Brief training to promote the use of less intrusive prompts by nursing assistants in a dementia care unit

We evaluated the efficacy of a brief staff-training procedure to increase the use of graduated prompting by 2 certified nursing assistants (CNAs) while they helped to dress 3 persons with dementia in a seven-bed dementia care unit. The multiple baseline design across participants showed that CNAs dressed residents with minimal resident involvement during baseline observations. Following brief in-service training, CNAs provided graduated prompts and praise appropriately, suggesting that CNAs can promote active involvement in personal care routines by older adults with dementia.     

Preference for leisure items over edible items in individuals with dementia: A replication

We replicated previous research in which adults with dementia tended to show a preference for leisure items over edible items when presented in the same array. Additionally, we conducted engagement analyses with the highest, middle, and lowest preference leisure items to determine whether relative preference corresponded to engagement in the natural environment. The most highly preferred stimulus for 6 out of 7 participants was a leisure item, and for each of those six the top 3 preferred stimuli were leisure stimuli. For 4 participants, the most preferred stimulus also produced the longest duration of engagement. We discuss the issues we encountered when conducting preference assessments with adults with intact vocal verbal repertoires, and suggest potential explanations for the displacement of edibles by leisure stimuli in older adults with dementia.     

SELF-MONITORING AND WORK PRODUCTIVITY WITH MENTALLY RETARDED ADULTS

We examined the use of self-monitoring to increase the productivity of five mentally retarded adults in a sheltered workshop. Data were collected daily during a 30-minute intervention and 30-minute generalization period. Following baseline, verbal praise, prompts, and physical encouragement were administered contingent on productive behavior on a specific task during the intervention period. In the next phase, self-monitoring was trained during the intervention period. During both phases, baseline conditions prevailed in the generalization periods. In the final phase, self-monitoring was extended across the intervention and generalization periods. Results showed that increased productivity levels, evident when praise and prompting were being administered, maintained with self-monitoring alone. Minimal generalization across time was observed until self-monitoring was begun in the generalization period.     

Age differences in executive functioning across the lifespan: the role of verbalization in task preparation

Age-related changes in executive functioning across the lifespan were assessed in children (mean age=9.4 years), younger adults (mean age=21.5 years), and older adults (mean age=65.3 years). Executive functioning was investigated with a task-switching paradigm that permits the separation of two control components: to select and to switch between task sets. The specific aims of this study were (a) to determine developmental functions in both control components across the lifespan; and (b) to examine whether age-related changes in these components are influenced by verbal prompts during task preparation. The results revealed an inverted u-shaped developmental function for the ability to select between task sets but not for the ability to switch between task sets. In contrast to younger adults and children, older adults generally benefited from verbalizations during task preparation. Children, but not older adults, showed a facilitation of task execution when verbal prompts were task-compatible. Conversely, older adults, but not children, showed stronger interference when verbal prompts are task-incompatible. Our findings suggest that inner speech in an important modulator of developmental changes in executive functioning across the lifespan.     

Catalysts for Developing Productive Life Reviews: A Multiple Case Study

Considered a naturally occurring process common to older adults, the life review becomes a more productive process through facilitation and development and application of effective prompts. The experiences of 6 older adults who participated in a facilitated life review process and the manner in which individualized prompts were developed are described.     

Age differences and similarities in the effects of cues and prompts

A series of 6 experiments investigated the use of cues and prompts by younger and older adults. Cues provide useful information about an impending target, even though the information is not always valid. Prompts provide an instruction about what aspect of the target is to be responded to. The costs and benefits of cues were most consistent with models in which the attentional resources that are shifted in response to the cue were as large or larger in older adults as they were in younger adults. The results with both cues and prompts converged on the conclusion that the time course of processing and using a cue or prompt is the same in younger and older adults. The attentional resources tapped by these procedures cannot be the diminished processing resource to which many age differences in cognitive performance are attributed.     

Aging and mental health in the decade ahead: what psychologists need to know

Until relatively recently, most psychologists have had limited professional involvement with older adults. With the baby boomers starting to turn 65 years old in 2011, sheer numbers of older adults will continue to increase. About 1 in 5 older adults has a mental disorder, such as dementia. Their needs for mental and behavioral health services are not now adequately met, and the decade ahead will require an approximate doubling of the current level of psychologists' time with older adults. Public policy in the coming decade will face tensions between cost containment and facilitation of integrated models of care. Most older adults who access mental health services do so in primary care settings, where interdisciplinary, collaborative models of care have been found to be quite effective. To meet the needs of the aging population, psychologists need to increase awareness of competencies for geropsychology practice and knowledge regarding dementia diagnosis, screening, and services. Opportunities for psychological practice are anticipated to grow in primary care, dementia and family caregiving services, decision-making-capacity evaluation, and end-of-life care. Aging is an aspect of diversity that can be integrated into psychology education across levels of training. Policy advocacy for geropsychology clinical services, education, and research remains critical. Psychologists have much to offer an aging society.     

Longitudinal change in language production: effects of aging and dementia on grammatical complexity and propositional content.

Mixed modeling was used to examine longitudinal changes in linguistic ability in healthy older adults and older adults with dementia. Language samples, vocabulary scores, and digit span scores were collected annually from healthy older adults and semiannually from older adults with dementia. The language samples were scored for grammatical complexity and propositional content. For the healthy group, age-related declines in grammatical complexity and propositional content were observed. The declines were most rapid in the mid 70s. For the group with dementia, grammatical complexity and propositional content also declined over time, regardless of age. Rates of decline were uniform across individuals. These analyses reveal how both grammatical complexity and propositional content are related to late-life changes in cognition in healthy older adults aswell as those with dementia. Alzheimer's disease accelerates this decline, regardless of age.     

Judgments of blame and forgiveness: A comparison of young adults,older adults,and older adults with dementia

IntroductionAlzheimer's disease may modify moral judgment.ObjectiveIn two studies, we assessed the impact of dementia on blame and forgiveness. Study 1 compared the ways in which young adults, older adults, and older adults with dementia cognitively integrated two factors. Study 2 assessed the number of different factors that older adults with dementia were able to integrate during these moral judgments.MethodThe participants recorded their moral judgements in a blame task and in a forgiveness task. In study 1, the two questionnaires contained scenarios built from the combination of two factors. In study 2, the participants were confronted with the same tasks under three different conditions with scenarios that combined three, four or five factors.ResultsThe data from study 1 showed that the older adults with dementia did not combine the two factors in the same way as young adults did: the combination depended on the type of moral judgment. Study 2 revealed differences in moral judgment between older adults with dementia and adults without dementia in all tasks (i.e. with three, four or five factors combined).ConclusionDementia has an impact on moral judgments. Moral judgment among people with dementia is both task- and condition-dependant.     

A Review of: Growing Up With Autism: Working With School-Age Children and Adolescents With Autism,edited by Robin L. Gabriels and Dina E. Hill (Eds.).

The influence of adult presence, peer smiling, and peer praise on the unprogrammed generalization of physical sharing over time was investigated. During free play three groups of five preschool children were taught to share toys via a behavioral training package composed of instructions, modeling, behavior rehearsal, prompts, and praise. Immediately following free play the children were given art materials and observed in the presence of different adults. An ABA design with a manipulation of adult presence nested within east phase was used. For all three groups, regardless of the adult presence manipulation, treatment facilitated sharing in both settings. In addition, two groups continued to share in both settings after termination of the training. The presence of an adult was necessary for unprogrammed maintenance of treatment gains in both settings whereas peer smiling and peer praise were not. Observer presence suppressed physical sharing and smiling prior to, during, and after treatment. Implications for behavioral assessment and applied significance are discussed.     

Linking resident behavior to dementia care communication: effects of emotional tone

Care for older adults with dementia is complicated by behaviors such as verbal and physical aggression and withdrawal that disrupt and increase the costs of providing care. These behaviors, referred to as resistiveness to care (RTC), have been linked to staff elderspeak communication, measured by behaviorally coded explicit behaviors. This study examined videotapes of nursing home (NH) residents with dementia interacting with staff during bathing to explore the relationships between implicit messages communicated by nursing staff and resident RTC behavior.Implicit messages in nursing staff communication were rated using the Emotional Tone Rating Scale by naïve coders. Associations between implicit ratings of care, respect, and control were analyzed in relation to RTC scale scores. Highly controlling communication was significantly correlated with increased resident RTC (r = .49, p < .05). Associations between the care and respect dimensions of communication were not significantly correlated with RTC; however, trends in hypothesized directions were identified. The association between emotional tone and RTC found in this study suggests that it is an important factor in care. Understanding affective messages is a first step in modifying these implicit messages conveyed during staff-resident communication. Research is needed to confirm these findings and to identify and test interventions to teach staff to reduce controlling messages that will to reduce RTC and improve care.     

The impacts of task relevance and cognitive load on adults’ decision information search

ABSTRACT

Higher relevance may increase older adults’ engagement in cognitively demanding activities; however, whether this effect will maintain when available cognitive resources are limited? Consequently, we investigated the joint impact of task relevance and cognitive load on older and younger adults’ decision search behaviors. We adopted a 2 (age: young/old) × 2 (cognitive load: without load/with load) × 2 (task relevance: high/low) mixed design. Sixty-one younger and 63 older adults completed high-relevance and low-relevance decisions. Our results revealed that older (vs. younger) adults took more time and more alternative-based search before decision-making. Both age groups sampled less information with an additional memory task. Additionally, they spent more time and effort to sample more information on high-relevance (vs. low-relevance) decisions; however, such differences disappeared when with an additional memory task. Task relevance promoted both age groups' search engagement, but this effect was subjected to their available cognitive resources.     

Using video modeling to teach siblings of children with autism how to prompt and reinforce appropriate play

This study investigated the use of video models to teach typically developing children how to prompt and reinforce appropriate play behavior during games with their sibling with autism. With 3 sibling dyads, we extended research on cooperative sibling play by examining video modeling as the sole intervention to facilitate appropriate play between siblings in the absence of specific reinforcement for skills learned in the video model. Video models included brief clips of adults playing games with the child with autism and demonstrating how to prompt and reinforce play behavior. Results indicated that for 2 of the 3 sibling dyads video modeling alone was sufficient to teach prompts and appropriate delivery of reinforcement. An increase in on‐task activity engagement was also observed for both siblings with autism across all 3 dyads.     

Prevention Activities for Older Adults: Social Structures and Personal Competencies That Maintain Useful Social Roles

A conceptual reorientation for providing responsive psychological services to older adults is presented, focusing on the need to develop prevention programs for older adults that encourage the maintenance of useful social roles. Changes in social structures that encourage more active social engagement are discussed, with examples drawn from housing options, part-time employment, and ways to develop more supportive social ties for older adults faced with network losses. Counselors and other mental health specialists can play a useful role in helping the public understand the social dilemmas faced by older adults and the value of their continued integration as useful citizens.     

Beliefs about age-related changes in physical functioning across the adult life span and their relationship with physical activity levels of older adults

Physical activity declines across the adult life span despite the well-established links between physical activity and health-related, psychological, cognitive, and social benefits. We contrasted the beliefs young and older adults hold about how aging affects both physical abilities and physical activity and determined whether older adults’ beliefs about physical aging relate to their engagement in physical activity. Using visual rating scales, 56 young and 49 community-dwelling older adults indicated the extent to which a typical woman or typical man aged 20–90 possesses six different physical abilities and engages in three different types of physical activity. Stereotypes of physical aging were ability- and activity-specific, and older adults endorsed more positive views than their younger peers. Stereotypical beliefs predicted older adults’ engagement in moderate-intensity activity. This study offers intriguing avenues for future research and suggests that better understanding physical aging stereotypes may contribute toward designing interventions that promote lifelong physical activity.     

Effects of setting and number of observations on generalizability of parent-child interactions in childhood obesity treatment

The generalizability of behaviors across observational conditions is a critical issue in behavioral assessment. Generalizability theory was used to examine two aspects of audio recorded parent-child interactions recorded over 6 days of home measurement and 1 day of laboratory measurement in a behavioral treatment program for childhood obesity. Families audiotaped parent-child home meetings during which they reviewed self-monitored diet and exercise records that were coded for the following types of interactions: praise statements, negative statements, prompts for new behaviors, and statements promoting problem solving. A similar meeting was audiotaped in our laboratory. The first question explored was the number of measurements needed to generalize to the universe of the six home measures. Results showed an increase in generalizability over measurements for each behavioral category. Using generalizability coefficients of .60 or more, praise, negative comments and prompts, respectively, could be reliably observed based on 1, 4, or 4 days of measurement. Second, the effects of setting (laboratory versus home) were assessed for 1 day of measurement in each environment. Again using generalizability coefficients of .60, generalizability analysis showed that the lab setting could not be generalized to the home setting based on 1 day of measurement, with generalizability coefficients ranging from .27 for negative comments to .57 for praise. Results suggest that 4 days of behavioral assessment in the home can be used to establish generalizable data for all the dependent measures studied. However, generalizability coefficients suggested that 1 day of laboratory measurement was not adequate to generalize to typical home behavior.This research was supported in part by Grant NIH HD 23713 awarded to the third author.     

Preliminary investigation of the Kitchen Picture Test (KPT): A new screening test of practical judgment for older adults

Judgment is widely recognized as an important executive function, and deficits in judgment can lead to health risks, safety concerns, and hospitalizations. Surprisingly, relatively few tests of judgment have been developed specifically for older adults—a population particularly vulnerable to executive and functional declines. The Kitchen Picture Test (KPT) is a new screening measure of practical judgment. In two independent studies (Study 1, N = 99 nursing home patients; Study 2, N = 163 nursing home and assisted living patients), psychometric analyses confirmed strong evidence for reliability, construct validity, and predictive validity. A receiver operating characteristic (ROC) curve was calculated from sensitivity and 1-specificity values for diagnoses of dementia versus no dementia. A KPT cut score can be used for identifying persons to be referred to appropriate health-care professionals who have specific expertise in the evaluation and treatment of cognitive impairment.     

Interpersonal Psychotherapy for Late Life Depression: Current Status and New Applications

Interpersonal Psychotherapy (IPT) is an empirically-supported treatment for depression and other mental disorders. This article discusses the structure of IPT, its use with older adults, and research that supports its efficacy with depressed older people. Depressed older persons with significant health problems or cognitive impairment present special challenges for those conducting IPT and other psychotherapies. Promising new psychotherapies developed for depressed older adults with cognitive impairment and those living in nursing homes are reviewed. Recommendations are made for use of IPT with older adults in nursing homes.     

Granny, (don't) get your gun: competency issues in gun ownership by older adults

This article explores the possible risks associated with gun ownership by older adults. We summarize existing regulations on who may own firearms, especially with respect to age. We then present data on older gun owners and violence committed by older adults in general, followed by a discussion of gun violence perpetrated by gun owners whose functional and cognitive abilities have declined, perhaps as a result of dementia. For comparison purposes, we review regulations on driving among older adults, drawing parallels to gun ownership. The paper concludes with recommendations for ensuring the safety of older gun owners and others, balanced against citizens' right to bear arms, and with some directions for research.