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The current study translated the Resources for Enhancing Alzheimer's Caregiver Health: Offering Useful Treatments (REACH OUT), a skills-building stress and burden intervention, for the primary care setting and pilot the resulting intervention. The 16-week intervention consisted of a combination of clinic-based group and one-on-one sessions offered within a medical home, geriatrics clinic. A quasi-experimental pre- and post-test study design without a control group tested the resulting intervention. Semi-structured qualitative exit interviews evaluated program satisfaction. Twenty-five caregivers participated in one of four intervention groups; 21 caregivers completed the intervention (attended at least five of six group sessions). Caregiver burden on standardized assessments was significantly reduced between pre- and post-intervention, specifically for physical/emotional strain and caregiving uncertainty. Significant reductions were found in the frequency of reported disruptive behaviors; increased caregiver confidence in handling behavior problem frequency, depressive symptoms, disruptive behaviors, and memory-related problems; and decreased bother with respect to behavioral problem frequency and care recipient depression. Program satisfaction was high. This work suggests that the REACH OUT program can be successfully modified for use within a primary-care medical home setting. [ABSTRACT FROM AUTHOR]

Objectives: Little is known about the patterns of psychotropic medication use in community-dwelling minority persons with dementia (PWD). The purpose of this study was to investigate racial/ethnic differences in psychotropic medication use across a diverse population of community-dwelling PWD and to examine the extent to which caregiver characteristics influence this use. Method: Data were drawn from the baseline assessment of the Resources for Enhancing Alzheimer's Caregiver Health II trial. Generalized linear models were used to identify racial/ethnic differences in psychotropic medication use. Akaike Information Criterion (AIC) model selection was used to evaluate possible explanations for observed differences across racial/ethnic group. Results: Differences in anxiolytic and antipsychotic medication use were observed across racial/ethnic groups; however, race/ethnicity alone was not sufficient to explain those differences. Perceptions of caregiving and caregiver socioeconomic status were important predictors of anxiolytic use while PWD characteristics, including cognitive impairment, functional impairment, problem behavior frequency, pain, relationship to the caregiver, sex, and age were important for antipsychotic use. Conclusion: Racial/ethnic differences in psychotropic medication use among community-dwelling PWD cannot be explained by race/ethnicity alone. The importance of caregiver characteristics in predicting anxiolytic medication use suggest that interventions aimed at caregivers may hold promise as an effective alternative to pharmacotherapy. [ABSTRACT FROM AUTHOR]

Objectives:The current practice of prescribing psychotropic medication for the management of dementia-related behavioral disturbances is under substantial debate. Using Pearlin's stress process model as theoretical underpinning, the aim of this investigation is to identify caregiver and care recipient characteristics as predictors of anxiolytic, antipsychotic, and antidepressant use among community-dwelling dementia patients. We hypothesized that caregiving burden and patient characteristics, particularly behavior disturbances and pain, would be positively associated with psychotropic medication use. Methods:Data for this exploratory, cross-sectional study were drawn from the baseline assessment of the Resources for Enhancing Alzheimer's Caregiver Health II trial. Only participants with full baseline information were examined (N= 598). Caregiver characteristics, such as confidence managing problematic behaviors, and care recipient characteristics including pain, problem behaviors, cognitive impairment, and functional impairment, were examined in relation to care recipient psychotropic medication use. Results:Contrary to our hypothesis, behavioral disturbances and burden associated with these disturbances were not significantly associated with psychotropic use. Rather, caregiver characteristics such as race and overall vigilance, and care recipient characteristics such as cognitive status, functional status, and pain were significantly associated with the use of psychotropic medication. Findings differed by class of medication. Conclusion:These exploratory findings suggest the utility of a holistic approach to understanding the factors associated with pharmacotherapy among community-dwelling elders with dementia. Significant associations between caregiver characteristics and care recipient psychotropic medication use suggest that educating caregivers in non-pharmacologic strategies hold promise for a more balanced biopsychosocial approach to maintaining dementia patients in the community. [ABSTRACT FROM AUTHOR]

Objective: We examined predictors of staff-reported need-driven behaviors and resistiveness to care in nursing home residents with dementia and predictors of certified nursing assistant (CNA) burden related to both constructs. Background and proximal factors from the need-driven dementia-compromised behavior model [Algase, D.L., Beck, C., Kolanowski, A., Whall, A., Berent, S., Richards, K., et al. (1996). Need-driven dementia-compromised behavior: An alternative view of disruptive behavior. American Journal of Alzheimer's Disease, 5, 10-19] were examined as potential predictors of need-driven behaviors (NDBs) and resistiveness to care and CNA burden. Method: We used secondary data analysis of prospective data from 10 nursing homes in Birmingham, Alabama. One-hundred and sixty-one residents (83.43 ± 8.56 years) with mini mental state examination (MMSE) score = 6.41 (± 6.66) were assessed via chart review, resident surveys, and surveys of CNAs. Results: Multiple regression models revealed that cognitive functioning, activities of daily living functioning, race, gender, and CNA-reported weekly resident pain intensity were associated with resident NDBs. Regression models also revealed that weekly pain intensity and medical comorbidity were associated with CNA burden associated with the resident NDBs. However, we were unable to explain a significant amount of variance in the resistiveness to care or CNA burden associated with resistiveness to care. Discussion: Results underscore the role of pain in both resident NDBs and associated CNA burden. Future research should focus on predictors of resident resistiveness to care and the relation of pain assessment and management practices to CNA burden. Moreover, interventions to improve resident care should seek to include CNAs in institutional pain assessment and management processes. [ABSTRACT FROM AUTHOR]

Rural dwelling elders who experience mental health problems often have difficulty finding help since rural communities often lack adequate mental health service providers. This paper reports on the initial phase of a 5-year, interdisciplinary clinical research study that is testing the effectiveness of providing a home delivered, therapeutic psychosocial intervention, aimed at improving the emotional well-being and the quality of life of medically frail elders who live in rural communities. In the early phases of this study, the clinical research team encountered a number of interesting and often unanticipated challenges as it attempted to recruit study participants and provide services to them. In this article, we examine these challenges and share what we have learned so far about providing mental health services to elderly persons living in rural environments. [ABSTRACT FROM AUTHOR]

This study is a critical analysis of the components of a communication skills training program designed to increase the quantity and quality of nursing aides' (N = 126) verbal interactions with residents with dementia (N = 125) during care routines. Training included a didactic in-service, one-on-one, criterion-based training during care interactions, the use of memory books, and a staff management system. Results indicated that this communication skills program significantly improved nursing aides' effective skills (p > .001), effective instructions (p > .01) and manner of communication during care interactions with residents. One-on-one performance training and feedback was required to master and maintain skill use 3 months beyond program termination. [ABSTRACT FROM AUTHOR]

The effect of memory aids on conversations between nursing aides and residents with dementia during 5-minute conversations was examined. Nursing home units in seven nursing homes were randomly assigned to treatment and control conditions. Residents in the treatment condition were given 12-page memory books consisting of autobiographical, daily schedule, and problem resolution information. Their assigned nursing aides were trained to use the memory books during care interactions and throughout the day. The duration and quality of verbal interactions between dyads of a resident and their nursing aide during 5-minute conversations were measured pre-and post-treatment using computer-assisted observational techniques and verbatim transcriptions of videotaped conversations (N = 66; 33 treatment dyads and 33 control dyads). The results revealed improvements on a variety of quantitative conversational measures (e.g., duration of speaking time, frequency of utterances) between treatment and control conditions as a function of memory book use. Similarly, the quality of conversations, as measured by the frequency of discourse characteristics (e.g., facilitative behaviors), improved as a function of memory book use for treatment dyads. Nursing aides' judgment of residents' depressive symptoms improved with memory aid use, suggesting changes in resident quality of life as a result of an AAC technique that enhanced information sharing and social closeness. [ABSTRACT FROM AUTHOR]

Recent changes in the nature and scope of nursing home practices challenge long-term care nurses to develop treatment programs that are both successful in enhancing residents' remaining quantity and quality of life, as well as cost-effective in treating specific problems. The characteristics of behavioral therapies make them ideal for the open, community environment that characterizes many long-term care (LTC) settings. Under the guidelines of the Omnibus Budget Reconciliation Act of 1987, LTC facilities are expected to initiate behavioral management programs and to train staff in behavioral management practices. The purpose of this article is to discuss five key issues that should be considered in planning behavioral management programs for LTC facilities. [ABSTRACT FROM AUTHOR]

We examined the effects of staff performance feedback delivered by a supervisor verbally, and combined with written feedback on geriatric nursing assistants' (GNAs) completion of assigned prompted voiding. The goal of the staff management procedures was to increase the frequency of prompted voiding which would consequently maintain improvements in continence brought about on a specialized continence unit. The basic staff management system included GNA self-monitoring of their performance of prompted voiding, periodic supervisory monitoring, and verbal and graphic feedback provided to all GNAs on their performance. At a later time, the staff management program was modified to include letters of praise or disapproval sent bi-weekly to all GNAs based on their performance of the prompted voiding procedure. Also, a letter was sent to all GNAs every three months summarizing their performance during this period. These summary letters were placed in the GNAs' personnel file and used as part of their annual performance evaluation. Results suggest that, although individual verbal feedback alone resulted in acceptable maintenance of prompted voiding, the addition of written feedback produced significant improvements in the number of assigned prompted voiding completed. This study displays the utility and practicality of employing formalized staff management procedures in nursing homes. [ABSTRACT FROM PUBLISHER]

Listening skills, assessed by examining the attentional behaviors and recall accuracy on two sentence-instruction tasks and on a story listening task, were evaluated in one training and two generalization situations, one outside of and one within a classroom situation, for four educable mentally retarded boys. Two modified “say-do-say” correspondence training procedures, one to increase attention directly and one to increase generalized attention, and a feedback reinforcement procedure to increase accuracy of immediate recall in a listening situation were separately and sequentially introduced in a multiple baseline design across subjects. One subject introduced in a multiple baseline design across subjects. One subject increased attention and accuracy of recall across situations after the introduction of the direct correspondence training procedure. Because two subjects failed to show generalized attentional behavior and accurate recall, the other two training procedures were introduced. Subsequently, attentional skills across settings increased for both subjects. The fourth subject, due to time limitations introduced only to the direct correspondence training procedure, showed direct and generalized attentional changes. The potential contributions of these procedures to developing a technology of listening behavior are discussed. [ABSTRACT FROM PUBLISHER]