Gayle Hersch

Evidence-based educational guidelines for stroke survivors after discharge home.

Stroke survivors today are discharged home from the hospital more quickly than in the past because of shifting economic realities. Survivors continue to experience significant impairments after discharge and families may be poorly prepared for the full extent of caregiving responsibilities. This article describes 39 comprehensive educational guidelines that have been tested with 72 stroke survivors and families during 1,150 home visits throughout the first 6 months after discharge from inpatient rehabilitation. Two case studies illustrate use of the guidelines with stroke survivors and their families.

TESTING THERAPEUTIC LIFE REVIEW OFFERED BY HOME CARE WORKERS TO DECREASE DEPRESSION AMONG HOME-DWELLING OLDER WOMEN

The purpose of the study was to test a psychosocial intervention, therapeutic life review, offered by home care workers to decrease depression among home-dwelling older women. A quasi-experimental, one-group time-series design measured the effect of a once-a-week, 40-minute therapeutic life review intervention, delivered for six weeks by home care workers, on the depression scores of women 65 years and older, compared to their scores during the ten weeks prior to the intervention. Over time, depression scores improved with a significant decrease in depression immediately following the six-week intervention. Based on these findings, we concluded that home care workers can deliver a community-based psychosocial intervention that decreases depression in their home-dwelling clients.

Managing pain to prevent aggression in people with dementia: a nonpharmacologic intervention.

Aggression is a common form of behavioral disturbance in dementia. Strategies to prevent and treat aggressive behavior are underdeveloped. However, recent work points to several modifiable risk factors that may be targets for intervention. Pain management is an evidence-based, feasible, but potentially underused, strategy that may be incorporated with other behavioral interventions to prevent aggression. In this article, we review areas of overlap in interventions for pain and for behavioral disturbances and describe an intervention concept that may hold promise for older adults with dementia who are at risk of developing aggressive behavior.

Voices of Elders Culture and Person Factors of Residents Admitted to Long-Term Care Facilities

Purpose: The aim of this study was to investigate person and environment factors of elders that facilitate adaptation to relocation to long-term care skilled nursing facilities. Results represent findings from Phase 1 of three phases of a 2-year study to develop and test a cultural heritage intervention to improve adaptation to nursing home relocation. Design: Qualitative interviews were conducted with 23 newly admitted Caucasians and African Americans residing in skilled nursing facilities. Findings/Results: Themes that emerged include (a) spirituality, death and dying, and philosophy of life; (b) life experiences with change; (c) cultural heritage; (d) health; (e) ethnicity; (f) social support, family and friends; (g) long-term care facility (LTCF) relationships; (h) LTCF system maintenance; and (i) LTCF support of personal growth. Comparison of African Americans and Caucasians showed more similarities than differences between the groups. Discussion: Implications for research, clinical practice, and cultural heritage interventions for LTCF adaptation are discussed.

Home-based psychoeducational and mailed information programs for stroke-caregiving dyads post-discharge: a randomized trial

Abstract Purpose: This randomized trial compared 6- and 12-month outcomes of a home-based psychoeducational program to mailed information provided to 159 survivors of stroke (SS) and their spousal caregivers (CG). Methods: SS (age 50+) and CG were recruited as dyads post-discharge from inpatient rehabilitation. All dyads received mailed information for 12 months. Dyads randomized to the home-based group received an average of 36.7 h of psychoeducation over 6 months. Health status, depression, stress, burden, coping, support, mutuality and function were obtained on all dyads. Repeated measures analysis with linear mixed models was used to compare the groups for change over time in the outcome variables. Results: Both groups demonstrated less depression and stress over time. Compared to the mailed information group, SS in the home-based group demonstrated significantly improved self-reported health and cognitive function; CG demonstrated significantly improved self-reported health and coping strategies. Mutuality and social support decreased in both groups. Conclusions: The home-based intervention was effective in improving self-reported health, coping skills in CG and cognitive functioning in SS. However, the finding that dyads in both groups demonstrated decreased depression and stress suggests that providing repeated doses of relevant, personalized information by mail may result in positive changes. Implications for Rehabilitation A stroke affects both the stroke survivor and the spousal caregiver, so nurses and therapists should use multicomponent strategies to provide education, support, counseling and linkages to community resources to ease the transition from hospital to home. Stroke may have a negative impact on the dyad’s relationship with each other and also on the availability of support people in their lives during the 12 months after hospital discharge. Comprehensive stroke programs should encourage dyads to attend support groups and to seek individual and group counseling, as needed. Establishing an ongoing relationship with stroke survivors and their spouses and providing relevant and engaging information by mail can reduce stress and depression over 12 months post-discharge at a minimal cost. Nurses and therapists should consider home visits post-discharge to reinforce education and skills taught in the hospital, increase self-reported health in stroke survivors and spousal CG, increase coping skills and to link the couple to community resources.

Daily Life and Forms of “Communitas” in a Personal Care Home for Elders

This study examined daily life in a personal care home using anthropological theories of liminality and communitas associated with rites of passage. Purposes of this article are to (1) describe daily life in terms of its setting, activities, and social system (elements of normative communitas) and (2) examine cultural beliefs and values that may foster ideological and existential communitas. Ethnographic methods included participant observations and semistructured interviews. Ongoing data analysis and interpretation were conducted by a five-member research team. Factors that foster social cohesion include a small-scale residential environment, a familiar round of activity routines, a social system with flexible roles of residents and staff, and a culture in which mutual support of persons with varying capabilities is valued. Some of these qualities, for which residents and staff used the metaphors of home and family, might be purposely cultivated in other residential settings for elders.

Effect of an occupation-based cultural heritage intervention in long-term geriatric care: a two-group control study.

OBJECTIVE We investigated the effectiveness of an occupation-based cultural heritage intervention to facilitate adaptation to relocation into long-term care (LTC) facilities as measured by quality of life, activity engagement, and social participation. METHOD We used a quasi-experimental nonequivalent control group design with pre- and posttests. Residents receiving the cultural intervention were compared with residents in a typical activity group. Eight sessions, two per week for 4 wk, were facilitated by certified occupational therapy assistants. RESULTS Twenty-nine participants completed the group sessions. Quality-of-life scores improved significantly over time for both groups. Statistically, a greater percentage of time was spent in discretionary than obligatory time, pretest and posttest, with no significant difference between groups. CONCLUSION The study demonstrated effectiveness of a structured, occupation-based social group intervention that improved quality of life, an indicator of adaptation. It also provided a description of activity patterns and social participation of LTC residents.

Falling and Mobility Experiences of Stroke Survivors and Spousal Caregivers

ABSTRACT More than 50% of survivors of stroke (SSs) fall after discharge from the hospital, some of whom sustain significant injury. The purpose of this study was to explore SSs’ and spousal caregivers’ (CGs’) lived experiences about falling and general mobility. Qualitative methods were used to perform a secondary analysis of interviews obtained from a larger study of 133 couples. Time, loss, and life changes emerged as themes in the qualitative analysis of expressers with “keep stepping no matter what,” as the overarching theme. Number of SSs were examined for reports of falls and fall-related events. Of the 133 couples, 65 were in the original studys intervention group. Sixty-six percent of the intervention group reported at least one fall, and 12% of the intervention group and total study population sustained fall-related adverse events. Health care providers can learn from the experiences of SSs and CGs related to falling and mobility for enhanced discharge planning and fall prevention. Falling can cause injury in the SS or fear of falling of the SS, CG, or both.

THE FEASIBILITY OF HOME CARE WORKERS DELIVERING AN INTERVENTION TO DECREASE DEPRESSION AMONG HOME-DWELLING, OLDER WOMEN: A QUALITATIVE ANALYSIS

Depression is associated with poorer functioning and may even increase the risk of dying. Home-dwelling frail older women with depression often receive inadequate treatment or no treatment at all. Therapeutic life review, an intervention based on Eriksons developmental stages, delivered by home care workers (HCWs) with three hours of training, is a cost effective way to enhance mood in these women. Nine HCWs who had implemented therapeutic life review participated in one of two focus groups and reported enhanced moods among their frail older clients.

Occupational Participation of Homeless People

The purpose of the study was to investigate the occupational participation of homeless people regarding their roles, habits, and contexts. The specific aims of the study were to examine homeless people with regard to their: (a) volition; (b) recurrent patterns, that is, roles and habits, in their everyday lives; (c) capacity in occupational performance areas; and, (d) physical and social environments. The Occupational Circumstances Assessment Interview and Rating Scale Version 4.0 is a semi-structured interview that gathers information about a client concerning various aspects of their lives. The Occupational Circumstances Assessment Interview and Rating Scale Version 4.0 was administered to a convenience sample of 15 adult male participants recruited from a homeless shelter. The scoring of the Occupational Circumstances Assessment Interview and Rating Scale Version 4.0 revealed that only 13.33% of the participants indicated that they were able to facilitate participation in occupation. Fifty percent allowed participation in occupation while 28.89% inhibited participation in occupation. The remainder 7.78% restricted participation in occupation. The results of this study provide information concerning the occupational participation of homeless people. Homeless people may have difficulty facilitating participation in occupations.