A model intervention for elder abuse and dementia This article describes a 2-year collaborative project in Cleveland, OH, that improved the reporting and management of potential and suspected elder abuse situations involving persons with dementia. Educational curricula for cross-training, screening tools, and referral protocols were developed and tested for staff and volunteers in adult protective services and dementia care. A handbook for caregivers of persons with dementia was produced that enables caregivers to self-identify elder abuse risk and seek appropriate interventions to prevent abuse. Project organization, implementation, and evaluation are discussed along with strategies for replication in other communities. Read more
Sustained Personal Autonomy A Measure of Successful Aging Objectives: This study addresses the following question: What characteristics of urban, noninstitutionalized elders predict which individuals are most likely to remain independent of personal assistance during a 2-year observation period? Methods: A population-based sample of 602 noninstitutionalized urban residents aged 70 and older was followed for 2 years. Results: Ninety-eight of the 487 survivors remained independent. Factors associated with sustained independence were relatively younger age, male gender, fewer medical conditions, good physical function, and nonsmoking. The attitudes “favors family or self over agency assistance” and “does not expect filial obligation” were also independently associated. Discussion: The results are consistent with previous studies of successful aging and show that attitudes expressed at baseline favoring personal independence are associated with sustained autonomy during a period of at least 2 years. Read more
The Influence of Religious and Personal Values on Nursing Home Residents’ Attitudes Toward Life-Sustaining Treatments A cross-sectional survey design was used to interview 133 Jewish, Catholic and Protestant residents from 13 nursing homes to examine the influence of religious and personal values on attitudes toward life-sustaining treatments. Subjects on average were 83 years old, Caucasian and female, with more than half having Advance Directives (ADs). Jewish subjects, as well as those who relied on God, were better educated and more anxious about death, had significantly more positive attitudes toward life-sustaining treatments at the end-of-life. On the other hand, those who had implemented ADs desired fewer life-sustaining treatments. Finding demonstrate that understanding individual desires for life-sustaining treatments is complex. Practitioners who provide education on end-of-life decisions need to discuss a myriad of issues including individual religious and personal values and other characteristics in an effort to understand and respect treatment choices. Read more
The Influence of Formal and Informal Helpers on Primary Caregivers’ Perceptions of Quality of Care 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. Read more
Predictors of Institutionalization for Persons with Alzheimer’s Disease and the Impact on Family Caregivers This study examines the factors which differentiate family caregivers who placed (n = 284) versus continued to provide in-home care (n = 642) to relatives with dementia over a 2-year period. Caregiver variables (i.e., income, kin relations, depression, burden, physical health, and social support) and care receiver variables (i.e., level of functional impairment and age) were entered into a logistic regression analysis predicting subsequent placement versus continuing care at home. Results indicate that compared to continuing care subjects, caregivers most likely to place their family member were more depressed, caring for impaired relatives with more problem behaviors (e.g., wandering, inappropriate behavior) and receiving respite assistance. After placement, caregivers were found to be more burdened and to have declined slightly in their levels of subjective physical health. Findings suggest that interventions for family caregivers before and after placement may be beneficial in alleviating the negative effects of this stressful transition. Read more
Effect of Giving Care on Caregivers’ Health This longitudinal study of 121 caregivers of the elderly evaluates the change in their self-assessed mental and physical health over two years. The care recipients, who were drawn from a random sample of noninstitutionalized urban elders, showed increased need for help with personal and instrumental activities of daily living in this period. Both the physical and mental health of the caregivers declined significantly during the study. Predictors of decline in physical health of the caregivers at the end of the study were poorer physical health at the start, the amount of help they provided, a decline in their own mental health, and an increase in the number of other persons also available to provide care. In contrast, decline in caregivers’ mental health at the end was predicted only by poorer mental health at the start and by decline in physical health. Read more
Screening Tools and Referral Protocol for Stopping Abuse Against Older Ohioans A Guide for Service Providers Screening Tools and Referral Protocol for Stopping Abuse Against Older Ohioans: A Guide for Service Providers (STRP) represents the product of an 18 month project aimed at improving the identification and reporting of elder abuse and domestic violence in late life. This article presents each component of STRP, describing it in detail and suggesting when and how it can be used. Recommendations also are offered for the replication of STRP in other locales as well as for its further evaluation. (Full set of materials including Appendices can be obtained from The Benjamin Rose Institute.) Read more
Cognitive Assessments in Late-Stage Dementia The purpose of this chapter is not to provide an extensive overview of all or most of the instruments used to assess cognitive function in late-stage dementia. Such compilations already exist, and their authors have done an excellent job of summarizing assessment instruments currently in use (e.g., Auer, Sclan, Yaffee, & Reisberg, 1994; Bellelli, Frisoni, Bianchetti, & Trabucchi, 1997; Morris, 1997; Doody, Strehlow, Massman, Feher, Clark, & Roy, 1999; Perlick & Mattis, 1994; Reisberg, Sclan, Franssen, Kluger, & Ferris, 1994, 1996; Weiner et al., 1996). Our review of some of the instruments used for assessing cognition in late-stage dementia is done within a different context. The focus of this chapter is to encourage the development of new instruments designed to assist in the development and assessment of new interventions for this population. Therefore, we discuss not only the information that current instruments provide but also what they do not provide. We attempt to elaborate a framework or set of boundary conditions for a new generation of cognitive assessment measures and discuss the uses of such measures. It is our hope that readers of this chapter will be encouraged to view cognitive assessment in late-stage dementia as an integral part or an overall program for designing interventions (Weaverdyck, 1990, 1991a, 1991b). To illustrate these points, we offer examples of some initial efforts in this area. Read more
