bluuebunny/crossref_metadata_2025 huggingface dataset:
Resident-Assisted Montessori Programming (RAMP™): Use of a Small Group Reading Activity Run by Persons With Dementia in Adult Day Health Care and Long-Term Care Settings
Authors: Skrajner Michael J. , Camp Cameron J.
Published: June 2007

Six persons in the early to middle stages of dementia (“leaders”) were trained in Resident-Assisted Montessori Programming (RAMP™) to lead a reading activity for 22 persons with more advanced dementia (“participants”) in an adult day health center (ADHC) and a special care unit (SCU) in a skilled nursing facility. Researchers assessed the leaders’ abilities to learn and follow the procedures of leading a group, as well as their satisfaction with their roles. In addition, participants’ engagement and affect were measured, both during standard activities programming and during client-led activities. Results of this study suggest that persons with dementia can indeed successfully lead small group activities, if several important prerequisites are met. Furthermore, the engagement and affect of participants was more positive in client-led activities than in standard activities programming.
Alzheimer's disease: the legal issues
Authors: Sandoe Anthony B.
Published: June 2007

For purposes of analysis, it might be suggested that the principal areas of legal concern to the Alzheimer's patient and family fall into four categories: 1) the care and management of the patient's assets during his lifetime; 2) the care and management of the patient himself; 3) the preservation and conservation of the patient's assets during this time for the benefit of the patient's dependents-the intervivos estate plan;'and 4) the passage of the patient's assets upon death-the postmortem estate plan. This article outlines some of the more important considerations of these areas.
What's different about a special care unit for dementia patients? A comparative study
Authors: Mathew Laura , Sloan Philip , Kilby Michael , Flood Roy
Published: June 2007

Segregated units for dementia patients, termed Special Care Units (SCU's) are a growing phenomenon in nursing homes. Advocates claim that these units provide more appropriate care, with improved outcomes, but objective data about such units is rare. This paper reports a study of 13 dementia patients in one SCU and 34 patients in two comparison settings: other wards of the same nursing home and a comparison settings; a separate analysis controlled differences in level of care.
Legal issues in Alzheimer's disease
Authors: Gottlieb Gary L. , Reisberg Barry
Published: June 2007

Pertinent legal and clinical issues related to Alzheimer's disease (AD) are reviewed in this article. The processes of competency determination and guardianship appointment are examined, particularly in regard to the special needs of patients with AD. The authors suggest an operational definition of AD, and outline the steps of progressive cognitive decline in this illness. This framework is utilized to recommend appropriate and flexible medicolegal guidelines.
An in-hospital respite program for Alzheimer's
Authors: Larkin John , Rheume Yvette , Seltzer Benjamin , Brown June , Lyon Paula , Fabiszewski Kathy , Whitaker Jan
Published: June 2007

A wide-range of respite services have been developed to meet the needs of families who care for the chronically ill and frail elderly. Institutional respite is a particular service that provides inpatient care to patients and offers their families temporary relief from the strain of continuous caregiving. This paper describes a two-week in-hospital respite program specifically designed for patients with Alzheimer's disease. Patients are profiled on the use of respite, sociodemographic characteristics, functional levels, and their dispositional outcome following respite.
State dementia registries: Diverse methodologic approaches to a common public health goal
Authors: Sayetta Rona Beth , Hackleman Karen T. , Howard James T.
Published: June 2007

A common goal of state dementia registries is public health disease surveillance for program planning service delivery, and research. Despite this similarity in perspective, methodologic differences involving coverage, diagnostic, and data coding issues distinguish the various registries. Some of these differences include the illnesses, geographic area(s), and population groups covered by dementia registries. Diagnostic differences center on the development and application of case definitions specific to the different types of dementing illness, the thoroughness of accessible sources of medical data, and the standardization of disease staging for the dementias. Competing coding systems for diagnoses exist, but fortunately the coding of procedures is already uniform.

A critical step toward facilitating the production of regional or national aggregate statistics and engaging in multisite research studies would be the achievement of enhanced standardization of the data elements and coding systems of public health and other dementia registries. This article promotes such methodologic compatibility.
Recommended mlinrimum data seL for state dementia registries
Authors: Sayetta Rona Beth ,   Workshop participants
Published: June 2007

The Alzheimer's Disease State Registry Operator's Workshop developed specific recommendations for a minimum basic data set to which all public health dementia registries at the meeting agreed to subscribe. In their databases, they will carry items of information relating to the patient's identifying and sociodemographic characteristics, diagnosis, reporting facility or physician, and death (with vital statistics and autopsy data). The workshop participants also reached consensus on the tentative nature of this set of recommendations and the need for further review and possible revision after additional operating experience has been obtained.
The first year operating experience of the Florida Dementia Registry
Authors: Pfeiffer Eric , Keller Donald M. , Doblas-Shaw Raquel , McCarthy Edwin
Published: June 2007

In January of 1987, Suncoast Gerontology Center at the University of South Florida in Tampa, signed a contract with the Department of Health and Rehabilitative Services (HRS) to establish and develop a statewide Registry for patients with Alzheimer's disease and other memory disorders.

The realization of the Registry's goals depends on the support and cooperation of all the participating programs. Suncoast Gerontology Center has the responsibility to demonstrate the utility of the data collection by stimulating new research and by enhancing communication and collaboration with service and research institutions throughout Florida.

Preliminary results will be presented in this article regarding the sociodemographic characteristics of Registry patients. Also, an attempt will be made to identify risk factors associated with Alzheimer's disease for this group.
Extending hospice care to end-stage dementia patients and families
Authors: Brechling Brigid G. , Heyworth Judith A. , Kuhn Dan , Peranteau Mary F.
Published: June 2007

Many families of terminally ill dementia patients may wish to care for their relatives at home until death occurs-either because they feel strongly that home is the most appropriate setting or in response to a past promise. Until recently, this had been difficult to accomplish because caring for patients with dementia is a demanding, time-consuming and frustrating task that can pose a tremendous threat to the welfare and happiness of the caregivers so that they eventually become secondary victims of the illness, and eventually seek institutional care for their relatives. A hospice home care program provides the practical help and emotional support that caregivers need in order to cope more effectively with the care and eventual death of their loved ones at home. This article describes the development and activities of the Alzheimer's Family Care Hospice, a pilot program sponsored by the Rush Alzheimer's Disease Center, and the Chicago area chapter of the Alzheimer's Association. This program has provided services to a total of nine terminally ill dementia patients and their families during the past ten months.
Parallel programming: For Alzheimer's disease and other dementia patients enrolled in day care
Authors: O'Leary Marianne , Glenner Joy
Published: June 2007

The needfor inclusion and afeeling of belonging are powerful. These needs can be met by participation in a group activity that has been designed to enhance the Alzheimer's patients' intact abilities, and help re-establish a positive self-image with a real sense of autonomy. In turn, this can strengthen the perception of identity in the Alzheimer's patient. Responsive well plannedparallelprogramming aims at giving these individuals alternative means of fulfilling their needs. The ideal activity for dementia patients counteracts the two greatest threats to these individuals: helplessness and hopelessness. A therapeutic care approach with the goals of enabling the patients to regain a sense of mastery over their lives is a challenge that can be met.
Death of the personality: The grief response of the Alzheimer's disease family caregiver
Authors: Austrom Mary Guerriero , Hendrie Hugh C.
Published: June 2007

The grief that follows death is understood and accepted by society. However, the grief associated with certain chronic illness is often misunderstood by family, friends and acquaintances. Unlike a terminal case of cancer where physical deterioration is quite evident, it is difficult to under-stand the grief associated with irreversible dementia because the patient is physically well for most of its duration. What has died in victims of Alzheimer's disease (AD) is the personality that quality or assemblage of qualities that makes a person what he or she is.

This paper describes family care-giver responses to providing chronic care for a demented relative and compares and contrasts it with the responses of coping with a non-dementing terminal illness. Based upon our clinical work and empirical research with AD patients and their families, it seems that while many of the AD family caregiver responses are similar to bereavement reactions and anticipatory grieving of other terminal illnesses, the intensity and duration of their responses make them qualitatively different. I nplications for intervention with family caregivers and directions for further research are discussed.
Designing environments for individuals with Alzheimer's disease: Some general principles
Authors: Schiff Myra R.
Published: June 2007

Recent years have seen an increase in the awareness of the environment's contribution to the functional abilities of individuals with Alzheimer's disease. This paper proposes that the environment should be viewed as an element in the care program of individuals with this condition, and that the principles used to plan and design environments should be consistent with the principles used in providing other aspects of care. Five basic principles derived from accepted concepts of good care are recommended. The environment should: (1) be clear and well structured; (2) be stable and familiar; (3) serve as a cue to behaviour; (4) serve as a cue to memory; and (5) support reality orientation.
A survey of attitudes toward group programs for Alzheimer's disease patients
Authors: Femie Bonnie , Brown Joanne , Femie Geoff
Published: June 2007

Patients' increased interaction, participation, and self concept contributed to positive patient, family and staff attitudes toward Alzheimer groups. Streamlined program implementation, compatibility with existing programs, and communication of patient outcomes facilitate support of specialized programs.
Availability of special nursing home programs for Alzheimer's disease patients
Authors: Leon Joel , Potter D. E.B. , Cunningham Peter J.
Published: June 2007

While still controversial, there is a growing belief that Alzheimer's disease patients require special programs across the service continuum. There is also a growing concern that nursing home facilities are not providing the programming required. Using data from the 1987 National Medical Expenditure Survey, national estimates are presented on the number of nursing facilities that have special units or programs directed towards the specific needs of the cognitively impaired elderly-primarily patients with Alzheimer's disease. The findings represent the first national estimates on special nursing home programs and units for Alzheimer's disease patients based on a nationally representative sample of nursing facilities. The survey included 759 facilities, and is weighted to be representative of all nursing facilities serving the elderly in 1987.

Examined are the numbers of facilities with Alzheimer's disease programs, the patient capacities of these programs, the characteristics of the facilities, the future plans of facilities to either expand present programs or develop new ones, the availability of specialized training received by the staff of these programs, and the respite care these programs offer to non residents.

The discussion centers on the implications these analyses hold for the further development of LTC policies and program provisions regarding Alzheimer's disease patients.
The subjective experience of Alzheimer's disease: A sociocultural perspective
Authors: Disman Milada
Published: June 2007

Although the North American population is multicultural, little is known of sociocultural variations in the subjective experience of Alzheimer's disease. In Canada, data on important health indicators from sociocultural minority groups are not readily available. The reasons for unavailability include problems with defining and measuring ethnicity - in particular, concern that the sociocultural background of a person is private information, linked to concerns about potential violation of the Canadian Charter of Rights. The current commitment to reducing inequalities in health is starting to stimulate more interest in research on health-related sociocultural issues. This focus on links between sociopsychological factors and health suggests that members of sociocultural minority groups, and especially seniors, may be neurologically vulnerable to the stresses associated with older age, particularly when compounded by stressesfrom immigration and from aging in an acquired culture. Cross-cultural psychiatry distinguishes between disease as malfunctioning biologic and psychophysiologic process in the individuals, and illness as a subjective experience of being ill. Consequently, Alzheimer's disease will appear universally across cultures, but may vary in the realm of subjective experience.

A strategy for building support groups for family caregivers from the targetedpopulation is presented as one example of effective intervention. The urgent needfor research to inform professional caregivers about sociocultural variations in the subjective experience of Alzheimer's disease is noted. In order to provide responsible and supportive care for patients and their caregivers in sociocultural minority groups, there is the urgent need for research to inform professional caregivers about sociocultural variations in the subjective experience of Alzheimer's disease.
Film Review: The subjective experience of Alzheimer's disease
Authors: Dastoor D. P.
Published: June 2007

This article reviews five films dealing with Alzheimer's disease as experienced both by the victim and the caregiver. Each of thesefilms looks at the fragility of human existence, the course of the disease, the mental and emotional anguish of those suffering from this disease as well as the courage, love and compassion experienced by those close to the afflicted person - qualities which enable them to endure extremes of pain and agony.

Visual image is effective in conveying messages. It has been used effectively by professionals to sensitize the public about the impact this disease can have on the life of others - the moral and ethical issues in ongoing caregiving and management techniques.
Memory training in early Alzheimer's disease: An optimistic look at the field
Authors: Arkin Sharon M.
Published: June 2007

The purpose of this article is to encourage caregivers and treatment providers of early Alzheimer patients to try various memory stimulation strategies since, as this article will show, some patients do benefit cognitively, while most-caregivers and patients-benefit emotionally and psychologically from the cooperative effort.

This article will review three published studies with encouraging results or elements, five with negative results, and three studies involving work with other populations that would seem to have applicability to early stage Alzheimer patients. This author will also describe two unpublished memory training interventions for early Alzheimer patients that have had promising results, but are not yet published. Related research and encouraging trends will be summarized, and treatment and rehabilitation strategies suggested by these and other published literature will be presented.
Predicting distress and life satisfaction of in-home spouse dementia caregivers: Implications for intervention
Authors: Knight Bob
Published: June 2007

The study of potentially changeable predictors of distress in help seeking dementia caregivers can help to inform the search for effective interventions. A model is presented which argues that typical interventions with dementia caregivers focus on increasing resources (information about the disease and social support) or the modification of mediating cognitive coping strategies. This investigation examined the prediction of emotional distress, life satisfaction, and burden in a group of 72 in-home spouse caregivers who were seeking help in alleviating their distress. In order to test the specificity of these strategies to caregiving, a comparison group of 35 older people seeking help in changing their moods was used. Distress among in-home spouse caregivers was predicted by cognitive coping strategies. Symptom-atic distress among the noncaregiver older adults was predicted by qualitative social support only. These results are interpreted as supporting a stress reduction model for understanding and helping dementia caregivers.
Long-term memory cuing to reduce visuo-spatial disorientation in Alzheimer's disease patients in a special care unit
Authors: Namazi Kevan H. , Rosner Tena Tarler , Rechlin Linda
Published: June 2007

Visuo-spatial disorientation typically occurs relatively early in Alzheimer's disease patients, and is usually reported by families who fear that the individual may leave the house and get lost. It is often this deficit which frightens the family members into consideration of a long term care facility. However, disorientation to place can occur within a long term care facility as well as outside of it. This study will examine whether prominently displayed personal memorabilia of long term significance to each resident will serve as orientation cues to help identify his or her bedroom. The results indicate that four out of 10 residents were more successful in locating their rooms with significant memorabilia items than with nonsignificant ones.
Environmental effects on incontinence problems in Alzheimer's disease patients
Authors: Namazi Kevan H. , Johnson Beth DiNatale
Published: June 2007

Incontinence is a problem for both AD patients as well as their caregivers and becomes increasingly difficult to treat as cognitive abilities deteriorate. There are a variety of behavioral interventions to help alleviate incontinence. However, these remedies are often in-appropriate for dementia patients since the ability to comply diminishes with the progression of the disease. This study examines the differences in toilet use under concealed and visible conditions to determine whether visibility of the toilet is a supportive cue for AD patients. The results indicate that utilization of the toilets increased when toilets were visually accessible.
Physical environmental cues to reduce the problems of incontinence in Alzheimer's disease units
Authors: Namazi Kevan H. , Johnson Beth DiNatale
Published: June 2007

Research has indicated that behavioral strategies such as cuing orientation within an environment may help reduce incontinence among dementia patients. However, there are no empirical studies that explore the relationship between incontinence and environmental modifications. This study compares the effectiveness of four nomenclatures such as “toilet” and “restroom” on the wayfinding abilities of residents in the early, middle, and advanced stages of dementia in two specially designed units. Results indicate that a series of directional arrows on the floor with the nomenclature “toilet” produced the most instances of utilization of public toilets in both units.
The effects of environmental barriers on the attention span of Alzheimer's disease patients
Authors: Namazi Kevan H. , Johnson Beth DiNatale
Published: June 2007

Anecdotal evidence indicates that Alzheimer's disease patients often appear confused and unable to concentrate, and that this may be related to attention span. This study utilizes barriers of three different heights to test how visual and auditory distracters affect the ability to concentrate on a given task. Residents were given art projects with adult themes and were observed for number of distractions. The results indicate that both low and high barriers are more effective than no barriers in screening out extraneous visual and auditory distractions. Of equal or greater importance is the finding that residents in the early and middle stages of the disease averaged 16 minutes of focused attention in a 20 minute trial.
How familiar tasks can enhance concentration in Alzheimer's disease patients
Authors: Namazi Kevan H. , Johnson Beth DiNatale
Published: June 2007

The issue of purposeful therapeutic activities for AD patients has largely been ignored in the literature. Continuity with pre-morbid life patterns and reinforcement of repetitive sequential behaviors may help support the remaining abilities of some AD patients and encourage active participation in the environment. This study examines residents' behaviors while working on familiar or unfamiliar tasks and measures how decision making affects attention. The results indicate that residents expressed preferences for different tasks and demonstrated the ability to sustain attention to a chosen task throughout the trial period. The suggestion is made that there is a need for greater integration of meaningful activities into the daily schedules of some residents in earlier stages of the disease.
The increase in the proportion of popular and professional publications concerning Alzheimer's disease and related disorders
Authors: Sun Richard K.P. , Helmick Charles G.
Published: June 2007

The observed death rates for Alzheimer's disease (AD) and related disorders have increased in recent years. Increased awareness of these conditions may have contributed to this increase in death rates, but no direct measures of awareness over time are available. Thus, we analyzed trends in publication rates as a possible indicator of awareness. The proportion of popular and professional literature devoted to Alzheimer's disease and related disorders (ADRDs) in five computerized indexes was calculated for each year from 1966 through 1989. Compared to baselines in the 1960s and 1970s, the proportions of popular and professional publications indexed concerning AD and ADRDs increased markedly through the 1980s. The increase in proportions in the database MEDLINE cannot be completely explained by the addition of journals covering ADRDs to the database. The proportions of articles concerning AD increased at a greater rate in neurology and psychiatry journals than in other categories of biomedical journals. The increasing proportions of publications on ADRDs may reflect an increased awareness of these disorders among the public and among health care providers.
Dementia caregivers: Expectations of respite care
Authors: Adler Geri
Published: June 2007

Caregivers of dementia patients frequently request respite care to alleviate the stress of 24 hour care. At the Minneapolis Veterans Affairs Medical Center in-hospital respite care is offered to families for pre-planned two week stays. Family caregivers speak favorably of the experience though they often note functional deterioration of the impaired person. Nonetheless, they frequently request repeat stays. Thirty-seven care giving families who had utilized this program were queried about their reasons for needing such care, as well as their expectations of it for themselves and for the care receiver. The questionnaires were completed at three different time intervals. The family care provider 's subjective experiences provide insight into the value they place on such a program.
The effects of a bereavement support group on caregivers of Alzheimer victims
Authors: Shadday-Haarhoff Allison
Published: June 2007

This paper investigates the effects of a structured seven-week pilot bereavement support group on six caregivers who are grieving the death of a loved one with Alzheimer's disease. The James and Cherry, 16-step grief recovery model is the design used by the group. A one group pretest post-test experimental design is used to test the experimental hypothesis that the bereavement support group will facilitate the participants' grieving process. The Beck Depression Inventory and the Texas Revised Inventory of Griefare the measurements used in this experiment. The post-test results indicate that a statistically significant improvement was seen in the reduction of grief, but no significant change was reported in regard to depression. These results indicate thatfurther research is needed to support the use of this particular grief recovery model. It also raises questions as to whether depression is a variable to be measured when studying the grief process.
Staff helping behaviors: Alzheimer day care
Authors: Hasselkus Betty Risteen
Published: June 2007

Helping behaviors of staff members at an Alzheimer day care center were examined through participant observation and ethnographic interviewing. Analysis of the field notes and interview data revealed a primary theme of prevention of harm in the helping patterns and secondary themes of enhancing client function and providing social connectedness. Comparisons with relational and dependency models of helping are made and implications for dementia care are discussed.
Behavioral dimensions of dementia: A comparison of three program groups in adult day care
Authors: Taft Lois B. , Seman Dorothy , Stansell Jane , Farran Carol J.
Published: June 2007

The purpose of the retrospective, descriptive study described in this article, was to measure differences in clients in three different program groups in an adult day care center. Recognizing the interaction between the functioning of clients and their physical and social environment, staff at the Alzheimer's Family Care Center developed three differentiated programs to meet the needs and support the abilities of clients. This article describes the setting, client characteristics, and types of programming in each group.

Client differences were measured by comparing mental status, agitation, and social accessibility. Significant differences were identified in cognitive and behavioral characteristics among the clients in the different groups. Behavioral differences in the three program groups were characterized by client scores representing:

•High sociability/low agitation;

•High sociability/high agitation; and

•Low sociability/low agitation.

The findings support the assumption that clients with dementia are a heterogeneous group responding to unique therapeutic approaches in differentiated programs.
Treating clients and families together in an Alzheimer day care center
Authors: Tappen Ruth M. , Weber Mary
Published: June 2007

Functional skills training techniques and effective communication strategies previously found to improve function and decrease behavioral problems in cognitively impaired nursing home residents were taught to family members in tandem with their introduction to an Alzheimer day care center. Compared to non-treatment control clients at the center; treated Alzheimer patients were found to have significantly improved ability to communicate and to exhibit less disoriented, withdrawn, depressed or anxious behaviors. Treated patients did not, however; improve significantly over controls in their ability to perform the basic activities of daily living, and their families did not perceive their care giving burden to have been significantly reduced. Results are interpreted as cautiously supportive of efforts to develop therapeutically-oriented programming in day care and supportive of patient management as a joint responsibility of professionals and family caregivers.
Nutrition-related training experiences of staff involved in the care of Alzheimer patients
Authors: Zahler Lucy P. , Keiser Alexis V. , Gates Gail E. , Holdt Candace S.
Published: June 2007

Staff training in special care units (SCU) and adult day care programs (ADC) is extremely important for the proper management of Alzheimer's disease (AD) patients, even though there are indications that current training programs may be inadequate. Staff of 11 SCUs and 12 ADCs completed questionnaires designed to characterize the nutrition-related training they received in order to identify areas where improved training could result in better nutritional care of clients with AD or other dementias. Staf of both settings reported in-services as the most commonly attended training activity followed by conferences. ADC staff attended significantly more college courses that included topics related to AD than SCU staff (p < .05). The most frequently reported topics included in training sessions were, encouraging Food Science and Human Nutrition, University of Missouri, Columbia, Missouri. Candace S. Holdt, PhD, RD, is Assistant Professor, Food Science and Human Nutrition, University of Missouri, Columbia, Missouri. food intake, responding to problem eating behaviors, and providing verbal cues to eating. The topics less frequently covered in training were managing overeating, sanitary feeding techniques and manipulation of food shapes, sizes and consistencies. Both groups reported that experience was their best preparation for work with AD clients. More studies are needed to determine what areas of training in the nutritional aspect of care are most effective, how to deliver training programs to impact the ability of staff to provide appropriate nutritional care to clients with AD, and how to measure the effectiveness of training.
Experience of at-homeness and homesickness in patients with Alzheimer's disease
Authors: Zingmark Karin , Norberg Astrid , Sandman Per-Olov
Published: June 2007

In order to gain deeper understanding of the patient's everyday life participant and non-participant observations were performed at a group-dwelling for Alzheimer patients, during one year and eight months. The patients' talking and acting in various situations were noted, and the contexts were described. The phenomena, “longing for home,” “on their way home “ and “being at home “ were identified and regarded as expressions of the experience of homesickness and at homeness in the patients.
Later-life remarriage and Alzheimer's disease: Caregivers at risk
Authors: Kapust Lissa Robins , Robins Mort , Freedman Donald N.
Published: June 2007

An increasing number of second marriages, coupled with the growing population of older individuals who become victims of Alzheimer's disease (AD) or other disabling dementias, is giving rise to a large group of later-life, remarried caretakers. This subgroup of caretakers face a formidable double burden. Like all AD caregivers, they must confront the emotional and physical demands of providing care for their dementing spouse. This stress is compounded by the additional challenge of negotiating within a stepfamily system that may well rest on a precarious equilibrium. As a result, health care professionals must become attuned to the synergistic effects of the special psychological problems of these stepfamily caregivers. The juxtaposition of AD and later-life remarriage also gives rise to complicated financial and legal issues that should be addressed by an attorney with expertise in this field.
Treating excess disabilities in special care units: A review of interventions
Authors: Martichuski Diane K. , Bell Paul A.
Published: June 2007

There is a predictable decline in functioning among individuals with progressive dementias. In addition, independent of the disease process, there can be “excess disabilities” due to incompatible components of the social and physical environment. We review the nature and sources of these excess disabilities and examine the literature on ameliorative interventions in special care units.
A telephone helpline for Alzheimer 's disease: Information, referral, and support
Authors: Silverstein Nina M. , Kennedy Karen , McCormick Dawn
Published: June 2007

Alzheimer's disease is a progressive, degenerative terminal disease. It has been the fourth leading cause of death among adults during the past decade, taking more than 100,000 lives annually. Approximately 10 percent of people age 65 and over have probable Alzheimer's disease and 47 percent of those over age 85 suffer from the disease. The National Institute of Aging predicts that there will be 14 million people with Alzheimer's disease by the year 2050.

This study examined the helpline of the Alzheimer's Association of Eastern Massachusetts. Its stated mission is to provide access to comprehensive services as well as provide support to callers who are caring for someone with dementia. How information is provided and perceived may impact upon a caller's overall satisfaction with the helpline and their consequent decision tofollow through on referrals.

Helpline staff identified callers who sought information regarding a specific family member or patient during November 1991. About 70 percent (100) of the callers consented to afollow-up telephone interview by a social work graduate student in January 1992. Approximately 63 percent of the calls regarded someone who was post diagnosis. Memory loss, confusion, and repetitive questioning were the major problem behaviors noted. The mostfrequent inquiries regarded nursing home placements, family support groups, and diagnostic referrals. Over 75 percent of the callers were not affiliated with the Alzheimer's Association or with a family support group.

While overall satisfaction with the helpline was high, callers who received follow-up information through the mail tended to report greater satisfaction. The majority (87 percent) noted they would call the helpline again as concerns arose in the future.

The study highlighted the need for professionals to be better informed about Alzheimer's disease and its impact on families. It also emphasized the lack of knowledge concerning available resources. The Alzheimer's Association through its network of helplines can provide valuable information to both informal and professional caregivers regarding the progression of the disease and its management. The Helpline should be recognized as a resource that may provide ongoing support through the duration of the disease.
The way to go home
Authors: Whitcomb Joan Butterfield
Published: June 2007

Music therapy has proven itself to be a very effective modalityfor connecting with persons with dementia and enabling them to reach optimal levels offunctioning and wellbeing. This article suggests methods of using music in group settings for lifeenhancing behavior management. Elements of therapeutic music and milieu are discussed.
Assisting cognitively impaired elders with activities of daily living
Authors: Beck Cornelia , Heacock Patricia , Rapp Carla Gene , Mercer Susan O.
Published: June 2007

As the population ages, cognitive impairment will affect larger numbers of older Americans. Decreased ability to perform activities of daily living is related to cognitive impairment. However, the extent to which activity of daily living (ADL) dependence is related to actual physical and cognitive impairment or is environmentally induced has yet to be established. A variety of strategies may help to increase the ADL ability of cognitively impaired (CI) older adults. Each older person has an individual pattern of cognitive deficits, therefore, a decision-making process for selection of the appropriate strategies must be used. Nurses often have the opportunity to help improve the quality of life of and interactions between the CI and their caregivers. The “prescribing” of strategies for use when performing ADL activities represents one method to improve the lives and care of CI persons. We encourage caregivers to use the decision-making process to identify appropriate strategies in their interactions with CI older adults regardless of the living situation. These concepts work equally well in acute-care hospitals, private home, or nursing homes. Through their use, maximal independencefor CI older adults is encouraged.
Family care of Alzheimer victims
Authors: Beach Diane L.
Published: June 2007

The burden of caregiver stress has been well documented in the literature. While attention has been paid to caregiving spouses and adult children, few studies have examined the impact of family caregiving on adolescents. With the rise in adult child caregivers simultaneously raising children of their own, increasingly greater numbers of young adults will be involved in caring for Alzheimer's type dementia (ATD) victims. This study examined the characteristics and experiences of these young adults. Specifically, 14 adolescents aged 14-18 were interviewed and asked a series of semi-structured questions regarding theirfeelings of burden and satisfaction as they related to caregiving. Employing features of content analysis methodology, all interviews were audiorecorded and transcribed. The results merged intofive primary categories:

• Positive caregiving outcomes; • Negative caregiving consequences; • Peer group support; • Teacher support; and • Patient behavior management.

These results are discussed within the context of developing support group interventionsforcaregiving adolescents.
Images in the twilight: Alzheimer's disease and palliative care
Authors: Breaden Katrina , Coulson Irene
Published: June 2007

This paper provides a discussion of some of the issues surrounding the provision of palliative care for Alzheimer's sufferers and their families during the final stages of the disease. Five nurses working in dementia care institutions in Australia were invited to tell their story about the experience of caring for people in a twilight zone, where the sufferer is suspended in a world that is at the edge of existence.

This paper explores the virtual silence in the literature regarding palliative care and Alzheimer's disease. However, it is primarily concemed with the images and metaphors surrounding the advancing stages of the disease. The images and the issues raised during the conversations with these nurses are discussed, together with recommendations for future research in this area.
Effects of calming music on the level of agitation in cognitively impaired nursing home residents
Authors: Tabloski Patricia A. , Mckinnon-Howe Leah , Remington Ruth
Published: June 2007

This study examines the use of music as a strategy to decrease agitated behavior in cognitively impaired nursing home residents. Twenty agitated subjects, 68 to 84 years of age, were exposed to 15 minutes of calming music on two occasions. Agitated behavior scores were recorded before, during and after the musical intervention using the Agitated Behavior Scale. Results indicate that a statistically significant reduction in agitated behavior occurs both during (p. <0]) and after the musical intervention (p. <05). Calming music was shown to be an effective, nonpharmacologic strategy which nurses and other caregivers may use to reduce agitated behavior in the nursing home.
The dilemma of feeding end-stage Alzheimer patients
Authors: Callahan Sally
Published: June 2007

This article presents a case summary o 1feeding issues for an endstage Azheimer patient who will not be tube Jed. It addresses the issues chronologically as they arose. It considers the ethical issues, caregix er responsibilities and the multidi aciplinary team approach of the long term care facility, primary caregii ing daughter and hospice. It concludes with a list of questions for professional and family caregivers to conslider for flrther discussion.
Healthy eating promotes a healthy caregiver
Authors: Price-Moisand Mary , Tebb Susan Steiger
Published: June 2007

Approximately one-third to onehalf of the health problems older people encounter are indirectly or directly related to dietary lacks. The need to identify risk factors and indicators of poor nutritional status in older caregivers is critical. Caregivers of persons with Alzheimer's disease and related disorders (ADRD) experience changes in lifestyle imposed by the stress and health risks associated with the caregiving role. Nutritional needs, requirements, and behaviors of older caregivers were addressed in this study. The study was conducted to look at how the stress of spousal caregiving may result in possible neglect of the caregiver's own nutritional health. The dietary intake patterns and intake of nutrients of those caring for persons with ADRD were examined. The results of the study indicate that every caregiver support group should provide nutritional counseling for all participants. Suggestions for nutritional self-improvement and its relationship to healthy caregiving/coping skills are made.
Caregiving and dementia: The impact of telephone helpline services
Authors: Coyne Andrew C. , Potenza Mildred , Nose Mary Anne Broken
Published: June 2007

We examined the impact of a telephone helpline providing information, referral, education, and counseling on caregivers for dementia patients. It lwas hypothesized that longitudinal telephone contact between caregivers and helpline staff would contribute to increased use of community services and decreased levels of burden and depression. Baseline and eight-week follow-up questionnaires were mailed to 98 caregivers who called a helpline. Half were assigned to an intervention group in which staff made biweekly return telephone calls for eight weeks to provide further assistance; the remaining (control) subjects only spoke with staff once during the eight week study period. Results indicated that extended telephone contact increased use of community services and decreased caregiver burden, in comparison to control subjects.
Tolerance weighted frequency indices for non-cognitive symptoms of dementia
Authors: Smith Glenn E. , Tangalos Eric G. , Ivnik Robert J. , Kokmen Emre , Petersen Ronald C.
Published: June 2007

In this study we examine factors which are associated with nursing home placement in terms of both their frequency of occurrence and the degree to which caregivers perceive them to have influenced placement. We propose “Tolerance Weighted Frequency Indices “ (TWFIs) to rank symptoms in terms of their association with placement decisions. Given our method for calculating TWFIs we observe that basic activity of daily living impairments appear to have a comparatively stronger association with nursing home placement than many disruptive behaviors. These findings emphasize the importance of management of ADL impairments in strategies designed to delay or prevent nursing home placement.
The Alzheimer functional status instrument: An instrument to assess rehabilitation strategies for Alzheimer patients
Authors: Lasch Kathryn Eilene , Burnham Julia , Lee Jennifer
Published: June 2007

The Alzheimer Functional St atus Inventory (AFSI) was developed to assess a kinesiotherapy program for 22 randomized pairs ofpatients with Senile Dementia of the Alzheimer Type (SDAT) residing in the Dementia Study Unit of the Edith Nourse Rogers Memorial VA Medical Center; Bedford, Massachusetts. The AFSI was developed by an interdisciplinary team to overcome some of the limitations of standard geriatric instruments to detect changes in functional status in SDAT patients following a rehabilitation program. The AFSI, which is performance-based, includes items adapted from Granger's PULSES Profile and activity disturbances itemsfrom the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), items on mood andbehaviorduring assessment, as well as, one on communication status. The AFSI thus includes items which evaluate physical, psychosocial, and cognitive dimensions offunctional status. These dimensions are:

• Sensory function; • Range of motion skills including lower limb and upper limbfunction; • Mood state; • Behavioral status; and • Time to complete tasks.
Further validation of the Hierarchic Dementia Scale: A longitudinal study of cognitive function in dementia
Authors: Gold Dolores Pushkar , Dastoor Dolly , Zieren Connie
Published: June 2007

A longitudinal study was undertaken assessing the efficacy of the Hierarchic Dementia Scale (HDS) as a measure of cognitive function over time, for individuals with dementia who were residing in the community. The participants were administered the HDS and the Mini Mental State Examination (MMSE). One hundred eighty-six people with a diagnosis of primary degenerative dementia were assessed. Two years later, 78 of the original sample were reassessed using the same measures. The HDS revealed a significant decline in cognitivefunctions with initial scores significantly predicting patient institutionalization or death. The study also reported additional psychometric data for the HDS.
Alzheimer friendly assisted living regulation
Authors: Hyde Joan
Published: June 2007

Assisted living is increasingly recognized as an important option for people with Alzheimer's and related disorders. Although 30 to 40 percent of people in assisted living and residential care settings are suffering from dementia, regulations in many states have not kept pace with this reality. This article identifies areas where regulations may support or undermine assisted living providers serving those with dementia, and suggests ways in which regulators, advocates, and providers may work together to create Alzheimer friendly assisted living regulation.
Assisted living for people with Alzheimer's disease: Strategic planning and management considerations
Authors: Noyes Lin E.
Published: June 2007

Providing assisted living services to people with dementia is different than providing assisted living to people who are physically frail, but mentally alert. Administrators need to acknowledge these differences and incorporate appropriate strategies and information in their philosophy strategic plan, marketing, and staffing endeavors. These are important factors in determining the quality of care a facility provides for people with dementia.
Assisted living residences in Massachusetts: How ready and willing are they to serve people with Alzheimer' s disease or a related disorder?
Authors: Stocker Kathy B. , Silverstein Nina M.
Published: June 2007

Assisted living is a growing residential option for persons with cognitive impairments and their families. Massachusetts recently passed legislation (January 1995) establishing assisted living residences into law. While many elder advocates applauded this legislation as a step forward in recognizing both the housing and supportive needs of older residents, others voiced concern that the legislation did not contain specific wording regarding the need Jbr 24-hour “awake” staff which many consider to be a crucial element in the care of dementia residents.