bluuebunny/crossref_metadata_2025 huggingface dataset:
Exterior space for patients with Alzheimer's disease and related disorders
Authors: Randall Priscilla , Burkhardt Sandra S. J. , Kutcher Joan
Published: June 2007

This paper examines program considerations for the design of exterior space for Alzheimer's disease patients. It is directed to planners and administrators, architects and landscape architects involved in the initial planning stages of an Alzheimer's disease facility (or nursing home) building project. The focus of the study is the Alzheimer's disease patient who is no longer able to attend to the activities of daily living (middle dementia), and therefore resides in a day care facility, a special unit, or a nursing home.

This paper outlines design schemes based on cognitive and behavioral symptoms of the disease. For example, sundowning (patient agitation and hallucination in late afternoon) is a common Alzheimer's diseases symptom. In order to ameliorate sundowning, the designer needs to provide not only familiarity and comfort, but also a way to minimize shadows that could be misinterpreted as frightening spectres. The exterior space should be located on the southeast side of the building in order to ensure only a monolithic building shadow cast into the garden by the afternoon sun. For this purpose, and a number of others discussed in the paper, siting is an important consideration in this design program. Considerations of agitation, frailty, loss of short-term memory, and reduced sensory perception suggest and control all elements of the design.

The study presents concepts and suggestions for creating outdoor activity and garden space for Alzheimer's disease patients. The outlined concepts may also be usefully employed in an already established facility. Creating exterior space that is safe and pleasant for Alzheimer's disease patients, as well as acceptable to adninistrators and visitors, is both a challenge and an attainable goal.
Classes for caregivers of persons with Alzheimer's disease: A practical approach
Authors: Cochrane Susan , Feldt Karen S.
Published: June 2007

A model for a series of educational classes for caregivers of persons with Alzheimer's disease is presented. This paper offers a rationale for comprehensive and practical classes as well as a detailed outline, bibliography, and tips for beginning instructors. Future areas of study include the long range impact of educational classes on the family's ability to manage the multiple tasks associated with the caregiver role.
Decision making and dementia
Authors: Zarit Steven H. , Goodman Caryn R.
Published: June 2007

One of the most complex problems facing families and practitioners is making decisions for the person with dementia. Families and other care providers are often faced with difficult decisions and they must weigh several potentially conflicting factors, including: • The patient's best interest, • What the patient previously indicated his or her preferences were, and • The potential of risk or harm to the patient or to others.

Examination of the process of decision making, including when to take over decision making and what principles to use in reaching a decision, can help prepare families and practitioners for some of the dilemmas they may encounter.
Adapting day care center settings for persons with Alzheimer's disease: Environmental design training for staff
Authors: Cohen Evelyn , Lyman Karen , Pynoos Jon
Published: June 2007

Until recently there has been limited awareness of the interaction between the adult day care environment and the functioning of participants and staff. Emphasis is often put on the program rather than on the setting in which it takes place. Even when environmental knowledge exists, there is often a lack of input by staff and adaptations may be made to poor physical conditions that can contribute to staff stress as well as reduced participant functioning.

This paper describes the development of training materials for an educational workshop. Thirty Alzheimer day care staff were participants. The purpose was to increase information concerning the impact of the physical environment on Alzheimer care, and to train “trainers” in this area. In developing training materials, evaluations of adult day care settings were made which included observer ratings, interviews with staff, and 35mm. slides of 12 Alzheimer day care facilities. A variety of materials were developed including a slide show and a script that represented three major areas of environmental design:

* Environmental cues to promote recall and wayfinding;

* Safety and accessibility; and

* Surveillance and wandering.

Findings within the adult day care centers evaluated are described. Pre- and post-test results are reported, indicating that awareness of the Participants was heightened in identifying and modifying design features in adult day care settings.

Practical contributions to the literature include materials on the planning of facilities for dementia care and training tools for staff.
Registration of Alzheimer patients in an autopsy program: Who does it and why?
Authors: Bidaut-Russell Michelle , Grossberg George T.
Published: June 2007

Registration of Alzheimer patients with an autopsy program is essential for research, for post-mortem validation of clinical diagnosis, and for genetic counseling of relatives. Although the number of Alzheimer patients is increasing, those undergoing autopsy constitute a minority because their relatives may be unaware of the benefits of autopsy or may be uncomfortable with autopsy as a sensitive issue. To learn about what motivates the families of Alzheimer patients to register them in an autopsy program, we surveyed the demographic characteristics and attitudes toward brain autopsy of next of kin to 250 consecutive registrants of the St. Louis University Medical Center I Alzheimer', Association Brain Bank. Mean age of respondents at registration of the patient was 56.9 ± 12.06. One-third of the respondents were registrants' spouses -and three out of five respondents had a parent with Alzheimer's disease. All respondents but three were white, and two-thirds of them were women. Forty percent of the respondents were at first either opposed or undecided about autopsy. Main objections to autopsy were uncertainty about the benefits of autopsy, concerns about disfigurement of body, and concern about delay of the funeral. Support organizations, such as the Alzheimer's Association played a more important role in informing family members about the benefits of brain autopsy than patients' physicians or nursing home staff. The most common reason for wanting an autopsy was concern about a possible hereditary component of Alzheimer's disease. Twenty-eight percent of the respondents had another relative with dementia
Psychodynamic perspectives on Alzheimer's disease and related dementias
Authors: Sadavoy J.
Published: June 2007

This paper describes internal psychological changes occurring secondary to the cognitive alterations of dementia of the Alzheimer's type. The relevance of psychodynamic models is reviewed with special emphasis on the interaction of dementia on processes conceptualized through self-psychology and object relations. Processes which are specifically altered by dementia of the Alzheimer's type and which are essential to the maintenance of the self, are memory, reality testing, insight and aspects of premorbid personality development. Clinical implications are outlined including environmental response to the patient's narcissistic needs, and containment of anxiety behavior.
Effectiveness of group work with the cognitively impaired older adult
Authors: David Paula
Published: June 2007

As a social worker in a special day care setting, I have documented the dynamics of a group's evolution and function as a successful intervention for older adults with varied forms of dementia. The benefits of the group modality, enhancing the quality of client's lives, has become apparent. Led by a social worker, in a structured format, members of the group have shown their capacity for mutual support, strengthened self esteem and allowing the group process to help maintain residual skills.
An in-home respite program for Alzheimer families
Authors: Kuhn Daniel R. , Kallish Carol
Published: June 2007

Family caregivers of those with Alzheimer's disease (AD) and related dementias desire affordable, in-home respite care both to relieve their perceived burden and to reinforce satisfactions associated with caring for a close relative. Caregivers also want paid helpers who are specially trained and effective in dealing with the wide range of symptoms manifested by those who have irreversible dementia. These needs have been addressed on a local level by the Chicago Area Chapter of the Alzheimer's Association in the form of the Alzheimer's Respite Training and Registry program. This paper describes the program's rationale, philosophy, training of aides, linkage with caregivers, administration, and future directions.
Automobile driving and Alzheimer's disease
Authors: Shemon K. , Christensen R.
Published: June 2007

Automobile driving surveys designed for drivers, nondrivers, and caregivers were mailed to 70 patients with a diagnosis of probable Alzheimer's disease and to their caregivers. The MMSE score of patients who were driving (n=16) was significantly higher (23.9 vs. 11.7 p < .001) than that of nondrivers. Other factors such as age, accident rate, and caregiver driving status did not differ. Caregiver surveys were utilized not only to validate patient responses, but also to identify their concerns. Actual behind the wheel test reports of 12 Alzheimer patients demonstrated serious deficiencies in judgement and in performance.
The prevalence of dementia: The confusion of numbers
Authors: Blume Lois , Persily Nancy Alfred , Mintzer Jacobo
Published: June 2007

The prevalence of dementia in American society is an important statistic. In order to allocate public dollars to both research and service programs designed for cognitively impaired persons and their families, and to aid policy makers at the community level in planning for services and facilities to meet the needs of their populations, accurate estimates of persons with dementia are critical. Inaccurate figures can lead to inefficiency in allocating resources at both the national and local levels, underutilization of resources resulting from overestimated demand, or barriers to access arising from excess demand for insufficient services.
Pathways: Serving the two victims of Alzheimer 's disease
Authors: Williams Judith K. , Stern Elliot J.
Published: June 2007

Pathways is a public-private partnership in Florida which was developed to test models of housing and support services for Alzheimer clients and their spouses, as well as to provide care in a home-like setting for those seeking a residential placement. It attempts to change the nearly inevitable choice of nursing home placement to a broader choice with the opportunity for couples to remain together in environments that meet the needs for safety, security, privacy and companionship. Guiding principles for the program were developed by interdisciplinary consensus.
Desires and perceptions of staff concerning work performance in a dedicated Alzheimer's facility
Authors: McCracken Ann L. , Gilster Susan D.
Published: June 2007

Clearly many authorities on Alzheimer's facilities and units indicate that staff are the key to a successfulI unit.1 No studies presently exist that have attempted to explore the desires andperceptions ofpersons who choose to work in this specialized environment. This article reports the findings of a study conducted at an 82-bed facility dedicated exclusively to the care of persons with Alzheimer's disease and dementia. Findings from this study will assist in planning an environment which decreases staff turn-over and increases staff satisfaction.
Needs of family caregivers and persons with Alzheimer's disease
Authors: Francis G. M. , Munjas B. A.
Published: June 2007

This study of 39 Richmond, Virginia residents with Alzheimer's disease and/or their primary caregivers was intended to replicate and extend Bennett's Needs Assessment of 40 persons in the District of Columbia area using the Older American Resources and Services Multidimensional Functional Assessment Questionnaire and the Caregiver Strain Questionnaire. The functional status profile revealed “good” socioeconomic resources, “moderately impaired” mental health resources, “severely impaired” physical health resources and Activities of Daily Living. The top three services used were housekeeping, legal/protective and supervision. Minimal cost in time per family was one and one-half hours per day at a weekly cost of $140. Caregiver strain wasfound to be in the moderate range. The most severe areas of strain were related to personality and behavioral changes.
Kin caregivers of the cognitively impaired elderly: Problems and interventions
Authors: Isenhart Elizabeth Gannon
Published: June 2007

Much can be found in the literature concerning the burdens, problems and stressors that caregivers experience. The following is an attempt to identify special needs of kin caregiver subgroups. It is hoped that the problems of the female categories within these subgroups are understood and that health care professionals will begin to develop an awareness that will lead to better ways to provide appropriate interventions.
Families in distress
Authors: McGannon Arlene
Published: June 2007

Families of persons with Alz-heimer's disease oftentimes face the difficult decision ofplacing their loved one in a care facility. This article addresses some of the predominant stresses involved in this process, and looks at how the long-term care industry can assist families in lessening the burden of such placement
What people know about Alzheimer's disease: A study of public knowledge
Authors: Steckenrider Janie S.
Published: June 2007

Given the frequent attention and focus on Alzheimer's disease by the mass media over the recent decades, it is assumed that the American public is fairly well-informed and knowledgeable about the disease. However, what the public actually knows about Alzheimer's disease and the characteristics of those persons most informed have generally remained a mystery as only afew aspects of disease awareness have been sporadically measured. Thus, this study explicitly explores the level of overall public knowledge about Alzheimer's disease measured through survey research based on a nationally representative sample of 1498 persons age 45 and over. The Alzheimer's Disease Awareness Test (ADAT) was developed and utilized with 17 items dealing with disease etiology, symptoms, and misconceptions. While almost everyone (91 percent) has heard of AD, there are wide gaps in disease knowledge among a significant portion of the public. Two tiers of knowledge arefound to exist indicating the different types of information known:

The Easy/General Knowledge Tier is comprised of eight items tapping disease aspects that are less technical in nature, require little conceptual sophistication and tend to be facts widely disseminated by the mass media; and

The Hard/Specific Knowledge Tier is comprised of nine items requiring more complex understanding and deal with more scientific disease aspects.

Most persons score moderately high on the Easy/General Index while few do well on the Hard/Specific Index. Correlates of a high level of knowledge on both tiers are education, age, knowing someone with AD as well as the closeness and relationship of the effected person, and having parents who are living
The effects of a socialization and music therapy intervention on self-esteem and loneliness in spouse caregivers of those diagnosed with dementia of the Alzheimer type: A pilot study
Authors: Clair Alicia Ann , Tebb Susan , Bernstein Barry
Published: June 2007

There is an increasing need to provide interventions which offer opportunities for individuals who care for spouses and other family members to decrease their loneliness and increase their self-esteem. This pilot study, which included four caregivers and their spouses, was a joint effort including music therapy and social work services. It was designed to determine if caregivers who had no prior musical experiences could be trained to use music with their care recipients. It was also designed to determine if caregivers' participation with other care giving and care receiving couples in a social gathering with music therapy programming would affect changes in their measure of loneliness and self-esteem. The results indicated that three of the four caregivers who participated in this study had changes in their selfes-teem scores which indicated improved self-esteem. These changes were not significant, but approached significance at the .05 level of confidence of two subjects. One subject showed little to no change in self-esteem. None of the spouses had significant changes in their measure of loneliness, although The American Journal of Alzheimer's Disease and Related Disorders & Research, January/February 1993 24 two of the four subjects showed trends for less loneliness while one remained about the same and one increased slightly. Additional research is required to further establish the effects of music therapy on self-esteem and loneliness in caregivers offamily members diagnosed with probable Alzheimer's disease
Instrumental activities of daily living and eligibility for long term home health care
Authors: Calvani Dorothy , Lawlor Brian
Published: June 2007

Federal eligibility criteria for non-institutionalized long term care stipulates that older persons must require human help with two personal activities of daily living (ADL) before they qualify for services. Therefore, physically healthy cognitively impaired persons may be discriminated against. The purpose of this study was to compare and contrast a demented, physically healthy group with a non-demented, physically compromised group to determine if instrumental activities of daily living (IADLs) rather than ADL function, is a better indicator of the need for long term home health care services (LTC). Although the Alzheimer group had significantly higher ADL function than the non-demented medically ill group, both groups showed similar impairment on IADL function. This would suggest that IADL function is sensitive to both cognitive and non-cognitive changes. We conclude that IADL rather than ADL function, is a more equitable criterion in determining eligibility for long term home health care.
Taxonomy of evening and nighttime behavior patterns of persons with Alzheimer's disease
Authors: Crosby Leanna J. , Wyles Christina L. , Verran Joyce A. , Tynan Concetta M.
Published: June 2007

Among the many symptoms associated with Alzheimer's disease, disrupted nighttime sleep has been identified as one of the most troublesome. Frequently disrupted sleep, as well as nighttime wandering, determines whether or not the person is able to remain within his/her home or must be institutionalized. The first step toward altering disrupted sleep is to gain an understanding of the associated behavior patterns. The purposes of this research were to:

• Describe - based on family care provider reports, the evening and nighttime behavior patterns of persons diagnosed with Alzheimer's disease; and • Develop a taxonomy that characterized the identified patterns.

Data were collected using a guided interview format. Eleven care providers were interviewed at length and asked to respond to open-ended questions. Themes and categories were identified including two major, four minor and 10 sub-categories. In addition, precipitating events that triggered, intensified or accelerated the behavior patterns were identified. These data will be used to develop an instrument designed to quantify the behaviors associated with sleep disruption. This will allow for evaluation of care provider burden as well as the effect of interventions designed to enhance the sleep/rest of persons with Alzheimer's disease.
Service needs and interests: A comparison of African American and white caregivers seeking Alzheimer assistance
Authors: Cox Carole
Published: June 2007

This paper is a report on the findings of a study of the use of Alzheimer's Association services in Washington, DC and Baltimore, Maryland by African American and white family caregivers. The findings reveal that both sets of caregivers contacted the Associations in similar stages of their caregiving situations. Both groups were well educated. Approximately one fourth of all caregivers were college graduates. The African Americans included a more diverse set of caregivers who also received more hours of assistance in their caregiving tasks. However, neither group felt understood by their supports and the African American perceived a significantly greater need for more assistance. All caregivers were interested in using the services of the Associations with the African Americans particularly more interested in the telephone advice program and the I.D. bracelets. The findings also reveal that the predictors of the need for help differ from those predicting future calls to the Associations.
Alzheimer's disease and dementing disorders: Practices and experiences of rural physicians
Authors: Glasser Michael
Published: June 2007

This paper presents information on rural primary care physicians' diagnoses, the procedures used, treatment recommendations, as well as reported advantages and disadvantages ofpracticing in a rural setting and managing patients with Alzheimer's disease and dementing disorders. A total of 102 primary care physicians in rural Illinois counties were interviewed (response rate = 72.3 percent). There was considerable variability in physicians' responses to the causes of dementia syndrome and the procedures used in making a diagnosis.

When questioned in an open-ended format about possible causes of dementing disorders, physicians mostfrequently mentioned Alzheimer's disease (80 percent), multi-infarct dementia (56percent), and drug toxicity (53 percent). “Non-specific” causes were also mentioned, including arteriosclerosis (36 percent), organic brain syndrome (27 percent), and old age (25 percent). Laboratory tests and CT scans were most often used in the diagnostic process.

Less than 10 percent of the physicians used more formal, cognitive screening tests like the Mini-Mental State Exam. Less than one-half of the physicians had previously recommended nursing home placement in the management of their dementia patients. Physician age, practice type (solo/group) and specialty (internal/family medicine) were associated with some of the physicians' responses regarding dementia causes and procedures used in diagnosis.

The rural setting was viewed as inadequate with regard to laboratory facilities and supportpersonnel as well as problematic in requiring long distance travel for consultation. On the other hand, the rural community provided an advantage over the urban in opportunities for support and cooperation forfamilies andfriends to assist in managing the care ofdementia disorder patients.

Alzheimer's disease and other dementias present the problem of uncertainty at many levels including medical, patient outcome, and family management issues. In the rural setting, the physician often represents the entire health professions community. It is imperative that rural physicians be prepared to both diagnose and, in turn, manage the complex and difficultsituation created by dementia syndrome.
The impact of infection on agitation: Three case studies in the nursing home
Authors: Cohen-Mansfield Jiska , Werner Perla , Marx Marcia S.
Published: June 2007

Agitation is a major problem in the demented elderly, and may be related to pain and discomfort. The aim of this article is to investigate the relationship between agitation and infection in three highly agitated cognitively impaired nursing home residents. Agitation was assessed using the Agitation Behavior Mapping Instrument (ABMI), a nonobtrusive assessment tool used for direct observation and recording ofagitated behaviors. Information concerning antibiotic drug use was extractedfrom the participants'charts.

A relationship was inferred between the presence of an infection (as suggested by antibiotic medication use) and higher levels of agitation. Elucidating the possible antecedents of the agitated behaviors is the first step in the management of these disruptive behaviors.
Some clinical consequences of the rest and activity disturbance in Alzheimer's disease
Authors: Hopkins Robert W. , Rindlisbacher Peter
Published: June 2007

Recently, the use of activity monitoring has led to several interesting findings related to activity/rest issues in the care and management of Alzheimer patients. Evidence suggests that the “sleep” disturbances commonly reported in Alzheimer patients are actually a disturbance of the normal circadian cycle. This seems to be a normal progression of the disease and as such is not likely treatable with behavioral or pharmacological methods. These altered activity/rest patterns have direct implications for such areas as physical and pharmacological restraint use, supervision and injury risk, access and mobility issues, hospital ward design, and staffing policies.
Environmental influences on agitation: An integrative summary of an observational study
Authors: Cohen-Mansfield Jiska , Werner Perla
Published: June 2007

This paper consolidates empirical findings from an observational study aimed at elucidating the environmental conditions surrounding the manifestation of agitated behaviors. Although great variability was found between and within participants, when environmental conditions were analyzed separately, different behaviors occurred under different environmental conditions and seem to have different meanings. For example, verbally disruptive behaviors seem to be associated with discomfort. Others, such as requests for attention and aggressive behaviors, may be adaptive, and may signal an attempt to communicate needs. Additionally, certain environmental conditions seem to affect agitation regardless of the specific manifestation, such that most agitated behaviors seem to increase when the resident is physically restrained, inactive, or alone.
Aggressive behavior in institutionalized elders: A theoretical framework
Authors: Kolanowski Ann
Published: June 2007

This review article explores current research on aggression in institutionc ized elders and proposes a theoretical framework for use by caregivers. The relationships of brain dysfunction, past behaviors, social networks and environmental triggers to the expression of aggression a te discussed. The framework can be used to generate research hypothesis, or as a guide for assessing rise factors associated with these behaviors.
A decision model for guiding the management of disruptive behaviors in demented residents of institutionalized settings
Authors: Williams David P. , Wood E. Carrol , Moorleghen Frances , Chittuluru V. C.
Published: June 2007

Nursing personnel contend with disruptive behavior in persons with dementing disorders on a daily basis. This article presents a practical decision model consistent with industry-wide efforts to reduce chemical and physical restraints. The model screens behavior having medical or somatic causes to ensure appropriate assessment and intervention. Four approaches taken from the literature address functionallydriven behavior: appropriate levels of stimulation, iatrogenic caregiving effects, stimulus control, and applied behavior analysis. Paraprofessional nursing personnel are able to learn and use this model with relatively little professional support.
A vocational workshop for residents and day care participants with dementia
Authors: Reingold Jacob , Werner Bryan J.
Published: June 2007

The Hebrew Home for the Aged at Riverdale developed and implemented a unique vocational workshop for a carefully screened population of residents and day care participants diagnosed with early to moderate dementia. The Hebrew Home's multidisciplinary team undertook a three-month planning process to define the populations to be served, select appropriate measurement tools, and train unit-based and day care social work, nursing, and occupational therapy professionals to perform the measurements. Attendee selection methods, program logistics, space requirements, scheduling, staffing, program timetable and a three-year budget were developed. Department of Labor certification, attendee transportation and scheduling vis-a-vis other social and therapeutic activities, clinic and diagnostic testing appointments, meal times and retention process, staffdevelopment, record-keeping, transportation coordination and production qualhty control were accomplished during the first year of operation. The authors provide a description of the programs first year experience as a basis for replication in similar settings.
Cautiousness in testing for Alzheimer's disease
Authors: Gunnarsson Lars-Gunnar , Lundberg Claes
Published: June 2007

Recently it was suggested that the instilling of tropicamide (an acetylcholine receptor antagonist) in the eye could be a simple diagnostic tool for Alzheimer's disease. The sensitivity was 95 percent and the specificity was 94 percent. However there might be several biological reasons, other than dementia, for a positive eye test and the predictive value of a positive test might be low even if the specificity and sensitivity should prove to be as high as in the presented pilot study.
A comparison of Spanish versus English-speaking caregivers' perception of early symptoms of Alzheimer's disease
Authors: Taussig Maribel , Mack Wendy J.
Published: June 2007

The pattern of initial symptoms reported by caregivers of Alzheimer's disease (AD) subjects were described and compared in 45 Spanish-speaking (SS) and 84 English-speaking (ES) caregivers. The majority (56 percent) of SS caregivers were monolingual. All caregivers were given a standard interview in their respective language which included information on the age at onset and initial symptoms observed in the AD subject. First symptoms reported most frequently by ES caregivers fell into the following categories: memory (27 percent), activities of daily living (ADLs, 21 percent), disorientation (13 percent), and personality changes (13 percent). In contrast, SS caregivers reported memory (47 percent), psychological problems (16 percent), and personality changes (11 percent) at the first sign of the disease process. After adjusting for duration of illness, significantly more SS than ES caregivers reported memory loss, and sign ficantly less SS than ES caregivers reported difficulty with ADLs as an initial symptom of dementia. In addition to cultural group, older caregivers were significantly less likely than younger caregivers to report memory loss as a first symptom. Caregivers of AD subjects with onset before, versus after age 70 were more likely to report ADL deficits as thefirst symptom. Finally, the report ofpsychological problems as afirst symptom was related to lower caregiver education and longer duration between disease onset and interview. These results highlight the need for professionals to consider potential cultural differences when assessing impairment in elderly persons. In addition, the high prevalence of non-English-speaking caregivers emphasizes the need for Spanish-speaking professionals to optimally service and research health needs in this growing elderly Hispanic population.
Clinical differentiation of the Rey Auditory-Verbal Learning Test
Authors: Britt Dana M. , Adams Serrhel G. , Godding Phillip R. , Grothues Carol A. , Varnado Paula
Published: June 2007

The Rey Auditory-Verbal Learning Test (RAVLT) was used to assess memory and learning in dementia, psychiatric, general medicine, and head injury patients. Subjects were 127 older male veterans who received the RAVLT as part of a routine assessment. The dementia group recalled fewer total words than the psychiatric and general medicine groups. While all men demonstrated a positive learning curve, learning patterns varied among the four groups. Recency effects were seen in all groups. Primacy effects were not seen in the dementia group. Specific trials of the RAVLT appear to distinguish groups better than the total score. Additionally, sequential organization of information may influence memory and learning in these groups.
Increasing oral intake in dementia patients by altering food texture
Authors: Boylston Eula , Ryan Cass , Brown Carla , Westfall Beth
Published: June 2007

Dementia patients lose the ability to tolerate texture in their diets which can result in a refusal to eat and subsequent weight loss. By observing for aversive eating behaviors and manipulating the diet texture, oral intake and weight can be maintained.
Caregivers and the nutritionalneeds of the patient with Alzheimer's disease: A pilot study
Authors: Ryan Cass , Kline Mya , Hamrick Dale , Edwards Kristen
Published: June 2007

A pilot study was conducted at a day care center for those affected with Alzheimer's disease (AD). The day care center is affiliated with a statewide Department of Mental Health. The purpose of the study was to determine the adequacy of caregivers' knowledge of nutrition in general and of the nutritional needs of the AD affected person, specifically. Also studied was the caregivers'perceived amount of burden and the caregivers' levels of depression.

It was found that the caregivers' knowledge of nutrition was below average overall, despite the fact that many were educated beyond high school. A high level of caregiver perceived burden was also discovered. Depression, however did not seem to be a factor with these caregivers.

While this was only a pilot study (n=12), one can begin to see the importance of assisting caregivers with nutrition education. The better prepared caregivers are to take care of their elderly, the longer it is before nursing home placement becomes a consideration. Health care workers are in an excellent position to assume this teaching role.
Pragmatic assessment of communication in dementia (PAC-D)
Authors: England Juliana E. , O'Neill John J. , Simpson Robert K.
Published: June 2007

This study evaluates the pragmatic communicative abilities ofpatients with dementia, primarily of the Alzheimer's type. A special screening test andfour other tests were utilized along with video recordings of selected subjects' test performances. Results revealed significant correlation among scores of the various tests as well as some communication skills which appear to be robustfor progression of dementia.
STIR Success Through Individual Recreation: Working with the low-functioning resident with dementia or Alzheimer's disease
Authors: Russen-Rondinone Tonya , DesRoberts Anne-Marie M.
Published: June 2007

STIR, Success Through Individual Recreation is examined to determine the benefits of individualized recreational activities geared towards the lower functioning Alzheimer's population. The STIR program has proven to be a successful way of meeting social and recreational needs of all levels of individuals afflicted with Alzheimer's disease.
Attitudes about Alzheimer's disease and the dementia service delivery network among family caregivers and service providers in rural Michigan
Authors: Connell Cathleen M , Kole Sara L. , Avey Holly , Benedict Christopher J. , Gilman Sid
Published: June 2007

The Community Outreach Education Program (COEP) was designed to provide educational interventions to disseminate information about the diagnosis, assessment, management, and treatment of dementia to health care professionals, service providers, staff of volunteer and community organizations and family caregivers. The present study describes one component of the needs assessment phase of the COEP-focus group interviews conducted with family caregivers and service providers. The predominant themes identified included myths and misconceptions about dementia, barriers to effective service delivery, and community strengths. The results were used to inform the curriculum and format of the community-based dementia education interventions designed for four sites in rural Michigan.
Obtaining consent for autopsy in dementia research: The Memory and Aging Project experience
Authors: Norton Joanne B. , Morris John C.
Published: June 2007

Although clinical diagnostic inaccuracy rates in dementia have been reduced in recent years because of increased understanding of dementing disorders, autopsy remains the definitive means for diagnosis of Alzheimer's disease (AD). However, barriers to obtaining autopsy still exist. We report here the voluntary autopsy consent protocol developed by Washington University's Memory and Aging Project. Suggestions by staff and participants over the years have been implemented to develop a protocol that insures a successful autopsy program. From a wallet-sized card of instructions for family reference, to 24-hour availability of staff families and institutions are provided a smooth transition from place of death to autopsy. The rate of voluntary autopsy consent for Memory and Aging Project participants (70 percent) reflects the effectiveness of this program.
Factors associated with family caregivers' choice not to use services
Authors: Hamilton Edith M. , Braun Jean W. , Kerber Paul , Thurlow Christine , Schwieterman Irma
Published: June 2007

The purpose of this descriptive study was to determine adaptation by family caregivers of persons with Alzheimer's disease who did not use community services. Previous research has focused on the use of services, highlighting the need for studies examining factors associated with service nonuse. Lawton and Nahemow's ecology model of adaptation and aging served as the foundation for this study; the relationship between personal competence and environmental press depicts a level of adaptation.

A mail and telephone survey of 70 caregivers revealed reasons for not using services to which they had been referred, as well as patterns of adaptation to caregiving. Personal competence, measured as perception of caregiving mastery, emerged as a significant factor in service nonuse. Caregiver gender and daily hours of caregiving, an environmental press factor combined with perception of mastery to most often correctly classify respondents' high and low adaptation. Strategies for enhancing caregiver competence should be given highest priority by primary health care professionals.
Rethinking Alzheimer's disease: The impact of words on thoughts and actions
Authors: Fazio Sam
Published: June 2007

Language used to describe Alzheimer's disease is largely negative and contributes to the development of people's perceptions, interpretations and approaches to care. By using a technique called reframing, or focusing on positives or solutions, negative terms can be renamed to a positive or less negative alternative. These new descriptions can then create new ways of thinking and interacting. As descriptions and interactions change. family members and other caregivers will be able to recognize and appreciate the opportunities for growth and development that the disease experience can give to them, rather than only what it takes away.
Volunteers in a peer support project for caregivers: What motivates them?
Authors: Pillemer Karl , Landreneau L. Todd , Suitor J. Jill
Published: June 2007

in recent years, human service agencies have attempted to recruit volunteers from the community at risk to provide emotional and instrumental support to other individuals experiencing the same condition or problem. Programs that assistfamily caregivers or relatives with Alzheimer's disease are on the forefront of using such volunteers, who have themselves been caregivers, as a method of helping to meet family members' needs. This article addresses the question: Why do these individuals choose to volunteer? As an alternative to previous conceptualizations of volunteer motivation, we suggest that identification is a major motivating factor We then present qualitative and quantitative data on volunteer motivation from the 'Peer Support Project'-a friendly visitor' support intervention for family caregivers to persons with Alzheimer's disease. in addition, we discuss the implications of the results for recruiting volunteers in AD caregiver support programs.
Reflections on a caregiver enrichment program
Authors: Trimmer Carolyn , Martin Kristin , Svetlik Doris , Sizemore Mark , Weiner Myron F.
Published: June 2007

The authors report their preliminary impressions of a caregiver enrichment program designed to mitigate caregiver burden, The program included individual needs assessment, an educational program, home visits, and an algorithm-based series of interventions based on a modification of the Caregiver Burden Inventory (CBI). Six illustrative cases are included that demonstrate the needfor individualized assessment and intervention rather than a fixed program of interventions
The effect of sensory stimulation activities on the psychological well being of patients with advanced Alzheimer's disease
Authors: Witucki Janet M. , Twibell Renee Samples
Published: June 2007

The authors investigated the effects of sensory stimulation activities on the psychological well being of 15 persons institutionalized with advanced Alzheimer's disease. A recently developed instrument, the Discomfort Scale for Dementias of the Alzheimer's Type (DS-DAT), measured nine indicators of discomfort and provided an outcome measure for interventions in this population. Mean baseline DS-DAT scores suggested that participants experienced a moderately high level of discomfort. Results indicated that overall discomfort decreased significantly during three stimulation interventions, including music, touch and smell. The DS-DAT variable of fidgeting body language also decreased significantly7 during three sensory stimulation activities.
An assessment and intervention study of aggressive behavior in cognitively impaired institutionalized elderly
Authors: Middleton Joan I. , Richardson J. Steven , Berman Elliot
Published: June 2007

Aggressive behavior is a common problem among elder persons suffering from dementia. It puts themselves, and other persons around them at risk of being injured.1 This qualitative study observed four individuals with Senile Dementia of the Alzheimer's Type (SDAT) who were living in a long term care facility and demonstrated a great deal of aggressive behavior It assessed these individuals for a baseline of behaviors, made environmental changes, and assessed the results. The interventions were successful in decreasing the amount and intensity of the aggressive behavior in three of the individuals studied. The pattern of aggressive behavior and possible causes of this behavior seemed to originate from distinct causes in each of these individuals.2
Copying and its concomitant tracing: Advantages for clients with dementia
Authors: Tate Frederic B. , Brown Walter L.
Published: June 2007

The purpose of this article is to discuss the advantages of using copying and tracing during supportive, educational and therapeutic sessions with clients who are diagnosed with dementia. Originality and inventiveness are pursued to such a great extent in working with clients, that this population for whom such is not always possible, may be forgotten. The authors attempt to demonstrate that copying and tracing are perfectly legitimate and often productive forms of operation for clients with Alzheimer's disease and other forms of dementia.
How do physicians diagnose dementia? Evidence from clinical vignette responses
Authors: Fortinsky Richard H. , Wasson John H.
Published: June 2007

This study examined how a sample of family practitioners, general internists, and osteopathic physicians practicing in the state of Maine (N=353) diagnose symptoms of cognitive dysfunction. Physicians' reported diagnostic approaches were compared to American and Canadian expert panel recommendations, and were associated with their sociodemographic and office practice characteristics. Sample members responded to a self-administered questionnaire, which was completed in response to a clinical vignette describing a patient with either mild symptoms or more progressive symptoms of cognitive dysfunction. Results showed that 59 percent of respondents would perform a formal cognitive status test and 32 percent would perform a depression screening test; both types of tests are recommended by American and Canadian expert panels. Adjusting for other factors, female physicians were twice as likely as males to perform a depression screening test (OR=2.04; 95 percent C1=1.13-3.67). Most respondents (87 percent) would order at least three of four recommended laboratory tests, and 59 percent would order a computerized tomography (CT) scan, even though expert guidelines are ambiguous about the value of CT scans in diagnostic workups. Diagnostic approaches were not significantly affected by plans to refer patients to other physicians for additional testing. Practicing physicians should be encouraged to perform recommended nueropsychological and mental status tests when patients present with symptoms of cognitive dysfunction.
Staffing and the mealtime experience of nursing home residents on a Special Care Unit
Authors: Kayser-Jones Jeanie , Schell Ellen S.
Published: June 2007

As part of a study that examined the social, cultural, clinical, and environmental factors that influence eating behavior in nursing homes, the effect of staffing on the mealtime experience of residents in a Special Care Unit (SCU) for dementia patients was investigated. An adequate staff to resident ratio, the presence of a knowledgeable and skillful nursing assistant who was an excellent role model, and sufficient supervision positively affected the experience of residents, making lunchtime a pleasant and nourishing event. In the evening, however; overtaxed and poorly supervised aides resorted to strategies that made dinnertime a hurried, unpleasant experience and put residents under duress. A discussion of how to provide extra help at mealtime, improve the education and training of staff, and enhance supervision at mealtime is presented.
A Total Environment Quality of Care approach to evaluation of management and care at two dementia care units in Tasmania
Authors: Coulson Irene , White Joan
Published: June 2007

When improving service delivery and best practice approaches to dementia care, it is imperative that the total environment be examined rather than just enhancing staffing and programming. Achievement of an integrated approach to care involves examining all aspects that the resident and staff experience during the process of care. This study examined the impact of the total environment in the care and management of residents in two dementia units in Tasmania. The research also tested the applicability of the Total Environment Quality of Care Model and the dementia care propositions
An exploratory study of pain in the institutionalized elderly
Authors: Middleton Joan I. , Knezacek Sandy , Robinson Lara , Hartley Terry , Kaasalainen Sharon
Published: June 2007

There is a paucity of research concerning pain in the elderly, and consequently, health care professionals' understanding of this phenomenon in the elderly is limited For the elderly subgroup who have a reduced ability to communicate due to cognitive impairment or severe physical disabilities, the experience of pain may go unreported In addition, staff perceptions of pain may differ depending upon the person's cognitive status. 1-6
Goals of care in advanced dementia: Comfort, dignity, and psychological well-being
Authors: Volicer Ladislav
Published: June 2007

Current changes of the health care system force all health care providers to reassess their activities. The emphasis has shifted from providing any available treatment to careful evaluation of costs and benefits of different treatment strategies. Such an evaluation is especially important for management of diseases that become more common with age because our population is rapidly aging. One group of these diseases consist of Alzheimer's disease and related dementias, which affect a large portion of our elders. The comfort, dignity, and psychological well-being of those with Alzheimer's disease must also be considered.