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Objective: This study explored how male and female family caregivers of Alzheimer's disease (AD) patients differ in their use of formal services and informal support and how religiousness may affect such differences. Methods: Data were from a sample of 720 family caregivers of AD patients who participated in the Resources for Enhancing Alzheimer's Caregiver Heath (REACH I) study sites in Birmingham, Boston, Memphis, and Philadelphia. Results: Female caregivers were less likely to use in-home services than males (M = 0.83 vs. M = 1.06, p < .01) but reported more use of transportation services (21.6% vs. 12.7%, p < .01) and more use of informal support (M = 13.9 vs. M = 10.7, p < .01). Mediation tests suggested that three measures of religiousness helped explain the relationship between gender and use of formal services and informal support. Discussion: These findings highlight the necessity to assess AD caregivers' religiousness to better understand their circumstances. [ABSTRACT FROM AUTHOR]

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.

The effects of a 12-week intervention on a patient-focused skills training group and a caregiver-focused skills training group were compared with those on a control group that received comparable attention, but no training. Intervention effects were monitored at the completion of the treatment phase and at 3- and 6-months postintervention. Treatment implementation was documented in a comprehensive fashion to ensure replicability. Both training groups acquired skills that enabled them to improve targeted behaviors (patient problem behaviors and caregiver mood, respectively). Weaker effects were found for more distal outcomes, such as depression, perceived stress, caregiver strain, and self-efficacy. [ABSTRACT FROM AUTHOR]

In this preliminary, intrasubject study (N = 8), we examined the effects of communication skills training and the use of memory books by Nursing Assistants (NAs) on the social ecology of a nursing home. Through inservice and on-the-job training, NAs were taught to use communication skills and memory books during their interactions with residents with mild to moderate cognitive impairment (Mini Mental Status Examination, M = 16.25), but relatively intact communication abilities. An abbreviated staff motivational system called Behavioral Supervision (Burgio and Burgio, 1990. Int. J. Aging Hum. Deve. 30: 287–302.) was attempted to encourage performance of these skills on the nursing units. Results showed that, regardless of sporadic implementation of the intervention by nursing staff, the intervention improved communication between staff and residents during care routines, increased the amount of time other residents and visitors spent talking with target residents, and increased the rate of positive statements made by the target residents and others in their immediate environment. Results are discussed in terms of limitations of the staff motivational system and modifications made to the system in a larger ongoing intervention trial. [ABSTRACT FROM AUTHOR]

Describes an intervention in which caregivers of people with Alzheimer's disease learned to use problem-solving skills training to help them achieve a personal goal. Case studies; Discussion of the methods and challenges of providing successful problem-solving training to Alzheimer's disease caregivers.

The negative impact of family caregiving can be significant. Research demonstrates that caregivers are at risk for considerable burden, depression, and disruption of their social activities. Recent intervention studies, however, have shown that family caregivers can benefit from skill training programs. Elements essential in training family caregivers in behavioral management skills will be highlighted in this article, with special attention given to three areas (1) education in Alzheimer's disease and the basic concepts of behavior management, (2) a curriculum of specific behavioral management techniques, and (3) the development and implementation of individualized behavioral prescriptions. A comprehensive case study is included. [ABSTRACT FROM AUTHOR]

Although direct observation has provided much information regarding caregiver-care recipient interactions, our understanding of the applications of this technique remains incomplete. This study expands upon earlier observational work by examining adults with mental retardation (MR) and their family caregivers in the home setting. Specialized computer software was used to conduct real-time observation and recording of interactional styles of maternal caregivers of eight younger (M = 23 years old) and eight older (M = 49 years old) MR adults during two cognitive tasks: block design and card sorting. Differences in the amount and type of assistance provided by the caregiver were examined by coding the occurrence and duration of seven interactional behaviors. The results demonstrated that the caregivers of the younger adults used more positive statements and modeling/gestural prompts, whereas the caregivers of the older adults provided more physical assistance and performed more of the tasks themselves. More importantly, this project provided information regarding interactions between MR adults and their maternal caregivers and demonstrated the utility of computer-assisted data collection technology with a community-based, nondemented population. [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]

Computer and manual systems were used simultaneously to record observations of nursing home residents with dementia during a study designed to improve their dressing performance. This article differentiates the overlapping and unique features of the two data collection systems and discusses the clinical and research utility of each system. Although the computer system was more suited to clinical research and the manual system to clinical practice, when used in tandem each system provided data about the residents' performance that could be used for both clinical research and clinical practice, and complemented or expanded upon data generated by the other system. [ABSTRACT FROM AUTHOR]

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.

Looks into the business of establishing and maintaining a nursing home in the U.S. Composition of the staff of a nursing home; Identification of the medical conditions of residents; Prevalence and impact of severe behavioral disturbances.

Self-stimulatory behavior is described as a class of stereotyped and repetitive behaviors. This behavior often warrants concern because it can interfere with the learning and maintenance of more appropriate functional behaviors. In the present study, several topographies of self-stimulation were generated and the behavior of three older adult nursing home patients was observed for six weeks. Self-stimulation was high rate in all three subjects, and the manifestation of the behavior was idiosyncratic. Potential etiological factors and implications for treatment were discussed. [ABSTRACT FROM AUTHOR]

An attempt was made to reduce the overall number of cigarettes smoked per day with a mildly retarded adult. Self-monitoring was compared to self-monitoring plus self-graphing and goal setting procedures in reducing the number of cigarettes smoked. Self-monitoring plus self-graphing and goal setting was superior to self-monitoring alone when the goal was set at 15 cigarettes per day, but the actual number of cigarettes smoked increased when the goal was set at 12. The number of cigarettes smoked during all treatment conditions was lower than either baseline conditions. The therapist also reduced the patient's caffeine intake and switched the client's brand of cigarettes to a low "tar"/nicotine brand. The reduction in caffeine and "tar"/nicotine was related to a small and transient increase in somatic complaints and verbal abuse, as well as the complete elimination of nocturnal enuresis. Brand switching to low "tar"/nicotine cigarettes did not result in an increase in the number of cigarettes smoked per day. [ABSTRACT FROM AUTHOR]

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.

The article examines the use of operantly-based treatment procedure for stair avoidance by a severely mentally retarded adult by researchers from the U.S. Results of the study indicate that operantly-based procedure, composed of contingent social and edible reinforcement and physical guidance, was effective in increasing stair use.

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]

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]