October 10, 2016

American Journal of Alzheimer’s Disease & Other Dementias,


Full text articles and books are available to fee paying members of Alzheimer’s Australia NSW by emailing NSW.Library@alzheimers.org.au

 

September 2016; 31 (6)
 Top of
Current Topics in Research

 

Spousal Caregiver Perspectives on a Person-Centered Social Program for Partners With Dementia

AM J ALZHEIMERS DIS OTHER DEMEN September 2016 31: 465-473,

 

Abstract

This qualitative study explored spousal caregiver perspectives on the experience and impact of a person-centered social program for partners with dementia. Interviews with 5 caregivers and the spouses with dementia were conducted 7 to 8 months after the program ended to explore the sustained impact of the program. Interpretative phenomenological analysis was used to support in-depth exploration of interviews. Three themes emerged including benefits of the program for caregivers, initial expectations and later perspectives of caregivers about the program, and conflicting values and perspectives between caregivers and the spouses. These findings suggest participation in a person-centered social program by people with dementia benefits their caregivers, by meeting the caregivers’ desire for their spouses to increase social participation and engagement in meaningful activities. Participation in the program provided a sustained benefit to one couple in particular, by encouraging the caregiver to resume arranging activities the couple once enjoyed but now had difficulty pursuing.

 

Field Evaluations of Tracking/Locating Technologies for Prevention of Missing Incidents

AM J ALZHEIMERS DIS OTHER DEMEN September 2016 31: 474-480,

Abstract

Background: Persons with dementia are at risk of a missing incident, which is defined as an instance in which a demented person’s whereabouts are unknown to the caregiver and the individual is not in an expected location. Since it is critical to determine the missing person’s location as quickly as possible, we evaluated whether commercially available tracking technologies can assist in a rapid recovery.

Methods: This study examined 7 commercially available tracking devices: 3 radio frequency (RF) based and 4 global positioning system (GPS) based, employing realistic tracking scenarios. Outcome measures were time to discovery and degree of deviation from a straight intercept course.

Results/Conclusion: Across all scenarios tested, GPS devices were found to be approximately twice as efficient as the RF devices in locating a “missing person.” While the RF devices showed reasonable performance at close proximity, the GPS devices were found to be more appropriate overall for tracking/locating missing persons over unknown and larger distances.

 

 

Depression in the Family of Patients With Dementia in Korea

AM J ALZHEIMERS DIS OTHER DEMEN September 2016 31: 481-491

 

Abstract

Introduction: Dementia is the leading cause of disability worldwide in the elderly individuals. Although prior studies have examined psychiatric symptoms in dementia caregivers, few studies have examined physician-diagnosed depression in the family caregiver of a patient with dementia.

Methods: We used data from 457 864 respondents from the Korea Community Health Survey. We used logistic regression to examine the relationship between physician-diagnosed depression and cohabitation with a patient with dementia.

Results: Cohabitation with a patient with dementia (1.2% of the Korean population) was significantly associated with physician-diagnosed depression. The significance remained in females when the data were stratified by sex. A significant association also occurred among males with low family income.

Conclusion: To reduce the burden of dementia, we need a management policy that includes the caregiver as well as the patient with dementia. In particular, political management for the vulnerable population, male caregiver in low-income family and female caregiver in high-income family, should be prepared.

 

Experiences and Learning Needs of African American Family Dementia Caregivers

AM J ALZHEIMERS DIS OTHER DEMEN September 2016 31: 492-501

Abstract

Dementia family caregivers display significant rates of psychological and physical symptoms. African Americans (AAs) are disproportionately affected by dementia. African American caregivers display unique patterns of symptomology and responses to interventions designed to promote caregiver well-being. This study analyzed qualitative focus group data from 32 AA caregivers to explore how issues of race and culture may be incorporated into a culturally sensitive intervention for AA dementia family caregivers. Caregivers were asked scripted questions about their caregiving experiences and to suggest alterations to an existing psychoeducation program. Analysis revealed 4 key themes: the tradition of family care, caregiving and caregiving issues, culturally appropriate care, and navigating without a map. Suggestions for an educational program included a focus on developing caregiver skills and knowledge for caregiving, promotion of self-care, and reflection on the AA family and community as resources for care.

 

Ecopsychosocial Interventions in Cognitive Decline and Dementia: A New Terminology and a New Paradigm

AM J ALZHEIMERS DIS OTHER DEMEN September 2016 31: 502-507,

Abstract

Dementia is a major medical and social scourge. Neitherpharmacological nor nonpharmacological interventions and treatments have received sufficient funding to be meaningful in combatting this tsunami. Because the term—“nonpharmacological”—refers to what these interventions are not, rather than what they are, nonpharmacological treatments face a special set of challenges to be recognized, accepted, funded, and implemented. In some ways, the current situation is analogous to using the term “nonhate” to mean “love.” This article presents a carefully reasoned argument for using the terminology “ecopsychosocial” to describe the full range of approaches and interventions that fall into this category. These include interventions such as educational efforts with care partners, social support programs for individuals with various levels of dementia, efforts to improve community awareness of dementia, an intergenerational school where persons with dementia teach young children, and the design of residential and community settings that improve functioning and can reduce behavioral symptoms of dementia. The proposed terminology relates to the nature of the interventions themselves, rather than their outcomes, and reflects the broadest range of interventions possible under the present rubric—nonpharmacological. The goal of this new label is to be better able to compare interventions and their outcomes and to be able to see the connections between data sets presently not seen as fitting together, thereby encouraging greater focus on developing new ecopsychosocial interventions and approaches that can improve the lives of those with dementia, their care partners, and the broader society

 

 

Predictors of Discrepancy Between Care Recipients With Mild-to-Moderate Dementia and Their Caregivers on Perceptions of the Care Recipients’ Quality of Life

AM J ALZHEIMERS DIS OTHER DEMEN September 2016 31: 508-515,

Abstract

Purpose: The goal of this study was to explore predictors of discrepancy between reports of caregivers (CGs) and care recipients (CRs) with mild-to-moderate dementia about CRs’ quality of life (QOL).

Design and Methods: This study was a secondary analysis of cross-sectional data drawn from a study of 200 care dyads of CRs with mild-to-moderate dementia and their primary family CGs. Paired t test, ordinary least squares multiple regression, and binary logistic regression were used for the analyses.

Results: Caregivers rated CRs’ QOL significantly lower (worse) than CRs did. Ordinary least square regression results showed that greater incongruence in perceptions of CRs’ decision-making involvement (DMI) and higher level of CR impairment in activities of daily living were significantly related to higher absolute discrepancy between CG and CR about CRs’ QOL. In the logistic models, when the dyad had more DMI incongruence, or CG reported higher relationship strain, the CG was more likely to report a lower CR QOL than CR reported.

Implications: Practitioners should consider incorporating CRs’ perspective when planning care instead of solely depending on CGs’ perspective. Also, practitioners should pay attention to any gap between perceptions of CGs and CRs, particularly with regard to CRs’ QOL.

 

 

Planning Ahead or Living a Day at a Time? A Family History of AD and Retirement Planning

AM J ALZHEIMERS DIS OTHER DEMEN September 2016 31: 516-523

Abstract

Background: We assess whether a family history of Alzheimer’s disease (AD) is associated with the odds that healthy family members’ engage in retirement planning activities.

Methods: This is a cross-sectional study utilizing individual-level data from the Utah Population Database that have been linked to Medicare records and to responses from a retirement planning survey. Engagement in 3 retirement planning activities was estimated as a function of the number of parents and grandparents diagnosed with AD along with a set of fundamental socioeconomic and demographic covariates.

Results: Adults who had a parent with AD were 86% more likely to have seen a professional financial advisor and 40% less likely to plan to retire before age 65.

Conclusions: Caregiving costs and/or knowledge of the familial risk of developing AD may provide adult children with a forewarning of their own future financial needs that, in turn, motivates them to engage in retirement planning.

Pain in Hospice Patients With Dementia: The Informal Caregiver Experience

AM J ALZHEIMERS DIS OTHER DEMEN September 2016 31: 524-529,

Abstract

Introduction: At the end of life, patients with dementia often experience high levels of pain due to complex interplay of disease processes and numerous barriers to symptom management. In the hospice setting, informal caregivers play an essential role in pain management. This study describes their experience managing pain in hospice patients with dementia.

Methods: We conducted a qualitative analysis of audio-recorded interviews with informal caregivers of hospice patients with dementia who had chosen pain as the challenge they wanted to work on within a problem-solving therapy intervention.

Results: The thematic analysis of sessions with 51 caregivers identified 4 themes: difficulty in communicating with patients, lack of consistent guidance from health-care professionals, perceived uncertainty about the etiology of pain, and secondary suffering.

Discussion: Our findings indicate the possible need for increased support for caregivers, including educational interventions targeting pain etiology and assessment, and improved communication with health-care professionals.

 

Current Topic in Care

 

Resident Reactions to Person-Centered Communication by Long-Term Care Staff

AM J ALZHEIMERS DIS OTHER DEMEN September 2016 31: 530-537,

Abstract

Long-term care staff caregivers who are person centered incorporate the life history, preferences, and feelings of residents with dementia during care interactions. Communication is essential for person-centered care. However, little is known about residents’ verbal reactions when staff use person-centered communication. Accordingly, this study investigated the impact of person-centered communication and missed opportunities for such communication by staff on resident reactions. Conversations (N = 46) between staff–resident dyads were audio-recorded during routine care tasks over 12 weeks. Staff utterances were coded for person-centered communication and missed opportunities. Resident utterances were coded for positive reactions, such as cooperation, and negative reactions, such as distress. Linear regression analyses revealed that the more staff used person-centered communication, the more likely that residents reacted positively. Additionally, the more missed opportunities in a conversation, the more likely that the residents reacted negatively. Conversation illustrations elaborate on the quantitative findings and implications for staff training are discussed.

 

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