Hebrew Home of Greater Washington

This article assessed whether bringing current self-care practices into greater correspondence with those performed before the onset of dementia benefits the dementia patient. Participants were 20 nursing home residents with dementia, their spouses, and nursing assistants. Past and current self-care routines were determined by proxy responses of spouses and nursing assistants, respectively, using the Self-maintenance Habits and Preferences in Elderly questionnaire. Interventions were proposed based on current practices that were inconsistent with those practiced in the past and that had been important to residents. Residents showed engagement with the interventions, as these resulted in significantly more positive than negative or neutral responses. There was no effect on agitation. Incorporating prior preferences into care routines can contribute to the quality of life of dementia patients.

Purpose: The goal of this study was to describe bathing, toileting, and mouth care habits and preferences of older persons, as well as the importance of such habits. Design and Methods: Fifty-eight community-dwelling older persons were administered the Self-maintenance Habits And Preferences in Elderly questionnaire (SHAPE) during a one-on-one interview with a research assistant. Preferences were described by frequency distributions and mean importance for each item was calculated. Gender differences in preferences were examined using χ² analyses, t tests were used to compare importance levels. Results: Women reported spending a longer time bathing, they were more likely to have privacy while bathing, to use a washcloth, a regular size towel, and less likely to use a large towel than were men. One-third of the women reported using some type of absorbent undergarment, while no men did so. Mouth care was the category that received the highest importance ratings. Although order of importance of items was similar across genders, women assigned higher levels of importance to these items than did men. Importance ratings given to atypical habits, such as unusually long or more than 1 bath/day, were higher than those attributed to more usual habits. Implications: Knowledge of the range and importance of such self-care practices can provide information useful in the development of programs and for individualized care.

Elderly computer novices received 1-on-1 e-mail training, which enabled them to communicate electronically with elementary school-aged pen-pals. A traditional intergenerational visiting program was conducted concurrently. Program evaluation revealed that the intergenerational visiting program was rated favorably by 88% of the participating seniors and the intergenerational e-mail program was rated favorably by 57% of the seniors. Yet, only 6 (out of 23) seniors expressed interest in continuing to e-mail their pen-pals beyond the program period. While technology may never take the place of human contact for some seniors, increased computer support as well as arranging for e-mail pen-pals to meet in person might help boost the popularity of this form of intergenerational communication.

To determine correlates of hoarding behavior in frail elderly persons. Information about nursing home residents (n = 408) and community-dwelling senior day-care participants (n = 177) was gathered through interviews with family and professional caregivers, medical chart review, and physician examinations, and included the following areas of assessment: hoarding behavior, demographic and health information, level of cognitive functioning, activities of daily living (ADL) performance, depressed affect, social functioning, manifestations of agitated behaviors, and previous stressful life experiences. We found that 15% of the nursing home residents and 25% of the community-dwelling senior day-care participants manifested hoarding behavior at a rate of several times a week or higher. For nursing home residents, hoarding behavior was significantly related to a larger appetite, taking fewer medications, higher social functioning, comparatively less ADL impairment, and manifestations of physically nonaggressive agitated behaviors. For senior day-care participants, hoarding behavior was significantly associated with being female, a larger appetite, comparatively less gait impairment, fewer medical diagnoses, more involvement in activities, a positive diagnosis of dementia, hallucinations, the delusion of infidelity, and manifestations of three syndromes of agitated behaviors. While hoarding behavior in our samples presents differently from compulsive hoarding described in the literature, we obtained robust findings that show that despite differences in living conditions, the elderly persons who manifested hoarding behavior were those with relatively fewer health and functional disabilities. In addition, those who exhibited hoarding behavior also manifested agitated behaviors. We suggest that future researchers develop alternative measures of hoarding behavior so as to further clarify the phenomenon of hoarding behavior in the elderly.

Advance directives are used to increase autonomy in decisions regarding care when a person lacks the ability to communicate such wishes. Based on studies showing internal consistency in individuals' preferences, this study demonstrates a new method for identifying a list of questions that may best predict patient preferences. Participants were 71 residents of a large nursing home and 97 hospital patients. All were administered the Preferences for Life-Sustaining Treatment Questionnaire. Advance directives sequence models were developed using conditional probabilities concerning preferences for utilization of specific treatment options, given prior responses to different treatment options. Models resulted in more than 90% accuracy of treatment preferences for both samples and eliminated two thirds to three quarters of questions asked. Although the specific models need validation using larger samples, they demonstrate a method that facilitates transfer of information concerning treatment preferences if future incapacitation occurs.

The aims of this study were to (1) identify behaviors that occur in noncommunicative nursing home residents that are perceived by nurses to be indicators of pain, (2) determine factors affecting the differentiation of pain behaviors from similar behaviors due to other causes, and (3) assess nurses' perceptions of the prevalence and importance of specific indicators of pain as well as barriers to the detection of pain in this population. Seventy-two staff members of three nursing homes were interviewed and surveyed about specific behaviors associated with pain. Focus groups were conducted with staff to validate pain indicators and investigate perceptions of their own ability to identify pain. Nursing staff members agreed on a core group of behaviors that they perceive as pain indicators in elderly persons suffering from dementia. These indicators include specific physical repetitive movements, vocal repetitive behaviors, physical signs of pain, and changes in behavior from the norm for that person. The nursing staff members' level of familiarity with the residents was reported to have a significant effect on staff members' ability to identify and differentiate pain behaviors from other behaviors of impaired residents. Barriers to the detection of pain pertain to staff issues, resident behaviors, and resident-staff relationships. The study of pain among the noncommunicative elderly and, in particular, the development of a tool that can be used to assess their pain may greatly improve the quality of life of the estimated 20% to 35% of nursing home residents who cannot adequately express their needs.

The major sources of heterogeneity in the manifestation of dementia are analyzed as stemming from three types of sources: initial predisposing factors, lifelong events, and the current condition. Each of these sources is, in turn, comprised of three general domains: genetic/biologic/medical, psychosocial, and environmental. These influences affect the manifestation of dementia in terms of cognitive, behavioral, self-maintenance, and affective functioning. Mapping the sources and manifestations of this heterogeneity can lead to both a more thorough understanding of people with dementia and the development of management settings and interventions that are more responsive to people with dementia.

In this study, the authors examined the characteristics of family-generated videotapes used to manage the manifestation of verbally disruptive behaviors (VDB) in nursing home residents. Videotapes prepared by the relatives of 30 verbally disruptive nursing home residents to be shown to residents were systematically observed and coded for content and mode of presentation. The relationship between the videotapes' characteristics and their impact on the resident was studied. The majority of the time in the videotape was spent talking about the past or present of the family, was characterized by an overall feeling of respect, and did not show great variability in the features examined. Videotapes coded as showing more love and those not talking about current events were associated with higher effectiveness in reducing VDB. This treatment proved to be an appropriate and rewarding avenue to involve family members in the care of their frail institutionalized elderly relatives.