- Email: [email protected]
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Posters: P-138 between normal condition, MCI and subtle early stage of AD is blurred. More accurate and standardized diagnostic tools are needed for detection of MCI by physicians. P-138
AN AUTOPSY-CONFIRMED CASE STUDY OF THE CONVERSION FROM NORMAL COGNITION TO AMNESTIC MCI TO AD
Ronald F. Zec, Nicole Burkett, Stephen Markwell, Brian Moore, SIU School of Medicine, Springfield, IL, USA. Contact e-mail: [email protected] Background: The conversion from Mild Cognitive Impairment (MCI) to dementia has received considerable research attention, whereas the transition from normal cognition to MCI and dementia in an autopsy-confirmed case of Alzheimer disease (AD) has not been studied in detail. Objective: We studied the conversion from normal memory and cognition to MCI of the amnestic type to early dementia with annual assessments over 10 years using a comprehensive neuropsychological test battery in a neuropathologically-confirmed case of AD. Methods: The woman was 74 years old at the first evaluation and was 84 years old at the time of her last assessment. She was a retired high school teacher with 18 years of education. An annual half-day cognitive assessment was administered to the patient including tests of mental status, attention, new learning and memory, language, visuospatial functioning, and problem solving ability. Results: The patient scored well within normal limits on all memory and cognitive test measures using age norms at her first evaluation (age 74). A gradual progressive decline over ten years on measures of new declarative learning and memory, especially on word-list learning tests, was found resulting in severe memory impairment at age 78. Only later did measurable decline on the non-memory cognitive measures emerge. Neuropathological findings at autopsy revealed Alzheimer-type changes that indicated a high likelihood, by NIA-Reagan criteria, that the dementia was due to Alzheimer disease. There was moderate CERAD plaque grade and Braak and Braak tangle stage V. There was a heavy NFT and NP burden in the hippocampus, entorhinal cortex, perirhinal cortex, and amygdala, a moderate number in the inferior temporal gyrus with less Alzheimer pathology burden in the frontal, parietal, and occipital cortices and the superior temporal gyrus. Conclusions: Progressive memory decline in an autopsy-confirmed case of AD occurred gradually over 7-8 years before there is detectable nonmemory cognitive deficits emerged on a comprehensive neuropsychological battery of tests. This case is likely representative of many, but not all, cases of AD. P-139
MULTIMEDIA BIOGRAPHIES TO ENHANCE AD OR MCI QUALITY OF LIFE
Ronald M. Baecker1, Elsa Marziali1,2, Sarah Chatland1, Masashi Crete1, Kante Easley1, Martin Yeung1, 1University of Toronto, Toronto, ON, Canada; 2Baycrest Centre for Geriatric Care, Toronto, ON, Canada. Contact e-mail: [email protected] Background: One serious consequence of AD is the loss of memories of one’s past, of names, places, and events, of a sense of one’s identity. We shall report on a multimedia biography intervention intended to help AD individuals and family members better cope with these consequences of AD. Objectives: Our research seeks to establish the practicality of the method, to provide case study evidence of its benefits for both individuals with AD and their family members, and to study how the intervention and its impact differs when applied to an individual with MCI. Methods: We are producing 12 multimedia biographies for participating persons with mid-stage or early-stage Alzheimer’s disease or with Mild Cognitive Impairment (MCI). We collaborate with the affected individual and in the case of AD family members in collecting a life history constructed from media such as still photos, videos, music, and recorded interviews. Qualitative analysis of observations of participants and interviews with family members are used to assess the impacts of weekly or bi-weekly viewings of the biography over a period of six months. Results: We have developed
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and will report on an effective method for the production of useful biographies. We have established the practicality of producing these at a reasonable cost using university students with no prior film production training. Early findings from this work in progress suggest that regular viewings of a visual biography serve to stimulate memories, reinforce a positive self-identity, and bring joy to the AD individual. The biographies seem to provide benefits to family members such as better remembering how the loved one once was and being better able to accept the disease. The biographies also seem to stimulate conversations between the AD individual and family members, and to enable third-party caregivers to better understand who is in their care and thereby approach caregiving with greater knowledge and empathy. Conclusions: More complete findings based on five months further work, including differences based on disease severity, will be presented in a conference poster P-140
EXPLORING THE EFFECTS OF CRANIOSACRAL STILL POINT TECHNIQUE IN PERSONS WITH DEMENTIA
Linda A. Gerdner1, Laura K. Hart2, M. Bridget Zimmerman2, 1 Stanford University, Palo Alto, CA, USA; 2University of Iowa, Iowa City, IA, USA. Contact e-mail: [email protected] Background: Agitation in persons with dementia negatively impacts quality of life by interfering with delivery of care and social interaction. Hall and Buckwalter (1987) theorized that the advancement of cognitive impairment is accompanied by a progressive decline in the person’s stress threshold resulting in a heightened potential for anxiety, advancing to agitation. The Craniosacral Still Point Technique (CSPT) is a therapeutic technique within the realm of Craniosacral Therapy that is claimed to induce a “profound relaxing effect on the autonomic nervous system” (Upledger, 2004, p. 113). Implementation of CSPT could potentially benefit elders with dementia who have a lowered tolerance to stress. Objective: Explore the effects of CSPT in persons with dementia with emphasis on agitation. Methods: This pilot study used a mixed methodology. A convenience sample included nine elders with dementia, residing in two long-term care facilities in Iowa and Minnesota. The Cohen-Mansfield Agitation Inventory (CMAI) was used to measure the frequency of agitation during the three-week baseline period, six-week intervention period, and three-week post intervention. CSPT was implemented daily over 6-weeks by an experienced therapist certified in craniosacral therapy. Staff, family, and therapists were also interviewed to query the resident’s response to the intervention and the barriers and facilitators to implementation. Results: Subject cooperation lead to an overall compliance of 99.65%. The linear mixed model of analysis for repeated measures showed a statistically significant reduction in the mean MCMAI total and subscale scores (aggression, physical non-aggression, and verbal agitation) during weeks 1-3 and 4-6 of the intervention period compared to baseline. A statistically significant reduction continued throughout the 3-week postintervention period for physically non-aggression and verbally agitated behaviors. Staff and family interviews provided convergent validity to quantitative findings. Subjects were also more cooperative during cares and displayed meaningful interactions. All therapists described the subject’s positive response to the intervention as a facilitator for continuing the protocol. Conclusions: This is the first effort to empirically evaluate the effects of craniosacral therapy (e.g. CSPT) in persons with dementia. As a pilot, our findings are limited by a small convenience sample, but provide an important foundation for future research. P-141
KNOWLEDGE OF DEPRESSION AMONG AFRICAN AMERICAN ALZHEIMER’S DISEASE CAREGIVERS
Yvonne G. Hipps1, Robin Socci1, Harry Strothers1, Regine Denis2, Brenda Hayes1, 1Morehouse School of Medicine, Atlanta, GA, USA; 2 Fulton County Department on Aging, Atlanta, GA, USA. Contact e-mail: [email protected]
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Posters: P-142
Background: Researchers cited depression significantly being the major declining element associated with caregiver morbidity (Whelan 2001; Burton, Zdaniu, Schulz, Jackson, Hirsch). “Providing daily care to demented family members is a physically and emotionally exhausting task. Among the consequences is depression which is alarmingly common among these caregivers and is often severe” (Ferris 2002). Objective: To examine depression knowledge, attitude and help seeking behaviors among older African Americans caring for their loved ones with Alzheimer’s disease. Methods: With a representative sample, we developed a 12-item qualitative survey from a focus group structured with open-ended questions relative to depression and caregiving. The survey was self-administered during a 2005 “Live Healthy Georgia” health fair in a multi-purpose senior center. Results: Thirty-three African Americans aged 50-90 responded to this survey, of which twenty-five were caregivers. Of the twenty-five, fourteen were caring for a loved one with Alzheimer’s disease and eleven were non-AD caregivers. Of the total sample population, 59% indicated that African American AD caregivers had no understanding of depression. Additionally, 69% of all caregivers indicated African American AD caregivers did not know how to seek help if they were depressed. Among fourteen African American AD caregivers, 69% agreed in strong association with age (Somers’ d⫽0.583, p⫽0.048). Additionally, 58% of non-AD caregivers answered that African American AD caregivers did not know how to seek help if they were depressed which was associated with age (lambda⫽1.0, p⫽0.003). Of all respondents, 87% indicated that African American AD caregivers grieve during the care of their loved one. There was a significant difference between the responses of AD and non-AD caregivers to this question (t-value⫽2.309; df⫽13; p⫽0.038). Of AD caregivers, 71% indicated African American AD caregivers grieve caring for their loved one; 100% of non-AD caregivers agreed. Conclusions: We may need further research in depression counseling intervention strategies among AD caregivers during and after the caring experience (Mittelman 2004). In 1999 the Surgeon General of the United States, David Satcher, MD, issued a report on mental health. His conclusions are our conclusions: “mental illnesses such as depression are real; treatment works; get help” (Satcher 2001). ACKNOWLEDGMENTS: Lorraine Cook, MSW, Emma Darnell MultiPurpose Senior Center; Rosalene King, MSW, Helene Mills Multi-Purpose Senior Center; Arnisha Norman, MS, RD, LD, Atlanta Regional Center. REFERENCES: Burton Lynda C, Zdaniu Bozena K, Schulz Richard, Jackson Sharon, and Hirsch Calvin. The Gerontologist 2003; 43:230-241. Ferris Mara, MS, RN, C, CS, CPHQ, CRRN, EMT (President AGE, Inc. / Association for Gerontologic Education) Reducing the Caregiver’s Depression, January 3, 2000, (Reviewed: November 1, 2002). Mittelman MS, Roth DL, Coon DW, Haley WE. Sustained benefit of supportive intervention for depressive symptoms in caregivers of patients with Alzheimer’s disease, Am J Psychiatry. 2004 May; 161(5):850-6. Neundorfer Marcia M., McClendon McKee J., Smyth Kathleen A., Stuckey Jon C., Strauss Milton E., and Patterson Marian B. A Longitudinal Study of the Relationship Between Levels of Depression Among Persons With Alzheimer’s Disease and Levels of Depression Among Their Family Caregivers, J. Gerontol. B. Psychol. Sci. Soc. Sci. 2001; 56:P301-P313. Satcher, David. Surgeon General’s Report on Children’s Mental Health, 2001. Schulz, R., G. Williamson, R. Morycz, and D. Biegel. “Changes in Depression Among Men and Women Caring for an Alzheimer’s Patient.” In: Caregiving Systems: Informal and Formal Helpers, edited by S. H. Zarit, L. Pearlin, and K. Schaie, pp. 119-40, 1993. Whelen Robinson- Susan, PhD, Caregiving negative effects can last years: study: depression rate didn’t drop, Journal of Abnormal Psychology, December 2001.
P-142
ADVANCE CARE PLANNING AND DEMENTIA
Karen B. Hirschman, Sarahlena Panzer, Jason H.T. Karlawish, University of Pennsylvania, Philadelphia, PA, USA. Contact e-mail: [email protected] Background: A person with dementia progressively loses his or her ability to make decisions. Over time, other people, usually family members, make decisions for the patient. However, we know little about whether older adults are having advance care planning (ACP) discussions and what factors older adults think are important if their family has to make medical decisions on their behalf. Objective: This study was designed to assess whether older adults are having discussions about health care preferences and to identify the factors that are important to ACP, the process of having discussions and creating formal written directives. Methods: In-depth interviews with 43 older adults: 22 Alzheimer’s Disease Center (ADC) patients with Mild Cognitive Impairment (MCI) or early stage Alzheimer’s Disease (AD) and 21 ADC control subjects (without dementia). Results: Fifty percent of the AD patients and 69% of controls have had a discussion about their health care preferences with their relatives, while 100% of the subjects expressed that they should discuss their preferences with their family. Sixty-eight percent of dementia patients and 100% of controls felt that it was more important to put their health care preferences in writing versus having only a conversation. Although 100% of the controls felt written directives were important, 24% reported not having a living will or durable power of attorney. When asked if it would be helpful to talk about ACP with a lawyer, only 59% of dementia patients said it would be helpful while 86% of controls said it would be helpful. Approximately two-thirds of both subject groups felt that talking with their physicians would be helpful. Dementia patients said educational materials would be helpful (73%) but fewer controls felt educational materials would be helpful (52%). Conclusions: While the majority of older adults, regardless of MCI or dementia, are having ACP discussions, 100% think that these discussions should take place. For patients with dementia these conversations will provide their family decision makers with information on which to base decisions in the future. Further research into the barriers and facilitators to ACP and medical decision making are necessary. P-143
FAMILY MEMBERS’ PERCEPTIONS OF PALLIATIVE CARE SERVICE NEEDS OF ADVANCED DEMENTIA PATIENTS
Karen B. Hirschman, Jennifer M. Kapo, Sarahlena Panzer, David J. Casarett, University of Pennsylvania, Philadelphia, PA, USA. Contact e-mail: [email protected] Background: Despite advances in therapeutics, Alzheimer’s Disease remains a progressive and terminal illness that will require palliative care. An increased understanding of the needs and preferences for palliative care services for persons with advanced dementia is essential to address the unique and complex needs of the growing population of elders and their family members. Objective: To identify the palliative care services that family members of nursing home residents with advanced dementia believe to be most helpful. Methods: In-depth telephone interviews with family members (n⫽35) of nursing home residents with advanced dementia (Cognitive Performance Scale score ⱖ5 and a diagnosis of “dementia” as reported on the Minimum Data Set). Subjects were recruited from both inner city and suburban nursing home facilities in two large nursing home and continuing care communities. Results: There were no differences between black (n⫽17) and white (n⫽18) family members’ perceptions of palliative care needs. Over 60% of family members thought it would be helpful to learn more about how to detect when their relative is in pain. Forty-three percent of family members indicated that they felt their relative needed more visitors. In addition, 43% of family members said they were emotionally exhausted in coping with their relatives’ illness. Thirty-eight percent of family members felt their relative could use more spiritual support and 36% felt it would be helpful to have more information on their
AN AUTOPSY-CONFIRMED CASE STUDY OF THE CONVERSION FROM NORMAL COGNITION TO AMNESTIC MCI TO AD
Ronald F. Zec, Nicole Burkett, Stephen Markwell, Brian Moore, SIU School of Medicine, Springfield, IL, USA. Contact e-mail: [email protected] Background: The conversion from Mild Cognitive Impairment (MCI) to dementia has received considerable research attention, whereas the transition from normal cognition to MCI and dementia in an autopsy-confirmed case of Alzheimer disease (AD) has not been studied in detail. Objective: We studied the conversion from normal memory and cognition to MCI of the amnestic type to early dementia with annual assessments over 10 years using a comprehensive neuropsychological test battery in a neuropathologically-confirmed case of AD. Methods: The woman was 74 years old at the first evaluation and was 84 years old at the time of her last assessment. She was a retired high school teacher with 18 years of education. An annual half-day cognitive assessment was administered to the patient including tests of mental status, attention, new learning and memory, language, visuospatial functioning, and problem solving ability. Results: The patient scored well within normal limits on all memory and cognitive test measures using age norms at her first evaluation (age 74). A gradual progressive decline over ten years on measures of new declarative learning and memory, especially on word-list learning tests, was found resulting in severe memory impairment at age 78. Only later did measurable decline on the non-memory cognitive measures emerge. Neuropathological findings at autopsy revealed Alzheimer-type changes that indicated a high likelihood, by NIA-Reagan criteria, that the dementia was due to Alzheimer disease. There was moderate CERAD plaque grade and Braak and Braak tangle stage V. There was a heavy NFT and NP burden in the hippocampus, entorhinal cortex, perirhinal cortex, and amygdala, a moderate number in the inferior temporal gyrus with less Alzheimer pathology burden in the frontal, parietal, and occipital cortices and the superior temporal gyrus. Conclusions: Progressive memory decline in an autopsy-confirmed case of AD occurred gradually over 7-8 years before there is detectable nonmemory cognitive deficits emerged on a comprehensive neuropsychological battery of tests. This case is likely representative of many, but not all, cases of AD. P-139
MULTIMEDIA BIOGRAPHIES TO ENHANCE AD OR MCI QUALITY OF LIFE
Ronald M. Baecker1, Elsa Marziali1,2, Sarah Chatland1, Masashi Crete1, Kante Easley1, Martin Yeung1, 1University of Toronto, Toronto, ON, Canada; 2Baycrest Centre for Geriatric Care, Toronto, ON, Canada. Contact e-mail: [email protected] Background: One serious consequence of AD is the loss of memories of one’s past, of names, places, and events, of a sense of one’s identity. We shall report on a multimedia biography intervention intended to help AD individuals and family members better cope with these consequences of AD. Objectives: Our research seeks to establish the practicality of the method, to provide case study evidence of its benefits for both individuals with AD and their family members, and to study how the intervention and its impact differs when applied to an individual with MCI. Methods: We are producing 12 multimedia biographies for participating persons with mid-stage or early-stage Alzheimer’s disease or with Mild Cognitive Impairment (MCI). We collaborate with the affected individual and in the case of AD family members in collecting a life history constructed from media such as still photos, videos, music, and recorded interviews. Qualitative analysis of observations of participants and interviews with family members are used to assess the impacts of weekly or bi-weekly viewings of the biography over a period of six months. Results: We have developed
S143
and will report on an effective method for the production of useful biographies. We have established the practicality of producing these at a reasonable cost using university students with no prior film production training. Early findings from this work in progress suggest that regular viewings of a visual biography serve to stimulate memories, reinforce a positive self-identity, and bring joy to the AD individual. The biographies seem to provide benefits to family members such as better remembering how the loved one once was and being better able to accept the disease. The biographies also seem to stimulate conversations between the AD individual and family members, and to enable third-party caregivers to better understand who is in their care and thereby approach caregiving with greater knowledge and empathy. Conclusions: More complete findings based on five months further work, including differences based on disease severity, will be presented in a conference poster P-140
EXPLORING THE EFFECTS OF CRANIOSACRAL STILL POINT TECHNIQUE IN PERSONS WITH DEMENTIA
Linda A. Gerdner1, Laura K. Hart2, M. Bridget Zimmerman2, 1 Stanford University, Palo Alto, CA, USA; 2University of Iowa, Iowa City, IA, USA. Contact e-mail: [email protected] Background: Agitation in persons with dementia negatively impacts quality of life by interfering with delivery of care and social interaction. Hall and Buckwalter (1987) theorized that the advancement of cognitive impairment is accompanied by a progressive decline in the person’s stress threshold resulting in a heightened potential for anxiety, advancing to agitation. The Craniosacral Still Point Technique (CSPT) is a therapeutic technique within the realm of Craniosacral Therapy that is claimed to induce a “profound relaxing effect on the autonomic nervous system” (Upledger, 2004, p. 113). Implementation of CSPT could potentially benefit elders with dementia who have a lowered tolerance to stress. Objective: Explore the effects of CSPT in persons with dementia with emphasis on agitation. Methods: This pilot study used a mixed methodology. A convenience sample included nine elders with dementia, residing in two long-term care facilities in Iowa and Minnesota. The Cohen-Mansfield Agitation Inventory (CMAI) was used to measure the frequency of agitation during the three-week baseline period, six-week intervention period, and three-week post intervention. CSPT was implemented daily over 6-weeks by an experienced therapist certified in craniosacral therapy. Staff, family, and therapists were also interviewed to query the resident’s response to the intervention and the barriers and facilitators to implementation. Results: Subject cooperation lead to an overall compliance of 99.65%. The linear mixed model of analysis for repeated measures showed a statistically significant reduction in the mean MCMAI total and subscale scores (aggression, physical non-aggression, and verbal agitation) during weeks 1-3 and 4-6 of the intervention period compared to baseline. A statistically significant reduction continued throughout the 3-week postintervention period for physically non-aggression and verbally agitated behaviors. Staff and family interviews provided convergent validity to quantitative findings. Subjects were also more cooperative during cares and displayed meaningful interactions. All therapists described the subject’s positive response to the intervention as a facilitator for continuing the protocol. Conclusions: This is the first effort to empirically evaluate the effects of craniosacral therapy (e.g. CSPT) in persons with dementia. As a pilot, our findings are limited by a small convenience sample, but provide an important foundation for future research. P-141
KNOWLEDGE OF DEPRESSION AMONG AFRICAN AMERICAN ALZHEIMER’S DISEASE CAREGIVERS
Yvonne G. Hipps1, Robin Socci1, Harry Strothers1, Regine Denis2, Brenda Hayes1, 1Morehouse School of Medicine, Atlanta, GA, USA; 2 Fulton County Department on Aging, Atlanta, GA, USA. Contact e-mail: [email protected]
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Posters: P-142
Background: Researchers cited depression significantly being the major declining element associated with caregiver morbidity (Whelan 2001; Burton, Zdaniu, Schulz, Jackson, Hirsch). “Providing daily care to demented family members is a physically and emotionally exhausting task. Among the consequences is depression which is alarmingly common among these caregivers and is often severe” (Ferris 2002). Objective: To examine depression knowledge, attitude and help seeking behaviors among older African Americans caring for their loved ones with Alzheimer’s disease. Methods: With a representative sample, we developed a 12-item qualitative survey from a focus group structured with open-ended questions relative to depression and caregiving. The survey was self-administered during a 2005 “Live Healthy Georgia” health fair in a multi-purpose senior center. Results: Thirty-three African Americans aged 50-90 responded to this survey, of which twenty-five were caregivers. Of the twenty-five, fourteen were caring for a loved one with Alzheimer’s disease and eleven were non-AD caregivers. Of the total sample population, 59% indicated that African American AD caregivers had no understanding of depression. Additionally, 69% of all caregivers indicated African American AD caregivers did not know how to seek help if they were depressed. Among fourteen African American AD caregivers, 69% agreed in strong association with age (Somers’ d⫽0.583, p⫽0.048). Additionally, 58% of non-AD caregivers answered that African American AD caregivers did not know how to seek help if they were depressed which was associated with age (lambda⫽1.0, p⫽0.003). Of all respondents, 87% indicated that African American AD caregivers grieve during the care of their loved one. There was a significant difference between the responses of AD and non-AD caregivers to this question (t-value⫽2.309; df⫽13; p⫽0.038). Of AD caregivers, 71% indicated African American AD caregivers grieve caring for their loved one; 100% of non-AD caregivers agreed. Conclusions: We may need further research in depression counseling intervention strategies among AD caregivers during and after the caring experience (Mittelman 2004). In 1999 the Surgeon General of the United States, David Satcher, MD, issued a report on mental health. His conclusions are our conclusions: “mental illnesses such as depression are real; treatment works; get help” (Satcher 2001). ACKNOWLEDGMENTS: Lorraine Cook, MSW, Emma Darnell MultiPurpose Senior Center; Rosalene King, MSW, Helene Mills Multi-Purpose Senior Center; Arnisha Norman, MS, RD, LD, Atlanta Regional Center. REFERENCES: Burton Lynda C, Zdaniu Bozena K, Schulz Richard, Jackson Sharon, and Hirsch Calvin. The Gerontologist 2003; 43:230-241. Ferris Mara, MS, RN, C, CS, CPHQ, CRRN, EMT (President AGE, Inc. / Association for Gerontologic Education) Reducing the Caregiver’s Depression, January 3, 2000, (Reviewed: November 1, 2002). Mittelman MS, Roth DL, Coon DW, Haley WE. Sustained benefit of supportive intervention for depressive symptoms in caregivers of patients with Alzheimer’s disease, Am J Psychiatry. 2004 May; 161(5):850-6. Neundorfer Marcia M., McClendon McKee J., Smyth Kathleen A., Stuckey Jon C., Strauss Milton E., and Patterson Marian B. A Longitudinal Study of the Relationship Between Levels of Depression Among Persons With Alzheimer’s Disease and Levels of Depression Among Their Family Caregivers, J. Gerontol. B. Psychol. Sci. Soc. Sci. 2001; 56:P301-P313. Satcher, David. Surgeon General’s Report on Children’s Mental Health, 2001. Schulz, R., G. Williamson, R. Morycz, and D. Biegel. “Changes in Depression Among Men and Women Caring for an Alzheimer’s Patient.” In: Caregiving Systems: Informal and Formal Helpers, edited by S. H. Zarit, L. Pearlin, and K. Schaie, pp. 119-40, 1993. Whelen Robinson- Susan, PhD, Caregiving negative effects can last years: study: depression rate didn’t drop, Journal of Abnormal Psychology, December 2001.
P-142
ADVANCE CARE PLANNING AND DEMENTIA
Karen B. Hirschman, Sarahlena Panzer, Jason H.T. Karlawish, University of Pennsylvania, Philadelphia, PA, USA. Contact e-mail: [email protected] Background: A person with dementia progressively loses his or her ability to make decisions. Over time, other people, usually family members, make decisions for the patient. However, we know little about whether older adults are having advance care planning (ACP) discussions and what factors older adults think are important if their family has to make medical decisions on their behalf. Objective: This study was designed to assess whether older adults are having discussions about health care preferences and to identify the factors that are important to ACP, the process of having discussions and creating formal written directives. Methods: In-depth interviews with 43 older adults: 22 Alzheimer’s Disease Center (ADC) patients with Mild Cognitive Impairment (MCI) or early stage Alzheimer’s Disease (AD) and 21 ADC control subjects (without dementia). Results: Fifty percent of the AD patients and 69% of controls have had a discussion about their health care preferences with their relatives, while 100% of the subjects expressed that they should discuss their preferences with their family. Sixty-eight percent of dementia patients and 100% of controls felt that it was more important to put their health care preferences in writing versus having only a conversation. Although 100% of the controls felt written directives were important, 24% reported not having a living will or durable power of attorney. When asked if it would be helpful to talk about ACP with a lawyer, only 59% of dementia patients said it would be helpful while 86% of controls said it would be helpful. Approximately two-thirds of both subject groups felt that talking with their physicians would be helpful. Dementia patients said educational materials would be helpful (73%) but fewer controls felt educational materials would be helpful (52%). Conclusions: While the majority of older adults, regardless of MCI or dementia, are having ACP discussions, 100% think that these discussions should take place. For patients with dementia these conversations will provide their family decision makers with information on which to base decisions in the future. Further research into the barriers and facilitators to ACP and medical decision making are necessary. P-143
FAMILY MEMBERS’ PERCEPTIONS OF PALLIATIVE CARE SERVICE NEEDS OF ADVANCED DEMENTIA PATIENTS
Karen B. Hirschman, Jennifer M. Kapo, Sarahlena Panzer, David J. Casarett, University of Pennsylvania, Philadelphia, PA, USA. Contact e-mail: [email protected] Background: Despite advances in therapeutics, Alzheimer’s Disease remains a progressive and terminal illness that will require palliative care. An increased understanding of the needs and preferences for palliative care services for persons with advanced dementia is essential to address the unique and complex needs of the growing population of elders and their family members. Objective: To identify the palliative care services that family members of nursing home residents with advanced dementia believe to be most helpful. Methods: In-depth telephone interviews with family members (n⫽35) of nursing home residents with advanced dementia (Cognitive Performance Scale score ⱖ5 and a diagnosis of “dementia” as reported on the Minimum Data Set). Subjects were recruited from both inner city and suburban nursing home facilities in two large nursing home and continuing care communities. Results: There were no differences between black (n⫽17) and white (n⫽18) family members’ perceptions of palliative care needs. Over 60% of family members thought it would be helpful to learn more about how to detect when their relative is in pain. Forty-three percent of family members indicated that they felt their relative needed more visitors. In addition, 43% of family members said they were emotionally exhausted in coping with their relatives’ illness. Thirty-eight percent of family members felt their relative could use more spiritual support and 36% felt it would be helpful to have more information on their