Erin R. Smith

Memory and communication support in dementia: research-based strategies for caregivers

BACKGROUND Difficulties with memory and communication are prominent and distressing features of dementia which impact on the person with dementia and contribute to caregiver stress and burden. There is a need to provide caregivers with strategies to support and maximize memory and communication abilities in people with dementia. In this project, a team of clinicians, researchers and educators in neuropsychology, psychogeriatrics, nursing and speech pathology translated research-based knowledge from these fields into a program of practical strategies for everyday use by family and professional caregivers. METHODS From the available research evidence, the project team identified compensatory or facilitative strategies to assist with common areas of difficulty, and structured these under the mnemonics RECAPS (for memory) and MESSAGE (for communication). This information was adapted for presentation in a DVD-based education program in accordance with known characteristics of effective caregiver education. RESULTS The resultant DVD comprises (1) information on the nature and importance of memory and communication in everyday life; (2) explanations of common patterns of difficulty and preserved ability in memory and communication across the stages of dementia; (3) acted vignettes demonstrating the strategies, based on authentic samples of speech in dementia; and (4) scenarios to prompt the viewer to consider the benefits of using the strategies. CONCLUSION Using a knowledge-translation framework, information and strategies can be provided to family and professional caregivers to help them optimize residual memory and communication in people with dementia. Future development of the materials, incorporating consumer feedback, will focus on methods for enabling wider dissemination.

Effects of subthalamic deep brain stimulation on noun/verb generation and selection from competing alternatives in Parkinson’s disease

Background and aim: Impaired generation of verbs relative to nouns has been reported in Parkinson’s disease (PD) and has been associated with the frontal pathophysiology of PD. The aim of the present study was to measure noun/verb generation abilities in PD and to determine whether noun/verb generation is affected by stimulation of the subthalamic nucleus (STN). Patients and methods: 8 participants who had been diagnosed with PD and had received surgery for deep brain stimulation (DBS) of the STN as well as 15 control participants completed a noun/verb generation task with four probe–response conditions—namely, noun–noun, verb–noun, noun–verb and verb–verb conditions. Patients with PD were assessed while receiving STN stimulation and without stimulation. Results: During the off stimulation condition, patients with PD presented with a selective deficit in verb generation compared with control participants. However, when receiving STN stimulation, patients with PD produced significantly more errors than controls during the noun–noun and verb–verb conditions, supporting evidence from previous studies that STN stimulation modulates a frontotemporal network associated with word generation. Finally, errors during verb generation were significantly correlated with item selection constraint (ie, the degree to which a response competes with other response alternatives) in the on stimulation condition, but not the off stimulation condition. Conclusion: Our results suggest that STN stimulation affects the ability to select from many competing lexical alternatives during verb generation.

Evaluation of a caregiver education program to support memory and communication in dementia: A controlled pretest–posttest study with nursing home staff

BACKGROUND There is a need for simple multimedia training programs designed to upskill the dementia care workforce. A DVD-based training program entitled RECAPS and MESSAGE has been designed to provide caregivers with strategies to support memory and communication in people with dementia. OBJECTIVES The aims of this study were: (1) to evaluate the effects of the RECAPS and MESSAGE training on knowledge of support strategies, and caregiver satisfaction, in nursing home care staff, and (2) to evaluate staff opinion of the training. DESIGN A multi-centre controlled pretest-posttest trial was conducted between June 2009 and January 2010, with baseline, immediately post-training and 3-month follow-up assessment. SETTING Four nursing homes in Queensland, Australia. PARTICIPANTS All care staff were invited to participate. Of the 68 participants who entered the study, 52 (37 training participants and 15 controls) completed outcome measures at baseline and 3-month follow-up. 63.5% of participants were nursing assistants, 25% were qualified nurses and 11.5% were recreational/activities officers. METHODS The training and control groups were compared on the following outcomes: (1) knowledge of memory and communication support strategies, and (2) caregiver satisfaction. In the training group, the immediate effects of training on knowledge, and the effects of role (nurse, nursing assistant, recreational staff) on both outcome measures, were also examined. Staff opinion of the training was assessed immediately post-training and at 3-month follow-up. RESULTS The training group showed a significant improvement in knowledge of support strategies from baseline to immediately post-training (p=0.001). Comparison of the training and control groups revealed a significant increase in knowledge for the training group (p=0.011), but not for the control group (p=0.33), between baseline and 3-month follow-up. Examination of caregiver satisfaction by care staff role in the training group revealed that only the qualified nurses showed higher levels of caregiver satisfaction at 3-month follow-up (p=0.013). Staff rated the training positively both for usefulness and applicability. CONCLUSION The RECAPS and MESSAGE training improved nursing home care staffs knowledge of support strategies for memory and communication, and gains were maintained at 3-month follow-up. Moreover, the training was well received by staff.

Hemispheric contributions to semantic activation: A divided visual field and event-related potential investigation of time-course

Hemispheric contributions to lexical-semantic processing were investigated using event-related potentials and a divided visual field semantic priming paradigm. Hemispheric activation for pairs related via semantic category membership and association (CA) or via semantic category membership only (CO) was examined over two stimulus onset asynchronies (SOAs). Experiment 1 employed a SOA of 250 ms, and Experiment 2 employed a SOA of 750 ms. Controlled semantic priming was targeted in both experiments via a high relatedness proportion. Behavioral accuracy data revealed significant bilateral priming for both CA and CO conditions at 250 ms SOA. At 750 ms SOA hemispheric differences were observed within the behavioral data, with significant priming of the CO condition and priming for the CA condition approaching significance in the left hemisphere, and significant priming of the CA condition only in the right hemisphere. At 250 ms SOA, ERP analysis revealed bilateral CA activation in the N400 and LPC time windows. The second experiment (750 ms SOA) revealed bilateral CA priming during the N400 time window, with no significant LPC effects. The CO condition did not elicit significant ERP priming within either time window at either SOA. The results indicate no hemispheric differences for the ERP measures, with bilateral hemispheric N400 priming observed for associated category members irrespective of SOA, and a bilateral LPC effect at 250 ms SOA only, under controlled semantic priming conditions.

Person-centered communication strategies in action: A focus on residents with dementia in aged care

Globalization is challenging social gerontologists’ notions of who older migrants are and how to cater to their needs. This presentation aims to show that there are specific risks for social exclus ...Narrative foreclosure is a new sensitizing concept for studying stagnation of identity development in later life. It is defined as the conviction that no new interpretations of one’s past, nor new commitments and experiences in one’s future are possible that can substantially change one’s life story. The Narrative Foreclosure Scale (NFS) was developed to study this concept empirically. The NFS comprises two subscales: Past and Future. The psychometric properties were studied in two samples of older adults (n=247 and n = 220). Confirmatory factor analyses confirm that the scale consists of two distinct factors. Internal consistencies are sufficient to good. The validity is further confirmed by the relationship with demographics and other psychological constructs, such as personality, hope, reminiscence, ego-integrity, balanced time perspective, wisdom, depression, and positive mental health. It is discussed that diminishing narrative foreclosure may be an important process factor in life-review and narrative therapy with older adults.

Manipulating hemispheric attentional mechanisms to modulate word retrieval in aphasia

Background: Emerging evidence suggests that left hemisphere damage may create an attentional bias towards stimuli initially processed in the right hemisphere. Aims: The current study aimed to investigate whether this hemispheric attentional bias influences spoken word production in a picture–word interference task. Methods & Procedures: Two participants with aphasia and seven healthy controls named centrally presented pictures that were preceded by a distractor word which appeared in either the left or right visual field 200 ms prior to the picture. Distractor words were semantically related, phonologically related, unrelated, or the name of the picture. Results were analysed in terms of response times and accuracy. Outcomes & Results: A greater overall facilitation effect was found in the left visual field/right hemisphere condition for both participants with aphasia, however this varied depending on distractor condition. These results are consistent with an attentional bias towards linguistic stimuli initially presented to the right hemisphere. In contrast, the results of the control group suggest a reduction in the lateralisation of language processing to the left hemisphere in healthy ageing. Conclusions: These results suggest that spoken word production may be influenced by changes in attentional mechanisms following left hemisphere damage in aphasia, as well as changes in hemispheric lateralisation and inhibition in healthy ageing. Identifying attentional conditions that optimise language performance in aphasia may have implications for new treatments in language rehabilitation.

Evaluating communication strategies in dementia: Conversations between aged care staff and residents

S The Gerontological Society of America 63rd Annual Scientific Meeting November 19–23, 2010 New Orleans, LA Abstracts are arranged numerically by session and in the order of presentation within each session.s are arranged numerically by session and in the order of presentation within each session. 63rd Annual Scientific Meeting 1 SESSION 5 (PAPER) CAREGIVER HEALTH AND BURDEN CAREGIVING AND CLINICALLY-ASSESSED BIOLOGICAL RISK FACTORS: EVIDENCE FROM MIDUS II S. Kang, N. Marks, 1. University of Wisconsin-Madison, Madison, Wisconsin, 2. UW Institute on Aging, Madison, Wisconsin Guided by a life course perspective and biopsychosocial approach to health, this study aimed to add to a population perspective on caregiving and health-related biological risks of family caregiving by (1) examining how providing caregiving for a child, spouse, parent, or parent-in-law due to their illness or disability (in contrast to not providing caregiving for any kin or nonkin) is linked to allostatic load (a 15-item composite measure of biological risk) and three subscales of allostatic load (metabolic dysfunction, inflammatory dysfunction, hypothalamicpituitary-adrenal axis/sympathetic nervous system [HPA/SNS] dysfunction) among midlife and older adults, and (2) evaluating how gender might moderate the link between caregiving and health-related biological risks. Data from a subsample of MIDUS II (Midlife in the U. S., 2005) respondents ages 34 to 83 that were recruited for additional clinical and biological assessment (N = 1054) were used to estimate multivariate models that also adjusted for numerous sociodemographic factors. Results revealed that providing caregiving for a spouse was associated with a greater risk in metabolic dysfunction. Models evaluating moderation of caregiving risks to biological health by gender revealed that women who were providing caregiving for a parent-in-law reported higher levels of allostatic load and its subscale indicators of inflammatory dysfunction than their men peers. Overall, results suggest that caring for a spouse is linked to important biological health risk for women and men, and caring for a parent-in-law is linked to important biological health risk for women. CAREGIVING TO ADVANCED CHRONIC ILLNESS (CHF/COPD) PATIENTS A. Wilkinson, S. Berry, 1. School of Nursing, Midwifery and Postgraduate Medicine, Edith Cowan University, Joondalup, Western Australia, Australia, 2. Rand Corporation, Santa Monica, California Background. The cost and responsibility for much of the care of seriously ill, elderly persons living in the community with advanced, eventually fatal, chronic illness has been shifted onto family members. Chronic organ system failure presents a distinct illness trajectory with an erratic and unpredictable course characterized by episodes of acute illness and periods of relative stability set against a background of gradual, progressive disability. Current caregiving research has not yet described the challenges, stresses, and rewards that accompany caregiving for individuals with advanced chronic organ system failure. This project sought to describe the factors that influence caregiver outcomes in caregiving to advanced CHF and COPD patients. Methods: We conducted a series of 9 focus groups (8-10 adults each), 18 years or older, who were currently providing care for a patient with advanced chronic CHF or COPD. Focus group discussion topics were identified from the literature Initial analysis resulted in a classification system for major topics derived from the material and a second analysis by both researchers determined a final set of themes. 65Results: Five major themes were identified: (1) how caregivers describe their experience, (2) prognosis/uncertainty impacts, (3) objective burden (tasks), (4) role conflict/reversal, and (5) subjective burden. Findings from this exploratory work suggest that interventions should provide information about topics of specific relevance to CHF/COPD caregivers (e.g., disease processes, prognosis, what to expect, symptom and self-management, and should address caregiver/patient social isolation. Details and implications for future research and intervention policy will be discussed. BEHAVIORAL PROBLEM SUBTYPES IN DEMENTIA AND EFFECTS ON INFORMAL CAREGIVER HEALTH, HEALTH BEHAVIORS, AND SERVICE USE J.M. Thorpe, C. Thorpe, 1. School of Pharmacy, University of Wisconsin Madison, Madison, Wisconsin, 2. School of Medicine & Public Health, University of Wisconsin Madison, Madison,

Supporting memory and communication in people with dementia: An educational program for caregivers

S The Gerontological Society of America 63rd Annual Scientific Meeting November 19–23, 2010 New Orleans, LA Abstracts are arranged numerically by session and in the order of presentation within each session.s are arranged numerically by session and in the order of presentation within each session. 63rd Annual Scientific Meeting 1 SESSION 5 (PAPER) CAREGIVER HEALTH AND BURDEN CAREGIVING AND CLINICALLY-ASSESSED BIOLOGICAL RISK FACTORS: EVIDENCE FROM MIDUS II S. Kang, N. Marks, 1. University of Wisconsin-Madison, Madison, Wisconsin, 2. UW Institute on Aging, Madison, Wisconsin Guided by a life course perspective and biopsychosocial approach to health, this study aimed to add to a population perspective on caregiving and health-related biological risks of family caregiving by (1) examining how providing caregiving for a child, spouse, parent, or parent-in-law due to their illness or disability (in contrast to not providing caregiving for any kin or nonkin) is linked to allostatic load (a 15-item composite measure of biological risk) and three subscales of allostatic load (metabolic dysfunction, inflammatory dysfunction, hypothalamicpituitary-adrenal axis/sympathetic nervous system [HPA/SNS] dysfunction) among midlife and older adults, and (2) evaluating how gender might moderate the link between caregiving and health-related biological risks. Data from a subsample of MIDUS II (Midlife in the U. S., 2005) respondents ages 34 to 83 that were recruited for additional clinical and biological assessment (N = 1054) were used to estimate multivariate models that also adjusted for numerous sociodemographic factors. Results revealed that providing caregiving for a spouse was associated with a greater risk in metabolic dysfunction. Models evaluating moderation of caregiving risks to biological health by gender revealed that women who were providing caregiving for a parent-in-law reported higher levels of allostatic load and its subscale indicators of inflammatory dysfunction than their men peers. Overall, results suggest that caring for a spouse is linked to important biological health risk for women and men, and caring for a parent-in-law is linked to important biological health risk for women. CAREGIVING TO ADVANCED CHRONIC ILLNESS (CHF/COPD) PATIENTS A. Wilkinson, S. Berry, 1. School of Nursing, Midwifery and Postgraduate Medicine, Edith Cowan University, Joondalup, Western Australia, Australia, 2. Rand Corporation, Santa Monica, California Background. The cost and responsibility for much of the care of seriously ill, elderly persons living in the community with advanced, eventually fatal, chronic illness has been shifted onto family members. Chronic organ system failure presents a distinct illness trajectory with an erratic and unpredictable course characterized by episodes of acute illness and periods of relative stability set against a background of gradual, progressive disability. Current caregiving research has not yet described the challenges, stresses, and rewards that accompany caregiving for individuals with advanced chronic organ system failure. This project sought to describe the factors that influence caregiver outcomes in caregiving to advanced CHF and COPD patients. Methods: We conducted a series of 9 focus groups (8-10 adults each), 18 years or older, who were currently providing care for a patient with advanced chronic CHF or COPD. Focus group discussion topics were identified from the literature Initial analysis resulted in a classification system for major topics derived from the material and a second analysis by both researchers determined a final set of themes. 65Results: Five major themes were identified: (1) how caregivers describe their experience, (2) prognosis/uncertainty impacts, (3) objective burden (tasks), (4) role conflict/reversal, and (5) subjective burden. Findings from this exploratory work suggest that interventions should provide information about topics of specific relevance to CHF/COPD caregivers (e.g., disease processes, prognosis, what to expect, symptom and self-management, and should address caregiver/patient social isolation. Details and implications for future research and intervention policy will be discussed. BEHAVIORAL PROBLEM SUBTYPES IN DEMENTIA AND EFFECTS ON INFORMAL CAREGIVER HEALTH, HEALTH BEHAVIORS, AND SERVICE USE J.M. Thorpe, C. Thorpe, 1. School of Pharmacy, University of Wisconsin Madison, Madison, Wisconsin, 2. School of Medicine & Public Health, University of Wisconsin Madison, Madison,