Perry Edelman

Comparison of Dementia-Specific Quality of Life Measures in Adult Day Centers

ABSTRACT This study evaluated five dementia-specific quality of life (DQOL) measures including client interviews, staff proxies, and observations with 54 clients in three adult day centers. Also, the relationship of cognitive and functional status to each of the DQOL measures was assessed. Client interviews correlated well with each other, but not with other measures. Staff proxies were strongly correlated with each other and moderately correlated with the observational measure. On average, clients rated their DQOL higher than staff. Analyses suggest that functional impairment is associated with poorer DQOL as indicated by staff and observer measures. Possible explanations and implications are explored.

Antecedents of physical activity among family caregivers

The authors examined exercise behaviors among family caregivers and the degree to which aspects of the caregiving role influenced exercise behaviors. Understanding factors associated with caregiver physical activity provides practitioners the means to design and tailor interventions to be effective for caregivers. Caregivers (N = 208) participating in a self-care intervention to promote caregiving skills were surveyed at baseline, prior to training. Measures included caregiver characteristics, care recipient characteristics, attitudes and intentions toward exercise, and levels of physical activity. Mental health variables and self-efficacy for exercise were significantly related to exercise levels in bivariate analyses. Regression analyses revealed that caregiver and care recipient characteristics accounted for a small percentage of the variance in exercise behavior. Caregiver vitality and self-efficacy for exercise were key variables most significantly related to exercise behaviors. Findings suggest that mental health factors and attitudes about exercise may be more important predictors of exercise than caregiving factors.

Streamlined models of dementia care mapping

Dementia Care Mapping (DCM) is an observational tool that provides rich data about the quality of life and quality of care of persons with dementia in group care settings. The method is time-consuming and thus costly to implement in practice. This paper presents an attempt to ‘streamline’ DCM for the sake of simplifying it and reducing the financial resources required to implement it. Data were collected for 166 persons with dementia in three types of care settings. Seven streamlined time-sampling models were tested against the original DCM model. In general, results support the use of certain models for specific purposes. The strengths and limitations of these streamlined models are discussed and recommendations are made.

Influence of cognitive impairment, functional impairment and care setting on dementia care mapping results.

Quality of life (QOL) for people with dementia has become a major focus over the past decade. Dementia care mapping (DCM) is an observational measure of quality of care given by staff in formal care settings, as well as a measure of QOL that has been used in many studies of people with dementia in residential care settings. However, the method itself has not been rigorously studied in a scientific manner. For this report, mapping data were collected for 166 persons with dementia in three types of care settings: special care facilities that are licensed nursing homes, assisted living facilities, and adult day centers. The relationships between DCM and several independent variables including cognitive status, functional status, care setting, depression, length of stay, and co-morbid illnesses were assessed. Both cognitive status and functional status were found to be associated with DCM scores. Moreover, DCM was sensitive in differentiating among persons with four levels of cognitive impairment. Implications for practice are discussed.

Daytime sleep and the threat to well-being of persons with dementia

Sleep dysfunction is common among persons with dementia. The relationship of daytime sleep to the quality of life and social engagement of persons with dementia has not been examined. The present study examined this relationship among 166 persons with dementia in three nursing homes, two assisted living facilities, and three adult day centers. Two staff proxy questionnaires and two measures of direct observation were used to assess quality of life and social engagement. Findings differed somewhat in nursing homes and assisted living facilities compared to adult day centers. In general, multivariate analyses indicated that greater frequency of daytime sleep was related to lower quality of life and lower social engagement, regardless of dementia severity.

Evaluation of the Managed Community Care Demonstration Project

The purpose of this article is to describe the impact of a capitated community-care demonstration in Illinois that attempted to increase the range of services provided while constraining overall costs. The authors examined the implementation and outcomes, using pretest and posttest measures of client satisfaction, range of services, agency costs, and nursing home admissions. Demonstration clients (n = 752) had a mean age of 80, and an average of two activities of daily living impairments. The number of covered services increased from 3 at baseline to 14 during the demonstration, whereas the mean number of services used increased from 1 to 2.5. Satisfaction with care remained stable and agency average costs declined. The capitation rate more closely approximated agency costs than customary fee-for-service (FFS) and provided a fixed deductible for clients. No difference was seen in nursing home admissions compared to clients served under FFS in the same geographic location. These results imply that capitation increased the range of covered services, maintained client satisfaction, increased efficiency, and did not affect rate of nursing home admissions. Capitated home- and community-based services needs to be tested in other locations and with other providers.

P2-237: A toolkit for assessing the quality of life of people with dementia and improving dementia care

translated and adapted into Portuguese. Thirty two mild AD patients, 25 moderate AD patients and 51 elderly without dementia were examined. The AD patients and the control group answered the Minimental State Examination (MMSE), the Geriatric Depression Scale (GDS) and Alzheimer’s disease Assessment Scale (ADAS-cog). The ASHA FACS was answered by their relative/caregiver. The scale internal consistency, its inter and intra-examiners reproducibility and scale’s criterion validity were researched. The effect of education and age in functional communication performance were analyzed. Results: Statistical analyses indicated that the ASHA FACS has excellent internal consistency (Cronbach’s Alpha 0,955), test-retest reliability (interclass correlation coefficient [ICC] 0,995; p 0,001) and inter-examiners (ICC 0,998; p 0,001). Besides, it showed excellent criterion validity when correlated with Adas-cog. The ASHA FACS scale showed good sensitivity (81.4%) and specificity (84.3%) values once it is an ecological and broad evaluation. It was verified that years of education intervened in functional communication performance of healthy elderly and ones with AD, but the age did not have the same influence on functional communication performance in both groups. Conclusions: The ASHA FACS Portuguese version is a valid and reliable instrument to verify communication alterations in AD patients. It is useful for diagnosis and track alterations along the disease aiming patient’s treatment and relative’s and caregiver’s orientation. It fills an important gap of efficiency indicators for speech language therapy.