bluuebunny/crossref_metadata_2025 huggingface dataset:
Relational Exchange Norms in Marketing: A Critical Review of Macneil’s Contribution
Authors: Ivens Bjoern S. , Blois Keith J.
Published: June 2007

Different theories make different assumptions about the mechanisms that govern economic transactions and there are several reviews that have summarized existing conceptual and empirical work associated with such frameworks as transaction cost analysis or agency theory. However, Macneil’s Relational Contracting Theory, another major theoretical foundation of current marketing research into business relationships, has not yet received similar attention. This article provides a review of a core concept developed in this stream of literature: the norm concept. It contrasts Macneil’s view of norms with the work developed in the field of marketing. As a result, the authors identify, first, a gap between Macneil’s interpretation of the norm concept and the application made by marketing scholars and second, contradictions in the results obtained from empirical marketing research.
Bright light therapy for demented nursing home patients with behavioral disturbance
Authors: Thorpe Lilian , Middleton Joan , Russell Gwen , Stewart Norma
Published: June 2007

The objective of this study was to examine the effects of morning bright light on behavioral disturbances in dementia using a repeated measures ABA design. We hypothesized that morning bright light in demented patients reduces the agitation rating and directly observed disruptive behavior, but increases observed positive behavior.

The study was done in a special care unit of a long term care facility, with 16 demented residents ages 60 to 89, 13 female and three male. Morning bright light (Day-Light Box 10000, produced by DayLight Technologies, Inc, providing 10,000 lux) was administered Monday to Friday during the treatment week. The Global Deterioration Scale rating at baseline, followed by baseline, treatment and post-treatment ratings in the Cohen-Mansfield Agitation Inventory (CMAI) and Environment-Behavior Interaction Code (EBIC) were used as measurements

Compared to baseline, the mean total Cohen-Mansfield score decreased more during the phototherapy week than during the post-treatment week (p < 0.05 on one-tailed paired t-test). Regardless of phototherapy, Cohen-Mansfield scores decreased significantly in summer versus fall-spring (p < .005). Although the direct behavioral measures [EBIC] showed no statistically significant change compared to baseline, there was a pattern of greater mean increase in positive behaviors (p = .08) during phototherapy than in the post-treatment week, and a mean decrease of total disruptive behaviors most pronounced in the post-treatment week (p = .05).

Bright light therapy has modest efficacy in reducing agitation, with possible concurrent improvement in positive behaviors. Disruptive behaviors may also become less frequent during phototherapy with evidence of even greater delayed optimal effect. Further research should focus on subgroups of patients demonstrating a particularly robust response, enhance power through a larger sample, provide for longer light exposure, and control for seasonal variables.
Evaluating an electronic monitoring system for people who wander
Authors: Altus Deborah E. , Mathews R. Mark , Xaverius Pamela K. , Engelman Kimberly K. , Nolan Beth A. D.
Published: June 2007

Wandering away from home, or elopement, is a behavior that places persons with dementia at risk of serious injury and may lead family caregivers to place their loved ones in institutions or to severely restrict their independence. Funding from the National Institute on Aging (NIA) was used to evaluate the Mobile Locater, an electronic device designed to help caregivers quickly locate a person who has eloped. This 6-month pilot study included case studies of seven users and an opinion survey of family caregivers, professional caregivers and search and rescue workers. The survey results showed that respondents were positively impressed by the device, only identifying cost as a potential drawback. Case studies revealed that the equipment was easy to use, effective, and helpful to caregivers' peace of mind. These results suggest that the Mobile Locater is a valuable tool deserving of further study.
“Media Memory Lane” interventions in an Alzheimer's day care center
Authors: Olsen Richard V. , Hutchings B. Lynn , Ehrenkrantz Ezra
Published: June 2007

The present study developed and systematically evaluated two inventions (Musical Memory Lane and Video Memory Lane) which present nostalgic music and videos to 15 plus day care clients with Alzheimer's disease (AD) in an easy-to-access, push button, picture format. Systematic observations indicated that the Memory Lanes had a favorable impact on engagement, stimulated positive affect and activity-related talking, while also reducing fidgeting. There was no impact on sleeping and general interaction. During free time, people chose a Memory Lane activity significantly more often than other activities and remained engaged with it for a longer time. The Memory Lanes show great potential for providing meaningful and easily accessible activities to people with dementia. Additional studies are needed in other care settings and to determine if the Memory Lanes can decrease agitation and enhance memory function.
Clergy support and caregiver expectactions for support: A replication study
Authors: Robinson Karen M. , Ewing Sarah , Looney Stephen
Published: June 2007

Clergy support is an important type of support that has often been neglected. The purpose of this study is to determine how knowledgeable clergy are about Alzheimer's disease (AD), what expectations AD families hold for support from clergy, and how clergy knowledge and caregiver expectations differ between a rural and urban area. Ries survey7 in Montana of clergy knowledge and caregiver expectations for support was replicated. The Montana study drew a clergy response rate of 41 percent compared with a 22 percent rate in this study. Responses of Kentuckiana families indicated less satisfaction with clergy support than found in Ries study. Findings suggested the need for more educational opportunities for clergy.
A one-year follow-up study of family caregivers of institutionalized elders with dementia
Authors: Lévesque Louise , Ducharme Francine , Lachance Lise
Published: June 2007

The purpose of this one-year follow-up study was to determine whether the caregiving experience of primary caregivers (N = 142) of institutionalized demented elders changed over time and to identify the factors predictive of caregiver well-being after a year. Based on the stress and coping model of Lazarus and Folkman, five dimensions of this experience were considered: caregivers’ stressors, their cognitive appraisal of these stressors, social support, coping strategies and well-being (psychological distress and positive affect). MANOVA and t test results revealed that two stressors changed over time. The elders’ functional impairment deteriorated and their depressive behaviors decreased. However, there was no change in the appraised disturbance associated with these stressors. Conflicts in informal social support decreased significantly, but there was no change in well-being. More formal support at T1 was predictive of decreased psychological distress and increased positive affect at T2. A coping strategy, the use of affective regulation at T1, was also predictive of increased positive affect at T2. Knowledge of the caregiving experience over time and of predictors of caregiver well-being provides guidelines for interventions that could be directed at this clientele by health care workers in institutional settings.
Communication between individuals with dementia and their caregivers during activities of daily living
Authors: Small Jeff A. , Geldart Kathy , Gutman Gloria
Published: June 2007

Much previous research has focused on linguistic factors that can lead to communication breakdown in caregiver-patient interactions. However, the impact of such linguistic deficits on communication may vary depending on the context, goals, and complexity of the interaction. As a result, the likelihood of experiencing communication problems is expected to differ across different activities. In the present study, family caregivers of persons with dementia were asked to discuss communication challenges that they have experienced in a range of daily activities in the home. Four focus groups, involving a total of 22 caregivers, were conducted in community settings. The main goal of the focus groups was to identify specific daily activities in the home in which caregivers most often experience communication problems. The content of the focus groups was audio recorded and transcribed, and then coded and analyzed using qualitative and quantitative analytic techniques. The analyses focused on identifying trends across caregivers in which particular activities were noted as being prone to communication breakdown at different stages of the disease. Information about which activities are most communicatively challenging should assist caregivers in preparing for and adapting to these changes.
Challenges of implementing intervention research in persons with dementia: Example of a glider swing intervention
Authors: Snyder Mariah , Tseng Yueh-hsia , Brandt Cheryl , Croghan Catherine , Hanson Sandy , Constantine Ray , Kirby Leann
Published: June 2007

Intervention studies for persons with dementia present many challenges. This article describes challenges encountered in conducting a glider swing intervention study for persons with dementia and the strategies used to manage the problems encountered. The overall purpose of a quasi-experimental study was to explore the effects of a glider swing intervention on emotions, relaxation, and aggressive behaviors in nursing home residents with dementia. Suggestions for investigators conducting intervention studies for persons with dementia are provided.
Apolopoprotein-E gene polymorphism and lipid profiles in Alzheimer's disease
Authors: Isbir Turgay , Agaçhan Bedia , Yilmaz Hülya , Aydin Makbule , Kara Ihsan , Eker Engin , Eker Deniz
Published: June 2007

In this study, the relationship between lipid profiles of sera and apolipoprotein E (apo E) gene polymorphism was investigated in 35 patients with Alzheimer's disease (AD) and 29 healthy people.

Apo E genotypes and allele frequencies of the AD patient group were: apo E2/3, 2 (5.7 percent); apo E2/4, 1 (2.9 percent); apo E3/3, 26 (74.3 percent); apo E3/4, 5 (14.3 percent); apo E4/4, 1 (2.9 percent); 2, 3(4.2 percent); 3, 59 (84.2 percent); 4, 8 (11.4 percent). The healthy group's apo E genotypes and allele frequencies were: apo E2/3, 1 (3.4 percent); apo E3/3, 27 (93.1 percent); apo E3/4, 1 (3.4 percent); 2, 1 (1.7 percent); 3, 56 (96.5 percent); 4, 1 (1.7 percent). In Alzheimer's cases, 4 allele frequencies increased significantly as compared to the healthy group (p < 0.05). When the effects of the apo E isoforms on lipid profiles were evaluated, a relationship between apo E 4 allele and high total levels of serum cholesterol was found, whereas of apo E 2 allele was associated with the low total cholesterol of serum, although the difference was not statistically significant (p > 0.05).

This study confirms the association of apo E 4 allele with lipid profiles in AD patients.
The Algase wandering scale: Initial psychometrics of a new caregiver reporting tool
Authors: Algase Donna L. , Beattie Elizabeth R. A. , Bogue Erna-Lynne , Yao Lan
Published: June 2007

This paper reports on the Algase wandering scale (AWS), a 28-item questionnaire, based on five dimensions of wandering. With factor analysis, an eight-factor solution explained nearly 70 percent of the variance in ratings for 151 long-term care subjects and confirmed three of the structuring dimensions. Reliability of the AWS was examined for internal consistency and for inter-rater reliability. The AWS had an alpha of .86; subscale alphas ranged between .88 (persistent walking) and .57 (routinized walking). Inter-rater reliabilities, estimated through crossrater comparisons of the AWS and subscales with a four-point judgement of wandering status, were moderately strong and no significant differences existed between two sets of raters. Validity of the AWS and its subscales was supported by examining their ability to differentiate wanderers and nonwanderers, by positive correlation with measures of cognitive impairment and with multiple parameters of observed wandering, and by negative or no correlations with nonwandering locomotion. Although the AWS may be a useful measure of wandering in long-term care settings, validation of its factor structure and evaluation in cross-cultural samples is needed.
Abandonment fears of persons with Alzheimer's disease attending abult day care
Authors: Judkins Wayne , Roberto Karen A.
Published: June 2007

By using participant observation and staff interviews, we examined the phenomenon of abandonment fears in persons with Alzheimer's disease who were frequent attendees of an adult day care center. Two women, who most frequently expressed fears of abandonment, were the primary participants of the study. Their fears stemmed from two sources: contextual confusion, centered on their inability to grasp the concept of attending an adult day care center, and imagined barriers between them and their caregivers. One of the women tended to “recruit” the other woman into her world of insecurity, and hence their friendship actually may have had a detrimental effect on each other's days at the center. Staff members discussed the issue with reluctance and indicated that methods to attempt to change the behavior would be futile.
The agitation-activity interface of people with dementia in long-term care
Authors: Kovach Christine R. , Schlidt Andrea Matovina
Published: June 2007

The purpose of this study was to examine agitated behaviors of people with dementia relative to time and activity variables. This descriptive study involved a sample of 420 units of 30-minute time periods collected in a longterm care setting. The highest agitation scores occurred during the evening (F = 3.93, p = 0.009). Agitation scores were significantly higher when the same level of activity was sustained for 1.5 hours or longer (p = 0.000). This study suggests that future examination is needed of an intervention to control activity schedules so that there is a balance between sensory-stimulating and sensorycalming activities.
Antecedents, descriptions and consequences of wandering in cognitively-impaired adults and the Safe Return (SR) program
Authors: Rowe Meredeth A. , Glover Judith C.
Published: June 2007

Unattended wandering is a major problem in cognitivelyimpaired (CI) individuals and can result in those individuals becoming lost in the community. The purpose of this study was to identify important characteristics of unattended wandering and important prevention strategies. Data were compiled from registration files and missing and discovery reports collected through the Safe Return (SR) program. These data were analyzed to determine where individuals were found, who found them, from what setting they left, what mode of transportation they used, and what circumstances surrounded the unattended wandering. The study highlights the unpredictable and varied nature of unattended wandering. Recommendations are provided for communities to develop strategies to minimize unattended wandering and to determine effective methods of locating CI individuals when they become lost.
Depression among Alzheimer's caregivers: Identifying risk factors
Authors: Shua-Haim Joshua R. , Haim Todd , Shi Yong , Kuo Yen-Hong , Smith Juanita M.
Published: June 2007

Purpose: The purpose of this study was to reveal risk factors contributing to the development of depression among caregivers of Alzheimer's disease patients.

Methods: In a cross-sectional study, all caregivers of consecutive Alzheimer's disease patients were asked to participate in the study. Patient and caregiver depression was evaluated by using the Yesavage Geriatric Depression Scale (GDS). Information regarding patients' functional status, driving status, and type of behavioral abnormalities was obtained from caregivers. Patients' functional status was evaluated by using the Katz Activity of Daily Living (ADL) scale. The Folstein Mini-Mental Status Examination (MMSE) was used to evaluate cognition. Risk factors for Alzheimer's caregiver depression were assessed by means of logistic regression analysis.

Results: A total of 92 patients and caregivers were evaluated. Fifteen were excluded due to incomplete data. A total of 77 pairs were included in this analysis. The age of caregivers ranged from 28 to 88 years. Mean (standard deviation [SD]) age was 63.1 (SD = 16.3) years old. Husbands and wives (caregivers) accounted for 49.4 percent; daughters or sons (or daughters-or sons-in-law) accounted for 42.9 percent. There were 29 caregivers (38 percent) found to be depressed. By using multivariate analysis, the following factors have been identified as risk factors for depression in Alzheimer's caregivers: depression in the dementia patient; ADL functional scores of 12 or greater; and the presence of hallucinations.

Conclusion: Three risk factors were found to have a strong association with Alzheimer's caregiver depression. Early recognition of such risk factors may help to identify Alzheimer's caregivers with depression.
Treating Alzheimer's disease: Do clinical trial methods produce unnecessary practitioner dilemmas?
Authors: Becker Robert E.
Published: June 2007

Recent clinical trials and critical reviews of Alzheimer's disease (AD) research discourage already relatively sparing clinical uses of cholinesterase inhibitors (ChEIs) considering the prevalence of AD. As evidence against use of this class of drugs, detractors cite critical reviews of ChEls and lack of long-term health benefits found in one long-term clinical trial. This paper describes the use of standard error of measurement to allow investigators to design clinical trials that address these issues. The new clinical trial procedures afford sufficient precision for two purposes. First, practitioners can assess individual patients with precision and certainty in their observations. Second, clinical trial researchers can study how short-term drug effects on individual patients predict long-term benefits from continued treatment. With these more clinically informative clinical trial designs, investigators would be able to avoid uncertainties currently raised by conflicts between short-and long-term AD clinical trials.
Caregivers' perceptions of dementia patients' functional ability
Authors: Davis Barbara A. , Martin-Cook Kristin , Hynan Linda S. , Weiner Myron F.
Published: June 2007

Dementia patients' caregivers often provide information about patients' daily functioning, but little is known about factors influencing caregivers' perceptions. Baseline data from an intervention trial were used to compare caregiver estimates of dementia patients' performance with their actual performance of instrumental activities of daily living (IADLs) and to assess relationships between measures of caregiver responses to caregiving, self-perceived sense of self-efficacy, and depression. We also assessed patient cognition, overall function and behavioral disturbance, and caregivers' perceptions of their patients' behavior as manipulative or deliberate. Disparities between these estimates and actual patient performance on structured IADL tasks were unrelated to any caregiver, patient, or relationship factor that we measured.
Challenges in the clinical diagnosis of Alzheimer's disease: Influence of “family coach ng” on the Mini-Mental State Examination
Authors: Gofton Teneille , Weaver Donald F.
Published: June 2007

The Mini-Mental State Examination (MMSE) is a commonly used clinical toolfor evaluating the cognitive aspects of mental function. In this study, 40 consecutive patients presenting to a memory disorder clinic and their caregivers were evaluated for coaching of the patient with respect to MMSE content over the 24 hours prior to clinical evaluation. Caregivers completed a questionnaire concerning MMSE practice sessions with the patient prior to the physician encounter; then, the patients were asked to spell the word “WORM” backwards instead of “WORLD” during the MMSE test. Some or all of the MMSE content was reviewed with the patient prior to the interview by 42.5 percent of the caregivers, 17.5 percent ofpatients spelled or attempted to spell “WORLD” backwards instead of “WORM” These results demonstrate that coaching of patients prior to administration of the MMSE is not uncommon, and that this needs to be taken into consideration when forming therapeutic decisions based on MMSE results.
An Individualized Approach to Treatment for Alzheimer’s Disease, Pick’s Disease, and Other Dementias
Authors: Lippa Carol F.
Published: June 2007

Treatment options for dementia are now available, and increasing numbers of individuals with cognitive disorders are being evaluated for intervention. Little effort is made to select patients who will benefit from the various treatments. Widespread use of medication places patients at risk for developing side effects, which is one reason to target patients likely to benefit from specific interventions. We have limited health care resources and a growing population of elderly individuals with dementia, so our current system of “hit or miss” intervention will become increasingly costly and inefficient. Selecting those likely to benefit from specific interventions would improve efficiency. This article reviews some current approaches for treating dementia and describes a strategy that may help predict which individuals will respond to specific dementia-related treatments. This individualized approach has potential to increase the beneficial effects of medications, reduce the likelihood of side effects, and preserve health care resources.
Clock Drawing and Frontal Lobe Behavioral Effects of Memantine in Alzheimer’s Disease: A Rater-Blinded Study
Authors: Paskavitz James F. , Gunstad John J. , Samuel Jesse E.
Published: June 2007

Caregivers of Alzheimer’s disease patients treated with memantine have reported improved frontal lobe behaviors. The present study examined these possible improvements in executive functioning using rater-blinded scoring of a clock-drawing test. Fifty-one Alzheimer’s disease patients were treated with open-label memantine for 10 weeks. Clock drawing and Mini-Mental State Examination data were collected before and after treatment. Clock drawing improved significantly with treatment, whereas Mini-Mental State Examination data did not. Twenty-seven patients judged as improved in frontal lobe behaviors by caregivers demonstrated a statistically significant improvement in clock drawing to command, whereas 24 patients judged to be unchanged or worse with memantine in their frontal lobe behaviors had no change in their clock drawing and had worsening on their Mini-Mental State Examination. The current findings suggest that memantine improves frontal lobe behavior in some Alzheimer’s disease patients and that clock drawing to command may be sensitive to these improvements.
Perceptions of the Process of Care Among Caregivers and Care Recipients in Dementia Care Networks
Authors: Jaglal Susan , Cockerill Rhonda , Lemieux-Charles Louise , Chambers Larry W. , Brazil Kevin , Cohen Carole
Published: June 2007

The Dementia Care Networks Study investigated 4 community-based, not-for-profit dementia care networks in Ontario, Canada. Investigators examined whether sociodemographic and health characteristics, type of support network, and amount of service use among care recipients and caregivers (n = 267 dyads) were associated with experiences with care processes. The process-of-care constructs were: family physicians' awareness of services; experiences with health care workers, and assessment and placement activities. The findings highlighted that family physicians' understanding of dementia and their ability to work with the dyad to become aware of and accept services, was an important component in the dyad's satisfaction. If caregivers received home support and the care recipients received emotional support from their social support network, they were more likely to be satisfied with their experiences with health care workers. In summary, increased awareness and provision of services were associated with more positive perceptions of network effectiveness.
Use of the Certified Nursing Assistant Pain Assessment Tool (CPAT) in Nursing Home Residents With Dementia
Authors: Cervo Frank A. , Raggi Robert P. , Bright-Long Lory E. , Wright William K. , Rows Ginette , Torres Adrian E. , Levy Ronnie B. , Komaroff Eugene
Published: June 2007

The purpose of this study was to develop a pain assessmenttool utilized by certified nursing assistant (CNA) direct-care providers for nursing home residents with dementia and to examine the impact of such a tool on their function, behavior, or medication use. In the first phase, 41 items from an observational pain assessment tool were correlated with an objective pain “gold standard”; 12 statistically significant items were retained and used in the CNA pain assessment tool. Symmetry analysis was then conducted to determine if this resulted in any significant change in resident function, behavior, or medication use. This failed to detect significant change in these characteristics. A pain assessment tool utilized by CNA direct-care providers can be developed for use in nursing home residents with dementia. Further study is required to determine whether the use of such a tool will improve their function or quality of life.
Is the glass half empty or half full?
Authors: Whitcomb Joan B.
Published: June 2007

Caregivers of Alzheimer's patients are faced with a tremendously trying task. It is imperative that caregivers are knowledgeable about strategies and techniques for caring for patients. This article explains creative and effective methods of dealing with AD patients. Some of these care techniques are adapted from other disciplines. It is suggested that these care techniques are shared through support groups, or by telephone or written correspondence.
Understanding the memory loss of Alzheimer's disease
Authors: Hyman Bradley T. , Van Hoesen Gary W. , Kromer Leslie J. , Damasio Antonio R.
Published: June 2007

Post-mortem examination of the brains of patients with Alzheimer's disease revealed both a regional and a cellular specific pattern of neurofibrillary tangles. The neurons that are affected are crucial projection neurons for memory-related structures in the medial temporal lobes. There loss is likely to interfere with normal learning and memory.
One step at a time
Authors: Chiverton Patricia , Goldenberg Beth
Published: June 2007

Alzheimer's disease (AD) takes as its own many victims the afflicted individual and the family or care providers. What happens to a family experiencing AD has been described as a “funeral that never ends. “ The endless hours of provision of care and the fact that our health care and legal systems are as yet unresponsive to the plight of the family, make the task of coping extraordinarily difficult. This paper focuses on the family, both in recognizing that support and care are needed by the family in managing its own needs and in offering practical suggestions for the planning of care for the victim.
The record of independent living
Authors: Weintraub Sandra
Published: June 2007

This paper describes the Record of Independent Living, a new measure of activities of daily living specifically designed for the evaluation of elderly patients experiencing cognitive decline.
Alzheimer's memory strategies
Authors: Zandi Taher , Woods Sheirel
Published: June 2007

Problems associated with the communication processes between Alzheimer's patients and their caregivers is suggested to be related to the memoryfailure of the Alzheimer's patient. In this study we explored the ways in which the Alzheimer's patient's recall ability of verbally communicated information may be improved. TWo strategies that werefound to be effective were: (1) simultaneous presentation of pictorial and verbal information; and (2) the enhanced reproduction of the processed information through the provision of response chosen. Findings from this study suggest that the A lzheim ers m em ory deficit does not globally affect the overallprocessingstrategies and that communication may improve ifothermodes of communication are introduced.
Improving cognitive abilities of elderly Alzheimer's patients with intense exercise therapy
Authors: Lindenmuth G. Frank , Moose Barbara
Published: June 2007

This study focused on changes in the cognitive abilities of Alzheimer's patients residing in two separate long term care facilities as they were part of a group exercise therapy program. The research problem of this study was how to measure possible improvement in cognitive abilities in this population. The sample consisted of43 elderly (65-98 years old) Alzheimer's patients who resided in either of two convalescent homes in Pennsylvania. Patients who had been diagnosed as having Alzheimer's disease by their physician were assigned to either group exercise therapy, or to a no treatment control group. A pre-test, post-test experimental design was utilized in an attempt to control extraneous variables. The study was based on the premise that daily group exercise enhances physiological as well as psychological processes and consequently may im-prove cognitive abilities of patients with Alzheimer's disease. A student's t-test was utilized to test significance. The difference in the before and after scores of the experimental group (exercise) were significant (p .001) while the control group change was not significant. It can therefore be concluded that the hypotheses of this study was supported by the data obtained.
Alzheimer's disease: A study of assessment and stages
Authors: Joiner Judy , LeDuc Janet , Neubauer Judi , Stehman Jean Mason , Strachan Geraldine , Glenner Joy
Published: June 2007

This investigation was performed for the purpose of determining whether the majority of Alzheimer's disease (AD) patients have well defined symptoms during the course of the disease that make it possible to characterize thefunctional level of the patient. There are numerous classifications of the stages of AD. The simplest of these classifications divide the disease into three stages (see Table 1). 1. Onset (Light) 2. Middle (Moderate) 3. Terminal (Severe)

From a predictive standpoint it is important to know definable steps in the progression of the disease and when a patient passes from one stage into the next stage. This assessment has importance both in terms of caregiving procedures as well as medicinal therapy, e.g., medication, and long term care provisions. The Alzheimer's Family Center, Inc. (AFC) has researched data on 12 AD patients who were reviewed in a two-year retrospective study (see Table 2).
Interactions by design
Authors: Nissenboim Sylvia , Vroman Christine
Published: June 2007

The Positive Interactions Program is a series of activities and planned interactions that encourage the AD person to experience success through various sensory focused tasks as well as daily living and physical activities. These activities have been grouped into categories and broken down individually into sequential steps. This article is designed to provide the information you need to utilize these activities. The AD patient's present abilities, at whatever level, are the focus of his individualizedprogram. The purpose is not to regain lost skills or to learn new skills. There will not be success if you are aiming beyond his level. The magic of the Positive Interactions Program lies in the quality of interaction, rather than the ability of task completion.
Husbands caring for demented wives: Sequelae of loss of wife as a support
Authors: Dura Jason A. , Haywood-Niler Elizabeth
Published: June 2007

Epidemiological data suggest that men benefit more from marriage than women, and suffer more from widowhood. When older mens' wives have progressive dementia it may be especially difficult for husbands. Twenty-one husbands caring for a wife with progressive dementia were compared with age, sex, and education-matched married peers on the role of their wives as supports, general social support available to them and requested of them, as well as distress measures. Caregiving husbands were less likely to list their wives as a significant support source and reported feeling lonely more often. On average, caregivers reported one fewer social support network member and were significantly more distressed than their non-caring counterparts. No differences were found between caregiving and control husbands on the frequency of contacts with network members, closeness to members, and frequency of making or receiving requests for support. Caregiver distress was correlated with patient impairment, but not duration of caregiving.
Alzheimer's disease and the need for supervision
Authors: Reed A. Thomas , Lach Helen W. , Smith Laurie , Birge Stanley J.
Published: June 2007

Caregivers of 35 Alzheimer's disease patients (AD), were interviewed regarding the amount of time the patient is left alone, previous accidents and hazardous behaviors, as well as the caregiver's perception of the patient's safety and the need for supervision. Dementia severity was highly correlated with the perceived need for supervision (p < .001). Dementia severity was less strongly associated with actual supervision intensity (p = .038). The variable most strongly associated with actual supervision was previous hazardous behavior in the past year (p < .001). Among the more severely demented, caregivers providing constant supervision were more likely to believe the patient was safe.
Awareness of Alzheimer's disease: A study in three rural Ohio counties
Authors: Boling T. Edwin
Published: June 2007

A random sample of respondents from 370 householis was interviewed in a telephone survey. Questions focused on: • Variability of awareness about Alzheimer's disease • How awareness is established, and • Family experience with the disease.
Delusions, hallucinations and depression in Alzheimer's disease: A biological perspective
Authors: Flint Alastair J.
Published: June 2007

Three symptoms complicating Alzheimer's disease - delusions, hallucinations, and depression - are discussed from a biological perspective. Relevant clinical, radiological and pathological data are reviewed and hypotheses are advanced regarding the possible biological mechanisms of these phenomena. In addition, pharmacological and physical treatments of delusions, hallucinations and depression in Alzheimer's disease are discussed. Areas for future research are suggested.
Historical changes in the subjective experience of Alzheimer's disease: The role of anxiety
Authors: Shorter Edward
Published: June 2007

Various obstacles impede the historical study of the patients' subjective experience of dementia, in particular the lack of testimony from the patients themselves and their families. The best historical sources for assessing the subjectivity of patients with dementia is probably doctors' accounts of the psychological symptoms of their patients. In evaluating a body of such accounts, chosen in a representative manner from the medical literature in the years after 1870, this paper suggests that an increase in levels of anxiety is the main change that dementia-Alzheimer's patients seem to have experienced historically. This rise in anxiety about the illness may be dated back several decades. Among the causes for such increased anxiety might be a greater tendency to institutionalize Alzheimer patients, and a higher societal valuation placed upon intellectual performance.
Alzheimer's disease: designing the physical environment
Authors: Brawley Elizabeth
Published: June 2007

As we become more deeply concerned with the care of people with Alzheimer's disease and related disorders, it becomes increasingly clear that design is not just an incidental concern, but is integral to a well balanced program for this population.

It is gratifying that over the last few years attention has begun to focus on the basic issues of quality of care. We have only begun to examine the potential of the physical surroundings in preventing and dealing with the loss of function-vision, hearing, mobility, social behavior and mental competence. It is, at the same time, equally disheartening that many involved in institutional care still seek only to meet minimum code requirements without responding to care, care management and the residence itself. The facilities themselves look dismal and depressing and perhaps more importantly, do not function much better.

The average facility may have a ”decorated“ lobby, but design that is both functional and attractive is the exception. Often buildings are renovated or ”designed“ without architectural or professional design input. These ”design efforts“ are characterized by the inclusion of super graphics, the cosmetic approach of bright colors and the inclusion of grab bars and handrails. It is my view that incorporating environmental design into the quality of care and care management programs can greatly enhance these programs to the benefit of both the cognitively impaired and the staff.
Effects of music on sleep in healthy elderly and subjects with senile dementia of the Alzheimer type
Authors: Lindenmuth G. F. , Patel Manish , Chang P. K.
Published: June 2007

Alteration in sleep function of the elderly is associated with the aging process. Subjective sleep surveys of the elderly commonly reveal a general dissatisfaction with the quantity and quality of sleep. The widespread utilization of sedative-hypnotic drugs in order to alleviate the sleeping complaints of the elderly probably rests on some untested assumptions made by physicians. Music has elicited some strong responses from subjects with Senile Dementia of the Alzheimer Type (SDAT), when other means of communication has failed. Music of a serene nature has been shown to lessen anxiety and allow individuals to relax. This study investigates music as an adjunct or alternative to sedative-hypnotic drugs in inducing sleep in “healthy” elderly subjects and patients with SDAT A behavioral assessment chart of sleeping behavior was designed and utilized by nurses on the midnight shift. Combined analysis of variance for the number of hours asleep for all four groups yielded a significant relationship between the numbers of hours asleep and music. A paired comparison between control and experimental SDAT disclosed a significant relationship between the use of music and the number of hours of productive sleep. A paired comparison of the number of hours asleep between control and experimental “healthy” elderly revealed no significant relationship.
Physician home visits for persons with dementia: Is there a need?
Authors: Collins Clare , Ogle Karen , Kokinakis Candance
Published: June 2007

This study explores the potential role ofphysician home visits in the care of persons with dementia. Family caregivers (n = 182) of relatives with irreversible dementia were surveyed about their use of physician home visits, perceptions of the availability of home visits and anticipatedfuture need for this service. Persons with dementia who had used home visits had higher functional and mobility deficits, were more likely to have used other types of in-home assistance and were more likely to require catheter or decubitus care. Over half of the sample intends to use physician home visits in the future, but mostfamilies have not investigated the availability of the service. Barriers to the use of physician home visits are presented and policy implications are discussed.
The relationship of problem behaviors in dementia patients to the depression and burden of caregiving spouses
Authors: Pearson Jane L. , Teri Linda , Wagner Amy , Truax Paula , Logsdon Rebecca G.
Published: June 2007

This study examined how 70 caregiving spouses of Alzheimer patients varied in their reports of depression and burden, and how these reports were associated with the nature and severity of patient behavior problems, in particular memory-related, depressive, and disruptive behaviors. Depression and burden were found to be overlapping, but separate constructs, with about half of the variance unshared. Caregivers were divided into subgroups according to high and low levels of depression and burden, with the three most common groups being low depression/low burden (46 percent), high depression/high burden (26 percent), and low depression/high burden (23 percent). Only 6 percent of caregivers reported high depression/low burden. The level of patient behavior problems varied significantly among the remaining depression/burden classifications. Caregivers in the high depression/high burden and low depression/high burden categories reported greater numbers of disruptive behaviors and greater reactivity to memory-related and disruptive behavior problems, compared to the low depression/low burden group. The implications of these findings as they pertain to further elaboration of individual differences in caregiving experiences and interventions are discussed
Respite-retreat for dementia caregivers: A demonstration
Authors: Nolan Karen A. , Trahar Margaret F. , Clarke Corita , Blass John P.
Published: June 2007

A one-day retreat focusing on spiritual renewal for caregivers was offered in conjunction with a concurrent dementia day care program. Postretreat questionnaire responses indicated positive attitudes overall toward the spiritual retreat, but many caregivers expressed a desire for greater informational content and more time for interaction with other caregivers. All were satisfied with the level of care patients received in the day program. Although there was no significant change in mean level of depression in caregivers following the retreat, the concurrent respite-retreat experience appeared to motivate several caregivers to try a group support service for thefirst time.
The impact of the total environment in the care and management of dementia
Authors: Coulson Irene
Published: June 2007

The way in which carers interact with residents is dependent on physical layout elements, how care is organized, available support and knowledge of carer processes. The major aim of this study was to examine the impact of the total environment in the care and management of dementia, based on interviews, observations and carer feedback sessions. Using the total environment model, a set of dementia care propositions evolved, which held true to all dementia units in the study. The propositions were used as guidelines for carers to participate in the development of strategies to improve the total environment.
The use of Piaget's theory in Alzheimer's disease
Authors: Thornbury Julia McGregor
Published: June 2007

Child-like behaviors of adults with Alzheimer's disease are often puzzling and stressful to caregivers. The possibility of using Piaget's child developmental model to understand these behaviors is explored in this paper. Based on data from recent studies revealing that adults with Alzheimer's disease appear to lose cognitive functions in the reverse order of acquisition in Piaget's theory, the purpose of this paper is to describe how the use of this theory to understand cognitive changes characteristic of AD might enhance caregiving techniques.
Emerging trends in environments for people with dementia
Authors: Cohen Uriel , Day Kristen
Published: June 2007

Using multiple methods, the authors conducted a review and analysis of 20 contemporary environmentsfor people with dementia This article briefly reviews some of the major trends and developments in these facilities, as they relate to therapeutic principles ofdesign. A design application-the Helen Bader Center; Milwaukee, Wisconsin-is presented as an example of an environment that integrates many of these goal-driven, research-based principles.
Impact of spouse caregiving on health behaviors and physical and mental health status
Authors: Connell Cathleen M
Published: June 2007

The impact of caring for a spouse with a progressive dementia on caregiver's health behaviors and health status was examined. Data collected from 44 spouse caregivers indicates that:

• Providing full-time care interferes with preventive health behaviors (eating nutritiously, exercising) and contributes to high risk behaviors (overeating, alcohol and substance use); • Health behaviors are frequently used as coping strategies; • Caregivers rated their own health as poorer than their spouse's health; and • Disabling (arthritis, cardiac and back problems) and stress-related health problems (migraines, colitis) are a consequence of and interfere with care provision.
Development of Alzheimer's disease special care units on a statewide level
Authors: Larrat E. Paul , McKernan-Markoff Janis L. , Lareau Maureen , Anderson Jean , Fretwell Marsha D. , Stoukides John
Published: June 2007

The Alzheimer Demonstration Project of Rhode Island is a statewide effort to nurture the development of Alzheimer's disease special care units in both public and private long term carefacilities. Since 1986, the effort has resulted in the establishment of eight special care units, the training of over four hundred health care professionals in both nursing homes, senior citizen centers and adult day carefacilities, the education and involvement offamily caregivers, and the implementation of a research protocol designed to evaluate the effectiveness of these facilities in improving patient outcomes. The project team has also developed special activity programsfor Alzheimer's disease residents, protocols for medication, regimen evaluation and alteration, as well as training materials for professional and family caregivers. Initial resultsfrom the research component of this project document positive effects on medication use, resident survival time and residentfunctional status.
Targeting the black church and clergy for disseminating knowledge about Alzheimer's disease and caregiver's support services
Authors: Chadiha Letha A. , Morrow-Howell Nancy , Darkwa Osei , McGillick Jan
Published: June 2007

This paper focuses on efforts to involve the black clergy in disseminating information about Alzheimer's disease and caregiver's support services to African American caregivers of Alzheimer patients. Because few African American families of elderlyAlzheimerpatients use the services of the local Alzheimer's Association, it was thought that this population might benefit from efforts to increase the awareness about both Alzheimer's disease and the Association's support services for caregivers of elderly Alzheimer patients. Three educational training sessions on Alzheimer's disease and caregiver's support services were conducted for clergy and lay persons. Efforts to involve the clergy in the educational training were successful when the training was included as an agenda item on the clergy's regular monthly meeting. Results of a program evaluation and knowledge survey indicated trainees benefitedfrom the Alzheimer's educational training and wished to share their knowledge with other clergy andfamilies of Alzheimer patients. Recommendations are offered for involving the church and clergy in knowledge dissemination about Alzheimer's disease and caregiver's support services.
Neuropsychological testing of older persons with dementia
Authors: Koss Elisabeth , Barry Margaret A.
Published: June 2007

As part of a broad evaluation of dementia that includes a medical and neurological examination, neuropsychological assessment provides standardized ways to understand the nature and extent of cognitive deficits, and is a powerful adjunct in establishing a diagnosis. Also, neuropsychological assessment is a quantitative measure of disease progression and an indicator of the efficacy of interventions, and consequently, directly hinges on crucial issues of treatment and behavior management. Administering tests to elderly demented patients requires special skills from an examiner Attention must be paid to the needs of elderly people as well as to those people with an insidious, emotionally charged illness. This paper proposes some guidelines for testing the demented person in ways that clarify interpretation of performance.