This qualitative study is an attempt to explore the adaptive experiences of elderly Chinese caregivers who have to take care of their spousal partners who are suffering from Alzheimer’s disease (AD). As the illness is known to be chronic and degenerative in nature, caregivers are thus faced with many stressful situations and adjustments are necessary. The purpose of this study is to examine how these caregivers in AD situations are interpreting the factors that might have influenced their adjustments. The sample consists of 26 participants aged 60 and above that have been a primary caregiver for not less than a year. Three in-depth interviews were conducted with each participant during the study period, which lasted for about two years. Findings show that most of them had to adjust to stressful situations in various aspects of life. They also developed many strategies for life adaption, which can be summarized in the following six adjustment themes. First, after hearing the AD diagnosis, they initially experienced a series of shocks and false hopes, and subsequent adjustments include eliminating uncertainty, establishing reasonable expectations toward both the disease and treatment, learning to take on the caregiver role, and finally, separating the disease from their partner’s personality. Second, these elderly caregivers gradually learned to attain inner peace through converting to various religions, searching for meanings within their stressful situations, and reconstructing rational explanations for their negative emotions. Third, in the area of spousal interaction, adaptive strategies included staying connected with their sick partners, reinforcing their caregiving motivations, completing the “familiar-strange-familiar” cycle, and re-establishing daily routines. Fourth, in situations involving other family members, such as adult children, the adjustment strategies included sharing economic burdens, re-allocating housework chores, delegating care responsibilities, and emotionally supporting one another. Fifth, in terms of social network, the main support that caregivers received usually came from informal sources; formal support is extremely limited. Findings further show a connection between the input and output of social support and personal capacity. Sixth, elderly spousal caregivers often possessed the ability to re-position and re-construct their self-confidence while adjusting to their new life rhythm. They were also able to achieve a balance between their private lives and their care responsibilities, which helps to maintain their well-being and neutralize their distresses. In summary, participants of the study often utilized more than one strategy in adjusting to their situations. The six aspects of adjustments are thus put together in this study as an integrated model of life adaptation and survival tactics adopted by elderly Chinese AD spousal caregivers. Also, whether these caregivers are successful in adapting depends on their abilities to accept changes in themselves and their environment, and achieve a compromise between the two. Based on the above findings, a culturally sensitive perspective is thus put forward to enhance the understanding of studied phenomenon within the contemporary Chinese context. Recommendations are also made regarding the needed policy changes and the revisions of social work practices in support of the elderly suffering from AD and their caregiving spouses. / published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

The effects of exogenous estrogen administration on aspects of memory and cognition in women were examined in two studies. In Study 1, women receiving estrogen replacement therapy were compared to untreated women on four measures of verbal memory. Those receiving estrogen had significantly better scores on a measure of delayed memory for propositional material. In Study 2, women in the early stages of Alzheimer's Disease (AD) were administered either estrogen or placebo on a double-blind basis for six months. Women given estrogen showed improvement on a measure of verbal memory and spatial attention compared to the placebo controls. The combined results of these studies provide evidence that estrogen enhances aspects of verbal memory in both healthy postmenopausal women and in postmenopausal women in the early stages of AD as measured by neuropsychological tests. These effects might be mediated by actions of estrogen on neuronal morphology and physiology in brain areas important for memory and cognition.

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Alzheimer's Disease (AD) is among the most prevalent of the dementias and it is anticipated that much of the care required for the dependent patient will be provided in the home setting by a caregiver. The purpose of this study was to identify the importance of needs related to caregiving and the level of satisfaction of those needs related to the caregivers of Alzheimer's victims. The theoretical framework for this study is Dorthea Orem's "Self-Care Deficit Theory."The sample was 18 caregivers who attended one of three Alzheimer's Support Group meetings held in three central Indiana cities. Human subjects rights were protected. The Home Caregiver Needs Survey (HCNS), Hileman, 1990, was used to identify the information, household, patient psychological needs of the and care needs, personal and caregivers of Alzheimer's patients and to determine if these needs are being adequately met. Findings included: (a) the caregivers perceived the need for information, patient care, personal, spiritual, psychological need to be somewhat important to important; teach, assist and support caregivers throughout the and (b) satisfaction of the needs indicated that the caregivers were somewhat satisfied to satisfied with the needs presented. Implications call for: (a) Nursing intervention to caregiving experience. (b) Home health care agencies and senior citizens action groups to lobby for support and programs to assist caregivers. / School of Nursing

Relationships between the steroid hormones estradiol (E2), testosterone (T), cortisol (CRT) and dehydroepiandrosterone-sulfate (DHEAS), memory and mood were investigated in men, in women estrogen-users and non-users, and in patients with Alzheimer's Disease (AD). In Study 1, 72 year-old healthy men and women estrogen-users performed better than estrogen non-users on Forward and Total Digit Span, which test attention and short-term memory, concomitant with their higher E2 levels. The estrogen-users performed better than the men and the non-users on Delayed Selective Reminding, a test of explicit verbal memory. Men and women with higher CRT levels performed worse on several explicit verbal memory tests compared to those with lower endogenous, CRT levels. In Study 2, male patients with AD performed better than estrogen non-using women with AD on several everyday memory tests, and women estrogen-users with AD performed similarly to the men. Both the men and estrogen-users had higher levels of E2 than the non-users. AD patients with higher endogenous levels of DHEAS performed better than those with lower levels on several everyday memory tests, and AD patients with higher CRT levels were impaired on one aspect of everyday spatial memory, Route Recall. In Study 3, no differences in hormone levels between AD patients and age-matched healthy elderly controls were found. The AD patients were most severely impaired on tasks involving explicit verbal recall compared to healthy controls, and least impaired on short-term memory and concentration tasks. The AD patients reported more dysphoric mood and mental dulling symptoms than healthy age-matched controls, but they did not report feeling less positive about the future. Taken together, these results suggest that higher levels of DHEAS and E2 are related to better memory performance in both healthy elderly men and women and in patients with AD, and higher CRT levels are associated with poorer explicit verbal memory performanc

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The results of neuropsychological tests are often used by clinicians to make important decisions regarding a demented patient's ability to competently and/or independently perform activities of daily living. However, the ecological validity of most neuropsychological instruments has yet to be adequately established. The current study examined the relationship between neuropsychological test performance and functional status in 42 individuals diagnosed with Alzheimer's Disease. A comprehensive battery of cognitive tests was employed in order to assess a wide range of neuropsychological abilities. Functional status was measured through the use of both a performance-based scale of activities of daily living (The Direct Assessment of Functional Status; Loewenstein et al., 1989) as well as by a caregiver/informant-based rating scale (Instrumental Activities of Daily Living; Lawton & Brody, 1969). Findings suggest that neuropsychological functioning is moderately predictive of functional status. Memory performance was the best predictor of functional status in most ADL domains, followed by executive functioning and visuospatial abilities.

Currently, 6 million Americans have Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD). As the segment of Americans aged 65 and older continues to increase, the number of older adults with AD/ADRD (referred to as Persons Living with Dementia [PLWD]) also grows. Additionally, the use of health care services, such as hospitalizations, is increasing among PLWD. Indeed, hospitalizations are more prevalent among PLWD compared to older adults without dementia. Some of these hospitalizations are ambulatory care sensitive condition hospitalizations that can be prevented if individuals have better access to high-quality primary care. However, delivering high-quality primary care is becoming increasingly challenging given the projected PLWD population increase and the shortage of primary care providers. On the other hand, the number of primary care nurse practitioners who can deliver high-quality and cost-effective care to older adults has grown in recent years and will continue to increase with demand. Nonetheless, little is known about how to strengthen essential practice features (i.e., structural capabilities) needed to deliver high-quality care in practices where nurse practitioners provide care to PLWD. Enhancing primary care delivery by strengthening structural capabilities in primary care, such as electronic health records, care coordination, community integration, and reminder systems, can be an effective way to reduce hospitalizations among PLWD. The overall objective of this dissertation is to assess the effects of primary care structural capabilities in practices employing nurse practitioners on both ambulatory care sensitive conditions and all-cause hospitalizations among PLWD. This dissertation entails five chapters. Chapter 1 describes the significance of structural capabilities and related outcomes among PLWD. Chapter 2 includes a systematic review of existing dementia care models in various ambulatory care settings and summarizes the impact of dementia care models on hospitalizations among community-residing PLWD in the United States. Chapter 3 describes the availability of the selected structural capabilities in primary care practices where nurse practitioners provide care to PLWD. The structural capabilities of practices that provide care to a high volume of PLWD are also compared to those caring for a low volume of PLWD in this chapter. Chapter 4 assesses the impact of structural capabilities in primary care practices employing nurse practitioners on hospitalizations among PLWD. Finally, Chapter 5 summarizes the findings from Chapters 2 to 4 and includes information on the strengths, limitations, and implications of the research and findings of the dissertation.

Alzheimer's disease (AD) is the most common form of nontreatable dementia, a syndrome which reflects a progressive and global impairment of memory, intellect, and other cognitive abilities. This devastating condition directly touches the lives of as many as 10 million Americans, including not only persons suffering from the disease but their primary caregivers and other family members as well. At present the course of AD cannot be halted or reversed, and no cure is known. The problem, then, is how to most effectively respond to the psychosocial needs of primary caregivers in order to help them provide the best possible care for a loved one with AD.

Loneliness in caregivers of Alzheimer's family members was examined through the use of an explanatory model. Stepwise multiple regression was used to test the association between characterological variables (introversion and control), situational variables (social support), demographics (income), and self-reported loneliness in a statewide mail survey of 190 caregivers. Results indicated that introversion, control, social support, and income account for almost two-thirds of the variance in loneliness. An interesting finding was that higher income was associated with higher levels of loneliness in the caregivers. Implications for practice are discussed and recommendations for future research are suggested. / Ph. D.