Silvia Orsulic-Jeras

Use of Montessori-based activities for clients with dementia in adult day care: Effects on engagement:

Clients with dementia in an adult day care center were observed taking part in regular activities programming or Montessori-based activities developed for persons with dementia. During the nine-month study, clients in Montessori-based activities exhibited greater amounts of constructive engagement, defined as motor or verbal behavior exhibited in response to the activity in which the client was taking part, than clients in regular programming. Montessori-based activities also elicited less passive engagement, defined as listening and/or looking behavior exhibited in response to the activity the clients were participating in, than regular programming. Implications of these results and ways to implement Montessori-based programming in settings serving persons with dementia are discussed.

Acceptability and Feasibility Results of a Strength-Based Skills Training Program for Dementia Caregiving Dyads

PURPOSE The current article provides an in-depth description of a dyadic intervention for individuals with dementia and their family caregivers. Using a strength-based approach, caregiving dyads received skills training across 5 key areas: (a) education regarding dementia and memory loss, (b) effective communication, (c) managing memory loss, (d) staying active, and (e) recognizing emotions and behaviors. Results of the acceptability and feasibility of the intervention protocols are also presented. DESIGN AND METHODS Caregiving dyads were randomly assigned to participate in the intervention. Participants in the treatment condition were asked to complete a series of evaluation questions after each intervention session and an overall evaluation of the program. Data were also collected from the intervention specialists who implemented the protocols. RESULTS Overall, the evaluation data indicated that the content and process of the intervention were viewed as highly acceptable and feasible by both participants and intervention specialists. IMPLICATIONS This article highlights the merit of using a strength-based approach for working with caregiving dyads with dementia and how a single intervention protocol can be used to address the goals of both care partners. Furthermore, the intervention program was found to be highly acceptable and feasible, which is an important aspect of developing dyadic protocols.

Montessori-Based Dementia Activities in Long-Term Care: Training and Implementation

Abstract This article describes Montessori-based activities for use with persons with dementia in long-term care settings. An overview of the Montessori method of education is presented, with emphasis on its application to geriatric populations. Individual and group activities are detailed, along with techniques for adapting Montessori materials and procedures for use in long-term care settings. A description is provided of training procedures used with activities staff to allow them to implement such activities within their regular programming schedules. In addition, activities staff relate examples of the effects of implementing such programming on residents.

Applying a strength-based intervention for dyads with mild to moderate memory loss: Two case examples

Managing and coping with the symptoms of dementia and memory loss is associated with negative psychosocial outcomes for both persons with dementia and their family caregivers. Research has indicated beneficial results in using dementia-management interventions to impact positively on mental health outcomes for caregivers and address cognitive and functional issues for persons with dementia. However, most intervention programmes to date have primarily worked with each care partner separately, rather than implementing a single intervention protocol that targets both members of the caregiving dyad. This article provides a description of a newly designed intervention that includes both care partners. Using a Strength-Based Approach, the dyadic intervention identifies and builds upon both care partners’ current abilities to address their specific care needs. Two case examples are presented to illustrate the flexibility and advantages of using a Strength-Based Approach. The discussion highlights the extent to which core intervention skills can be tailored to fit a range of care needs.

The SHARE program for dementia: Implementation of an early-stage dyadic care-planning intervention:

This article describes the implementation of SHARE (Support, Health, Activities, Resources, and Education), a counseling-based care-planning intervention for persons living with early-stage dementia and their family caregivers (CGs). The foundation of SHARE is built upon assessing and documenting the person living with dementia’s care values and preferences for future care. Using the SHARE approach, CGs are given an opportunity to achieve an understanding of their loved one’s desires before the onset of disease progression when the demand for making care decisions is high. Through working together with a SHARE Counselor, the care dyad begins to identify other sources of support, such as family and friends and service providers, in order to build a more balanced and realistic plan of care for the future. Data were collected from 40 early-stage dementia care dyads to determine the acceptability of having structured discussions about future care in the early stages of dementia. Findings from this study demonstrate the importance of planning in the early stages when persons with dementia can voice their care values and preferences for future care. Finally, this paper illustrates the use of supportive strategies such as rapport building, establishing buy-in, and communication to initiate care-related discussions with care dyads in the early stages that will help lead to more effective decision making in the future.

Meeting the Informational, Educational, and Psychosocial Support Needs of Persons Living With Dementia and Their Family Caregivers

Background and Objectives Meeting the unique and changing needs of individuals living with Alzheimers disease and their family caregivers can be very challenging given the dynamic and often unpredictable nature of the disease. Effective programs are available to help families manage the challenges they will face. Research Design and Methods This article first describes the educational, information, and support needs of individuals living dementia and their family caregivers across all stages of Alzheimers. Next, we describe the variety of services and program models targeted to the needs of individuals living with Alzheimers disease or other types of dementia and their families. Results These programs can help ensure that person- and family-centered care is maintained from time of first symptoms through end-of-life. Discussion and Implications We end with our recommendations for maintaining person- and family-centered care through the provision of targeted information, education, and support to individuals and their families.

Recruitment challenges and strategies: Lessons learned from an early-stage dyadic intervention (innovative practice)

An increasing number of family caregivers are seeking services and support due in large part to the dramatic increase in the number of older adults obtaining dementia diagnoses. This paper describes barriers and challenges experienced by our research team in recruiting early-stage dementia caregiving dyads into research studies. Effective recruitment and screening strategies to address these barriers are also discussed. Recruitment and enrollment success depends on these strategies as well as having well-trained recruitment staff who are knowledgeable about the study and have experience working with older adults, and more specifically, persons with dementia.

The Support, Health, Activities, Resources, and Education program for early stage dementia: Results from a randomized controlled trial:

Purpose A randomized controlled trial was conducted to test the effectiveness of the Support, Health, Activities, Resources, and Education Program. This six-session psycho-educational program provides dyadic counseling for individuals in the early stages of dementia and their family caregivers. The goal is to prevent common problems in care that emerge during the course of dementia by (1) actively engaging the person with dementia in developing a balanced plan of future care with his/her caregiver, (2) increasing use of available services, (3) enhancing dyadic relationship functioning, (4) improving well-being, and (5) evoking satisfaction with components of the intervention. Design and methods Persons with early stage dementia (n = 128) and their caregivers (n = 128) were randomly assigned either to Support, Health, Activities, Resources, and Education Program or a control condition. Intervention efficacy was evaluated for completion of a care plan, use of services, dyadic relationship functioning, participant well-being, and program satisfaction. Results Dyads in the treatment condition were able to construct a balanced care plan and increased their use of services. Dyadic functioning improved for one dimension (decreased emotional disruptions). Compared to the control condition, satisfaction with the intervention was higher for caregivers enrolled in Support, Health, Activities, Resources, and Education Program on four of five dimensions and one dimension for persons with dementia. Implications: Support, Health, Activities, Resources, and Education Program is a promising prevention approach that takes advantage of the early stage of dementia when both members of the dyad can participate fully in making decisions about later care.

Support, health, activities, resources, and education: The evidence-based share program for persons with early-stage dementia and their family caregivers

Background: Consumer engagement is promoted as best practice however is often done without authenticity leading to “tokenism”. This is particularly true for people living with dementia, often viewed as less capable of contributing meaningfully. In 2012, a research team of 17 including people living with dementia, informal caregivers and service providers began developing an 8week self-management education program for people living with dementia “Taking Control of Our Lives”. 3 Advisory Hubs (40 people, 20 living with dementia) participated in an iterative knowledge translation process, guiding decisions about content, defining objectives, and testing learning tasks. Two pilots were held with 10 people living with dementia and 8 care partners. The goals of this project were to explore processes for meaningfully engaging people living with dementia in program development, develop tools to support meaningful engagement of people living with dementia, and develop a highly effective self management of dementia curriculum informed by the real needs of participants. Methods: The product and process applied principles of Social Citizenship (Bartlett & O’Connor 2010), Authentic Partnerships (MAREP, 2011) and Dialogue Education (Vella, 2008). Data was gathered through research team and advisory hub interviews and focus groups, meeting notes analysis, and meeting and program facilitator reflections, and reflective focus groups with pilot participants. Results:Mid-project data revealed 4 components critical to meaningful engagement: (1) Purpose (clear, meaningful, relevant), (2) People (enthusiasm, commitment, openness, humility), (3) Relationships (respect, safety, listening, relationships beyond, facilitation, connections, humour), and (4) Process (honour process, expectations, consistency, information flow, reflecting). These components are being

IMPLEMENTATION OF AN EARLY-STAGE CARE PLANNING INTERVENTION FOR INDIVIDUALS LIVING WITH DEMENTIA AND THEIR FAMILY CAREGIVERS, SHARE FOR DEMENTIA, IN A COMMUNITY HEALTH SETTING: LESSONS LEARNED FROM THE FIELD

can be difficult in a standard medical practice due to time constraints and the need for staff trained in assessing biopsychosocial needs. PWD and CP may also lack access to services for various reasons, which may include difficulty traveling to multiple locations to receive services. The collocated Memory Counseling Program (MCP) and Memory Assessment Clinic (MAC) at Wake Forest (WF) provides a BPSA and tailors interventions to needs important to PWD and CP (neuropsychological symptoms, mental health, social and natural supports, and environmental resources). Methods: The BPSA is a 90-minute assessment that is administered by a licensedmental health provider (LMHP) and invites anyone involved in the care of PWD to participate. During the BPSA, the LMHP ascertains relevant data about PWD and CP including occupational, social, legal, and familial history, as well as the overall functioning of PWD. The LMHP is pivotal during the process to ascertain proper evaluation of mental health history, screening of current symptoms of mental health for all participants, and case formulation that yields concise recommendations. Recommendations may include any combination of psychotherapy, case management, psychoeducation, support group, medical counseling, and outside referrals. All recommendations, except outside referrals, can be accessed onsite, which increases access for PWD and CP. The BPSA is provided at no cost to PWD or CP. Results: The BPSA administered by a LMHP provides a means of identifying needs and makes clear and concise recommendations, which improves efficiency of time of PWD, CP, and clinicians involved in treatment. Of the PWD and CP who complete the BPSA, 70% also receive mental health support through theMCP, which theymay not otherwise receive.Conclusions: The BPSA provides a unique evaluation of needs specific to PWD and CP that allows for concise recommendations to improve efficiency of time for PWD, CP, and all providers involved in care. The BPSA allows PWD and CP to access mental health and social support that they may not otherwise receive.