American Journal of Alzheimer's Disease & Other Dementias®

In this study we examine factors which are associated with nursing home placement in terms of both their frequency of occurrence and the degree to which caregivers perceive them to have influenced placement. We propose “Tolerance Weighted Frequency Indices “ (TWFIs) to rank symptoms in terms of their association with placement decisions. Given our method for calculating TWFIs we observe that basic activity of daily living impairments appear to have a comparatively stronger association with nursing home placement than many disruptive behaviors. These findings emphasize the importance of management of ADL impairments in strategies designed to delay or prevent nursing home placement.

This paper explores the parallels between the mainstreaming of disabled and non-disabled students in schools and the integration of cognitively impaired and cognitively intact residents in nursing homes. The research on educational mainstreaming at a more mature stage of development, can serve as a foundation for gerontologists by suggesting that:

• The physical location of service is non-specific and relatively meaningless as an independent variable;

The Alzheimer Functional St atus Inventory (AFSI) was developed to assess a kinesiotherapy program for 22 randomized pairs ofpatients with Senile Dementia of the Alzheimer Type (SDAT) residing in the Dementia Study Unit of the Edith Nourse Rogers Memorial VA Medical Center; Bedford, Massachusetts. The AFSI was developed by an interdisciplinary team to overcome some of the limitations of standard geriatric instruments to detect changes in functional status in SDAT patients following a rehabilitation program. The AFSI, which is performance-based, includes items adapted from Granger's PULSES Profile and activity disturbances itemsfrom the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), items on mood andbehaviorduring assessment, as well as, one on communication status. The AFSI thus includes items which evaluate physical, psychosocial, and cognitive dimensions offunctional status. These dimensions are:

• Sensory function;

The role of autopsy is critical in confirming diagnoses and advancing research in Alzheimer's disease. In collaboration with the Alzheimer's Association chapters in Michigan, the staff of the Education Core of the Michigan Alzheimer's Disease Research Center developed, implemented, and evaluated an educational intervention based on a train-the-trainer model to disseminate information about autopsy to chapter staff and volunteers. Participants at a one-day Autopsy Education Workshop (AEW) developed skills to make presentations about autopsy in their local communities and assist family caregivers with decision-making. Participants reported significant gains in knowledge about autopsy and an increased level of confidence in discussing autopsy withfamily members. The AEW curriculum and evaluation design will be described.

The pattern of initial symptoms reported by caregivers of Alzheimer's disease (AD) subjects were described and compared in 45 Spanish-speaking (SS) and 84 English-speaking (ES) caregivers. The majority (56 percent) of SS caregivers were monolingual. All caregivers were given a standard interview in their respective language which included information on the age at onset and initial symptoms observed in the AD subject. First symptoms reported most frequently by ES caregivers fell into the following categories: memory (27 percent), activities of daily living (ADLs, 21 percent), disorientation (13 percent), and personality changes (13 percent). In contrast, SS caregivers reported memory (47 percent), psychological problems (16 percent), and personality changes (11 percent) at the first sign of the disease process. After adjusting for duration of illness, significantly more SS than ES caregivers reported memory loss, and sign ficantly less SS than ES caregivers reported difficulty with ADLs as an initial symptom of dementia. In addition to cultural group, older caregivers were significantly less likely than younger caregivers to report memory loss as a first symptom. Caregivers of AD subjects with onset before, versus after age 70 were more likely to report ADL deficits as thefirst symptom. Finally, the report ofpsychological problems as afirst symptom was related to lower caregiver education and longer duration between disease onset and interview. These results highlight the need for professionals to consider potential cultural differences when assessing impairment in elderly persons. In addition, the high prevalence of non-English-speaking caregivers emphasizes the need for Spanish-speaking professionals to optimally service and research health needs in this growing elderly Hispanic population.

Disruptive behavior of nursing home residents is a serious problem. One such disruptive behavior-aggression toward caregivers in a long-term care setting where all residents in one unit were being relocated is thefocus of the study. Recent research indicates that aggressive behavior leads to isolation of the aggressive resident and increases stress of the caregiver No one, however has studied what happens to the behavioraftersuch a resident is relocated The purpose of the study was to see if relocation affects the frequency and nature of aggressive behavior in any way. I studied 12 aggressive residents three months pre- and post-relocation. These residents were relocated with the same caregivers. Six of the 12 residents were receiving psychotropic drugs, and this drug use did not change during or after the move. The mean number of separate incident reports decreased after the relocation; however, thisfinding was statistically in-significant. Additionally, whereas some subjects in-creased their aggressive activity after the move, others decreased it. Aggressive behavior occurred more often in the day shift, confirming the findings of earlier studies.