The role of acculturation in health status and utilization of health services among the iranian elderly in metropolitan Sydney.

The present study explores the impact of acculturation on health status and use of health and community aged care services among elderly Iranian-born immigrants to Australia. Three hundred two Iranian immigrants aged 65 years and over who had lived in the Sydney Metropolitan area for at least six months participated. Data were collected using a written survey instrument, face-to-face interviews, and telephone interviews. Iranian immigrants had higher levels of psychological distress, more limited physical function, greater need for help or assistance with activities of daily living, lower feelings of wellbeing, and were much less likely to use aged care services than the general population of older Australians. Participants who did not speak English at home were more likely to experience psychological distress and had greater limitations in their physical functioning. Elderly Iranians with better English proficiency had lower levels of anxiety and depressive symptoms and reported less need for help and supervision in activities of daily living; they were also more likely to access health care services. Elderly Iranian immigrants experience higher levels of psychological distress and lower levels of physical function than the general population of older Australians; those with limited proficiency in English are at greatest risk. These findings contribute to the enrichment of multicultural policy, social fairness, access, and equity for ethnic aged people.

Pre- and postoccupancy evaluation of new dementia care cottages.

Concerns about negative outcomes associated with relocating residents are common. Fifty-five residents of a traditional high-care nursing home moved to new, purpose-built, dementia-specific cottages; 35 additional residents moved into the cottages within the first 8 months of operation. Direct-care staff participated in workshops on engaging residents in life-skill activities. Resident behavior was observed using a time sampling and a de-identified behavior mapping procedure. Results showed increases in resident engagement following the move and further increases after staff training. Staff engagement in resident interactive tasks similarly increased both after the move and again after staff training. The newly built cottages scored higher across all domains of 3 different types of environmental assessment, and family satisfaction ratings also improved. These results suggest that relocation need not negatively affect residents with dementia and that this environment provides an attractive model of care for dementia facilities.

Participation of older adults in cyberspace: how Australian older adults use the Internet.

AIM: The present study explores how Australian older adults use the Internet. METHOD: Older adults were recruited online to complete an online survey. RESULTS: Participants primarily used the Internet for interpersonal communication, followed by information seeking, commerce and entertainment. CONCLUSION: The Internet is an important technology in helping older adults lead independent and social lives.

Internet use as a predictor of sense of community in older people.

The Internet opens new options for communication and may change the extent to which older people use other modes of communication. The importance of older adults' participation in cyberspace has increased as Internet use for commerce and communication has increased. The present study explores how older adults' Internet use affects their sense of community. An online survey was conducted at the University of Sydney to determine the associations between Internet use and seniors' sense of community and well-being. Participants were recruited online. There was a positive association between a sense of belonging to an online community, sense of community, and well-being. Seniors' use of the Internet for communication and information, and the frequency and history of their Internet use, were consistently related to a greater sense of community.

Internet use and loneliness in older adults.

Use of the Internet by seniors as a communication technology may lead to changes in older adult social relationships. This study used an online questionnaire to survey 222 Australians over 55 years of age on Internet use. Respondents primarily used the Internet for communication, seeking information, and commercial purposes. The results showed negative correlations between loneliness and well-being. Multiple regression analyses revealed that greater use of the Internet as a communication tool was associated with a lower level of social loneliness. In contrast, greater use of the Internet to find new people was associated with a higher level of emotional loneliness.

Staff-administered functional analysis and treatment of aggression by an elder with dementia.

In the current study, nursing home staff were taught to administer functional analyses to determine the variables maintaining aggression by an elder with dementia. The results indicated that aggression was evoked during bathroom routines and that escape maintained aggression. Staff then reduced aggression to near-zero levels with noncontingent escape. Implications for the assessment and treatment of problem behaviors in nursing home settings are discussed.

Assessment of active music participation as an indication of subsequent music making engagement for persons with midstage dementia.

Persons with midstage dementia and in special care (N = 45) were assessed in groups by a music therapy practitioner to determine the level of engagement in a 15-minute protocol that included a five-minute segment for each of three music activity types--rhythm playing, exercising with music, and singing. Activity staff with little to no formal music training who were employed by the facility were taught to use the protocol to conduct eight subsequent activity sessions for small groups from which activity engagement data were collected for each subject. Results indicated the protocol was accessible and successful for indigenous activity staff, initial assessments were strong predictors of subsequent engagement, and participation levels were stable over time and across each of the three activities.

Facilitating resident information seeking regarding meals in a special care unit: an environmental design intervention.

Repetitive questions and requests for information are common in older adults with dementia. The purpose of this environmental design intervention was to provide residents continuous access to information about common mealtime questions with the intent of decreasing agitation around mealtimes and facilitating more pleasant patient-staff and patient-patient interactions. A special care unit for residents with dementia of the Alzheimer's type was the setting. During the intervention conditions, a large clock and a sign with large lettering that identified mealtimes were hung in the dining area. Direct observations of 35 residents were conducted at mealtimes for a 5-month period. Results showed reductions from baseline to the intervention phase in food-related questions or requests. These results suggest a simple, inexpensive environmental change intervention can reduce repetitive questions commonly exhibited by individuals with dementia.

Brief training to promote the use of less intrusive prompts by nursing assistants in a dementia care unit.

We evaluated the efficacy of a brief staff-training procedure to increase the use of graduated prompting by 2 certified nursing assistants (CNAs) while they helped to dress 3 persons with dementia in a seven-bed dementia care unit. The multiple baseline design across participants showed that CNAs dressed residents with minimal resident involvement during baseline observations. Following brief in-service training, CNAs provided graduated prompts and praise appropriately, suggesting that CNAs can promote active involvement in personal care routines by older adults with dementia.

Using family-style meals to increase participation and communication in persons with dementia.

Although researchers stress the importance of encouraging independent behavior in persons with dementia, institutional practices often foster dependence. This study took place in a six-resident locked dementia care unit that followed the common institutional practice of serving meals on prepared plates. The purpose of this study was to examine if changing the mode of meal delivery to "family-style," where residents were presented with serving bowls and empty plates, would increase resident communication and participation in mealtime tasks. An ABAB' reversal design revealed very low rates of appropriate communication (5% of intervals) and mealtime participation (10% of tasks) during baseline, when residents received prepared plates (A). Communication and participation doubled when family-style meal delivery was introduced (B) and dropped back to baseline levels when it was withdrawn (A). Because the levels of communication and participation during family-style meals were still low, the nursing assistant was provided with instruction on prompting and praising appropriate mealtime behaviors (B'). After instruction was provided and family-style meals were reintroduced, resident participation rose to 65% of tasks and appropriate communication increased to 18% of observations. This study suggests family-style meals may result in modest increases in mealtime participation and communication of residents with dementia, but staff training in prompting and praising may be necessary to see large changes in these behaviors.

Finding a practical method to increase engagement of residents on a dementia care unit.

Previous research has shown that it is possible to increase the engagement of residents with dementia in daily activities by making changes in institutional care practices. However, these changes often require expensive and cumbersome staff training programs that long-term care facilities may be unlikely to adopt and maintain. This study evaluates a simple, inexpensive recording and feedback procedure to increase resident engagement in a way that may be more amenable to adoption by long-term care facilities. Nursing assistants working in a locked dementia care unit were asked to complete a daily activity record on which they recorded the amount and quality of resident engagement. The facility's activity director was asked to read these activity records each day and give immediate, positive feedback to the nursing assistants. This procedure was evaluated by using a control series design. Results revealed baseline engagement observations with a mean of 11 percent, which increased to a mean of 44 percent during observations under treatment conditions. This study suggests that simple, inexpensive changes in institutional practices can make meaningful improvements in the level of engagement of residents with dementia.

Restoring dressing independence in persons with Alzheimer's disease: a pilot study.

PURPOSE: Well meaning nursing facility staff may compromise the independence of older adults with dementia by performing activities of daily living for residents. We assessed the impact of teaching certified nursing assistants (CNAs) to use a graduated prompting procedure to increase dressing independence of persons with dementia. DESIGN AND METHODS: This study was conducted in a seven-bed dementia care unit. Three residents and two CNAs participated in the study. We used a repeated-measures experimental design to evaluate the effect of a training workshop for CNAs on a strategy for increasing resident engagement in self-care activities. RESULTS: During a series of baseline observations, we found that CNAs typically dressed residents with minimal resident involvement. Results showed that, following the training workshop for CNAs, resident independence in dressing increased and range of motion improved. IMPLICATIONS: CNAs can provide restorative care that increases dressing independence and range of motion of older adults with dementia.