Kevan H. Namazi

Pertinent autonomy for residents with dementias: Modification of the physical environment to enhance independence

Autonomy and independence have recently become important issues for the elderly, but have not been applied to Alzheimers disease patients. This project explores pertinent autonomy for the cognitively disabled by studying exit door behaviors. A specially designed environment satisfied safety and health concerns and enabled residents to have free access to the outdoors during daylight hours. Twenty two residents in early to advanced stages of the disease participated in the project. The results indicate that the number of agitated behaviors in five categories decreased under the unlocked door condition.

Physical environmental cues to reduce the problems of incontinence in Alzheimer's disease units:

Research has indicated that behavioral strategies such as cuing orientation within an environment may help reduce incontinence among dementia patients. However, there are no empirical studies that explore the relationship between incontinence and environmental modifications. This study compares the effectiveness of four nomenclatures such as “toilet” and “restroom” on the wayfinding abilities of residents in the early, middle, and advanced stages of dementia in two specially designed units. Results indicate that a series of directional arrows on the floor with the nomenclature “toilet” produced the most instances of utilization of public toilets in both units.

Long-term memory cuing to reduce visuo-spatial disorientation in Alzheimer's disease patients in a special care unit

Visuo-spatial disorientation typically occurs relatively early in Alzheimers disease patients, and is usually reported by families who fear that the individual may leave the house and get lost. It is often this deficit which frightens the family members into consideration of a long term care facility. However, disorientation to place can occur within a long term care facility as well as outside of it. This study will examine whether prominently displayed personal memorabilia of long term significance to each resident will serve as orientation cues to help identify his or her bedroom. The results indicate that four out of 10 residents were more successful in locating their rooms with significant memorabilia items than with nonsignificant ones.

Environmental effects on incontinence problems in Alzheimer's disease patients

Incontinence is a problem for both AD patients as well as their caregivers and becomes increasingly difficult to treat as cognitive abilities deteriorate. There are a variety of behavioral interventions to help alleviate incontinence. However, these remedies are often in-appropriate for dementia patients since the ability to comply diminishes with the progression of the disease. This study examines the differences in toilet use under concealed and visible conditions to determine whether visibility of the toilet is a supportive cue for AD patients. The results indicate that utilization of the toilets increased when toilets were visually accessible.

Dressing independently: A closet modification model for Alzheimer's disease patients

The deteriorative nature of AD often affects the ability of patients to perform ADLs independently, resulting in reduced autonomy and decreased opportunities to make pertinent decisions. This study separates decision making into two components and describes pertinent autonomy for AD patients in a supportive environment. The project examines how the alteration of a closet modifies resident dressing behavior and measures the degree of patient independence according to the level of caregivers intervention. Results indicate that when the selection process is separated from the motor skillfunctions, and when clothing is visually assessable in a preplanned sequential order, independence in dressing is enhanced in some AD patients.

Issues related to behavior and the physical environment: Bathing cognitively impaired patients

Twenty-two patients in moderate and late stages of dementia were observed for 8 weeks by caregiving staff of a special care unit. Results indicated that bathing in a typical institutional tub is both a source of apprehension and obstreperous behavior and a considerable departure from prior lifelong bathing experiences. Given information about the habits and idiosyncrasies of patients, staff can play an important role in minimizing obstreperous behaviors. Staff training and awareness of the physical environment, which included attention to the interrelationship between environment and behavior, were found to be instrumental in successful bathing.

The effects of environmental barriers on the attention span of Alzheimer's disease patients

Anecdotal evidence indicates that Alzheimers disease patients often appear confused and unable to concentrate, and that this may be related to attention span. This study utilizes barriers of three different heights to test how visual and auditory distracters affect the ability to concentrate on a given task. Residents were given art projects with adult themes and were observed for number of distractions. The results indicate that both low and high barriers are more effective than no barriers in screening out extraneous visual and auditory distractions. Of equal or greater importance is the finding that residents in the early and middle stages of the disease averaged 16 minutes of focused attention in a 20 minute trial.

Health Diaries and Interviews Consistency in Reporting by Older Adults

The daily health diary has been used as a research instrument to collect information on health, illness, and associated behaviors. There is conflict in the literature, however, on whether the diary is useful in studying gerontological health. The purpose of this study is to examine whether two different formats, the interview and the diary, are similar or different in eliciting health data from older people. Interviews were conducted with 728 randomly selected adults ranging in age from 45 to 94; a random subsample of 83 was selected subsequently to keep a diary. The study focused exclusively on chronic health problems. The results suggest that the reporting format and age may influence what is reported about chronic health problems.