Linda Beuscher

A Controlled Trial of an Intervention to Improve Urinary and Fecal Incontinence and Constipation

OBJECTIVES: To evaluate effects of a multicomponent intervention on fecal incontinence (FI) and urinary incontinence (UI) outcomes.

Challenges in conducting qualitative research with individuals with dementia.

Qualitative research can capture the meaningful experiences and life values of individuals with dementia not reported in quantitative studies. This article shares a personal experience of the challenges faced and the lessons learned while conducting a qualitative study of 15 people with early-stage Alzheimers disease. The purpose of this article is to discuss the issues concerning determination of capacity to consent to research, consent/assent, communication challenges, and trustworthiness of data when conducting a qualitative study of people with dementia. Understanding communication challenges related to dementia is important to develop effective communication strategies, such as simplifying the structure of questions, allowing ample time for the participants response, using reminiscence, and redirecting the dialogue. This information will be valuable to researchers conducting qualitative studies and the resulting contributions to the body of knowledge about Alzheimers disease.

Evaluation of two fatigability severity measures in elderly adults.

To document the stability, concurrent validity, and clinical correlates of two fatigability severity measures as recommended by the American Geriatrics Society.

Using Spirituality to Cope With Early-Stage Alzheimer's Disease:

Alzheimers disease (AD) robs persons living with the disease of their independence and self-esteem, which can lead to depression, anxiety, and loneliness. Understanding how people with early-stage AD cope is a critical step in enhancing their adaptive abilities and ultimately improving their quality of life. This qualitative study describes how individuals with early-stage AD use spirituality to cope with the losses of self-esteem, independence, and social interaction that they face. The purposive sample for this focused ethnographic study consisted of 15 participants living at home in central Arkansas. Holding onto faith, seeking reassurance and hope, and staying connected were the global themes. Personal faith, prayer, connection to church, and family support enhanced the ability of people with early-stage AD to keep a positive attitude as they face living with AD.

Prevalence of Constipation Symptoms in Fecally Incontinent Nursing Home Residents

OBJECTIVES: To determine the prevalence of constipation symptoms and the effects of a brief toileting assistance trial on constipation in a sample of fecally incontinent nursing home (NH) residents.

A controlled trial of an intervention to increase resident choice in long term care.

OBJECTIVE The purpose of this study was to evaluate an intervention to improve staff offers of choice to nursing home residents during morning care. DESIGN A controlled trial with a delayed intervention design. SETTING Four community, for-profit nursing homes. PARTICIPANTS A total of 169 long-stay nursing home residents who required staff assistance with morning care and were able to express their care preferences. INTERVENTION Research staff held weekly training sessions with nurse aides (NAs) for 12 consecutive weeks focused on how to offer choice during four targeted morning care areas: when to get out of bed, when to get dressed/what to wear, incontinence care (changing and/or toileting), and where to dine. Training sessions consisted of brief video vignettes illustrating staff-resident interactions followed by weekly feedback about how often choice was being provided based on standardized observations of care conducted weekly by research staff. MEASUREMENTS Research staff conducted standardized observations during a minimum of 4 consecutive morning hours per participant per week for 12 weeks of baseline and 12 weeks of intervention. RESULTS There was a significant increase in the frequency that choice was offered for 3 of the 4 targeted morning care areas from baseline to intervention: (1) out of bed, 21% to 33% (P < .001); dressing, 20% to 32% (P < .001); incontinence care, 18% to 23%, (P < .014). Dining location (8% to 13%) was not significant. There was also a significant increase in the amount of NA staff time to provide care from baseline to intervention (8.01 ± 9.0 to 9.68 ± 9.9 minutes per person, P < .001). CONCLUSION A staff training intervention improved the frequency with which NAs offered choice during morning care but also required more time. Despite significant improvements, choice was still offered one-third or less of the time during morning care.

The value of resident choice during daily care: do staff and families differ?

Allowing long-term care (LTC) residents to make choices about their daily life activities is a central tenet of resident-centered care. This study examined whether staff and family rated care episodes involving choice differently from care episodes not involving choice. Seventeen nurse aide and 15 family participants were shown paired video vignettes of care interactions. Participants were asked to rate their preferred care vignette using a standardized forced-choice questionnaire. Focus groups were held separately for staff and family members following this rating task to determine reasons for their preferences. Both staff and family rated the vignettes depicting choice as “strongly” preferred to the vignettes without choice. Reasons provided for the preference ratings during the focus group discussions related to resident well-being, sense of control, and respondents’ own personal values. These findings have implications for LTC staff training related to resident-centered care to promote choice.

A Robotic Coach Architecture for Elder Care (ROCARE) Based on Multi-User Engagement Models

The aging population with its concomitant medical conditions, physical and cognitive impairments, at a time of strained resources, establishes the urgent need to explore advanced technologies that may enhance function and quality of life. Recently, robotic technology, especially socially assistive robotics has been investigated to address the physical, cognitive, and social needs of older adults. Most system to date have predominantly focused on one-on-one human robot interaction (HRI). In this paper, we present a multi-user engagement-based robotic coach system architecture (ROCARE). ROCARE is capable of administering both one-on-one and multi-user HRI, providing implicit and explicit channels of communication, and individualized activity management for long-term engagement. Two preliminary feasibility studies, a one-on-one interaction and a triadic interaction with two humans and a robot, were conducted and the results indicated potential usefulness and acceptance by older adults, with and without cognitive impairment.

A Collaborative Virtual Game to Support Activity and Social Engagement for Older Adults.

Many older adults suffer from Alzheimer’s disease or other dementias and have affected cognitive abilities. In general, physical exercise, cognitive stimulation, and social engagement have been found to be beneficial for the physical and mental health of older adults with and without cognitive impairment. In an effort to address these needs, researchers have been developing human-machine interaction (HMI) systems to administer activity-oriented therapies. However, most of these system, while promising, focus on one-on-one interaction with the computer and thus do not support social engagement by involving multiple older adults. In this paper, we present the design and development of a motion-based collaborative virtual environment (CVE) application to support both activity and social engagement. The CVE task is based on a book-sorting activity and has embedded collaborative components to encourage human-human interaction (HHI). The system records quantitative data regarding users’ performance, interaction frequency, and social interaction. A preliminary user study was conducted to validate system usability and test on older adults’ tolerance and acceptance of the motion-based user interface (UI) as well as the CVE task. The results showed the usability of the motion-based UI and system capability to assess HMI and HHI from recorded quantitative data. The results from post-test and analysis of audio files indicated that the system might be potentially useful. More user study and data analysis need to be conducted to further investigate the CVE system.

Jade Angelica, Where two worlds touch: A spiritual journey through Alzheimer’s disease.

In the introduction of Where two worlds touch: A spiritual journey through Alzheimer’s disease, author Jade Angelica identifies her purpose for sharing her story and discoveries ‘‘to reassure caregivers that they and their loved ones with Alzheimer’s need not suffer in isolation or be overwhelmed by fear, loss, and responsibility on this journey.’’ The title alone inspires the reader to the possibilities of connecting with the person living with Alzheimer’s disease. From the beginning of this book, Angelica draws the reader emotionally into her personal journey with her mother who lived with Alzheimer’s disease. Using improvisation methods, she opened the doors to communicate with her mother and discovered beauty in moments with her mother. Her experiences and observations of persons living with Alzheimer’s disease contest the belief that the illness steals a person’s capacity for any meaningful relationship with others. In the chapter ‘‘The Value and Beauty of Every Person,’’ Angelica leads a theological discussion of hope that ‘‘inspires us to accept the loss, decline, suffering of Alzheimer’s . . . to overcome it and transform it into an experience that is essence, life-giving.’’ Throughout the book are several inspiring poems such as ‘‘Heart Memories’’ by Louis Eder that exemplify the spiritual journey of caregiving. The book provides insight into the art of care giving and guidance for caregivers, ‘‘On healing when there is no cure,’’ ‘‘Forgetting, forgiving, reconciling’’ and ‘‘Nourishing compassion.’’ The last section of the book provides additional resources for caregivers. This is an exceptionally well-written book. I plan to encourage nursing homes and memory care assisted living facilities to acquire this book and pass it along to their staff and family caregivers. I recommend this book to healthcare educators to share with their students. Angelica’s story will be an excellent starting point for discussion.