Reported practices of primary care physicians in the diagnosis and management of dementia.

The shortage of geriatric specialists in the US may require that primary care physicians (PCPs) receive more education on diagnosing and managing dementia since the number of older Americans with dementia will increase from about five million in 2010 to up to 14 million in 2050. Thus, we administered a brief, anonymous questionnaire to determine PCPs' diagnostic, referral, and management practices to a convenience sample of 142 PCPs in Arkansas. We reworded a Scottish survey to conform to terminology used in the US and added items on referral practices. The PCPs who reported difficulty establishing the diagnosis of dementia had more difficulty telling the diagnosis (O.R = 3.59, p < 0.004). The PCPs were less likely (p < 0.001) to tell the patient if they suspected dementia (73%) than if they were sure the patient had dementia (88%). In both cases, they were more likely to tell the family (92% & 100%, respectively), although this difference was not statistically significant. The PCPs discussed disease progression and driving risks with patients and families, but few referred them to social workers or community agencies. Findings support training PCPs in the diagnosis and management of persons with dementia and providing tools to improve care.

Enabling and empowering certified nursing assistants for quality dementia care.

Currently, 1.2 million full-time equivalent employees (FTEs) care for more than 1.5 million residents in nursing homes where 75% of residents have dementia. By the year 2010, the number of residents in these institutions may double. Registered nurses (RNs) make up less than 7% of a home's total FTEs. In contrast, certified nursing assistants (CNAs) account for more than 40% of total FTEs. Thus, CNAs serve as the primary caregivers in nursing homes. Typically, CNAs have a high school education or less, and receive little more than minimum wage. Their extensive contact with residents has a tremendous impact on quality of life, but significant barriers limit their caregiving effectiveness. These barriers include poor pay, minimal long-term benefits, and insufficient training, recognition and support for their physically and emotionally labor-intensive care. This paper addresses the issues of training CNAs for dementia care by suggesting an organizational framework within which to view dementia training; providing an overview of barriers to empowering CNAs to provide quality care to dementia residents; reviewing research that has addressed a specific barrier; making recommendations for future research; and suggesting research approaches to address these recommendations.

Interventions for treating disruptive behavior in demented elderly people.

Studies aimed at explaining and decreasing disruptive behaviors need to be designed within conceptual frameworks. A number of researchers provide examples of such efforts. Meddaugh is examining the theory of reactance, Matteson et al are examining Piagetian concepts (personal communication, 1992), and Hurley is examining the concept of resistance. Such efforts will serve to enlighten our understanding of the dynamics of disruptive behavior and eventually may result in a common multicausal conceptualization of its cause. Additional study of the cause of disruptive behaviors also is needed. Currently the explanations for disruptive behaviors involve a variety of conceptual frameworks with little consistency among studies. Furthermore, many studies designed to decrease these behaviors do not clearly base their interventions on conceptual explanations for the behaviors. Studies aimed at explaining and decreasing disruptive behaviors need to be designed within conceptual frameworks. A number of researchers provide examples of such efforts. Meddaugh is examining the theory of reactance, Matteson et al are examining Piagetian concepts (personal communication, 1992), and Hurley is examining the concept of resistance. Such efforts will serve to enlighten our understanding of the dynamics of disruptive behavior and eventually may result in a common multicausal conceptualization of its cause. This developing conceptualization of causes needs to encompass biologic as well as psychosocial explanations. A number of researchers are conducting studies that will contribute to the understanding of the role of biologic factors. Examples of such efforts include Kolanowski's and Satlin et al's work on the effects of artificial lighting on disruptive behavior and Meddaugh's study of the role of exercise. As interventions are designed for decreasing disruptive behaviors, systems of care that use these interventions need to be evaluated for their cost effectiveness and their impact on quality of life.

Cognitive impairment in the elderly.

This article reviews research related to assessment and interventions for cognitive impairment conducted by nurses as principal and coinvestigators. It focuses on the broad areas of delirium and dementia, which are divided into assessment and intervention-related research. The intervention research begins with descriptive studies and has subdivisions for primary and secondary symptoms. Ideas for future research follow.

Prevalence of glioblastoma multiforme subjects with prior herbicide exposure.

The charts of 100 patients with established diagnoses of glioblastoma multiforme (GBM) provided the data base for a descriptive study of patients' exposure to herbicides. The study focused on place of residence and occupation during the year prior to diagnosis of GBM. Although subjects reported residences in 33 of the 75 counties in Arkansas, more than one-third of the sample came from just 3 counties in which rice, cotton or wood products are produced. These industries were reported as the occupations of almost one-third of the sample for whom occupations involved a risk of herbicide exposure. The findings of this study add to the epidemiological profile of those at risk for GBM and underscore the need for assessment of residence and occupation on a consistent basis when counseling patients and providing health education.