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The present review highlights results from recent studies that delivered brief electrical stimulation to the basolateral complex of the amygdala in rats to reveal its capacity to prioritize declarative memories on a moment-to-moment basis even after the moment has passed. The results indicate that this memory enhancement depends on the hippocampus and elicits intrahippocampal gamma synchrony that possibly corresponds with sharpened hippocampal spike-timing dependent plasticity. These recent findings are discussed in relation to past studies of emotional memory in rodents and humans.

This study describes engagement of veterans with dementia in an evidence-based care coordination intervention called Partners in Dementia Care (PDC). PDC uses a person-centered approach that encourages participation by individuals with dementia (IWDs), despite their cognitive impairment. PDC also targets primary family or friend caregivers, who often are the main user of the program. Of the total 316 IWDs, 202 passed a mental status screening and were considered to have engagement potential. The study of actual engagement was based on data from IWDs’ PDC records, combined with data from structured research interviews. Approximately 80% of IWDs with engagement potential had a minimum level of actual engagement in PDC. A smaller subsample was more actively engaged, as indicated by assigned and/or accomplished action steps. Younger IWDs and those self-reporting more memory difficulties had higher levels of engagement. Results describe one example of the extent and limits of IWD engagement in psychosocial interventions.

This study examines whether the delivery of three components, (a) exercise training, (b) behavior management skill building, and (c) dementia-related education, in an evidence-based program are differentially associated with changes in outcomes for individuals with dementia (IWDs) after 3 months. Data come from 508 IWDs participating in the community replication of the evidence-based “Reducing Disability in Alzheimer’s Disease” program. Regression results indicate that after 3 months, more exercise sessions are associated with improvements in physical functioning, mobility, minutes exercising, and symptoms of depression; more dementia education sessions are related to fewer restricted activity days; and more behavior management sessions are related to more symptoms of depression. As resource-strapped agencies look to best serve participants, further analysis and consideration is needed to determine the ideal balance of program efficacy, feasibility, and resources, as well as program benefits for IWDs and caregivers.

Background: We examined emergency room (ER) utilization by persons with dementia (PWDs) using caregiver and patient characteristics as predictors. Methods: A secondary analysis of 296 veteran–caregiver dyads. Caregivers recorded PWD baseline characteristics and noted ER visits over the next year. Two sets of regression models analyzed categorical ER use and repeat ER use. Results: In the univariate analysis, categorical use of the ER was predicted by patients’ functional status ( P ≤ .008) and Veterans Affairs priority grouping ( P ≤ .02). Repeat ER admissions were predicted by functional status ( P ≤ .04), number of chronic conditions ( P ≤ .01), and caregiver-reported relationship strain ( P ≤ .04). In multivariate analysis, categorical ER use was predicted by functional status ( P ≤ .02), priority grouping ( P ≤ .03), and number of chronic conditions ( P ≤ .06). Conclusions: Functional status most strongly predicted ER use, highlighting the promise of home-based interventions to improve activities of daily living. Number of chronic conditions and caregiver-reported relationship strain are potential targets of intervention during discharge process.

This study examined the characteristics of caregivers and persons with dementia (PWD) to determine their association with caregiver depression. Participants included 508 PWD (veterans) and 486 caregivers from Boston, Houston, Providence, Beaumont (Texas), and Oklahoma City, identified from diagnoses from medical records and recruited from February 2007 to July 2009, for a larger study evaluating Partners in Dementia Care, a care-coordination intervention. Characteristics evaluated for PWD included activities of daily living, instrumental activities of daily living, cognitive impairment, and disruptive behavior. Caregiver characteristics evaluated included caregiver unmet needs, support-service use, and number of informal helpers. Caregiver depression was measured using the Iowa form 11-item Center for Epidemiologic Studies Depression Scale. Depressed caregivers reported significantly more unmet needs than the nondepressed caregivers. Depressed caregivers also reported a high frequency of disruptive behavior in their PWD. Caregiver perceptions of unmet needs may be an important target for intervention.

We studied perceptions of dementia diagnosis and treatment in patient-caregiver dyads enrolled in a care coordination intervention trial for veterans with dementia. We compared patient and caregiver perceptions of diagnosis and treatment to information in the medical record and assessed concordance between patient and caregiver perceptions. Data were derived from medical record abstraction and structured interviews with 132 patients and 183 caregivers. Most caregivers, but only about one fourth of patients, reported having received information about a diagnosis related to memory loss. Caregivers were more accurate than patients in recalling the patient’s use of memory-enhancing medications. Within dyads there was poor agreement regarding a diagnosis of dementia. Our findings suggest that there is substantial room for improvement in disclosure and education of dementia diagnosis, especially at the level of the patient-caregiver dyad.

Primary caregivers' perceptions of the overall quality of care given to their impaired elderly relatives are more strongly related to the perceived helpfulness of selected formal care providers (home aides, physicians, and social workers) than to the perceived helpfulness of selected kin caregivers. Caregiver race and age, the types of other family members who are helping, and whether a nurse is involved influence caregivers'perceptions of the helpfulness of these formal care providers.

One goal of support services for family members of Alzheimer's patients is to facilitate the use of other formal services. Few existing studies empirically test the relationship between support service use and the use of other community or residential services. This research describes the relationship between support and other service use by comparing families who used three types of support services: • Information and referral • Educational programs; and • Support groups. Data from in-person interviews with 127 family caregivers showed that families who used one of the three support services differed in the use of other services, service attitudes, past service experiences, and reasons for support service use. Results profile the characteristics of families who turn to different types of support services and illustrate the importance of past service characteristics for explaining current and future utilization. Information and referral (I & R), educational programs, and support groups are commonly provided support services for family members of Alzheimer's disease victims. These three support services share the common goal of facilitating and encouraging the use of other formal services for Alzheimer patients and their family members. Despite this goal, research on support services has seldom considered whether their use is related to the use of other services.

Few studies have examined whether the use of different types of services is predicted by different characteristics of elderly care recipients and primary kin caregivers. Most research aggregates services into a single category, thereby assuming that different services have the same predictors. This investigation differs from the aggregation approach by comparing four groups of elderly care recipients: in-home service of users, out-of-home service users, users of both in- and out-of-home services, and those who do not use services. Data come from personal interviews with 171 family caregivers of mild to moderate dementia patients who reside in the community. Using the modified Andersen framework and multiple group discriminant analysis, results show that care recipients who do not use services and those using only in-home services have inadequate informal supports, more emotionally strained caregivers, and more functionally impaired care recipients compared with users of out-of-home or both in- and out-of-home services.

Research on bereavement primarily focuses on conjugal loss; few studies examine differences between losing a spouse and losing an aged parent. The present investigation compares perceptions of nineteen bereaved spouses with forty-seven bereaved adult children in order to specify differences between conjugal and parental loss. Data from two larger surveys of family caregivers show spouses feel their physical and emotional health has been more negatively affected by the death, yet report increased participation in social activities. Adult children are more likely to discuss dying with an ill parent, although little difference occurs in other preparations. Differences between spouses and children also are found in the appraised difficulty of the death and in the number of peripheral sources of support, and in the likelihood of receiving assistance from friends and neighbors.

Many factors influence the decision of an abused wife to leave or remain in an abusive situation; one common factor might be the response of the helping agencies from which these women seek assistance. Certain issues that potentially affect a social service agency's response to the abused wife are examined here.

This research examines the role that relationship and household arrangement have in explaining the levels of care-related stress effects experienced by spouse and adult-child caregivers in shared and separate residences. Data from 180 spouse and adult-child caregivers were analyzed to identify differences in caregiver health decline, relationship strain, and activity restriction across these settings when the effects of elder impairment, caregiver age, and use of social supports are controlled. Results show that spouse and adult children in shared households experience similar levels of care-related strain. However, comparison of adult children in shared and separate households show considerable cross-setting differences in strain, with those in shared households having significantly greater activity restriction but less relationship strain. These findings have implications for the delivery of social services, specifically for targeting health monitoring, respite, and family counseling services.

Hospice is a concept of terminal care based on an ideology that specifies a particular way for patients and families to deal with death and dying. This article describes this ideology and attempts to assess its success for hospice patients. Findings show that hospice care is more successful for patients who are more aware of their terminal status, who are older, and who have a primary caregiver who experiences fewer difficulties with the caregiver role.

This study describes selected characteristics of a group of terminal patients who were enrolled in a home-based hospice program. Similar characteristics of the patients' primary caregivers also are described. Relationships between the characteristics of patients and caregivers are examined, as are relationships between these characteristics and the rate at which various services were utilized. Implications for hospice service delivery and for future hospice research are explored.

Client-centered needs assessments are a useful tool in attempting to design hospice programs so that they meet the needs and wants of their clients. Because of its recent development, hospice proponents face difficult decisions concerning what services would best serve their clients. Needs assessments provide empirical data on issues that are of most concern to hospice clients. This information can then be used to select services to meet those concerns. In gathering data from hospice clients, researchers must be aware that the sensitive nature of the life event may lead to a response bias in client surveys. This paper examines the response bias that occurred in one needs assessment study. The results showed that the bias may have eliminated clients having had the most difficult illness experiences from the study. Had the bias gone unnoticed, the needs of the nonrespondents may have been neglected in the construction of the hospice program.

It would appear that hospice care providers in the program investigated here are highly accurate in their perceptions of their clients' needs. The program therefore is in an excellent position to accomplish its goals. However, findings also suggest that nurses are most accurate in their perceptions of social, emotional, and physical needs. They don't do as well in estimating the importance of material needs, such as financial and legal concerns. Nurses are also more likely to misperceive the importance of religious and spiritual needs. Hospice programs might consider implementing a structural mechanism to assist nurses in the task of understanding these patient and family concerns. Encouraging nurses to routinely inquire about the need for assistance with these issues is one potential remedy. Specific in-service training to teach nurses how to cue in on material and religious needs may also be beneficial. Another approach would be to further integrate staff persons who have specific training in understanding these types of needs into hospice programs. Attorneys, financial consultants, and clergy may need direct contact with patients and families rather than being called into a specific case only after nurses identify the need. Another implication of these results stems from the finding that nurses' perceptions become more similar to caregivers over time. This is particularly true for the assessment of patients' needs. Previous research shows that a substantial proportion of patients do not enter hospice until a few days prior to their deaths.(ABSTRACT TRUNCATED AT 250 WORDS)