Memory and communication support strategies in dementia: effect of a training program for informal caregivers.

BACKGROUND: People with dementia have a range of needs that are met by informal caregivers. A DVD-based training program was developed using research-based strategies for memory and communication in dementia. The effectiveness of the training on the caregiver experience and the well-being of the person with dementia was evaluated. METHODS: A pre-test/post-test controlled trial was undertaken with caregiver-care-recipient dyads living in the community. Measures of the carers' knowledge of memory and communication strategies, burden, positive perceptions of caregiving, and perceptions of problem behaviors were taken pre- and three months post-intervention. The depression and well-being of the person with dementia were also evaluated. Satisfaction with the training and feedback were measured. RESULTS: Twenty-nine dyads (13 training group, 16 control group) participated. Bonferroni's correction was made to adjust for multiple comparisons, setting α at 0.00385. A significant improvement was found in caregivers' knowledge for the training group compared to the control group (p = 0.0011). The training group caregivers reported a reduction in the frequency of care recipient disruptive behaviors (p = 0.028) and increased perceptions of positive aspects of caregiving (p = 0.039), both at a level approaching significance. The training group care recipients had increased frequency of verbally communicated depressive behaviors at a level approaching significance (p = 0.0126). The frequency of observed depressive behaviors was not significantly different between groups. CONCLUSIONS: This approach to training for caregivers of people with dementia appears promising for its impact on knowledge and the caregiving experience. Further research could monitor the impact of the training on broader measures of depression and well-being, with a larger sample.

Word length and age influences on forward and backward immediate serial recall.

The present research is aimed at understanding the processes involved in short-term memory and how they interact with age. Specifically, word length effects were examined under forward serial recall, backward serial recall, and item recognition tasks, with performance being interpreted within an item-order theoretical framework. The interaction of age, word length, and direction of recall was examined in two experiments, the first of which confirmed that the word length was present with forward recall and absent with backward recall. In addition, age effects were stronger in backward recall than in forward recall. In the second experiment, an item-order trade-off methodology was utilized with backward recall. When order memory was required, there was no word length effect and strong age effects. When memory was tested via an item recognition test, there was a reverse word length effect and no age effect. While word length effects can be interpreted within the item-order framework, age effects cannot.

Memory and communication support in dementia: research-based strategies for caregivers.

BACKGROUND: Difficulties with memory and communication are prominent and distressing features of dementia which impact on the person with dementia and contribute to caregiver stress and burden. There is a need to provide caregivers with strategies to support and maximize memory and communication abilities in people with dementia. In this project, a team of clinicians, researchers and educators in neuropsychology, psychogeriatrics, nursing and speech pathology translated research-based knowledge from these fields into a program of practical strategies for everyday use by family and professional caregivers. METHODS: From the available research evidence, the project team identified compensatory or facilitative strategies to assist with common areas of difficulty, and structured these under the mnemonics RECAPS (for memory) and MESSAGE (for communication). This information was adapted for presentation in a DVD-based education program in accordance with known characteristics of effective caregiver education. RESULTS: The resultant DVD comprises (1) information on the nature and importance of memory and communication in everyday life; (2) explanations of common patterns of difficulty and preserved ability in memory and communication across the stages of dementia; (3) acted vignettes demonstrating the strategies, based on authentic samples of speech in dementia; and (4) scenarios to prompt the viewer to consider the benefits of using the strategies. CONCLUSION: Using a knowledge-translation framework, information and strategies can be provided to family and professional caregivers to help them optimize residual memory and communication in people with dementia. Future development of the materials, incorporating consumer feedback, will focus on methods for enabling wider dissemination.

The burden of online friends: the effects of giving up Facebook on stress and well-being.

People occasionally choose to cut themselves off from their online social network by taking extended breaks from Facebook. This study investigated whether abstaining from Facebook reduces stress but also reduces subjective well-being because of the resulting social disconnection. Participants (138 active Facebook users) were assigned to either a condition in which they were instructed to give up Facebook for 5 days or continue to use Facebook as normal. Perceived stress and well-being, as well as salivary cortisol, were measured before and after the test period. Relative to those in the Facebook Normal condition, those in the No Facebook condition experienced lower levels of cortisol and life satisfaction. Our results suggest that the typical Facebook user may occasionally find the large amount of social information available to be taxing, and Facebook vacations could ameliorate this stress-at least in the short term.

An Automated Approach to Examining Conversational Dynamics between People with Dementia and Their Carers.

The progressive neuropathology involved in dementia frequently causes a gradual decline in communication skills. Communication partners who are unaware of the specific communication problems faced by people with dementia (PWD) can inadvertently challenge their conversation partner, leading to distress and a reduced flow of information between speakers. Previous research has produced an extensive literature base recommending strategies to facilitate conversational engagement in dementia. However, empirical evidence for the beneficial effects of these strategies on conversational dynamics is sparse. This study uses a time-efficient computational discourse analysis tool called Discursis to examine the link between specific communication behaviours and content-based conversational engagement in 20 conversations between PWD living in residential aged-care facilities and care staff members. Conversations analysed here were baseline conversations recorded before staff members underwent communication training. Care staff members spontaneously exhibited a wide range of facilitative and non-facilitative communication behaviours, which were coded for analysis of conversation dynamics within these baseline conversations. A hybrid approach combining manual coding and automated Discursis metric analysis provides two sets of novel insights. Firstly, this study revealed nine communication behaviours that, if used by the care staff member in a given turn, significantly increased the appearance of subsequent content-based engagement in the conversation by PWD. Secondly, the current findings reveal alignment between human- and computer-generated labelling of communication behaviour for 8 out of the total 22 behaviours under investigation. The approach demonstrated in this study provides an empirical procedure for the detailed evaluation of content-based conversational engagement associated with specific communication behaviours.

Evaluation of a caregiver education program to support memory and communication in dementia: a controlled pretest-posttest study with nursing home staff.

BACKGROUND: There is a need for simple multimedia training programs designed to upskill the dementia care workforce. A DVD-based training program entitled RECAPS and MESSAGE has been designed to provide caregivers with strategies to support memory and communication in people with dementia. OBJECTIVES: The aims of this study were: (1) to evaluate the effects of the RECAPS and MESSAGE training on knowledge of support strategies, and caregiver satisfaction, in nursing home care staff, and (2) to evaluate staff opinion of the training. DESIGN: A multi-centre controlled pretest-posttest trial was conducted between June 2009 and January 2010, with baseline, immediately post-training and 3-month follow-up assessment. SETTING: Four nursing homes in Queensland, Australia. PARTICIPANTS: All care staff were invited to participate. Of the 68 participants who entered the study, 52 (37 training participants and 15 controls) completed outcome measures at baseline and 3-month follow-up. 63.5% of participants were nursing assistants, 25% were qualified nurses and 11.5% were recreational/activities officers. METHODS: The training and control groups were compared on the following outcomes: (1) knowledge of memory and communication support strategies, and (2) caregiver satisfaction. In the training group, the immediate effects of training on knowledge, and the effects of role (nurse, nursing assistant, recreational staff) on both outcome measures, were also examined. Staff opinion of the training was assessed immediately post-training and at 3-month follow-up. RESULTS: The training group showed a significant improvement in knowledge of support strategies from baseline to immediately post-training (p=0.001). Comparison of the training and control groups revealed a significant increase in knowledge for the training group (p=0.011), but not for the control group (p=0.33), between baseline and 3-month follow-up. Examination of caregiver satisfaction by care staff role in the training group revealed that only the qualified nurses showed higher levels of caregiver satisfaction at 3-month follow-up (p=0.013). Staff rated the training positively both for usefulness and applicability. CONCLUSION: The RECAPS and MESSAGE training improved nursing home care staff's knowledge of support strategies for memory and communication, and gains were maintained at 3-month follow-up. Moreover, the training was well received by staff.

How many variables can humans process?

The conceptual complexity of problems was manipulated to probe the limits of human information processing capacity. Participants were asked to interpret graphically displayed statistical interactions. In such problems, all independent variables need to be considered together, so that decomposition into smaller subtasks is constrained, and thus the order of the interaction directly determines conceptual complexity. As the order of the interaction increases, the number of variables increases. Results showed a significant decline in accuracy and speed of solution from three-way to four-way interactions. Furthermore, performance on a five-way interaction was at chance level. These findings suggest that a structure defined on four variables is at the limit of human processing capacity.