Behavioral improvement in long-term geriatric patients during an age-integrated psychosocial rehabilitation program

Improving Quality of Care and Life in Nursing Homes

For nursing home residents, quality of life is largely determined by the quality of the care they receive. Unfortunately, that quality is all too often inadequate. Current regulatory systems have failed in their efforts to assure high-quality care. Policy could vitally improve institutional quality of care in three ways: (1) increase efforts to derive a valid and reliable quality of care index that incorporates resident outcomes; (2) change the emphasis of resident care inspections; and (3) expand outside involvement. These elements are all essential and interdependent. They offer a myriad of creative opportunities for researchers, practitioners, and volunteers to make major contributions toward improving the quality of care, and, ultimately of life, for nursing home patients.

Treating learned helplessness in the elderly dementia patient: preliminary inquiry

Learned helplessness is the psychological state that results when an individual who is unable to exercise reasonable mastery in one situation incorrectly assumes that he or she is then unable to exercise reasonable control in other situations as well. This may complicate the delivery of health interventions since the individual with learned helplessness may assume that no care provider or treatment intervention can be of assistance. Elderly patients with Alzheimer's disease and other dementias are not immune to this stance of learned helplessness. This paper presents one possible psychosocial rehabilitation approach, the Project SMART (Stress Management and Relaxation Training) program, to the problem of learned helplessness. Based on the skills of adaptive stress-resistant problem solvers, Project SMART can be adapted to the needs of the elderly demented. The clinical and research implications are discussed.

An observational study of intergenerational activities and behavior change in dementing elders at adult day care centers

This study investigated whether dementing adult day care clients demonstrate consistent positive behaviors (i.e., eye contact, smiling, attentiveness, etc.) during structured, weekly activities with young children that these adults do not demonstrate during similar activities when the young children are not present. The study built on a preliminary informal study conducted in conjunction with an intergenerational adult day care project. Participants for the study were twenty-one adult day care clients who have behavioral characteristics of Alzheimer's or related disorders. The study involved five consecutive weeks of planned, structured music activities prepared by a musical therapist as part of the regular intergenerational activities of the adult day care center. The same activities were repeated twice in the same day at each site, once with children present and once without them present. Two fixed videotape cameras recorded client behaviors in three-minute segments. Scoring was completed by trained, "blind" scorers. The scorers tallied positive behaviors by individuals for randomly selected ten-second segments of the taped intervals. Sessions with and without children were compared using non-parametric tests. Categories of behaviors were compared and specific observed behavioral changes were reported.

Sickness Impact Profile: the state of the art of a generic functional status measure

The Sickness Impact Profile (SIP) is a widely used health status measure, known to be valid and reliable. After the final development and testing in 1978, however, in which several methodological aspects were investigated, no descriptions of research projects that systematically evaluate the methodological and theoretical aspects of the instrument were found. In this article a review is presented of literature on the SIP. This review is the first step taken in a project that evaluates the SIP. The instrument appears to be a reliable instrument with sufficient content validity. It shows good correlations with other health status and functional status measures. Yet a number of questions about the SIP remain unanswered. Theoretical implications of the construct of sickness, the effect of age and gender on SIP scores, the construct validity judged by factor analysis, the responsiveness of the instrument, and the possibilities to use proxy-respondents or to shorten the list and to simplify the scoring procedure still have to be studied. If the instrument is to be used as an international standard measure of functional status, these topics should be thoroughly examined.

The PALS program. Intergenerational remotivation

Social isolation is a major problem for the institutionalized elderly. An intergenerational geriatric remotivation program is one method to stimulate social awareness and functioning. Data analysis revealed the construct of invitational work as describing the social behaviors of children and elders during the program sessions, and the basic social psychological process of reconnecting as referring to what certain elders did in the Pals Program and to what the program meant to the elders. Although touted as a panacea for social isolation of elders, intergenerational remotivation programs are revealed in this research to be quite complex and even problematic. To be successful in decreasing social isolation, such programs require ongoing staff monitoring and interventions.

The status of preventive care for the aged: a meta-analysis

One response to the growing needs of the elderly is to expand the scope of preventive care from the younger and middle aged cohorts to include an emphasis on preventive care for older people. In the past it has been difficult to consider prevention and aging as concepts which could co-exist because we can neither cure nor prevent aging. The potential of preventive care to improve, maintain, or lessen decline in the quality of life of the elderly has not been included in the definition or mainstream of prevention activities. This study identifies and reviews research and programmatic activities which have been reported in the literature over the last ten years in the area of prevention and aging. Topical areas and methodological approaches are explored to define what has been considered appropriate preventive care for the elderly. An evaluation process, meta-analysis, is used to assess the therapeutic effect and overall effectiveness of techniques in prevention and aging. These findings can be used in formulating future initiatives related to aging and prevention.