bluuebunny/crossref_metadata_2025 huggingface dataset:
Balancing nurse empowerment with improved practice and care: An evaluation of the impact of shared governance
Authors: Mitchell Martin , Brooks Fiona , Pugh Jean
Published: June 2007

This paper reports on the preliminary findings of a two-year ethnographic study of the implementation of shared governance at Kettering General Hospital NHS Trust. Key aims of the study were to identify the impact of shared governance on clinical practice and patient care, and the effects of its implementation on nurses and midwives. The findings suggest that the early impact of shared governance related primarily to effects on the professional environment and culture of nursing, particularly increased information-sharing and feelings of empowerment. Impact on patient care and service delivery was limited, with key obstacles to successful implementation including poor communication systems, lack of a means of publicising the work of shared governance councils, and difficulties finding the best ways of managing time spent away from clinical areas on practice and professional development issues. There was evidence that shared governance could have an indirect impact on patient care in the longer term. We suggest that it may have to be accepted that, initially, the early impact of shared governance is felt mainly by health professionals, and that the desired impacts on service delivery are the indirect benefits of more empowered and professionally accountable nurses and midwives in the longer term.
Weighing up the evidence: The contribution of critical literature reviews to the development of practice
Authors: Sleep Jennifer , Clark Elisabeth
Published: June 2007

Over the past decade there has been increasing awareness of the importance of using sound research evidence to assist clinicians, patients and clients to make informed decisions about aspects of care. The recent drive towards promoting evidence-based healthcare has provided an added impetus, highlighting the important and unique contribution of systematic reviews to this decision-making process. This paper argues that healthcare professionals should also draw on evidence and insights derived from a broader range of research traditions rather than relying on synthesised evidence from randomised controlled trials. The potential of other types of literature is explored.
The impact of health professionals' involvement in sex education in schools
Authors: Measor Lynda , Tifin Coralie , Miller Katrina
Published: June 2007

This paper is based on research which assessed the provision of appropriate and effective sex education to pupils in the early years of their secondary schooling. It aimed to develop an awareness of their views about heath professionals working in schools to help with sex education. The pupils had a range of responses to the work: they liked the openness with which the medical personnel tackled the subject and welcomed their medical knowledge and the accompanying confidentiality they perceived that went along with that. There were also some profoundly negative reactions: gender had a bearing on the pupils' responses, and boys responded more negatively than girls. Differences in the level of development and sophistication of the pupils had an impact on how they received the message.
Development of nurse-led follow-up in the management of patients with lung cancer
Authors: Moore Sally , Corner Jessica , Fuller Frances
Published: June 2007

This paper describes the first two phases of an NHS R&D-funded study to develop and evaluate an alternative model of nurse-led follow-up care in the management of patients with lung cancer. Phase I of the study identified the needs of lung cancer patients during their follow-up period of care. This was achieved through observation of outpatient consultations and an audit of patients' medical records. Phase two of the study developed and piloted a nurse specialist-led model of follow-up care. This model moved away from the existing medical one focusing on disease surveillance towards a more patient-centred model responsive to the specific needs of lung cancer patients that were identified during Phase 1. The paper concludes that nurse-led follow-up care of lung cancer patients was demonstrated to be safe, acceptable and appropriately managed. Patients in the study reported positive benefits from a model of care responsive to the experience of, and needs arising from, living with lung cancer.
To Queer or Not to Queer a Lesbian and Gay Group? Sexual and Gendered Politics at the Turn of the Century
Authors: Humphrey Jill C.
Published: June 2007

This article explores some emerging tensions between ‘lesbian and gay’ people and politics on the one hand, and ‘queer’ people and politics on the other. These are described by reference to a case-study of the lesbian and gay group in the public-sector trade union UNISON, which is the largest nationwide organization of lesbians and gay men in the UK. The article analyses the struggles over personal identities and political agendas which have been occasioned by challenges from queer subjects, notably bisexuals and transgendered people. It is argued that these struggles need to be situated in broader historical and international contexts, and that this could deconstruct the antinomy between the ‘lesbian and gay’ movement and novel forms of ‘queerdom’.
Conceptualizing a relationship management capability
Authors: Jarratt Denise
Published: June 2007

The call for marketing practitioners and academics alike to move relationship marketing’s dyadic perspective into a multi-firm network context is building momentum. As network forms of organizing work expand, organizations will need to build their capability to leverage not only their customer assets but also the value-creating knowledge and innovation assets spanning multiple relationships within their business network form. Drawing on theories of evolutionary economics, resource advantage, organizational learning, and organizational capabilities, a model of a relationship management capability is conceptualized. The relationship management capability, combining both functional and integrative capabilities, is represented through second order constructs of relationship infrastructure capability, relationship learning capability and relationship behavioral capability.
Human nature and the marketing concept
Authors: Lawson Rob , Wooliscroft Ben
Published: June 2007

The marketing and sales orientations that are basic to our understanding of marketing history and also underlie distinctions about different company philosophies are considered in the light of the works of Hobbes and Rousseau. These philosophical treatises propose contrasting views of the essential nature of mankind that are similar to the implicit assumptions about buyer behaviour that underlie marketing and sales orientations. By extension, we propose that a case exists for the adoption of the marketing concept being considered as the equivalent to the Enlightenment for business practices. Renewed emphasis on the study of the mind in management theory adds weight to the need to make our assumptions about the nature of mankind explicit when we develop concepts and theories in marketing.
Transcendent Ethnography
Authors: Falzone Paul
Published: June 2007

This article proposes an action research based approach to ethnographic filmmaking within the context of cultures of conflict. It explores the history and ethics of traditional ethnographic film and demonstrates how past weaknesses and failures can be transformed into strengths through the reconceptualization of basic a priori assumptions of research methodology. This ‘transcendent ethnographic’ model designs a paradigm in which members of competing cultures are encouraged to form shared metacultures and become self-ethnographers, creating collaborative narratives that redefine their relationship from an intergroup to an intra-group perspective. The author explicates a decentralized, deregulated and cooperative approach to the creation of transcendent ethnographic film, demonstrating this model with an example from his own fieldwork.
Review Article: Addressing the sexual health of patients with COPD: the needs of the patient and implications for health care professionals
Authors: Vincent E.E. , Singh S.J.
Published: June 2007

Sexual expression is an important part of our individual identity and yet, this area is rarely addressed by health professionals. This article will explore the possible reasons for this and will also demonstrate the importance of assessing sexuality in patients with chronic obstructive pulmonary disease (COPD). Chronic Respiratory Disease 2007; 4: 111—115
Gambling, the WTO, and Public Morals
Authors: Magder Ted
Published: June 2007

This article reviews a recent WTO trade dispute between Antigua and the United States concerning the regulation of remote gambling. The case, United States–Measures Affecting the Cross-Border Supply of Gambling and Betting, raises important questions about the regulatory regimes that affect the cross-border traffic in media and cultural products and offers a detailed analysis of the principle that even in the context of an international trade agreement, states can restrict the flow of media in the interests of protecting public morals. The article situates this legal dispute in the context of gambling's recent growth as a business and social pastime.
Alzheimer's disease as a “trip back in time”
Authors: Johnson Christopher J. , Johnson Roxanna H.
Published: June 2007

Persons with Alzheimer's disease (AD) seem to vary from day to day in their recall of loved ones' names and faces. Such erratic fluctuating and regressive cognition is often puzzling and stressful to caregivers. This paper explores the possibility of conceptualizing AD as a “trip back in time” to help caregivers understand the variation in an AD person's memory, behavior, and physical abilities. Clinical observations suggest that these individuals experience a cognitive, emotional, social, physical and functional regression with AD. The “trip back in time” paradigm uses aspects of Piaget's theory of adult development in reverse, Reisberg and associates FAST and GDS, and other cognitive, behavioral, and affective research on AD. Using past research to indicate how patients tend to lose many of their functions, the conceptualization goes further to advance a non-linear regression model of AD. This paradigm of AD as a “trip back in time” uses connecting loops spiraling downward to depict the fluctuating regression. Previous theoretical frameworks have tended to rely solely on fixed stage regression models of AD. The insight this model provides will hopefully increase gerontologist/caregivers' understanding and provide new ways to develop strategies to enhance future caregiving techniques.
The Cambridge Cognitive Examination (CAMCOG): A validation study in outpatients suffering from dementia and non-demented elderly subjects (including Age Associated Cognitive Decline patients) in Greece
Authors: Tsolaki Magda , Fountoulakis Konstantinos N. , Chantzi Helen , Kazis Aristides
Published: June 2007

Introduction: The Cambridge Cognitive Examination for the elderly (CAMCOG) was first published in 1986 as a reliable instrument for the study of patients with cognitive function impairment. Objective: To standardize the Greek version of CAMCOG. Setting: Dementia Outpatient Clinic, 3rd Department of Neurology, Aristotle University of Thessaloniki. Participants: 150 nondemented controls and 100 patients suffering from mild to severe dementia of various types took part in the study. Results: CAMCOG manifests Cronbach's alpha=0.93. In the group of patients under 75, sensitivity (Sn) is 90.00 percent at the level of 76/77 and specificity is 91.89 percent at the level of 70/71. The respective scores for the group of patients over 74 are 68/69 (Sn=90.00 percent) and 60/61 (Sp=92.30 percent). It seems that CAMCOG shows an “uncertainty zone” in both groups between the scores of 71 to 76 for the first group and of 61 to 68 for the second. The MMSE cut-off point, for the two groups are 23/24 (Sn=94.28 percent, Sp=90.99 percent) and 22/23 (Sn=96.60 percent, Sp=94.87 percent), respectively. Conclusion: The Greek version of CAMCOG manifests different properties than the original British Version. This is probably due to differences in education and social background (e.g., cultural isolation of rural areas). MMSE performs better than CAMCOG mainly because diagnosis is based on the assessment of fundamental aspects of cognitive function, which is reflected in MMSE in a way that is less affected by the mental or educational status of the subject.
Relinquishing in-home dementia care: Difficulties and preceived helpfulness during the nursing home trasition
Authors: Gaugler Joseph E. , Pearlin Leonard I. , Leitsch Sara A. , Davey Adam
Published: June 2007

Institutionalization of an elderly relative suffering from dementia is a key transition in the caregiving career. This study determines factors that predict the problems and help dementia caregivers perceive while institutionalizing an elderly relative. By using a sample of 185 dementia caregivers interviewed before and after institutionalization, the authors conducted a multivariate regression to identify relevant predictors of search difficulties, professional help, and family help during the nursing home transition. The personal and social resources of caregivers prior to placement (e.g., mastery, family conflict, socioemotional support, duration of care, education, and physical health) were reliable predictors of search difficulties and perceived helpfulness. Such findings will prove useful to long-term care practitioners who wish to facilitate the institutionalization process for caregiving families.
Products for Alzheimer's self-stimulatory wanderers
Authors: Lucero Mary , Pearson Rebecca , Hutchinson Sally , Leger-Krall Sue , Rinalducci Ed
Published: June 2007

The objective of this study was to develop a variety of sensory stimulation products for the behavioral intervention of patients with Alzheimer's type dementia. Many caregivers have relied on physical and chemical restraints as the primary method of patient intervention due to the lack of appropriate dementia management products. This significantly lowers the sufferer's quality of care and life. As the age group most susceptible to Alzheimer's disease (65 and older) is the fastest growing segment of our society, an appropriate care solution must be sought. The specific aim of this study was to develop products that are sensory satisfying for the Alzheimer's patient that exhibits self-stimulatory wandering behavior. Sensory satisfying objects for product development would be determined through structured observations of self-stimulatory wanderers in an institutionalized setting. Variations of product design and mounting would be pursued in order to develop products that are not only safe and effective for patient use, but are easy for the caregiver to implement and maintain. Such products would have widespread commercial application in both the institutional and private care settings such as nursing homes, adult day care facilities, Alzheimer's care facilities, convalescent homes, mental health institutions, and assisted-living facilities.
Long-term consequences of the Alzheimer's caregiver role: A qualitative analysis
Authors: Karlin Nancy J. , Bell Paul A. , Noah Jody L.
Published: June 2007

A qualitative analysis was performed on responses of 51 participants to open-ended questions about the experience of being family caregivers for a loved one affected by Alzheimer's disease. Participants had been in the caregiver role for at least eight years. Results indicated a pattern of adapting successfully or unsuccessfully to the caregiver role, experiencing initial caregiver burden, finding relief in social support when available, and longterm distress or long-term positive change. Memories and feelings were strong about individuals and institutions that had been helpful or indifferent many years earlier as the caregivers struggled to cope with their unplanned predicament.
Family history of dementia does not influence the progression of Alzheimer's disease at two years: Results from the REAL.FR Study
Authors: Cortes Frédéric , Gillette-Guyonnet Sophie , Nourhashemi Fati , Christelle Cantet , Vellas Bruno
Published: June 2007

The purpose of this study was to determine whether a family history of dementia in afirst-degree relative influenced the progression of Alzheimer s disease (AD) after two years offollow-up. Patients were recruited in the REAL.FR (Reseau sur la Maladie d'Alzheimer Franqais) study and underwent behavioral, global, nutritional, and medical evaluation with assessment ofcognitivefunction and independence every six months. At inclusion, 113 patients reported a family history of dementia, and 358 patients had no family history of dementia. There was no statistical difference for any factors between the two groups at baseline. After two years offollow-up, a similar percentage of patients were still followed in each group, and although most parameters showed significant deterioration, there was no difference between the two groups, indicating that a family history of dementia does not appear to influence the progression of AD.
Using Choice-Making Opportunities to Increase Activity Engagement in Individuals With Dementia
Authors: LeBlanc Linda A. , Cherup Stacey M. , Feliciano Leilani , Sidener Tina M.
Published: June 2007

Structured choice-making procedures, referred to as preference assessments, have been frequently used to identify reinforcers for individuals with developmental disabilities; however, few studies have examined the use of preference assessments with older adults with dementia. This study evaluated the utility of 4 versions of a 2-choice preference assessment for identifying items and activities associated with high levels of engagement in clients at an adult day care program. The same 8 items were presented in 4 formats (ie, verbal, pictorial, textual, tangible), and items from each assessment were ranked with respect to the subsequent level of participant engagement with each item. Correlations were computed between the preference hierarchy and subsequent engagement levels for each format. The format with the highest correlation coefficient was subsequently used in interventions in which frequent structured choice opportunities were presented throughout the day to increase engagement. For 3 of 4 participants, the vocal modality was optimal, while the tangible modality was optimal for the fourth. Moderate to substantial increases in engagement were observed for all participants when structured choices were offered. Implications for activity engagement in adult day care programs are discussed.
Becoming Forgetful: How Elderly People Deal With Forgetfulness in Everyday Life
Authors: Imhof Lorenz , Wallhagen Margaret I. , Mahrer-Imhof Romy , Monsch Andreas U.
Published: June 2007

Studies show that complaints about being forgetful are weakly correlated with standardized measures of memory impairment. Little attention has been paid to those complaints in a healthy elderly population. Therefore, this qualitative, grounded-theory study investigated the experiences and consequences of becoming forgetful. In-depth interviews with 32 participants were conducted and analyzed. The findings show that forgetfulness became part of daily life through 3 strategies, conceptualized as doing forgetfulness: (1) reducing complexity; (2) creating and maintaining routines; and (3) dealing with feelings of embarrassment and shame. The well-being of people experiencing forgetfulness depended on how successfully they performed the strategies of doing forgetfulness. Gaining insight into this process allows health care professionals to assess the phenomenon early and to individualize counseling and further diagnostic procedures.
Efficacy and Tolerability of Quetiapine in the Treatment of Behavioral and Psychological Symptoms of Dementia
Authors: Onor Maria Luisa , Saina Marisa , Aguglia Eugenio
Published: June 2007

Behavioral symptoms start to appear in mild and moderate dementia and become increasingly severe with the progression of the disease. Agitation, aggressiveness, and psychosis can be seen in Alzheimer’s disease, and in particular are common manifestations in Lewy body dementia. It is the behavioral disturbances rather than the cognitive disorders that are more often the cause of the institutionalization of these patients because of the heavy assistance and emotional burden they represent for caregivers. Traditionally, these kinds of symptoms were controlled by classical antipsychotic agents, which after long-term use cause severe extrapyramidal effects, late dyskinesia, sedation, orthostatic hypotension, and cognitive function impairment. More recently, atypical antipsychotic agents have shown a better tolerability profile, with a reduced incidence of extrapyramidal effects, orthostatic hypotension, sedation, and a reduced impact on cognitive function. The aim of this study is to evaluate the efficacy and tolerability of quetiapine in a group of patients with a diagnosis of dementia and concomitant psychotic disorders. The response to treatment was evaluated by the Neuropsychiatric Inventory (NPI) and the Behavioral Pathology in Alzheimer’s Disease Rating Scale (BEHAVE-AD). The NPI and BEHAVE-AD were administered at baseline and after 4 weeks and 12 weeks of therapy. Tolerability was assessed by the incidence of clinically evident side effects. The results show that quetiapine is effective in reducing behavioral symptoms, deliria and hallucinations, aggressiveness, and sleep disturbances. Quetiapine tolerability proved to be satisfactory. The only side effect of clinical significance was orthostatic hypotension, which was, however, partially preventable by a slower drug titration.
Language-Enriched Exercise Plus Socialization Slows Cognitive Decline in Alzheimer’s Disease
Authors: Arkin Sharon
Published: June 2007

This article reports the effects of language-enriched physical fitness interventions provided by University of Arizona undergraduate students to 24 mild-to moderate-stage Alzheimer’s disease patients (AD Rehab group). Socialization experiences consisted of supervised volunteer work and cultural/recreational activities. Changes in global functioning and neuropsychological test performance were tracked and compared to those of a similar group of untreated patients from the Consortium for the Establishment of a Registry for Alzheimer’s Disease (CERAD). Cohorts completing 4 semesters or longer showed no significant between-year changes after their first year on the Clinical Dementia Rating, a measure of global functioning, and on 5 or 6 of the cognitive and language measures. Comparisons with the CERAD sample suggested a slower rate of decline for the AD Rehab group. The stabilization of global and cognitive performance was not apparent among participants who completed only 2 semesters. Significant physical fitness and mood outcomes were previously reported in this journal.
Genetic Counseling and Presenilin-1 Alzheimer's Disease: “Research Family” Members Share Some Thoughts
Authors: Nee Linda E.
Published: June 2007

Genetic counseling is a 2-way street between counselor and the counseled. In this article, both share experiences gained through more than 25 years of searching for the gene, finding the presenilin-1 Alzheimer's disease gene, and waiting for a cure. “Research Families” made research models a reality. Few family members requested presymptomatic testing.
Feasibility Study of the Integrated Circuit Tag Monitoring System for Dementia Residents in Japan
Authors: Greiner Chieko , Makimoto Kiyoko , Suzuki Mizue , Yamakawa Miyae , Ashida Nobuyuki
Published: June 2007

Videotaping, direct observation, and biomechanical devices have been used to measure the wandering behavior of institutionalized people with dementia and to identify patterns of movement. Owing to technical limitations, the variability in movement patterns or the distance traveled could not be examined. The present study examined the feasibility of an integrated circuit tag monitoring system to monitor the movement patterns of Japanese dementia residents. This system generated the following data: the frequency of detection by each receiver, the duration of stay in each location, the cumulative distance walked per day, and the graphic display of the movement pattern. This new system offers objective measurements of ambulation in time and space, which can be used to characterize demented patients and to evaluate the effects of treatment and care.
Work therapy: Intervention for community-based Alzheimer's patients
Authors: Ebbitt Brenda , Burns Theressa , Christensen Renee
Published: June 2007

Most individuals with Alzheimer's disease live in the community. However, appropriate activities and community services are frequently lacking for persons in the early stages of dementia. Programs that do exist, such as adult day care, are often not acceptable to the mildly impaired person, or appropriate to his or her abilities. Caregiver stress and caregiver need for respite already exists at this stage of the disease. The authors were interested in the application of a sheltered workshop model to this population. A pilot study was conducted to investigate the feasibility and potential therapeutic effects of an adapted work program (AWP) offering paid work experiences in a supervised setting. Seven patients with mild to moderate AD along with the patient's spouse caregivers were enrolled in a six month study. Participants attended the workshop two half-days a week, and performed tasks adapted to their skill and ability levels. At regular intervals, study participants were evaluated to assess work behavior, depression, self-esteem, as well as cognitive and functional status. Caregivers' perceived burden and depression scores were also measured. The results of the study suggest that work therapy may be a potentially useful intervention with benefits to both patients and families.
Including persons with early stage Alzheimer's disease in support groups and strategy planning
Authors: McAfee Mary E. , Ruh Patricia A. , Bell Paul , Martichuski Diane
Published: June 2007

The Metro Denver Chapter of the Alzheimer's Association (ADRDA) conducted a pilot program that included early stage Alzheimer's patients in a group setting with family members. The goal of the program was to provide a positive arena where Alzheimer's patients and family members could develop strategies for issues to be considered following the diagnosis of Alzheimer's disease. Participants felt that the program provided empowerment to the family unit. In addition, patients felt grateful for the opportunity to help plan their future care. Technological advances and public awareness of Alzheimer's disease, in conjunction with the increasing numbers of elderly, are yielding more early stage diagnoses of irreversible dementias. Patients in the early stages of these diseases need not be kept out of support groups—a positive environment where they can address some of their issues and problems.
Alzheimer's disease and the institution: Issues in environmental design
Authors: Cluff Pamela J.
Published: June 2007

Increasingly, owners and administrators of long term care facilities and chronic care hospitals are becoming involved in determining the most appropriate way of managing frail, elderly residents and patients with significant cognitive impairment or behavioural disorders, as a result of Alzheimer's disease or similar dementing illnesses. The extent to which existing or new facilities can be modified or designed to offset cognitive and physical losses, as well as to ensure a creative and supportive setting for preferred models of care delivery, is explored in this article. Specific topics addressed include: • The size, design and layout of a unit, • The use of colour, lighting and signage (to enhance way-finding), as well as • The appropriate selection of furniture and equipment.
Discontinuation of tube feeding in patients with dementia of the Alzheimer type
Authors: Volicer Ladislav , Rheaume Yvette , Riley Mary Ellen , Karner Jo , Glennon Mary
Published: June 2007

The need for tube feeding was evaluated in six patients with clinical diagnosis of probable dementia of the Alzheimer type (DAT). Four patients were fed by a nasogastric tube for a period of 10 to 42 days; two patients were fed by a gastrostomy tube for periods of one and eight years. In five of these patients, it was possible to discontinue artificial feeding and reestablish oralfeeding. The duration of survival after discontinuation of tube feeding rangedfrom four to 35 months. These results indicate that despite the progressive course of DAT, in most cases natural feeding by experienced nursing staff can replace tubefeeding.
Research directions in Alzheimer's disease
Authors: Davis George T. , Hurford David P.
Published: June 2007

This paper examines some of the current research approaches in Alzheimer's disease. Although Alzheimer research is making progress in identifying the etiology of the disease, this paper suggests that some of the research funding could be more appropriately allocated for research into identifying the most beneficial types of palliative care for Alzheimer patients.
The University of California, San Diego, Continuing Medical Education and the Alzheimer's Family Center's School of Dementia Care Training Program for Licensed Residential Care Facilities for the Elderly
Authors: Stehman Jean Mason , Glenner Joy , Neubauer Judi
Published: June 2007

The provision of appropriate care for dementia patients differs greatly from that required for cognitively normal frail elderly individuals. Appropriate care requires knowledge of the causes, physical and behavioral symptoms of dementia; as well as an understanding of how to deal effectively and compassionately with such individuals -and their families on a day to day basis.

Symptoms of dementia are manifested very differently in each patient, so that careful individual assessment is necessary, and development of a plan of care for each person is needed. The smaller residential care facilities for the elderly are ideally suited to implementation of genuinely individualized care. With good training, these small facilities can be real innovators in providing humane and appropriate care for dementia patients who do not require skilled nursing care.
The study of wandering in persons with senile dementia
Authors: Madson Jan
Published: June 2007

Wandering in persons with senile dementia of the Alzheimer type represents a problematic behavior for people with dementia and their caregivers. Ideally, the demented individual's environment should be modified to safely contain or control wandering. To achieve a therapeutic environment for the wanderer, it will be necessary to objectively evaluate the impact that specific environmental modifications have on wandering behavior. Until recently, research on wandering behavior has been without suitable methodology. However, several methods and techniques are currently available to measure wandering. These wandering assessment tools and techniques are reviewed in this paper. Also presented in this paper are the results of this author's methodological study in which a reliable and valid device was developed and tested for the purpose of measuring wandering. This new device is called a Stepsensor. Preliminary testing shows the Stepsensor prototype to be a highly reliable and valid tool for the measurement of wandering. Hence, the methodology to study wandering is available. Research on wandering is one of the keys to the provision of a therapeutic environment for individuals with senile dementia.
Cognitive impairment: Policy implications for service design
Authors: Lombardo Nancy E.
Published: June 2007

A large proportion of persons needing long term care services at home or in institutions are cognitively impaired, including a majority of severely functionally impaired elderly. The estimate arrived at for this paper is that over six million Americans are cognitively impaired enough to negatively affect their functioning including over four million with Alzheimer's disease and other dementias. Thus, it is essential that long term care legislation and programs be designed to assure appropriate services for the cognitively impaired.
The subjective experience of Alzheimer's disease: The anatomy of an illness as perceived by patients and families
Authors: Cohen Donna
Published: June 2007

The onset of Alzheimer's disease is insidious and its course progressive. It robs the person-turned-patient of sense and sensibilities and disrupts the lives of victims and family members for years. Over the years I have come to regard individuals with Alzheimer's disease and other devastating chronic illnesses along with their families as modern archetypal figures. Borrowing the words of Oliver Sacks' they are both “warriors and heroes” as well as “victims and martyrs,” whose odyssey of care usually extracts an enormous emotional, physical, and financial toll.

Caring for victims of Alzheimer's disease requires what Elaine Brody and Carl Eisdorfer have described as “interminable care” as the death of the mind precedes the death of the body. Inevitably, physical death becomes a reality, and family members have described the long process of watching a loved one die as a “living funeral.” Ethical and moral decisions around care and death with dignity often present deep andprotracted crises. The grieving after death varies a great deal, butfor many family members powerful emotions ranging from guilt to anger and sadness persist long after their relative is gone. Although we have learned a great deal over the last several years, we need to know more about the subjective experience of the dementing illnesses to provide better clinical care and develop ethical standards for clinical decision making.
The use of symbolic interaction in the management of Alzheimer's disease: A review of the literature
Authors: Moore Roxanna H.
Published: June 2007

The following review of literature highlights a common theme in social gerontology today Symbolic Interaction. The symbolic interaction theory emphasizes the dynamic interaction present between people and their social worlds. It is the purpose of this paper to establish that symbolic interaction is a consistent dimension present in the multidisciplinary practices addressing the management of the person with Alzheimer's disease. The multidisciplinary authors examined use diverse terminology and represent an assortment of perspectives, but the predominant and consistent theme is symbolic interaction.
Improved neuropsychological test scores in Alzheimer 'S disease patients after ecologically sensitive, cognitive interventions: A pilot study
Authors: Frey Lance W. , Leeah Laura , Nelson Naomi , Pirozzolo Francis J. , Mahurin Rick
Published: June 2007

The purpose of this pilot study was to:

• Integrate various cognitive interventions into one program for Alzheimer's disease (AD) patients; • Identify effective interventions; and • Measure cognitive changes over the course of instruction.

Five AD patients completed thefive week program. Techniques reflected recent cognitive intervention advances including:

• Imagery mnemonics, • Home attention exercises, • Relaxation exercises, and • Weekly clinic instruction.

While the participants' ability to master specific techniques varied with dementia severity, all patients showed improvements in certain neurop-sychological tests at week six.
Problems in establishing case definitions for Alzheimer's disease registries
Authors: Brandes Debra A. , Macera Caroline A. , Still Charles N. , Abramson Ruth K.
Published: June 2007

Case definition, an important component of any patient registry, is particularly problematic for conditions such as Alzheimer's disease that do not have a definitive diagnostic test. Implementation of an effective registry for Alzheimer's disease requires:

• Agreement on a set of clinical criteria for diagnosis; • Educational programs to ensure consistent diagnoses and to reduce the social stigma associated with this disease; and • Awareness of the potential use of registries for risk factor analyses and planning for services to encourage timely diagnosis and reporting of cases.
The use of Alprazolam for decreasing problem wandering in geriatric patients
Authors: Szwabo Peggy , Woodward Velva , Grossberg George T. , Shen Winston W.
Published: June 2007

The effects of wandering behavior have been well identified as a problem in providing care for the cognitively impaired. Wandering behavior takes its toll not only on the patient, but also upon the caregiver who is trying to manage and redirect this behavior. This wandering behavior may precipitate admission to a long term care facility where several residents with wandering behaviors present treatment, management, and staff concerns. The costs to the patient have been in the use of traditionalpharmacological options that have potential side effects and iatrogenicity. The costs to the caregiver are stress, frustration, and time constraints in providing care for others. Though the literature discusses wandering, there are varied definitions.

This study attempts to define more precisely which wandering behaviors are perceived as problematic, disruptive and intrusive. Secondly, the study investigates the use of Alprazolam as a less toxic, potentially more effective option for decreasing problem wandering.
An investigation of the sundowning syndrome and ambient light
Authors: Hopkins Robert W. , Rindlisbacher Peter , Grant Nuala T.
Published: June 2007

Geriatric clinicians have observed that some demented individuals show increased agitation, restlessness and confusion in late afternoon, evening or night. This has popularly been named “sundowning,” or the “sundowning syndrome.” References to “sundowning' “in clinical writings disagree on virtually every aspect of the syndrome, and little research has been conducted to investigate this phenomenon. Despite this, light or light levels have been the most consistently noted cause.
Partners in Care: A program for family caregivers and nursing home staff
Authors: Wilken Carolyn S. , Farran Carol J. , Hellen Carly R. , Boggess Julie E.
Published: June 2007

The Partners in Care program was an eight-week education and support group designed to create an environment where family caregivers and nursing home staff could share their knowledge about caregiving and reduce ambiguity about caregiving roles in the nursing home. Twenty-seven caregivers (17 attended group meetings and 10 served as the contrast group) participated in an evaluation of the program. Pretest and post-test scores on the Knowledge of Nursing Home Caregiving scale, staff observations, anecdotal information and continuing partnerships suggest that both staff and family caregivers benefitted from the program. This article describes the development, implementation and evaluation of the Partners in Care program.
Ethnic differences in the burden of caregiving
Authors: Macera Caroline A. , Eaker Elaine D. , Goslar Pamela W. , Deandrade Susan J. , Williamson Jane S. , Cornman Carol , Jannarone Robert J.
Published: June 2007

Family caregivers of dementia patients experience varying levels of burden (or stress) associated with care giving tasks. Although this burden may lead to negative health effects for caregivers, very few studies have focused on ethnic differences in the correlates of perceived burden. In a pilot study, we examined correlates of perceived burden associated with providing care for a family member with dementia among African-American (n=20) and white (n=62) caregivers. In this limited sample, we found that mean burden scores were increased among whites if they were the spouse of the patient, and among African-Americans if annual family income was in excess of $20,000. We found no mean burden score differences for either group by past use of a variety of services. Although these results are preliminary, this ongoing study has the potential to provide needed information on sources and correlates of perceived burden among rural African-American and white caregivers.
Evaluating the functional autonomy of persons with Alzheimer's disease: A tool for observing four activities of daily living
Authors: Gendron Marie , Levesque Louise
Published: June 2007

The goal of this study was to develop an instrument for evaluating the functional autonomy of demented persons in four ADLs:

• Getting dressed; • Getting washed; • Eating; and • Eliminating.

Thirteen persons with Alzheimer's disease who were living in care facilities were filmed three times while they were performing the first three ADLs, and observed during the last ADL. Based on these direct observations, the various sequences of tasks required to accomplish each of the ADLs were identified. Criteria for the successful accomplishment of each sequence were established and classifications of both autonomous behaviors and blocking conditions to autonomy were developed. The instrument includes three types of prompts to promote the emergence of potential abilities and provides two autonomy ratings - one of which distinguishes between actual and potential ability level. The prototype was submitted to different experts in the field and tried out on 26 other subjects suffering from Alzheimer's disease. Dividing tasks into sequences appears essential in identifying what subjects can accomplish without help and what they can do after a prompt.
Verbal interaction during the lunch-meal between caregivers and vocally disruptive demented patients
Authors: Hallberg Ingalill R. , Norberg Astrid , Johnsson Kristina
Published: June 2007

The purpose of this study was to investigate the establishment and maintenance of the relationship between vocally disruptive severely demented patients and their caregivers as well as what was communicated during a verbal interaction episode (lunchmeal). Two dimensions of verbal interaction were studied, the amount of interactions focused on the task versus the person and the process of verbal interaction. Tape-recordings that had been typed out were analyzed. They concerned 34 vocally disruptive demented patients at psychogeriatric wards and their caregivers. The caregivers'verbal interaction was extremely oriented towards the task performed. Very little interaction took place with more personal orientation. Clarity of cues was found in only one third of the episodes and turn-taking was established in about half of them. The findings show that there was little emphasis on making the feeding procedure a social experience in combination with the task performed. Seemingly, the therapeutic possibilities that caring entails was not taken advantage of
The ethics of locked special care units for persons with Alzheimer's disease
Authors: Noyes Lin E. , Silva Mary Cipriano
Published: June 2007

Ten percent of nursing homes in the United States have special care units for persons with Alzheimer's disease. Over three-fourths of these units have locked doors or use other methods or devices aimed at controlling patients who wander from the unit. In a time when the literature isfilled with moral arguments about older adults' rights and respect for their autonomy, locked special care units seem to be a reversal of this trend. Using paternalism to justify locked units is discussed and is based on the theory that many Alzheimer patients have diminished capacity to choose right from wrong and therefore have limited autonomy. Nurses are obligated to safeguard their well-being and protect themfrom wandering into harm.
Creutzfeldt-Jakob disease in a nursing home resident
Authors: Woolery William A.
Published: June 2007

Creutzfeldt-Jakob disease (CJD) is a rare neurodegenerative disease. Alzheimer's disease is the most common neurodegenerative disease in the United States. The onsetof CJD is often heralded by behavioral changes, depression, and amnesia. Progressive dementia and myoclonus (often in response to sensory stimuli) invariably occur.

It is important to evaluate all new nursing home residents who have an admitting diagnosis of dementia. Dementia in the elderly is not always caused by Alzheimer's disease. This report identifies a rare cause of dementia in an elderly woman.
Activities of daily living and cognitive levels of function in dementia
Authors: Thralow Joan Ungerecht , Rueter Mary Jo Schaubach
Published: June 2007

The number of progressive dementia patients being caredfor in long term institutions is increasing. As medical science continues to search for answers to treatment and cure, caregivers continue to struggle with managing cares and promoting patient dignity. Evaluation and identification of individual patient cognitive assets and limitations is essential in planning patient cares. The purpose of this study is to describe two tools, used in a team aproach, to facilitate managing basic daily cares. The study compares the scoring of the two tools indicating a substantial relationship between the two instruments and suggests that the Cognitive Performance Test (CPT) and the Self Care Performance Test (SCPT) rate behavior and task performance in a consistently similar manner. The results suggest that the scales are an accurate predictor of demented patients cognitive abilities and limitations and can facilitate designing nursng care plans. The CPT(which can be given in about 20 minutes) can be completed upon admission, the test score shared with nursing and the SCPT can guide plans of care. Cares planned in this manner are likely to allow the patients independence in performing those cares they are capable of and not frustrating them by expecting them to perform skills they have lost.

This study focuses on patients in the later stages of progressive dementia. Fifty-eight subjects were rated using the two tools. Fifty-one of the 58 subjects in the study received a rating level offour or lower. (Allen 's levels of rating progressive dementia with level six being normalfunctioning.) Patient scores for both the CPT and the SCPT are based on observance of performance and do not require verbal responses and therefore lower level dementia patients can be more reliably rated.
Caregivers and the ministry in Alzheimer's disease
Authors: Ries Daryl T.
Published: June 2007

Some families experiencing Alzheimer's disease (AD) have unmet expectations regarding provision of ministerial support with resultant dissatisfaction. A descriptive survey of ministers and families was conducted and results indicated that ministers were current in knowledge and symptom recognition of dementia. Appropriate judgment and guidance of the AD family with some limitation in understanding was evident as the family's needs changed over time. Consensus was lacking in the family group in ministerial role expectations and in level of current satisfaction. Conclusions point to incomplete communication between family and ministers which, if corrected, would yield mutual understanding of needs.
Recognizing and working with remaining abilities: Toward improving the care of Alzheimer's disease sufferers
Authors: Sabat Steven R.
Published: June 2007

Empirical evidence derivedfrom the discourse of two Alzheimer's disease (AD) sufferers is presented and found to support the notion proposed by Kitwood and Bredin1 that there are aspects of “relative well-being” which are preserved in Alzheimer's disease sufferers despite the loss of a variety of individual cognitive abilities as measured by standard tests. The present in-depth case studies also reveal that aspects of relative well-being can be supported by the social environment in which the afflicted person lives. It is proposed that supporting the afflicted person's remaining intact abilities, as seen in the signs of relative well-being, can enhance the interactions between the caregiver and AD sufferer, and thus be a source of benefit to both.