Video Respite (VR) refers to a series of videotapes designed to engage cognitively impaired individuals so that caregivers can have opportunities for respite. Previous work has evaluated the impact of VR with family caregivers. This study assessed use of VR in special care units (SCUs) for persons with dementia. The foci of the study were 10 SCUs and the individual staff members caring for the residents. The findings suggest VR is more likely to be used in SCUs with relatively higher levels of organization and lower levels of conflict. In addition, resident agitation was found to be significantly lower after VR use. Implications for future evaluation of Video Respite in special care units are discussed. / Graduation date: 1995

The purpose of the present study was to examine the effect of environmental density on the behavior (Disruptive and Nondisruptive) of elderly residents with dementia living on a special care unit. A building project that led to relocation of residents from high density units to units that varied in density (low vs. high) provided a natural context for this study. Disruptive and Nondisruptive behavior are composite variables that together include the full range of behavioral responses. Both are composed of several subvariables. Data were collected using direct behavioral observation using the Environment-Behavior Interaction Code (Stewart & Hiscock, 1992b) and a hand-held computer. The first objective of the study was to examine behavior patterns in relation to density and privacy. This objective was addressed with a quasi-experimental design (Study 1), in which three hypotheses were tested. It was predicted that residents who moved from a high density unit to a low density unit would exhibit a greater reduction in rate of Disruptive behavior (Hypothesis 1) and a greater increase in rate of Nondisruptive behavior (Hypothesis 2), compared to residents in a constant high density condition. It was also predicted that use of Private Time (time spent alone in one's bedroom) would be greater on the low density unit, where residents had private rooms (Hypothesis 3). Results of Study 1 provided support for Hypotheses 1 and 2, in relation to comparisons with the External Comparison Group only. Within subjects analyses provided additional support for Hypothesis 1 (Disruptive behavior). Hypothesis 3 (Private Time) was also supported. The second objective of the study was to explore the perceptions of family and staff caregivers with regard to the effect of the environment on resident behavior. This study was addressed with a qualitative design (Study 2) using the grounded theory method. Participants in Study 2 described the needs of residents with dementia in relation to the physical and social environment, and the outcomes that occurred when these needs were met or not met. (Abstract shortened by UMI.)

No description available.

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.

The number of elderly people moving into long-term care facilities is expected to increase as the population of people 65 and older continues to rise at a significantly high rate. Simultaneously, the number of people expected to be diagnosed with dementia will also increase unless a cure for this devastating disease is found. In the meantime, caregivers face many problems in providing healthy and humane treatments. One such problem that is a major concern for caregivers is controlling wandering behavior. This behavior often places patients in life threatening situations, and the current methods used by many facilities do not promote a high quality of life. The purpose of this study was to examine the effects of various tape patterns on the wandering behaviors of residents living in a special dementia care unit in Heritage Hall Nursing Home, Blacksburg, Virginia. Similar studies revealed that alternative methods using tape patterns could reduce exiting attempts at a fire exit door or could possibly increase these attempts. In order to address these inconsistencies, exiting attempts at a fire exit door were recorded during one baseline and two similar test conditions. It was found that exiting attempts was a serious problem in this unit as 40% of the residents attempted to exit the faci I ity during the study. The use of tape patterns reduced exiting attempts by 19.05% and 11.12%; however, this reduction was not statistically significant. In conclusion, the use of these tape patterns affected wandering behavior differently for each of the residents, suggesting that a multi-method approach for controlling exiting behavior may prove to be more successful when dealing with a heterogeneous sample and their multi-needs. / Master of Science

Unsafe exits from dementia care units present problems for residents and pose ethical dilemmas for caregivers. The purpose of this experimental research was to determine whether visual barriers reduced the exiting behavior of residents in a long-term care facility. A visual barrier was defined as one that appeared to be an obstruction, but that did not impede egress through the door. The study was conducted in a 30-bed dementia care unit and was limited to the emergency exit door where an alarm sounded each time the panic bar was touched. An “exit" was defined as a resident touching the panic bar and sounding the alarm. The sample consisted of 3 females and 6 males who attempted to exit the unit at least once during baseline condition. All residents were diagnosed with some form of dementia. The tests were conducted under three visual barriers and one baseline condition. Each condition was observed for seven days from 2:00 to 4:00 p.m. The schedule was as follows: Baseline Condition: No experimental manipulation was used. This observation provided a comparison for the three test conditions. Test Condition 1: Mini-blinds that covered the glazing of the door. Test Condition 2: Cloth panel that covered the panic bar of the door. Test Condition 3: Both the mini blind and the cloth panel. During baseline collection, 9 residents triggered the alarm for a total of 120 attempted exits. Test condition 1 decreased exiting to 73 attempts. During test condition 2, 5 attempted exits occurred, and 18 attempted exits occurred during test condition 3. Statistical analysis included Friedman’s Rank test for correlated samples and Wilcoxon Sign Rank tests for treatment versus control comparisons. Test conditions 2 and 3 significantly reduced attempted exits while test condition 1 was not statistically significant. In conclusion, visual barriers were a safe and effective method for deterring resident exiting for this particular nursing home. / Master of Science

This comparative research explores the work experiences of dementia care workers in nursing homes. The aim of this study is to understand concepts central to care and to gain insights from the care workers‟ perspectives. A comparative framework and symbolic interactionist approach is used to analyse data collected using ethnographic methods from 59 dementia care workers in Canada, Scotland, and the United States. The fieldwork settings are institutionalised; dominated by for-profit ownership; and provide care for a resident population with high cognitive and physical needs. The comparative findings underscore the importance of work conditions that provide care workers with sufficient resources to do their job and enough time to complete their work. The absence of these critical components creates stressful work conditions for the care workers. The lack of time, staff and supplies such as towels, wash cloths, and continence products do not allow the residents‟ choices in their care and disregard their dignity and rights. The inability to deliver care for the residents according to the guaranteed government care standards often result in the violation of human rights for the care workers and residents. The care workers are unable to supply the quality of care they know the residents need and are capable of providing given better circumstances. There are frequently not enough care workers, resources, or time to meet the level of care that relevant standards mandate or the care workers know is possible. The analysis reveals that care workers struggle to provide more than basic physical care and are seldom able to meet essential social care needs for the residents. Unwritten rules are implemented in each setting that include separating people with dementia, placing these residents out of view of the public, not allowing the residents access to go outside, and not providing them with engaging and meaningful interactions. While policies are frequently developed with good intentions, many are counter-productive without dementia knowledge. This comparative research reveals care practices and routines share strong similarities across the fieldwork sites while the care worker characteristics as a workforce vary the most between countries. Some differences involve the training required, average age, pay and mode of dress or appearances. Too often researchers frame stress issues for care workers as problems with attitudes, motivation, training and incentives. Yet, the broader social structures and conditions that set the context in which these problems have their origins are commonly ignored. Good working conditions for care workers are precursors to good care for the residents. This thesis concludes with recommendations for practice, research and policy development.

The purpose of the study was to develop a behavioral nursing intervention strategy for specific deficits in grooming performance of elders with dementia. A quasi-experimental two-group design using switching replications with removed intervention was employed. Three residents with severe cognitive impairments and three residents with mild cognitive impairments were chosen from a special dementia care unit of a long-term care facility. Three residents among six residents were randomly selected to receive the behavioral intervention early. Baseline and post-intervention assistance was provided by nurse aides. Each resident was asked to wash hands, brush teeth, wash face, and comb hair in a sequence. Ten intervention sessions were conducted by the trained intervener for two consecutive weeks. The intervention consisted systematic prompting and social reinforcement. A total of 21 sessions were collected in the morning using videotape recordings. Interobserver agreement for the instruments designed by the investigator was measured by the trained observers. Data were analyzed in two phases. First, the quantitative data were analyzed to determine the independent functional behaviors of individuals, and the change in the intensity of nursing effort associated with grooming of elders with dementia. Data were examined by individual graphic display throughout the three phases (baseline, nursing intervention, post-intervention). Second, the qualitative data were analyzed to determine the antecedents, consequences, and resident responses associated with grooming, the caregiver problem behaviors, and resident problem behaviors associated with grooming performance. The results show that the functional behaviors of even severely demented elders can be promoted, indicating the effectiveness of nursing care strategies on the ADL task of grooming. The data in this research suggest that maintaining or improving functional ability is possible with a behavioral nursing intervention, which was a highly structured and systematic approach that involved modifying the environmental and behavioral context, through strategies such as prompting and social reinforcement, when necessary. Furthermore, through the qualitative analysis, the functional relationships between antecedents, consequences, and behaviors of demented elders allowed the investigator to analyze the caregiver problem behaviors and resident behavior problems associated with grooming.

Bibliography: leaves 347-361. Presents results of 2 longitudinal studies investigating the oral health of older adults with dementia, using questionnaires and clinical inspections at baseline and one year. Groups studied were nursing home residents and those living in the community, with moderate to severe dementia or no dementia diagnosis. Caries experience was related to dementias severity and not to specific dementia diagnoses. Coronal and root caries experience was higher in dementia participants with moderate-severe dementia, the socio-economically disadvantaged, more functionally dependent, taking neuroleptic medications with high anticholinergic adverse effects, with eating and swallowing problems, were not attending the dentist, who needed assistance and were behaviourally difficult during oral hygiene care and whose carers were burdened.

Bibliography: leaves 347-361. / 403 leaves ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Presents results of 2 longitudinal studies investigating the oral health of older adults with dementia, using questionnaires and clinical inspections at baseline and one year. Groups studied were nursing home residents and those living in the community, with moderate to severe dementia or no dementia diagnosis. Caries experience was related to dementias severity and not to specific dementia diagnoses. Coronal and root caries experience was higher in dementia participants with moderate-severe dementia, the socio-economically disadvantaged, more functionally dependent, taking neuroleptic medications with high anticholinergic adverse effects, with eating and swallowing problems, were not attending the dentist, who needed assistance and were behaviourally difficult during oral hygiene care and whose carers were burdened. / Thesis (Ph.D.)--University of Adelaide, Dept. of Dentistry, 2001