- Email: [email protected]
Dementia care in Maracaibo, Venezuela
Poster
Presmtcltion:
Psychosocial
Studies
I
s195
montha we have been able to get 8 caregivers to the project. Our target is 50 caregivers and each of those would be supported a maximum of one year. Intervention: Based on key worker concept a registered nurse with psychotherapeutic approach provides both individual support and support through group meetings. The registered nurse will also train nursmg staff to under&tad the situation of caregivers and to help the staff to find individual ways support caregivers. Methods: The efficacy of intervention is evaluated by following up the changes in caregivers mental health. depression and social network. The processes of individual counselling and group meetings are documented and analyzed. Conclusions: Preliminary experiences suggest that the most unportant task is to support caregivers to recognize their needs for support and to support them to go through underlying feelings. Also much work should be done to get the staff in social and health care system to change their attitudes towards the caregivers.
SHARING KNOW? He&her
A Wilkimon,
THE DIAGNOSIS
Rehckuh
J Prutt.
OF DEMENTIA:
Univ
of Stirling.
WHO WANTS
Stirlrng
United
TO
Kingdom
In making a diagnosis of dementia pracitionera are faced with the declaion of whether to share that diagnosis with the patient or not. This is not a straightforward decision. One recent study in Cambridgshire, England, showed that only 36% of General Practitioners will tell an mdividual their diagnosis (Vaasilaa and Donaldson, 1998). With the opportunity to now provide diagnosis at earlier stages, people often have the capacity to understand and perhaps benefit from knowmg their diagnosis. There ia wide debate on the pot&&d positive and negative effects that sharing the diagnosis may have. This research wed qualitative explorative interviews with 30 people who have been given a diagnosis of dementia in Scotland. The objectives of the research were to: I explore how people with dementia feel about the way in which they were told the diagnosis; 2. gam insight into the opportunities and limitations offered by an early diagnosis for the person with dementia; 3.guide best practice in diagnosis disclosure. This presentation will outline the preliminary findings from the study. These findings will provide information from the perspective of the person with dementia about the effect of knowing her or his diagnosis. This will include the advantages and disadvantages to the person knowing their diagnosis.
LISTENING TO pGEiJTIA: RESULTS
THE INDIVIDUAL DIAGNOSED WITH DEMENFROM AN EARLY STAGE DEMENTIA PEER SUPPORT GROUP PROGRAM
The early dlagno\i\ of dementia provide\ a largely ignored opportunity to increase OUI understanding of the psychodynamic effect\ of this diagnosis on mdividuala while they are still cognitively intact enough to describe the impact. The purpose of this study was to increase our understandmg of the impact of the diagnosis of dementxa on a aample of elderly individuals with early stage dementia. Qualitative methods were used to collect, code, and analyze the dialogue from a aeriea of early stage dementia peer support groups. Analysis of the trianscribed support group sessions indicated that the participants were keenly aware of their diagnosis and were concerned with how their lives as well ab the livea of their family caregivers would be impacted as the disease progressed. Partupants appeared to possess an awareness of their decline as they wanted to know how best to combat the illness and the associated negative outcomes. The results of this study clearly indicate the importance of obtaining the perspective of the client with newly diagnosed dementia. Contrary to popular belief. theae individuals are able to discuss the negative effects of the dementia diagnosis. how they think and feel about the diagnosis, 85 well a\ how they cope and adapt to mcreasing levels of impairment. There is much we can learn from listening to individual\ diagnosed with early stage dementia.
DEMENTIA Gloria
Pino-Ramirez,
Molrro, Rodriguez,
ofZ&u,
CARE IN MARACAIBO,
Uxiv
of
Murucaibo Mdmcuiho
Rafael
Zulia,
Urdanetu’~
Maracaibo
Aging
Study,
Unrv.
Venezuela; Maracarbo
VENEZUELA
Marucuiho Muriu Venezuela:
Z
Venezurlu; Castellmo, Gladys
Aldrin
E
Mulliru
Y
E Muesrre,
Univ
Venrzurlo
The Mamcaibo Aging Study (MAS) is the first population-based study of the elderly in Venezuela. The MAS is carried out prospective and longitudinally in an urban area of the second largest city in the country, where more than 3.000 subjects older than 55 reside, including a nursing home. One of the goals of this study was to caractherize the conditions that are associated to the quality of life of the elder people. 6968 housholds were visited and a third of them were found to have at least an elegible resident. The survey instrument, standardiaed and validated for this populatton, included the Short Portable Mental Status Questionnaire (SPMSQ), and a recolection
of health hablts, life history of diseasea, an scale of mstrumental activities and questions about personal and family income as well as living arragements. Of 2507 subject& surveyed, 68.9% were classified as cognitively intact by the SPMSQ, 19.4% with mild, 7.5% moderate and 2.5 % severe impairment. Although these proportiona are almost identical to those reported by Pfeiffer, dementia was perceived as a consequence of aging, and no treatment was sought particularly for it. Most elders lived with their family, and those demented were most likely cared by them. There are not public nursmg home in the entire city that would accept a moderate or severely demented subjects. Lack of awareness of the disease is accompanied by the absence of dementia activtsts organizations in the area, difficulty in pronouncing and reading the name of the most common type of dementia, Alzheimer’s, high costs of the cholinesterase inhibitors. and the lack of a critical mass of behavioral neurologists and neuropsychologists to support the differential diagnosis of dementia at early stages. Behavioral disturbances are the most important incentive to seek medical advice. De&on-making for the family of a demented elderly in Maracalbo offer\ very few pathways, mostly consist in taking care of basic needs, struggling with a health care system overwhelmed with acute and curable diseases, pharmacological treatments are far out reach of most families and there are not structured programa to prowde support to the caregiver.
THE FACTOR STRUCTURE OF THE BEHAVIORAL RATING SCALE AND ITS RELATIONSHIP TO INDICATORS OF FUNCTIONAL STATUS Paul
D
Rodman. q&i.\.
Tllums, Kirnbrrly
Mirmeapolis Bares,
V.4 Mrd Mike
Ctr,
Kuskowski,
Minneupoli.\, Maurice
MN;
Dwken,
Mar-k VA Mrd
Hurisu, C/r.
John
Mlme-
MN
Objectives: Behavioral problems are one of the primary predictora of institutionaliation in Alrheimer’s patients. In this study we examined the factor structure of the Behavioral Rating Scale and Its relationship to functional status after controlling for level of cognitive impairment in adults with probable Alzheimer’< Disease. Methods: The sample cons&d of I85 subject\ in the Consortium to Establish a Registry for Alrheimer’s Disease (CERAD) who had been given the Behavioral Rating Scale (BRS) at the time of their entry evaluation into the CERAD study. Participants in the CERAD study were adulta over the age of 40 aith possible or probable Al~hemxr’\ Disease (AD) at the time of inmal assessment. The Mini-Mental State Exam was used as a primary measure of cognitive impairment and the ADL portion of the Blessed Dementia Scale was used as an indicator of functional \tatur Analyses In order to produce a more robust factor analyst thirteen composites were created from 35 variables in the BRS. Five additional variables were judged to be independent from the others and were entered into the factor analysis ab individual items. Principal component analysis was wed for the initial extraction of factors. Subsequent factor ;Inaly\is used varimax rotation. Only those factors wth eigenvalues greater than I.0 wrr retamed. Rewlta Six factors (depression. aggression. psychotic features, +xp dlsturhancc, apathy, and appetite disturbance) emerged with eigenvalues greater than 1.0 and accounted for 61.9% of the variance. Depression and aggression factors accounted for 36% of total variance. Uamg hierarchical multiple regression, the six BRS f&xor scores explained significant variance in the Blessed beyond that accounted for by the MMSE score lr’change=.217, F(6.171)~ 10.03. pi.0011. Furthermore, all factor scores, with the exception of Apathy. t= 1.85. p<.O66), were significant predictors as well Diwussion: Behavioral factorr.especially depression and aggres\ion, significantly predict functional imparment after controlling for cog?itive rmpairment in Al/heimer’\ patientr.
Presmtcltion:
Psychosocial
Studies
I
s195
montha we have been able to get 8 caregivers to the project. Our target is 50 caregivers and each of those would be supported a maximum of one year. Intervention: Based on key worker concept a registered nurse with psychotherapeutic approach provides both individual support and support through group meetings. The registered nurse will also train nursmg staff to under&tad the situation of caregivers and to help the staff to find individual ways support caregivers. Methods: The efficacy of intervention is evaluated by following up the changes in caregivers mental health. depression and social network. The processes of individual counselling and group meetings are documented and analyzed. Conclusions: Preliminary experiences suggest that the most unportant task is to support caregivers to recognize their needs for support and to support them to go through underlying feelings. Also much work should be done to get the staff in social and health care system to change their attitudes towards the caregivers.
SHARING KNOW? He&her
A Wilkimon,
THE DIAGNOSIS
Rehckuh
J Prutt.
OF DEMENTIA:
Univ
of Stirling.
WHO WANTS
Stirlrng
United
TO
Kingdom
In making a diagnosis of dementia pracitionera are faced with the declaion of whether to share that diagnosis with the patient or not. This is not a straightforward decision. One recent study in Cambridgshire, England, showed that only 36% of General Practitioners will tell an mdividual their diagnosis (Vaasilaa and Donaldson, 1998). With the opportunity to now provide diagnosis at earlier stages, people often have the capacity to understand and perhaps benefit from knowmg their diagnosis. There ia wide debate on the pot&&d positive and negative effects that sharing the diagnosis may have. This research wed qualitative explorative interviews with 30 people who have been given a diagnosis of dementia in Scotland. The objectives of the research were to: I explore how people with dementia feel about the way in which they were told the diagnosis; 2. gam insight into the opportunities and limitations offered by an early diagnosis for the person with dementia; 3.guide best practice in diagnosis disclosure. This presentation will outline the preliminary findings from the study. These findings will provide information from the perspective of the person with dementia about the effect of knowing her or his diagnosis. This will include the advantages and disadvantages to the person knowing their diagnosis.
LISTENING TO pGEiJTIA: RESULTS
THE INDIVIDUAL DIAGNOSED WITH DEMENFROM AN EARLY STAGE DEMENTIA PEER SUPPORT GROUP PROGRAM
The early dlagno\i\ of dementia provide\ a largely ignored opportunity to increase OUI understanding of the psychodynamic effect\ of this diagnosis on mdividuala while they are still cognitively intact enough to describe the impact. The purpose of this study was to increase our understandmg of the impact of the diagnosis of dementxa on a aample of elderly individuals with early stage dementia. Qualitative methods were used to collect, code, and analyze the dialogue from a aeriea of early stage dementia peer support groups. Analysis of the trianscribed support group sessions indicated that the participants were keenly aware of their diagnosis and were concerned with how their lives as well ab the livea of their family caregivers would be impacted as the disease progressed. Partupants appeared to possess an awareness of their decline as they wanted to know how best to combat the illness and the associated negative outcomes. The results of this study clearly indicate the importance of obtaining the perspective of the client with newly diagnosed dementia. Contrary to popular belief. theae individuals are able to discuss the negative effects of the dementia diagnosis. how they think and feel about the diagnosis, 85 well a\ how they cope and adapt to mcreasing levels of impairment. There is much we can learn from listening to individual\ diagnosed with early stage dementia.
DEMENTIA Gloria
Pino-Ramirez,
Molrro, Rodriguez,
ofZ&u,
CARE IN MARACAIBO,
Uxiv
of
Murucaibo Mdmcuiho
Rafael
Zulia,
Urdanetu’~
Maracaibo
Aging
Study,
Unrv.
Venezuela; Maracarbo
VENEZUELA
Marucuiho Muriu Venezuela:
Z
Venezurlu; Castellmo, Gladys
Aldrin
E
Mulliru
Y
E Muesrre,
Univ
Venrzurlo
The Mamcaibo Aging Study (MAS) is the first population-based study of the elderly in Venezuela. The MAS is carried out prospective and longitudinally in an urban area of the second largest city in the country, where more than 3.000 subjects older than 55 reside, including a nursing home. One of the goals of this study was to caractherize the conditions that are associated to the quality of life of the elder people. 6968 housholds were visited and a third of them were found to have at least an elegible resident. The survey instrument, standardiaed and validated for this populatton, included the Short Portable Mental Status Questionnaire (SPMSQ), and a recolection
of health hablts, life history of diseasea, an scale of mstrumental activities and questions about personal and family income as well as living arragements. Of 2507 subject& surveyed, 68.9% were classified as cognitively intact by the SPMSQ, 19.4% with mild, 7.5% moderate and 2.5 % severe impairment. Although these proportiona are almost identical to those reported by Pfeiffer, dementia was perceived as a consequence of aging, and no treatment was sought particularly for it. Most elders lived with their family, and those demented were most likely cared by them. There are not public nursmg home in the entire city that would accept a moderate or severely demented subjects. Lack of awareness of the disease is accompanied by the absence of dementia activtsts organizations in the area, difficulty in pronouncing and reading the name of the most common type of dementia, Alzheimer’s, high costs of the cholinesterase inhibitors. and the lack of a critical mass of behavioral neurologists and neuropsychologists to support the differential diagnosis of dementia at early stages. Behavioral disturbances are the most important incentive to seek medical advice. De&on-making for the family of a demented elderly in Maracalbo offer\ very few pathways, mostly consist in taking care of basic needs, struggling with a health care system overwhelmed with acute and curable diseases, pharmacological treatments are far out reach of most families and there are not structured programa to prowde support to the caregiver.
THE FACTOR STRUCTURE OF THE BEHAVIORAL RATING SCALE AND ITS RELATIONSHIP TO INDICATORS OF FUNCTIONAL STATUS Paul
D
Rodman. q&i.\.
Tllums, Kirnbrrly
Mirmeapolis Bares,
V.4 Mrd Mike
Ctr,
Kuskowski,
Minneupoli.\, Maurice
MN;
Dwken,
Mar-k VA Mrd
Hurisu, C/r.
John
Mlme-
MN
Objectives: Behavioral problems are one of the primary predictora of institutionaliation in Alrheimer’s patients. In this study we examined the factor structure of the Behavioral Rating Scale and Its relationship to functional status after controlling for level of cognitive impairment in adults with probable Alzheimer’< Disease. Methods: The sample cons&d of I85 subject\ in the Consortium to Establish a Registry for Alrheimer’s Disease (CERAD) who had been given the Behavioral Rating Scale (BRS) at the time of their entry evaluation into the CERAD study. Participants in the CERAD study were adulta over the age of 40 aith possible or probable Al~hemxr’\ Disease (AD) at the time of inmal assessment. The Mini-Mental State Exam was used as a primary measure of cognitive impairment and the ADL portion of the Blessed Dementia Scale was used as an indicator of functional \tatur Analyses In order to produce a more robust factor analyst thirteen composites were created from 35 variables in the BRS. Five additional variables were judged to be independent from the others and were entered into the factor analysis ab individual items. Principal component analysis was wed for the initial extraction of factors. Subsequent factor ;Inaly\is used varimax rotation. Only those factors wth eigenvalues greater than I.0 wrr retamed. Rewlta Six factors (depression. aggression. psychotic features, +xp dlsturhancc, apathy, and appetite disturbance) emerged with eigenvalues greater than 1.0 and accounted for 61.9% of the variance. Depression and aggression factors accounted for 36% of total variance. Uamg hierarchical multiple regression, the six BRS f&xor scores explained significant variance in the Blessed beyond that accounted for by the MMSE score lr’change=.217, F(6.171)~ 10.03. pi.0011. Furthermore, all factor scores, with the exception of Apathy. t= 1.85. p<.O66), were significant predictors as well Diwussion: Behavioral factorr.especially depression and aggres\ion, significantly predict functional imparment after controlling for cog?itive rmpairment in Al/heimer’\ patientr.