Linda A Gerdner

Impact of a psychoeducational intervention on caregiver response to behavioral problems.

BackgroundEighty percent of persons with Alzheimer’s disease and related disorders are cared for by family members who often lack adequate support and training for this all-consuming job. ObjectiveTo evaluate the efficacy of a longitudinal, multisite, community-based intervention designed to teach home caregivers to manage behavioral problems in persons with Alzheimer’s disease. MethodsUsable data were analyzed from 237 caregiver/care recipient dyads (n = 132 Experimental;n = 105 Comparison). The experimental group received a psychoeducational nursing intervention that was conceptually grounded in the Progressively Lowered Stress Threshold model (Hall & Buckwalter, 1987). The comparison group received routine information and referrals for case management, community-based services, and support groups. Although a variety of psychosocial outcomes were compared between caregivers in the two groups, this article focuses on frequency and response to behavioral problems and functional decline. ResultsThe Progressively Lowered Stress Threshold intervention had a statistically significant effect on spousal response to memory/behavioral problems (p < .01) for all caregivers and on response to activities of daily living problems (p < .01) for spousal caregivers. In addition, nonspouses in the experimental group reported a reduction in the frequency of memory/behavioral problems (p < .01). No intervention effect on reports of activities of daily living frequencies was found for either spouses or nonspouses. ConclusionsThis Progressively Lowered Stress Threshold-based intervention had a positive impact on both the frequency of and response to problem behaviors among spousal caregivers.

Use of Individualized Music by Trained Staff and Family: Translating Research into Practice

This pilot study used a mixed methodology to evaluate the effectiveness of individualized music for the management of agitation when implemented by trained staff and family. Music was administered daily and as needed to eight elderly individuals with dementia who resided in a long-term care facility. A statistically significant reduction in agitation was found during the presentation of music and an overall reduction in agitation was found on day shift during weeks 1 to 8 and on evening shift during weeks 5 to 8. Staff and family interviews provided convergent validity of findings. Music also promoted meaningful interaction between the resident and others.

A nursing challenge: Assessment and management of agitation in Alzheimer's patients

1. Agitation in patients with Alzheimers disease is a pervasive problem. The behaviors associated with agitation may have detrimental effects on the patient, health care providers, and other patients. 2. Management of these behaviors is particularly challenging and, at times, frustrating for nursing personnel. 3. Attempts to identify the causative factors are essential to the development of an individualized plan of care.

STANDARDIZED CARE PLAN: Managing Alzheimer's Patients at Home

1. Family-provided care of members with Alzheimers disease and related disorders (ADRD) is complicated by the presence of secondary behavioral symptoms, such as agitation, that lead to caregiver depression, burden, and breakdown. 2. Caregiver education to manage secondary symptoms in ADRD can be simplified by using a theoretical framework of person-environment fit, providing a selection of interventions to modify the environment to reduce demand on the dwindling resources of the demented person. 3. The Progressively Lowered Stress Threshold (PLST) model identifies six areas of stress for persons with ADRD fatigue, change of caregiver, environment or routine, demands to achieve beyond capability, multiple and competing stimuli, affective response to perceived losses, and physical stressors.

Shining through: the humor and individuality of persons with Alzheimer's disease

1. Elders with diminished levels of cognitive functioning are capable of providing meaningful, consistent responses that illustrate individual expressions of self. 2. The demented elders history and experiences may provide important clues to understanding his or her current behaviors, verbalizations, and perceptions. 3. Humor may be used as a therapeutic intervention for persons with dementia and as a coping strategy for caregivers.

Uncovering and managing denial during the research process

This article describes experiences of geropsychiatric nurses examining the effectiveness of the Progressively Lowered Stress Threshold Model for caregivers of persons with Alzheimers disease and related disorders, and briefly reviews the literature on coping and denial. This research project, and those of many other psychiatric nurses, is predicated on the expectation that subjects will be able to acknowledge and report to investigators their personal and intimate responses to the challenges and everyday experiences of caregiving. Clearly, the research findings will be most valid if subjects are completely open about all aspects of their experiences, no matter how painful; yet this is often an idealized expectation. Therefore, this article also explores the concerns of geropsychiatric nurse researchers attempting to balance sensitivity to the needs of subjects and the reliability and validity of the data.

Review of state policies regarding special care units: Implications for family consumers and health care professionals.

This article compares and contrasts state regulations regarding minimum standards for the establishment of Special Care Units (SCUs). A case study approach is then used to assess the criteria for two special care units in Iowa (which requires licensure) and two special care units in Illinois (which does not require licensure). The article concludes with implications for family consumers and health care professionals related to placement decisions, research, policy development and consumer education.

Elder Mistreatment among Rural Family Caregivers of Persons with Alzheimer's Disease and Related Disorders

This article presents four case studies of elder abuse from the files of a multisite training project designed to teach rural caregivers of persons with Alzheimers disease and related disorders how to better manage behavioral problems associated with dementia. The cases are used to illustrate characteristics of victims, perpetrators, andfamily systems that are vulnerable to abuse. The examples presented reflect a variety of factors associated with abuse in caregiving situations, including denial and maladaptive personality characteristics in the caregiver, and anxiety and lack of knowledge. The role of health care professionals and researchers who uncover abuse or neglect situations is also discussed.