, poor quality of life, and inferior sleep quality.

Purpose: To examine potential independent predictors of depressive symptoms in chronic stroke.

Methods: Cross-sectional design using baseline data from the first 100 community-dwelling stroke survivors enrolled in an exercise intervention study. Eligible subjects included men and women aged ≥ 50 years and at ≥ 3 months post-stroke. Prior to their baseline study visit; subjects completed a comprehensive, self-administered health survey including medical history and valid/reliable questionnaires: Center for Epidemiological Studies Depression (CES-D) scale, Multidimensional Scale of Perceived Social Support, Medical Outcomes Study SF-36, and Pittsburgh Sleep Quality Index. At the baseline visit, functional disability (Modified Rankin Scale), and cognitive impairment (Mini-Mental Status Exam) were assessed using standardized procedures. Multiple linear regression was conducted to explore potential independent predictors of depressive symptoms.

Results: Subjects (n=100) were on average 70±10 years old, and 39±49 months post-stroke. The majority reported an ischemic stroke (68%), were married (59%), White/European-American (78%), men (54%), college-educated (79%), and annual income ≥$50,000 (32%). Hemiparesis was common (right-side=39%, left-side=42%). A total of 35% of subjects had a CES-D scores ≥16, with 21% reporting a history of major depression. Approximately 64% of the variance in depressive symptoms, could be explained by the optimal combination of the independent variables in the model: functional disability, lesion location, time since stroke, gender, age, cognitive impairment, history of major depression, social support, quality of life, and sleep quality (R2=0.64, F12,87=12.97, p<0.01). Only poor quality of life (t1,87=-6.99, p<0.01) and low social support (t1,87=-2.14, p=0.04) contributed uniquely and significantly to the severity of depressive symptoms among these stroke survivors.

Conclusion: Depressive symptoms are prevalent in chronic stroke survivors, even among an educated and economically advantaged population. Our findings are similar to reports by others that poor quality of life and low social support are major contributors to depressive symptoms in chronic stroke; and should be routinely assessed and monitored to improve long-term rehabilitation efforts, promote wellness and community reintegration.

This article presents an adaptation of the Family Management Style Framework (FMSF)—a well-established framework of family response to chronic condition care of children—to families caring for older adults with dementia. Using the FMSF to better understand how families manage dementia care can provide clinicians with insights on how to work effectively with families. Using data from interviews with eight female caregivers of older adults with dementia, this secondary analysis adapts the FMSF, and identifies new dimensions that apply specifically to families caring for older adults with dementia. The discussion draws comparisons between the family management of a child with chronic condition to management of an older adult with dementia. The article concludes with a discussion of how understanding how families manage care of an older adult with dementia informs assessment for management styles and the tailoring of interventions specific to family, caregiver, and older adult needs.

Acute psychiatric care is an essential component of a comprehensive system of mental health services (The President’s New Freedom Commission on Mental Health, 2003). Dramatic shifts in psychiatric inpatient utilization patterns began in 1955 with the deinstitutionalization from long-stay psychiatric hospitals to community care settings. This was accompanied by an overall decline of psychiatric inpatient beds per capita (Center for Mental Health Services, 2006). 

Cognitive impairment is a clinically complex symptom commonly experienced by cancer survivors. Although research in this area has grown, many questions remain regarding underlying mechanisms, trajectory, and specific interventions nurses can offer patients to prevent, treat, and manage cognitive impairment effectively. As part of the Oncology Nursing Society (ONS) Putting Evidence Into Practice (PEP) initiative, a comprehensive examination of the current literature was conducted to identify effective interventions for cognitive impairment in cancer survivors. The studies were categorized into nonpharmacologic interventions, including complementary and alternative therapies and cognitive training, and pharmacologic interventions, including psychostimulants and erythropoietin-stimulating agents. Using the ONS PEP Weight of Evidence Classification Schema, the levels of evidence for these interventions were consistent with the categories of effectiveness not established or not recommended for practice. Additional research is needed to identify effective preventive and treatment strategies for cognitive impairment in cancer survivors.