Menorah Park Center for Senior Living

Primary objective: The purpose of this study was to evaluate the effects of an errorless training approach, Spaced Retrieval (SR) training delivered over the telephone, on the reported everyday memory problems of adults with chronic traumatic brain injury (TBI).Research design: The study was a randomized controlled clinical trial.Methods: Thirty-eight participants received either SR training or didactic strategy instruction (SI). Participants in both groups identified three memory-related goals and were paired to receive the same total telephone contact time. The main outcome measures were frequency of reported memory problems and perceived quality of life.Results: Participants in the SR group reported significantly more treatment goal mastery/strategy use than those in the SI group, immediately and at 1-month post-training. Caregivers reported similarly significant between-groups differences in everyday use of treatment behaviours at 1 month. Both groups reported some generalized strategy use to other non-targeted behaviours and decreased frequency of reported memory problems, but there were no significant between-groups differences in participant or caregiver reports of generalized strategy use or reported memory problems at either time-point. There was no change in perceived quality of life in either group.Conclusions: SR treatment delivered by phone produced significantly more treatment goal mastery/strategy use and maintenance than SI; however, both treatments improved reported everyday memory functioning for persons with TBI, without significant group differences on measures of generalized strategy use or perceived quality of life.

ABSTRACT This pilot study describes a cognitive intervention designed to compensate for cognitive deficits among persons with HIV/AIDS aged 50 and over. Seventeen participants were screened for memory and executive function deficits. Ten participants received the intervention, based on Spaced Retrieval (SR) and use of external memory aids. At two months post-treatment, all participants reported that the intervention helped them meet two self-selected functional goals (e.g., remembering to take medications, remembering clinic appointments) and the majority successfully learned and retained the correct memory strategy. Spaced Retrieval, coupled with external aids, has potential for helping persons with HIV adhere to treatment regimens.

A commentator asked Lady Bird Johnson why she released to the public, over 25 years earlier than planned, the audio recordings made in the Oval Office by her husband. She responded, with a phrase used by her husband and familiar to most Southwesterners, that Lyndon Johnson had believed strongly in the importance of history “with the bark off.”1 Such history provides one with an account of events unbuffered by a thick “bark” that obscures the true grain of the life beneath it and a raw narrative unfiltered through the prisms of individual interests and academic fashion. To speak of “neurology with the bark off” may seem somewhat strange until one reads work such as that of David Gifford et al.2 The picture they present of how tacrine is used to address Alzheimer’s disease (AD) in nursing homes has something of the same raw quality as a stripped tree. On the one hand, only a few residents received the drug, and the rarity of its use among nursing home residents is somewhat reassuring. However, for those who did receive it, the data presented by the authors provide an unflattering view of how physicians use a treatment for a chronic, progressive, and incurable neurological disorder among a frail and vulnerable population of institutionalized elderly rarely seen by neurologists.3 As the authors note, tacrine was the first medication approved for the treatment of AD. However, tacrine is only the first of what may soon be many medications aimed at alleviating the symptoms or stopping the progression of this disorder. This inquiry, using a relatively new clinical and administrative database, reveals how a serious neurological disorder is treated in a care setting in which the disorder is endemic and which is largely a “neurologist-free” environment. The results of their inquiry indicate …

To describe the reliability of new assessment items and their clinical utility as judged by experienced nurse assessors, based on the results from the field test of Version 2.0 of the Resident Assessment Instrument (RAI). Independent dual assessment of residents of nursing facilities by staff nurses using a draft of Version 2.0 of the minimum data set (MDS). A total of 187 randomly selected residents from 21 nursing homes in seven states volunteered to test Version 2.0 of the MDS. The full array of MDS assessment items included measures in the following areas: Background information, cognitive patterns, communication/hearing, vision, mood and behavior, psychosocial well-being, physical functioning and structural problems, continence, disease diagnoses, health condition, oral/nutritional status, dental status, skin condition, activity pursuit patterns, medications, special treatments and procedures, and discharge potential and overall status. Evaluative data address issues of MDS item utility and reliability. For new items, almost all achieved a reasonably high-weighted Kappa interrater reliability; revised items also surpassed earlier items, and with the updated training materials, even the non-changed items had higher average reliability levels. Based on the success of the field test and the positive response of the industry, Version 2.0 of the RAI has been adopted, and HCFA has initiated a more long-range process to update further the RAI when necessary. Findings support the reliability and clinical utility of the new and revised assessment items incorporated by HCFA in Version 2.0 of the MDS.

to examine the prevalence of therapy use in nursing homes in selected countries and to describe the characteristics of nursing home residents who receive therapy. DESIGN and the design of the study is cross-sectional, using Minimum Data Set (MDS) assessments of nursing home residents. The sample includes all nursing home residents in six US states (n = 273491), in Copenhagen, Denmark (n = 3451), Reyjkavik, Iceland (n = 1254), and selected locations in Italy (n = 1089) and Japan (n = 1255). we determined who had received physical or occupational therapy treatments in the last 7 days. Demographic and clinical characteristics of recipients were compared relative to other nursing home residents within each country. in the five countries, the prevalence of receiving therapy was 31% (Iceland), 30% Japan), 23% (Denmark), 14% (Italy) and 11% (USA). Substantial proportions of the recipients were over the age of 85, were clinically stable and had been in the nursing home for longer than 90 days. Across all countries, residents with poorer activities of daily living (ADL) scores but good cognitive scores were more likely to receive therapy than other residents. Rehabilitation nursing, an adjunct to therapy, was concentrated on residents with poor ADL scores. substantial numbers of long-stay residents receive therapy in nursing homes, including those over the age of 85 years and those with cognitive impairment. Hence, future rehabilitation outcome studies can involve these previously understudied patient populations.

the nursing home Resident Assessment Instrument (RAI) includes a set of core assessment items, known as the Minimum Data Set (MDS), for assessment and care screening and more detailed Resident Assessment Protocols in 18 areas that represent common problem areas or risk factors for nursing home residents. Its primary use is clinical, to assess residents on admission to the nursing home, at least annually thereafter and on any significant change in status and to develop individualized, restorative plans of care. to describe the content and development of the RAI, including US testing for MDS item reliability and validity of the RAI, and the results of a 4-year evaluation of the effects of its clinical use. the evaluation found that implementation of the RAI was associated with significant improvements in a variety of measures of process quality, resident functional outcomes and reduced hospitalization. Other uses of the RAI data in the USA-including payment using resident classification systems and, with RAI-based outcome-oriented quality indicators, quality assurance activities-and the status of RAI use in other countries are also summarized.

Older People as Caregivers: Embracing a Life-Span Perspective Get access The Elderly Caregiver: Caring for Adults with Developmental Disabilities, edited by Karen A. Roberto. Sage Publications, Newbury Park, CA, 1993, 216 pp., $46.00 (cloth); $23.95 (paper). Family Caregiving Across the Lifespan, edited by Eva Kahana, David E. Biegel, and May L. Wykle. Sage Publications, Thousand Oaks, CA, 1994, 418 pp., $25.95 (paper). Older People Giving Care: Helping Family and Community, by Sally K. Gallagher. Auburn House, Westport, CT, 1994, 182 pp., $49.95 (cloth). Robert H. Binstock, PhD, Robert H. Binstock, PhD Editor Search for other works by this author on: Oxford Academic PubMed Google Scholar Rachel A. Pruchno, PhD Rachel A. Pruchno, PhD Director of Research Myers Research Institute of Menorah Park Center for the AgingBeach wood, OH 44122 Search for other works by this author on: Oxford Academic PubMed Google Scholar The Gerontologist, Volume 35, Issue 6, December 1995, Pages 842–844, https://doi.org/10.1093/geront/35.6.842 Published: 01 December 1995