Do nursing homes with a higher proportion of residents with dementia have greater or fewer complaints?

Objectives: Nursing home (NH) residents' capacity to communicate deteriorates with dementia. Consequently, NHs with high proportions of people living with dementia (PLWD) may receive fewer resident complaints, and/or investigating complaints may be challenging. We assessed NHs' proportion of PLWD in relation to total and substantiated complaints. Methods: Data were from the ASPEN Complaints/Incident Tracking System and the Certification and Survey Provider Enhanced Reports (2017). NHs (N = 15,499) were categorized based on high (top-10%), medium (middle-80%), and low (bottom-10%) dementia prevalence. Negative binomial Poisson regression assessed complaint patterns in relation to NHs' high/low (vs. medium) proportions of PLWD and other facility/resident characteristics. Results: Compared to NHs with medium-dementia prevalence, NHs with low proportions of PLWD had higher total (average marginal effect [AME] = 0.16, p < 0.001) and substantiated (AME = 0.30, p < 0.001) complaints, whereas NHs with high proportions of PLWD had fewer total (AME= -0.07; p < 0.05) and substantiated (AME= -0.11, p < 0.05) complaints. Also, NHs' profit status, chain-affiliation, size, staffing, and resident ethnicity were associated with total and substantiated complaints. Conclusion: The association between high proportions of PLWD and lower NH complaints suggests either that these NHs have higher overall quality or that complaints are underreported. Regardless, surveyors and families may need more involvement in monitoring higher dementia prevalence facilities.

Impact of visitation restrictions on the mental health of family caregivers during the COVID-19 pandemic: A mixed methods study.

AIM: To examine the mental health conditions of family caregivers residing away from their loved ones who experienced visitation restrictions during the coronavirus disease 2019 pandemic. DESIGN: A mixed-methods design applying the Kessler Scale-10 for the quantitative measurement of psychological distress and an open-ended question for qualitative analysis. METHODS: The participants were recruited from care facilities between February and September 2021. This cross-sectional study included 197 family caregivers who were utilizing formal residential care services for their loved ones. Using thematic analyses, open-ended responses regarding the impact of visitation restrictions were coded. These themes were then examined to determine thematic patterns across caregiver characteristics. RESULTS: Thirteen themes were identified regarding the impact of visitation restrictions. Many participants reported primary harmful effects as follows: 'inability to confirm the type of care and lifestyle assistance provided to an older relative' and 'difficulty communicating with an older relative because of the inability to converse face-to-face'. Younger age, being employed, poor sleep, poor relationship quality with the care recipient and experiencing harmful effects from the visitation restrictions were associated with psychological distress. CONCLUSION: Our findings suggest that to maintain positive mental health after a care transition, it is important for family caregivers to take part in the care of their loved ones and ensure information sharing between the care recipient's family and institution. IMPACT: These findings suggest that both residents and family caregivers living outside facilities may feel distressed due to separation. Therefore, institutional care staff needs to consider how to adjust facility procedures or communication with family caregivers. PATIENT OR PUBLIC CONTRIBUTION: The comments obtained from the participants in this survey helped to shape the study design and are expected to contribute to the further development of quality facility care.

Family Caregivers' Progress Toward Values Moderates the Associations between Behavioral Symptoms of Dementia, Caregiver Burden, and Depressive Symptoms.

Increasingly, dementia caregiver interventions are informed by acceptance-based approaches such as Acceptance and Commitment Therapy. These interventions promote psychological skills like psychological flexibility and value-based living. Less is known how these constructs interact within well-established caregiver stress processes. We examined a moderated mediation model (N = 161 dementia caregivers; PROCESS Procedure; SPSS Release 4.1), with BPSD frequency (Revised Memory and Behavior Problems Checklist) predicting depressive symptoms (10-item CES-D), mediated via caregiver burden (short Burden inventory). The moderator was the Values Questionnaire, and we controlled for gender, caregiver duration, age, income, and education. Results: revealed that the indirect effect of BPSD on depressive symptoms through caregiver burden was weakened through higher progress toward values (moderated mediation significant at p < .05). Committed action toward values signify caregivers' success at balancing care-related stress with other priorities. Interventions that build skills in values-based living have promise for caregivers, offering healthier ways to adjust to being a caregiver.

Protective roles of meditation practice and self-esteem on cognitive functions over time: findings from the Midlife in the United States study.

BACKGROUND: Cognitive function is an important component of healthy ageing. However, it is unclear whether relaxation/meditation practices provide cognitive benefits, particularly in midlife and early late life. Meditative practices are associated with higher self-esteem, and self-esteem serves as a general protective factor for many health outcomes. The current study examines associations between meditation practice, self-esteem, and change over 10 years in midlife cognitive performance. METHODS: Data were from waves 2 (2003-2004) and 3 (2013-2014) of the Midlife in the United States (MIDUS) study. We used structural equation modelling to examine whether persistent meditation practice at both waves or episodic practice at one wave is associated with better cognitive function over 10 years, compared to no meditation practice, while controlling for prior cognitive function and covariates (baseline socio-demographics, health, and functional status). Additionally, we assessed if self-esteem mediates the above associations. RESULTS: We included 2168 individuals (Mage = 65 ± 11). After controlling for covariates, the findings revealed that persistent meditation practice in both waves was associated with significantly less decline in episodic memory; however, no such effects were found for executive function. Further, although participants' higher self-esteem was significantly associated with less decline in executive function and episodic memory, it did not mediate the associations between meditation practice and cognitive functions. CONCLUSIONS: While both persistent meditation practice and self-esteem have associations with cognitive outcomes for middle-aged and older adults in MIDUS, self-esteem as a mediator was not supported. Thus, future investigations should examine mechanisms that underlie these protective factors on cognitive performances across adulthood.

Predictive Factors of Negative Spillover From Caregiving to Employment Among Japanese Family Caregivers With Older Relatives in a Care Facility.

This cross-sectional study included 211 employed family caregivers with older relatives living in care facilities in Japan. Using multiple linear regression analysis, we examined the caregiving context after institutionalization of an older family member. Specifically, we examined predictors of negative spillover from caregiving to employment among family caregivers. The outcome was the extent of negative spillover. Primary predictors included caregiver characteristics and postinstitutionalization caregiving contexts such as caregiving tasks and dissatisfaction with institutional care services. Among all caregivers, 134 (63.5%) were female, and approximately half of all caregivers reported satisfaction with institutional care services. We found that dissatisfaction with institutional care services and being a female each had a main effect on greater negative spillover. However, they did not have any interacting effect on negative spillover after the institutionalization. Negative spillover did not terminate when older family members were institutionalized. Higher satisfaction with institutional care may reduce negative spillover.

Functional limitations before and after cancer diagnosis and contributing factors: findings from the China health and retirement longitudinal study.

BACKGROUND: Although there is a general trend of functional decline with age, there lacks an understanding of how cancer diagnosis and other factors may contribute to this trend. This study aimed to examine functional limitation trajectories among adults with and without cancer, and before versus after the cancer diagnosis, and to explore potential contributing factors associated with functional trajectories among cancer survivors. METHODS: The sample were middle-aged and older Chinese adults who participated in all 3 waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011-2015). Ordinary and multiphase growth curve analyses were conducted to examine (1) differences in functional trajectories between participants with (n = 139) and without cancer (n = 7,313), (2) pre-and post-cancer diagnosis changes in functional limitations among those who reported a cancer diagnosis over the 4-year timeframe, and (3) contributing factors associated with functional trajectories among cancer survivors, guided by the Disablement Process Models, including psychological (depressive symptoms), physical (pain and falls), cognitive (self-reported memory problems), and environmental (social contact and available support) factors. RESULTS: There was a trend of increased functional limitations among all participants over time (unstandardized ß = 0.17, p < .0001). However, participants with cancer did not differ from non-cancer participants in neither the level (unstandardized ß = 0.77, p = .08) nor the rate of functional decline (unstandardized ß = -0.43, p = .07). Functional limitation trajectories were different pre- versus post-cancer diagnosis, although not in expected directions (unstandardized ß = -0.48, p < .05). Cancer survivors with greater pain had higher levels of functional limitations which were sustained over time compared to those with less pain (unstandardized ß = 0.93, p < .001). CONCLUSIONS: The study confirmed that Chinese middle-aged and older adults had overall decreased functional decline over time. A novel finding that cancer survivors experienced less rapidly functional decline after the cancer diagnosis suggested that cancer diagnosis might serve as an inflection point at which early intervention is promising to slow the functional decline. In addition, findings that within-person contributing factors, such as pain, can be influential in functional limitation trajectories suggested that more attention is needed to pay to patients with cancer-pain. These findings demonstrated the heterogeneity of functional limitation trajectories and needs for person-centered interventions among Chinese cancer survivors.

Outcomes from a pilot online Acceptance and Commitment Therapy program for dementia family caregivers.

OBJECTIVES: Psychosocial and cognitive-behavioral dementia caregiver interventions are effective, yet accessing counselor/therapist-led programs can be costly and difficult. Face-to-face therapist-led Acceptance and Commitment Therapy (ACT) is highly effective in dementia caregivers, as established by two different randomized control trials. The current study evaluates a pilot ACT for Caregivers program, which is a community-based, self-guided, online adaptation of ACT. METHOD: Participants (N = 51; Mage=66.0 S. D =11.7, 80% women) completed 10 self-guided sessions teaching ACT, along with accessing an online dementia education library. RESULTS: Repeated measures ANOVA from pre-, posttest, and 4-week follow-up demonstrated decreased depressive symptoms, burden, and stress reactions to behavioral symptoms, and increased positive aspects of caregiving and quality of life. ACT-specific measures improved, with decreases in cognitive fusion and psychological inflexibility (AAQ-II), and improvements in living according to personal values (ValuingProgress increased; ValuingObstruction decreased). All outcomes were statistically significant (at p < .01) and sustained over 4-week follow-up. Although this was a non-clinical sample, the program demonstrated clinical significance, as average depressive symptoms were at the clinical cutoff at baseline, but one standard deviation below clinical cut-off at post-test and 4-week followup. Use of education materials was low (29% of participants used these, albeit rating them helpful), suggesting that ACT likely contributed more to overall improvements. CONCLUSION: The online ACT for Caregivers pilot program offers an empirically supported translation of traditional ACT, improving accessibility, and affordability for family dementia caregivers.

A Non-randomized, Quasi-Experimental Comparison of Effects Between an In-person and Online Delivery of a College Mental Health Literacy Curriculum.

Mental health literacy (MHL) training is essential in college environments. These programs are commonly delivered in-person via workshops or for-credit courses. Campuses now seek high-quality online options. We compare the effectiveness of a for-credit MHL course against a comparison course, focusing on whether online asynchronous delivery was as effective as in-person synchronous delivery. This quasi-experimental pretest/posttest treatment/comparison study included 1049 participants across five semesters (pre-COVID-19) who were 18 years or older and self-selected enrollment in a Mental Health Awareness and Advocacy (MHAA) course (treatment; n = 474) or a general lifespan development course (comparison; n = 575). Using linear mixed effect modeling, changes in MHL were compared across groups and across online/in-person modalities. Students in the treatment group significantly increased their MHL knowledge (ß Identifying = .49, p < .001; ß Locating = .32, p < .001; ß Responding = .46, p < .001) and self-efficacy (ß = .27, p < .001), and treatment effects did not differ across modalities. With increased concern regarding mental health issues of isolated college students during the COVID-19 pandemic, this study supports the efficacy of delivering MHL courses online.

Associations between college students' personal experience with mental health issues and their mental health literacy: a strengths-based perspective.

BACKGROUND: Mental health literacy (MHL) programs are a promising approach to help prevent mental health issues (MHI) among college students; however, there is an increasing need to understand individual factors that influence the development of students' MHL. AIMS: Following a strengths-based approach, we examined if college students' individual characteristics and MHI experience were associated with students' MHL. METHODS: Using two vastly different college samples (Sample 1, N = 617; Sample 2, N = 306), we used the Mental Health Awareness and Advocacy framework, guided by the health belief model and social-cognitive theory, to investigate associations between students' mental health literacy, demographic factors, and their previous experience with MHI. RESULTS: Results from nested regression analyses suggest that personal experiences with MHI are associated with higher MHL (knowledge, self-efficacy, and behaviors), even after controlling for key individual characteristics. Prior experience with having an MHI and receiving therapy appeared to be most important in explaining MHL behaviors. CONCLUSIONS: Students with personal experience with an MHI may be one of the most valuable resources for increasing MHL and utilization of mental health resources on college campuses. Additional implications and future research directions are offered.

Challenging the relationship of grip strength with cognitive status in older adults.

OBJECTIVE: Grip strength is a widely used motor assessment in ageing research and has repeatedly been shown to be associated with cognition. It has been proposed that grip strength could enhance cognitive screening in experimental or clinical research, but this study uses multiple data-driven approaches to caution against this interpretation. Furthermore, we introduce an alternative motor assessment, comparable to grip dynamometry, but has a more robust relationship with cognition among older adults. DESIGN: Associations between grip strength and cognition (measured with the Montreal Cognitive Assessment) were analysed cross sectionally using multivariate regression in two datasets: (1) The Irish LongituDinal Study on Ageing (TILDA; N = 5,980, community-dwelling adults ages 49-80) and (2) an experimental dataset (N = 250, community-dwelling adults aged 39-98). Additional statistical simulations on TILDA tested how ceiling effects or skewness in these variables influenced these associations for quality control. RESULTS: Grip strength was significantly but weakly associated with cognition, consistent with previous studies. Simulations revealed this was not due to skewness/ceiling effects. Conversely, a new alternative motor assessment (functional reaching [FR]) had a stronger, more robust and more sensitive relationship with cognition compared to grip strength. CONCLUSIONS: Grip strength should be cautiously interpreted as being associated with cognition. However, FR may have a stronger and clinically useful relationship with cognition.

Co-occurrence of positive staff interactions and positive affect in memory-care residents: An observational study.

OBJECTIVES: With high numbers of persons with dementia living in residential care, it is vital to maximize psychosocial well-being for this population in this setting. The current study observed whether proportions of positive affect in residents differed based on co-occurring staff (typically certified nurse assistants) interaction types. METHODS: A trained research team observed staff/resident interactions and affect in residents with dementia in common areas of a residential memory care unit (n = 22; observations over one year, or 6999 minutes total). RESULTS: The most observed resident affect type was neutral (53.1% of all minutes observed), followed by positive affect (44.5%). The most common staff interaction type was neutral/no interaction (81.1% of all minutes observed), followed by positive staff interactions (18.1%). There was very little resident negative affect (2.4%) and staff negative interactions (.8%) observed. When staff had neutral/no/negative interactions, residents were positive 36% of the time, whereas when staff had positive interactions with them, residents were positive 81% of the time (z = 28.84, p < .001). A qualitative review of field notes identified themes and subthemes providing a more thorough understanding and context for the resident affect and staff interactions. While quantitative analyses suggested low rates of negative staff interaction, field notes highlight that neutral or no interactions with residents sometimes comprised missed opportunities, as well as more problematic lack of interaction (ignoring). CONCLUSIONS: Not just avoiding negative interactions, but eliciting positive social interactions between staff and residents is important in promoting positive affect and overall wellbeing in persons with dementia.

Closer caregiver and care-recipient relationships predict lower informal costs of dementia care: The Cache County Dementia Progression Study.

INTRODUCTION: Identifying factors associated with lower dementia care costs is essential. We examined whether two caregiver factors were associated with lower costs of informal care. METHODS: A total of 271 care dyads of the Cache County Dementia Study were included. Estimates of informal costs were based on caregiver reports of time spent in care-related activities and inflation-adjusted 2012 Utah median hourly wages. Caregiver coping and emotional closeness with the care-recipient were assessed using the Ways of Coping Checklist-Revised and Relationship Closeness Scale, respectively. RESULTS: Higher closeness was associated with 24% lower costs (expß = 0.763 [95% confidence interval: 0.583-0.999]) in linear mixed models controlling for demographics and baseline dementia severity and duration. Problem-focused coping was not associated with informal costs (P = .354). DISCUSSION: Caregiver closeness, a potentially modifiable factor, predicted lower dementia informal care costs over time. Future studies examining the care environment in closer dyads may identify specific care-related behaviors or strategies that are associated with lower costs.

Dementia severity and the longitudinal costs of informal care in the Cache County population.

BACKGROUND: Dementia costs are critical for influencing healthcare policy, but limited longitudinal information exists. We examined longitudinal informal care costs of dementia in a population-based sample. METHODS: Data from the Cache County Study included dementia onset, duration, and severity assessed by the Mini-Mental State Examination (MMSE), Clinical Dementia Rating Scale (CDR), and Neuropsychiatric Inventory (NPI). Informal costs of daily care (COC) was estimated based on median Utah wages. Mixed models estimated the relationship between severity and longitudinal COC in separate models for MMSE and CDR. RESULTS: Two hundred and eighty-seven subjects (53% female, mean (standard deviation) age was 82.3 (5.9) years) participated. Overall COC increased by 18% per year. COC was 6% lower per MMSE-point increase and compared with very mild dementia, COC increased over twofold for mild, fivefold for moderate, and sixfold for severe dementia on the CDR. CONCLUSIONS: Greater dementia severity predicted higher costs. Disease management strategies addressing dementia progression may curb costs.

Comparing the neuropsychiatric inventory and the revised memory and behavior problems checklist for associations with caregiver burden and depressive symptoms.

BACKGROUND: Few empirical studies compare the ability of prominent measures of behavioral and psychological symptoms of dementia (BPSD) to explain key caregiver outcomes. We compared the respective abilities of the Neuropsychiatric Inventory (NPI) and the Revised Memory and Behavior Problems Checklist (RMBPC) to detect associations between BPSD and caregiver depressive symptoms. Our results may facilitate measurement decisions for researchers and clinicians. METHODS: The NPI and the RMBPC, which measure BPSD frequency and corresponding caregiver appraisals, were administered to 164 caregivers of persons with dementia to compare the measures' ability to explain caregiver depressive symptoms. Depressive symptoms were measured using the Geriatric Depression Scale (GDS), and caregiver burden was measured (using the Zarit Burden Interview) as a mediator between BPSD frequency/appraisal and caregiver depressive symptoms. Path analysis using Mplus facilitated the comparison between the RMBPC and the NPI. RESULTS: Significant indirect associations were present when NPI frequency, NPI appraisal, RMBPC frequency, and RMBPC appraisal were modeled separately with burden and depressive symptoms, although indirect relationships are not associated with increases in R(2). Only RMBPC appraisal produced both a significant direct association with depressive symptoms and a significant increase in R(2) when modeled separately (ß = 0.24, p < 0.01; ΔR(2) = 0.04, p < 0.05). When all independent variables were modeled together, only RMBPC appraisal demonstrated significant direct (ß = 0.23, p < 0.01) and indirect associations. CONCLUSION: The RMBPC might be more suitable than the NPI in studies measuring BPSD to explain key caregiver outcomes such as depressive symptoms.

The Importance of Zero-Deficiency Complaints in Nursing Homes: A Mere Consequence or Serious Concern?

Complaints represent an important metric for assessing the quality of nursing home (NH) care. Using the Automated Survey Processing Environment (ASPEN) Complaints/Incidents Tracking System dataset (2017), we examined the relationships between zero-deficiency complaints (ZDCs) and zero-deficiency substantiated complaints (ZDSCs) and the proportion of residents with dementia. NHs (N = 15,339) were separated into three groups-proportion of residents with dementia in the top, two middle, and the bottom quartiles. Negative binomial regressions assessed zero-deficiency complaint patterns in relation to NHs' proportion of residents with dementia, controlling for facility characteristics, staffing, and racial pattern. We reported average marginal effects (AMEs) and 95% confidence intervals (CIs). NHs in the top quartile yielded higher numbers of both ZDC (AME = .189, 95% CI: .102-.276, p < .001) and ZDSC (AME = .236, 95% CI: .094-.378, p = .001), than NHs in the bottom quartile. Results suggest a need for more uniform investigation processes and staff training to promote a more valid complaint process for residents with dementia.

An exploratory analysis of moderating effects in a non-randomized, quasi-experimental evaluation of a college-based mental health literacy curriculum.

Objective: To assess possible moderating variables that influence the effectiveness of a college-based mental health literacy curriculum, Mental Health Awareness and Advocacy (MHAA). Participants: Students at a Western University in the United States (MHAA treatment group: N = 474; Comparison group: N = 575). Methods: Using a non-randomized, quasi-experimental design over six semesters (2017-2019), students in the treatment and control groups reported on key demographic factors, experiences with mental health, and their knowledge, self-efficacy, and behaviors related to mental health literacy in a pretest/post-test format. Linear mixed effects models were used to assess moderation. Results: MHAA curriculum's efficacy varied based on participants' current depression and anxiety levels, whether they had prior personal experience with a mental health concern, whether they had been diagnosed with a mental health concern, and whether they had experienced suicidal thoughts. Conclusions: Reducing anxiety and depression among students may increase the efficacy of the MHAA program.

Baseline disability in activities of daily living predicts dementia risk even after controlling for baseline global cognitive ability and depressive symptoms.

OBJECTIVES: Late-life disability in activities of daily living (ADL) is theorized to be driven by underlying cognitive and/or physical impairment, interacting with psychological and environmental factors. Although we expect that cognitive deficits would explain associations between ADL disability and dementia risk, the current study examined ADL as a predictor of future dementia after controlling for global cognitive status. METHODS: The population-based Cache County Memory Study (N = 3547) assessed individuals in four triennial waves (average age 74.9 years, years of education 13.36 years; 57.9% were women). Cox proportional hazards regression models assessed whether baseline ADL disability (presence of 2+ Instrumental ADL and/or 1+ Personal ADL) predicted incident dementia after controlling for APOE status, gender, age, baseline cognitive ability (Modified Mini-mental State Exam, 3MS-R; adjusted for education level), and baseline depressive symptoms (Diagnostic Interview Schedule). RESULTS: Over the course of study, 571 cases of incident dementia were identified through in-depth cognitive assessment, ending in expert consensus diagnosis. Results from Cox models suggest that ADL disability is a statistically significant predictor of incident dementia (adjusted hazard ratio = 1.83, p < 0.001), even after controlling for covariates. CONCLUSIONS: Findings suggest that ADL disability offers unique contributions in risk for incident dementia, even after controlling for global cognitive status. We discuss how physical impairment and executive function may play important roles in this relationship, and how ADL is useful, not just a diagnostic tool at, or after dementia onset, but also as a risk factor for future dementia, even in individuals not impaired on global cognitive tests.

Caregiver personality predicts rate of cognitive decline in a community sample of persons with Alzheimer's disease. The Cache County Dementia Progression Study.

BACKGROUND: Environmental influences on the rate of Alzheimer's disease (AD) progression have received little attention. Our objective was to test hypotheses concerning associations between caregiver personality traits and the rate of AD progression. METHODS: Care receivers (CR) were 161 persons with AD from a population-based dementia progression study; 55 of their caregivers were spouses and 106 were adult children. Cognitive status of the CR was measured with the Mini-Mental State Examination every six months, over an average of 5.6 (range: 1-14) years. Linear mixed models tested rate of cognitive decline as a function of caregiver personality traits from the NEO Five-Factor Inventory. RESULTS: Significantly faster cognitive decline was observed with higher caregiver Neuroticism overall; however, in stratified models, effects were significant for adult child but not spouse caregivers. Neuroticism facets of depression, anxiety, and vulnerability to stress were significantly associated with faster decline. Higher caregiver Extraversion was associated with slower decline in the CR when caregivers were adult children but not spouses. CONCLUSIONS: For adult child caregivers, caregiver personality traits are associated with rate of cognitive decline in CRs with AD regardless of co-residency. Results suggest that dementia caregiver interventions promoting positive care management strategies and ways to react to caregiving challenges may eventually become an important complement to pharmacologic and other approaches aimed at slower rate of decline in dementia.

Trends in Nursing Home Complaints: Prevalence and Variation Across Center for Medicare and Medicaid Services Regions.

Resident complaints are vital to understanding nursing home (NH) quality. Using complaints as facility- and resident-level outcomes, this study replicates prior analyses (spanning 1998-2002 and 2007-2012) with 2013-2017 data, the phase prior to NH regulatory changes initiated in November, 2017. Advancing prior papers, we analyze the number of complaints, allegations, and deficiency citations separately. Between 2013-2017, 458,101 total complaints (5.9/NH/year) were identified, containing 949,466 allegations (12.2/NH/year), and resulting in the issuance of 156,135 deficiency citations (2.0/NH/year) in about 15,600 NHs across the country. Regarding the number of complaints, substantiated complaints, and deficiency citations, results show a steady increase compared to previous years. Furthermore, there are marked differences among the CMS survey regions on the prevalence of overall complaints, substantiated complaints, and deficiency citations. However, the average rate of substantiation of complaint allegations shows a decreasing trend over these years, suggesting that complaints may have increased due to higher care expectations.

Supporting Persons With Dementia: Perspectives From Certified Nurse's Assistants.

Background and Objectives: Many persons with Alzheimer's disease or related dementias (ADRD) receive care from paid staff in residential communities. The most common staff in these communities are certified nursing assistants (CNAs). Although CNAs have a high number of interactions with residents, and thus the possibility of engaging in social interactions, evidence suggests that they provide limited social support to persons with ADRD. Little is known about the attitudes of CNAs toward providing social support to persons with ADRD and their perception of components of quality social interactions with these individuals. Research Design and Methods: We conducted a thematic analysis of semistructured interviews with 11 CNAs (91% female participants, mean age 23.6) to understand their perceptions about providing social support to persons with ADRD and the components of effective social interactions. Results: Our results show that CNAs consider providing social support to be an important part of their role as CNAs. Additionally, participants emphasized the interplay of verbal communication, nonverbal communication, and internal beliefs and attitudes toward persons with ADRD in creating effective social interactions. Participants highlighted multiple barriers to providing residents with social support, including lack of time, lack of training, and the behavioral and psychological symptoms of dementia. Discussion and Implications: We offer implications for expanding training for CNAs working with persons with dementia and improving policy based on our results.