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Purpose of the Study: To describe the experience of recruiting, training, and retaining retired senior volunteers (RSVs) as interventionists delivering a successful reminiscence and creative activity intervention to community-dwelling palliative care patients and their caregivers. Design and Methods: A community-based participatory research framework involved Senior Corps RSV programs. Recruitment meetings and feedback groups yielded interested volunteers, who were trained in a 4-hr session using role plays and real-time feedback. Qualitative descriptive analysis identified themes arising from: (a) recruitment/feedback groups with potential RSV interventionists; and (b) individual interviews with RSVs who delivered the intervention. Results: Themes identified within recruitment/feedback groups include questions about intervention process, concerns about patient health, positive perceptions of the intervention, and potential characteristics of successful interventionists. Twelve RSVs achieved 89.8% performance criterion in treatment delivery. Six volunteers worked with at least one family and 100% chose to work with additional families. Salient themes identified from exit interviews included positive and negative aspects of the experience, process recommendations, reactions to the Interventionist Manual, feelings arising during work with patient/caregiver participants, and personal reflections. Volunteers reported a strong desire to recommend the intervention to others as a meaningful volunteer opportunity. Implications: RSVs reported having a positive impact on palliative care dyads and experiencing personal benefit via increased meaning in life. Two issues require further research attention: (a) further translation of this cost-effective mode of treatment delivery for palliative dyads and (b) further characterization of successful RSVs and the long-term impact on their own physical, cognitive, and emotional functioning. [ABSTRACT FROM AUTHOR]

Purpose: Exemplary care (EC) is a new construct encompassing care behaviors that warrants further study within stress process models of dementia caregiving. Previous research has examined EC within the context of cognitively intact older adult care recipients (CRs) and their caregivers (CGs). This study sought to expand our knowledge of quality of care by investigating EC within a diverse sample of dementia CGs. Design and Methods: We examined the relation between CG subjective appraisal (daily care bother, burden, and behavioral bother), EC, and CG emotional outcomes (depression and positive aspects of caregiving [PAC]). Specifically, EC was examined as a possible mediator of the effects of CG subjective appraisals on emotional outcomes. Using a bootstrapping method and an SPSS macro developed by Preacher and Hayes (2008 Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models), we tested the indirect effect of EC on the relation between CG subjective appraisals and CG emotional outcomes. Results: Overall, EC partially mediates the relation between the subjective appraisal variables (daily care bother, burden, and behavioral bother) and PAC. Results for depression were similar except that EC did not mediate the relation between burden and depression. This pattern of results varied by race/ethnicity. Implications: Overall, CGs’ perception of providing EC to individuals with dementia partially explains the relation between subjective appraisal and symptoms of depression and PAC. Results of this study suggest that interventions may benefit from training CGs to engage in EC to improve their emotional outcomes and quality of care. [ABSTRACT FROM PUBLISHER]

Purpose: The primary aim of this study was to test the stress process model (SPM; Pearlin, Mullan, Semple, & Skaff, 1990) in a racially diverse sample of Alzheimer's caregivers (CGs) using structural equation modeling (SEM) and regression techniques. A secondary aim was to examine race or ethnicity as a moderator of the relation between latent constructs (e.g., subjective stressors and role strain) in the SPM. Sompile: Participants included White or Caucasian (n = 212), Black or African American (n =201), and Hispanic or Latino (n = 196) Alzheimer's CGs from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) II clinical trial. Results: SEM revealed that the Pearlin model obtains a satisfactory fit across race or ethnicity in the REACH II data, despite significant racial differences in each of the latent constructs. Race or ethnicity moderated the impact of resources on intrapsychic strain, such that CGs reported similar intrapsychic strain across race at lower levels of resources, but White or Caucasian CGs reported more intrapsychic strain than Black or African American or Hispanic or Latino CGs when resources are higher. Implications: Strengths and weaknesses for each race or ethnicity vary considerably, suggesting that interventions must target different aspects of the stress process to provide optimal benefit for individuals of different cultural or ethnic backgrounds. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to translate the evidence-based Resources for Enhancing Alzheimer's Caregiver Health (REACH) II intervention for use in 4 Area Agencies on Aging (AAAs). A secondary aim was to examine possible moderators of treatment outcome. Design and Methods: We used a quasi-experimental pre-post treatment design with no control group. A partnership was formed between the Alabama Department of Senior Services and the University of Alabama. The partnership trimmed the REACH II intervention used in the clinical trial for feasible use in a social service agency. The condensed REACH intervention, termed REACH OUT, was delivered to 272 dementia caregivers during 4 home visits and 3 phone calls for a period of 4 months. The assessment examined pre-post treatment effects on a number of outcomes, including care recipient risk, mood, memory, and behavior problems; caregiver stress and emotional well-being; caregiver health; and program satisfaction. All aspects of the program except for training, periodic consultation, and data analysis were controlled by the AAA staff. Results: Analyses were conducted on the 236 dyads that completed at least 3 of the 4 planned sessions. Significant positive pre-post effects were found on caregiver subjective burden, social support, caregiver frustration, depression, caregiver health, care recipient behavior problems and mood, and 2 of 4 care recipient risk behaviors. Site of intervention and certain participant characteristics (e.g., caregiver relationship) moderated several pre-post differences. A caregiver survey and interventionist focus group reported high acceptability of the program Implications: This project suggests that the REACH II intervention can be modified for feasible and effective use in AAAs. The next step is to integrate the intervention into usual service delivery to achieve sustainability. [ABSTRACT FROM AUTHOR]

Purpose: Agitation frequently accompanies cognitive decline among nursing home residents. This study used cross-sectional and longitudinal (up to 18 months) methods to examine agitation among profoundly and moderately impaired residents using both staff report and direct observation methods. Design and Methods: The study included participants (N = 78) from a larger study who completed either 12 or 18 months of data collection. There were four measurement points, each separated by 6-month intervals. We recorded agitation using two measures: (a) the computer-assisted behavioral observation system (CABOS) and (b) the staff-completed Nursing Home Behavior Problem Scale. We used 'ongitudinal hierarchical linear modeling to capture the dynamic nature of behavior change as a function of individual resident characteristics and time. Results: The profoundly cognitively impaired residents (M Mini-Mental State Examination [MMSE] score = 1.7) displayed more agitation than the moderately impaired group (M MMSE score = 15.4) at Epoch 1 (cross-sectional analyses). Longitudinal analysis found a significant linear and quadratic trend only with the profoundly impaired residents using the CABOS. These residents showed slight improvements in agitation up to 12 months, with agitation increasing significantly from 12 to 18 months. Implications: With nursing homes receiving an increasing number of profoundly cognitively impaired residents, these results have potential cost and policy implications. Measuring agitation over time by using both staff report and observation measures presents various problems, and we present an alternative measure that may help to avoid these difficulties. [ABSTRACT FROM AUTHOR]

Purpose: We developed and evaluated an explicit procedure for obtaining self-report pain data from nursing home residents across a broad range of cognitive status, and we evaluated the consistency, stability, and concurrent validity of resident responses. Design and Methods: Using a modification of the Geriatric Pain Measure (GPM-M2), we interviewed 61 residents from two nursing homes (Mini-Mental State Examination score, M = 15 ± 7) once a week for 4 consecutive weeks. We collected additional data by means of chart review, cognitive status assessments, and surveys of certified nursing assistants. We used descriptive and correlational analyses to address our primary aims. Results: Eighty-nine percent of residents completed all four scheduled interviews. Cognitive status was not significantly correlated with number of nonresponses and prompts for yes-no questions, but it was significantly correlated with nonresponses and prompts for Likert-scale questions (r = -.48, p < .001 and r = -.59, p < .001, respectively). Completion time for the 17-item pain measure (M = 13 min) was not predicted by cognitive status. Residents' scores on the GPM-M2 were significantly correlated with number of chronic pain-associated diagnoses, r = .37, p < .01, and internal consistency was excellent, = 0.87 - 0.91. Residents' GPM-M2 scores were stable over time, r = .74-.80, p < .0001, for all comparisons. Implications: Using explicit protocols and reporting procedural data allows researchers and clinicians to better understand and apply results of self-report studies with cognitively impaired elders. Results suggest that many nursing home residents can provide consistent and reliable self-report pain data, given appropriate time and assistance. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine group differences in verbal agitation, verbal interaction, bed restraint, pain, analgesic and neuroleptic medication use, and medical comorbidity among agitated nursing home residents who died during a 6-month clinical trial compared with residents of the same gender and similar initial cognitive status who did not die during the trial. Design and Methods: We conducted a two-group secondary data analysis of prospective observational data from 10 nursing homes in Birmingham, Alabama. By means of chart review, resident assessments, surveys of certified nursing assistants, and direct observation of residents' daily behaviors and environment, 32 residents (87.34 ± 7.29 years) with a Mini-Mental State Examination (MMSE) score = 4.31 (±5.54) who died were compared with 32 residents (84 ± 6.96 years) with a mean MMSE score = 4.28 (±5.49) who did not die during the clinical trial. Results: Residents who died displayed more verbal agitation, less time in verbal interaction with staff, and almost twice as much time restrained in bed during observation time in comparison with residents who did not die during the clinical trial. However, groups did not differ significantly in severity of comorbid illness, functional status, number of painful diagnoses, certified nursing assistants reports of residents' pain, or opioid or nonopioid analgesic prescription or dosage. Surviving residents were more likely to receive neuroleptic medication than residents who died. Implications: Results suggest that agitated nursing home residents may exhibit a heightened level of verbal agitation, decreased verbal interaction with staff, and increased bed restraint up to 3 months prior to death. Prospective observational studies are needed to identify markers for imminent mortality among nursing home residents. [ABSTRACT FROM AUTHOR]

We examined differences in positive aspects of caregiving (PAC) among 275 African American and 343 Caucasian caregivers of individuals with Alzheimer's disease from the National Institutes of Health Resources for Enhancing Alzheimer's Care Health (REACH) study sites in Birmingham, Memphis, and Philadelphia. African Americans reported higher scores on PAC than did Caucasians. African Americans' higher religiosity partially mediated the relationship between race and PAC. Additional variables that contributed to their higher PAC scores were African Americans' lower anxiety, lower feelings of bother by the care recipient's behavior, and lower socioeconomic status. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare a variety of resident and staff outcomes across two types of staffing patterns, permanent and rotating assignment, and work shift. Although studies have examined these staffing patterns as part of multicomponent intervention packages, few studies have examined the isolated effects of staffing pattern by using an experimental design. Design and Methods: A between-groups comparison design was used to compare residents and certified nursing assistants (CNAs) from four nursing homes; two self-identified as using permanent assignment (PA) staffing and two as using rotating assignment (RA) staffing. Measures yielded data on verbal interaction among residents and staff, resident disruptive behavior, and specific aspects of resident-staff behavior during care routines. Other assessments included resident personal appearance and hygiene, expressed affect, and CNAs' job satisfaction, burnout, absenteeism, and turnover rates. A treatment fidelity check was conducted to confirm PA and RA staffing patterns. Results: Staffing patterns were significantly different between self-identified PA and RA nursing homes. Residents in PA nursing homes and on morning shifts received significantly higher ratings of personal appearance and hygiene. Rates of expressed sadness and interest among residents differed by staffing patterns and shift. However, these differences do not appear to be clinically significant. Although absenteeism was higher in PA nursing homes, these CNAs reported greater job satisfaction than CNAs from RA nursing homes. As expected, evening shifts across nursing homes had significantly higher turnover rates and significantly more resident disruptive behavior. Implications: Quality-of-care outcomes were similar among the two types of nursing homes, despite significantly different staffing patterns. Though staff permanency rates in PA nursing homes (50%) were twice that of RA nursing homes (26%), more research is needed to determine feasibility of higher rates of staff permanency (i.e., > 50%) and effects on resident and CNA outcomes. [ABSTRACT FROM AUTHOR]

Presents a study that examined the impact of psychological interventions on White and Afro-American family caregivers of individuals with dementia. Care recipient (CR) problem behaviors; Caregiver (CG) social support and activity; Effects of the relationship between CG and CR.

Provides an overview of the Resources for Enhancing Alzheimer's Caregiver Health (REACH) research program sponsored by the U.S. National Institute on Aging and the U.S. National Institute on Nursing Research. Primary purpose of REACH; REACH interventions by site; Descriptive profile of the caregivers participating in the interventions at REACH intervention sites.

Presents information on a study which identified correlates of advance care planning in nursing homes in the U.S. Assessment of resident capacity; Relation of study variables with advance directive possession; Statistical analysis.

Agitation in nursing home residents presents a serious challenge to caregivers and may place residents at risk for harm. Understanding the etiology of agitation can assist clinicians in developing nonpharmacologic interventions for preventing and treating this problem. The purpose of this study was to examine independent and common predictors of resident agitation with structural equation modeling. Agitation was measured with both a standardized staff report rating scale and direct behavioral observation. No indirect or mediating effects were found. Cognitive impairment, vision and hearing impairment, and gender were found to be independent predictors of agitation as measured by direct behavioral observation. Only cognitive impairment was found to be predictive of agitation as measured by the standardized staff report scale. An unexpected finding was that vision impairment appeared to exert a protective effect for agitation in these severely cognitively impaired residents. The clinical implications of these findings are discussed as well as the relative merits of the two methods of measuring agitation. [ABSTRACT FROM AUTHOR]

Computer-assisted behavioral observation data were collected from 66 nursing home residents while they received assistance during personal care routines from a certified nursing assistant (CNA). Data were collected both before and after a comprehensive behavior-managemenl and communication-skills training program was delivered to the nursing staff. A total of 30 residents showed 6 or more episodes of disruptive vocalization or other forms of agitation during baseline observations, and timed-event sequential analysis methods were used to test whether certain CNA behaviors either elicited or prevented onsets of agitation in these 30 residents. Simple verbal prompts used by CNAs during personal care routines before staff training were found to elicit agitation onset (p = .03), whereas positive statements to the resident were found to reduce the likelihood of agitation onset (p = .02). In a previous analysis of the effects of staff training, we found that rates of resident agitation were significantly lower after training compared with baseline and that CNAs increased their rates of positive statements to residents. In the present study, timed-event sequential analyses indicated that the verbal prompts used by CNAs during personal care routines were no longer associated with an increased rate of resident agitation after staff training among the 20 residents who showed 6 or more episodes of agitation both before and after staff training. These findings suggest that the staff training program improved the quality of CNA verbal prompts. The sequential analysis of observational data provides an important method for studying interpersonal interactions, including those of nursing home residents and the nursing staff who care for them. [ABSTRACT FROM AUTHOR]

Presents information on a study which examined the efficacy of a comprehensive behavior management skills training program for improving certified nursing assistants' skill performance in the nursing home. Design and methods; Results and discussion; Implications.

Deals with a study which discussed the importance of assessing and reporting treatment implementations in dementia caregiver research. Fundamental aspects on intervention application; Multiple threats to consistency of inducing treatment delivery; Strategies in inducing and assessing treatment delivery.

Presents information on a study which examined the effects of communication skills training and the use of memory books by certified nursing assistants (CNA) on verbal interactions between CNA and nursing home residents during care routines. Functions of memory books; Intervention conditions; Methodology; Results and discussion.

Evaluates the effectiveness of written cues by caregivers to manage Alzheimer's disease (AD) patients' repetitive verbalizations. Behavior changes from cuing interventions and behavior tracking process; Evaluation of treatment effects; Social validation; Care-giver perception of self-efficacy.

Reports on the behavioral disturbances among elderly individuals particularly those suffering from dementia. Health care professionals questioned practice; Respondents; Dependent measure; Design and procedure; More.

Employs vignette methodology to examine physicians' acceptance of two behavioral treatments and haloperidol using Kazdin's Treatment Evaluation Inventory, in response to growing interest in employing behavioral treatments and environmental modification for behavioral disturbances in older adults. Methods; Results; Discussion.

Reports on the development of a system for real-time recording of disruptive vocalization (DV) and environmental contextual events using laptop computers. Mini-Mental State Examination; Berthel Self-Care Rating Scale; Survey of disruptive vocal behavior; Computer-assisted data collection system; Categories and code; Observer training and interobserver reliability.

Examines the efficacy of auditory stimulation intervention for verbal agitation treatment in demented nursing home residents. Use of environmental `white noise' audiotapes; Verbal agitation reduction; Individual response.

Two studies compared acceptability ratings of a positive behavioral treatment (differential reinforcement of incompatible behavior), a mildly aversive behavioral procedure (time-out), and pharmacotherapy used for older adults. In study I, college students were presented with descriptions and asked to rate the treatments of case clients who were depicted as either young or elderly, cognitively intact or impaired, and engaging in physical aggression, verbal abuse, or noncompliance. The respondents in study 2 were adults aged 30–49, and senior center participants aged ≥ 60 who were asked to evaluate only the scenarios involving elderly case clients. The treatment evaluation in ventory and a semantic differential scale were used to assess acceptability. Results showed that: (a) college students rated medication higher for elderly case clients, and the behavioral treatments higher when applied with children; (b) adult and elderly respondents assigned the highest acceptability ratings to the differential reinforcement of incompatible behavior procedure, followed by medication and time-out; (c) all respondents assigned differential acceptability ratings depending on the behavior problem described, with more severe problems generally warranting more invasive treatments; (d) acceptability ratings of treatments did not differ as a function of cognitive capacity of case clients. Implications of these results for clinicians employing behavioral interventions with elderly clients are discussed, and suggestions are made for additional research. [ABSTRACT FROM PUBLISHER]