Linda J. Garcia

English performance of proficient bilingual adults on the Boston Naming Test

Background: The Boston Naming Test is widely used in several versions and languages. However, there are few studies of its use with bilingual adults. A recent study by Kohnert, Hernandez, and Bates (1998) found that Spanish/English bilingual adults scored well below unilingual adults. Aims: This study tested two hypotheses. (1) Fluently bilingual adults will obtain significantly lower scores than unilingual, English-speaking adults on the BNT, in English. (2) The order of difficulty of the 60 items will differ for the bilingual and unilingual groups. Methods & Procedures: This study compared the English performance of unilingual speakers (n = 42) to that of two groups of bilingual adults: Spanish/English (n = 32) and French/English (n = 49). All bilingual participants learned English as a second language as children and claimed high levels of ability in English. All participants completed high school (range 11–27 years of schooling). The three groups did not differ significantly in age or education. An ANOVA compared the mean Total Correct obtained by the three groups. Outcomes & Results: Both hypotheses were confirmed. The mean scores (Total Corrrect) for the bilingual groups (42.6 and 39.5/60) were both significantly below the mean score of the unilingual group (50.9/60) but not different from each other. Item difficulty showed some similarities but also important differences across groups. Conclusions: The English language norms cannot be used, even with proficient bilingual speakers. Cultural factors appear less important than bilingualism. Some items on the Boston Naming Test have more than one correct name and suggestions for “lenient” scoring are given.

Dementia Caregivers’ Responses to 2 Internet-Based Intervention Programs

Purpose: The aim of this study was to examine the impact on dementia caregivers’ experienced stress and health status of 2 Internet-based intervention programs. Design and methods: Ninety-one dementia caregivers were given the choice of being involved in either an Internet-based chat support group or an Internet-based video conferencing support group. Pre-post outcome measures focused on distress, health status, social support, and service utilization. Results: In contrast to the Chat Group, the Video Group showed significantly greater improvement in mental health status. Also, for the Video Group, improvements in self-efficacy, neuroticism, and social support were associated with lower stress response to coping with the care recipient’s cognitive impairment and decline in function. Implications: The results show that, of 2 Internet-based intervention programs for dementia caregivers, the video conferencing intervention program was more effective in improving mental health status and improvement in personal characteristics were associated with lower caregiver stress response.

Analysis of Conversational Topic Shifts: A Multiple Case Study ☆ ☆☆ ★

Investigation into the natural conversational discourse of patients with Dementia of the Alzheimer Type has received minimal attention, in part due to the inherent methodological problems. There are no satisfactory theoretical models of conversation; existing global checklists give minimal information on meaning relationships and analysis of conversation does not lend itself to group studies. The present study offered an initial example of how meaning relationships, expressed through topic shifting behavior, can be described in DAT and normal elderly subjects in natural conversational discourse. Categorization of topic units was done in an attempt to describe general phenomena, type of shift, reason for shift, and contextual relationship. Although very little differences were visually observed in the general categories, some convergence of data were observed in other topic shift categories. Discussion of the results in relation to a discourse processing model is presented.

Pathways to diagnosis: exploring the experiences of problem recognition and obtaining a dementia diagnosis among Anglo-Canadians.

Increasing evidence suggests that early diagnosis and management of dementia-related symptoms may improve the quality of life for patients and their families. However, individuals may wait from 1-3 years from the onset of symptoms before receiving a diagnosis. The objective of this qualitative study was to explore the perceptions and experiences of problem recognition, and the process of obtaining a diagnosis among individuals with early-stage dementia and their primary carers. From 2006-2009, six Anglo-Canadians with dementia and seven of their carers were recruited from the Alzheimers Society of Calgary to participate in semi-structured interviews. Using an inductive, thematic approach to the analysis, five major themes were identified: becoming aware of memory problems, attributing meanings to symptoms, initiating help-seeking, acknowledging the severity of cognitive changes and finally obtaining a definitive diagnosis. Individuals with dementia reported noticing memory difficulties earlier than their carers. However, initial symptoms were perceived as ambiguous, and were normalised and attributed to concurrent health problems. The diagnostic process was typically characterised by multiple visits and interactions with health professionals, and a diagnosis was obtained as more severe cognitive deficits emerged. Throughout the diagnostic pathway, carers played dynamic roles. Carers initially served as a source of encouragement to seek help, but they eventually became actively involved over concerns about alternative diagnoses and illness management. A better understanding of the pre-diagnosis period, and the complex interactions between peoples beliefs and attributions about symptoms, may elucidate some of the barriers as well as strategies to promote a timelier dementia diagnosis.

Symbolic meaning of relocation to a residential care facility for persons with dementia

Objectives: This study explored the perspectives of persons with dementia (PWD) on the meanings and experiences associated with relocation to a residential care facility (RCF). Methods: A qualitative design was employed, which involved in-depth interviews with 16 PWD at their homes within two months prior to relocation. The work of Strauss and Corbin guided the analysis process. Results: Participants viewed relocation to an RCF as a major residential change and life transition requiring significant adaptive efforts. The experience clearly had a profound personal meaning for the participating PWD, shaped by their unique personal identities, psycho-environmental histories and current living circumstances. However, despite individual variations, four major themes captured the common perspectives and experiences in the sample. Relocation to an RCF: (a) symbolized the end of an era and a long-established way of life; (b) signaled the inevitable downward trajectory of old age; (c) meant living a more protected, dependent, structured and communal lifestyle in a place that is associated with ‘hospitality’ and ‘rest’; and (d) presented a life course challenge that could be dealt with by drawing on ones sense of identity as a ‘survivor’. Conclusion: The findings raise awareness of the subjective meanings of residential transitions in the experience of aging with dementia, and inform supportive interventions to optimize housing decisions for PWD in order to promote successful adaptation to their new living environments.

Work integration issues go beyond the nature of the communication disorder

UNLABELLED The ability to obtain and maintain employment is one of societys most valued life participation events and is often considered in measurements of quality of life (QOL). Many workplaces now require good communication skills and this may jeopardize the opportunity for persons with communication disorders (CD) to access interesting jobs. Sarno, Silverman, and Levita (1970) have long emphasized that functioning is a result of the interaction of psychosocial factors as well as communication disorder characteristics. The current study gathered perceptions from different groups of persons with CD, from service providers and employers on the barriers to work integration. The results show that many barriers are common across types of CD. Such examples are noise, tasks requiring speed, having to speak to groups of persons and the attitudes of others. Although some common barriers were identified between the service providers and the persons with CD, service providers placed more emphasis on psychological adaptation aspects than did persons with CD. Employers generated an equivalently long list of barriers but were also very concerned about job market issues. LEARNING OUTCOMES As a result of this activity, the following learning outcomes will be realized: participants will be able to (1) identify barriers that service providers and persons with CD each perceive; (2) identify differences in the perceptions of each group concerning barriers; (3) learn ways to modify or eliminate barriers that interfere with successful employment among individuals with CD.

Perceptions of the obstacles to work reintegration for persons with aphasia

The Handicap Creation Process Model (HCPM) suggests that persons with disabilities may experience difficulties at work because of environmental barriers. The present study reports on the perceptions of persons with aphasia, of speech-language pathologists and of employers regarding the potential barriers to job (re)integration. Statements were gathered using a focus group and a nominal group technique, and analysed according to whether the barriers were perceived as residing with the individual, with the organization or with society. Qualitative differences were noted among the perceptions of the three groups. Speech-language pathologists focused on the personal and societal barriers where employers focused on the organizational barriers. Persons with aphasia perceived barriers at all levels. Suggestions for strategies for eliminating these barriers for persons with communication disorders were also collected.

Needs of People With Dementia in Long-Term Care A Systematic Review

With the aging of the population and the projected increase of dementia in the coming years, it is crucial that we understand the needs of people with dementia (PWD) in order to provide appropriate care. The aim of this study is to determine, using the best evidence possible, the care needs of PWD living in long-term care (LTC). A total of 68 studies, published between January 2000 and September 2010, were identified from six databases. From the selected studies, 19 needs of PWD were identified. The existing evidence suggests that psychosocial needs such as the need to engage in daily individualized activities and care must not be ignored in LTC. This review aims to provide a clearer picture of the needs of this growing patient population.

Pathways to dementia diagnosis among South Asian Canadians

Urban centers are increasingly ethnically diverse. However, some visible minorities are less likely than their majority counterparts to seek and receive services and treatment for dementia. This study explored experiences of South Asian Canadians, Canada’s largest visible minority group, prior to dementia diagnosis. Six persons with dementia and eight of their family carers described their early perceptions of dementia-related changes, actions taken, including help seeking and diagnosis, and affective responses. Early signs were attributed to aging or personality. Even after cognitive enhancers were prescribed, some respondents continued to believe that the dementia symptoms were ‘normal’. Family carers’ affective responses may be related to their attributions. Before seeking medical attention, family carers modified physical or social environments because of symptoms. Help seeking was delayed up to four years, even with significant dementia symptoms. Recognition of a health problem was influenced by safety concerns, emergence of new symptoms following trauma, and treatment for other health problems. For some, relatives living outside the home or outside Canada were instrumental in recognizing a problem and convincing family carers and persons with dementia to seek medical attention. The pathway to diagnosis might be easier with outreach to help South Asian immigrants differentiate between normal aging and dementia. Symptom recognition by physicians treating other acute conditions was a portal to dementia services for others. Screening and referral in acute care could result in earlier diagnosis and treatment.

Perceptions of family and staff on the role of the environment in long-term care homes for people with dementia.

BACKGROUND Disruptive behaviors are frequent and often the first predictor of institutionalization. The goal of this multi-center study was to explore the perceptions of family and staff members on the potential contribution of environmental factors that influence disruptive behaviors and quality of life of residents with dementia living in long-term care homes. METHODS Data were collected using 15 nominal focus groups with 45 family and 59 staff members from eight care units. Groups discussed and created lists of factors that could either reduce disruptive behaviors and facilitate quality of life or encourage disruptive behaviors and impede the quality of life of residents. Then each participant individually selected the nine most important facilitators and obstacles. Themes were identified from the lists of data and operational categories and definitions were developed for independent coding by four researchers. RESULTS Participants from both family and staff nominal focus groups highlighted facility, staffing, and resident factors to consider when creating optimal environments. Human environments were perceived to be more important than physical environments and flexibility was judged to be essential. Noise was identified as one of the most important factors influencing behavior and quality of life of residents. CONCLUSION Specialized physical design features can be useful for maintaining quality of life and reducing disruptive behaviors, but they are not sufficient. Although they can ease some of the anxieties and set the stage for social interactions, individuals who make up the human environment are just as important in promoting well-being among residents.