A Descriptive Study of Home Modifications for People with Dementia and Barriers to Implementation

This study describes home environmental features, safety issues, and health-related modifications in a community dwelling sample of 82 elderly people with dementia. Main barriers to the accessibility of the homes were steps both inside and outside the home. The majority of the caregivers had made home modifications that pertained mainly to physical limitations. Home modifications to support cognitive deficits were made to a lesser extent. The main barrier to the implementation of home modifications to accommodate the care recipient's memory loss was skepticism about their usefulness. Regarding the removal of physical barriers, financial constraints were most frequently mentioned.     

Establishing Continuity of Self-Memory Boxes in Dementia Facilities for Older Adults: Their Use and Usefulness

Spatial and detailed design aspects of dementia care centers deserve attention because they contribute to the overall experience of vulnerable individuals who need more support from the designed environment. This study examined the use and usefulness of memory boxes (wall-mounted display cases) at the entrances to resident rooms in dementia care facilities. Environmental walk-throughs, photodocumentation, memory box inventory, and staff interviews in three residential care facilities confirmed that memory boxes were beneficial in creating identity, assisting in orientation and wayfinding, and encouraging reminiscence. An additional use that emerged from this study was their usefulness as a tool for staff.     

Using the Therapeutic Relationship to Promote an Internal Locus of Control in Elderly Mental Health Clients

Seniors who feel powerless to effect change on their environment or who feel that their lives are controlled by external circumstances are said to have an external locus of control. This may adversely affect commitment to and participation in mental health treatment. This article presents the conce t of using the therapeutic relationship to encourage internal contro f' beliefs in elderly mental health clients, with the goal of promoting personal empowerment and improving the efficacy of therapy. Included is a review of litera- ture relevant to aging and locus of control. The develoament of an external locus of conbol is explained by the theories of self psychol- ogy and the social breakdown syndrome.     

Examination of a Psychoeducational Intervention and a Respite Grant in Relieving Psychosocial Stressors Associated with Being an Alzheimer's Caregiver

Alzheimer's disease can be particularly devastating to those who are caring for their loved one with the condition. There have been recent calls for the tailoring of caregiving interventions to examine outcome differences between groups of caregivers and the reporting of effectiveness via longitudinal and specific outcomes. The purpose of this study was to examine 3 interventions (psychoeducational training, a respite voucher-type grant, or their combination) while looking for possible group differences. A total of 367 caregivers participated in the study. Participants completed surveys and questionnaires before the intervention and at a 6-month follow-up. Positive outcomes were found, including lower depression scores, increased support service use, and increased support group usage. Possible effectiveness of the 3 types of interventions and variation among caregiver characteristics are discussed along with implications for future research.     

Clinically Significant Effects of Group Cognitive Behavioral Therapy on Spouse Caregivers' Mental Health and Cognitive Functioning: A Pilot Study

The objective of this pilot study was to investigate whether group cognitive behavioral therapy (CBT) resulted in clinically meaningful improvements in caregiver mood, burden, and cognition. We screened 97 caregivers in Toronto, Canada, of whom 25 with DSM-IV disorders began the 13-week CBT intervention, and 12 completed therapy and the 3-month follow-up. Each caregiver experienced clinically significant improvement on at least 2 of the following outcomes: diagnostic criteria, mood, attention, memory, and caregiver burden. Despite effectiveness, the challenges of recruiting distressed caregivers for therapy suggest that CBT might be most useful as part of a stepped care model of treatment.     

盐酸多奈哌齐治疗血管性痴呆的临床研究

目的评价盐酸多奈哌齐治疗血管性痴呆患者的安全性和有效性。方法对62例VD患者随机分为两组,治疗组30例(男性20例,女性10例),年龄(78±6)岁和对照组32例(男性22例,女性10例),年龄(77±7)岁,进行12周临床观察。用MMSE为主要评价指标,日常生活能力量表(ADL)和临床痴呆程度量表(CDR)为次要评价指标。结果5mg/d盐酸多奈哌齐治疗12周时,盐酸多奈哌齐组较对照组安慰剂MMSE,ADL,CDR分数显著改善(依次P<0.01,P<0.05,P<0.01)。对照组安慰剂,研究结果显示,5mg/d盐酸多奈哌齐治疗12周时,治疗后较治疗前MMSE,CDR,ADL分数分别较明显改善(P<0.05)。安慰剂组评价指标无改善。结论盐酸多奈哌齐可显著改善VD患者的认知功能,且安全性良好。     

Controlling behaviour using neuroleptic drugs: the role of the Mental capacity act 2005 in protecting the liberty of people with dementia

The use of neuroleptic drugs to mediate the behaviour of people with dementia living in care homes can lead to them being deprived of their liberty. Whilst regulation has been successful in reducing neuroleptic prescribing in the USA, policy guidance has been unsuccessful in reducing the use of these drugs in the UK. Yet the Mental capacity act 2005 aimed to protect the liberty of people lacking capacity and provided safeguards to ensure that they are not inappropriately deprived of their liberty in institutions. This article highlights the potential for using this law to identify when neuroleptic prescribing in care homes would deprive people with dementia of their liberty and, in turn, to act as a check on prescribing levels. However, the extent to which the Act can promote and protect the right to liberty of people with dementia is constrained by a lack of access to social rights.     

顾客管理概念及其在现代旅游业中的实践

近年来服务性企业正在兴起顾客管理经营理念。本文重点结合旅游业,论述了顾客的分级管理、顾客档案开发、顾客联系与反馈、常客优惠以及建立顾客组织和顾客持续教育等具体实施措施。     

A Latent Process Model for Joint Modeling of Events and Marker

The paper formulates joint modeling of a counting process and a sequence of longitudinal measurements, governed by a common latent stochastic process. The latent process is modeled as a function of explanatory variables and a Brownian motion process. The conditional likelihood given values of the latent process at the measurement times, has been drawn using Brownian bridge properties; then integrating over all possible values of the latent process at the measurement times leads to the desired joint likelihood. An estimation procedure using joint likelihood and a numerical optimization is described. The method is applied to the study of cognitive decline and Alzheimer's disease.     

被动吸烟与老年期痴呆的关系研究

越来越多的研究清楚表明,吸烟使老年人患痴呆的风险增加,由此引发了对被动吸烟与认知障碍或老年期痴呆关系的研究,但目前研究尚少,且结果不一?文章通过对国内外相关文献的研究,归纳被动吸烟暴露评价与老年期痴呆筛查和诊断的方法,梳理被动吸烟与认知障碍或老年期痴呆之间的关系,为控烟运动的开展及老年期痴呆的预防提供流行病学依据?