Apathy and care environments in dementia and measures of activity

Antonakos for the PEAR apathy project. Their great work helped this dissertation generate rigorous and fruitful findings. I also want to thank two NIH/NINR-funded studies— " Wandering: Background and Proximal Factors " (PI: Algase) and " Bioburden Predictors of Diabetic Ulcer Complications " (PI: Gardner)—for providing access to research samples and resources. I am extremely grateful for my dissertation committee, Drs. She has always believed in me and our mentorship has made this journey enjoyable. I am also grateful to have worked on Dr. Gardner's research team for more than six years and have led multiple research projects, which have established my research skills and inspired me to continue my education in the doctoral program at the University of Iowa. Finally, I want to thank all my family in Taiwan for their unconditional love and support, which gave me courage to pursue my passion in the U.S. I especially want to thank my grandparents. They have been my motivation to pursue gerontological nursing as my long-term career. iii ABSTRACT Objective: This dissertation includes three projects that study care environments and apathy in dementia as well as measures of activity. Project 1 developed the Person-Environment Apathy Rating (PEAR) scale to measure environmental stimulation and apathy, and tested its psychometrics. Project 2 examined the association between care environments and apathy in persons with dementia. Project 3 tested the accuracy of ActiGraph and activPAL TM activity monitors in measuring weight-bearing activities among persons with previous diabetic foot ulcers. Methods: The PEAR consists of environment (PEAR-Environment) and apathy (PEAR-Apathy) subscales. The validity and reliability of the PEAR was examined through video observation of 24 participants. Project 2 selected 40 participants with dementia in order to examine the association between apathy and environmental stimulation, ambiance, crowding, staff familiarity, and light and sound. Study procedures involved video observation and data extraction. Project 3 enrolled 31 participants to test the accuracy of ActiGraph and activPAL TM in measuring number of steps taken and duration of walking, standing, sitting, and lying. Results: The PEAR-Environment subscale had significant but fair correlation with the Crowding Index (ρ=.27, p<.01), suggesting fair validity. The PEAR-Apathy highly correlated with the Passivity in Dementia Scale (ρ=.81) and Neuropsychiatry Inventory (NPI)-Apathy subscale (ρ=.266), and moderately correlated with the NPI-Depression subscale (ρ=.46), indicating good convergent validity and moderate discriminate validity. The PEAR also demonstrated good internal consistency (Cronbach's α= .84-.85) and moderate to good inter-rater (Weighted …