Distinctive effects between cognitive stimulation and reminiscence therapy on cognitive function and quality of life for different types of behavioural problems in dementia.

BACKGROUND: Among the various complementary therapies for patients with dementia (PwD), cognitive stimulation therapy (CST) and reminiscence therapy (RT) are frequently used to improve cognitive function and quality of life. However, no studies have examined the use of complementary therapies applied to different types of behavioural and psychological symptoms of dementia in PwD. AIMS: The purpose of this study was to investigate the distinctive effects of CST and RT on cognitive function and quality of life for PwD with three types of behavioural problems - the dispute, return and dissociate types. METHODS: A quasi-experimental design was employed. A total of PwD residing in 10 long-term care institutions participated in the study and were divided into three groups. The CST and RT groups received 50-minute sessions of intervention therapy once a week for 10 continuous weeks, and the control group participated in regular activities. The pretest (week 1), post-test (week 12) and follow-up (week 24) data were collected using the Mini-Mental State Examination and Quality of Life-Alzheimer's Disease. Two-way analysis of variance was used for data analysis. RESULTS: The results of our study revealed CST and RT interventions had positive effects on cognition and quality of life of PwD. For short-term effects on cognitive function, CST was the most positive intervention for the dispute type. With regard to short-term effects on quality of life, CST was greater than RT for PwD. For follow-up effects, CST and RT may have potentially sustained effects. CONCLUSION: This study suggests that CST and RT could be applied to improve the cognitive function and quality of life for PwD, as well as contribute to the effectiveness of nonpharmacological approaches to PwD with certain types of behavioural problems.

Delusions and underlying needs in older adults with Alzheimer's disease: influence of earlier life experiences and the current environment.

Delusions are one of the most severe psychiatric symptoms of individuals with Alzheimer's disease (AD), which often increase the stress experienced by caregivers. The purpose of this study was to understand the influences of earlier life experiences and the current environment on delusions, as well as the underlying needs of older adults with AD who experience delusions. Using an exploratory research design with a qualitative approach and purposive sampling, 20 family caregivers were interviewed. Two psychosocial types of attributes of delusion were categorized: Type A, the influence of earlier life experiences; and Type B, current environmental influences. The underlying needs of those with delusions include physical comfort, a desire to be secure, and a sense of belonging. The contents of delusions are easily influenced by patients' earlier negative experiences and responsibilities, whereas the current environment exerts a crucial influence on the occurrence, frequency, and severity of specific delusions. These results can facilitate planning for patient-centered care by enhancing health care providers' understanding of the psychosocial and environmental attributes and needs behind delusions.

Experience of cognitively intact residents cohabitating with residents with dementia in long-term care facilities.

A qualitative research approach was used to explore the life experience of cognitively intact (CI) residents cohabitating with residents with dementia in mixed placement facilities. Purposive sampling was used to recruit 21 CI residents from 6 long-term care facilities in southern Taiwan. Using a semi-structured interview guide, data were analyzed by content analysis. Two themes emerged: emotional diversity and coping. Emotional diversity described the wide range of responses, both positive and negative, expressed by the participants. Coping referred to the CI residents' ability to adapt to behaviors exhibited by the residents with dementia and the environment. Results of this study provide nurses and other health care providers with an understanding of the life experience of CI residents who live among residents with dementia. An understanding can lead to improved quality of life and positive social interactions among CI residents and those with dementia.

Characteristics and underlying meaning of hoarding behavior in elders with Alzheimer's dementia: caregivers' perspective.

BACKGROUND: Dementia and its associated problem behaviors remain bothersome to family and professional caregivers. Exploring characteristics and the underlying meaning of disruptive behaviors in elders with Alzheimer's dementia can be a first step to pursuing patient-centered care. Although hoarding is relatively harmless, unattended excessive hoarding can create health and safety issues for both patients and caregivers. PURPOSE: This study examined the characteristics and underlying meaning of hoarding behavior among Taiwanese elders with Alzheimer's dementia from the perspective of family caregivers. METHODS: We used an exploratory research design and purposive sampling. A total of 12 family caregivers of elders with Alzheimer's dementia received qualitative interview. We used one-on-one in-depth interviews to collect data and content analysis to analyze data. RESULTS: Three main characteristics related to hoarding behavior emerged from the data were "influence of former and current symptoms," "recurrence of the original personal characteristics and habits," and "re-experiencing past economic crises." These three characteristics reflected patients' past social and family background and the current life situation. We elicited "a desire for security" as the underlying meaning of hoarding behavior. CONCLUSION: Findings of this study provide a reference for family and professional care providers to understand dementia-related problem behaviors. Improved caregiver understanding of dementia patient behaviors may help improve caregiver-patient interaction and communication and help caregivers better meet patient needs.

[Dementia patients: effective communication strategies].

The importance of effective communication with dementia sufferers has grown with the increasing prevalence of this degenerative condition. Regardless of the presence of aphasia, the vocal tones and behaviors of dementia patients are meaningful, and may signal unmet needs. If caregivers ignore or fail to respond to these messages, more irritable or aggressive behaviors may result. Therefore, it is critical for caregivers to learn and apply appropriate communication strategies and skills with dementia patients. Based on a review of the literature, this paper provides guidelines for assessing dementia patients' residual communication ability and suggests strategies and skills for communicating with dementia patients. Evidence based guidelines are important for caregivers when communicating with dementia patients in order to achieve positive outcomes and high care quality.

Assessing cross-cultural equivalence through confirmatory factor analysis.

This article presents a study in which Picot's caregiver rewards scale (PCRS), originally developed in English, was cross-culturally validated with 137 Chinese adult children family caregivers in the United States using confirmatory factor analysis. A one-factor structure of the 21-item revised Chinese PCRS was supported as indicated by goodness-of-fit index = .94, adjusted goodness-of-fit index = .93, standardized root mean square residual = .09, and chi-square to df ratio = 2.7. Chi-square for this model was (chi(2) [189, n = 137] = 514, p < .05). The standardized alpha was .90. All factor loadings were significant (p < .00) and above .30. Construct validity was supported by significant associations with caregivers' filial beliefs (r = .32, p < .01) and caregivers' filial affection toward parents (r = .23, p < .05). Results suggest that the Chinese PCRS is a summative measure of perceived caregiver rewards with potential for evaluating interventions to reduce perceived burden among adult children family caregivers.