Expressions of individuality in cognitively impaired elders. Need for individual assessment and care

Experience of People in Mild and Moderate Stages of Alzheimer’s Disease in Spain

Objective: To analyze the meaning of dementia by those affected by it, and to give them a voice. Material and methods: Descriptive phenomenology through interviews with people of both genders who are over 50 years old and living in Tarragona (Spain), with a diagnosis of mild or moderate dementia, mainly related to Alzheimer’s disease. Results: Three main themes emerged: 1) normalization of memory loss in early stages as part of the natural aging process; 2) self-awareness of progressive memory decline, which is concealed from others, and 3) adaptation processes and strategies to coexist with their condition after diagnosis. Conclusions: The most evident features were the lack of specialized infrastructures within the health system in terms of care, prevention programs, and early detection.

Improving nursing home quality of life: Residents helping residents

Is it possible to have a positive impact on the quality of life (QOL) of nursing home residents? This pilot project tested a goal-focused intervention designed to improve QOL. In a sample of nursing home residents with cognitive impairments, investigators compared outcomes of residents who experienced the intervention as pairs with those who experienced it as singles. To various degrees, all 16 male residents (mean age = 66.6) who participated in the project attained individualized goals. Pre- to post-intervention, mean ratings for QOL measures increased for the total group, with the exception of perceived health, which decreased slightly. Pairs had greater frequency of increased ratings than singles. Further, nurses reported pairs initiated social and helping behaviors more frequently than singles.

Perceptions and Management of Change by People with Dementia and Their Carers Living at Home

This article presents findings from a research study that examined, by observation and interview, the nature of care as a form of social organization in the homes of people with dementia whose care was at least partly provided by relatives or friends. Twenty situations were included in which the carers and people with dementia were interviewed. Each participating pair was observed for an average of nine hours. Change was perceived, on the whole, in negative terms for both caregiver and the person with dementia. The main categories of change to emerge were those to do with normal routines or practices, perceived deterioration in the condition of the person with dementia, and changes concerning living arrangements. Coping strategies used reflect those in the general coping literature. They included denial, attempts to restore the situation or regain control, making positive comparisons, attempting to understand dementia and acceptance.

Individualisation of drug treatments for patients with long-term conditions: a review of concepts

OBJECTIVES

Patients and policy makers advocate that drug treatments should be individualised. However, the term is used in a variety of ways. We set out to identify the range of related terminology and concepts in the general field of individualisation, map out the relationships between these concepts and explore how patients' perspectives are considered.

DESIGN

We consulted members of an established patient and public involvement group about their experience of medicine taking for long-term conditions and their ideas about individualisation. We then conducted a scoping review of the literature to explore how terms surrounding individualisation of drug treatment are used and defined in the literature, and to explore the extent to which patients' perspectives are represented, with a view to informing future recommendations as to how individualisation can be operationalised.

METHODS

We identified relevant literature using a range of search strategies. Two researchers independently extracted definitions of terms using a template. Inductive and deductive methods were used to explore the data.

RESULTS

Definitions were categorised according to the following themes: medical management; pharmacogenetics, the patient's perspective; interactions between the healthcare provider and patient and management of long-term conditions.

CONCLUSIONS

Within the literature reviewed, the involvement of patients in the ongoing management of drug treatment was largely absent. We propose the use of a new term 'mutually agreed tailoring' (MAT). This describes the ongoing pharmacological management of conditions that incorporates patients' specific needs, experiences and existing strategies for using their medications, and the professionals' clinical judgement. This usually includes patients monitoring their symptoms and, with the support of the professional, making appropriate product, dose or timing adjustments as necessary. Our previous work suggests that many patients and doctors are successfully practising MAT, so we suggest that a formal description may facilitate wider utilisation of strategies that will improve patient outcomes.

Shifting patterns of everyday activity in early dementia: experiences of men and their families

In this article we draw from a larger study to examine experiences of two men and their families as they negotiate changing patterns of everyday activity in the months after receiving a diagnosis of dementia. We conducted in-depth interpretive phenomenological analysis of interview and observational data that were gathered from the men and various members of their families (n = 7) over a period several months. Findings are presented as three themes: The best kind of man (highlighting participants' historical positioning); It's a little different now (recognizing challenges posed by the dementia); and You have to do something (showing how the men and their families responded to and accommodated these challenges). We discuss these findings in terms of how everyday activity is not only important for supporting personhood in dementia, but it also contributes to sustaining family identity, and does so in a way that is deeply influenced by gender and masculinity.

Exploring the affective dimension of the life review process: Facilitators’ interactional strategies for fostering personhood and social value among older adults with early dementia

We employed an auto-ethnography approach to explore the affective dimension of life review sessions with community-dwelling older military veterans with minor cognitive impairment (MCI) and early dementia. Using researchers’ analytic memos, we identified facilitators’ interactional strategies that fostered the participant’s sense of personal identity, dignity and social self-worth. Interaction among participant, caregiver, and facilitators evoked a range of emotional responses, offering a window into the affective world of MCI and early dementia. Positive emotional responses outnumbered negative emotional responses by a ratio of two-to-one in the life review sessions; however, negative emotions were more revelatory of current struggles with declines in health and function. Facilitators utilized two interactional strategies, in particular, to foster personhood and social value of participants: focusing on the participant and creating an empathic connection with the participant. Further work is needed to understand the role of emotions in research interactions and to examine the psychosocial mechanisms through which positive affect functions in promoting identity, personhood and social value among persons with MCI and early dementia.

Figuring it out in the moment: a theory of unregulated care providers' knowledge utilization in dementia care settings

BACKGROUND

Within the context of knowledge translation, the disconnect between the results of research and the practice patterns of nursing care providers has not been reported in the context of institutional dementia care practice. Therefore, little is known about how knowledge about best dementia care practice, defined broadly as the person-centered approach, gets used by institutional nursing care providers.

AIM

Unregulated care providers provide the majority of nursing care for older people with Alzheimer's disease and related disorders living in long-term care facilities. The purpose of this grounded theory study was to explore the process whereby these workers use knowledge about person-centered care in their dementia care practice.

METHODS

Transcribed data from tape-recorded interviews with 20 unregulated care providers among eight long-term care facilities in Ontario, Canada, were coded and categorized at progressively more abstract levels until concepts and the relationships among them were integrated in a middle-range theory of knowledge utilization.

RESULTS

The theory of Figuring it Out in the Moment illustrates how unregulated care providers in dementia care settings practice in the context of unpredictability, variability, and personal threat. Their use of knowledge about person-centered care is dependent on the existence of certain individual and relational conditions that interrelate with four separate, but interconnected, phases of clinical decision-making and action.

CONCLUSIONS

As a middle-range theory, Figuring it Out in the Moment is concrete and pragmatic information for promoting evidence-based dementia care not included in existing overarching knowledge utilization frameworks. Areas for further investigation include how knowledge utilization is conceptualized, as well as the influences of practitioners' clinical decision-making, the nature of caregiving with particular client populations, and the characteristics of individuals alone and in relationship on the utilization of best practice knowledge.

Doing as much as I can do: the meaning of activity for people with dementia

While it is assumed that persons with dementia benefit from being involved in meaningful activity, research examining this claim is limited. In particular, how individuals with dementia perceive this involvement is poorly understood. Therefore, the purpose of this research is to determine what constitutes meaningful activity from the perspective of persons with dementia, and to explore how they perceive its significance in their lives. We conducted an interpretive phenomenological analysis of multiple interviews and participant observation conducted with eight community-dwelling elders with mild to moderate dementia. For several participants, the single most important driving force in their lives was being active, doing as much as they possibly could. They were involved in a wide range of activities including leisure pastimes, household chores, work-related endeavors, and social involvements. These activities were meaningful in three ways: Through their involvement, participants experienced feelings of pleasure and enjoyment; felt a sense of connection and belonging; and retained a sense of autonomy and personal identity. Findings suggest that familiarity of the social and physical environment promotes involvement in activities. This provides a sense of continuity for people with dementia, with implications for their quality of life and personhood. Further implications of these findings for dementia care and future research are discussed.

Reframing Person-Centered Nursing Care for Persons With Dementia

Alzheimer’s dementia manifests in a complex clinical presentation that has been addressed from both biomedical and phenomenological perspectives. Although each of these paradigmatic perspectives has contributed to advancement of the science, neither is adequate for theoretically framing a person-centered approach to nursing care. The need-driven dementia-compromised behavior (NDB) model is discussed as an exemplar of midrange nursing theory that promotes the integration of these paradigmatic views to promote a new level of excellence in person-centered dementia care. Clinical application of the NDB promotes a new level of praxis, or thoughtful action, in the care of persons with dementia.

Family strategies for supporting involvement in meaningful activity by persons with dementia

Involvement in meaningful activity may be helpful for those with dementia, although it is a poorly understood phenomenon among those living in the community with family members. An interpretive phenomenological study was conducted with eight families to determine how family members support involvement in activity of persons with dementia and what it means to families. Repeated individual interviews were conducted with the person with dementia and a family member; they were asked to tell stories about their usual activities, to consider the impact of the dementia on everyday life and what they did to cope with difficulties. They were also observed taking part in everyday activities. Analysis revealed three strategies used by families to support activity: (a) reducing demands, (b) guiding, and (c) accompanying. These strategies allowed families to sustain meaning for both the person with dementia and the family itself. Significance for practice and ideas for future research are discussed.

Positive affect among nursing home residents with Alzheimer's dementia: the effect of recreational activity

The experience of positive emotions is an integral component of quality of life. Research suggests that cognitive deficits in persons with dementia may impede their ability to generate pleasurable moments and hence decrease their positive affect. Therefore, structured recreation activities may have the potential to significantly improve resident affect. However, differences in affect between ordinary time and recreation time are not well known. The present study used previously published structured-observation instruments to measure affect and behaviour among 35 dementia residents at two nursing homes in Japan during ordinary time and during recreation time. A total of 3,854 one-minute observations were coded. Dementia residents expressed happiness over seven times more often during recreation time than during ordinary time. Over 60% of ordinary time was solitary, with 65.72% of all observed affect being 'Null Affect'. A total of 43.75% of residents expressed happiness only during recreation time. In addition 48.9% of all behaviour during 'Ordinary Time' was coded as 'Null Behaviour', which indicated that the resident was sitting and doing nothing. Findings indicate that recreation time is significantly higher in positive affect than ordinary time and that virtually all residents benefited from recreation.

Compiling life history resources for older adults in institutions: development of a guide

Focus groups were conducted for nursing staff, visiting family members, and residents of a long-term care facility, with the purpose of developing a guide for compiling a life history resource. When compiling the proposed guideline, one must consider not only the topics to include, but also the process of collecting the information and the format for presentation. A key finding was that members of all three groups believed that the process of sharing and collecting life history information was an important step in promoting and enhancing the relationship between nursing staff and residents, and nursing staff and residents' families.

Creating a Therapeutic Psychosocial Environment in Dementia Care: A Preliminary Framework

Research in dementia care during the past few years has focused on identifying and designing therapeutic physical environments while the psychosocial environment has remained a largely unexplored domain. More recently, discussions regarding the effect of the social environment on individuals with dementia have increased in the literature. Nevertheless, the authors suggest the term "social environment" does not adequately represent the critical psychological and emotional effect social interaction has on individuals with cognitive impairment. Through an examination of the literature, three conceptual frameworks, and clinical observations of several special care units (SCUs), the authors suggest that the psychosocial environment is the most important element of institutional dementia care. A preliminary conceptualization is offered which identifies the elements necessary to facilitate a supportive psychosocial environment in long-term care. The potential benefits of implementing such a model include preservation of personhood, simple recognition of remaining abilities and a decreased focus on disabilities, and reduction of pharmacologic therapy for disruptive behavior resulting in overall improvement in quality of life.

Assessment of social cognition in frail older adults and its association with social functioning in the nursing home

PURPOSE

The aims of this study were to reliably assess a range of social-cognitive functioning in frail seniors and to examine the association between measures of social cognition and nurses' ratings of residents' social functioning in a nursing home.

DESIGN AND METHODS

Forty nursing home residents with and without cognitive impairment completed 11 social cognition tasks on two occasions after assessment of their cognitive functioning with the Cambridge Cognitive Examination-Revised (CAMCOG), CAMCOG Executive Function, and two tests of working memory. Staff on the nursing units completed two measures of social behavior.

RESULTS

Participants completed the social cognition protocol without difficulty. The measures demonstrated good internal (median alpha =.75) and test-retest reliability (median correlation =.70). Four of the social cognition measures were significantly associated with the measures of cognitive functioning; three additional measures showed significant positive associations with subsets of the cognitive tests. Regression analyses revealed that measures of social cognition were significantly and independently associated with nurses' ratings of residents' social functioning after age, gender, education, and the four measures of cognitive functioning were controlled for. One measure of social cognition that assessed interpersonal problem-solving accounted for 45% of the variance in nurses' ratings of participants' social functioning (F = 41.35; df = 1,17; p <.001).

IMPLICATIONS

Measures of social cognition assess a domain of functioning that is not evaluated by traditional tests of cognitive status. These measures are informative about frail, older adults' ability to understand and respond to others and could be used to predict patterns of social functioning in nursing homes and other naturalistic settings.

"Individualised care" from patients', nurses' and relatives' perspective--a review of the literature

This paper provides an overview of the empirical research literature on individualised care. It offers a description of the methods that have been used in studies of individualised care over the years, and then discusses the meaning and realisation of individualised care from patients', nurses' and relatives' points of view in order to highlight needs for further research. The review focuses on empirical articles retrieved from the MEDLINE database published between 1973 and June 1999. It draws attention to the complexity of individualised care, which at first sight may look like a relatively straightforward nursing activity. It is shown that a wide range of methods have been used to study individualised care in the current literature. There is a lack of research where patients' experiences of the individuality of care in hospital settings are concerned.

Relationships among caregiver factors and quality of life in care recipients with irreversible dementia

Using Lawton's (1983) model of quality of life (QoL) in older adults as a guiding framework, the central purpose of this ongoing longitudinal, prospective study is to examine predictors of QoL outcomes in persons with irreversible dementia as they move through the disease stages. From an initial sample of 96 caregiver/care recipient pairs, 73 (N = 146) pairs remain at the 18-month data collection point. Changes in care recipient outcomes from baseline to the 18-month assessment include significant declines in mental status, productive behaviors, and functional ability, with a statistically significant improvement in depression. Controlling for 12-month mental ability, caregiver factors at 12 months predicting care recipient QoL outcomes at 18 months include psychologic well being predicted by the quality of the relationship with the caregiver and activity participation. Depression was predicted by activity participation as well. Care recipient functional ability was predicted by activity participation and caregiver role stress (disruption to routines and social functioning). Two of the three aspects of care recipient productive behaviors were predicted by caregiver factors, with quality of the relationship predicting problem solving and caregiver role stress (negative attitudes toward care recipient) and total social contacts predicting care recipient social behaviors in the expected direction. Lawton's QoL model was supported by this analysis, with a total explained variance of 32% for three (psychologic well being, productive behaviors, functional ability) of the five (physical impairment and perceived personal control not included) components of care recipient QoL outcomes.

Problem behaviour, caregiver reactions, and impact among caregivers of persons with Alzheimer's disease

BACKGROUND

Problem behaviours that occur during Alzheimer's disease (AD) can have major impact on caregivers. How caregivers react to these behaviours may determine the total impact experienced from caregiving.

PURPOSE

This study examined the relationships between problematic behaviours and caregiving impact in 30 primary caregivers of persons with AD. The first question explored the relationship between frequency of problem behaviour and impact; the second explored the relationship between caregiver reactions to problem behaviours and impact from caregiving.

METHODS

The frequency of problem behaviour and the caregiver reaction was measured using The Revised Memory and Behaviour Problem Checklist (Teri et al. 1992). The impact from caregiving was operationalized using the Cost of Care Index developed by Kosberg and Cairl (1986).

RESULTS

Significant associations were found for 11 of the 20 subscales that measured the association between the frequency of problem behaviour in the client and the impact from caregiving experienced by the caregiver. In comparison, the association between caregiver's reaction to problem behaviours and impact from caregiving was even more significant in value with 15 subscales of 20 being significant. Female caregivers experienced a greater reaction to disruptive and depressive behaviour when compared with male caregivers even though both genders reported similar frequencies of problem behaviours. In regard to findings about the impact from caregiving, four of the six indicators were higher for women than for men.

CONCLUSIONS

Caregiver reaction to problem behaviours was more highly associated with impact from caregiving than the actual frequency of the behaviours. These findings have great implications for intervention programs. Caregivers, especially females, need to receive individualized, specific education/training on how to understand and manage disruptive and depressive behaviour in persons with AD.

A review of research on religious and spiritual variables in two primary gerontological nursing journals: 1991 to 1997

All articles published between 1991 and 1997 in the Journal of Gerontological Nursing and Geriatric Nursing were classified as qualitative research, quantitative research, or non-research. Of the 784 articles reviewed, 5.1% mentioned religion or spirituality. Research articles (7.7%) were more likely than non-research articles (2.8%) to address religion and spirituality. No statistical difference was found between the percentage of qualitative (10.7%) and quantitative (6.8%) studies addressing religious and spiritual factors. The percentage of quantitative studies including religious and spiritual variables was found to be higher than that found by systematic reviews of the research literature in various health professions.

Individually adjusted meals for older people with protein-energy malnutrition: a single-case study

The objective of this study was to investigate the effect of a 3-month intervention programme consisting of meals based on individual nutritional requirements in residents assessed as protein-energy malnourished on admission to a municipal care Institution. Using a single-case design, 11 malnourished residents were given individual care aimed at fulfilling their personal requirements for energy intake during a period of 12 weeks. The residents were selected from a sample of 261 newly admitted older adults of whom 87 were assessed to be malnourished on admission. Nutritional status, including anthropometric and biochemical variables and functional capacities were assessed before, during, and after the intervention. Energy intake was recorded every day. Body weight, and serum concentration of albumin and transthyretin were measured every other week. During a 3-month period, the mean value of energy intake reached the calculated energy requirement in 10 residents. Eight residents increased in weight, triceps skin-fold thickness, and transthyretin concentration. Nine residents increased in arm muscle circumference, and 10 showed increased serum albumin concentration and functional capacity. We conclude that nursing care based on individual nutritional requirements, resources, and desires improves nutritional status and functional capacity in a group of malnourished residents.

Developing and testing an instrument for the measurement of individual care

This paper describes a preliminary study in which an instrument was developed for the measurement of individual care in adult patients and in which the reliability and validity of the instrument were evaluated. Individual care was defined in terms of how patient individuality was taken into account and how patient participation in decision-making was facilitated. The purpose here is to describe the process by which the individual care instrument (IC) was developed, the preliminary testing of the instrument and psychometric evaluation of the instrument in a sample of adult patients discharged from a Finnish general Hospital (n=203). Item analyses showed an acceptable level of internal consistency reliability and homogeneity in each scale of the IC, and Cronbach alpha values were high in every measurement. Exploratory factor analysis supported a three-factor solution. The psychometric evaluations suggested that the instrument is worthy of further development.

Individualized care in a Finnish healthcare organization

This paper reports the findings of a study exploring the provision of individualized care in a regional hospital in Finland. Individualized care was defined in terms of how patient individuality was taken into account and how patient participation in decision-making was facilitated. The data were collected from hospitalized patients (n = 203) using a questionnaire specially developed for this study. The response rate was 89%. A strong support to facilitate patient participation in decision-making was reported. Most shortcomings concerning the provision of individualized care related to consideration of the patient's cultural background and the involvement of the patient's family in the planning of care. Patients' age and the type of ward were associated with the provision of individualized care: patients aged 65 or over were more satisfied than younger age groups with the way in which their personal life situation had been taken into account. Patients from the gynaecological ward thought, more than patients from the surgical ward, that their situation had been taken into account during hospitalization.

Evaluation of Simulated Presence: a personalized approach to enhance well-being in persons with Alzheimer's disease

OBJECTIVE

To evaluate the efficacy of Simulated Presence, a personalized approach to enhance well-being among nursing home residents with Alzheimer's disease and related dementia's (ADRD).

DESIGN

Latin-Square, double blinded, 3-factor design with restrictive randomization of three treatments (the study intervention, a placebo audio tape of a person reading the newspaper, and usual care). The three factors were treatment, time, and facility type.

SETTING

Nine nursing homes in Eastern Massachusetts and Southern New Hampshire.

PARTICIPANTS

Fifty-four subjects with documented ADRD who were aged 50 years or older, medically stable, had resided in their current nursing home for at least 3 months, and who had no planned discharge. All subjects had a history of agitated or withdrawn behaviors.

INTERVENTION

The purpose of Simulated Presence is to provide a personalized intervention for persons with moderate to severe cognitive impairment. Through a unique testing process, some of the best loved memories of the ADRD person's lifetime are identified and then those memories are introduced to the patient in the format of a telephone conversation using a continuous play audio tape system. The intervention may be used for extended periods of time because each repetition is viewed as a fresh, live telephone call as a result of the short-term memory deficit of the person with ADRD.

MEASUREMENTS

Direct observations of outcomes included using a newly developed scale, the Scale for the Observation of Agitation in Persons with Dementia, an agitation visual analog scale, the Positive Affect Rating Scale (mood and "interest"), a withdrawal visual analog scale, and facial diagrams of mood. Reported measures included daily staff observation logs of responses to interventions offered, and weekly staff surveys using the short-form Cohen-Mansfield Agitation Inventory and the Multidimensional Observation Scale for Elderly Subjects (mood and "interest"). Severity of dementia was assessed by the Mini-Mental State Exam, the Test for Severe Impairment, the Bedford Alzheimer's Nursing Scale, and the ADL Self-Performance Scale.

RESULTS

Chi-square analysis of direct observations, using facial diagrams, revealed that Simulated Presence was equivalent to usual care (P = .141) and superior to placebo for producing a happy facial expression (P = .001). A positive effect was also documented in nursing staff observation logs using Analysis of Variance techniques (ANOVA) for subjects during Simulated Presence phases compared with the placebo phases (P < .001) and usual care phases (P < .001). According to ANOVA analyses of "interest" from weekly surveys, Simulated Presence was superior to both usual care (P = .001) and placebo (P = .008). We were unable to find evidence of significant differences (P < .05) among interventions for other direct observations and weekly reports of overall agitation or mood aspects of withdrawal. Subjects accepted the intervention most of the time, except for five subjects who refused it more than 50% of the time.

CONCLUSION

This study provided evidence that Simulated Presence can be effective in enhancing well-being and decreasing problem behaviors in the nursing home setting as a substitute for or complement to usual care.

Assessing patients in the early stages of irreversible dementia. The relevance of patient perspectives

1 Individuals with Alzheimer's dementia are able to describe their personal responses to the disease, including how the disease has affected their perceptions of self. 2 Individual-centered variables, other than those related to the disease, are associated with quality of life outcomes in individuals with Alzheimer's dementia, including the individuals' personality, age, and education level. 3 The importance of maintenance of social activities and past pleasant activities is shown by the relationships among these variables and quality of life outcomes in individuals with dementia. 4 The quality of the relationship between caregivers and individuals with dementia, including the role-stress experiences by the caregivers, is moderately to strongly associated with the individuals' level of depression, psychological well-being, and productive behaviors.

Does your care plan tell my story? Documenting aspects of personhood in long-term care

Learning about aspects of one's personhood allows the nurse to know the individual as a person and to individualize the care provided. A pilot project was conducted on a supportive residential care unit to explore why health records in long-term care rarely reveal who the person is. Five nurse participants generated a list of features of an individual's personhood that they felt should be known by members of the team. They subsequently gathered that information from a variety of sources, with documentation in a designated location provided on the plan of care. They were thus able to overcome some of the previously encountered barriers to collecting and documenting the personhood data reflecting their knowledge of the individual as a person. Although nurses were successful in learning who the persons were, changes in approach to care as a result of the new knowledge have not been measured.

Living with dementia from the patient's perspective

This study describes the illness experience of dementia from the patient's perspective. Five people with Alzheimer's disease and their spouses were interviewed and observed during home visits. Thematic analysis revealed two themes: being unsure and trying to be normal. Being unsure describes people's fluctuating experience of symptoms that leaves them feeling unsure of themselves in a world that is increasingly unfamiliar. Trying to be normal describes people's efforts to counter the impact of dementia to maintain continuity in their lives. These findings point to the importance of taking into account the patient's perspective to better understand the experience of living with dementia and develop improved treatment and care practices.

Life-span perspective of personality in dementia

PURPOSE

To propose an alternative view of personality change in dementia by presenting existing evidence for the continuity of personality.

SIGNIFICANCE

As the population continues to age, dementing illnesses will account for a greater proportion of morbidity and mortality; the care of these people will have a significant effect on the health care system.

ORGANIZING FRAMEWORK

Life-span perspective of personality continuity. SCOPE METHOD: Review of current literature on personality in dementia using Medline, 1980-1994; CINAHL, 1990-1994; and Psych Lit., 1980-1994.

FINDINGS

Although there are systematic shifts in personality with dementia, individuals tend to maintain their unique pattern of premorbid personality traits.

CONCLUSIONS

The personalities of dementia patients seem to reflect adaptive patterns that served them in the past.

IMPLICATIONS

Use of a life-span perspective can enhance individualized care for demented patients and advance theory development.

Cognitive developmental approach to dementia

Systematic observations of people suffering from dementia of the Alzheimer's type (DAT) reveal they regress in behavior and become childlike. These observations have been used to structure clinical research and therapeutic interventions for dementia patients. However, no concise framework explains successful caregiving. Models for care exist but they lack an adequate framework for the long-term care of a person with DAT. This state of the science review describes what is known about cognitive functioning in people with DAT. It examines studies based on cognitive functioning. It also then relates this information to an emerging theory tentatively identified as a "cognitive developmental approach" which may be useful for understanding people with dementia and for predicting caregiver requirements.

Shining through: the humor and individuality of persons with Alzheimer's disease

1. Elders with diminished levels of cognitive functioning are capable of providing meaningful, consistent responses that illustrate individual expressions of self. 2. The demented elder's history and experiences may provide important clues to understanding his or her current behaviors, verbalizations, and perceptions. 3. Humor may be used as a therapeutic intervention for persons with dementia and as a coping strategy for caregivers.