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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.

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.

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-management 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.

This study presents preliminary data on the efficacy of two environmental 'white noise' audiotapes for the treatment of verbal agitation in severely demented nursing home residents. The researchers employed a computer-assisted real-time observational system to assess both the frequency of verbal agitation and the actual use of the intervention on the nursing units (treatment fidelity). Intervention by nurse aides (NAs) on the unit was preceded by a researcher-controlled functional analysis phase that provided information regarding which of the two audiotapes would be most effective for individual residents. Results indicate a 23% reduction in verbal agitation with this individualized treatment strategy on the nursing units. These results were obtained even though treatment fidelity data showed that the audiotapes were used during only 51% of the observations. The authors discuss the need for formal staff management procedures for increasing staff compliance with treatment regimens.

Primary and secondary caregivers of patients with Alzheimer's disease substantially disagree in their perceptions about various caregiving domains. While the disagreement is less about patient problem behavior and primary caregiver strain, it is more about primary caregiver coping efficacy. Primary caregivers assisted by secondary caregivers with pessimistic views have less psychosocial distress than those with optimistic helpers. Female-female caregiving dyads exhibit strongest relationships of this kind.

A study was conducted to examine the effects of written and verbal supervisory feedback on staff compliance. The study applied both feedback types to a nursing home. It was expected that the procedures will increase prompted voiding frequency and generate constant continence improvements. Results show that although verbal feedback already exhibited a positive impact on worker compliance, a written feedback further enhanced the level of prompted voiding.

The significance of ethnic differences in depression in dementia caregivers is examined using the four-factor model of depressive symptoms in dementia caregivers. Significant differences are observed among African American, White and Hispanic caregivers based on the four factors of depressed affect, well-being, interpersonal problems and somatic symptoms.

A study is carried out in older adults to check the performance of home-delivered cognitive-behavioral therapy by which the psychological symptoms would be reduced and quality of life would be improved. It is felt that psychological intervention can help older adults in improving their mental health and to lead a satisfactory life.

The extent to which the positive aspects of caregiving (PAC) that include satisfaction with and rewarding appraisals of caregiving can lessen the stress of caregiving and enhance emotional outcomes is examined.

A modified version of the Revised Memory and Behavior Problems Checklist (RMBPC) was administered across family caregivers of community-dwelling adults with dementia. Correlations with other caregiver and care-recipient measures supported the convergent and discriminant validity of the RMBPC measures.

The confirmatory factor analysis of the Revised Memory and Behavior Problems Checklist-Nursing Home (RMBPC) replicated the factor structure of the community-based RMBPC. The RMBPC-NH represents a reliable and valid assessment of the frequency of nursing home residents' behavior problems.

The Resources for Enhancing Alzheimer's Caregiver Health (REACH) project was designed to test interventions for enhancing family caregiving for persons with dementia. The research designs, interventions and outcome measures used in REACH and the sample recruited for the study are analyzed and characterized.

Results of an analytical approach that allows researchers to describe the individual elements of multicomponent interventions are presented, and the relationship between those components and outcomes is examined. This approach is successfully applied to interventions being evaluated in the Resources for Enhancing Alzheimer's Caregiver Health (REACH) program.