The preference assessment literature has mainly focused on children and adults with developmental disabilities. To date, minimal research related to preference and reinforcer assessments has been conducted with the elderly population with cognitive impairment. This study assessed the predictive validity of engagement- and selection-based preference assessment formats with two types of reinforcer assessments. One of these reinforcer assessments was engagement-based, and the other one included a task. The participants were three elderly individuals at an adult day program with a formal diagnosis of Dementia and a score less than 24 on the MMSE. The first participant's top items in the each preference assessment were validated in both reinforcer assessments. The second participant's top items from the free operant and MSWO were validated with the engagement-based reinforcer assessment, but the other assessment produced variable responding. The third participant's top items were validated in three out of four reinforcer assessments. Results are discussed in terms of their implications for preference and reinforcer assessments and their utility with the population of elderly adults with cognitive impairments.

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No description available.

M.A. (Clinical Psychology) / Families, most commonly the adult daughters, provide the majority of informal caregiving. Research has focused on the negative implications of being a home caregiver to someone with an illness such as dementia, with very few studies considering the positive aspects that are associated with caregiving. This phenomenological study seeks to gain a deeper understanding into the holistic experience of Muslim women who are the primary home caregivers of a family member who has been diagnosed with dementia. Furthermore, this study contributes to the growing body of caregiving literature by considering the cultural context in which caregiving occurs. The sample is composed of three Muslim home caregivers of a family member living with dementia. Semi-structured interviews were used to obtain an in depth account of the participants’ experiences of caregiving. Data received for this study was analysed in accordance with Smith and Osborn’s (2008) steps for the method of interpretive phenomenological analysis. Themes that have emerged from the study include 1) understanding the condition; 2) reorganisation of life and the change of attitude towards caregiving; 3) social support; 4) strengthening the relationship with God and spiritual growth; 5) decision to care for the family member at home; and 6) anger and forgiveness. Through the interpretation of these themes, it was found that the caregivers’ cultural and religious values were deeply rooted and that the caregiving process can be transformed from a negative experience into a positive and meaningful experience provided that the caregiver changes their attitudes regarding their role and situation. Future research needs to be conducted to understand the various cultural contexts that influence the caregiving process.

Class of 2013 Abstract / Specific Aims: The purpose of the project was to determine if implementation of a detailed pharmacist recommendation form written for providers, could be an effective tool to reduce the use of antipsychotics in the psychiatric nursing home patients with dementia by 15%. Methods: The project was conducted by a pharmacy student and a consultant pharmacist at a single psychiatric nursing home. Thirty recommendations were written to the nursing home providers. The prescribers made comments on the forms and returned them to investigators for analysis. Active orders were compared pre and post pharmacy recommendations. Main Results: Of the 30 interventions, the prescriber addressed 26 (87%) recommendations and agreed to 15 (58%) of them. Nine recommendations involved either a GDR, discontinuation of a medication, or switching to a non-pharmacological method. Six of the nine (66%) recommendations led to the prescriber reducing the dose or discontinuing the medication. Overall, six out of 30 (20%) interventions resulted in a successful reduction of the use of antipsychotics. Conclusion: This project showed that when the prescribers see a more detailed pharmacist written recommendation regarding the therapy, they are more likely to respond with an explanation. However, even though the overall reduction was 20%, black box warnings did not seem to be a deterrent for prescribing in this psychiatric nursing home. Antipsychotics are heavily relied on to control behaviors associated with dementia.

The automobile driving performance of 18 mildly demented subjects was compared to that of 18 normal elderly and 18 mid-age controls. Driving tasks were grouped according to a three-level hierarchical model that characterizes driving as a problem solving skill involving (a) low-level vehicle control skills, (b) intermediate level manoeuvring skills in response to on-road events, and (c) higher level driving-related judgemental abilities. Driving simulator measures of brake reaction time and steering accuracy were selected to represent the lowest level of hierarchy. A Motor Vehicle Branch (MVB) road test and a test of emergency braking distance indexed the intermediate level. Driving-related judgment was assessed by evaluating the accuracy of subjects' appraisals of their own driving skills, and by examining whether the demented subjects evidenced an increased level of driving avoidance that might be commensurate with the extent of their driving deficits. Overall the demented subjects performed significantly less well than did controls on the driving behaviour measures. Particularly striking were their deficits at the highest and lowest levels of the hierarchical task analysis. They were markedly impaired on the driving simulator tasks and they showed a clear tendency to over-estimate their driving competence relative to their actual performance. However, from a practical standpoint it was noted that despite significant group differences at the intermediate level, the overlap in performance scores between the demented and the normal elderly was considerable for these in-car tasks. Also, although the mildly demented subjects had significantly more demerit points on the MVB road test than did the elderly controls, nearly 70% were able to pass the licensing exam. Mildly demented drivers might best be characterized as having marginal driving abilities, a fact which may pose considerable challenges to clinicians and policy makers. A second component of the study involved evaluation of the correlations between the driving measures and several common psychometric tests of attention, perception, and psychomotor speed. After group membership was accounted for, the psychometric tests failed to add precision to the prediction of driving performance. / Arts, Faculty of / Psychology, Department of / Graduate

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Abstract Background. People with dementia (PWD) have difficulty adhering to their medication regiment and maintaining a sense of identity and social connectedness. Moreover, caregivers constantly worry about PWD especially when they are left home alone. Objective. To examine the usefulness and usability of the Claris Companion (CC) in assisting PWD and their caregivers. Results. Most participants found some of the communication functions, leisure functions and reminder functions difficult to use. They found that the email/text messaging, photos and videos function useful. Surprisingly, they did not find the reminder functions useful. Conclusion. This study demonstrated how the CC could help PWD regain their sense of identity and feel more socially connected to their family and friends. Furthermore, it also demonstrated how the CC gives peace of mind to caregivers in leaving PWD home alone while they are at work or running errands. Résumé Contexte. Les personnes avec la démence (PAD) ont de la difficulté à adhérer à leur régiment de médicaments ainsi que maintenir leur sens d’identité et de sociabilité. De plus, leurs proche-aidants s’inquiètent constamment de la PAD, spécialement lorsque qu’ils ou qu’elles sont à la maison tout(e)s seul(e)s. Objectif. D’examiner l’utilité et l’utilisabilité du Claris Companion (CC) pour assisté la PAD et son proche-aidant. Résultats. La plupart des participants ont trouvé les fonctions de communication, loisirs et de rappels difficiles à utilisés. Ils ont trouvé la fonction de messages courriel/SMS, les photos et les vidéos utiles. Étonnamment, ils n’ont pas trouvé les fonctions de rappels utiles. Conclusion. Cette étude démontre comment le CC peut aider la PAD à reprendre leur sens d’identité et sociabilité. De plus, ça démontre aussi comment le CC donne aux aidants naturels un sens de tranquillité d’esprit lors qu’ils ou qu’elles sont au travail ou font des courses.

Delirium and delirium superimposed on dementia (DSD) have a high prevalence in elderly populations presenting to the emergency department (ED). Despite their prevalence, diagnosis remains a problem and has led to increased healthcare costs and adverse health outcomes. Various tools and diagnostic screening tests exist to aid clinicians in their diagnosis but the need for a simple, sensitive and specific tool that can be used in a busy ED setting still exists. The objective of this study is to further validate two cognitive screening assessments, the 6-Item Cognitive Impairment Test (6-CIT) and Vigilance A Test, for their use in the ED as a screening test for delirium and DSD. The study will be a prospective cohort study performed at a tertiary academic medical center with elderly patients greater than 65 years old. The diagnostic accuracy of the 6-CIT and Vigilance A tests administered by emergency medicine attending physicians will be compared to a reference standard expert assessment performed by a psychiatrist. Patients will be assessed within 3 hours of presenting to the ED. Sensitivity, specificity, positive and negative predictive values with 95% confidence intervals will be calculated. The goal of the study is to determine whether the 6-CIT and Vigilance A tests can accurately exclude delirium and dementia in elderly ED patients, which would have future implications for their use as a time-efficient screening tool in these populations.

This research study examines the decreased agitation level utilizing nonpharmacological therapeutic interventions in dementia patients, age 65 and older. The study examined the following question: Will a therapeutic art program diminish agitated behaviors in persons diagnosed with dementia, aged 65 and older? In this quasi-experimental research design, the sample consisted of 19 participants in 3 groups, selected using these criteria: must be receiving services from a long term care facility, be diagnosed with dementia, display agitated behaviors, and be age 65 and older. This research measures the reduction of agitated behaviors in demented patients with the use of a therapeutic art program. The therapeutic art group pretest, midtest and posttest means were separated into Factor 1: aggressive behavior, Factor 2: physically nonaggressive behaviors, and Factor 3: verbally aggressive behavior. A multivariate analysis of covariance (ANCOVA) was conducted on the data for Factor 1, Factor 2, and Factor 3. The ANCOVA was not statistically significant for Factor 1. The ANCOVA indicated statistically significant findings when using a one tailed test for Factor 2 and Factor 3. The ANCOVA indicated statistically significant findings using a two tailed test for overall agitation. These findings inform professionals about the efficacy of therapeutic art programs on patients with levels of agitation and dementia. A therapeutic art program may contribute to a better quality of life for persons with dementia. Recommendations are included for use with dementia patients, therapeutic programs and long term care.