Use of the physical environment to support everyday activities for people with dementia: A systematic review.

Difficulty with everyday activities is a key symptom and defining feature of dementia, relating to subjective reports of well-being and overall quality of life. One way to support individuals in their daily activities is by modifying the physical environment to make it easier to interact with during activity performance. This systematic review explores the range of studies available using physical environmental strategies to support performance in everyday activities for people with dementia. Seventy-two relevant studies were identified by the search. Physical environmental strategies included changes to the global environment and to architectural features, use of moveable environmental aids and tailored individual approaches. Strategies supported general everyday activity functioning (N = 19), as well as specific activities, particularly mealtimes (N = 15) and orientation in space (N = 16); however, few studies were found that focused on aspects of personal care such as dressing (N = 1) and showering or the preferred hobbies of individuals (N = 0). Overall, there appeared to be a lack of research within private home environments, and of studies which specify the dementia syndrome or the whole neuropsychological profile of people with dementia. More work is needed to extend theoretical understandings of how people with dementia interact with their environments so that these spaces can be designed to further support activities of daily living performance. Future work in this field could also incorporate the perspectives and preferences of those living with dementia.

A meta-review of stress, coping and interventions in dementia and dementia caregiving.

BACKGROUND: There has been a substantial number of systematic reviews of stress, coping and interventions for people with dementia and their caregivers. This paper provides a meta-review of this literature 1988-2014. METHOD: A meta-review was carried out of systematic reviews of stress, coping and interventions for people with dementia and their caregivers, using SCOPUS, Google Scholar and CINAHL Plus databases and manual searches. RESULTS: The meta-review identified 45 systematic reviews, of which 15 were meta-analyses. Thirty one reviews addressed the effects of interventions and 14 addressed the results of correlational studies of factors associated with stress and coping. Of the 31 systematic reviews dealing with intervention studies, 22 focused on caregivers, 6 focused on people with dementia and 3 addressed both groups. Overall, benefits in terms of psychological measures of mental health and depression were generally found for the use of problem focused coping strategies and acceptance and social-emotional support coping strategies. Poor outcomes were associated with wishful thinking, denial, and avoidance coping strategies. The interventions addressed in the systematic reviews were extremely varied and encompassed Psychosocial, Psychoeducational, Technical, Therapy, Support Groups and Multicomponent interventions. Specific outcome measures used in the primary sources covered by the systematic reviews were also extremely varied but could be grouped into three dimensions, viz., a broad dimension of "Psychological Well-Being v. Psychological Morbidity" and two narrower dimensions of "Knowledge and Coping" and of "Institutionalisation Delay". CONCLUSIONS: This meta-review supports the conclusion that being a caregiver for people with dementia is associated with psychological stress and physical ill-health. Benefits in terms of mental health and depression were generally found for caregiver coping strategies involving problem focus, acceptance and social-emotional support. Negative outcomes for caregivers were associated with wishful thinking, denial and avoidance coping strategies. Psychosocial and Psychoeducational interventions were beneficial for caregivers and for people with dementia. Support groups, Multicomponent interventions and Joint Engagements by both caregivers and people with dementia were generally found to be beneficial. It was notable that virtually all reviews addressed very general coping strategies for stress broadly considered, rather than in terms of specific remedies for specific sources of stress. Investigation of specific stressors and remedies would seem to be a useful area for future research.

Verbalization and problem solving: insight and spatial factors.

Two groups of participants attempted eight examples of each of four different problem types formed by combining insight versus non-insight and verbal versus spatial factors. The groups were given different verbalization instructions viz., Silent (N=40) or Direct Concurrent (N=40). There were significant differences between insight and non-insight tasks and between spatial and verbal tasks in terms of solution rates and latencies. Significant interactions between the verbal versus spatial factor and verbalization condition on solution rates and latencies reflected a greater (negative) effect of verbalizing on spatial as against verbal problems. However, no significant interactions of the insight versus non-insight factor with verbalization condition on solution rates or latencies were found. These results favoured the 'business as usual' view of insight problem solving as against the 'special process' view which predicted larger effects of verbalization for insight problems as against non-insight problems.

Cognitive aging: activity patterns and maintenance intentions.

This study examined relationships between cognitive functioning in older people and (1) levels of mental, physical and social activities, and (2) intentions regarding maintenance of cognitive functioning. Participants (N=145) were 70-91 years of age, varied in health status and socio-economic backgrounds. Current cognitive functioning was assessed by psychometric tests and real world problem solving tasks. Crystallized ability was indexed by the National Adult Reading Test (NART). Degree of involvement in mentally demanding activities was positively related to a fluid cognitive factor after effects of age, prior functioning, gender, health, and socio-economic status were accounted for. Social and physical activities were not related to the cognitive measures. Age effects on cognitive functioning were reduced among participants who reported undertaking activities intentionally to maintain cognitive functioning.

Real-world problem solving and quality of life in older people.

OBJECTIVES: This study examined relationships between quality of life (QoL) in older people and cognitive functioning in both abstract and real-world problem solving. DESIGN: Contributions of levels of mental, physical and social activities, self-rated and objective health status, self-rated cognitive functioning, socio-economic status, gender, real-world and abstract problem solving were examined in a regression study of factors related to QoL in older people. METHOD: Participants (N=145) were 70-91 years of age. The current cognitive functioning was assessed by psychometric tests and real-world problem-solving tasks. Prior functioning was indexed by crystallized ability measures. QoL was assessed using the Leiden-Padua questionnaire (LEIPAD), Faces scales and Hospital and Anxiety Depression Scale. A single QoL factor was derived. RESULTS: Simultaneous multiple regressions indicated that QoL was related to real-world but not to abstract problem-solving ability. Separate contributions to QoL were also found for health and self-rated cognitive functioning. CONCLUSIONS: The present study replicates previous findings that abstract problem-solving ability is not related to QoL and supports the hypothesis that real-world or everyday problem-solving ability is associated with QoL in older people.

Divergent thinking: strategies and executive involvement in generating novel uses for familiar objects.

Although the Alternative Uses divergent thinking task has been widely used in psychometric and experimental studies of creativity, the cognitive processes underlying this task have not been examined in detail before the two studies are reported here. In Experiment 1, a verbal protocol analysis study of the Alternative Uses task was carried out with a Think aloud group (N=40) and a Silent control group (N=64). The groups did not differ in fluency or novelty of idea production indicating no verbal overshadowing. Analysis of protocols from the Think aloud group suggested that initial responses were based on a strategy of Retrieval from long-term memory of pre-known uses. Later responses tended to be based on a small number of other strategies: property-use generation, imagined Disassembly of the target object into components and scanning of Broad Use categories for possible uses of the target item. Novelty of uses was particularly associated with the Disassembly strategy. Experiment 2 (N=103) addressed the role of executive processes in generating new and previously known uses by examining individual differences in category fluency, letter fluency and divergent task performance. After completing the task, participants were asked to indicate which of their responses were new for them. It was predicted and found in regression analyses that letter fluency (an executively loading task) was related to production of 'new' uses and category fluency was related to production of 'old' uses but not vice versa.

Mental planning and the Tower of London task.

The Tower of London (TOL) task has been used extensively as a test of planning ability in neuropsychological patients and normal populations. Participants are asked to preplan mentally a sequence of moves to match a start set of discs to a goal, and then to execute the moves one by one. The mental preplanning stage has been identified as critical to efficient performance. The current experiments examined whether manipulations of mental preplanning influence performance on the TOL. In Experiment 1, the effect of different planning instructions was examined. Those told to make full mental plans spent considerably longer in planning than participants given no specific planning instructions, yet there was no effect of instruction condition on the efficiency of executing plans. Experiment 2 investigated whether people were able to plan mentally, by looking at their ability to identify intermediate states of an optimum mental plan. Results indicated that most individuals could make accurate preplans up to two subgoals ahead, but not three. However, making an efficient preplan did not result in better subsequent execution of moves to solve the TOL trial. It is concluded that people can make effective mental plans for a limited number of moves. However, on the TOL task, mental preplanning does not offer benefits in terms of quicker performance, or more accurate solution. The nature of planning in the TOL task is therefore questioned.

The role of memory in the Tower of London task.

The Tower of London (TOL) task is widely used as a neuropsychological test of planning. Relatively little is known of the cognitive components of the task, and in particular the role of memory in performance. The current studies on normal adults looked at the role of verbal and spatial working memory in the TOL. The effects of verbal and visuospatial dual-task manipulations on TOL performance were examined in an experiment with 36 participants. Both verbal and visuospatial executive secondary tasks caused poorer performance on the TOL; however, concurrent articulatory suppression enhanced performance. The results suggest that executive and spatial components are important in the task, and raise questions about the role of preplanning in the TOL.

Aberdeen polygons: computer displays of physiological profiles for intensive care.

The clinician in an intensive therapy unit is presented regularly with a range of information about the current physiological state of the patients under care. This information typically comes from a variety of sources and in a variety of formats. A more integrated form of display incorporating several physiological parameters may be helpful therefore. Three experiments are reported that explored the potential use of analogue, polygon diagrams to display physiological data from patients undergoing intensive therapy. Experiment 1 demonstrated that information can be extracted readily from such diagrams comprising 8- or 10-sided polygons, but with an advantage for simpler polygons and for information displayed at the top of the diagram. Experiment 2 showed that colour coding removed these biases for simpler polygons and the top of the diagram, together with speeding the processing time. Experiment 3 used polygons displaying patterns of physiological data that were consistent with typical conditions observed in the intensive care unit. It was found that physicians can readily learn to recognize these patterns and to diagnose both the nature and severity of the patient's physiological state. These polygon diagrams appear to have some considerable potential for use in providing on-line summary information of a patient's physiological state.

Counting on working memory in arithmetic problem solving.

Mental calculation is an important everyday skill involving access to well-learned procedures, problem solving, and working memory. Although there is an active literature on acquiring concepts and procedures for mental arithmetic, relatively little is known about the role of working memory in this task. This paper reports two experiments in which dual-task methodology is used to study the role of components of working memory in mental addition. In Experiment 1, mental addition of auditorily presented two-digit numbers was significantly disrupted by concurrent random letter generation and, to a lesser extent, by concurrent articulatory suppression, but was unimpaired by concurrent hand movement or by presentation of irrelevant pictures. Although the number of errors increased with two of the dual tasks, the incorrect responses tended to be quite close to the correct answer. In Experiment 2, the numbers for addition were presented visually. Here again, random generation produced the largest disruption of mental arithmetic performance, while a smaller amount of disruption was observed for articulatory suppression, hand movement, and unattended auditorily presented two-digit numbers. The overall levels of performance were better and the absolute size of the disruptive effects shown with visual presentation was very small compared with those found for auditory presentation. This pattern of results is consistent with a role for a central executive component of working memory in performing the calculations required for mental addition and in producing approximately correct answers. Visuospatial resources in working memory may also be involved in approximations. The data support the view that the subvocal rehearsal component of working memory provides a means of maintaining accuracy in mental arithmetic, and this matches a similar conclusion derived from previous work on counting. The general implications for the role of working memory in arithmetic problem solving will be discussed.

Working memory and strategies in syllogistic-reasoning tasks.

It has often been asserted that working-memory limitations are a major factor contributing to problem difficulty; for example, Johnson-Laird's (1983) mental-models theory appeals to working-memory limitations to explain the difficulty of syllogistic reasoning. However, few studies have directly explored working memory in problem solving in general or syllogistic reasoning in particular. This paper reports two studies. In the first, working-memory load was varied by presenting syllogistic tasks either verbally or visually (so that the premises were continuously available for inspection). A significant effect of memory load was obtained. In the second study, premises were presented visually for a subject-determined time. Dual-task methods were used to assess the role of working-memory components, as identified in Baddeley's (1986) model. Syllogistic performance was disrupted by concurrent random-number generation but not by concurrent articulatory suppression or by concurrent tapping in a preset pattern. Furthermore, the concurrent syllogism task interfered with random generation and to a lesser extent with articulatory suppression, but not with tapping. We conclude that while the central-executive component of working memory played a major role in the syllogistic-task performance reported here, the articulatory loop had a lesser role, and the visuospatial scratch pad was not involved.

Human factors and computerisation in intensive care units: a review.

Current literature on the computerisation of Intensive Care Units indicates that many human factor considerations are relevant to the design and introduction of computer systems and to the evaluation of such systems within this environment. This paper aims to review and summarise essential points from the literature.

Users' perceptions of a computerised information system in intensive care (ABICUS) on introduction and after 2 months use.

The aim of the present study was to assess the perceived utility of a computerised information system in an intensive care unit (ICU). Questionnaires were devised in which ICU staff indicated the ease or difficulty of obtaining and recording information (a) under the previous manual system, (b) soon after the introduction of the computerised system and (c) two months after computerisation. Results indicated the system was well received immediately and this favourable attitude persisted unchanged after two months experience. The questionnaire method also served to pinpoint some particular interface problems which are to be remedied in future versions of the system.