Jeffrey A. Buchanan

Command Use and Compliance in Staff Communication With Elderly Residents of Long-Term Care Facilities

Verbal communication between nursing assistants and individuals with dementia can be challenging, particularly during hands-on caregiving tasks. Although there are many aspects of verbal communication that can affect the quality of an interaction, one potentially important communication variable is the types of commands issued by nursing assistants when they need a resident to complete a task. The purpose of this study was to examine the kinds of commands used by nursing care staff when they interact with patients with dementia during activities of daily living. Commands were categorized according to their feasibility/specificity as well as form. An additional goal of this study was to measure compliance and noncompliance rates associated with the various categories of commands. Results indicate that alpha commands (clear, concise, and feasible) account for higher compliance and less noncompliance compared with beta commands (ambiguous, interrupted, and not feasible). In addition, commands that are stated directly, that clarify a previous command, and that are repeated exactly produce better compliance. It is concluded that training nursing staff to change the types of commands they provide during caregiving tasks may reduce distress experienced by both staff and residents.

The role of behavior analysis in the rehabilitation of persons with dementia.

With the rapidly aging population, it is expected that increases in cases of dementia will double over the next 20 years. Currently, there is no cure for diseases such as Alzheimers disease or frontotemporal dementia (FTD) that cause progressive dementia, and only a few pharmacological interventions that slow the progression of the decline exist. Given that there is no cure available, a rehabilitation approach that emphasizes maintaining existing abilities and removing excess disability (as opposed to emphasizing cure or recovery) for as long as possible is warranted. The current paper proposes that nonpharmacological rehabilitation efforts need to target 5 broad areas/targets: memory enhancement, altering social contingencies and communication styles, improving self-care skills, the arrangement of physical environments to maintain and improve functioning, and increasing physical fitness/physical activity. The purpose of this paper is to review specific behaviorally oriented interventions that target these 5 areas and show promise for inclusion in comprehensive rehabilitation efforts for individuals with dementia.

Psychometric properties of the Pyramids and Palm Trees Test

The Pyramids and Palm Trees Test (PPT) is a nonverbal measure of semantic memory that has been frequently used in previous aphasia, agnosia, and dementia research. Very little psychometric information regarding the PPT is available. The purpose of this study was to investigate the psychometric properties of the PPT in a population of healthy college students. Results indicated that the PPT achieved poor test–retest reliability, failed to obtain adequate internal consistency, and demonstrated poor convergent validity, but showed acceptable discriminant validity. The results of this study suggest that the PPT lacks acceptable reliability and validity for use with a college student population.

Identifying Preferences in Persons with Dementia: Systematic Preference Testing vs. Caregiver and Family Member Report

One problem facing professional caregivers of dementia patients involves identifying preferences in patients with impaired verbal abilities. Long-term care staff often rely on the opinions of family or trial and error to discover patient preferences despite the availability of empirical methods for assessing preferences in nonverbal populations. The purpose of this study was to examine whether caregivers and family members could accurately determine the preferences of dementia patients. Patient preferences were determined using an empirical preference assessment while caregivers and family completed a self-report measure concerning their opinions about patient preferences. Results indicated that family and staff were relatively inaccurate in determining the preferences of patients. Results may have implications for developing more effective care plans and improving quality of life for persons with dementia residing in long-term care facilities.

Differences in perception of gerotranscendence behaviors between college students and community-dwelling older adults

Within the field of gerontology, several different theories have attempted to explain common psychological and social changes associated with the aging process. The Theory of Gerotranscendence is one such theory which purports that a shift in meta-perspective from a more materialistic and pragmatic view of the world to a more cosmic and transcendent one occurs as we age. Corresponding with this shift in meta-perspective, the individual exhibits certain behaviors that could be mistaken as signs of psychopathology if viewed based on the assumptions of more culturally-assimilated theories of aging. The purpose of this study was to examine the difference in perception of gerotranscendence behaviors between college students and older adults. Perceptions were quantified using an instrument that described many behaviors indicative of gerotranscendence within the context of a written narrative depicting an older adult living in an assisted living facility. Respondents were then asked to rate these behaviors in terms of how unusual they were and how concerning they were. As hypothesized, results indicated that several behaviors indicative of gerotranscendence were rated as more concerning and unusual by college students compared to older adults. Implications of these findings in terms of interactions between younger and older individuals occurring in the community and within healthcare settings are discussed.

The Use of In Vivo Desensitization for the Treatment of a Specific Phobia of Earthworms

Graduated in vivo desensitization was used to treat an intense fear of earthworms in a female college student. The participant reported intense physiological anxiety and avoidance behavior in situations where worms could be encountered. Treatment outcome was measured using a behavioral avoidance test (BAT) and the State-Trait Anxiety Inventory (STAI). Exposure therapy sessions required the client to confront a variety of anxiety-producing situations arranged in a hierarchy. Results indicated that at posttreatment the client was able to complete the BAT and was able to complete the fear hierarchy. State anxiety scores as measured by the STAI declined by 50% from pretreatment to posttreatment. In addition, the client reported little subjective anxiety and no avoidance of situations where worms might be present at posttreatment. The client maintained all posttreatment gains at 1-, 5-, and 8-month follow-ups.

Bullying in Senior Living Facilities: Perspectives of Long-Term Care Staff

Resident-to-resident bullying has attracted attention in the media, but little empirical literature exists related to the topic of senior bullying. The aim of the current study was to better understand resident-to-resident bullying from the perspective of staff who work with older adults. Forty-five long-term care staff members were interviewed regarding their observations of bullying. Results indicate that most staff members have observed bullying. Verbal bullying was the most observed type of bullying, but social bullying was also prevalent. Victims and perpetrators were reported to commonly have cognitive and physical disabilities. More than one half of participants had not received formal training and only 21% reported their facility had a formal policy to address bullying. The implications of these results support the need for detailed policies and training programs for staff to effectively intervene when bullying occurs. [Journal of Gerontological Nursing, 43(7), 34-41.].

Is elderspeak appropriate? A survey of certified nursing assistants.

Elderspeak is a form of patronizing speech that is sometimes used with older adults and can result in unintended negative consequences. Certified nursing assistants (CNAs) working in long-term care facilities may be particularly prone to using elderspeak because they frequently interact with vulnerable and frail older adults who require assistance with activities of daily living. The purpose of the current study was to assess contextual variables that may prompt the use of elderspeak by CNAs. One hundred thirty-four CNAs completed a 36-item questionnaire intended to determine their evaluations of the appropriateness of elderspeak in a variety of contexts. Results indicated that specific resident-related variables (e.g., age, cognitive impairment) and situational variables (e.g., the absence of others during a CNA-resident interaction) were associated with higher ratings of appropriateness of elderspeak. These findings may have implications for improving communication training for CNAs.

Improving Recall in a Person With Dementia Investigating the Effectiveness of Memory Priming and Spaced Retrieval in an Older Adult With Dementia

Because it is often perceived that individuals with dementia cannot relearn information that has been forgotten, few nonpharmacological memory-enhancing interventions have been developed for this population. The current study involved the investigation of a novel memory-enhancement procedure called memory priming (MP) with a 95-year-old individual with dementia. MP is based on the assumption that an individual’s ability to learn is enhanced when learning trials are preceded by an activity that is enjoyable and can be done successfully. MP required the individual to engage in a 5-min preferred conversation followed by the presentation of target questions every 2 min. A memory-enhancement procedure known as spaced retrieval was then used to maintain the information learned through MP. Results provide initial evidence for the utility of MP followed by spaced retrieval for enhancing the recall and retention of meaningful information. MP may provide a simple means for helping individuals with dementia relearn forgotten information.

Developing the Family Involvement Questionnaire-Long-Term Care: A Measure of Familial Involvement in the Lives of Residents at Long-Term Care Facilities

INTRODUCTION Existing measures designed to assess family involvement in the lives of older adults residing in long-term care facilities are basic, using visitation frequency as the prominent gauge of involvement in a situation specific fashion. The purpose of this study was to design and validate a measure of family involvement that could be used to gauge more aspects of family involvement than visitation alone and be useful in a variety of settings for both researchers and long-term care facility administrators. METHODS Long-term facility staff were asked to assist in creating a 40-item questionnaire that used 4-point Likert scales to measure various aspects of family involvement. The finalized Family Involvement Questionnaire-Long-Term Care (FIQ-LTC) was distributed to the family members of older adults residing in long-term care facilities around the country. RESULTS A total of 410 participants responded. Researchers found that the FIQ-LTC was highly reliable (α = .965). Results also indicated that a significant correlation between distance and overall involvement (r = -.121, p = .015) was no longer significant (r = .17, p = .740) when the effect of a question asking the frequency of visitation was controlled for. DISCUSSION These results indicate that existing measures that use visitation frequency as the sole measure of involvement are insufficient. The newly developed FIQ-LTC can serve as a more complete measure of family involvement.