A comparison between lecture and videotape inservice for certified nursing assistants in skilled nursing facilities.

OBJECTIVE: Certified Nursing Assistants (CNA) provide most of the direct patient care in skilled nursing facilities (SNF). CNAs undergo mandatory inservice education regarding a variety of clinical conditions, but high CNA turnover and diverse cultural and educational backgrounds are persistent obstacles to overall staff education. A standardized, easily administered, highly reproducible training intervention would be valuable. We compared the efficacy of videotape versus standard lecture for inservice education relating to topics of dementia care, restraint use, and falls. DESIGN: A prospective randomized study. SETTING: Certified Nursing Assistants were recruited from three SNFs in San Diego County California between November 1997 and August 1998. PARTICIPANTS: The 82 CNAs who participated in the study were all CNA certified in California, employees of the study SNFs, and provided direct clinical care to SNF residents. All participants received regular inservice training. INTERVENTIONS: (1) Standard inservice lecture, (2) Videotape of inservice lecture material supplemented with brief clinical video vignettes. MAIN OUTCOME MEASURES: Scores on a 72-item multiple choice/true-false examination. MAIN RESULTS: Both lecture and video inservice education were effective in this CNA population. Test scores were significantly higher for both inservice groups compared with the control group (P < 0.001). There was no statistically significant difference between test scores for the two intervention groups (control = 63.1 +/- 8.2%, lecture = 78.2 +/- 8.9%, video = 77.9 +/- 11.2%). Knowledge retention was similar between the two intervention groups at 4 months. Lecture subjects who scored highest were more likely to have family members with dementia (P = 0.037), and video subjects who scored highest were younger (P = 0.007). CNA video subjects who scored highest on the examination were more likely to have English as their primary language compared with the highest scoring CNA lecture subjects (P = 0.012). CONCLUSIONS: Compared with control group scores, videotape and lecture inservice interventions were equally effective at increasing and maintaining test scores. The ease of frequent video intervention and the identification of learner characteristics most suited to the video format make audiovisual education a potentially powerful medium for CNA training. These data have important implications for future educational interventions in the SNF.

Nutritional status of patients with Alzheimer's disease: a 1-year study.

OBJECTIVE: To describe the effects of activity level and energy intake over time on the body weight of patients with Alzheimer's disease compared with cognitively normal subjects. DESIGN: Repeated measures, case-control design with measurements taken at quarterly intervals for 12 months. Subjects were grouped by gender and activity level (sedentary or active) within cognitive status. SETTING: The Alzheimer's disease Special Care Unit, The Clinical Research Center at University of California, San Diego, and the Fred Kasch Exercise Physiology Laboratories at San Diego State University. PATIENTS: Seventeen institutionalized subjects with Alzheimer's disease and 23 community-dwelling control subjects successfully completed the 1-year study. MEASUREMENTS: Before admission to the nursing home, the patients with Alzheimer's disease had a formal assessment for dementia, which showed that they met the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association work group for probable or possible Alzheimer's disease. Control subjects were screened using the Information-Memory-Concentration Mental Status Test and were found to have no cognitive disabilities. Baseline and quarterly measurements included height, weight, bioimpedance for body composition, and activity by accelerometer counts. Dietary intake of energy and protein was determined at baseline and at 6 and 12 months. RESULTS: Patients with Alzheimer's disease had a significantly higher energy intake than patients in the control group. Both women and men with Alzheimer's disease maintained their weight. Women with Alzheimer's disease had higher percentage of fat-free mass than the control group, but there were no differences in body composition between the groups of men. CONCLUSION: Subjects with Alzheimer's disease can maintain their weight if they are given a diet with adequate energy (35 kcal/kg of body weight).

The effects of theophylline on metabolic rate in chronic obstructive lung disease patients.

OBJECTIVE: To study the effect of theophylline and an alternative bronchodilator, ipratropium, on resting energy expenditure (REE) and thermic effect of food (TEF). DESIGN: 5-week randomized, repeated measures, double-blind, cross-over design, comparing the effects of theophylline and ipratropium drug treatments on metabolic measurements made during a baseline period. SETTING: Ambulatory Clinical Trials Center at University of California, San Diego. SUBJECTS: 14 patients at least 65 years old with a clinical diagnosis of chronic obstructive pulmonary disease. MEASUREMENTS: Resting energy expenditure and thermic effect of food were measured by indirect calorimetry. Body composition was determined using bioimpedance. RESULTS: Resting energy expenditure did not differ between baseline and either of the two drug treatments. In men, the thermic effect of food increased significantly during theophylline and ipratropium drug treatment periods (p < 0.03). CONCLUSIONS: Theophylline or ipratropium does not appear to increase resting energy expenditure in patients with chronic obstructive lung disease. The elevated values for thermic effect of food in men need further study.

Cognitively impaired spouses as primary caregivers for demented elderly people.

OBJECTIVE: To describe problems of dementia patients whose spousal caregivers are also cognitively impaired. DESIGN: Retrospective chart review. SETTING: The geriatric assessment clinic at University of California, San Diego, which is one center for the California State sponsored Alzheimer's Disease Diagnosis and Treatment Center Program. PATIENTS: During the period from January 1992 through May 1994, 65 patients completed the assessment and met the entry criteria of being demented and having a spousal caregiver. Twelve of the spouses scored six or more error points on the Katzman Short Orientation-Memory-Concentration Test. MEASUREMENTS: Patient data included age, living situation, other caregivers, use of formal and informal support systems, profiles of medical, cognitive, and functional ability, caregivers interactions, and recommendations from the evaluation. MAIN RESULTS: Dementia patients with cognitively impaired spouses utilized fewer community resources (P = .021) and experienced difficulty with medication compliance (P = .041) more often than those with cognitively normal spousal caregivers. CONCLUSIONS: Older caregivers of patients suffering from dementia should be screened for cognitive problems.

Effects of theophylline and ipratropium on cognition in elderly patients with chronic obstructive pulmonary disease.

OBJECTIVES: To determine whether chronic therapy with theophylline or ipratropium has an adverse effect on cognition and psychomotor skills in geriatric patients with chronic obstructive pulmonary disease. DESIGN: The study design was a randomized, repeated measures, double-blind, double-dummy, placebo-controlled comparison of theophylline and ipratropium treatments. SETTING: Ambulatory patients were tested at the Clinical Trials Center of the University of California, San Diego, Medical Center. PATIENTS: Ambulatory patients with chronic obstructive pulmonary disease aged 65 years or more with FEV1 less than 60% predicted, FEV1/FVC less than 70%, and post bronchodilator FEV1 less than 70%. INTERVENTIONS: Patients received either theophylline or ipratropium for 2 weeks, followed by a 1-week placebo control period, then a 2-week treatment period of the alternative drug therapy. A standard therapy of albuterol MDI, 2 puffs (180 microg) qid was given throughout the study. MEASUREMENTS: The main response level was an 11-part battery of psychometric tests. Tests were administered at the end of each treatment period and at the end of the washout period. Covariates were sequence of treatment, pulmonary function tests, age, and baseline psychometric test scores. RESULTS: There was no difference in performance scores on the cognitive tests among the three treatment periods. CONCLUSIONS: We were unable to detect a harmful effect of treatment with either theophylline or ipratropium on the performance of elderly patients with chronic obstructive pulmonary disease on a battery of psychometric tests, suggesting that significant cognitive impairment in the elderly is not commonly associated with treatment with either theophylline or ipratropium.

Body composition of patients with Alzheimer's disease.

Low body weight is frequently reported in patients with Alzheimer's disease. We sought to discover why by comparing the body composition of 28 cognitively normal elders and 23 institutionalized individuals with Alzheimer's disease. Body mass index was calculated from standing height and weight. Percentages of lean body mass, body fat, and body water were derived from bioimpedance measurements of resistance and reactance. Skinfold thickness was measured at seven body sites to estimate regional fat distribution. Variables were analyzed by analysis of variance with subjects grouped by cognitive status within gender. Activity level and age were not significant covariates. Both women and men with Alzheimer's disease weighed less than control subjects. Differences in body composition were more pronounced in women with Alzheimer's disease, who had lower body mass index (22.0 +/- 3.0 vs 26.1 +/- 5.1), higher percentage of lean body mass (73.8 +/- 5.1 vs 66.9 +/- 6.5), lower percentage of body fat (26.1 +/- 5.1 vs 33.1 +/- 6.5), and higher percentage of body water (55.8 +/- 5.0 vs 49.3 +/- 6.5) compared with control women. Except for lower body weight, the body composition of men with Alzheimer's disease was not significantly different from that of control men. Patients of both sexes with Alzheimer's disease had less truncal body fat compared with controls, which gave them a youthful body habitus. These differences were not accounted for by age, diet, or activity. Our findings indicate that patients with Alzheimer's disease have lower body weight and may require higher energy intake than cognitively normal elders.

Nutritional status of free-living Alzheimer's patients.

Self-reported, dietary intake and biochemical estimates of thiamine, riboflavin, folate, vitamin B-12, protein, and iron were compared in 22, free-living elders by individuals who had senile dementia of the Alzheimer's type (SDAT) and in 41 who were cognitively normal (CN). The two groups did not differ significantly in their intake of these nutrients or the number of deficiency states for intake (less than 67% RDA). Low serum transketolase (thiamin; p less than 0.055), red blood cell (RBC) folate (p less than 0.06), and serum vitamin B-12 (p less than 0.05) levels occurred more often in SDAT patients than in CN subjects. Individuals in both groups who used multivitamin supplements had significantly higher biochemical values for thiamine (p less than 0.03), riboflavin (p less than 0.01), and vitamin B-12 (p less than 0.003) than nonsupplement users. Because of the differences in vitamin B-12 and RBC folate levels between groups, a retrospective analysis was performed on a larger group of subjects drawn from a geriatric assessment clinic. Patients with SDAT had significantly lower serum vitamin B-12 (p less than 0.01) and lower RBC folate (p less than 0.03) values than CN subjects. Which mean values for vitamin B-12 and RBC folate were grouped by degree of impairment in SDAT subjects, vitamin B-12 was significantly lower in mildly and moderately impaired subjects than in those with normal cognition. Mean values for both nutrients did not differ significantly between severely impaired and CN subjects. There was a significant quadratic relationship between cognitive impairment and biochemical values for vitamin B-12.(ABSTRACT TRUNCATED AT 250 WORDS)