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.     

Pragmatic communication skills in patients with Parkinson's disease

BACKGROUND: Pragmatic communication abilities may depend on intact frontal lobe systems. Independent evidence suggests that some persons with Parkinson's disease (PD) are impaired on measures of frontal lobe function. HYPOTHESIS: We therefore hypothesized in Study 1 that pragmatic communication skills would be impaired in some persons with PD and would be linked to frontal dysfunction in these patients. In Study 2 we hypothesized that PD patients would be unaware of their pragmatic communication deficits. METHODS: In Study 1 we administered tests of pragmatic abilities and frontal lobe functioning to twenty-two persons with Parkinson's disease (PD) and 10 healthy controls. In Study 2 we obtained self-ratings of pragmatic abilities from 11 PD patients and then checked these self-ratings against ratings of these same abilities by the patient's spouses. RESULTS: We found in Study 1 that patients with PD were: (a) significantly impaired on measures of pragmatic communication abilities, especially in the areas of conversational appropriateness, turn-taking, prosodics and proxemics, and that this impairment was significantly related to measures of frontal lobe function. In study 2 we found that PD patients overestimated their own abilities relative to spousal ratings of those abilities and thus were unaware of the extent of their problems with pragmatic social communication skills. CONCLUSION: We conclude that pragmatic social communication skills are impaired in PD and that this impairment may be related to frontal lobe dysfunction.     

Love and space in the nursing home

Nursing homes and other institutionsdesigned for persons with impairments are not,in fact, designed for persons with impairments.They are typically designed for theimpairments, not the persons, and therebybecome a part of the problem by reinforcingphysical and cultural manifestations of theimpairments. In the essay that follows, Idescribe an architectural design project inwhich students were asked to make changes to anexisting nursing home for the persons who livedthere. This requires not only becoming familiarwith the spaces, but with the personsthemselves and designing space to helparticulate their voices and being. This revised version was published online in June 2006 with corrections to the Cover Date.     

Ego atrophy in substance abuse: addiction from a socio-cultural perspective

The use of intoxicants is indexed in American history adopting a social perspective of the role of alcoholism in traditional American society. Appealing to societal patterns, the elaboration of substance abuse as a disease is explored with a diagnostic focus on intervention as it relates to pathogenesis. Using clinical vignettes, the ego is proposed as the focus of pathology in the addiction process, featuring a regression to the defenses of projection and denial. Following the model proposed in Zinberg's seminal paper on addiction and ego function, various deficits are annotated that typify such regression. The ultimate clinical picture is one of ego atrophy, where basic interests and object relations are usurped by the all-consuming preoccupation with the substance of abuse.     

The Feeling-Tone Questionnaire: Reliability and Validity of a Direct Patient Assessment Screening Instrument for the Detection of Depressive Symptoms in Cases of Dementia

The purpose of this study was to develop a reliable and valid measure of affective disorder in elderly demented patients. The field lacks instruments which are sensitive to detecting depressive signs in severely as well as mildly and moderately demented subjects. Two samples of subjects were chosen for study. The first sample consisted of subjects from six institutions, which were chosen for study from a probability sample of 25 long-term care institutions in New York City. This sample was part of the Cross-National Institutional Study conducted in New York and London (Gurland et al., 1979; Mann et al., 1984). Thirty patients were selected at random within each institution. The second sample consisted of 52 inpatients at Willard Psychiatric Center, a traditional state psychiatric hospital in upstate New York. All subjects had a chart diagnosis of dementia and were 60 years old or older. The mean age of the sample was 82 years and 56% of the subjects were female. The Feeling-Tone Questionnaire, which was developed for these analyses, consists of 16 dichotomous items and 16 5-point Likert ratings of affect. The reliability of this scale using Cronbach's alpha is .91 for the long-term care institutional sample and .90 for the psychiatric hospital sample. Interrater reliability for two raters on ten cases is .99. Test–retest reliability on ten cases with a 1-day to 2-day interval between trials is .81. A short mood scale was developed from the observational data as a validity measure for the Feeling-Tone Questionnaire. Evidence for the validity of the Feeling-Tone Questionnaire is provided.     

Counseling Older Adults with Dementia: A Survey of Therapists in Massachusetts

Although much has been written about therapeutic interventions with caregivers, little is known about the counseling services that are available for victims of dementia. The present study was designed to explore community mental health center (CMHC) services and therapists' experiences in providing psychotherapy to this population in Massachusetts. Only 27 of the 36 CMHCs in the state reported providing mental health services to older adults with a dementing illness. A survey of therapists who specialized in working with older adults found that the percentage of older adult clients estimated to have dementia averaged about half of their caseload. Older persons in the early phase of a dementing illness were most frequently referred for depression and anxiety, whereas those with moderate decline were most frequently referred for management of disruptive behavior. The most common services provided to clients with dementia consisted of assessment and individual counseling. The latter finding indicates a discrepancy between what is practiced and the professional literature. Most of the psychotherapy described in the literature concerns group interventions, which were rarely provided by the mental health centers in Massachusetts. The centers tended to offer individual counseling; however, little information on how to provide this form of treatment can be found.     

The Burden of Dementia: A Medical and Research Perspective

Alzheimer's disease remains the most common form of dementia. Dementia symptoms vary depending on individual personality, life experience, and social and cultural influences. As dementia progresses, involvement of multi-disciplinary health care professionals is needed to manage the disease. Alzheimer research is progressing rapidly. While 5% of all Alzheimer's disease may be genetically determined, the majority is not. Susceptibility genes can reveal the risk of contracting Alzheimer's disease. Early life risk factors such as education, nutrition, and vascular disease may increase the likelihood of dementia in later life. In the United States, two acetylcholinesterase inhibitors have been approved as cognitive enhancers. Possible prevention and symptomatic treatment interventions have focused on estrogen replacement therapy, antioxidants, and anti-inflammatory medications. Research advances have improved the clinical management of dementia. Ethical implications to the patient, family, and society are multiple and remain challenging.     

Disgusting clusters: trypophobia as an overgeneralised disease avoidance response

Individuals with trypophobia have an aversion towards clusters of roughly circular shapes, such as those on a sponge or the bubbles on a cup of coffee. It is unclear why the condition exists, given the harmless nature of typical eliciting stimuli. We suggest that aversion to clusters is an evolutionarily prepared response towards a class of stimuli that resemble cues to the presence of parasites and infectious disease. Trypophobia may be an exaggerated and overgeneralised version of this normally adaptive response. Consistent with this explanation, individuals with trypophobia, as well as comparison individuals, reported aversion towards disease-relevant cluster stimuli, but only the trypophobic group reported aversion towards objectively harmless cluster stimuli that had no relevance to disease. For both groups the level of aversion reported was predicted uniquely by a measure of disgust sensitivity. Scaled emotion ratings and open-ended responses revealed that the aversive response was predominantly based on the disease avoidance emotion, disgust. Many open-ended responses also described skin sensations (e.g. skin itching or skin crawling). These findings support the proposal that individuals with trypophobia primarily perceive cluster stimuli as cues to ectoparasites and skin-transmitted pathogens.