bluuebunny/crossref_metadata_2025 huggingface dataset:
The struggle for the soul of hospice: Stress, coping, and change among hospice workers
Authors: DiTullio Maria , MacDonald Douglas
Published: May 2006

This article reports preliminary findings from an ongoing study of occupational stress, coping, and change among employees at a hospice in New York state. The study sought to identify those aspects of hospice work that direct-service and middle-management staff considered unique and rewarding, and also to examine those conditions that created problematic levels of stress. A qualitative methodology was employed, based on heuristic principles of grounded theory and action research. Techniques included field observation and participation, 38 semi-structured interviews, and group discussion and review of data by research participants. The authors elaborate upon established models of occupational stress and coping, and identify hospice-specific stressors and resources for coping. The research highlights “support” as a critically important, multidimensional element for successful coping. A re-examination and reinterpretation of “coping” as it applies to stress in hospice work is suggested.
Prison hospice: An unlikely success
Authors: Craig Elizabeth L. , Craig Robert E.
Published: May 2006

Efforts to introduce hospice and palliative care into American prisons have become fairly widespread, in response to the sharp increase in inmate deaths. The primary impetus originally came from the alarming number of AIDS deaths among prisoners. The new combination therapies have proved very successful in treating AIDS, but are very costly, and many problems must be overcome to ensure their effectiveness in correctional settings. Although the AIDS epidemic seems to be in decline, prisons are experiencing a rise in the number of deaths due to “natural causes.”

In this article we present a review of the prison hospice scene—the response to this crisis in correctional health care. First, we discuss the challenges facing the introduction of hospice into the correctional setting. Then, we present a brief overview of recent developments and a discussion of some ways hospice components have been adapted for life behind bars. Finally, we indicate some of the prospects for the future.

Hospice professionals, armed with thorough professional training and years of experience, often fear that correctional health care providers will only parody superficial aspects of the hospice approach.

Continual nudging and nurturing by local and state hospice professionals is required in order to bring about this change in the first place and to sustain it through time. Prison hospice workers need not only initial training, but also ongoing education and personal contact with experienced hospice professionals.

While the interest of the big national organizations is necessary, the real action happens when local hospices work with nearby prisons to attend to the needs of dying inmates.
Dealing with the anger and hostility of those who grieve
Authors: Rueth Thomas W. , Hall Scott E.
Published: May 2006

Hospice caregivers are often targets of appropriate or displaced anger from the patients and family members that they try to help. Although anger is often an essential part of the grieving process, it may be difficult to endure. Caregivers must therefore understand the causes and signs of anger in themselves, patients, and family members, and find strategies to reduce the anger. A therapeutic response to anger will better facilitate the grief process as well as the effectiveness and well-being of the hospice caregiver.
Information Desired and Acquired by Men With Prostate Cancer: Data From Ethnic Focus Groups
Authors: Maliski Sally L. , Connor Sarah , Fink Arlene , Litwin Mark S.
Published: May 2006

Informationand understandingare needed so that men with prostate cancer can effectively manage and cope with their disease. Although research has shown that cultural beliefs and practices influence the way people access health-related knowledge, little research has addressed how ethnicity affects the information desired and received among low-income men with prostate cancer. This research sought to (a) describe baseline knowledge at diagnosis, information subsequently received, information sources utilized, and knowledge believed to have been helpful and (b) explore differences in desired information among men of various ethnicities. Six ethnicityspecific focus groups among men diagnosed with prostate cancer were conducted. With content analysis, themes emerging from each focus group were identified and compared. Results highlight disparities in the pros tate cancer information desired and acquired by men of different ethnicities.
An Evaluation of the “TrEAT Yourself Well” Restaurant Nutrition Campaign
Authors: Acharya Ram N. , Patterson Paul M. , Hill Esther P. , Schmitz Troy G. , Bohm Erica
Published: May 2006

This study examined the effect of the “TrEAT Yourself Well” campaign on diners'menu choices using data from four restaurant chains in California. Within each chain, two locations in the greater San Diego area were selected as experimentalsites and either one or two locations outside the greater San Diego area were selected as control sites. Various promotional activities, including in-restaurant promotions, community events, and paid media advertising, were conducted in the experimental region to promote healthy menu entrées. The results show that the campaign was successful in reaching diners and had positive effects on their beliefs and attitudes toward healthy dining. The campaign directly increased the probability of a consumer purchasing a healthy menu item by 3.7% ( p = .05). By improving consumer attitudes toward healthy menu items, the campaign indirectly increased purchases of these items by 4.4%.
Transformative Professional Development: Outcomes of the Inner Life Renewal Program
Authors: Kreitzer Mary Jo , Zhang Lixin , Trotter Michelle J.
Published: May 2006

Health professionals have jobs that are inherently stressful and most have had little opportunity or encouragement to focus on self-care. Over the past 10 years, professional development programs such as the “Courage to Teach” have been developed for teachers in primary and secondary schools. Reported outcomes include personal and professional growth, increased satisfaction and well-being, and renewed passion and commitment for teaching. Based on this model of transformational professional development, a program was developed for health professionals, the Inner Life Renewal Program. Four cohorts of health professionals have completed the program. This brief report provides descriptive information regarding the structure, format, and process of the program and evaluative data based on program evaluations and participant interviews. Outcomes reported by participants include an increase in self-awareness, improved listening skills and relationships with colleagues, and an increased ability to manage or cope with stress.
Primary progressive aphasia: A review of the neourobiology of a common presentation of Pick complex
Authors: Kertesz Andrew , Munoz David G.
Published: May 2006

Primary progressive aphasia (PPA) is an identifiable and distinct form of clinical presentation of focal degenerative disease. The underlying pathology is often considered heterogeneous, but we propose that, in fact, this syndrome has a characteristic underlying neurobiology related to Pick's disease and frontotemporal dementia. The authors reviewed the literature of PPA and found 58 cases with autopsy. The majority of the cases had related underlying pathology, termed “Pick complex,” a form of non-Alzheimer's dementia. This includes Pick's disease, corticobasal degeneration, dementia lacking distinctive histology, and motor neuron disease inclusions. Several of the cases described with focal Alzheimer's pathology do not fulfill the criteria of PPA, but have Alzheimer's disease with a major aphasic component.
Awareness of ageism, motivation, and countertransference in the care of elders with Alzheimer's disease
Authors: Kane Michael N.
Published: May 2006

This article focuses on the importance of a practitioner's awareness of ageism, motivation, and countertransference in working with elders with dementia. These factors have the capacity to significantly affect a professional's performance. Additionally, they may also affect the type and quality of services a memory-impaired client receives. Ageism is discussed at the micro, mezzo, and macro level, and practitioners are urged to develop an increased awareness of the effects of ageism on client/service options and as well as practitioner's beliefs. Monitoring professional motivation and being aware of countertransference are important considerations in practitioner-client relationships. Professionals are encouraged to incorporate personal introspection and consultation or supervision to ensure that clients receive the most appropriate service available. Case examples are provided to illustrate concepts.
The JNK/c-Jun cascade and Alzheimer's disease
Authors: Okazawa Hitohi , Estus Steven
Published: May 2006

Emerging evidence indicates that the JNK/c-Jun cascade is activated in neurons of the Alzheimer's disease brain and suggests its involvement in abnormal processes, ranging from tau phosphorylation to neuronal death. Substantial new data have accumulated on the functional relevance of causative genes in familial Alzheimer's disease and the pathological processes that occur within neurons. In this review, we summarize reported findings of the JNK/c-Jun cascade in Alzheimer's disease and discuss the relationship between the cascade and other pathological processes. We suggest that the effort to connect amyloid deposition with intracellular activation of the JNK/c-Jun cascade may modify the amyloid theory of Alzheimer's disease. Therapeutic approaches targeting the JNK/c-Jun cascade and other signaling may complement therapeutic strategies directed at reducing amyloid deposition.
Caregiving appraisal and interventions based on the progressively lowered stress threshold model
Authors: Stolley Jacqueline M. , Reed David , Buckwalter K. C.
Published: May 2006

The purpose of this article is to describe the impact of a theoretically driven, psychoeducational intervention based on the Progressively Lowered Stress Threshold (PLST) model on caregiving appraisal among communitybased caregivers of persons with Alzheimer's disease and related disorders. A total of 241 subjects completed the year-long study in four sites in Iowa, Minnesota, Indiana, and Arizona. Caregiving appraisal was measured using the four factors of the Philadelphia Geriatric Center Caregiving Appraisal Scale: mastery, burden, satisfaction, and impact. Analysis of trends over time showed that the intervention positively affected impact, burden, and satisfaction but had no effect on mastery when measured against the comparison group. The PLST model was influential in increasing positive appraisal and decreasing negative appraisal of the caregiving situation.
Virtual Dementia Tour© helps senditiz health care providers
Authors: Beville P. K.
Published: May 2006

A review of the literature on sensitivity training among caregivers for the elderly revealed that no programs focused specifically on the cognitive changes that occur due to aging. Second Wind Dreams, a national nonprofit organization committed to improving society's perception of aging, conducted a study in which degenerative physical symptoms common for this population, such as impaired vision and motor skills, were simulated in a group of 146 subjects who worked in the field of elder care to give them a broader sense of the patient's perspective. Overwhelmingly, participants in the study came away with heightened awareness of the plight of confused elders and a strong sense that the high behavioral expectations caregivers have for dementia patients are unrealistic and need to change.
The psychological contract: enhancing productivity and its implicatona for long-term care
Authors: Flannery Raymond B.
Published: May 2006

When hired, a new employee is usually given a job description and an explanation of benefits. In addition, the employee will also have a psychological contract with the organization. This contract, often unstated, reflects the main source of the employee's motivation to work hard. This is true of all groups of employees, including long-term care staff. Common examples of psychological contracts for long-term care administrative staff include autonomy, social acceptance, and being in the forefront of cutting-edge research. An awareness of these psychological contracts can result in better “fits” between employee aspirations and relevant long-term care organization tasks so that productivity is enhanced. This article outlines the steps necessary to create these good fits in ways that benefit both the organization and its employees. These recommendations are of particular relevance to administrators and supervisors in long-term care facilities.
Influence of aromatherapy on medication administration to residential-care residents with dementia and behavioral challenges
Authors: Gray Suzanne G. , Clair Alicia Ann
Published: May 2006

Thirteen older persons (seven men and six women) in residential care participated as subjects in this study. All participants had histories of confusion due to dementia and were identified by staff as being consistently resistant to medication administration as indicated by vocal outbursts, moving away, or physical combativeness. Subjects were exposed to four aroma interventions during medication administration: 1) lavender vera (lavendula officinalis); 2) sweet orange (citrus aurantium); 3) tea tree (malaleuca alternifolia); and 4) no aroma (control). All medication administrations were videotaped for later data collection. Observers were trained to record frequency and duration of resistive behaviors during medication administration in all four interventions for each subject. Reliability between two observers was extremely high. Results showed no statistically significant differences across all aroma conditions for either resistive behavior or duration of administration. Also, there were no statistically significant differences based on gender. This study indicates that aromatherapy does not reduce combative, resistive behaviors in individuals with dementia. Research with a larger sample in future studies may yield other results.
Finding a practical method to increase engagement of residents on a dementia care unit
Authors: Altus Deborah E. , Engelman Kimberly K. , Mathews R. Mark
Published: May 2006

Previous research has shown that it is possible to increase the engagement of residents with dementia in daily activities by making changes in institutional care practices. However, these changes often require expensive and cumbersome staff training programs that longterm care facilities may be unlikely to adopt and maintain. This study evaluates a simple, inexpensive recording and feedback procedure to increase resident engagement in a way that may be more amenable to adoption by long-term care facilities. Nursing assistants working in a locked dementia care unit were asked to complete a daily activity record on which they recorded the amount and quality of resident engagement. The facility's activity director was asked to read these activity records each day and give immediate, positive feedback to the nursing assistants. This procedure was evaluated by using a control series design. Results revealed baseline engagement observations with a mean of 11 percent, which increased to a mean of 44 percent during observations under treatment conditions. This study suggests that simple, inexpensive changes in institutional practices can make meaningful improvements in the level of engagement of residents with dementia.
Decision-making for persons with cognitive impairment and their family caregivers
Authors: Feinberg Lynn Friss , Whitlatch J.
Published: May 2006

Despite the large number of persons affected by cognitive impairment, very little is known about how they and their families make choices and decisions about everyday living and long-term care. Moreover, few studies have examined the concept of consumer direction, particularly the ability of cognitively impaired persons to delegate decision-making to other persons. This study explored decision-making through personal interviews with 51 respondent pairs, or dyads (i.e., the cognitively impaired person and the family caregiver). Results suggest that persons with mild to moderate cognitive impairment are able to answer questions about their preferences for daily care and to choose a person, usually a spouse or adult child, to make a variety of decisions on their behalf. By recognizing both voices—those of the care receiver and the family caregiver—we can enhance future research and practice, foster the development of consumer direction in long-term care, and advance public policy to support caregiving families.
Disrupted caring attachments: Implications for long-term care
Authors: Flannery Raymond B.
Published: May 2006

Caring attachments or social supports are the positive psychological and physical contacts and relationships between people. These attachments have been associated with improved health, well-being, and longevity. It is also true that disrupted caring attachments are associated with impaired health and wellbeing. This paper reviews the general medical and elder medical findings of disrupted caring attachments and negative health outcomes. The implications of these findings for dementia sufferers, caregivers, and long-term care staff are examined.
Leadership: Key to creating a caring culture
Authors: Gilster Susan D.
Published: May 2006

The subject of leadership is rarely addressed in the health care literature and the field is essentially silent to the need for leadership in long-term care. In this article, leadership is defined as the art of influencing and engaging colleagues to serve collaboratively toward a shared vision. The leadership model includes passion; commitment; vision; service; education; inclusion of staff, patients, and families; and self-knowledge.
Goals in symptomatic pharmacologic management of frontotemporal lobar degeneration
Authors: Chow Tiffany W. , Mendez Mario F.
Published: May 2006

This review of pharmacotherapy for frontotemporal lobar degeneration describes the chemical rationale for agents used and reports observed responses to psychotropic medications. Paroxetine addressed anxiety and repetitive, ritualistic behaviors. Depression was resistant to treatment. Valproic acid and quetiapine calmed agitated subjects without exacerbating Parkinsonism. Donepezil has not emerged as a beneficial medication for this group of subjects. Behavioral disturbances can be alleviated pharmacologically, but further research might determine guidelines for management of this non-Alzheimer's dementia syndrome that could decrease the frequency of adverse drug events.
Special characteristics affecting the neuropsychologic assessment of the elderly in Greece
Authors: Fountoulakis Konstantinos N. , Kaprinis Stergios G. , Kaprinis George S.
Published: May 2006

An important element in the diagnostic approach to psychogeriatric patients is the neuropsychologic assessment. Most instruments have been developed in the United States or the United Kingdom, but their appropriateness for culturally different populations is still an open question. Validation studies in Greece revealed certain difficulties both for the Mini-Mental State Examination and the Cambridge Cognitive Examination for the Elderly. These results were probably due to the functional illiteracy of elderly people in Greece, the coexistence of mood disorders, restricted access to news over past decades, and low levels of cooperation between the subject and the examiner. The need for a more suitable diagnostic instrument for this kind of population led to the development of the Epidemiological Dementia Index.

Data from developing countries support the possibility that research results from Europe and the United States are not directly applicable to the whole world; thus, the need for data from non-English speaking countries is evergrowing. Our understanding of psychogeriatric disorders in the developing world is like an iceberg: The larger portion is hidden because of the lack of relevant data.
Behavioral observations and quality of life among persons with dementia in 10 assisted living facilities
Authors: Kuhn Daniel , Kasayka Roseann E. , Lechner Carolyn
Published: May 2006

This study examined the quality of life of 131 persons with dementia living in 10 assisted living facilities in a Midwestern state, using the observational method known as Dementia Care Mapping (DCM). Trained observers collected detailed information on the types of interactions and activities taking place among residents and staff on a given day. Key differences were noted between residents living in small, dementia-specific sites(10 to 28 residents) and those living in large sites that were not dementia-specific (40 to 63 residents). The latter group fared better overall with respect to quality of life and diversity of interactions and activities. Additional methods of examining quality of life among persons with dementia will be helpful to explain these differences.
Intervention strategies for exit-seeking wandering behavior in dementia residents
Authors: Lucero Mary
Published: May 2006

Long-term care facilities need effective intervention strategies to assist residents who, out of confusion, frustration, or anger, seek to exit the facility, which can result in their becoming lost or injured. This article describes some of the factors that lead to exit-seeking behavior and offers proven methods for educating staff to intervene during these episodes, enabling them to deal with the exitseeker in a calm, compassionate, and dignified manner.
The stress of dementia: View from the inside
Authors: Ostwald Sharon K. , Duggleby Wendy , Hepburn Kenneth W.
Published: May 2006

This descriptive exploratory study used thematic analysis to interpret short videotaped speech samples produced by persons with dementia in response to the question, “How have things been going for you lately?” The researchers were able to identify themes in 50 of the 56 interviews with men and women with Mini-Mental State Examination (MMSE) scores that ranged from five to 28. The major themes across all MMSE levels were losses, feelings about losses, and attempts to manage losses. The individuals’ choice of themes as well as their verbal and nonverbal expressions suggested that they were experiencing a significant amount of stress, especially related to their relationships with family and friends.
Treating learned helplessness in the elderly dementia patient: Preliminary inquiry
Authors: Flannery Raymond B.
Published: May 2006

Learned helplessness is the psychological state that results when an individual who is unable to exercise reasonable mastery in one situation incorrectly assumes that he or she is then unable to exercise reasonable control in other situations as well. This may complicate the delivery of health interventions since the individual with learned helplessness may assume that no care provider or treatment intervention can be of assistance. Elderly patients with Alzheimer's disease and other dementias are not immune to this stance of learned helplessness. This paper presents one possible psychosocial rehabilitation approach, the Project SMART (Stress Management and Relaxation Training) program, to the problem of learned helplessness. Based on the skills of adaptive stress-resistant problem solvers, Project SMART can be adapted to the needs of the elderly demented. The clinical and research implications are discussed.
Depression and Alzheimer's disease: Symptom or comorbidity?
Authors: Moretti Rita , Torre Paola , Antonello Rodolfo M. , Cazzato Giuseppe , Bava Antonio
Published: May 2006

Alzheimer's disease is the most frequent form of dementia, where behavioral and cognitive disruption symptoms coexist. Depression, apathy, anxiety, and other conduct disorders are the complaints most often reported by caregivers.

Fifty subjects were referred to our Institute with a diagnosis of probable Alzheimer's disease. Cognitive impairment was equally distributed among the subjects. Patients, aged 68 to 76 years old, were randomized to receive inhibitors of cholinesterase (Donepezil, 5 mg/ day) alone, or inhibitors of cholinesterase plus selective seratonin reuptake inhibitors (SSRIs) (citalopram HBr, 20 mg/day).

We followed up all the patients for one year, with particular concern for neuropsychological aspects associated with eventual behavioral changes. Results indicate that SSRI intake seems to be effective for depression, decreasing it and improving quality of life for both patients and caregivers. Side effects in both groups were few, and there were no study withdrawals.

This paper discusses the relationship between dementia-and depression, and presents our finding that depressive symptoms, if specifically treated, tend to reduce caregiver stress and improve well-being in patients with Alzheimer's disease.
Assessing correlates of concern about developing Alzheimer's dementia among adults with no family history of the disease
Authors: Werner Perla
Published: May 2006

In an attempt to add to the knowledge about concerns regarding the development of Alzheimer's disease (AD), a sample of 186 Jewish and Arab adults with no family history of the disease were examined on the basis of sociodemographic and health characteristics, socialcognitive determinants, and knowledge about AD. Nearly 50 percent of the participants reported being very concerned about developing AD. Memory problems and the likelihood of developing the disease emerged as significant predictors of concern about AD. The need to expand the use of theoretically-based models, including social-cognitive determinants, for the study of specific concerns about AD as a basis for the development of educational programs is discussed.
Age-or stage-appropriate? Recreation and the relevance of Piaget's theory in dementia care
Authors: Mahoney Alison E. J.
Published: May 2006

In this study, the immediate effects (within 10 minutes) of age-and stage-appropriate activities and two control activities were observed in 56 dementia sufferers. Compared with the control activities, the two experimental treatment conditions elicited greater reductions in agitation and negative emotion and increases in positive emotion and duration of activity. Stage-appropriate activity was superior to age-appropriate activity in increasing positive emotion and had about the same effect in reducing negative emotion and agitation.

The study also addressed the idea that people with Alzheimer's disease may regress through Piaget's stages of cognitive development and thus display the play interests associated with each stage. There was a significant relationship between cognitive level and type of Piagetian play observed; however, Piaget's descriptions of play were not entirely appropriate for persons with with Alzheimer's disease.
Intergenerational activities involving persons with dementia: An observational assessment
Authors: Jarrott Shannon E. , Bruno Kelly
Published: May 2006

Although benefits of intergenerational programs (IGP) have been identified for older adults, adults with dementia are rarely targeted for such programs. Characteristics of dementia challenge caregivers to find appropriate activities that successfully engage the adults. With consideration of participants' abilities and interests, beneficial IGP can be facilitated. A co-located program for children and seniors was assessed for effects of IGP on adults with dementia. Results indicate that affect was higher during IGP for treatment group members than during non-IGP activities for treatment and comparison group members. Behaviors supporting personhood were common during IGP and non-IGP activities for treatment and comparison group members. Cognitive ability was unassociated with participation in IGP and affect during IGP. Findings suggest IGPs are appropriate and effective for persons with dementia.
Biomechanical activity devices to index wandering behaviour in dementia
Authors: Algase Donna L. , Beattie Elizabeth R. A. , Leitsch Sara A. , Beel-Bates Cynthia A.
Published: May 2006

Valid and reliable measures of wandering are needed to study this troubling behavior. Although researchers have used various perspectives, definitions, and approaches to study wandering, spontaneous ambulation is a key characteristic across all views. Biomechanical activity devices for capturing movement provide one way to index wandering. This study examined four devices with ambulatory nursing home residents with dementia (N = 178) who wore devices simultaneously during four observations. Among the Actillume, StepWatch, Step Sensor, and TriTrac-R3D, the StepWatch yielded data from the highest proportion of observations, explained the most variance (63.9 percent) among all instruments, and was acceptable to nursing staff. Although the Step Sensor was the staff's preferred device, its performance was least acceptable for research purposes. Results support use of the StepWatch in future studies of wandering.
Staff victims of elder patient abuse and the Assaulted Staff Action Program (ASAP): Preliminary empirical inquiry
Authors: Flannery Raymond B.
Published: May 2006

Patient assaults on healthcare staff are a serious and ongoing issue in long-term care facilities. Emerging studies have begun to empirically document assaults by elders in skilled nursing facilities as well as the negative impact of these events on healthcare staff victims. This study examined assaults by elders and their impact on staff over a six-year period within the context of the Assaulted Staff Action Program (ASAP), a crisis intervention program for staff victims to address the psychological aftermath of patient assaults. Findings confirmed both elder assaultive behavior and its negative impacts on staff victims. The efficacy of ASAP in ameliorating these negative impacts was presented. The implications of the findings for longterm care settings were discussed.
A cognitive and physical performance assessment of retirees entering a continuing care retirement community: The Moorings Assessment Protocol
Authors: Wimberley Edward T. , Herrera Angel , Kidrowski Brian , Brown Diane , L'Esperance Lily
Published: May 2006

Moorings Park Continuing Care Retirement Community (CCRC) screened 267 applicants (115 males; 152 females; mean age 80.22 years) using the Mini-Mental State Examination (MMSE), the 7-Minute Screen, the Geriatric Depression Scale (GDS), and the Physical Performance Test (PPT). They compared mean scores across admission/nonadmission groups to determine the extent to which cognitively impaired persons were effectively redirected from independent living settings inadequate for their needs. Groups differed (p < .05) on 21 test items/scores, including subscales of the 7-Minute Screen. The nonadmission group underperformed the admission group and healthy controls from earlier research, and outscored persons with Alzheimer's disease on all 7-Minute Screen subscales. Researchers concluded that geriatricians had effectively identified those with dementia and mild cognitive impairment (MCI) and placed them into supervised settings more appropriate to their clinical and social needs.
The relation between the perceived role of family and the behavior of the person wiht dementia
Authors: de Geest Gwendolyn
Published: May 2006

The purpose of this study was to investigate the relation between the perceived role of family and the behavior of the person with dementia in a sample of older adults. Two instruments were used in data collection: The Family Perceptions of Caregiving Role (FPCR) and the Cohen-Mansfield Agitation Inventory (CMAI). A total of 40 persons with dementia were included in the study. Each had a family respondent and a nurse respondent.

The data analyses produced three major findings. First, it was revealed that there was no significant difference between agitation levels of persons with dementia who received more frequent family visits and those who did not. Second, the study revealed that family caregivers did not perceive a partnering relationship with staff. Finally, correlational analysis provided little evidence of a link between the family's perceived role in partnering and the behavior of the person with dementia, specifically in relation to agitation levels.

Although no significant relation was established between the family's perceived role in partnering and the behavior of the person with dementia, there was high family and caregiver satisfaction. The clearest element of the family's perspective was the desire that staff members care about the individual with dementia as a person.
Disruptive vocalizations: A means to communicate in dementia?
Authors: Matteau Evelyne , Landreville Philippe , Laplante Louis , Laplante Christian
Published: May 2006

Disruptive vocalizations (DVs) constitute a serious problem in geriatric nursing homes. The current literature suggests that DV can be interpreted as a way for demented persons with language limitations to communicate with others. In an attempt to test this hypothesis, 59 participants were recruited from six nursing homes to form two groups: one group of individuals with preserved language skills (PLS) and another group with altered language skills (ALS). They were compared on the frequency and types of DV. The results indicate that individuals with ALS manifest DV at a greater frequency than those with PLS. These persons also present a greater number of distinct DV forms. The results are interpreted in terms of language deterioration associated with dementia.
Creutzfeldt-Jakob disease: Two case studies
Authors: Rentz Clarissa A.
Published: May 2006

Creutzfeldt-Jakob disease (CJD) is a rapidly progressive, neurodegenerative disorder causing dramatic neuromuscular symptoms, profound dementia, and death. In this article, the epidemiology, etiology, modes of transmission, clinical manifestations, determination of possible/ probable CJD diagnosis in life, and the postmortem neuropathology of definite CJD are discussed in depth. Case studies of two individuals, each affected by different subtypes of sporadic Creutzfeldt-Jakob disease (sCJD), are presented, along with a discussion of the many challenging nursing and psychosocial issues surrounding the supportive care of these individuals and families in life and death.
Voices from the margin: The nurse aide's role in pain management of institutionalized elders
Authors: Wright Jean , Varholak Dorothy , Costello Janice
Published: May 2006

The training and function of Certified Nurse Aides (CNAs) has traditionally focused on safe, hygienic, direct care and concrete, practical task completion. These two basic premises have directed training and job criteria and have evolved without much regard for the personal opinions, desires, and thoughts of the nurse aides themselves.1However, CNA roles are expanding and changing daily, and what this expansion means in terms of patient care has ever-increasing relevance. How and what CNAs think and feel about their role and their training, and how both could be improved to meet the needs of patients and the demands of the healthcare system, are of vital interest to all those who rely upon their expertise.
Activity calendars for older adults with dementia: What you see is not what you get
Authors: Buettner Linda L. , Fitzsimmons Suzanne
Published: May 2006

This paper reports on a two-part study of nursing home recreation. In part one, a retrospective activity calendar and chart review was used in this comparative study of 107 long-term care residents with dementia. Data were collected and documented regarding demographics, cognitive and physical functioning, medications, activities listed on facility activity calendars, leisure preferences, and actual involvement in recreation over a two-week consecutive period during baseline. In part two, this information was compared to opportunities offered during a two-week clinical trial of recreational therapy. The results showed that, during baseline, almost 45 percent of the subjects in the sample received little or no facility activities, 20 percent received occasional activities, and 12 percent received daily activities but they were deemed inappropriate based on the functioning levels or interests of the residents. The clinical trial period demonstrated that small group recreational therapy was successful in engaging residents 84 percent of the time.
Community residential care: Comparison of cognitively impaired and noncognitively impaired residents
Authors: Tornatore Jane B. , Hedrick Susan C. , Sullivan Jean H. , Gray Shelly L. , Sales Anne , Curtis Michael
Published: May 2006

Community residential care (CRC) is growing, with cognitive impairment the most common reason for CRC placement. We enrolled cognitively impaired and noncognitively impaired residents, informal caregivers, and providers in 219 CRC facilities for this study. Residents with cognitive impairment were older (p < .001), needed more activities of daily living (ADL) assistance (p < .001), and had a higher frequency of behavior problems (p < .001) than noncognitively impaired residents. Cognitively impaired and noncognitively impaired residents did not significantly differ in the facility-related factors they perceived as important or in the amount of control they felt they had over the decision to move. Including residents with cognitive impairment in future research and separately analyzing residents by cognitive status will give a more accurate picture of the needs of CRC residents.
Long-distance caregiving: A case study of an African-American family
Authors: Collins Wanda Lott , Holt Tangerine A. , Moore Sharon E. , Bledsoe Linda K.
Published: May 2006

A growing number of Americans are managing and monitoring long-distance caregiving for an elderly parent. The authors offer a first-hand experience of caregiving involving an African-American family, which will be useful to both caregivers and practitioners. The challenges that result from long-distance caregiving are discussed. A detailed case study and assessment is followed by suggested strategies for lessening caregiver stress.
Secondary dementia caregiving and its consequences
Authors: Gaugler Joseph E. , Mendiondo Marta , Smith Charles D. , Schmitt Frederick A.
Published: May 2006

The purpose of this study was to ascertain variations between primary and “secondary” caregivers (those who play a more supplemental role in the care of a relative). Survey data were collected from a sample of dementia caregivers recruited from the University of Kentucky Alzheimer's Disease Research Center (N = 1,016). Bivariate analyses found that primary and secondary caregivers varied on a number of background characteristics, and regression models indicated that primary caregivers provided a wider range of assistance with instrumental activities of daily living (IADLs), but not help with activities of daily living (ADLs). Primary and secondary caregivers did not differ significantly in reports of subjective health. The findings suggest that future research and interventions should be inclusive of primary and secondary caregivers.
Memory for emotional stimuli in patients with Alzheimer's disease
Authors: Fleming Kirsten , Kim Susan H. , Doo Michael , Maguire Gerald , Potkin Steven G.
Published: May 2006

Although a hallmark of Alzheimer's disease (AD) is memory impairment, there is speculation that recall may be enhanced when an emotional component is associated with an event. The current study aims to assess whether patients with AD would recall emotionally laden material better than neutral stimuli. DSMIVdiagnosed AD patients with mild to moderate dementia, as well as groups of young and elderly healthy controls, participated in this study. All subjects were administered three word lists for three trials each. The words were positive, negative, or neutral in valence and matched for concreteness, emotionality, and pleasantness. As expected, the controls performed significantly better than the AD patients. Importantly, the pattern of recall for the emotions was different, such that both control groups recalled all emotions equally, whereas the AD patients recalled significantly more negative words than positive or neutral. These findings of improved immediate memory for emotional material in AD lends support to the notion that mnemonic functions are differentially affected in the disease.
Exploring the meaning of everyday life, for those suffering from dementia
Authors: Holst Göran , Hallberg Ingalill R.
Published: May 2006

Living with dementia means struggling to preserve a sense of self, to retain (and reevaluate) one's values in a new situation, and to search for a new way of life. This study explored the meaning of everyday life as expressed by 11 people suffering from dementia. Data were collected through interviews with people in the early stage of a diagnosed dementia disease. The findings indicate that many people with dementia feel shame, sorrow, and sadness when their life with the disease begins but also indicate prospects of a more manageable life. Since the reaction and adjustment to dementia differs from person to person, professional caregivers need to use a casespecific approach in the provision of care.
Effect of respite care training on the knowledge, attitude, and self-esteem of volunteer providers
Authors: Robinson Karen M. , Kiesler Kay F. , Looney Stephen W.
Published: May 2006

This pilot study explored the effect that respite care training had on volunteers' knowledge about Alzheimer's disease (AD), their attitudes toward the cognitively impaired, and their self-esteem. Volunteer respite providers (n = 52) were recruited and participated in four different day (seven-hour) respite care training programs. The sample was predominantly female (85 percent) and white (90 percent). Knowledge about AD increased significantly after respite training (p < .001), and attitudes toward someone who wanders were also significantly improved (p = .026). Overall, the findings support the immediate effectiveness of the respite training program.
A look at deaths occurring in persons with dementia lost in the community
Authors: Rowe Meredeth A. , Bennett Vikki
Published: May 2006

The purpose of this study was to examine cause of death in persons with dementia (PWDs) who have become lost in the community. The study was a retrospective review of 93 US newspaper articles describing PWDs being found dead in the community after leaving their caregiving situations unattended. Of these PWDs, 87 percent were found dead in natural, secluded, unpopulated areas, such as woods, fields, ditches, and bodies of water. They were generally found less than a mile from where they left, but often were not found for extended periods. Males and persons from community-based residential facilities appear to be at higher risk of dying after leaving unattended than females and those living at home.
Review of delusions in dementia
Authors: Fischer Corinne , Bozanovic-Sosic Radenka , Norris Mireille
Published: May 2006

Although delusions are common symptoms in dementia and are associated with a number of adverse outcomes, research in this area has been limited This article attempts to summarize the existing literature on delusions in dementia with respect to known riskfactors, etiology, pathogenesis, neurocognitivefindings, behavioral symptoms, and treatment. This study reviews all relevant abstracts and articles pertaining to delusions and dementia. The reviewers found that the studies were limited by confusion concerning phenomenology. However consistentfindings show that delusions are associated with certain demographic variables, neuropathologic and neurocognitive findings, adverse behavioral outcomes, and limited treatment response. The authors conclude thatfurther longitudinal studies with better clarifi cation of terminology are required to clarify inconsistencies and shed light on future treatment options.
Reducing anxiety in Alzheimer's disease family caregivers: The effectiveness of a nine-week cognitive-behavioral intervention
Authors: Akkerman Rhonda L. , Ostwald Sharon K.
Published: May 2006

Although the literature is replete with studies examining the psychological concomitants and interventions for Alzheimer's disease (AD) family caregivers, a surprisingly small amount of research exists on anxiety. Given prevalence rates suggesting that anxiety significantly impacts one in three family caregivers, brief group cognitive-behavioral therapy (CBT) interventions may offer assistance. To assess CBT's effectiveness, 38 anxious AD family caregivers were recruited and randomly assigned to a nine-week group CBT intervention or to a waitlist control. Caregivers randomized to CBT demonstrated less anxiety on self-report and clinician-administered questionnaires than waitlist group participants at posttreatment and six-week follow-up assessments. A subsample of caregivers also demonstrated improved sleep, as assessed through actigraph measurements. Additional study is recommended with diverse anxious family caregiving groups to further investigate the effectiveness of brief CBT group interventions.
Hospice use for the patient with advanced Alzheimer's disease: The role of the geriatric psychiatrist
Authors: Aupperle Peter M. , MacPhee Edward R. , Strozeski Janet E. , Finn Myra , Heath John M.
Published: May 2006

Advanced Alzheimer's disease (AD) can place an immense burden on caregivers as they struggle to provide end-of-life (EOL) care for the patient. Palliative care, as delivered by hospice, provides a viable solution. Hospice maintains the patient's quality of life (QOL) and helps the family during the grieving process. However, many providers are not familiar with hospice and its care for advanced AD patients. Geriatric psychiatrists can be central in implementing hospice, and they can remain an important part of the care once it is in place. A principal clinical challenge is establishing the six-month prognosis for such patients, which is a prerequisite for initiating hospice admission.
Therapeutic robocat for nursing home residents with dementia: Preliminary inquiry
Authors: Libin Alexander , Cohen-Mansfield Jiska
Published: May 2006

Traditional pet therapy enhances individual wellbeing. However, there are situations where a substitute artificial companion (i.e., robotic pet) may serve as a better alternative because of insufficient available resources to care for a real pet, allergic responses to pets, or other difficulties. This pilot study, which compared the benefits of a robotic cat and a plush toy cat as interventions for elderly persons with dementia, was conducted at a special care unit of a large, not-for-profit nursing home. Various aspects of a person's engagement and affect were assessed through direct observations. Though not identical, similar trends were seen for the two cats. Interacting with the cats was linked with decreased agitation and increased pleasure and interest. The study is intended to pave the way for future research on robotherapy with nursing home residents.
Cognitive dementia and memory service clinics: Opinions of general practitioners
Authors: Gardner Ian L. , Foreman Peter , Davis Sandra
Published: May 2006

This study examined general practitioners' (GPs) satisfaction with services provided by memory clinics and the extent to which the clinics were seen as assisting with the management of their patients with dementia. Thirty-five GPs, who had recently referred patients to the Cognitive Dementia and Memory Service (CDAMS) in Victoria, Australia, were interviewed about their experiences. Overall, most were satisfied with the service the clinic provided. They were most positive about the completeness and utility of the assessment and diagnostic information provided, but relatively less satisfied with advice regarding the family's coping and community support services for the patient. It was concluded that the CDAMS is enhancing the capacity of GPs to provide ongoing care to people with dementia. However, the establishment of firmer communication and collaborative protocols between the clinics and GPs would improve their usefulness.