The role of behavior analysis in the rehabilitation of persons with dementia.

With the rapidly aging population, it is expected that increases in cases of dementia will double over the next 20 years. Currently, there is no cure for diseases such as Alzheimer's disease or frontotemporal dementia (FTD) that cause progressive dementia, and only a few pharmacological interventions that slow the progression of the decline exist. Given that there is no cure available, a rehabilitation approach that emphasizes maintaining existing abilities and removing excess disability (as opposed to emphasizing cure or recovery) for as long as possible is warranted. The current paper proposes that nonpharmacological rehabilitation efforts need to target 5 broad areas/targets: memory enhancement, altering social contingencies and communication styles, improving self-care skills, the arrangement of physical environments to maintain and improve functioning, and increasing physical fitness/physical activity. The purpose of this paper is to review specific behaviorally oriented interventions that target these 5 areas and show promise for inclusion in comprehensive rehabilitation efforts for individuals with dementia.

Command use and compliance in staff communication with elderly residents of long-term care facilities.

Verbal communication between nursing assistants and individuals with dementia can be challenging, particularly during hands-on caregiving tasks. Although there are many aspects of verbal communication that can affect the quality of an interaction, one potentially important communication variable is the types of commands issued by nursing assistants when they need a resident to complete a task. The purpose of this study was to examine the kinds of commands used by nursing care staff when they interact with patients with dementia during activities of daily living. Commands were categorized according to their feasibility/specificity as well as form. An additional goal of this study was to measure compliance and noncompliance rates associated with the various categories of commands. Results indicate that alpha commands (clear, concise, and feasible) account for higher compliance and less noncompliance compared with beta commands (ambiguous, interrupted, and not feasible). In addition, commands that are stated directly, that clarify a previous command, and that are repeated exactly produce better compliance. It is concluded that training nursing staff to change the types of commands they provide during caregiving tasks may reduce distress experienced by both staff and residents.