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.     

中药穴位敷贴治疗血管性痴呆的临床观察

目的探讨中药穴位敷贴治疗血管性痴呆的临床疗效。方法黄芪、石菖蒲、川芎三药研磨成粉,敷贴于大椎、神门、足三里、三阴交四穴,分别于治疗前、治疗后4周、治疗后8周,根据MMSE量表评分与对照组比较疗效。结果治疗组MMSE评分在治疗后8周明显增高（P=0．01）。治疗组总有效率40．6％,对照组总有效率13.3％,两组有差异（P=0．016）。结论中药穴位敷贴治疗对于血管性痴呆的恶化进程有良性作用。     

小组治疗对老年脑卒中患者康复效果的影响

目的探讨小组治疗对老年脑卒中患者康复疗效的改善作用。方法将47例老年脑卒中患者平均分为两组,治疗组24例,对照组23例,两组患者均进行常规的康复训练,治疗组在进行常规训练的基础上,实施小组康复治疗,每周2次,每次（30—60）分钟。治疗6周,治疗前后均采用患者总体治疗评价表、Fugel—Meyer、Barthel指数、HAMD对两组患者进行测评,观察患者治疗效果的改善状况。结果6周后两组患者的各项评分均有所改善（P〈0．01）,但治疗组平均得分较对照组改善更明显,其比较差异具有显著意义（P〈0．05）。结论小组治疗对老年脑卒中患者康复效果的改善具有一定的临床意义。     

Live Discharge from Hospice and the Grief Experience of Dementia Caregivers

When an individual has dementia, family members are involved in many care transitions in their roles as caregivers. One such transition is the ‘live’ discharge from hospice services. This occurs when an individual no longer meets eligibility criteria. This can be difficult for caregivers who have been anticipating an end to understand in the context of their grief process. This qualitative study (N = 24) explored the experience of caregivers of adults with dementia, including Alzheimer’s disease, who experienced a ‘live’ discharge from hospice. Specifically, the experience of grief is examined. Results from this study highlight the complexity of caring for someone with a terminal disease and the grief experience in end-of-life care as caregivers struggle to understand the individual’s terminal prognosis as temporary. This is further complicated for caregivers who must resume caregiving responsibilities or assume a new caregiving role after experiencing a loss of hospice services. Finally, hospice social workers are well positioned to offer emotional and other concrete support to caregivers who experience a ‘live’ discharge.     

Exploration of Choice for Older People with Daily Care Needs: Scottish Professionals’ Perspectives on Self-Directed Support

ABSTRACT

This article explores The Social Care (Self-Directed Support [SDS]) (Scotland) Act 2013 developments, influence’s on individuals informed choices for care decisions and implications for direct practice situations. The article discusses perspectives from 18 professionals and front-line care workers interviewed in Scotland on SDS policy changes. Barriers included attitudes on dependence, power and control, shortage of direct client contact time, clients becoming “employers,” and reductions in the number of qualified social workers. Some recommendations included allowing social workers freedom of creativity, sharing and application of practice experience. Findings revealed an outcome-focused, person-centered approach was utilized to support an independent living environment.     

Recognising the agency of people with dementia

People with dementia have been assumed to possess weak or even no agency, so this paper provides a novel contribution to academic debate by examining their actual potential for agency. The author draws on findings from a qualitative study of everyday decision-making by people with dementia that aimed to identify the role of social factors (such as gender) in influencing their involvement in decisions. Whilst decision-making constitutes a form of deliberative agency, the research also identified when agency was alternatively habituated, embodied or emotional. The Economic and Social Research Council-funded research was undertaken in the North of England. Existing theoretical perspectives on agency are critiqued, particularly in relation to rationality, language and individualised agency. The study highlighted that people with dementia who lack deliberative capacity can nonetheless demonstrate creative capacity for agency. A more expansive concept of agency is needed in social science theory that is informed by the experiences of cognitively disabled people.     

Dementia Caregivers and Live Discharge from Hospice: What Happens When Hospice Leaves?

ABSTRACT

Hospice offers holistic support for individuals living with terminal illness and their caregivers. Some individuals receiving hospice services experience a slower decline in health as than expected, resulting in a ‘live discharge’ from hospice. A live discharge affects both patient and caregiver(s).The current study (N=24) explored the experiences of caregivers of adults with dementia who experienced a live discharge from hospice. Findings emphasize the comprehensive services covered under the Medicare Hospice benefit and those lost after a live discharge. Implications for social workers supporting caregivers are discussed, including the need to view the patient-caregiver unit during a live discharge.     

The Psychological and Health Consequences of Caring for a Spouse With Dementia: A Critical Comparison of Husbands and Wives

Caring for someone with dementia can be demanding, particularly for spouses living with the care recipient. The main goal of this study was to clarify differences in the experience of caregivers who were husbands and wives with respect to burden, health, healthy behaviors, presence of difficult care recipient behaviors, social supports, and the quality of the premorbid relationship. The results of this study support research demonstrating a difference between the caregiving experiences of women and men. It is becoming increasingly apparent that female gender is a marker that places them at increased risk of high burden and less support.     

Implementation of a Community-Based Approach to Dementia Care in England: Understanding the Experiences of Staff

ABSTRACT

Given the increasing numbers of people living with dementia, it is imperative that new, practical solutions are found to the issues faced by this group of people and their families. This article draws on findings from a qualitative study that explored the implementation of a community-based project to support people living with dementia in one local area in England. This approach has different names; in the United Kingdom it is Shared Lives or adult placement, which would be most comparable to family care in Europe and adult foster care in the United States. Interviews were conducted with 14 staff connected to the Shared Lives project. Interview data were coded using the normalization process theory constructs of coherence, cognitive participation, and collective action. Supportive program factors identified were a dedicated staff member and resources, and the availability of specialist knowledge and skills. Detriments to program success included lack of understanding about the service, perceptions it was a poor fit with existing practice, and wider organizational issues that negatively affected normalization of the intervention. Suggestions for future research go beyond staff opinions, stressing the importance of using a wider range of stakeholders and incorporating measurement of outcomes for people using the service.     

养老机构失智老人的多元社会支持网络研究——基于社会工作介入的视角

随着现代化社会进程的不断加快,老龄化问题与日俱增,由此而产生的一大难题便是老年人失智症的患病比例不断升高,失智老人的养老形势愈加严峻。目前,国内失智老人的机构生活状况并不乐观,失智老人往往因为缺乏必要的支持网络而导致生活质量难以保证。基于社会工作介入的视角,以青岛市X机构内失智老人为对象进行研究的结果表明,失智老人正式社会支持网络存在着社工服务效果难以维持、护理员服务质量难以保证、养老机构自身支持有限和政府政策支持力度不足等问题,非正式社会支持网络存在着家属联系不足、朋友沟通渠道不畅和同住老人关系紧张等问题。因此,应该从正式支持和非正式支持两个方面整合、运用失智老人的各方支持力量和资源,从社会工作者、护理人员、养老机构以及政府政策等方面为养老机构内失智老人构建起正式的社会支持网络,从家属、朋友和同住老人等方面为养老机构内失智老人构建起非正式的社会支持网络,从而改善养老机构内失智老人的生活处境,提高其生活质量。