Marcia M. Neundorfer

Effects of group interventions on cognition and depression in nursing home residents.

The effects of cognitive-behavioral group therapy, focused visual imagery group therapy, and education-discussion groups on cognition, depression, hopelessness, and dissatisfaction with life were studied among depressed nursing home residents. Seventy-six depressed subjects with mild to moderate cognitive decline participated in nurse-led 24-week protocols. Data were collected 4 weeks before the interventions, 8 and 20 weeks after treatment initiation, and 4 weeks after treatment termination. There were no significant changes in depression, hopelessness, or life satisfaction scores for any of the three conditions. Participants in the cognitive-behavioral and focused visual imagery groups showed a significant improvement beginning 8 weeks after treatment initiation on cognitive scores. These findings are encouraging indications that cognitive-behavioral and focused visual imagery group therapies may reduce cognitive impairment in depressed nursing home residents with mild to moderate cognitive decline.

Assessment of functional ability in Alzheimer disease: a review and a preliminary report on the Cleveland Scale for Activities of Daily Living.

SummaryAssessment of activities of daily living (ADL) in Alzheimer disease (AD) is critical in establishing the diagnosis, monitoring disease progression, evaluating the efficacy of treatment interventions, and determining the need for health and social services. The proper method to measure ADL depends on the purposes to which the scale is to be put. Existing ADL scales differ as to the type of behaviors assessed, the nature of the observations made, and the manner in which the observations are quantified. These scales were not specifically designed to evaluate changes in the nature and extent of the broad spectrum of functional difficulties seen in individuals with AD. We describe the Cleveland Scale for Activities of Daily Living (CSADL), an informant-based instrument designed to expand upon the capacity of existing physical and instrumental ADL scales by assessing both premorbid and current component acts (e.g., initiation versus implementation) of daily living functions.

The relationship of self-restraint and distress to coping among spouses caring for persons with Alzheimer's disease

This study investigated the relationship between two basic dimensions of social-emotional adjustment: distress and self-restraint, as identified by Weinberger and Schwartz (1990), and the use of four coping strategies by spouse caregivers of persons with Alzheimers disease. Care givers were most frequently categorized as oversocialized (high distress, high self-restraint) and repressive (low distress, high self-restraint) according to Weinberger and Schwartzs (1990) social-emotional adjustment typology. A higher proportion of males than females were under- socialized (low distress, low self-restraint) and reactive (high distress, low self-restraint), whereas a higher proportion of females than males were oversocialized (high distress, high self-restraint). High distress caregivers were more likely to use the emotion-focused coping strategy of wishfulness, whereas low distress caregivers were more likely to use acceptance and the problem-focused strategy of instrumental coping. Although there were gender differences in distress and the use of specific coping strategies, the relationships between distress and coping strategies used held regardless of gender. Implications for caregiver intervention programs as well as directions for future research are discussed.

Quality of Life and Deficit Identification in Dementia

Numerous studies have examined self-identification of deficits in persons with dementia. Few of these studies consider the influence of interpersonal and social factors on deficit identification, and most focus on whether or why deficits are ‘underreported’ by persons with dementia. In our studies, we found considerable variation in deficit identification within and among persons with dementia, and some ‘overreporting’ of deficits in comparison with caregiver reports across all of the domains studied. Thus, focusing on ‘underreporting’ and aggregate level data neglects information that could be important to measuring and understanding quality of life in dementia. Current approaches to measuring and understanding quality of life in dementia make divergent assumptions about the impact of deficit identification. Emerging phenomenological perspectives suggest that proactive interventions that treat deficit identification as an interpersonal and social challenge inherent in the experience of dementia would enhance the quality of life of caregiving dyads.

Changes in Resident Mix in Nursing Homes: Cognitive and Sensory Data from a (Redesigned) Sampling Plan

In planning and implementing a study, we unintentionally and seren-dipitously obtained data about changes in resident mix over a 2.8-yr. period. We screened residents of a 184-bed nursing home for cognition and sensorium in October 1984 to assess sampling feasibility for a grant proposal in preparation. At that time, 65.2% of the residents met the sampling criteria. However, in July/August 1987, after award of funding, only 5.4% of residents of the same nursing home met the cognitive and sensory criteria. We were forced to recruit from an additional six nursing homes, in which only 9.3% of residents met the sampling criteria.