Family perceptions of mouth care for assisted living residents with dementia: Implications for care.

Mouth care is an important component of care for persons with dementia in assisted living (AL). However, there is little information about family member knowledge, beliefs, and experiences with resident oral health. Family perceptions and involvement in care may impact oral and systemic health for AL residents. Therefore, semi-structured interviews to assess these domains were conducted with 23 adult family members of AL residents with dementia, from 9 AL communities. Thematic analysis found that families identified (1) the centrality of oral health to well-being; (2) organizational influences on mouth care; (3) mouth care in the context of dementia; and (4) collaboration to facilitate mouth care. Family perspectives can provide useful guidance for collaborative interventions that support oral health and mouth care in AL.

Triadic treatment decision-making in advanced cancer: a pilot study of the roles and perceptions of patients, caregivers, and oncologists.

PURPOSE: The research on cancer treatment decision-making focuses on dyads; the full "triad" of patients, oncologists, and caregivers remains largely unstudied. We investigated how all members of this triad perceive and experience decisions related to treatment for advanced cancer. METHODS: At an academic cancer center, we enrolled adult patients with advanced gastrointestinal or hematological malignancies, their caregivers, and their oncologists. Triad members completed a semi-structured qualitative interview and a survey measuring decisional conflict and perceived influence of the other triad members on treatment decisions. RESULTS: Seventeen patients, 14 caregivers, and 10 oncologists completed the study. Patients and caregivers reported little decisional regret and voiced high satisfaction with their decisions, but levels of decisional conflict were high. We found sizeable disagreement among triad members' perceptions and preferences. For example, patients and oncologists disagreed about the caregiver's influence on the decision 56% of the time. In addition, many patients and caregivers preferred to defer to their oncologist about treatment decisions, felt like no true decision existed, and disagreed with their oncologist about how many treatment options had been presented. CONCLUSIONS: Patients, caregivers, and oncologists have discordant perceptions of the cancer treatment decision-making process, and bring different preferences about how they want to make decisions. These data suggest that oncologists should assess patients' and caregivers' decisional preferences, explicitly signal that a decision needs to be made whenever approaching an important crossroads in treatment and ensure that patients and caregivers understand the full range of presented options.

Effects of enhanced caregiver training program on cancer caregiver's self-efficacy, preparedness, and psychological well-being.

PURPOSE: We examined the effects of an enhanced informal caregiver training (Enhanced-CT) protocol in cancer symptom and caregiver stress management to caregivers of hospitalized cancer patients. METHODS: We recruited adult patients in oncology units and their informal caregivers. We utilized a two-armed, randomized controlled trial design with data collected at baseline, post-training, and at 2 and 4 weeks after hospital discharge. Primary outcomes were self-efficacy for managing patients' cancer symptoms and caregiver stress and preparedness for caregiving. Secondary outcomes were caregiver depression, anxiety, and burden. The education comparison (EDUC) group received information about community resources. We used general linear models to test for differences in the Enhanced-CT relative to the EDUC group. RESULTS: We consented and randomized 138 dyads: Enhanced-CT = 68 and EDUC = 70. The Enhanced-CT group had a greater increase in caregiver self-efficacy for cancer symptom management and stress management and preparation for caregiving at the post-training assessment compared to the EDUC group but not at 2- and 4-week post-discharge assessments. There were no intervention group differences in depression, anxiety, and burden. CONCLUSION: An Enhanced-CT protocol resulted in short-term improvements in self-efficacy for managing patients' cancer symptoms and caregiver stress and preparedness for caregiving but not in caregivers' psychological well-being. The lack of sustained effects may be related to the single-dose nature of our intervention and the changing needs of informal caregivers after hospital discharge.

Assessing literacy in clinical and community settings: the patient perspective.

A common concern among patient advocates and practitioners is the potential to offend patients with literacy testing in clinical settings. Patients' perceptions of, and comfort level with, literacy testing have not been well established. The aim of this study was to assess patient attitudes about literacy assessments in a primary care clinic and a community-based wellness program and to explore whether patients preferred one assessment tool over another. Participant recruitment occurred at a general internal medicine clinic and two community settings (YMCAs) in the southeast. Two literacy measures (Rapid Estimate of Adult Literacy in Medicine and Test of Functional Health Literacy in Adults) and a questionnaire to assess opinions on the instruments were administered. Most participants were comfortable having their literacy assessed and indicated that it would be useful for practitioners to know the literacy levels of patients. A sizable minority (10%) were concerned that such testing in health care settings may be inappropriate. An additional finding was that self-reported reading skills of participants did not correspond to actual reading scores. Patients recognize the importance of literacy in their health care and most are comfortable with literacy assessments. An important minority, however, object to this practice.

Environmental and policy change to support healthy aging.

Given the growing evidence of the influence of the environment on older adult health, the need to design and implement effective environmental policy around healthy and vital aging is urgent. This article describes issues amenable to improvement through policy change, evidence supporting specific policy approaches and outcomes, and promising strategies for implementing those approaches. Key areas of focus are neighborhood design and safety, housing, transportation, and mobility. Strategies to build capacity for policy change are also addressed. Our goals are to foster greater attention to environmental change in support of healthy aging and to illuminate directions for policy change.