American Journal of Alzheimer's Disease & Other Dementias®

Two new intergenerational interventions for Alzheimer's disease (AD) patients (with moderately severe to severe cognitive impairment) and families are being evaluated, with work to date described. Both interventions share the common goals of:

• Introducing a novel long-term care intervention for Alzheimer patients and their families in order to increase the quality of life for both;

• Increasing the incentive of family members, significant others, and volunteers to visit and spend time with AD patients;

• Increasing staff knowledge of the patient as person;

• Effecting a new intergenerational environment at sites providing care for AD patients; and

• Providing a new paradigm for innovative budget neutral programs, requiring no new public monies, building upon and leveraging existing resources to enhance the quality of life of older adults coping with dementing disorders.

The first intervention uses video biographies; the second involves the first game specifically designed for AD patients and their families. In pilot studies both interventions have been shown to increase patient engagement during visits approximately three-fold. Family and staff interest in both projects has been high.

Too often the attention of formalized ethical decision making in health care settings turns to hard to deal with life and death issues. Consequently, consideration of the ethical aspects of ordinary everyday issues affecting nursing home residents with dementia and those who care for them remains limited. The purpose of this twoyear anthropological study was to develop a taxonomy of commonplace ethical issues, taking into account resident, family member, and nursing home staff member points of view. This paper defines the guiding concept of everyday ethics as it has been used in the research and describes the taxonomy, of which there are four domains:

• Learning the limits of intervention;

• Tempering the culture of surveillance and restraint;

• Preserving the integrity of the individual; and

• Defining community norms and values.

Discussion considers the usefulness of the taxonomy as a framework for thinking about what may be involved in understanding the ethics of the ordinary and resolving common types of issues and concerns.

Eleven subjects with Alzheimer's disease took a 30-item biographical baseline quiz. Seven experimentals received 10 weekly sessions of a tape-recorded narrative plus quiz exercise, created and administered by university undergraduates. Controls had equivalent student contact, but no memory training. The exercise contained all items missed on the baseline quiz, plus additional items. Experimentals learned or relearned seven - 13 personal facts, as determined by a post-test administered one distraction-filled hour after the 10th training session. Experimentals' improvement in performance from the first to the last session was highly significant and experimentals did significantly better than controls on a readministration of the baseline test.

The present study developed and systematically evaluated two inventions (Musical Memory Lane and Video Memory Lane) which present nostalgic music and videos to 15 plus day care clients with Alzheimer's disease (AD) in an easy-to-access, push button, picture format. Systematic observations indicated that the Memory Lanes had a favorable impact on engagement, stimulated positive affect and activity-related talking, while also reducing fidgeting. There was no impact on sleeping and general interaction. During free time, people chose a Memory Lane activity significantly more often than other activities and remained engaged with it for a longer time. The Memory Lanes show great potential for providing meaningful and easily accessible activities to people with dementia. Additional studies are needed in other care settings and to determine if the Memory Lanes can decrease agitation and enhance memory function.

Emotional distress and disruptive behaviors were assessed for 26 persons with Alzheimer's disease (AD) at admission to a research registry and again three years later. Average prevalence of disruptive behaviors increased, as did the variability among patients in these characteristics. Individual differences in disruptive symptoms at initial assessment were unrelated to symptom status three years later. Emotional symptoms decreased on average and the patient group became more homogeneous in this symptom dimension. Nonetheless, individual differences in prevalence showed significant stability over three years. These differences in pattern of average change and predictability of changes suggest the importance of studying behavioral change in Alzheimer's disease in terms of individual differences as well as group trends within specific symptom clusters.

Clergy support is an important type of support that has often been neglected. The purpose of this study is to determine how knowledgeable clergy are about Alzheimer's disease (AD), what expectations AD families hold for support from clergy, and how clergy knowledge and caregiver expectations differ between a rural and urban area. Ries survey7 in Montana of clergy knowledge and caregiver expectations for support was replicated. The Montana study drew a clergy response rate of 41 percent compared with a 22 percent rate in this study. Responses of Kentuckiana families indicated less satisfaction with clergy support than found in Ries study. Findings suggested the need for more educational opportunities for clergy.