Browsing by Author "Orth, Jessica"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Exploratory Factor Analysis of the Comfort Assessment in Dying With Dementia Scale
    (Oxford University Press, 2023-12-21) Zhang, Peiyuan; Stump, Timothy; Tu, Wanzhu; Becker, Todd; Orth, Jessica; Floyd, Alexander; Unroe, Kathleen; Cagle, John; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
    The 14-item Comfort Assessment in Dying with Dementia (CAD-EOLD) scale is a widely used instrument measuring end-of-life care for people with dementia (PWD). The instrument has been used to evaluate symptom burden among PWD in nursing homes, but the measurement properties are less studied for symptoms reported by family and staff caregivers. We conducted an exploratory factor analysis to evaluate the psychometric properties of the scale using staff and family (N=476) responses to CAD-EOLD at the baseline of an NIH-funded clinical trial. Subjects were long-stay nursing home residents with moderate-to-severe cognitive impairment in Indiana and Maryland. Staff (n=368) and family members (n=108) completed the CAD-EOLD, describing participating residents. We performed separate exploratory factor analyses on family and staff responses. Family and staff data showed similar clustering patterns. Restlessness, anxiety, fear, crying, and moaning had high factor loadings in the first cluster, interpreted as “Physical and Psychological Distress” (loading range = 0.47–0.91). Choking, gurgling, and difficulty swallowing had high loadings in the second cluster that depicted “Dying Symptoms” (loading range = 0.62–1.15). Serenity, calm, and peace had high loadings in the third factor on “Well-Being” (loading range = 0.72–0.93). Three “Physical Distress” items (i.e., discomfort, pain, and shortness of breath) cross-loaded with “Dying Symptoms.” Accordingly, “Physical and Psychological Distress,” “Dying Symptoms,” and “Well-Being” represented important but separate dimensions for measuring end-of-life experiences of PWD. Findings demonstrated favorable construct validity of CAD-EOLD in PWD with moderate-to-severe cognitive impairment in nursing homes, as reported by staff and family caregivers.
  • Thumbnail Image
    Item
    Symptom Burden and Quality of Life for Nursing Home Residents with Dementia: Uplift Trial Early Data
    (Oxford University Press, 2022-12-20) Cagle, John; Orth, Jessica; Becker, Todd; Zhang, Peiyuan; Ersek, Mary; Tu, Wanzhu; Floyd, Alex; Unroe, Kathleen; Biostatistics, School of Public Health
    Communication difficulties in nursing home (NH) residents with dementia make valid assessment of symptoms and quality-of-life (QOL) challenging. Thus, researchers and clinicians frequently rely on proxy-based measures. The End-of-life Dementia-Comfort Assessment in Dying (EOLD-CAD) and two single-item QOL measures (7-point item; 5-point item) have been used in several studies, though evaluation of their psychometric properties is limited. We used baseline data from an ongoing multi-site randomized trial (UPLIFT) to describe symptoms and QOL and examine the measures’ validity and reliability in 138 residents with moderate to severe dementia living at 16 facilities. Descriptive data and assessments of convergent validity and inter-rater reliability are provided. Based on assessments by 134 staff and 45 family, physical symptoms, physical distress, and emotional distress were reported as infrequent by staff and family; indications of well-being were more frequently observed. Median QOL was the same for staff and family observers (4=“Life is so-so” [7-point item]; 3=“Fair” [5-point item]). Inter-observer assessments of resident QOL (staff vs. family) were correlated (7-point item: r=0.47, ICC=.643; 5-point item: r=0.48, ICC=.645, p<.05 for all). Seven of 18 EOLD-CAD symptoms were significantly positively correlated. ICC values varied between high or moderately high: shortness-of-breath (ICC=.74), choking (ICC=.65), gurgling (ICC=.81), agitation (ICC=.51), fear (ICC=.46), crying (ICC=.65), peace (ICC=.57), and care resistance (ICC=.68) (p<.05 for all). Choking and gurgling were the most prominently reported symptoms by both groups.Early findings provide a contemporary assessment of QOL and symptoms among NH residents with dementia. Measurement properties affirm general reliability and validity of study instruments.