Search

This study investigated the musculoskeletal consequences of travel aids, particularly white canes and guide dogs, as perceived by 21 individuals (ages 27-68) with visual impairments or blindness. They experienced a variety of negative physical effects that they denied, ignored, or minimized because of benefits derived from being independently mobile. (Author/CR)

PARTICIPANTS: M. Corcoran (George Washington University, Washington, DC), K. Love (Consumer Coalition of Assisted Living, Falls Church, VA). The Easy Approach: 'A Staff-Developed Program to Enhance Quality Care for Residents with Dementia'. C. Camp. M. Malone (Myers Research Institute, Beachwood, OH). Montessori-Based Activities Programming for Dementia: Models for Dissemination Into Long-Term Care Settings. A. Stevens. E. Roberts, R, Johns (University of Alabama, Birmingham, Birmingham, AL). Preliminary Findings From the Start Project (Studying Therapeutic Activities and Recreation as Therapy). A. Ragan. A. Stevens (University of Alabama, Birmingham, Birmingham, AL). Augmentation of the Cornell Scale for Depression in Dementia for Administration by Outreach Personnel. Activity-based interventions provide positive, engaging experiences in recreational and routine activities for individuals with dementia. Positive engagement in activities s hypothesized to reduce problem behaviors and excess disability in activities of daily living, resulting in fewer negative consequences for the caregiver and improved quality of life for the person with dementia. Successful activity-based interventions result in supportive environments and caregivers who are able to adapt life-long activities into achievable tasks for the person with dementia. Documenting outcomes resulting from these interventions requires assessment tools that are sensitive to indicators of the overall quality of life for individuals with dementia. Within this symposium, three unique activity-based interventions will be described. Target populations include both community dwelling individuals with dementia and their family caregivers as well as nursing home residents and staff. Strategies aimed at accurate and consistent implementation of intervention techniques, including training protocols, and outcome data will be included. Special emphasis will be placed on the assessment of depressive symptoms as an indicator of quality life within and activity-based intervention.

Caregiving style is defined by the authors as thinking and action processes that guide care decisions and behaviors of spouses who provide dementia care. As presented at GSA in 2001, fundamental elements of all caregiving styles include beliefs (what is true), meanings (the significance of care), and actions (how care is provided) (NIA-R29 AG13019). The purpose of this follow-up presentation is to provide an in-depth examination of the actions of caregiving style. A description of caregiving actions can contribute to developing effective intervention services and care policies. Based on thematic analysis of interviews and observations (350 hours) with 70 spouse caregivers, caregiver actions can be categorized as: a) taking full responsibility, b) preserving identities, c) being a lay practitioner, d) managing discrepancies, e) striving to communicate, f) setting the emotional tone, and g) maintaining control. Caregiver gender and well-being appear to be associated with use of selected action categories.

Although fear of falling is an important psychological syndrome, little is known about its predictors. This study examined the relationship of fear of falling (modified Tinetti's Falls Efficacy Scale) and respondent characteristics (demographic profile, number of falls within six months, perceived ability to manage fall risks and control falling, physical function and depressive symptomatology) among 163 community-living elders. Participants were primarily female (83%), lived alone (67%), white (53%) and were 79.6 years of age. As predicted, multiple regression analysis revealed that fear of falling was associated with lower physical function, lower perceived ability to manage fall risks and control falling, and greater depressive symptomatology (CES-D). However, number of recent falls, gender, race, age and living arrangement were not significantly associated. Findings show that difficulty with everyday tasks and psychological well-being contribute to fear more so than an actual falls event. (Funded by NIA AG13687)

Background:Behavioral and psychological symptoms of dementia (BPSD) are often considered to be the greatest challenge in dementia care, leading to increased healthcare costs, caregiver burden, and placement into care facilities. With potential for pharmacological intervention to exacerbate behaviors or even lead to mortality, the development and rigorous testing of non-pharmacological interventions is vital. A pilot of the Tailored Activities Program (TAP) for reducing problem behaviors in people with dementia was conducted in the United States with promising results. This randomized trial will investigate the effectiveness of TAP for reducing the burden of BPSD on persons with dementia and family caregivers within an Australian population. This trial will also examine the cost-effectiveness and willingness to pay for TAP compared with a control group.Methods:This randomized trial aims to recruit 180 participant dyads of a person with dementia and their caregivers. Participants will have a diagnosis of dementia, exhibit behaviors as scored by the Neuropsychiatric Inventory, and the caregiver must have at least 7 h per week contact. Participants will be randomly allocated to intervention (TAP) or control (phone-based education sessions) groups, both provided by a trained occupational therapist. Primary outcome measure will be the revised Neuropsychiatric Inventory – Clinician rating scale (NPI-C) to measure BPSD exhibited by the person with dementia.Conclusions:This trial investigates the effectiveness and cost-effectiveness of TAP within an Australian population. Results will address a significant gap in the current Australian community-support base for people living with dementia and their caregivers. [ABSTRACT FROM PUBLISHER]

Although there has been considerable interest in racial differences in family caregiving for persons with dementia, most research to date has either ignored racial diversity or based conclusions on small numbers of caregivers drawn primarily from single site studies. The current study utilized participants from four sites of the REACH (Resources for Enhancing Alzheimer's Caregiver Health) multi-site study to compare well-being, appraisal, and religious coping by race. African-American ( n = 295) and Caucasian ( n = 425) dementia caregivers from four cities (Birmingham, Memphis, Boston, and Philadelphia) were compared in their demographics, care recipient characteristics, mental and physical health, and psychosocial coping resources including appraisal and religious coping. African-American caregivers reported lower anxiety, better well-being, less use of psychotropic medications, more benign appraisals of stress and perceived benefits of caregiving, and greater religious coping and participation, than Caucasian caregivers. Self-rated health did not differ by race, but African-American caregivers reported more unhealthy behaviors than Caucasian caregivers. Some results were specific to site, possibly due to differences in recruitment strategies, inclusion/exclusion criteria, and regional differences. Adjustment for covariates, including caregiver relationship to the care recipient, gender, age, socioeconomic status, and care recipient behavioral problems, altered few of these differences. Results are discussed in terms of their relevance to psychosocial intervention programs for ethnically diverse caregivers. [ABSTRACT FROM AUTHOR]

A study was designed to investigate the feasibility of computer-based communication to monitor self-care needs of older persons with disabilities. As a preliminary measure, tracking software was used to observe patterns of computer and Internet use. This case study report of 5 physically frail elders found that study participants primarily used e-mail, accessed health related Internet sites, and played computer games. These individuals reported that having access to this technology allowed them to feel less isolated from their family, better informed about health issues, and more socially connected. The findings also suggest patterns of use that could assist in implementing computer based communication programs for older persons with disabilities. [ABSTRACT FROM AUTHOR]

Abstract Background Decreased functional ability is common in older adults after hospitalisation. Lower levels of functional ability increase the risk of hospital readmission and nursing care facility admission. Discharge planning across the hospital and community interface is suggested to increase functional ability and decrease hospital length of stay and hospital readmission. However evidence is limited and the benefits of occupational therapists providing this service has not been investigated. This randomised trial will investigate the clinical effectiveness of a discharge planning program in reducing functional difficulties of older adults post-discharge. This trial will also examine the cost of the intervention and cost effectiveness when compared to in-hospital discharge planning. Methods/design 400 participants admitted to participating hospitals will be recruited. Participants will be 70 years of age and over, have no significant cognitive impairment and be independently mobile at discharge. This study protocol was approved by the ethics committee of Ryde Rehabilitation Human Research Ethics Committee, Western Sydney Local Health District (Westmead Campus) Human Research Ethics Committee, Alfred Health Human Research ethics committee for the randomised trial and NSW Population and Health Service Human Research Ethics Committee for data linkage. Participants will provide informed written consent. Participants will be randomly allocated to the intervention or control group. The intervention group will receive discharge planning therapies primarily within their home environment while the control group will receive an in-hospital consultation, both provided by trained occupational therapists. Primary outcome measures will be the Nottingham Extended Activities of Daily Living Scale (NEADL) and the Late Life Disability Index (LLDI) which will measure functional independence, and participation and limitation in daily life activities. Discussion This trial will investigate the effectiveness and cost effectiveness of occupational therapy discharge planning in reducing functional difficulties. Results will have a direct impact on healthcare practice and policy. Trial registration ACTRN12611000615987.

Abstract Background Primary care is the principle setting for depression treatment; yet many older African Americans in the United States fail to report depressive symptoms or receive the recommended standard of care. Older African Americans are at high risk for depression due to elevated rates of chronic illness, disability and socioeconomic distress. There is an urgent need to develop and test new depression treatments that resonate with minority populations that are hard-to-reach and underserved and to evaluate their cost and cost-effectiveness. Methods/Design Beat the Blues (BTB) is a single-blind parallel randomized trial to assess efficacy of a non-pharmacological intervention to reduce depressive symptoms and improve quality of life in 208 African Americans 55+ years old. It involves a collaboration with a senior center whose care management staff screen for depressive symptoms (telephone or in-person) using the Patient Health Questionnaire (PHQ-9). Individuals screened positive (PHQ-9 ≥ 5) on two separate occasions over 2 weeks are referred to local mental health resources and BTB. Interested and eligible participants who consent receive a baseline home interview and then are randomly assigned to receive BTB immediately or 4 months later (wait-list control). All participants are interviewed at 4 (main study endpoint) and 8 months at home by assessors masked to study assignment. Licensed senior center social workers trained in BTB meet with participants at home for up to 10 sessions over 4 months to assess care needs, make referrals/linkages, provide depression education, instruct in stress reduction techniques, and use behavioral activation to identify goals and steps to achieve them. Key outcomes include reduced depressive symptoms (primary), reduced anxiety and functional disability, improved quality of life, and enhanced depression knowledge and behavioral activation (secondary). Fidelity is enhanced through procedure manuals and staff training and monitored by face-to-face supervision and review of taped sessions. Cost and cost effectiveness is being evaluated. Discussion BTB is designed to bridge gaps in mental health service access and treatments for older African Americans. Treatment components are tailored to specific care needs, depression knowledge, preference for stress reduction techniques, and personal activity goals. Total costs are $584.64/4 months; or $146.16 per participant/per month. Trial Registration ClinicalTrials.gov #NCT00511680

We examined differences in positive aspects of caregiving (PAC) among 275 African American and 343 Caucasian caregivers of individuals with Alzheimer's disease from the National Institutes of Health Resources for Enhancing Alzheimer's Care Health (REACH) study sites in Birmingham, Memphis, and Philadelphia. African Americans reported higher scores on PAC than did Caucasians. African Americans' higher religiosity partially mediated the relationship between race and PAC. Additional variables that contributed to their higher PAC scores were African Americans' lower anxiety, lower feelings of bother by the care recipient's behavior, and lower socioeconomic status. [ABSTRACT FROM AUTHOR]