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Interventions for older persons reporting memory difficulties: a randomized controlled pilot study
- Authors:
- COHEN-MANSFIELD Jiska, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 30(5), 2015, p.478–486.
- Publisher:
- Wiley
Objective: The objective of this study is to compare three different interventions for persons who report memory difficulties: health promotion, cognitive training, and a participation-centred course, using a single-blind, randomized controlled design. Methods: Participants were 44 Israeli adults with memory complaints, aged 65 years or older. The main outcome variable was the Global Cognitive Score assessed using the MindStreams® mild cognitive impairment assessment, a computerised cognitive assessment. The Mini-Mental State Examination and the self-report of memory difficulties were also utilised. To assess well-being, the UCLA Loneliness Scale-8 was used. Health was evaluated by self-report instruments. Results: All three interventions resulted in significant improvement in cognitive function as measured by the computerised cognitive assessment. All approaches seemed to decrease loneliness. The only variable which showed a significant difference among the groups is the self-report of memory difficulties, in which the cognitive training group participants reported greater improvement than the other groups. Conclusion: Multiple approaches should be offered to older persons with memory complaints. The availability of diverse options would help fit the needs of a heterogeneous population. An educational media effort to promote the public's understanding of the efficacy of these multiple approaches is needed. (Edited publisher abstract)
Knowledge of and attitudes toward nonpharmacological interventions for treatment of behavior symptoms associated with dementia: a comparison of physicians, psychologists, and nurse practitioners
- Authors:
- COHEN-MANSFIELD Jiska, et al
- Journal article citation:
- Gerontologist, 52(1), February 2012, pp.34-45.
- Publisher:
- Oxford University Press
Behaviour problems are common in nursing home residents with dementia. Although current guidelines recommend non-pharmacological interventions (NPHIs) as first-line treatment, pharmacological regimens (PIs) continue to be used. The purpose of this study was to explore the attitudes and beliefs of physicians (MDs), psychologists (PhDs), and nurse practitioners (NPs) concerning PI and NPHI usage as well as knowledge of NPHIs. A total of 108 MDs, 36 PhDs, and 89 NPs responded to a web-based questionnaire that captured level of agreement with statements concerning treatment of behaviour symptoms and familiarity with NPHIs. The findings showed that NPs were the most favourable toward NPHIs. MDs were significantly more favourable to the use of PIs than were PhDs, with attitudes of NPs falling in between. All felt that NPHI usage should increase and that NPHIs should be implemented before using PIs but also believed that PIs work well for behaviour problems. MDs had significantly lower knowledge of NPHIs than PhDs or NPs. Overall, NPHI knowledge was similar for PhDs and NPs, although they differed on their use of specific interventions. The article concludes that more comprehensive training of professionals in the growing toolkit of NPHI and in the tailoring of NPHI to resident habits, preferences, remaining abilities, and behaviour is indicated.
Assessment and treatment of behavior problems in dementia in nursing home residents: a comparison of the approaches of physicians, psychologists, and nurse practitioners
- Authors:
- COHEN-MANSFIELD Jiska, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(2), February 2012, pp.135-145.
- Publisher:
- Wiley
Physicians, psychologists, and nurse practitioners all assist in evaluation and treatment planning for residents with behaviour problems in long-term care facilities. The aim of this study was to compare the approaches of these different health professionals in the assessment and treatment of dementia-associated behaviour problems in nursing home residents. The members of 3 professional associations representing these groups were invited by e-mail to participate in a web-based survey. The survey solicited information about the symptoms, assessment methods, suspected etiologies, and interventions with respect to the most recently treated resident with dementia-associated behaviour problems. Completed responses were obtained from 108 physicians, 38 psychologists, and 100 nurse practitioners. The findings showed that all groups relied similarly on information from the nursing staff, speaking with nursing assistants, and care team meetings in assessment. Nurse practitioners were more likely to consult with family members. A standard assessment instrument was used most frequently by psychologists (50%), but this generally assessed cognitive status rather than problem behaviours. Groups were similar in attributing the behavioural symptoms to dementia and to underlying medical conditions, but psychologists were more likely to indicate depression, loneliness/boredom, staff-resident communication, and insufficient activities as etiologies. Use of pharmacological and nonpharmacological interventions of physicians and nurse practitioners were similar. Psychologists reported least satisfaction with treatment.
Engaging nursing home residents with dementia in activities: the effects of modeling, presentation order, time of day, and setting characteristics
- Authors:
- COHEN-MANSFIELD Jiska, et al
- Journal article citation:
- Aging and Mental Health, 14(4), May 2010, pp.471-480.
- Publisher:
- Taylor and Francis
Engagement in activities can have positive effects on persons with dementia. This study focuses on the impact of setting characteristics and presentation effects on engagement with stimuli in persons with dementia, specifically asking if stimulus modelling, order of presentation, and setting characteristics impact the duration and quality of engagement. The participants were 193 residents of 7 Maryland nursing homes. Engagement was assessed through systematic observations using the Observational Measurement of Engagement, and data pertaining to setting characteristics (background noise, light, and number of persons in proximity) were recorded via the environmental portion of the Agitation Behavior Mapping Inventory. The results revealed that study participants were engaged more often with moderate levels of sound and in the presence of a small group of people (from 4 to 9 people). As to the presentation effects, multiple presentations of the same stimulus were found to be appropriate for the severely impaired as well as the moderately cognitively impaired. Moreover, modelling of the appropriate behaviour significantly increased engagement, with the severely cognitively impaired residents receiving the greatest benefit from modelling. These findings have direct implications for the way in which caregivers could present stimuli to residents in order to optimise engagement in persons with dementia.
The impact of past and present preferences on stimulus engagement in nursing home residents with dementia
- Authors:
- COHEN-MANSFIELD Jiska, et al
- Journal article citation:
- Aging and Mental Health, 14(1), January 2010, pp.67-73.
- Publisher:
- Taylor and Francis
In spite of evidence that involvement in meaningful social activities is beneficial to persons with dementia, nursing home residents with dementia spend the majority of their time not engaged in any kind of activity. This study examined engagement with stimuli in 193 nursing home residents with dementia. The hypothesis was that activities and stimuli based on a person's past and current preferences would result in more engagement than other activities and stimuli. A phone interview was conducted with the closest relative to determine which activities had been enjoyed in the past and which are presently enjoyed in the following areas: art, music, babies, pets, reading, television, and office work. Observational Measurement of Engagement (duration, attention and attitude) were recorded through direct observations. The results revealed that residents with current interests in music, art, and pets were more engaged by stimuli that reflect these interests than residents without these interests. Although past preferences were predictive of current responsiveness, information about current preferences was generally more potent. The article concludes that the findings demonstrate the utility of determining a person's preferences for stimuli in order to predict responsiveness. Lack of prediction for some stimuli may reflect differences between past preferences and activities that are feasible in the present.
The impact of personal characteristics on engagement in nursing home residents with dementia
- Authors:
- COHEN-MANSFIELD Jiska, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(7), July 2009, pp.755-763.
- Publisher:
- Wiley
This study aimed to examine the impact of personal attributes on engagement in persons with dementia. Participants were 193 residents of seven Maryland nursing homes. All participants had a diagnosis of dementia. Cognitive functioning was assessed via the Mini-Mental State Examination, and engagement was assessed via the Observational Measure of Engagement. Data pertaining to activities of daily living were obtained from the Minimum Data Set. Women had longer mean engagement duration than men, and significant results were not seen with the other demographic variables. Significant, positive correlations were found between higher cognitive functioning and longer engagement duration, more attention, a more positive attitude, and a higher refusal rate. There was a positive and significant correlation between the comorbidity index and engagement duration, and between the number of medications and attention. All functional status variables yielded significance in a positive direction. Participants with poor hearing had a higher refusal rate. Cognitive status was the most consistent and potent predictor of engagement in this population. The authors conclude that, despite a higher refusal rate among those with higher cognitive levels, their overall engagement with stimuli is higher. Caregivers should anticipate higher refusal rates in those with poor hearing, and therefore compensatory methods should be used in presenting stimuli in this population. The potent role of cognitive and functional status on engagement of persons with dementia underscores the importance of tailoring activities to nursing home residents' needs, interests, and limitations.
Dressing of cognitively impaired nursing home residents: description and analysis
- Authors:
- COHEN-MANSFIELD Jiska, et al
- Journal article citation:
- Gerontologist, 46(1), February 2006, pp.89-96.
- Publisher:
- Oxford University Press
Getting dressed is an activity that is of particular difficulty for many persons with dementia, given the need for hand-eye coordination, fine motor skills, and overall planning skills. Despite several studies concerning interventions to improve dressing behaviour, very little is known about the dressing process as it is currently performed. The purpose of this study is to characterize the dressing activity of daily living (ADL) of nursing home residents suffering from dementia and thereby identify ways to improve the dressing process. The authors analyzed videotapes of dressing of 20 special care unit residents to describe the dressing process and the interaction between residents and staff members. Staff members completely dressed the residents in the majority of cases. Interaction between the staff members and the residents was considered insufficient in most sessions. The study identified possible intervention techniques, assistive devices, organizational routines, and environmental changes that may improve the dressing process. The results have implications that nursing homes may consider in their policies, care activities, staff training, and environment to facilitate safety, comfort, and satisfaction during the dressing process.
Elderly persons' preferences for topics of discussion and shared interest groups
- Authors:
- COHEN-MANSFIELD Jiska, et al
- Journal article citation:
- Journal of Gerontological Social Work, 44(3/4), 2005, pp.39-57.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Less than 20% of elderly persons age 65 and over participate in senior center activities. Therefore, there is a need to clarify the preferences of older persons for activities. This paper represents the first attempt to systematically determine such interests in order to better tailor programs to this population. Participants in the study were 148 residents of five low-income independent senior apartment buildings in Maryland. Two types of assessments of interest were attempted. The highest rates of interest exhibited were for music groups, followed by games, health and legal issues, aging/memory problems, and movies or videos. Overall interest in groups was related to higher level of education, greater loneliness, and younger age.