Activity Preferences of Persons With Dementia Older adults prefer to engage in a variety of leisure and recreational activities. These activities vary in type depending on the older adult’s level of physical and mental ability. There is little empirical evidence documenting the preferred activities of older adults with dementia. The present study examines the self-reported activity preferences of 216 persons with dementia and the relationship of these activities to demographic characteristics and well-being outcomes. Results demonstrate hypothesized demographic differences and reinforce the importance of engaging persons with dementia in activities that they find meaningful. Read more
Understanding Discrepancy in Perceptions of Values Individuals With Mild to Moderate Dementia and Their Family Caregivers Purpose of the Study: We explore discrepancies in perceptions of values and care preferences between individuals with dementia (IWDs) and their family caregivers. Design and Methods: We interviewed 266 dyads consisting of an individual with mild to moderate dementia and his or her family caregiver to determine IWDs’ beliefs for 5 values related to care (autonomy, burden, control, family, and safety). We used multilevel modeling to investigate if there are dyadic level discrepancies in beliefs and what factors are associated with such discrepancies. Results: Caregivers consistently underestimated the IWD’s values for all five values. Discrepancies were associated primarily with caregivers’ beliefs about the IWD’s involvement in decision making. Race was also associated with the discrepancies for control and safety, whereas cognitive functioning of the IWD was associated with the discrepancy for burden. Implications: Many caregivers do not have an accurate depiction of the IWD’s values, yet, caregivers will become the surrogate decision makers for IWDs as dementia progresses. These findings indicate the need for assessments of values and preferences in care and to develop programs that assess values, consider the caregiver’s beliefs about care, and improve communication within the dyad in the early stages of dementia. Read more
Partners in Dementia Care A Care Coordination Intervention for Individuals with Dementia and their Family Caregivers Purpose: This article provides a detailed description of a telephone-based care coordination intervention, Partners in Dementia Care (PDC), for veterans with dementia and their family caregivers. Essential features of PDC included (a) formal partnerships between Veterans Affairs (VA) medical centers and Alzheimer’s Association Chapters; (b) a multidimensional assessment and treatment approach, (c) ongoing monitoring and long-term relationships with families, and (d) a computerized information system to guide service delivery and fidelity monitoring. Read more
Knowledge of Documented Dementia Diagnosis and Treatment in Veterans and Their Caregivers Design and Methods: Data illustrating the use of the intervention were displayed for 93 veterans and their caregivers after 12 months in PDC. Descriptive data were provided for each major component of the intervention protocol, including: initial assessment, goals, action steps, and on-going monitoring. Care coordinators completed a 12-item questionnaire ascertaining the acceptability and feasibility of implementing PDC. Read more
Existential Loss as a Determinant to Well-Being in the Dementia Caregiving Dyad A Conceptual Model The following describes a conceptual model for dementia caregiving. The interdisciplinary model proposes that a caregiver’s confrontation with existential loss plays a determining role in the wellbeing of the dementia care dyad. The paper describes how existential threats can affect a caregiver’s appraisal of the care situation, and thus how a caregiver copes. Still further, it is speculated that caregiver coping (as manifested primarily through avoidance or acceptance of loss) will influence behavioral interaction within the caregiving dyad, where communication and decision making between caregiver and the person with dementia is predominantly inequitable (e.g., authoritarian) or equitable (e.g., negotiated). Lastly, it is proposed that the type of dyadic behavior is an antecedent to dyadic well-being. In terms of intervention, as the model is centered on the intrapsychic threat posed by loss, particular emphasis is on both individual and social factors that negatively influence a caregiver’s ability to integrate the emotional costs related to dementia and its care. Read more
Irritability and Social Isolation in Dementia Patients With and Without Depression Results: Data from the assessments and goals indicated areas of need were not limited to any one issue or subset of issues, but were widely distributed across a variety of domains. Findings for action steps suggested a primary focus on getting/giving information and action-oriented tasks to access services Read more
Building Resilience Mild Cognitive Impairment and Early-Stage Dementia Innovative Approaches to Intervention and Outcome Evaluation Read more
Racism Reported By Direct Care Workers in Long-Term Care Settings This article focuses on reports of racism experienced by direct care workers (DCWs). These DCWs provide the majority of hands-on care to older residents/ clients that need help with activities of daily living such as bathing and dressing in long-term care (LTC) settings. Interviews were conducted with 644 DCWs working in three types of LTC settings. Proportionate random sampling techniques were used to select 49 LTC agencies from a five-county area in northeast Ohio. The DCWs included nurse assistants in nursing homes, resident assistants in assisted living facilities, and home care aides in home health agencies. Analyses reported include frequencies, chi-square tests, and analysis of variance. Hearing racial and ethnic remarks, particularly from residents/clients, was widely reported by DCWs. Despite this, DCWs were likely to believe that remarks from residents/clients were not intended to hurt their feelings. Although DCWs heard fewer racial/ethnic remarks from family members or other staff, they were likely to believe that such remarks were intended to hurt their feelings. At the organizational level, DCW reports of hearing racial/ethnic remarks in nursing homes were more frequent than those in other LTC settings. Further, DCWs in organizations in which racial differences between them and the residents/clients that they served was very large reported hearing significantly more racial/ethnic remarks. These findings have important implications for addressing racism in LTC agencies with anti-discrimination policies and programs. Read more
Applying a Strength-Based Intervetion 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. Read more
