Perceptions of a cognitive rehabilitation group by older people living with cognitive impairment and their caregivers: A qualitative interview study.

Cognitive rehabilitation has been developed to improve quality of life, activities of daily living and mood for people with cognitive impairment, but the voice of people with cognitive impairment has been underrepresented. This study aimed to understand the experience of people living with cognitive impairment, as well as their caregivers who took part in a cognitive rehabilitation intervention programme. Twelve individuals with cognitive impairment and 15 caregivers participated in individual qualitative interviews. The interview data were analysed in three steps: 1) familiarisation of the transcripts; 2) identification of themes; 3) re-interpretation, refinement and integration of themes with methodological auditors. Both participants living with cognitive impairment and caregivers valued the comfortable environment with friendly, caring and supportive group leaders who taught practical tips and strategies. The participants living with cognitive impairment enjoyed socialising with like others. Caregivers benefited from learning about memory problems and sharing their challenges with other caregivers. The participants living with cognitive impairment emphasised the benefits of relational and practical aspects, whereas the caregivers valued the informational and emotional support. In conclusion, both participants living with cognitive impairment and caregivers found the cognitive rehabilitation group useful.

Randomized controlled trial of different models of care for nursing home residents with dementia complicated by depression or psychosis.

OBJECTIVE: To compare the outcomes of 3 interventions for the management of dementia complicated by depression or psychosis: psychogeriatric case management, general practitioners with specialist psychogeriatric consultation, and standard care for nursing home residents. METHOD: The sample for this 12-week randomized controlled trial consisted of 86 subjects with dementia from 11 Sydney, Australia, nursing homes, of whom 34 had depression, 33 had depression and psychosis, and 19 had psychosis. All participants received full psychiatric assessments and physical examinations. Information was obtained from the residents' families and nursing home staff. Depression measures included the Even Briefer Assessment Scale for Depression, Hamilton Rating Scale for Depression, Cornell Scale for Depression in Dementia, and Geriatric Depression Scale. Psychosis measures included the Behavioral Pathology in Alzheimer's Disease Rating Scale, Neuropsychiatric Inventory, and Scale for the Assessment of Positive Symptoms. Data were obtained from nursing home records on prescription of psychotropic medication and demographic information. Management plans were formulated by a multidisciplinary team before random assignment to interventions. RESULTS: All 3 groups improved from pretreatment to posttreatment on depression scales for depression groups and psychosis scales for psychosis groups. Mode of management appeared to make no difference in rate or amount of improvement; neither of the treatment group-by-time interactions were significant. Neither use of antidepressants nor use of antipsychotics predicted depression or psychosis outcomes. CONCLUSION: Participation in the study was associated with improvement in depression and psychosis, perhaps because of the presence of a psychogeriatric team, the increased attention focused on residents, or the generalization of active intervention techniques to control subjects. A formula-driven psychogeriatric team case management approach was not significantly more effective than a consultative approach or standard care. This study demonstrates the difficulties and feasibility of conducting service-oriented research in nursing homes.

Self-destructive behaviors in nursing home residents.

OBJECTIVES: To validate the Harmful Behaviors Scale (HBS) as a measure of direct and indirect self-destructive behaviors in nursing home residents and to determine the prevalence of self-destructive behaviors and their relationship to other variables. DESIGN: A cross-sectional study. SETTING: Eleven nursing homes in the eastern suburbs of Sydney, Australia. PARTICIPANTS: Six hundred ten nursing home residents aged 65 and older. MEASUREMENTS: Instruments used were the HBS, Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), Functional Assessment Staging Scale (FAST), Even Briefer Assessment Scale for Depression (EBAS-Dep), and the suicide item from the structured Hamilton Depression Rating Scale. Data on diagnoses of dementia, depression, or psychotic disorder; prescription of psychotropic medication; and demographics were obtained from nursing home records. RESULTS: On the HBS, indirect harmful behaviors occurred at least weekly in 61% of subjects, and direct harmful behaviors occurred in 14% of subjects. The HBS total score was significantly positively correlated with the BEHAVE-AD score (Pearson's r=0.679, P <.001) but not with the EBAS-Dep "wish for death" item and total score. HBS scores were significantly higher in residents scoring greater than zero on the Hamilton suicide item (F=1.380, df=3,325, P=.249). Stepwise multiple linear regression indicated that younger age, chart diagnosis of dementia, greater incapacity as measured by FAST, and a higher Hamilton suicide item score predicted a higher HBS total score. CONCLUSIONS: Self-destructive behaviors are common in nursing home residents and are mostly related to dementia. There was little evidence of a relationship between depression and self-destructive behaviors.

Speeded induction under uncertainty: the influence of multiple categories and feature conjunctions.

When people are uncertain about the category membership of an item (e.g., Is it a dog or a dingo?), research shows that they tend to rely only on the dominant or most likely category when making inductions (e.g., How likely is it to befriend me?). An exception has been reported using speeded induction judgments where participants appeared to use information from multiple categories to make inductions (Verde, Murphy, & Ross, 2005). In two speeded induction studies, we found that participants tended to rely on the frequency with which features co-occurred when making feature predictions, independently of category membership. This pattern held whether categories were considered implicitly (Experiment 1) or explicitly (Experiment 2) prior to feature induction. The results converge with other recent work suggesting that people often rely on feature conjunction information, rather than category boundaries, when making inductions under uncertainty.