Ward orientation training with psychogeriatric patients

Cognitive Rehabilitation with Older Adults

The proportion of older adults seeking rehabilitation services are certain to rise as the population ages. Cognitive rehabilitation techniques can be successfully adapted and used with older adults with a range of clinical diagnoses. An understanding of cognitive changes which could be expected as a result of “normal” (non-disease-related) aging is essential for both assessment and treatment planning for this group. Age-related changes in attention, memory and executive functioning are briefly noted. Common cognitive sequelae of head-injury, depression and dementia are discussed, and useful assessment and rehabilitation strategies described. Case illustrations are used to illustrate major points.

Promoting well-being and independence for people with dementia

This paper reviews the research evidence relating to non-pharmacological interventions with people with dementia aiming to improve well-being and independence. There have been a number of attempts to improve the person's level of independent functioning through programmes training and supporting self-care skills, mobility, continence, orientation and participation in activities. Well-being has been less often directly addressed, although recently studies have begun to specifically target aspects of it. Increased independence does not necessarily lead to greater well-being, and it is clear that the greatest potential for increasing function is in tackling the excess disability which many care giving situations in effect impose on the person with dementia. In carrying out research in this area, the limitations of randomized controlled trials are evident, and there is much to be said for the reporting of series of carefully controlled single-case studies in addition to group studies. Further development of methods of measuring well-being in people with dementia is also required.

Nurse/patient dependency-a review of different approaches with particular reference to studies of the dependency of elderly patients

The dependency of elderly patients is the outcome of interaction effects between the patient and his or her environment, and over a protracted stay in hospital, environmental factors can be as influential in determining a patient's dependency as the patient's medical or physical condition. Rigid institutional regimes and inadvertent reinforcement of dependent behaviours by nursing staff appear to play an important part in the development of institutionally induced dependency. Studies of patient dependency which assume that dependency arises largely from the physical or mental condition of the patient lack validity because the major source of variation in nursing activity is seen as an almost mechanistic response to patients' dependency. It is argued that, rather than patient dependency 'causing' nursing actions, nursing actions can cause patients to become more or less dependent.