Michelle S. Bourgeois

Interventions for Caregivers of Patients with Alzheimer's Disease: A Review and Analysis of Content, Process, and Outcomes:

Current reviews of the caregiver intervention literature have focused primarily on the outcomes of interventions for caregivers and general methodological limitations of individual studies (i.e., sampling and recruitment issues, adequacy of outcome measures, and generalization issues). Little attention has been paid to the specific factors affecting the therapeutic process, including the intensity and integrity of the interventions used. The purpose of this review is to examine closely the content and process of Alzheimers disease (AD) caregiver interventions. We describe the types of interventions currently in use, factors affecting intervention outcomes, and we conclude with specific recommendations for the application of intervention technology and for the documentation of intervention research.

A comparison of training strategies to enhance use of external aids by persons with dementia

UNLABELLED The purpose of this study was to compare the effectiveness of two training approaches, Spaced Retrieval (SR) and a modified Cueing Hierarchy (CH), for teaching persons with dementia a strategy goal involving an external memory aid. Twenty-five persons with dementia living in either community or nursing home settings received training on two individual-specific strategy goals, one with each training approach. Results revealed that significantly more goals were attained using SR procedures than CH, but that a majority of participants learned to use external aids using both strategies. There were no significant differences in the number of sessions required to master goals in either condition; however, significantly more SR goals were maintained at both 1-week and 4-months post-training compared to CH goals. Mental status was not significantly correlated with goal mastery, suggesting the potential benefits of strategy training beyond the early stages of dementia. LEARNING OUTCOMES As a result of this activity, the reader will be able to (1) identify ways to enable persons with dementia to make effective use of external memory aids; (2) describe a method, Spaced Retrieval, by which persons with dementia can learn and retain information; and (3) describe two approaches to working with persons with dementia to train a strategy learning goal.

Conversational coherence: discourse analysis of older adults with and without dementia

Abstract The purpose of this study was to compare the discourse profiles of 30 nursing home residents with dementia and of 30 healthy older adults. A total of 60 transcripts of interview style conversations were analyzed using a discourse analysis schema. The results revealed a higher frequency of discourse building features, such as coherence and cohesion, for healthy adults compared to adults with dementia. Conversely, discourse-impairing features, such as disruptive topic shifts and empty phrases, were found more often in conversations of adults with dementia compared to healthy adults. Conversational partners deviated from their conversation protocol when talking to adults with dementia by including facilitative strategies in the conversation. Discourse features in interview style conversations in adults with dementia reflect declines in their memory.

Skills Training for Spouses of Patients with Alzheimer's Disease: Outcomes of an Intervention Study

The effects of a 12-week intervention on a patient-focused skills training group and a caregiver-focused skills training group were compared with those on a control group that received comparable attention, but no training. Intervention effects were monitored at the completion of the treatment phase and at 3- and 6-months postintervention. Treatment implementation was documented in a comprehensive fashion to ensure replicability. Both training groups acquired skills that enabled them to improve targeted behaviors (patient problem behaviors and caregiver mood, respectively). Weaker effects were found for more distal outcomes, such as depression, perceived stress, caregiver strain, and self-efficacy.

MEMORY WALLET INTERVENTION IN AN ADULT DAY-CARE SETTING

The use of memory wallets to prompt factual information during conversations with day-care center volunteers was evaluated for four subjects with dementia. Memory wallets contained 15–20 pictures and sentences about familiar persons, places, and events that each subject had difficulty remembering. All subjects used the memory wallets to improve their conversations by increasing factual statements and decreasing ambiguous, unintelligible, and perseverative utterances. Volunteers decreased their use of questions and prompts during conversations in which subjects used their memory wallets. These results demonstrate the effectiveness of using volunteers to develop memory wallets and to encourage their use during conversations with day-care clients.

Communication and Aging

People with communication disorders form a diverse group with some experiencing long-standing disorders and others the onset of new disorders in old age. Regardless of age at onset, the burden of communication disorders is cumulative and has important implications for health care providers. Communication serves many roles for older people, not only establishing and maintaining social affiliations but also providing access to health care services. Health care providers should be aware of potential communication disorders and make provision for quiet environments, reading materials at appropriate literacy levels, and longer appointments for people with communication difficulties.

Effects of memory aids on conversations between nursing home residents with dementia and nursing assistants

The effects of personalised memory books on the conversations between four residents with dementia and three nursing assistants (NAs) were evaluated using an experimental, single-subject design. Most residents increased their production of factual utterances, NAs decreased their use of non-facilitative conversational behaviours, and conversational turn-taking became more equitable when residents used their books. The addition of NA instruction resulted in further reduction of non-facilitative NA behaviour. The effects of the intervention were somewhat weaker with residents with greater dementia severity. Social validity measures suggested that this intervention may hold promise for improving conversations between NAs and residents with dementia.

The effects of cognitive teletherapy on reported everyday memory behaviours of persons with chronic traumatic brain injury

Primary objective: The purpose of this study was to evaluate the effects of an errorless training approach, Spaced Retrieval (SR) training delivered over the telephone, on the reported everyday memory problems of adults with chronic traumatic brain injury (TBI). Research design: The study was a randomized controlled clinical trial. Methods: Thirty-eight participants received either SR training or didactic strategy instruction (SI). Participants in both groups identified three memory-related goals and were paired to receive the same total telephone contact time. The main outcome measures were frequency of reported memory problems and perceived quality of life. Results: Participants in the SR group reported significantly more treatment goal mastery/strategy use than those in the SI group, immediately and at 1-month post-training. Caregivers reported similarly significant between-groups differences in everyday use of treatment behaviours at 1 month. Both groups reported some generalized strategy use to other non-targeted behaviours and decreased frequency of reported memory problems, but there were no significant between-groups differences in participant or caregiver reports of generalized strategy use or reported memory problems at either time-point. There was no change in perceived quality of life in either group. Conclusions: SR treatment delivered by phone produced significantly more treatment goal mastery/strategy use and maintenance than SI; however, both treatments improved reported everyday memory functioning for persons with TBI, without significant group differences on measures of generalized strategy use or perceived quality of life.

Increasing Communication Among Nursing Home Residents

In this preliminary, intrasubject study (N = 8), we examined the effects of communication skills training and the use of memory books by Nursing Assistants (NAs) on the social ecology of a nursing home. Through inservice and on-the-job training, NAs were taught to use communication skills and memory books during their interactions with residents with mild to moderate cognitive impairment (Mini Mental Status Examination, M = 16.25), but relatively intact communication abilities. An abbreviated staff motivational system called Behavioral Supervision (Burgio and Burgio, 1990. Int. J. Aging Hum. Deve. 30: 287–302.) was attempted to encourage performance of these skills on the nursing units. Results showed that, regardless of sporadic implementation of the intervention by nursing staff, the intervention improved communication between staff and residents during care routines, increased the amount of time other residents and visitors spent talking with target residents, and increased the rate of positive statements made by the target residents and others in their immediate environment. Results are discussed in terms of limitations of the staff motivational system and modifications made to the system in a larger ongoing intervention trial.

Dementia : from diagnosis to management : a functional approach

1. Introduction: History and Philosophy of Treatment in Dementia. 2. Diagnosis of Dementia: Clinical and Pathophysiological Signs of Various Etiologies. 3. Cognitive, Language, and Behavioral Characteristics across the Stages of Dementia. 4. Assessment: Cognitive, Communicative and Behavioral Characteristics. 5. Treatment: Solutions to Cognitive- and Communication-based Problems. 6. Management: A Multidisciplinary Focus. 7. Management of Eating and Swallowing Challenges. 8. Quality of Life Issues. 9. Caregiver and Family Issues. 10. Impact on Staff: Training and Supervision Issues. 11. Treatment Settings, Goals, and Documentation Issues.