The life experiences of living alone among Indonesia dwelling widowed women: A phenomenological study.

In this study, the researchers aimed to understand the life experience of older widowed women living alone. Employing a phenomenological approach, we interviewed 15 older women (age 62 to 95) living alone at homes in two villages in Central Java. Through systematic text condensation procedure, we identified five themes: (1) negative feelings at times, (2) getting used to living alone, (3) needing help to support independent living, (4) coping toward negative feelings, (5) attachment to the original house. We depicted the struggles of older women living alone in their homes. Despite the coping strategies they have developed over time, older women needed help during hard times, especially when getting sick. Families and neighbors were the main resources to maintain their independent living. Improving the home environment to increase suitability for aging residents and providing a support system are the options that best fit the needs and values the older women believed.

A Multicomponent Cognitive Intervention May Improve Self-Reported Daily Function of Adults With Subjective Cognitive Decline.

IMPORTANCE: Limited evidence exists to support cognitive intervention improving the daily function of adults with subjective cognitive decline (SCD). OBJECTIVE: To examine the preliminary efficacy of a group-based multicomponent cognitive intervention that integrates Lifestyle Redesign® (LR) techniques. DESIGN: Single-arm two-period crossover trial; 16-wk waiting period, 16-wk intervention, and 16-wk follow-up. SETTING: Memory clinic in a medical center, Taiwan. PARTICIPANTS: Purposive sample of adults ages >55 yr with SCD. INTERVENTION: Sixteen 1.5-hr weekly multicomponent sessions of cognitive training, cognitive rehabilitation, psychological intervention, and lifestyle intervention. OUTCOMES AND MEASURES: Primary outcomes were (1) self-reported daily function, measured with the Activities of Daily Living Questionnaire (ADLQ) and Cognitive Failure Questionnaire; (2) performance-based daily function, measured with the Brief University of California San Diego Performance-Based Skills Assessment-Traditional Chinese Version; and (3) functional cognition, measured with the Contextual Memory Test (CMT) and Miami Prospective Memory Test. Secondary outcomes included cognitive functions, anxiety, and depression. RESULTS: Seventeen participants completed the intervention; 4 missed the follow-up. The generalized estimating equations model showed significant changes from baseline to pretest (control) and pretest to posttest (intervention) on the ADLQ (p = .014) and CMT-delayed (p = .003). Effects remained at the 16-wk follow-up. After adjusting for the effects of covariates, the self-reported daily function of participants ages ≤ 63 yr improved more than that of other participants (p = .003). CONCLUSIONS AND RELEVANCE: Multicomponent cognitive interventions integrating LR techniques may improve self-reported daily function and context-dependent memory function of adults with SCD, with efficacy sustained at follow-up. What This Article Adds: A group-based multicomponent cognitive intervention consisting of cognitive training, cognitive rehabilitation, psychoeducation, and lifestyle intervention may provide benefits for the daily function and cognitive function of adults with SCD.

Professional perspectives on providing recovery-oriented services in Taiwan: a qualitative study.

BACKGROUND: The experiences of professionals in well-established recovery-oriented programs are valuable for professionals in similar practice settings. This study explored professionals' experiences with providing recovery-oriented services in community psychiatric rehabilitation organizations. METHODS: Semi-structured interviews were conducted with 14 professionals from five recovery-oriented psychiatric rehabilitation organizations in Taiwan. The interviews were recorded and transcribed verbatim. Thematic analysis was used for the qualitative data analysis. RESULTS: The analyses documented three main themes with 13 subthemes. Recovery-oriented service implementation included seven subthemes: Enabling clients to set their own goals and make decisions, using a strengths-based approach, establishing partnerships with clients, improving individuals' self-acceptance, encouraging community participation, seeking family, peer, and organizational support, and building team collaboration. Problems with implementing recovery-oriented services included limited policy and organizational support, a lack of understanding of recovery among professionals, stigma, clients' lack of motivation or self-confidence in their own ability to achieve recovery, and passive or overprotective family members. Strategies to resolve implementation problems included policy changes and organizational support, improving the recovery competence and confidence of professionals, and family and public education. CONCLUSIONS: To date, this is the first known study examining the perspectives of mental health professionals who have experience implementing recovery-oriented services in Asia. The participants identified family collaboration, anti-stigma efforts, and changes in policy and attitudes as critical to successful implementation and delivery of recovery-oriented services.

Multi-component cognitive intervention for older adults with mixed cognitive levels: implementation and preliminary effectiveness in real-world settings.

BACKGROUND: In most controlled studies of multi-component cognitive intervention, participants' cognitive levels are homogenous, which is contrary to real-world settings. There is a lack of research studying the implementation of evidence-based cognitive intervention in communities. This study describes the implementation and preliminary effectiveness of a Multi-component Cognitive Intervention using Simulated Everyday Tasks (MCI-SET) for older adults with different cognitive levels in real-world settings. METHODS: Single group, pre-intervention assessment, post-intervention assessment, and 3-month follow-up research design. MCI-SET consists of 12 two-hour weekly sessions that include motor-cognitive tasks, cognitive training, and cognitive rehabilitation. One hundred and thirty participants, > = 65 and frail, dependence on > = one instrumental daily activity, or with confirmed dementia, from eight community centers were included. The primary outcome is general cognition (Montreal Cognitive Assessment-Taiwan, MoCA-T). Secondary outcomes are memory (Miami Prospective Memory Test, Digits Forward, Digits Backward), attention (Color Trail Test-Part 1), executive function (Color Trail Test-Part 2), and general function (Kihon Checklist-Taiwan). RESULTS: Pre-intervention workshop for group leaders, standardized activity protocols, on-site observation, and ten weekly conferences were conducted to ensure implementation fidelity. MCI-SET had an 85% retention rate and 96% attendance rate. The participants had a mean age of 78.26 ± 7.00 and a mean MoCA-T score of 12.55 ± 7.43. 73% were female. General cognition (Hedges' g = 0.31), attention (Hedges' g = 0.23), and general function (Hedges' g = 0.31), showed significant post-intervention improvement with small effect size. Follow-ups showed maintained improvement in general cognition (Hedges' g = 0.33), and delayed effect on attention (Hedges' g = 0.20), short-term memory (Hedges' g = 0.38), and executive function (Hedges' g = 0.40). Regression analysis indicated that the intervention settings (day care centers vs neighborhood centers), the pre-intervention cognitive levels, and the pre-intervention general function of the participants were not associated with the outcomes. CONCLUSIONS: MCI-SET is feasible and can improve the cognitive skills and general functions of older adults with heterogeneous cognitive skills or disabilities. It is essential to tailor programs to fit the interests of the participants and the culture of local communities. Group leaders must also have the skills to adjust the cognitive demands of the tasks to meet the heterogeneous cognitive levels of participants. TRIAL REGISTRATION: This study was retrospectively registered at clinicaltrials.gov (Identifier: NCT04615169 ).

High-Ecological Cognitive Intervention to Improve Cognitive Skills and Cognitive-Functional Performance for Older Adults With Mild Cognitive Impairment.

IMPORTANCE: Evidence of the effectiveness of cognitive activity and preparatory tasks in improving the cognitive skills and functional performance of people with cognitive decline is limited. OBJECTIVE: To examine the efficacy of a high-ecological cognitive intervention. DESIGN: Quasi-experimental, pretest-posttest design with nonequivalent control. SETTING: Community. PARTICIPANTS: Older adults with mild cognitive impairment from two senior centers. INTERVENTION: Twelve 90-min weekly group sessions of a high-ecological cognitive intervention using simulated everyday cognitive tasks (experimental group) and of nutrition education (active control group). Outcomes and Measures: Cognitive skills were measured with the Color Trails Test (CTT), the Contextual Memory Test (CMT; Immediate Recall [CMT-Im] and Delayed Recall [CMT-De] tasks), and the Wechsler Adult Intelligence Scale-Fourth Edition Digit Span subtest (Digits Forward and Digits Backward). Cognitive-functional performance was measured with the Rivermead Behavioural Memory Test-Third Edition (RBMT-3; Immediate Recall [RBMT-3-Im] and Delayed Recall [RBMT-3-De] tasks) and the Cognitive Failures Questionnaire (CFQ). RESULTS: Thirty-seven participants (M age = 70.84 yr; 70.3% women) met the inclusion criteria for analysis (20 participants in the intervention group, 17 participants in the control group). Multivariate linear regression showed that the intervention group improved significantly more than the control group on the CTT, CMT-Im, and RBMT-3-Im but not on the CMT-De, RBMT-3-De, and CFQ. CONCLUSIONS AND RELEVANCE: Twelve 90-min weekly group sessions of a high-ecological cognitive intervention improved attention, executive function, immediate memory, and objective cognitive-functional performance with immediate-memory task demands. What This Article Adds: Carefully designed and structured simulated everyday cognitive tasks can be used as a cognitive training agent to improve both cognitive skills and objective cognitive-functional performance. The effectiveness of group-based cognitive interventions depends on the skills of occupational therapy practitioners in activity analysis and grading.

Living alone, loneliness, and depressive symptoms among Indonesian older women.

In this study, the researchers aimed to investigate the factors associated with loneliness and depressive symptoms among Indonesian older women. A secondary data analysis of the Indonesian Family Life Survey-5 was conducted. Data from 1233 women aged 60 years or above were analyzed using logistic regression. Results indicated fewer than one in five older women lived alone, half reported loneliness, and 16% reported depressive symptoms. Living alone was significantly associated with loneliness and depressive symptoms. Different factors were associated with loneliness and depressive symptoms. Loneliness and depression were found to be independent constructs of older women living alone in Indonesia.

[Development and Psychometric Validation of a Tool for Assessing the Care Needs of Families of Patients With Dementia].

BACKGROUND: The rapid aging of the global population has sharply increased the prevalence of dementia. Most people with dementia (PwD) live at home and are cared for by family caregivers. The complicated care needs of PwD and family caregivers necessitate the provision of comprehensive and transdisciplinary assessment and service support. PURPOSE: The purpose of this study was to construct the contents of the "Assessment Tool for Family Care Needs of People with Dementia" using a transdisciplinary perspective and to establish the reliability and validity of this tool. METHODS: Based on a literature review and clinical experience, the preliminary items of the assessment tool were drawn up and pilot tests of the case were conducted in the Clinic for Dementia Care. The transdisciplinary research team discussed the pilot tests and verified the preliminary items, and then experts were invited to assess the content validity of the assessment tool. Next, quota sampling was conducted in accordance with the national proportion of the severity of dementia and the questionnaire surveys were administered in an outpatient department of neurology at a medical center in southern Taiwan. Two hundred dyads of PwD and their family caregivers participated in the survey. Reliability and validity analysis of the data were completed. RESULTS: The assessment tool contains 21 items of demographic data and 31 items in the eight subscales of "language and communication", "activities of daily living", "sleep", "activity arrangements", "nutrition and diet", "behavioral and psychological symptoms of dementia", "care stress", and "obtaining resources". The overall content validity of the assessment tool was .99 and the Cronbach's alpha of each subscale ranged between .625 and .905. The concurrent validities of the "activities of daily living" subscale and the "behavioral and psychological symptoms of dementia" subscale were, respectively, correlated with the Barthel Index (r = -.889, p < .001) and the Neuropsychiatric Inventory Questionnaire (r = .750, p < .001). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The assessment tool was assessed as having satisfactory validity and reliability. Moreover, the tool was clear and concise, and was able to be completed quickly by the caregivers. Transdisciplinary professionals involved in dementia care may use this assessment tool in outpatient departments, centers for integrated dementia care, and discharge preparation services to acquire information related to family care needs. The results of the assessment tool may be used as a reference in developing appropriate transdisciplinary care plans to improve the quality of care and quality of life of families of patients with dementia.

Diagnostic accuracy of Instrumental Activities of Daily Living for dementia in community-dwelling older adults.

BACKGROUND: many people living with dementia remain underdiagnosed and unrecognised. Screening strategies are important for early detection. OBJECTIVE: to examine whether the Lawton's Instrumental Activities of Daily Living (IADL) scale, compared with other cognitive screening tools-the Mini-Mental State Examination (MMSE), and the Ascertain Dementia 8-item Informant Questionnaire (AD8)-can identify older (≥ 65 years) adults with dementia. DESIGN: population-based cross-sectional observational study. SETTING: all 19 counties in Taiwan. PARTICIPANTS: community-dwelling older adults (n = 10,340; mean age 74.87 ± 6.03). METHODS: all participants underwent a structured in-person interview. Dementia was identified using National Institute on Aging-Alzheimer's Association core clinical criteria for all-cause dementia. Receiver operator characteristic curves were used to determine the discriminant abilities of the IADL scale, MMSE and AD8 to differentiate participants with and without dementia. RESULTS: we identified 917 (8.9%) participants with dementia, and 9,423 (91.1%) participants without. The discriminant abilities of the MMSE, AD8 and IADL scale (cutoff score: 6/7; area under curve = 0.925; sensitivity = 89%; specificity = 81%; positive likelihood ratio = 4.75; accuracy = 0.82) were comparable. Combining IADL with AD8 scores significantly improved overall accuracy: specificity = 93%; positive likelihood ratio = 11.74; accuracy = 0.92. CONCLUSIONS: our findings support using IADL scale to screen older community-dwelling residents for dementia: it has discriminant power comparable to that of the AD8 and MMSE. Combining the IADL and the AD8 improves specificity.

Psychological Distress, Multicare Needs and Social Resource Utilisation of Family Caregivers of People With Dementia: A Descriptive-Correlational Study.

BACKGROUND: The population of people with dementia increases yearly, imposing a growing burden on family caregivers. Psychological distress impacts the mental health of family caregivers of people with dementia. Caregiver psychological distress can result in increased social resource utilisation and unmet multicare needs. PURPOSE: The study explored the psychological distress of family caregivers of people with dementia and examined the impact on social resource utilisation and multicare needs. METHODS: A descriptive-correlational study collected data in Taiwan from a cross-sectional sample of family caregivers of people with dementia using a self-report questionnaire. Data were analysed using linear and logistic regression. RESULTS: A total of 301 caregivers provided data for analysis. Nearly two-thirds of caregivers were female with a mean age of 57 years old (SD = 12). Over half of the family caregivers of people with dementia experienced mild-to-moderate psychological distress. The greater the psychological distress, the greater the probability of using social resources (1.09 times per 1-point increase, p = 0.002). Psychological distress was positively associated with the number of caregivers' care needs (ß = 0.371, p < 0.001). CONCLUSIONS: Findings of this study can assist healthcare professionals in better understanding the psychological distress and care needs of caregivers. Services designed to meet the needs of family caregivers will improve psychological distress.

Institutional contexts contribute to the low priority given to developing self-care independence in a rehabilitation ward: a qualitative study.

OBJECTIVES: To examine the institutional contexts that contribute to the low priority given to the development of self-care independence in a rehabilitation ward. DESIGN: Research was guided by ethnographic principles of Martyn Hammersley and Paul Atkinson (2007). Individual in-depth interviews were completed. Participant observation was done daily during the rehabilitation stay of the patients. PATIENTS: Six men and three women with neurological impairments and their caregivers. RESULTS: Patients' daily routines on a rehabilitation ward in Taiwan are described. Four prominent themes emerged from the data: (1) the attitudes of patients, caregivers, and staff facilitated extended rehabilitation stays within the first year after disability, (2) attending therapy sessions was the most important activity, (3) pragmatic considerations, such as 'faster and easier', outweighed the value of developing self-care independence, and (4) strategic organization of daily routines to keep therapy the priority was critical for daily activity. CONCLUSION: Multiple institutional factors jeopardize the development of self-care independence in a rehabilitation ward. The factors include the primacy of biomedical-oriented rehabilitation ideology, insurance reimbursement policies, and cultural values associated with family caregiving. They legitimize the low priority given to developing self-care independence. Therapists need to include a critical review of daily routines (what and how activities are carried out inside and outside of therapy clinics) as part of therapy regime to identify opportunities and institutional constraints to the development of self-care independence.

Driving practice effects for older drivers with mild cognitive impairment: A preliminary study.

BACKGROUND: Older drivers with mild cognitive impairment (MCI) often show declining driving performance. Evidence is lacking regarding whether their driving skills can be improved after practice. AIMS/OBJECTIVES: To compare the practice effects of older drivers with MCI and drivers with normal cognition in an unfamiliar, standardized driving course with three practices. MATERIALS AND METHODS: Single-blind two-group observational design. Twelve drivers with confirmed MCI as the experimental group and ten with normal cognition (NC) as the control, all ≥ 55 years old. The primary outcome was to assess the practice effects, measured with an in-car global-positioning-system mobile application to compare the speed and directional control of a complex manoeuvre after practices. Secondary outcomes were to assess the pass/fail rate and mistakes observed for the 3rd/final on-road driving practice. No instructions were given during practice. Descriptive statistics and the Mann-Whitney U test were used for data analysis. RESULTS: No significant inter-group difference in the pass/fail rate and number of mistakes. Some MCI drivers performed better in the speed and directional control of the S-Bend manoeuvre after practices. CONCLUSIONS: The driving performance of drivers with MCI may improve with practice. SIGNIFICANCE: Older drivers with MCI may potentially benefit from driver retraining. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (Identifier: NCT04648735).

Using exergame-based exercise to prevent and postpone the loss of muscle mass, muscle strength, cognition, and functional performance among elders in rural long-term care facilities: A protocol for a randomized controlled trial.

Objective: Elderly individuals in long-term care facilities (LTCFs) have a higher prevalence of sarcopenia than those in the community. Exercise is the gold standard for preventing and treating sarcopenia. Regarding exercise, multicomponent exercises, including progressive resistance training (PRT), are beneficial. However, developing routine, structured exercise programs for the elderly in LTCFs is difficult because of a shortage of healthcare providers, particularly in rural regions. Exergame-based exercises can increase a player's motivation and reduce staff time for an intervention. Nintendo Switch RingFit Adventure (RFA) is a novel exergame that combines resistance, aerobic, and balance exercises. In this study, we aim to investigate the clinical effectiveness of RFA on muscle and functional performance parameters among the elderly in LTCFs. Methods: The EXPPLORE (using EXergame to Prevent and Postpone the LOss of muscle mass, muscle strength, and functional performance in Rural Elders) trial is a single-center randomized controlled trial involving elderly individuals (≥60 years) living in LTCFs in rural southern Taiwan. The participants will be equally randomized to the intervention group (exergame-based exercise plus standard care) or the control group (standard care alone). Both groups will receive standard care except that the intervention group will receive exergame-based exercises at the time previously scheduled for sedentary activities in the LTCFs. The exergame-based exercise will be performed using RFA in the sitting position with a specialized design, including arm fit skills and knee assist mode. Each session of the exercise lasts 30 mins and will be performed two times per week for 12 weeks. The primary outcomes will be the osteoporotic fracture index, appendicular skeletal muscle mass index, dominant handgrip strength, and gait speed. Meanwhile, the secondary outcomes will be the dexterity and agility, muscle strength and thickness, range of motion of the joints of the dominant upper extremity, Kihon checklist, Medical Outcomes Study 36-Item Short-Form Health Survey, and Brain Health Test. Discussion: This trial will provide valuable knowledge on whether exergames using RFA can counteract physical decline and improve quality of life and cognition among the elderly in LTCFs. Clinical trial registration: [www.ClinicalTrials.gov], identifier [NCT05360667].

Integration of complementary medical treatments with rehabilitation from the perspectives of patients and their caregivers: a qualitative inquiry.

OBJECTIVE: This article uses a qualitative design and examines how patients and their caregivers integrate pluralistic health practices into rehabilitation from their perspectives. DESIGN: Ethnography was used as the framework for research design. Data were collected via participant observation, taped in-depth interviews and regular chart review, and all interviews were transcribed verbatim. SETTING: An inpatient rehabilitation unit in Taiwan. SUBJECTS: Twenty-one patients, their caregivers and their rehabilitation professionals. RESULTS: The patients and their caregivers used pluralistic illness explanations and treatments to make sense of their suffering, to control healing and to find the hope that rehabilitation professionals often deliberately avoided giving. Spiritual healing and therapies related to Traditional Chinese Medicine, such as functional food and herbal medicines, were popular alternative therapeutics. Although the patients and their caregivers perceived opposition from the medical staff on the unit, they used a variety of covert strategies to integrate their pluralistic illness explanations and treatments into their daily routines without openly challenging the rehabilitation primacy. CONCLUSION: Aware of the rehabilitation staff's opposition, the patients and caregivers resorted to a variety of underground strategies to conceal their use of complementary medical treatments.

The Implementation of Restorative Care and Factors Associated with Resident Outcomes in Long-Term Care Facilities in Taiwan.

This study aimed to analyze how restorative care is implemented in long-term care facilities and factors associated with resident outcomes in Taiwan. A one-group pre-test and post-test design was adopted in 24 long-term care facilities by collecting a sample of 310 participants at the baseline and 210 at six months. Participants were residents aged 65 or over, and were being constrained, used diapers, or were bedridden, or a combination of these. Their physical and mental functions were measured using Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), Mini-Mental State Examination (MMSE), Geriatric Depression Scale-15 (GDS-15), and EuroQol-5D (EQ-5D). Mean differences in the outcomes were analyzed, and mixed effect models were used to examine influencing factors. The results showed that most of the participants had good family support. However, participants with better family support were more likely to drop out. Improvements were found in the residents' outcomes on physical function, depression and quality of life. Social support was a significant influencing factor on most of the outcomes. In conclusion, restorative care was found to have positive effects on residents' physical function and helped maintain mental function. Sufficient support and communication between participants, families, and staff in facilities are key factors leading to positive outcomes.

The linear relationship between the Vulnerable Elders Survey-13 score and mortality in an Asian population of community-dwelling older persons.

BACKGROUND: The Vulnerable Elders Survey-13 (VES-13) has been used as a screening tool to identify vulnerable community-dwelling older persons for more in-depth assessment and targeted interventions. Although many studies supported its use in different populations, few have addressed Asian populations. The optimal scaling system for the VES-13 in predicting health outcomes also has not been adequately tested. This study (1) assesses the applicability of the VES-13 to predict the mortality of community-dwelling older persons in Taiwan, (2) identifies the best scaling system for the VES-13 in predicting mortality using generalized additive models (GAMs), and (3) determines whether including covariates, such as socio-demographic factors and common geriatric syndromes, improves model fitting. MATERIALS AND METHODS: This retrospective longitudinal cohort study analyzed the data of 2184 community-dwelling persons 65 years old or older from the 2003 wave of the national-wide Taiwan Longitudinal Study on Aging. Cox proportional hazards models and Generalized Additive Models (GAMs) were used. RESULTS: The VES-13 significantly predicted the mortality of Taiwan's community-dwelling elders. A one-point increase in the VES-13 score raised the risk of death by 26% (hazard ratio, 1.26; 95% confidence interval, 1.21-1.32). The hazard ratio of death increased linearly with each additional VES-13 score point, suggesting that using a continuous scale is appropriate. Inclusion of socio-demographic factors and geriatric syndromes improved the model-fitting. CONCLUSIONS: The VES-13 is appropriate for an Asian population. VES-13 scores linearly predict the mortality of this population. Adjusting the weighting of the physical activity items may improve the performance of the VES-13.

Development of the Taiwanese version of the Health Enhancement Lifestyle Profile (HELP-T).

OBJECTIVES: To develop and validate a Taiwanese version of the Health Enhancement Lifestyle Profile (HELP-T) for community-dwelling older Taiwanese adults (≥ 55 years). METHODS: The original Health Enhancement Lifestyle Profile (HELP) is a 56-item self-report questionnaire measuring various aspects of health-related lifestyles in older adults. The standard cultural-adaptation procedure was used for questionnaire translation and modification. A field test was conducted for culturally specific item selection, rating-scale analysis, and psychometric validation of the HELP-T in a sample of 274 community-dwelling older adults via classical test theory. RESULTS: The 59-item HELP-T is culturally adapted from the original 56-item HELP. The original 6-point rating scale was modified to a 3-point scale for easy use by Taiwanese older adults. The HELP-T had good internal consistency (Cronbach's alpha = 0.82). The test-retest reliability for the total score was high (0.92), and moderate to high (range: 0.57-0.92) for subscales. The construct validity was supported by the significant correlations between each subscale and the total score (Spearman's rho = 0.41-0.67, p < 0.0001) and by the ability of the scores to significantly discriminate between participants with different levels of self-rated health (p = 0.0001). CONCLUSIONS: The HELP-T is a suitable clinical tool for assessing and monitoring lifestyle risk factors, establishing client-centered lifestyle intervention goals, and determining the outcomes of lifestyle interventions.

Caregiver active participation in psychoeducational intervention improved caregiving skills and competency.

AIM: To determine whether giving dementia caregivers active psychoeducational intervention is more efficacious than passive intervention for improving their caregiving skills and reducing their caregiving burden. METHODS: This study was a prospective, single-blinded, controlled trial with 43 caregiver/person-with-dementia dyads. The dyads were randomly assigned to the active psychoeducational intervention (AP) group, which used role-play, discussion, and development of problem-solving capacity to build up their caregiving skills and competence, or the passive psychoeducational intervention (PP) group, which gave caregivers educational materials on common caregiving strategies. Primary outcomes were the levels of caregiver competence (Care Skill Inventory [CSI]), burden (Chinese Zarit Burden Inventory [CZBI]), and distress caused by the behavioral and psychological symptoms of dementia (Neuropsychiatric Inventory-Questionnaire [NPI-Q]). Outcomes were assessed pre-test, post-test and after 3 months. Repeated measures one-way analysis of variance was used to compare mean-change scores between time-points, and generalized estimating equations (GEE) were used to compare groups. RESULTS: Post-test or 3-month (or both) Care Skill Inventory, Chinese Zarit Burden Inventory and Neuropsychiatric Inventory-Questionnaire distress levels were significantly (p < 0.05) better in the AP but not in the PP group. The generalized estimating equation intergroup comparison, adjusted for potential confounders, showed that Care Skill Inventory in the AP group was more significantly improved than in the PP group, and that Chinese Zarit Burden Inventory nearly reached significance. CONCLUSIONS: Active rather than passive psychoeducation, even in a short (3 months) intervention of six visits, was more efficacious for improving caregiving competence. Future studies will require larger samples. Geriatr Gerontol Int 2018; 18: 750-757.

Determinants of generic and specific health-related quality of life in patients with Parkinson's disease.

OBJECTIVES: Generic and disease-specific health-related quality of life (HRQoL) instruments may reflect different aspects of lives in patients with Parkinson's disease (PD) and thus be associated with different determinants. We used the same cluster of predictors for the generic and disease-specific HRQoL instruments to examine and compare the determinants of HRQoL. METHOD: HRQoL was measured in 92 patients with PD by the 36-item Short-Form Health Survey (SF-36) and the 39-item Parkinson's Disease Questionnaire (PDQ-39). The predictors included demographic and disease characteristics, and motor and non-motor symptoms. Multiple regression analyses were used to identify HRQoL determinants. RESULTS: Depressive symptoms and motor difficulties of daily living were the first two significant determinants for both instruments. The other significant determinant for the SF-36 was fatigue and non-motor difficulties of daily living, and for the PDQ-39 was motor signs of PD. CONCLUSIONS: The results suggest the importance of the evaluation and intervention focused on depressive symptoms and motor difficulties of daily living in patients with PD. In addition, the SF-36 seems more related to non-motor symptoms, while the PDQ-39 appears more associated with motor symptoms. This information is important for understanding results from these two instruments and for choosing which to use.

Developing a Referral Protocol for Community-Based Occupational Therapy Services in Taiwan: A Logistic Regression Analysis.

Because resources for long-term care services are limited, timely and appropriate referral for rehabilitation services is critical for optimizing clients' functions and successfully integrating them into the community. We investigated which client characteristics are most relevant in predicting Taiwan's community-based occupational therapy (OT) service referral based on experts' beliefs. Data were collected in face-to-face interviews using the Multidimensional Assessment Instrument (MDAI). Community-dwelling participants (n = 221) ≥ 18 years old who reported disabilities in the previous National Survey of Long-term Care Needs in Taiwan were enrolled. The standard for referral was the judgment and agreement of two experienced occupational therapists who reviewed the results of the MDAI. Logistic regressions and Generalized Additive Models were used for analysis. Two predictive models were proposed, one using basic activities of daily living (BADLs) and one using instrumental ADLs (IADLs). Dementia, psychiatric disorders, cognitive impairment, joint range-of-motion limitations, fear of falling, behavioral or emotional problems, expressive deficits (in the BADL-based model), and limitations in IADLs or BADLs were significantly correlated with the need for referral. Both models showed high area under the curve (AUC) values on receiver operating curve testing (AUC = 0.977 and 0.972, respectively). The probability of being referred for community OT services was calculated using the referral algorithm. The referral protocol facilitated communication between healthcare professionals to make appropriate decisions for OT referrals. The methods and findings should be useful for developing referral protocols for other long-term care services.

Indicators of perceived useful dementia care assistive technology: Caregivers' perspectives.

AIM: The study aims to investigate the caregivers' context-specific perceived usefulness of available assistive technology (AT) devices and the professionals' perspectives on the usefulness indicators of AT devices for home-dwelling individuals with mild-to-moderate dementia. METHODS: A total of 72 caregivers completed a questionnaire rating 82 AT devices with a high-perceived usefulness (HPU) or low-perceived usefulness (LPU). A total of 21 experts rated 10 usefulness indicators of these devices. We compared the mean of each indicator between the HPU and LPU groups. RESULTS: Most caregivers, who are generally amenable to using AT devices, thought they were useful for helping to care for home-dwelling older adults with mild-to-moderate dementia. The level of perceived usefulness from the experts' perspectives depends on specific design indicators (e.g. familiarity) and the context in which the AT is used (e.g. in everyday life or in emergencies). Indicators for HPU devices were: allows selective accident prevention, has an intuitive interface, is familiar, offers ease of use and simplifies activities. LPU devices featured client prompting. There were no significant differences between HPU and LPU devices with indicators of: is automated, informs caregiver, preserves privacy and preserves autonomy. Safety issues were considered important, and sometimes overshadowed ethical dilemmas, such as privacy and autonomy concern. CONCLUSIONS: The present study provides insight into how caregivers perceived the usefulness of AT devices, and how that varied with context. Indicators of devices perceived as useful can serve as guidelines for modifying existing devices and designing new devices. Future application could also incorporate the points of view from the persons with dementia.