Developing a Memory and Communication App for Persons Living With Dementia: An 8-Step Process.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.3928/19404921-20210825-02.

The Functional External Memory Aid Tool Version 2.0: A How-To Clinical Guide.

PURPOSE: Although compensatory cognitive rehabilitation is a common treatment approach for adults with cognitive-communication disorders, there are few assessment tools available to support clinicians in developing person-centered treatment plans. In addition to understanding a client's cognitive and functional abilities, it is also important to understand how they compensate for their weaknesses, specifically with external aids (e.g., calendars, notes), in everyday life. The Functional External Memory Aid Tool (FEMAT) is a performance-based measure that quantifies and describes external aid use during task completion. METHOD: The purpose of this clinical focus article is to educate and equip clinicians to administer and interpretate the FEMAT with adult clients with cognitive-communication disorders. This clinical focus article describes the theoretical motivation for the FEMAT as well as the administration, scoring, and interpretation procedures for Version 2.0 of the measure. A hypothetical case example is included to illustrate how to use the FEMAT to develop person-centered goals and treatment plans. CONCLUSIONS: The FEMAT is psychometrically sound, clinically relevant, free, easily accessible, and quick to administer and provides data that are complementary to data obtained from traditional performance-based and/or patient-reported measures. This clinical focus article describes new resources that are available to help clinicians administer and interpret Version 2.0 of the FEMAT when serving adults with cognitive-communication disorders. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21651311.

A Seat at the Table: Supporting Persons with Severe Dementia in Communicating Their Preferences.

Objective: Persons with severe dementia are less likely to have a role in preference assessment due to communication challenges associated with the disease. Research is limited on how to support preference communication while using existing preference assessment tools (e.g., the Minimum Data Set 3.0).Methods: This study examined the effect of two assessment conditions (standard verbal; visual-and-text supported;) on residents' (N = 21) social and leisure preference consistency over 1-week and utterance types (acknowledgment, elaboration, off-topic, request for clarification) in response to preference questions. Residents with severe dementia were recruited from four nursing homes (n = 11) and three assisted living facilities (n = 10). As a preliminary measure of provider acceptability and social validity, a sample of 10 naïve judges (University students) listened to the interviews and rated residents' communication clarity and their confidence with understanding residents' preferences.Results: Neither assessment condition promoted significantly greater levels of consistency (i.e., the same preference rating at Time 1 and Time 2). Residents expressed significantly fewer requests for clarification in the visual-and-text supported condition. Naïve judges rated residents' communication positively, with no significant differences between conditions.Conclusions: This study addresses a gap in current research and holds important implications for enhancing care planning participation by residents with severe dementia.Clinical Implications: Residents with severe dementia can successfully participate in activity preference discussions without proxy participation. Residents may comprehend interview questions better when provided in a supported format.

Development and Initial Validation of the Functional External Memory Aid Tool.

Purpose The purpose of this study was to develop the item pool and investigate the structure and measurement properties of the Functional External Memory Aid Tool (FEMAT), a performance-based measure of everyday strategy use for persons with mild memory impairments. The FEMAT examines one's use of strategies to compensate for cognitive communication impairments that interfere with the completion of complex daily tasks. Method During Phase 1, six expert panel members reviewed the initial item pool and scoring rubric to assess item verification. Each item was developed to elicit strategy use and represent a complex daily task. During Phase 2, 99 participants with possible mild neurocognitive disorder (as determined by screening procedures) responded to 11 items. The factor structure of the data was analyzed using confirmatory factor analysis. Reliability and relationships between the FEMAT and additional factors were also examined. Results The process of development (Phase 1) resulted in 11 items distributed among three factors: (a) Medical Tasks, (b) Instrumental Daily Tasks, and (c) Retrieval-Based Tasks. Internal consistency (Phase 2), assessed with confirmatory factor analysis, confirmed the proposed three-factor model. Reliability analyses revealed at least 62%-84% of within-test score variance was due to true score variance. Correlation analyses indicated weak and strong relationships between the FEMAT and participant demographic variables and additional assessment measures. Conclusions The FEMAT provides reliable measurement of everyday external memory aid use in persons with possible mild neurocognitive disorder. The FEMAT was designed to be used in clinical settings and to provide better guidance to clinicians to design person-centered interventions than currently available cognitive communication measures.

Structured External Memory Aid Treatment for Mild Cognitive Impairment.

Purpose The aims of this study were (a) to examine the effects of a structured external memory aid (EMA) treatment for individuals with possible mild neurocognitive disorder on their use of EMAs to compensate for memory impairments, (b) to examine the extent that improved functional EMA use maintains following intervention, and (c) to measure the effects of treatment on participants' self-reported memory skills. Method The researchers employed a multiple-baseline design across subjects within dyads. Data were collected using the Roleplay Assessment. The graphed data were analyzed visually at baseline, treatment, and maintenance sessions. In addition, the researchers examined the participants' self-report of memory skills through an experimental pre-post design. Results Following intervention, a functional strategy use treatment effect was observed. All 6 participants' graphs revealed a large positive change in level, with no overlapping data. Statistical analyses also supported the positive effects of treatment. The participants maintained the use of strategies for 1-3 months. The participants self-reported a statistically significant increase in strategy use following intervention. Conclusions With treatment, individuals with mild memory impairments can learn to use EMAs to facilitate enhanced performance on functional activities. This study provides evidence for the importance of documenting individual treatment effects and using a functional measure to examine compensatory strategy use in everyday tasks.

Effects of Visual Aids for End-of-Life Care on Decisional Capacity of People With Dementia.

Purpose This study evaluated the decision-making capacity of persons with mild and moderate dementia on end-of-life care when using visual aids. A secondary purpose was to learn whether the judges naive to the experimental conditions would rate participants' decisional abilities as better when augmented by visual aids, thereby validating the behavioral changes due to the use of these external support. Method Twenty older adults with mild and moderate dementia demonstrated Understanding, Expressing a Choice, Reasoning, and Appreciation of 2 medical vignettes under 2 counterbalanced conditions: verbal alone or verbal with visual aids. Transcripts were analyzed and scored to measure decisional skills. Twelve judges rated participants' decisional abilities using a 7-point Likert scale. Results Participants demonstrated significantly better overall decisional capacity in Understanding, Reasoning, and Appreciation when supported by visual aids during the decision-making process. No significant differences between conditions were found in Expressing a Choice, the decisional skill Logical Sequence under Reasoning, and Acknowledgment under Appreciation. Overall, the judges' ratings validated these outcomes; the judges' ratings reflected greater agreement in the visual condition than in the verbal condition. Conclusions Findings indicated that visual aids (a) improved the decision-making capacity of individuals with dementia in comprehending medical information, employing supportive reasons, and relating this information to his or her own situation and (b) contain the potential for judges who majored or are majoring in speech-language pathology to reach a stronger consensus when determining the decision-making capacity of individuals with dementia.

External Memory Aid Preferences of Individuals with Mild Memory Impairments.

Individuals with mild memory impairments often rely on external memory aids (EMAs) to compensate for impaired cognitive abilities and to support independent completion of activities of daily living. These strategies are evidence based; however, professionals have limited knowledge regarding individual preferences and guidance on how to incorporate a person-centered approach into the EMA development phase. The purpose of the current study was to qualitatively investigate individuals' preferences and experiences as they relate to EMAs. Data analysis included (1) evaluation of a posttreatment questionnaire to explore individual strategy preferences following intervention and (2) evaluation of group intervention videos using thematic coding to investigate individuals' experiences with strategies during intervention. Results suggest that older adults with mild memory impairments have unique preferences and experiences, despite limited variability in demographic characteristics. Some themes that emerged included memory ability awareness and attitudes toward technology. Within a person-centered approach, skilled professionals must consider individuals' unique needs, preferences, and experiences when developing strategies throughout the continuum of care to promote sustained EMA use within everyday settings.

Join the Revolution: How Montessori for Aging and Dementia can Change Long-Term Care Culture.

Efforts to improve the quality of life of persons with dementia in long-term care through the implementation of various approaches to person-centered care have been underway for the past two decades. Studies have yielded conflicting reports evaluating the evidence for these approaches. The purpose of this article is to outline the findings of several systematic reviews of this literature, highlighting the areas of improvement needs, and to describe a new person-centered care model, DementiAbility Methods: The Montessori Way. This model focuses on the abilities, needs, interests, and strengths of the person and creating worthwhile and meaningful roles, routines, and activities for the person within a supportive physical environment. This is accomplished through gaining the commitment of the facility's leaders, training staff, and monitoring program implementation. The potential for a culture change in long-term care environments is dependent on the development and rigorous evaluation of person-centered care approaches.

Agrammatism in Jordanian-Arabic speakers.

The studies of agrammatism show that not all morpho-syntactic elements are impaired to the same degree and that some of this variation may be due to language-specific differences. This study investigated the production of morpho-syntactic elements in 15 Jordanian-Arabic (JA) speaking individuals with agrammatism and 15 age-matched neurologically healthy individuals. Two experiments were conducted to examine the production of complementizer, tense, agreement and negation morphology in JA. The results indicated that the speakers of JA with agrammatism had marked dissociations in producing specific morpho-syntactic elements. The observed impairment patterns overlapped, in many respects, with those observed in other linguistic groups. The findings are discussed with respect to current theories of agrammatism, including both morpho-syntactic and computational accounts.

Communication and aging.

People with communication disorders form a diverse group with some experiencing long-standing disorders and others the onset of new disorders in old age. Regardless of age at onset, the burden of communication disorders is cumulative and has important implications for health care providers. Communication serves many roles for older people, not only establishing and maintaining social affiliations but also providing access to health care services. Health care providers should be aware of potential communication disorders and make provision for quiet environments, reading materials at appropriate literacy levels, and longer appointments for people with communication difficulties.

The effects of cognitive teletherapy on reported everyday memory behaviours of persons with chronic traumatic brain injury.

PRIMARY OBJECTIVE: The purpose of this study was to evaluate the effects of an errorless training approach, Spaced Retrieval (SR) training delivered over the telephone, on the reported everyday memory problems of adults with chronic traumatic brain injury (TBI). RESEARCH DESIGN: The study was a randomized controlled clinical trial. METHODS: Thirty-eight participants received either SR training or didactic strategy instruction (SI). Participants in both groups identified three memory-related goals and were paired to receive the same total telephone contact time. The main outcome measures were frequency of reported memory problems and perceived quality of life. RESULTS: Participants in the SR group reported significantly more treatment goal mastery/strategy use than those in the SI group, immediately and at 1-month post-training. Caregivers reported similarly significant between-groups differences in everyday use of treatment behaviours at 1 month. Both groups reported some generalized strategy use to other non-targeted behaviours and decreased frequency of reported memory problems, but there were no significant between-groups differences in participant or caregiver reports of generalized strategy use or reported memory problems at either time-point. There was no change in perceived quality of life in either group. CONCLUSIONS: SR treatment delivered by phone produced significantly more treatment goal mastery/strategy use and maintenance than SI; however, both treatments improved reported everyday memory functioning for persons with TBI, without significant group differences on measures of generalized strategy use or perceived quality of life.

The Revised Memory and Behavior Problems Checklist--Nursing Home: instrument development and measurement of burden among certified nursing assistants.

Confirmatory factor analysis of the Revised Memory and Behavior Problems Checklist--Nursing Home (RMBPC) replicated the factor structure of the community-based RMBPC (L. Teri et al., 1992). The reliability of the total score was high as indexed by estimates of internal consistency (alpha = .95), test-retest reliability (r = .86), and interrater reliability between 2 interviewers (r = .88). Notably, the interrater reliability between 2 independent certified nursing assistants (CNAs) regarding residents' behavior problem frequency was more modest (r = .46), possibly reflecting the degree to which resident behaviors capture individual CNA's attention. This may have implications for the interpretation of data from the Minimum Data Set. CNAs reported moderately severe burden associated with behavior problems in 47% of residents under their care.

A comparison of training strategies to enhance use of external aids by persons with dementia.

UNLABELLED: The purpose of this study was to compare the effectiveness of two training approaches, Spaced Retrieval (SR) and a modified Cueing Hierarchy (CH), for teaching persons with dementia a strategy goal involving an external memory aid. Twenty-five persons with dementia living in either community or nursing home settings received training on two individual-specific strategy goals, one with each training approach. Results revealed that significantly more goals were attained using SR procedures than CH, but that a majority of participants learned to use external aids using both strategies. There were no significant differences in the number of sessions required to master goals in either condition; however, significantly more SR goals were maintained at both 1-week and 4-months post-training compared to CH goals. Mental status was not significantly correlated with goal mastery, suggesting the potential benefits of strategy training beyond the early stages of dementia. LEARNING OUTCOMES: As a result of this activity, the reader will be able to (1) identify ways to enable persons with dementia to make effective use of external memory aids; (2) describe a method, Spaced Retrieval, by which persons with dementia can learn and retain information; and (3) describe two approaches to working with persons with dementia to train a strategy learning goal.

Advance care planning in nursing homes: correlates of capacity and possession of advance directives.

PURPOSE: The identification of nursing home residents who can continue to participate in advance care planning about end-of-life care is a critical clinical and bioethical issue. This study uses high quality observational research to identify correlates of advance care planning in nursing homes, including objective measurement of capacity. DESIGN AND METHODS: The authors used cross-sectional, cohort study between 1997 and 1999. Seventy-eight residents (M age = 83.97, SD = 8.2) and their proxies (M age = 59.23, SD = 11.77) were included across five nursing homes. The authors obtained data via chart review, proxy interviews, resident assessments, survey completion by certified nursing assistants, and direct observation of residents' daily behaviors. RESULTS: Capacity assessments revealed that most residents could state a simple treatment preference (82.4%), but a sizable number did not retain capacity to understand treatment alternatives or appreciate the consequences of their choice. Global cognitive ability (Mini-Mental State Examination score) was related to understanding and appreciation. When the authors removed the effects of global cognitive ability, understanding and appreciation were related to time spent by residents in verbal interaction with others. Residents were more likely to possess advance directives when proxies possessed advance directives, proxies were less religious, and residents were socially engaged. IMPLICATIONS: Assessment of proxy beliefs and direct determination of residents' decisional capacity and social engagement may help nursing home staff identify families who may participate in advance planning for end-of-life medical care. Measures of global cognitive ability offer limited information about resident capacity for decision making. Decisional capacity assessments should enhance the verbal ability of individuals with dementia by reducing reliance on memory in the assessment process. Interventions to engage residents and families in structured discussions for end-of-life planning are needed.

Prescription and dosage of analgesic medication in relation to resident behaviors in the nursing home.

OBJECTIVES: To examine correlates of analgesic medication prescription and administration in communicative, cognitively impaired nursing home residents. Residents' behaviors were assessed using computer-assisted real-time observations as potential adjunctive indicators of pain. DESIGN: Cross-sectional study over a 4-week period. SETTING: Five nursing homes in the greater Birmingham, Alabama, area. PARTICIPANTS: Ninety-two residents (mean age +/- standard deviation = 83.86 +/- 8.55) with a mean Mini-Mental State Examination (MMSE) score of 13.81 +/- 6.34. MEASUREMENTS: Data were obtained via chart review, resident assessments, questionnaire completion by certified nursing assistants familiar with residents' care, and direct observation of residents' daily behaviors. RESULTS: Receipt of analgesic medication was related to self-report of pain (F2,89 = 9.89, P =.0001), MMSE (F2,88 = 3.98, P =.022), and time spent inactive (F2,89 = 3.04, P =.053). Residents who received analgesic medication reported greater intensity of pain than other residents. Residents who received analgesics had higher MMSE scores than those who did not receive analgesics. Residents who received analgesics spent less time being inactive than those not prescribed analgesics. Receipt of higher dosage of opioid analgesic medication was associated with more time spent with others in verbal interaction (r =.22, P =.03). CONCLUSION: This study refines the methodology of measuring analgesic medication dosage and its effect on resident behavior. Analgesic prescription and administration patterns are related to time residents spend being inactive. Results suggest that opioid analgesics may hold particular promise in alleviating pain, as indicated by resident behaviors.