Team mentored reflective practice in gerontological social work education.

Attracting students to gerontological social work has long been difficult. A possible strategy is to provide students with experiential learning opportunities with older adults that provide them with support while reflecting on this work. Our Team Mentored Reflective Practice model represents an effort to enhance students' reflective practice skills in the context of a clinical research project in which both instructors and students form a supportive team. Students reported a number of benefits that included the development of meaningful relationships with older clients, clinical skills that related to memory loss, and the integration of research and practice. Students who were engaged in the team mentored process of reflection evidenced changes in how they were thinking about clients. These new understandings have the potential to impact the ways in which students work with older adults.

The effectiveness of a couple-based intervention for people living with mild Alzheimer's disease and their spousal caregivers in Korea.

BACKGROUND AND OBJECTIVES: We evaluated the effectiveness of a Korean version of the Couples Life Story Approach (CLSA-K), a structured life-review program originally developed in the U.S. to help older adults with dementia and their spousal caregivers engage with each other and improve their quality of life.Research design and methods: Fifty mild people living with mild Alzheimer's disease and their spouses were recruited and 37 couples completed the five-week CLSA-K program. Data on psychosocial outcomes-i.e., depressive symptoms, talkativeness, mutuality (for both caregivers and care recipients) and burden (for caregivers)-were collected one week prior to (Time 1) and one week after the intervention (Time 2). Using repeated measures generalized linear models, we examined the differences in the amounts and patterns of the changes in outcomes according to age, gender, and the care-recipients' level of cognitive impairment. RESULTS: Some participants benefited from the CLSA-K program, while others did not. For caregivers, mental health, and marital quality remained stable, while caregiver burden increased among those with spouses who had moderate levels of cognitive impairment. For care-recipients, younger and male participants showed increased talkativeness. DISCUSSION AND IMPLICATIONS: CLSA-K appears to be promising for specific subgroups of participants in Korea. Multi-component or other approaches may be more beneficial for other couples. Cultural differences as well as social positions may play a role in the acceptability and efficacy of the couple-based intervention.

Dementia Care Across a Tertiary Care Health System: What Exists Now and What Needs to Change.

OBJECTIVES: This study explored the process of care for persons living with dementia (PLWDs) in various care settings across a tertiary care system and considers challenges and opportunities for change. DESIGN: Aimed at quality improvement, qualitative interviews were conducted with key stakeholders in dementia care across geriatric outpatient clinics, medical and psychiatric emergency departments, and the main hospital in 2016. SETTING AND PARTICIPANTS: Forty-nine interactive interviews were conducted with a purposive and snowball sampling of health care professionals (physicians, nurses, social workers, administrators) and families in a large, academic health care system. MEASURES: Qualitative interview guides were developed by the study team to assess the process of care for PLWDs and strengths and challenges to delivering that care. RESULTS: Key themes emerging from the interviews in each care setting are presented. The outpatient setting offers expertise, a multidisciplinary clinic, and research opportunities, but needs to respond to long waitlists, space limitations, and lack of consensus about who owns dementia care. The emergency department offers a low nurse/patient ratio and expertise in acute medical problems, but experiences competing demands and staff turnover; additionally, dementia does not appear on medical records, which can impede care. The hospital offers consultative services and resources, yet the physical space is confined and chaotic; sitters and antipsychotics can be overused, and placement outside of the hospital for PLWDs can be a challenge. CONCLUSIONS AND IMPLICATIONS: Five key recommendations are provided to help health systems proactively prepare for the coming boom of PLWD and their caregivers, including outpatient education, a dementia care management program to link services, Internet-based training for providers, and repurposing sitters as Elder Life specialists.

"We are a Team": Couple Identity and Memory Loss.

Couplehood can be an important source of resilience in the face of memory loss, but couple identity has only recently been explored and has rarely been measured. This paper examines older spouses' descriptions of their couple identity and discusses salient themes. Data come from 19 couples from the Couples Life Story Project, a life review intervention where one partner has memory loss. Using baseline data, we analyzed how partners depicted their couple identity using a series of separate and overlapping circles. Almost half of the partners independently chose identical depictions of their relationships. An interpretative phenomenological approach revealed three major themes of couple identity: (1) doing things together and separately; (2) feelings, shared history, and closeness over time and; (3) essence of relationship. This study contributes to the small body of literature that focuses on couple identity and how partners mutually cope with aging-related challenges.

Cultural Adaptation of a Dyadic Intervention for Korean Couples Coping with Alzheimer's Disease.

OBJECTIVES: The Couples Life Story Approach (CLSA) was recently developed in the U.S. for older couples dealing with dementia to improve their quality of life. The purpose of this article is to describe how the CLSA was adapted to be culturally appropriate for older Korean couples and to discuss cultural themes that emerged during the implementation process. METHODS: The intervention was adapted using the Cultural Adaptation Process Model. The revised materials were implemented on 56 Korean couples. A multiple case study method was used to analyze the clinical data. RESULTS: Four cultural themes were identified: (1) dealing with negative memories in early years of marriage; (2) communication styles and patterns; (3) ways to incorporate difficult life events into the Life Story Book; and (4) complex dynamics of heirarchy in the relationship between older couples and the interventionist. With each theme, case examples are described that illustrate relevant issues. CONCLUSIONS: Cultural adaptation can be conducted systematically to improve the delivery of the CLSA for different populations. CLINICAL IMPLICATIONS: Cliniocians working with older Korean couples affected by dementia should consider cultural uniqueness in a life-story approach.

Creating a duet: The Couples Life Story Approach in the United States and Japan.

There is a global need for interventions that help couples who are dealing with dementia. This paper describes the way in which interventionists from the United States and Japan participated in the development of an intervention for dyads in which one person is experiencing memory loss. The 5-week intervention, the Couples Life Story Approach, helps dyads to reminisce about their life together as a couple, to work on their patterns of communication, and to develop a Life Story Book. Based on an analysis of cases conducted in the United States (n = 20 couples) and Japan (n = 9 couples), this paper highlights the cross-fertilization process that has occurred as interventionists from the two countries have shared their experiences with one another. Using case illustrations, the discussion focuses on the clinical themes that have emerged for couples in the United States and Japan.

Constructing Couples' Stories: Narrative Practice Insights from a Dyadic Dementia Intervention.

Memory loss and dementia can be devastating for both caregivers and care recipients. Narrative therapeutic approaches offer promise, as well as challenges, for social interventions with couples where one partner has dementia. The Couples Life Story Approach is a recently-developed method by which practitioners work with such couples to help them narrate the story of their life together. This narrative approach is augmented by mementoes (e.g., photos, cards) that are collected by the couple during the intervention. Significant memories are elicited from both partners and developed into a Life Story Book. Drawing on data from this clinical research intervention with 20 older couples, we ask: What are some of the challenges of conducting narrative-based therapeutic interventions with older couples with memory loss? Clinical themes were identified utilizing a multiple case study approach during weekly team meetings. Six of the most prominent themes are presented here. Specifically, how to: (1) construct a narrative from disparate stories, (2) tell a mutual story, (3) tell the story of a couple that has been in a shorter relationship, (4) incorporate others in the story, (5) include difficult life moments, and, (6) end the story. Within each theme, we utilize case examples to illuminate relevant issues and describe strategies that were developed to resolve these clinical challenges. Implications for practitioners and clinical researchers who are engaged in dyadic interventions are discussed.

The couples life story approach: a dyadic intervention for dementia.

This article describes an approach for working with individuals who have dementia, along with their spouses or partners. The 5-week intervention focuses on helping couples communicate, reminisce about the story of their relationship, find photographs and mementoes from their past, and develop a book that incorporates these mementoes. This clinical approach highlights the strengths and the resilience of couples and adds to the limited repertoire of dyadic interventions for dementia care which are currently available. Preliminary findings from 24 couples are presented, including the intervention's feasibility and acceptability.

Ethical and practical challenges raised by an adult day program's caregiver satisfaction survey.

A consumer satisfaction survey was completed by 21 caregivers to persons with dementia, who participated in Silver Club, a person-centered Adult Day Service program. Two themes emerged: caregivers expressed high program satisfaction based on joint benefits to members and caregivers, and they desired more information about the nature of the members' daily participation. These findings raised two important issues for program staff. First, Adult Day Service programs are often referred to and marketed as providing caregiver respite. This approach does not acknowledge caregivers' interest in programs that meet the needs of their loved ones, and may lead to reluctance to use programs that only stress the value of respite. Second, caregivers' desires for detailed feedback about members' program participation raise ethical and practical challenges within person-centered models of care. Collecting feedback from both participants and their caregivers can help monitor and improve services provided by person-centered Adult Day Service programs.