J. Edward Jackson

Coping With Dementia: Evaluation of Four Nonpharmacologic Interventions

To evaluate nonpharmacologic interventions, caregivers (65 women, 38 men) and their dementia-diagnosed spouses (patients) were randomized to one of four treatment programs (cognitive stimulation, dyadic counseling, dual supportive seminar, and early-stage day care) or to a wait-list control group. Assessments occurred initially and at postintervention (3 months). Patients were evaluated on memory, verbal fluency, and problem-solving ability, and caregivers were assessed on marital interaction, emotional status, and physical health, along with stress, coping, and social support. Caregivers also completed a program evaluation. Repeated measures procedures showed that patients in the cognitive stimulation group demonstrated more improvement over time in cognitive outcomes, and caregivers decreased in depressive symptoms. Early-stage day-care and dual supportive seminar group caregivers reported a decrease in hostility and a decrease in use of negative coping strategies, respectively. Although qualitatively derived benefits differed across groups, similarities in program content reduced the potential for quantitative differentiation among the groups.

Clinical Features Distinguishing Large Cohorts with Possible AD, Probable AD, and Mixed Dementia

Objective: To determine whether clinical features and rate of cognitive and functional decline differed in cohorts of possible AD (poAD), probable AD (prAD), and mixed dementia (MIX) patients.

Alzheimer Disease: Basic and Clinical Advances

he decade of the 1980s has represented a period that has shown both great progress in public awareness of Alzheimer’s disease (AD) T and significant progress in AD research. During this decade, many service activities to aid caregivers and families in the care of Alzheimer patients have been developed. Since AD was first described in 1907, it is perhaps surprising that this last decade has been a period in which there have been advances in clinical diagnosis. During these last 10 years, both accuracy of the clinical diagnosis of the dementia syndrome and accuracy in the diagnosis of AD have improved, and we have begun to recognize subtypes of AD based upon clinical pathological correlations. And though we do not have a specific treatment or #cure,” substantial advances have also been made in the clinical management of AD.

The Yield of a Home Visit in the Assessment of Geriatric Patients

Elderly patients often have problems not easily detected during an office visit. We investigated the yield of a home visit by a geriatric nurse specialist as part of an interdisciplinary assessment process. Compared with the findings of an office‐based assessment by a general internist, the home visit resulted in up to four new problems (median = 2, mean = 1.7, 95% confidence interval = 1.5–1.8) and one to eight new recommendations (median = 4, mean = 3.6, 95% confidence interval = 3.4–3.9.) Twenty‐three percent of the problems could have resulted in death or significant morbidity. The most frequent problems related to psychobehavioral difficulties (23.1% of problems involving 38.3% of patients), safety (21.6% of problems involving 35.7% of patients), and caregiver related problems (20.4% of problems involving 33.8% of patients). The most common recommendations related to safety (30.7% of recommendations involving 81.8% of patients), caregiver well‐being (19.8% of recommendations involving 52.6% of patients), and social issues (12.7% involving 33.8% of patients). Baseline clinical information did not predict the yield of the home visit in this sample. We conclude that an in‐home assessment contributes unique and meaningful information to the geriatric assessment process.

Recurring epiglottitis in an adult

We report a case of recurring epiglottitis in an adult. The patient presented with complaints of a sore throat and fever. The presence of a muffled voice led to radiologic and indirect laryngoscopic examination confirming the diagnosis. The patient responded promptly to glucocorticoids and parenteral antibiotics. Over the ensuing six months, he was readmitted to the hospital on three separate occasions with recurrent symptoms and findings of epiglottitis. On each occasion, he responded promptly to therapy. An exhaustive investigation failed to reveal a cause for this unique occurrence of recurring disease.

Recommendations for a Change in Living Situation Resulting from an Outpatient Geriatric Assessment: Type, Frequency and Risk Factors

We analyzed the outcomes of 480 comprehensive outpatient geriatric assessments to determine the frequency of recommendations for home help or a change in residence and to determine whether simple clinical observations could predict such recommendations. Fifty‐eight percent (280) of the patients received no recommendation for a change in the living situation. Of the 200 patients receiving a recommendation for a change in living situation, 97 (49%) were felt to be able to stay at home with increased in‐home support and/or day care, and 51.5% (103) were advised to seek placement. After adjusting for age and gender, risk factors predicting a recommendation for change were dementia (odds–ratio = 9.98), vision deficits (odds ratio = 2.02), lower education level compared to college (odds–ratio = 1.88 high school, 1.42 for < high school), an increasing number of medical diagnoses (odds–ratio = 1.49 per diagnosis), and a functional impairment on the Katz index (odds–ratio = 1.09). The presence of these risk factors should lead to consideration of further evaluation of the home environment in this study. We conclude that geriatric patients presenting for a comprehensive outpatient evaluation commonly need a change in home situation, though most can remain in their home, and that simple clinical observations can be helpful in screening patients for further evaluation of their home enviornment.