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Daytime Observed Emotional Expressions of People With Dementia

Lee, Kyung Hee; Algase, Donna L.; McConnell, Eleanor S.

doi: 10.1097/NNR.0b013e31829999d7

Background: Emotional expression among people with dementia (PWD) may inform person-centered approaches to care and improvements in dementia-related quality of life.

Objectives: The aim of this study was to examine frequency and variability of positive and negative emotional expressions, personal factors influencing positive and negative emotional expressions, and trajectories of emotional expression among PWD during daytime hours.

Methods: We conducted a secondary analysis of daytime positive and negative emotional expressions of 30 PWD living in residential long-term care who completed twelve 20-minute observation periods occurring hourly as part of a multi-site study of wandering behavior. Hierarchical linear modeling was used to examine relationships between influencing factors and frequency of emotional expressions; group-based trajectory analysis was applied to identify clusters of individuals with similar daytime patterns of emotional expression.

Results: Time of day (rate ratio [RR] = 1.05) and impaired mobility (RR = 1.37) significantly influenced positive emotional expression; gender (RR = 1.85), age (RR = 1.03), and education (RR = 0.54) were significantly related to negative emotional expression. Three distinct trajectory groups were identified for positive emotional expression: a low stable group, a fluctuating group displaying afternoon peaking, and a fluctuating group displaying morning peaking. Two trajectory groups were identified for negative emotional expression: a consistent pattern and an inconsistent pattern.

Discussion: PWD showed a broad range of emotional expression and significant within-person variation in daytime positive and negative emotional expressions. Observed emotional display is a promising measure of psychological well-being among PWD that, if more fully understood, could guide care approaches to improve quality of life.

Kyung Hee Lee, PhD, RN, MPH, GNP-C, is Postdoctoral Fellow, School of Nursing, Duke University, Durham, North Carolina.

Donna L. Algase, PhD, RN, is Associate Dean for Research and Evaluation, College of Nursing, University of Toledo, Ohio.

Eleanor S. McConnell, PhD, RN, GCNS-BC, is Associate Professor, School of Nursing, Duke University, Durham, and is Clinical Nurse Researcher Geriatric Research, Education and Clinical Center (GRECC), Durham Veterans Affairs Medical Center, North Carolina.

Accepted for publication March 29, 2013.

Preparation of this article was funded by the Duke University School of Nursing, Trajectories of Chronic Illness and Care Systems postdoctoral fellowship program. Data for this project were obtained with support from the National Institute of Nursing Research (R01 NR04569) to Donna Algase.

The authors have no conflicts of interest to declare.

Corresponding author: Kyung Hee Lee, PhD, RN, School of Nursing, Duke University, 307 Trent Dr., Durham, NC 27710 (e-mail:

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.