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The purpose of this study was to gain understanding about nurse practitioners' (NPs') prescriptive decision making for geriatric patients with attention to pharmaceutical marketing influences. Prior research has focused on physician prescribers and identified suboptimal practices. Because the majority of medications are prescribed to older adults, NPs in geriatric practice were targeted as an information-rich group to interview about prescribing issues. Given the exploratory nature of this research, qualitative focus group methods were employed using content analysis. Fifteen NPs were recruited at an annual national geriatric NP conference. They worked in all regions of the United States, had an average of 9 years prescribing experience, and participated in 1 of the 2 focus groups. The key theme that emerged was that they were more than a prescriber. Findings revealed overwhelming consistency among the NP participants that their nursing background instilled a holistic approach that encompassed both nondrug and therapeutic drug options and skepticism about drug marketing, as well as offered a positive difference by tailoring to their patients' biophysical, psychological, and economic needs with an involvement in the interplay of geriatric care issues not typically addressed by physicians. The participants' reported approaches were in alignment with geriatric prescribing recommendations. Copyright 2010 Mosby, Inc. All rights reserved. [ABSTRACT FROM AUTHOR]

Disparities that exist for racial and ethnic minority groups in healthcare status and access are compounded in the presence of Alzheimer's disease (AD). Recent improvements in the diagnosis and care of persons with AD need to be paralleled in minority communities with early recognition and timely evaluation. Innovative information technologies can help reduce health disparities. A qualitative study was conducted with 48 participants: to understand how cultural values influence responses to signs of memory loss and to critique a CD-ROM memory loss educational program for the purpose of tailoring it to better meet the needs and preferences of African American and Chinese American users. Traditions of close family relationships, respect for elderly and the commitment to care, central to both groups, provided the basis for the frequently parallel recommendations for a revised program. Principles of adult education and web-based program design proved essential in developing a culturally relevant program. © 2005 SAGE Publications Ltd. [ABSTRACT FROM AUTHOR]

This study used a geographically diverse sample to estimate the total cost of informal care and formal services for community-residing Alzheimer's disease (AD) care recipients. Baseline data were used for 1200 family caregivers from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) study, a multisite intervention trial. The replacement-wage-rate approach estimated informal cost. Formal services were assigned a cost based on secondary sources. Annual cost per care recipient amounted to $23,436 for informal care and $8,064 for formal services. Variation in informal cost was almost entirely due to instrumental activities of daily living (IADLs) assistance. Cross-site differences in cost persisted after controlling for caregiver and care-recipient characteristics. Geographic variation may suggest regional preferences or ethnic/cultural values. Further study is needed to determine whether this reflects differences in access or availability or how including a control group for care recipients with nondementia diagnoses might have affected these findings. [ABSTRACT FROM AUTHOR]

Family caregivers are a critical component in home care. Employee caregivers carry an additional set of demands that overlay their caregiving responsibilities. Work accommodations may result in loss of work time, pay, and benefits with detrimental income and retirement implications. Can technology be used to better manage the dual demands of employment and caregiving? Through the aegis of the Department of Commerce, National Telecommunications and Information Administration Technology Opportunity Program, this question is addressed through the development and testing of an innovative telecare system designed to support working caregivers concerned about vulnerable adults or older adults at home. Known as the Worker Interactive Networking (WIN) Project, an Internet-based telecommunication program was developed to promote workplace intergroup support and links to a home-based wireless sensor monitoring system (Nursense) that informs and alerts the worker about his or her personalized areas of oversight concern. This article presents the background and development of this application, the nursing framework, and the implications for home care. [ABSTRACT FROM AUTHOR]

The language of caregiving relies heavily on terms that are frequently negative such as caregiver stress and burden, but these are not universally accepted phenomenon. The purpose of this article is to report on the development of caregiver vigilance and to suggest it offers both neutral terminology and a means to include caregivers' perceptions of their supervisory role. The concept of vigilance emerged from a qualitative study of caregivers of family members with Alzheimer's disease. Vigilance is defined as the caregivers' continual oversight of their care recipients' activities. The five key components of vigilance were watchful supervision, protective intervening, anticipating, always on duty, and being there. Vigilant caregivers saw themselves as 'on duty' even when they were not 'doing things.' The findings of this study support caregivers' perceptions of 24-hour-a-day responsibility. Nurses need to realize that caregiver vigilance is not necessarily diminished when professional caregivers intervene or institutionalization occurs. Debriefing caregivers about their unique family caregiving knowledge and incorporating it into caregiving is a key strategy for nurses to use to build caregiver trust and reduce their vigilance time. [ABSTRACT FROM AUTHOR]

Differences in ethno-cultural perspectives have been previously suggested as the source of variation among ethnic groups regarding their approaches to dementia family caregiving. This study explored the perceptions and experiences that African American caregivers of family members with dementia encountered on their journey toward obtaining a diagnosis of dementia for their loved ones. An overall theme of respect emerged from a focus group session with seven family caregivers. Reports of respecting older family members through `normalization', thereby delaying evaluation for dementia, then encountering a lack of respect from health care providers when one was finally sought, created a duality of respect vs disrespect. This tension constituted a subtle but profound form of caregiver stress that may be unique to African American caregivers, and one that has not been considered in standardized measures. Findings inform providers about important issues to consider when working with and studying dementia caregiving among African American families. [ABSTRACT FROM AUTHOR]

This article reports on the measurement properties of Caregiver Vigilance, a four-item caregiver self-report of perceived oversight demand for Alzheimer's disease and related disorders family caregiving. The self-report uses data from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) project, a multisite National Institutes of Health (NIH) sponsored study of over 1,200 family caregivers. Results indicate that the items were clearly understood by the racially/ethnically diverse respondents; and, when responses were transformed into a summary scale and analyzed, unidimensionality was evident and internal consistency reliability favorably demonstrated. We suggest using the Caregiver Vigilance Scale in conjunction with traditional burden measures to systematically include the caregiving time associated with protectively watching over care recipients and the daily duration of this responsibility. We also highlight the practical utility of selected items for potential use in the caregiver assessment process. [ABSTRACT FROM AUTHOR]

Audiometric examinations were conducted on a random sample of 104 elderly Massachusetts' nursing home residents. The testing revealed that the majority of the participants were hearing impaired. The participants, however, consistently reported satisfaction with their hearing ability and no related hearing problems. Qualitative observations of communication among the participants, staff, and visitors documented that the elderly were negatively affected by their hearing loss. Recommendations are made to improve the quality of care for residents with hearing impairment in the nursing home setting. [ABSTRACT FROM AUTHOR]

Objective: To gain an understanding of Latino/Hispanic caregivers' dementia-related dressing issues, their impressions of using a "smart" context-aware dresser to coach dressing, and recommendations to improve its acceptability., Method: The same Latina moderator conducted all the caregiver focus groups. She followed a semi-structured interview guide that was previously used with White and African American family caregivers who experienced Alzheimer's disease related dressing challenges. From that study, the Preservation of Self model emerged. Using a deductive qualitative analytic approach, we applied the thematic domains from the Preservation of Self model to ascertain relevance to Latino/Hispanic caregivers., Results: Twenty Latino/Hispanic experienced caregivers were recruited, enrolled, and participated in one of three focus groups. The majority were female (75%) and either the spouse (25%) or adult child (35%). Striking similarities occurred with the dressing challenges and alignment with the Preservation of Self model. Ethnic differences arose in concerns over assimilation weakening the Latino culture of family caregiving. Regional clothing preferences were noted. Technology improvement recommendations for our system, called DRESS, included developing bilingual prompting dialogs and video modules using the local vernacular to improve cultural sensitivity. Caregivers identified the potential for the technology to enable user privacy, empowerment, and exercise as well as offering respite time for themselves., Conclusion: Findings suggest dementia-related dressing issues were shared in common by different racial/ethnic groups but the response to them was influenced by cultural dynamics. For the first time Latino/Hispanic voices are heard to reflect their positive technology impressions, concerns, and recommendations in order to begin to address the cultural digital disparities divide., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Alzheimer's caregiving literature acknowledges dressing as a major daily stressor but research on this topic is negligible. A qualitative grounded theory approach was used to explore Alzheimer's family caregivers' perspectives about issues that arise when their family members lose the ability to dress independently. Three focus groups and seven individual interviews were conducted and audio recorded with 25 information rich caregivers. Constant comparative analyses and coding of the transcripts identified six major themes leading to a 'Preservation of Self Model: Care Recipient to Care Giver' that portrays the caregiving trajectory. Initially, caregivers tried to protect the self dignity of the family member by maintaining usual routines and absorbing blame for difficulties. Dressing 'battles' occurred and caregivers learned management through trial and error. Crossing adult-child-gender role boundaries escalated discomfort. When facing unrelenting demands, concern shifted to preservation of the caregivers' health and self. Results suggest that caregivers would benefit from more pro-active dressing counseling to shorten the trial and error periods, dressing aids more relevant to dementia and more knowledgeable helpers. The preservation model can facilitate understanding of the caregiving trajectory and guide intervention support., (© The Author(s) 2013.)

Background: Prior research has critiqued the lack of attention to the stressors associated with dementia related dressing issues, stigmatizing patient clothing, and wearable technology challenges. This paper describes the conceptual development and feasibility testing of an innovative 'smart dresser' context aware affective system (DRESS) to enable dressing by people with moderate memory loss through individualized audio and visual task prompting in real time., Methods: Mixed method feasibility study involving qualitative focus groups with 25 Alzheimer's family caregivers experiencing dressing difficulties to iteratively inform system design and a quantitative usability trial with 10 healthy subjects in a controlled laboratory setting to assess validity of technical operations., Results: Caregivers voiced the need for tangible dressing assistance to reduce their frustration from time spent in repetitive cueing and power struggles over dressing. They contributed 6 changes that influenced the prototype development, most notably adding a dresser top iPad to mimic a familiar 'TV screen' for the audio and visual cueing. DRESS demonstrated promising overall functionality, however the validity of identification of dressing status ranged from 0% for the correct pants dressing to 100% for all shirts dressing scenarios. Adjustments were made to the detection components of the system raising the accuracy of detection of all acted dressing scenarios for pants from 50% to 82%., Conclusions: Findings demonstrate family caregiver acceptability of the proposed system, the successful interoperability of the built system's components, and the system's ability to interpret correct and incorrect dressing actions in controlled laboratory simulations. Future research will advance the system to the alpha stage and subsequent testing with end users in real world settings.

Objective: To study the adoption of a transitional minimum data set (TMDS) and its effectiveness in conveying essential clinical data elements between skilled nursing facility (SNF) and emergency department (ED) staff., Design: Retrospective medical record review of patients transferred from one SNF to one ED over a 14-month period before and after the implementation of the TMDS, to determine whether it improved data transfer compared with prior practice., Settings: One urban 140-bed SNF, averaging 17 ED transfers per month, and their affiliated ED at a major tertiary care hospital in Boston, MA., Participants: The medical records of 74 residents transferred from the SNF to the ED comprised the study data., Intervention: A Transition of Care Minimum Data Set necessary for ED care was developed based on a literature review and expert panel consensus. From this, a TMDS tool was derived. The nursing facility staff was trained on the use of the TMDS tool (Resident Transfer Form and transfer packet), which was sent with each patient at the time of transfer from the SNF to the ED., Measurements: Effectiveness of data transfer was determined by the proportion of TMDS items received by the ED following implementation of the TMDS in comparison with prior care. Adoption rate of the TMDS tool was determined by the proportion of hospital medical records that contained a paper copy of the resident transfer form., Results: Following the implementation of the TMDS there was statistically significant improvement in data transfer of 15 of 30 TMDS items. Among these items were the following: patient's family notified of transfer, contact information for the MD/NP at the SNF, contact information for obtaining more patient information from the SNF, resuscitation status, baseline cognitive and functional status, isolation precautions and risk alerts, and whether the SNF could accept the patient back after treatment in the ED. The Resident Transfer Form was found in the hospital medical record of 73% of patients. There were anecdotal reports of hospital provider satisfaction with the TMDS and RTF., Conclusion: The TMDS was associated with marked improvement in the transfer of essential clinical information. Educational efforts are warranted to increase consistency of usage., (Copyright © 2012 American Medical Directors Association. All rights reserved.)

Objective: To assess nurse practitioners' interactions with pharmaceutical industry promotional activities and their perception of information reliability and self-reported prescribing behaviors., Study Design: Self-administered online survey., Methods: A nationally randomized sample of nurse practitioner prescribers was surveyed. Eligibility criteria included current clinical practice and licensure to prescribe medications in their state of practice., Results: A total of 263 responses were analyzed. Almost all respondents (96%) reported regular contact with pharmaceutical sales representatives, and most (71%) reported receiving information on new drugs directly from pharmaceutical sales representatives some or most of the time. A large portion (66%) dispensed drug samples regularly to their patients, and 73% believed that samples were somewhat or very helpful in learning about new drugs. Eighty-one percent of respondents thought that it was ethically acceptable to give out samples to anyone, and 90% believed that it was acceptable to attend lunch and dinner events sponsored by the pharmaceutical industry. Almost half (48%) stated that they were more likely to prescribe a drug that was highlighted during a lunch or dinner event. Most respondents stated that it was ethically acceptable for speakers to be paid by industry., Conclusions: Nurse practitioner prescribers had extensive contact with pharmaceutical industry promotional activities such as pharmaceutical representative contact, receipt of drug samples, and regular attendance at industry-sponsored meal events and continuing education programs. They reported that industry interface with nurse practitioner prescribers in the form of sponsored meals, education events, and paid speakers was ethically acceptable.

What benefit will new technologies offer if they are inadequately or not used? This work presents a meta-synthesis of adoption of technology related findings from four innovative monitoring intervention research studies with older adults and their informal and/or formal caregivers. Each study employed mixed methods analyses that lead to an understanding of the key variables that influenced adoption of telephone and Internet based wireless remote monitoring technologies by elders and their caregivers. The studies were all conducted in "real world" homes ranging from solo residences to multi-story independent living residential buildings. Insights gained came from issues not found in controlled laboratory environments but in the complex interplay of family-elder-staff dynamics around balancing safety and independence. Findings resulted in an adoption of technology model for remote monitoring of elders' daily activities derived from evidence based research to advance both practical and theoretical development in the field of gerontechnology.

The increasing number of cognitively impaired older adults who exhibit wandering tendencies raises safety concerns. The purpose of the current study was to research the State-of the-Art in Wearable Technologies for persons with Alzheimer's Disease and identify challenges unique to this population and lessons learned. Inclusion criteria specified systems/devices that completed laboratory testing and were commercially available for usage by community-based Alzheimer's family caregivers. Methods included a series of Internet product searches and telephone interviews with related corporate representatives and participant's referrals. Results indicated many products in development or academic research use but only a limited number were available that met the study criteria. The interviews with key informants revealed features necessary to consider when making products to be worn by persons with cognitive impairment. In conclusion, there is no ideal solution and opportunities remain for marketplace innovations and for addressing the challenges associated with balancing safety and security.

With the upcoming reform of the healthcare system and the greater emphasis on care in the home and other living environments, geriatric providers will need alternate ways of monitoring disease, activity, response to therapy, and patient safety. Current understanding of the dynamic nature of chronic illnesses, their effects on health over time, and the ability to manage them in the community are limited to measuring a set of variables at discrete points in time, which does not account for the dynamic interactions between physiological systems and the environments of daily life. Recent developments of sensors, data recorders, and communication networks allow the unprecedented measurements of physiological and sociological data for use in geriatrics care. This article identifies and discusses the important issues regarding the use of monitoring technologies in elderly patients. The goals are fourfold. First, some emerging technology that may improve the lives of older adults and improve care are highlighted. Second, the possible applications of technology in geriatrics settings are discussed, with a focus on acute falls, dementia, and cardiac conditions. Third, real and perceived concerns in using monitoring technology are identified and addressed, including technology adoption by elderly people; stigma; and the reduction in social contact; ethical concerns of privacy, autonomy, and consent; concerns of clinicians, including information overload, licensure, and liability; current reimbursement schemes for using technology; and the reliability and infrastructure needed for monitoring technology. Fourth, future approaches to make monitoring technology useful and available in geriatrics are recommended., (© 2010, Copyright the Authors. Journal compilation © 2010, The American Geriatrics Society.)

Severe staff shortages in long-term care (LTC) make it difficult to meet the demands of the growing aging population. Further, technology-savvy Baby Boomers are expected to reshape the current institutional environments toward gaining more freedom and control in their care and lives. Voices from business, academia, research, advocacy organizations, and government bodies suggest that innovative technological approaches are the linchpin that may prepare society to cope with these projected demands. In this article, we review the current state of aging-related technology, identify potential areas for efficacy testing on improving the quality of life of LTC residents in future research, and discuss barriers to implementation of LTC technology. Finally, we present a vision of future technology use that could transform current care practices., (Copyright 2010, SLACK Incorporated.)

OBJECTIVE: To gain an increased understanding about the geriatric health and safety concerns related to vulnerable elders residing alone in independent living facilities (ILFs). METHODS: Qualitative focus group methodology was used to elicit the perceptions of elderly residents representing three ILFs, their family members, housing staff, and Nurse Practitioner consultants. RESULTS: Staff comprised 3 focus groups, residents 4 groups, and families 1 group for a total of 26 participants across eight focus groups. Content analyses of transcripts revealed that falls, forgetfulness/confusion, medication management and unexpected critical health events were concerns shared across the groups. Subgroups differed greatly in other concerns and service expectations. DISCUSSION: Findings resulted in a thematic model of Connected Disconnections with shared concerns, differences in beliefs and tension points. Problems arise when the wrong residents are living in the wrong type of housing. More attention to pre-admission resident evaluation and clarifying service expectations with families before acceptance and during periods of elder functional decline are recommended.

Innovative technologies are rapidly emerging that offer caregivers the support and means to assist older adults with cognitive impairment to continue living "at home." Technology research and development efforts applied to older adults with dementia invoke special grant review and institutional review board concerns, to ensure not only safe but also ethically appropriate interventions. Evidence is emerging, however, that tensions are growing between innovators and reviewers. Reviewers with antitechnology biases are in a position to stifle needed innovation. Technology developers who fail to understand the clinical and caregiving aspects of dementia may design applications that are not in alignment with users' capabilities. To bridge this divide, we offer an analysis of the ethical issues surrounding home monitoring, a model framework, and ethical guidelines for technology research and development for persons with Alzheimer's disease and their caregivers.

Research has demonstrated the health and financial cost to working caregivers of older adults and the cost to business in lost productivity. This paper describes the implementation of the Worker Interactive Networking (WIN) project, a Web-based program designed to support employed caregivers at work. WIN innovatively linked working caregivers via the Internet to home to monitor elders' status using wireless sensor technology and included an online information and support group for a six-month period. Twenty-seven employees from thirteen business sites participated. Despite problems with wireless carrier service, feasibility outcomes were achieved. We were able to collect six months of continuous real time data wirelessly from multiple types of homes across 4 states. This model demonstrates that businesses can offer a similar program and not be overwhelmed by employee demand or abuse of technology access. Reluctance to consider home monitoring was apparent and was influenced by familial relationships and values of privacy and independence.

Purpose: We explored cross-cultural similarities and differences in minority family caregivers' perceptions of the onset and diagnosis of Alzheimer's disease in their relatives, with specific attention to clinical encounters., Design and Methods: We performed a meta-synthesis of three qualitative studies conducted in Massachusetts with 22 African American, Latino, and Chinese caregivers., Results: All participants conveyed striking similarities of thought about normalization of cognitive symptoms until one critical event, usually relocation, precipitated family awareness that an elder's behavior was not the result of "normal aging." A lack of knowledge about Alzheimer's disease, rather than culturally influenced beliefs, was the major deterrent to having an elder's memory assessed. Community physicians' failure to recognize Alzheimer's disease or refer to specialists was more problematic than language or ethnic differences. Physicians' disrespect for caregivers' concerns about memory loss was particularly noted by African Americans, stigmatization of persons with Alzheimer's disease was noted by Chinese, and fears that acculturation would end family home care was noted by Latinos., Implications: Amid ethnocultural differences, there are many similarities in needs that offer providers the possibility to unify quality improvements in Alzheimer's disease outreach, education, and physicians' services. Suggestions include providing the public with more confidential access to Alzheimer's disease information, increasing dementia awareness among community physicians, motivating clinicians to adopt culturally sensitive communication patterns, and providing community education to reduce normalization by families and stigmatization of persons with Alzheimer's disease.

The purpose of this study was to explore the phenomenon of dementia caregiving in an ethnically diverse group of Latino caregivers, with the goal of identifying cultural influences on the caregiving experience. This qualitative, descriptive, cross-sectional study used Leininger's ethnonursing approach. There were more similarities than differences in this multiethnic sample of Latino caregivers in understanding of dementia symptoms, beliefs about the caregiving role, and in the factors affecting ongoing care. A lack of knowledge about dementia, rather than culturally influenced beliefs, was the major deterrent to recognition of initial symptoms. Participants viewed family-centered home care as a culturally embedded value but were willing to consider placement when home care became impractical. Providers need to understand the ways in which caregivers must negotiate the tension between cultural beliefs and the demands of their individual circumstances.

Although there has been considerable interest in racial differences in family caregiving for persons with dementia, most research to date has either ignored racial diversity or based conclusions on small numbers of caregivers drawn primarily from single site studies. The current study utilized participants from four sites of the REACH (Resources for Enhancing Alzheimer's Caregiver Health) multi-site study to compare well-being, appraisal, and religious coping by race. African-American (n = 295) and Caucasian (n = 425) dementia caregivers from four cities (Birmingham, Memphis, Boston, and Philadelphia) were compared in their demographics, care recipient characteristics, mental and physical health, and psychosocial coping resources including appraisal and religious coping. African-American caregivers reported lower anxiety, better well-being, less use of psychotropic medications, more benign appraisals of stress and perceived benefits of caregiving, and greater religious coping and participation, than Caucasian caregivers. Self-rated health did not differ by race, but African-American caregivers reported more unhealthy behaviors than Caucasian caregivers. Some results were specific to site, possibly due to differences in recruitment strategies, inclusion/exclusion criteria, and regional differences. Adjustment for covariates, including caregiver relationship to the care recipient, gender, age, socioeconomic status, and care recipient behavioral problems, altered few of these differences. Results are discussed in terms of their relevance to psychosocial intervention programs for ethnically diverse caregivers., (Copyright Taylor & Francis Ltd)

Purpose: We determine the main outcome effects of a 12-month computer-mediated automated interactive voice response (IVR) intervention designed to assist family caregivers managing persons with disruptive behaviors related to Alzheimer's disease (AD)., Design and Methods: We conducted a randomized controlled study of 100 caregivers, 51 in the usual care control group and 49 in the technology intervention group, who received yearlong access to an IVR-mediated system. The system provided caregiver stress monitoring and counseling information, personal voice-mail linkage to AD experts, a voice-mail telephone support group, and a distraction call for care recipients. We conducted analyses by using a repeated measures approach for longitudinal data and an intention-to-treat analytic approach. Outcomes included the caregiver's appraisal of the bothersome nature of caregiving, anxiety, depression, and mastery at baseline, 6, 12, and 18 months., Results: There was a significant intervention effect as hypothesized for participants with lower mastery at baseline on all three outcomes: bother (p =.04), anxiety (p =.01), and depression (p =.007). Additionally, wives exhibited a significant intervention effect in the reduction of the bothersome nature of caregiving (p =.02)., Implications: Wives who exhibited low mastery and high anxiety benefited the most from the automated telecare intervention. Findings suggest that, to optimize outcome effects, similar interventions should be tailored to match the users' characteristics and preferences.

Objective: The aim of the project was to develop and evaluate the effectiveness of a CD-ROM-based multimedia program as a tool to increase user's knowledge about the differences between "normal" forgetfulness and more serious memory loss associated with Alzheimer's disease., Design and Measurements: The research was a controlled randomized study conducted with 113 adults who were recruited from the community and who expressed a concern about memory loss in a family member. The intervention group (n=56) viewed a module entitled "Forgetfulness: What's Normal and What's Not" on a laptop computer in their homes; the control group (n=57) did not. Both groups completed a 25-item knowledge-about-memory-loss test (primary outcome) and a sociodemographic and technology usage questionnaire; the intervention group also completed a CD-ROM user's evaluation., Results: The mean (SD) number of correct responses to the knowledge test was 14.2 (4.5) for controls and 19.7 (3.1) for intervention participants. This highly significant difference (p<0.001) corresponds to a very large effect size. The program was most effective for participants with a lower level of self-reported prior knowledge about memory loss and Alzheimer's disease (p=0.02). Viewers were very satisfied with the program and felt that it was easy to use and understand. They particularly valued having personal access to a confidential source that permitted them to become informed about memory loss without public disclosure., Conclusion: This multimedia CD-ROM technology program provides an efficient and effective means of teaching older adults about memory loss and ways to distinguish benign from serious memory loss. It uniquely balances public community outreach education and personal privacy.

Objectives: This study examined the cost and outcomes associated with multiple recruitment strategies used to enroll participants in an Alzheimer's disease (AD) caregiver study., Methods: Recruitment data were collected as part of an AD caregiving intervention study and examined for number of referrals and participants, yield, personnel cost, materials cost, total cost, and cost per participant., Results: Recruitment rates varied by method implemented and referral source. Overall, 100 participants were enrolled for a total cost of $10,127, yielding an average per participant cost of $101.00. The Formal Recruitment Method, used at agencies with large participant pools, emerged as the most cost-effective strategy., Discussion: Recruitment costs varied greatly, depending on the referral sites and their available pool of participants. Substantial time, money, and personnel need to be budgeted for recruitment efforts given the expected costs, the competing pressures in the health care region, and the variability of participant response.

Administrators and key informants in restraint-free nursing homes participated in a telephone survey to improve understanding of the process, resources, and measures for successful adoption of restraint-free care. Respondents expressed a strong opinion that each facility must develop its own individualized approach to restraint removal. However, similar approaches were found which suggest that efficiencies in conversion may be gained through application of change theory informed by restraint removal experience.

For many years NPs have worked to change the state regulations that restricted their ability to prescribe medications. Now, as the majority of states have removed sanctions against NP prescribing, attention is needed to monitor the implementation of the regulatory changes. Findings from this study indicate that some employers continue arbitrary practice restrictions on NP prescribing even after legislative reforms.

Legislators' concerns about the ability of nurse practitioners (NPs) to appropriately prescribe medications underlie the regulatory policies governing prescribing in the United States. As a result, state legislation varies concerning whether prescriptive authority is granted to NPs. The prescribing decisions of NPs and physicians were compared using three standardized geriatric case vignettes. NPs scored higher on an index of appropriateness than physicians a difference that remained whether or not the nurse had regulatory support to prescribe. Recommendations are made for more equitable state prescription policies.

Sensitivity to older adults as consumers will ensure the development of programs that are targeted appropriately to fill a need in the marketplace. Programs should be designed on the basis of information gained in the programmatic needs assessment. Health professionals who assume they know the needs, wants, and desires of older consumers because they treat so many ill elderly people risk program failure. By contrast, those that listen to older consumers and heed the signals from the geriatric marketplace are most likely to succeed.