American Journal of Alzheimer's Disease & Other Dementias®

The world is aging. The United Nations' has estimated an increase in those 65 years of age and older in the world from 6 percent of the total population in 1985 to 9.7 percent of the population by the year 2025. The growth in the elderly population is most significant among the oldest of the old.

While the incidence of Alzheimer's disease (AD) is related to advanced age (as are other forms of dementia), it can be concluded that the aging of the world will result in an increase in the worldwide number of AD patients. For example, in the United States presently there are in excess of 2.5 million persons with AD and 100,000 AD patients are dying on a yearly basis-it is the fourth leading cause of death in the United States for the elderly, following heart disease, cancer, and stroke.² Holmes et al project that the number of AD victims in the United States will increase to over 14 million persons by the year 2050.3 It has been estimated that one-third of all American families have at least one parent who has AD.⁴

The authors investigated the effects of sensory stimulation activities on the psychological well being of 15 persons institutionalized with advanced Alzheimer's disease. A recently developed instrument, the Discomfort Scale for Dementias of the Alzheimer's Type (DS-DAT), measured nine indicators of discomfort and provided an outcome measure for interventions in this population. Mean baseline DS-DAT scores suggested that participants experienced a moderately high level of discomfort. Results indicated that overall discomfort decreased significantly during three stimulation interventions, including music, touch and smell. The DS-DAT variable of fidgeting body language also decreased significantly7 during three sensory stimulation activities.

This paper focuses on the concepts, specifics and effects of dementia programming within an assisted living setting. The target population consists of 20 people, 60 years of age and older, who reside at Kensington Cottages, Rochester, Minnesota, a residential assisted living facility for people with Alzheimer's disease and other forms of dementia. The residents at Kensington Cottages are unable to live independently and require assistance with their daily cares in varying degrees. They also need to be provided with homemaker services and recreational stimulation. This 24-hour assistance is provided by staff caregivers; these residents do not require the degree of skilled nursing supplied in a nursing home.

The paper begins with an analysis of the concept of dementia programming. This concept is then applied to the specifics of the program which is presently being used at Kensington Cottages Rochester The effects of dementia specific programming are shown through case studies of two Kensington Cottages residents diagnosed with Alzheimer's disease. These case studies demonstrate the positive effects of dementia programming on individuals through program involvement, the results of which are analyzed through the eyes of family members. Further information is derived from a January 1996, Kensington Cottages Corporation survey of Kensington Cottages Rochester family members which elicits information concerning the general well being of their relatives with dementia.

Aggressive behavior is a common problem among elder persons suffering from dementia. It puts themselves, and other persons around them at risk of being injured.¹ This qualitative study observed four individuals with Senile Dementia of the Alzheimer's Type (SDAT) who were living in a long term care facility and demonstrated a great deal of aggressive behavior It assessed these individuals for a baseline of behaviors, made environmental changes, and assessed the results. The interventions were successful in decreasing the amount and intensity of the aggressive behavior in three of the individuals studied. The pattern of aggressive behavior and possible causes of this behavior seemed to originate from distinct causes in each of these individuals.²

The purpose of this article is to discuss the advantages of using copying and tracing during supportive, educational and therapeutic sessions with clients who are diagnosed with dementia. Originality and inventiveness are pursued to such a great extent in working with clients, that this population for whom such is not always possible, may be forgotten. The authors attempt to demonstrate that copying and tracing are perfectly legitimate and often productive forms of operation for clients with Alzheimer's disease and other forms of dementia.

Daily unpleasant and pleasant events and specific unpleasant caregiving events were examined in relation to depression in 93 caregivers of demented patients. This study differs from previous research on caregivers in that it focuses on general events (hassles) in addition to specific caregiving events (hassles). Even after controlling for specific unpleasant caregiving events, general unpleasant and pleasant events accounted for additional variance in depressive symptomatology. The results are discussed in terms of their importance for treatment of caregiver depression.

The way the caring environment meets the needs of its staff is influential in achieving job satisfaction. Given the current issues in recruitment and retention of nursing staff in long-term care, knowledge of those factors which influence job satisfaction is of great importance.

This study examined factors associated with job satisfaction of nursing staff on a Dedicated Alzheimer's Unit, Special Care Units (SCU's) compared to staff on traditional Nursing Home Units, or using the Stamps and Piedmont Index of Work Satisfaction. The factors of pay, autonomy task requirement, organizational policies, interaction and professional status were examined in their relationship to total job satisfaction between the two groups.

Professional and paraprofessional nursing staff were surveved. Of a total of 125 surveys, 61 LWS's were analyzed utilizing univariate and bivariate descriptive statistics. Differences in factors influencing satisfaction were also examined among caregivers (i.e. professional vs. nonprofessional staff). Staff working on the Alzheimer's Unit had significantly higher total LWS scores than did staff working on traditional units (p<.001). In particular the factors of professional status, interaction and organizational policies were rated significantly higher by Alzheimer's Unit staff as these influenced job satisfaction.

Clearly, the results support further research into factors influencing satisfaction of nursing staff in long term care and serve (is a useful guide for development of programs to recruit and retain nursing staff in nursing home settings. Results also encourage further research into factors which influence successful implementation and management of staff development iln the specialized area of Alzheimer's care.