Falls Among Nursing Home Residents An Examination of Incident Resports Before and After Restraint Reduction Programs Objective: To examine changes in the rate of falling of an experimental group of restrained subjects who underwent restraint reduction, and to compare their rate of falling with a group of subjects who did not have restraint orders during the study period. Design: A quasi‐experimental, multiple time‐series study utilizing the principles of single‐subject design. Each subject was followed for 25 weeks before and 25 weeks after initiation of the intervention. Setting: Seven nursing homes. Intervention: Formal programs aimed at reducing all bed and chair restraints were initiated in all sites after staff received education and training. Multidisciplinary teams implemented the restraint reduction process on a case‐by‐case basis, beginning with 1 unit/floor at a time in each site. Most experimental subjects reached their optimum restraint‐elimination/reduced status within 2 weeks of intervention initiation. The implementation periods ranged from 4 months to more than a year. Participants: Subjects with chart orders for restraints at the start of the study comprised the experimental group and participated in the restraint reduction program (184 subjects). Subjects with no orders for restraints during the study period comprised the nonequivalent control group (111 subjects) and, therefore, did not undergo the intervention. Measurements: Incident reports documenting all falls during the study period were examined. Falls, the dependent variable, were classified as serious or nonserious. The independent variable (intervention) was the restraint reduction program offered to experimental subjects. Based on the principles of single subject design, the impact of the intervention on falls was calculated before and after the date the restraint reduction process was initiated for an individual (experimental group) subject. For the control group, the pre‐ and posttest period was calculated from the start date of the restraint reduction program on the unit on which each subject resided. Results: Serious falls did not increase, but nonserious falls increased significantly after restraints were removed or reduced in experimental subjects. The total mean weekly fall rate for this group increased from 1.87% of residents falling per week during preintervention to 3.01% during postintervention. The mean weekly fall rate of the control group was 3.18% at pretest and did not change statistically over time. Read more
Differences in Service Attitudes and Experiences Among Families Using Three Types of Support Services 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. Read more
Analysis of Clustered Data in Community Psychology With an Example From a Worksite Smoking Cessation Project Although it is common in community psychology research to have data at both the community, or cluster, and individual level, the analysis of such clustered data often presents difficulties for many researchers. Since the individuals within the cluster cannot be assumed to be independent, the use of many traditional statistical techniques that assumes independence of observations is problematic. Further, there is often interest in assessing the degree of dependence in the data resulting from the clustering of individuals within communities. In this paper, a random-effects regression model is described for analysis of clustered data. Unlike ordinary regression analysis of clustered data, random-effects regression models do not assume that each observation is independent, but do assume data within clusters are dependent to some degree. The degree of this dependency is estimated along with estimates of the usual model parameters, thus adjusting these effects for the dependency resulting from the clustering of the data. Models are described for both continuous and dichotomous outcome variables, and available statistical software for these models is discussed. An analysis of a data set where individuals are clustered within firms is used to illustrate features of random-effects regression analysis, relative to both individual-level analyses which ignores the clustering of the data, and cluster-level analysis which aggregates the individual data. Read more
The Maturation of a Multiagency Computerization Effort for Alzheimer’s Respite Services This paper reports on a two-year project which developed a computerized multiagency database of respite service users. The project’s primary aim was to make seven non-profit respite programs technologically self-sufficient in terms of clinical information. The outcomes of computerization for these agencies are discusses, as well as modifications during the post-project period. Read more
Predictors of the Use of Respite Services by Caregivers of Alzheimer’s Patients Racial and Generational Differences This research applies one prominent model of service utilization (the Andersen Newman Model) to better understand the way in which family care givers utilize respite services when caring for older relatives. Specifically, this research examines racial (black and white) and generational (spouse and adult-child) differences between caregivers of Alzheimer's patients and the volume and type of respite services used. The sample (N= 359) is drawn from six Northeast Ohio programs in a consortium that uses a personal computer-based information system to collect intake, assessment, service use, and program satisfaction data from respite clients. Racial differences are found in client attrition and turnover. Results also show adult-child caregivers are the greatest users of day care. These generational differences persist despite the similarities in patient and caregiver need. Fee subsidy and relationship strain between the caregiver and elder predict the amount of service used. Findings suggest that practitioners need to take into account racial and generational factors in addition to traditional patient and caregiver needs when formulating care plans. Read more
Predictors of In-Home and Out-Of-Home Service Use By Family Caregivers of Alzheimer’s Disease Patients 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. Read more
Respite Use and Caregiver Well-Being in Families Caring for Stable and Declining AD Patients The current controversy about respite's value centers on consistent reports of no significant reduction in caregiver strain with respite service use. In this study one explanation for the inability of prior research to document respite's impact is offered. This research demonstrates that respite may well reduce depression, reported health problems and family relationship strain in families caring for stable AD patients and may stabilize caregiver strain in families of declining AD patients. Read more
Predicting the Volume of Health and Social Services Integrating Cognitive Impairment into the Modified Andersen Framework This investigation examined cognitive impairment as a predictor of the volume of community services used by older adults. Predictors of service volume were selected according to the modified Andersen framework and tested with 97 health care and 246 social service clients of a large multiservice agency. Results for health care clients showed that the effects of four predictors differ depending on clients’ level of cognitive impairment: living arrangement, presence of secondary caregivers, client depression, and task burden of the primary caregiver. No differences in predictors of social service use were observed for cognitively impaired and lucid clients. Read more
The Influence of Caregiving and Bereavement Support on Adjusting to an Older Relative’s Death This study examines the influence of both caregiving social support to an impaired older relative and bereavement social support to a surviving caregiver on that caregiver's bereavement adjustment. Although past research has considered the link between bereavement support and adjustment to a loved one's death, the influence of support to the care recipient has not been investigated. Analyses of prospective panel data from 73 spouse and adult-child caregivers show caregiving support characteristics to be more important for bereavement adjustment than support provided to the surviving caregiver after their relative's death. Read more
Using Information System Technology to Coordinate Specialized Services for the Elderly In mid-1988 six of Cuyahoga County’s non-profit providers of respite service to caregivers of persons with Alzheimer’s disease began a project (SISTERS: Shared Information System Technology to Evaluate Respite Services) to develop an interagency database. This grew out of an existing PC-based information system at The Benjamin Rose Institute that was designed to improve the operation of its specialized respite program and facilitate its monitoring. The SISTERS project’s aims include: improving the design and delivery of community respite services using information system technology; improving the effectiveness of each participating program through standardized forms and documentation via a PC-based system to track clients, monitor service delivery, and provide for quality assurance; and disseminating the design and technology of this system as a model for coordinating and evaluating respite programs. Read more
