Intensity of Case Management Services

ABSTRACT

In a systematic sample of Florida-licensed clinical social workers (N = 273), this study investigated the correlates of perceived adequacy to work with elders with Alzheimer's disease and other types of dementia. Five predictor variables were identified from a standard regression analysis that account for 35.7% of the model's adjusted variance: (a) employment with elders (Beta = .225, p = .000), (b) years of experience (Beta = -.125, p = .018), (c) attitude toward working with elders with Alzheimer's disease (Beta = .351, p = .000), (d) perceived sufficiency of professional education to work with elders with Alzheimer's disease (Beta = .178, p = .002), and (e) attitude toward the delivery of nonclinical services to elders with Alzheimer's disease (Beta = .192, p = .000). Overall, respondents perceived their abilities to work with elders as slightly less than adequate. Implications are discussed.     

THE SOCIAL PRESERVATION OF MIND: THE ALZHEIMER'S DISEASE EXPERIENCE

Data from the Alzheimer's disease (senile dementia) experience are interpreted to extend and refine George Mead's theory of mind. While Mead conceived of mind as an internal conversation, the disease experience shows that the reality-status of mind is more practical and radically dialogical in organization. Taken as collectively preserved, mind is circumscribed through agents by means of rule-guided articulations and closures. Suggestions are offered for a more fully dialogical appreciation of Mead's view.     

Centre Stage Diagramming: Late-stage Parkinson’s disease and Alzheimer’s disease

Using the method of centre stage diagramming, this 3-year [2007–2009] longitudinal study reports a single case study of Ben and Mary that maps the onset of Alzheimer's disease within Ben's late-stage Parkinson's disease and the impact, adjustment and meaning that this had for the couple. It is believed that that this is the first time that such a transition has been documented within a qualitative research design. The importance of Ben and Mary obtaining a diagnosis of Alzheimer's disease is reported as the diagnosis helped to locate the meaning of Ben's memory and behavioural changes within a ‘dementia’ context, rather than as an extension of late-onset Parkinson's disease as was originally considered by the couple. Ben and Mary's search for stability within their life once the diagnosis of Alzheimer's disease was made is also shared. The couple was recruited from the caseload of a Parkinson's disease nurse specialist in North Wales and the couple was visited five times over the duration of the study. All interviews were conducted in Ben and Mary's own home and with their full involvement in the development and reporting of each centre stage diagram. Policy and practice implications are also considered.     

Living with Dementia: Lay Definitions of Alzheimer's Disease among African American Caregivers and Sufferers

While the medical world aggressively pursues scientific knowledge about Alzheimer's disease, sufferers and caregivers live with this ailment, not as patients, but as people going about their lives, needing and providing care. This article reports explanations of Alzheimer's from the perspectives of African American family caregivers and sufferers. Data were collected from thirty‐six families using participant observation and focus group interviews. Although caregivers sought and used medical expertise, their explanations of Alzheimer's were not only nonmedical, but not necessarily explanations of illness per se. Alzheimer's was presented instead as a way of being, predominantly characterized by views of the sufferer as childlike and by issues of continuity/discontinuity, though some saw Alzheimer's as part of a larger picture.     

Alzheimer's Disease:

Alzheimer's disease and other dementias are increasingly being recognized as important problems for older persons and their caregivers, but these disorders are rarely discussed in the context of elder abuse and neglect. This paper reviews information on the prevalence and clinical characteristics of Alzheimer's and other dementias and on the unique stresses experienced by Alzheimer's caregivers. Patients with Alzheimer's are often misdiagnosed and not accurately identified within medical and social service systems, and the special problems faced by caregivers and patients are not sufficiently addressed. Recommendations that would make clinicians and policy makers more responsive to Alzheimer's patients and their families are discussed.     

Elder Abuse and Neglect Substantiations:

This study set out to measure rates of substantiation of initial abuse and neglect reports and to identify case related factors that are associated with substantiation. Toward this end, analysis was performed on 2,849 cases reported to the Wisconsin Elder Abuse Reporting System in 1988 and 1989. Over 57% of all initial reports were substantiated by the investigating agencies with higher rates for cases of self-neglect only. Among cases involving other abusers, physicial and emotional abuse had the highest substantiation rates. Results also indicate that substantiation rates for all types of abuse and neglect are higher in urban settings. Cases referred by professionals usually have higher substantiation rates than those referred by relatives and neighbors. Higher rates were found for elders living alone and those with several high risk characteristics such as mental illness and Alzheimer's disease. The abusers in substantiated cases were more likely to be spouses, sons, and other relatives. These abusers were also likely to be in one or more risk categories. The amount of services that were offered to and accepted by the victims was associated with substantiation only for alternative placements but not for community based services. Clients in substantiated cases were in fact more likely to refuse services than their peers in unsubstantiated ones.     

Losing Selves: Dementia Care as Disruption and Transformation

Caregiving is a process of transformed identities and reconstructed relations. The disruption of Alzheimer's disease affects both the individual with dementia and the person providing care. One becomes enselfed in dementia, the other transformed into a caregiver. Using data from twenty qualitative interviews with family caregivers, this article traces the transformative process by which the previous relational selves of both participants become casualties of the disease. Findings suggest that the ill person in this dyad is silenced through dementia, leaving the caregiver narratives to become the morality tales of transformation from disorder to order, from havoc to meaningful interaction. By becoming caregivers, family members construct value in their struggles to negotiate the disorder of illness and recreate meaningful and affirming selves and relationships.     

Asian Americans and Alzheimer's disease: Assimilation,culture, and beliefs

Because most successful interventions for Alzheimer's disease (AD) rely upon early diagnosis and implementation, it is important to understand the factors influencing dementia treatment-seeking behaviors. These include perceptions, beliefs, values, and feelings relating to AD, which may vary among and within ethnic groups according to the strength of culturally-based explanatory models and individual group members' ages and experiences. This study used ten focus groups drawn from Asian American communities representing different national origins (Chinese, Japanese, and Korean) to examine the factors shaping attitudes toward AD in general, and treatment-seeking in particular, that may constitute barriers to timely diagnosis and treatment of AD among Asian Americans of various ages and cultural backgrounds. The results suggest that, while these communities share a keen awareness of AD, beliefs regarding the disorder may be influenced at least as strongly by folk wisdom and culturally acceptable partial truths as by scientific information.     

Dementia Policy Revisited

Abstract

Even though state governments assume public responsibility for persons with dementia, formal analysis of state laws concerning individuals with Alzheimer's disease and other forms of dementia has been rare. We responded to this by collecting and evaluating state legislation targeted towards individuals with dementia. These laws were collected by searching online statutory archives and were defined by the type of action, year of passage, and legislative purpose. Our research revealed that the legislatures have targeted an average of slightly more than five actions towards persons with dementia. We also discovered that the earliest legislative act targeting individuals with dementia was passed by South Dakota in 1939, and by the end of the 1997 sessions, 49 state legislatures had enacted at least one targeted law. We sorted the variety of legislative actions into eight categories and illuminated how the purposes of these laws differed from one state legislature to the next. This research expands knowledge concerning state policies targeting people with dementia, introduces a reliable method of collecting state laws, and contributes to the advocacy effort made on behalf of persons with dementia.     

In sickness and in health: A qualitative study of elderly men who care for wives with dementia

It is estimated that approximately 1,000,000 elderly men care for spouses with Alzheimer's disease or other forms of cognitive impairment, yet we have only a limited understanding of their work, and central questions arise. What do men caregivers do, and what meanings do they ascribe to their work? What are their distinctive strengths and vulnerabilities, and what can we learn about men and caregiving from their stories? This qualitative study was based on in-depth, open-ended interviews with 14 elderly men who are primary caregivers to wives with dementia. All interviews were taped, transcribed, and manually coded. The resulting information then underwent analysis from which three major themes emerged: feelings of isolation and invisibility of their care work, a style of caregiving that jointly utilizes management and nurturing, and feelings of commitment, responsibility, and devotion.     

FDA cracks down on CBD claims

Last week, the Food and Drug Administration (FDA) issued a warning letter to Curaleaf Inc. of Wakefield, Massachusetts, for illegally selling cannabidiol (CBD) with claims that their products treat cancer, Alzheimer's disease, opioid withdrawal, pain and “pet anxiety,” among other conditions and diseases.     

Alzheimer's Disease Caregiver Burden: Does Resilience Matter?

Caring for an individual with Alzheimer's disease is at times challenging and can lead to caregiver burden. Resilience is a personality characteristic that has emerged as a protective factor among aging individuals. This study was conducted to examine the moderating effect of resilience between caregiver stressors and caregiver burden. The results indicate that resilience was not identified as a moderator between stressors and caregiver burden; however, a relationship exists between resilience and caregiver burden. Specifically, as resilience in Alzheimer's disease caregivers increases, their caregiver burden decreases. These findings highlight the importance of supportive interventions that will increase resilience in Alzheimer's disease caregivers.     

Social Workers’ and Students’ Attitudes toward Electronic Tracking of People with Alzheimer's Disease

Global Positioning Systems (GPS) have recently been employed to help monitor persons with dementia. While the advantages of such technologies are clear, making use of them raises a number of ethical dilemmas. Considering the fact that social workers may be called upon to assist families in making decisions regarding the use of GPS, their attitudes on this issue are important. Fifty-five social workers and 61 social work students completed a questionnaire including: attitudes toward tracking, knowledge of Alzheimer's Disease (AD) symptoms, familiarity with persons who have AD, and ratings of who should be involved in the decision-making process regarding GPS use. Findings showed that the highest-scored attitude factor was respecting elders’ autonomy, while the lowest-scored factor opposed GPS use. The elderly and their spouses were rated as important decision-makers regarding the use of GPS. Knowledge of AD and respecting autonomy were negatively correlated. Students gave a higher rating to respecting elders’ autonomy than the social workers. Social workers gave a higher rating to the importance of a multidisciplinary team. Implications for social work education are discussed including recommendations for person-centered AD care on the one hand, and the need to balance the interests of the individual and the family on the other.     

Ageing Siblings: Supporting New Care Partnerships

Through the lens of a case study of a sibling caring for an unmarried sister affected by dementia, the article explores a phenomenon of growing social importance, late life care for those ageing without a spouse, partner or adult children. The purpose of the article is to describe the experience of sibling care partnering, to highlight the needs of sibling care partnerships and discuss how the support group model can address some of the challenges faced by this population. This article addresses the caregiving sibling's experience of participating in a support group of adult children caregivers of parents with Alzheimer's. Ultimately, the article argues for the development of services geared specifically for older adult siblings caring for each other for the first time in later life.     

The social and nutritional meaning of food sharing among older rural adults

In most societies, the gift of food conveys social meaning, as well as nutritional sustenance. While food sharing has been widely noted, there has been little focused study of this practice among older adults in the US, who, as a group, are considered nutritionally vulnerable. We completed in-depth interviews with 145 adults (African American, European American, and Native American) aged 70+ years in rural North Carolina. Our objectives are (1) to describe the types of food shared by gender and ethnicity, (2) to identify values and meaning elders associate with giving and receiving food, and (3) to discuss the nutritional and social contribution food sharing makes to the lives of these rural elders. All elders participated in food sharing, as givers, recipients, or both. It is valued by these elders as a way to maintain reciprocity in social relations and to create a feeling of community membership. For older adults, receiving food gifts may augment a diet limited by income and functional status.     

Designing Successful Gardens and Outdoor Spaces for Individuals with Alzheimer's Disease

SUMMARY

There are many benefits derived from exposure to the outdoors for older adults with Alzheimer's disease, which include exposure to fresh air, sunlight and opportunities for walking and other forms of exercise. There are also opportunities for socialization that can minimize feelings of isolation and vulnerability, improve depression, enhance self-esteem, and simply experience the joys and surprises of nature.

While there seems to be universal agreement of the health and quality of life benefits in getting institutionalized persons into appropriate outdoor settings, in many ways gardens and outside spaces have failed. Time after time visitors stroll through the gardens admiring the landscaped grounds, the abundance of beautiful and fragrant flowers and other features, while noting the absence of residents.

Creditable research studies support the health benefits of exposure to the outdoors and nature. This discussion of design issues, barriers to use, the role of activity, the necessity of staff involvement, and design recommendations supports the urgent need for empirical research to inform the development of effective gardens and outdoor spaces to benefit older adults with Alzheimer's disease.     

Ethnic Variations in Dementia Caregiving Experiences

Abstract

The proportion of minority elders with dementia in the United States is projected to rise substantially. This study elicited perceptions of the caregiving experience from informal caregivers of persons with dementia, across different ethnicities. Six focus groups with 47 dementia caregivers of African-American, Chinese-American, Euro-American, and Hispanic-American ethnicities were conducted. Caregiving roles, concern about the person with dementia, and unmet information and resource needs were expressed similarly. However, perspectives differed across ethnic groups on stigma surrounding dementia, benefits of caregiving, spirituality/religion to ease caregiving burden, and language barriers and discrimination. Findings suggest that interventions to reduce disparities in dementia care quality need to address ethnic variations in caregiving experiences.     

Caregiving for relatives with Alzheimer's disease: feelings of Chinese-Canadian women

Chinese-Canadian female caregivers were asked about their feelings of providing care for relatives with Alzheimer's disease. Using an adapted version of the conceptual model of Alzheimer's caregivers' stress by Pearlin et al. [Gerontologist 30 (1990) 583] to guide data collection, 12 in-depth interviews were conducted in Cantonese. Qualitative analysis was inductive and done manually. Despite anticipating and accepting their caregiving role as a cultural obligation, they, like most caregivers, felt overwhelmed, anxious, and fearful of the future. Against their stated cultural and personal values, all caregivers had made applications to nursing homes, and six were ready to institutionalize their relatives when a place became available. While coping mechanisms and social support appeared to mediate their stress, participants' concerns about the influence of western culture on traditional values and in particular, intergenerational issues regarding caregiving provided an added burden. Findings are particularly relevant given the rapid growth of the Chinese population in North America.