Coping with dementia: evaluation of four nonpharmacologic interventions.

To evaluate nonpharmacologic interventions, caregivers (65 women, 38 men) and their dementia-diagnosed spouses (patients) were randomized to one of four treatment programs (cognitive stimulation, dyadic counseling, dual supportive seminar, and early-stage day care) or to a wait-list control group. Assessments occurred initially and at postintervention (3 months). Patients were evaluated on memory, verbal fluency, and problem-solving ability, and caregivers were assessed on marital interaction, emotional status, and physical health, along with stress, coping, and social support. Caregivers also completed a program evaluation. Repeated measures procedures showed that patients in the cognitive stimulation group demonstrated more improvement over time in cognitive outcomes, and caregivers decreased in depressive symptoms. Early-stage day-care and dual supportive seminar group caregivers reported a decrease in hostility and a decrease in use of negative coping strategies, respectively. Although qualitatively derived benefits differed across groups, similarities in program content reduced the potential for quantitative differentiation among the groups.

Intervention effects on dementia caregiving interaction: a stress-adaptation modeling approach.

OBJECTIVES: Our purpose was to evaluate the adequacy of a stress adaptation framework for guiding intervention research on caregivers and patients coping with Alzheimer's disease, and to test the effect of a cognitive stimulation intervention as an interactive outcome. METHODS: Using a repeated measures design, 87 caregiver-patient dyads were randomized to one of three conditions: active cognitive stimulation, passive stimulation, or control. Assessments occurred at preintervention, postintervention (3 months), and 9 months. RESULTS: The LISREL model was entirely satisfactory by the chi-square goodness-of-fit criteria. However, the coefficients associated with the paths between the mediating concepts and the dyadic interaction differed significantly at 3 months and 9 months. The intervention group caregivers were shown to be more satisfied with their interaction with the impaired member. DISCUSSION: The improvement in caregiver satisfaction was attributed to an attenuation of the behavioral stressor effects through increased use of a problem-focused coping strategy, namely, positive reappraisal of the stressful situation.

Discovering life quality in coping with dementia.

Using qualitative techniques, data were obtained from 20 informants, comprising 10 caregiving dyads--that is, the caregiver and the spouse diagnosed with possible or probable Alzheimer's disease in the mild to moderate stages. Processes were identified in caregiving reactions and interactions during implementation of a cognitive remediation intervention designed to disrupt the trajectory of decline in dementia. Of interest was the impact of the implementation process on both the Alzheimer-diagnosed care recipient and the caregiver, as individuals and as a dyad. A four-phase process model of discovering life quality was delineated through analysis of log recordings, interviews and observational notes, and written evaluative responses of the families. The phases that emerged from the data address movement from an initial state of depleted interaction to a regaining of familial life quality.

Supportive seminar groups: an intervention for early stage dementia patients.

A supportive seminar group was developed and conducted for individuals with early stage dementia and their caregivers. The eight sessions focused on pertinent topics, namely, coping with memory problems, daily living, self-esteem, relationships, health, legal, and financial concerns. Content analysis of the evaluative statements from nine men and six women patients revealed positive themes of feelings of purposefulness, gratification, belongingness, and survival, while other themes reflected the turmoil of the disease, namely, feelings of helplessness, devaluation, and unpredictability. These preliminary findings lend support to the feasibility of a group approach for early stage dementia patients.

A dyadic remediation program for care recipients with dementia.

A cognitive remediation intervention was tested for its effect on functional outcomes of older care recipients with the diagnosis of dementia of the Alzheimer's type. The 78 community-dwelling care recipients were assessed on cognitive and behavioral functioning and randomly assigned to one of three conditions. Care recipients were expected to benefit most from active cognitive stimulation training as compared to placebo (passive) activity or wait-list control conditions. Following each weekly instruction session, the intervention was executed in the home by the family caregiver. Care recipients in the experimental group improved in cognitive and behavioral performance with treatment, but returned to former level of functioning by the 9th month. In contrast, the control group declined, while the placebo group remained static on these variables. These findings support the viability of remediation interventions in dementia despite the trajectory of cognitive decline.

Perceptual and enactment measurement of self-care.

The concept of self-care was conceptualized as having three major components: enabling perceptual elements (motivation, values, responsibility, and decision making); domains for enactment (cognitive/ perceptual, psychosocial/affective, and physical functioning); and self-care enactment factors (capacity), which included self-care action and knowledge adequate for self-care. A new tool, The Self-Care Agency Inventory, was designed to discriminate between those who will enact self-care and those who will not because of either a lack of knowledge or a lack of motivation. Content validity was demonstrated (.77 or greater from each scale) and concurrent validity documented. Alpha reliability for the new scale and principal components factor analysis of the scale items did not achieve desired levels, although a pilot sample demonstrated test-retest reliability of .82. The conceptual model is presented.

The level and focus of geriatric nursing content in ADN and BSN programs.

The didactic and clinical focus of geriatric curriculum content within both associate (ADN) and baccalaureate (BSN) schools of nursing in California was reviewed. Geriatric nursing content experts confirmed the detail of a geriatric nursing curriculum, then determined which of the content items were basic to both educational levels, and which might be appropriately deferred to programs of baccalaureate preparation. Nurse educators may use the results of this study to guide curriculum development in both depth and breadth of content.

From models to measures in assessment of mature families.

Although assessment of families as guided by nursing conceptual models is gaining impetus in the field of nursing, the incorporation of psychometrically sound clinical research measures into assessment protocols is a relatively recent phenomenon in family health nursing. Therefore, the purpose of this article is to describe an educational approach for students enrolled in a graduate nursing course focusing on mature and aging families. In this course, valid and reliable clinical research measures were incorporated into assessment protocols for practice based on nursing models. Criteria for selection of clinical research measures emphasized appropriateness for nursing assessment of families, age and ethnic relevancy of the measures, strength of psychometric properties, ease of administration and understandability, and potential for delineating nursing diagnoses and nursing intervention foci. The methods used to incorporate this approach into a graduate-level family nurse clinician course are presented. Theoretical issues include (1) the fit between the selected measures and the nursing conceptual model of choice and (2) the use of individual-focused versus family-focused paradigms. Clinical issues include student involvement in instrument selection, ethical implications of use of the measures, interpretation of data, and sharing of results with families.

Differential effects of family-based strategies on Alzheimer's disease.

Assessed was the efficacy of a home-based program of cognitive stimulation for the functional status of patients with Alzheimer's disease, as well as the well-being of caregivers. Ten family dyads (caregiver and patient) participated in the intervention and six family dyads formed the comparison group. Patients in the program maintained their levels of cognitive and behavioral functioning while improving emotionally, whereas the comparison group patients deteriorated. Similarly, the caregivers in the program maintained well-being and enhanced their coping resources.

Correlates of caregiving satisfaction: prerequisites to elder home care.

In this comparative study, a path analytic model was used to identify variables predictive of satisfaction in providing care to elderly family members, and to determine differences in the predictor variables between past and present caregivers as potential precipitators of institutionalization. Nineteen current caregivers and 29 past caregivers were recruited from health agencies in a rural area. Demographic predictors of caregiving satisfaction included age and sex of the client and age of the caregiver; psychological problems of the client influenced caregiver satisfaction. Measures of situational stress (medical, psychological, environmental) revealed that the past caregivers had higher psychological and environmental stress and less life satisfaction than current caregivers. Additional analysis revealed that the most common pattern of nursing home admission was hospitalization of the client for physical illness, with subsequent physician-recommended nursing home placement. Areas of identified need for preventing premature relinquishing of the caregiving role are discussed.