Using Spaced Retrieval With External Aids to Improve Use of Compensatory Strategies During Eating for Persons With Dementia

Identifying Components of a Person-Centered Augmentative and Alternative Communication Intervention for People With Dementia: Opinions of an International Expert Panel

PURPOSE

Despite general agreement on the importance of person-centered care in speech-language pathology, guidelines for developing person-centered interventions for those with dementia are limited. This study aimed to obtain expert opinion on the components of a person-centered augmentative and alternative communication (AAC) intervention for persons with dementia.

METHOD

A modified electronic Delphi technique was employed in a single round. A purposively sampled panel of experts was invited to provide their opinion on three open-ended questions related to (a) the elements of person-centered care, (b) communication supports, and (c) the interaction outcomes of a person-centered intervention. Thirty-one experts from nine countries participated on the panel. The majority were speech-language pathologists primarily involved in research. Qualitative written data were coded and analyzed using content analysis.

RESULTS

Nine components were identified across the three open-ended questions: (a) the unique characteristics of the person with dementia, (b) working with a person with dementia, (c) preserving personhood, (d) a different view on person-centered care, (e) a range of communication supports, (f) supportive conversational partners, (g) designing communication supports, (h) interaction outcome measure, and (i) meaningful interaction outcomes.

CONCLUSION

This study identified nine components that are useful in guiding speech-language pathologists in crafting future person-centered AAC interventions for people with dementia.

Nutritional Care for Institutionalized Persons with Dementia: An Integrative Review

BACKGROUND

Older people are at risk of malnutrition, especially when they suffer from cognitive impairment. Guidelines that orient nursing care in this regard need to be updated. The aim of this review is to address the best available evidence on interventions that can benefit nutritional nursing care for institutionalized older adults with dementia.

METHODS

Integrative review using the Dimensions and Eureka search engines, and the PubMed, Embase, Scielo, CINAHL, and ScienceDirect databases. We searched from the year 2015 through to 2021. We employed the MMAT guidelines for mixed, qualitative, and quantitative studies, and the PRISMA, CASP, and JBI guidelines to value the reviews.

RESULTS

A total of 55 studies met the inclusion criteria. The best available evidence to support nutritional nursing care for institutionalized older adults with dementia highlights several aspects related to the assessment and caring interventions that are focused on people with dementia, their caregivers, and their context.

CONCLUSIONS

Both the assessment and nutritional care interventions for older people with dementia should consider the patient-caregiver dyad as the subject of care and understand the context as a fundamental part of it. The analysis of the context should look further than the immediate environment.

Interventions for Nursing Home Residents with Dysphagia-A Scoping Review

Oropharyngeal dysphagia is common in nursing home residents. The objective of this scoping review was to summarize and disseminate the findings from the literature on interventions for dysphagia in nursing home residents. Searches were conducted in four databases. The criteria for including the studies were nursing home residents, dysphagia, interventions, original research, published in English, Danish, Norwegian, or Swedish with no restriction placed regarding publication date. Excluded were literature reviews, editorial comments, conference abstracts, protocols, papers not available in full text, and studies with a mixed population, for example, geriatric patients and nursing home residents and where the results were not separated between the groups. A total of 14 papers were included and analyzed. The included papers represented interventions focusing on feeding intervention, oral hygiene, caregiver algorithm, stimulation (taste and smell), teaching the residents what to eat, mobilization of the spine, exercises/training, and positioning. This scoping review identifies sparse knowledge about interventions affecting nursing home residents' dysphagia. But the results indicate that multi-component interventions, including staff training, training of residents, and/or next of kin, might be successful. This scoping review clarifies that there is a need for well-designed studies that uncover which specific interventions have an effect in relation to nursing home residents with dysphagia and can serve as a guide for designing multi-component person-centered intervention studies. Future studies should implement high evidence study designs, define the measures of dysphagia, and quantify the severity of dysphagia, its underlying diseases, and comorbidities.

Behavioral Mimicry as a Strategy to Increase Drinking Behaviors in Older Adults

Purpose Individuals with dysphagia, particularly in the presence of dementia, are at high risk for decreased nutrition and hydration. Unfortunately, current treatment options are not without limitations and often ignore the crucial social aspects of mealtimes. The aim of this exploratory, proof-of-concept study was to examine whether the social phenomenon of nonconscious behavioral mimicry can increase drinking behaviors in healthy older adults. Method Forty-two older adults (M _age = 68.26 years, SD = 6.49) participated. Participants and a member of the research team posing as another participant (a confederate) took turns describing two series of pictures, while, unbeknownst to the participants, the confederate either frequently drank from a cup of water or touched the cup. The primary outcome measures (number of drinks per minute, number of cup touches per minute, percentage of time spent drinking, and percentage of time spent touching the cup) were coded and analyzed across both the confederate drinking and cup-touching conditions. Results Participants drank more frequently and spent more task time drinking during the confederate drinking condition as compared to the cup-touching condition. There was significant variability in drinking patterns across participants, with some only drinking when they were not engaged in the picture description task. Conclusions Behavioral mimicry may increase drinking behaviors in healthy older adults, although the effect may not be as robust among certain subsets of individuals. Clinically, mimicry may hold potential as a powerful, noninvasive supplemental mealtime strategy for increasing intake in those who are most at risk for malnutrition.

Spaced Retrieval and Episodic Memory Training in Alzheimer's Disease

Introduction

This study replicated and extended the findings from the author's previous pilot study to further explore how a spaced retrieval (SR) memory training program might be effectively applied to help persons with Alzheimer’s disease (AD)  improve both short- and long-term recall of recent episodic events.

Methods

A quasi-experimental within-subject group study was conducted with 15 participants with a diagnosis of AD.

Results

Compared to a control condition, all participants were able to spontaneously recall significantly more specific details about trained events, and their recall was significantly enhanced when they were provided with cues. Although the findings indicated that people with AD were able to encode information during training, recall gains diminished by the end of the maintenance period.

Discussion

This study provides evidence that individuals with mild to moderate AD can learn and recall new episodic information through SR training. These findings support the use of SR as an intervention tool to help individuals maintain their functioning in episodic recent memory. However, more research into maintaining the long-term recall of recent episodic events is warranted.

Effects of Visual Aids for End-of-Life Care on Decisional Capacity of People With Dementia

Purpose This study evaluated the decision-making capacity of persons with mild and moderate dementia on end-of-life care when using visual aids. A secondary purpose was to learn whether the judges naive to the experimental conditions would rate participants' decisional abilities as better when augmented by visual aids, thereby validating the behavioral changes due to the use of these external support. Method Twenty older adults with mild and moderate dementia demonstrated Understanding, Expressing a Choice, Reasoning, and Appreciation of 2 medical vignettes under 2 counterbalanced conditions: verbal alone or verbal with visual aids. Transcripts were analyzed and scored to measure decisional skills. Twelve judges rated participants' decisional abilities using a 7-point Likert scale. Results Participants demonstrated significantly better overall decisional capacity in Understanding, Reasoning, and Appreciation when supported by visual aids during the decision-making process. No significant differences between conditions were found in Expressing a Choice, the decisional skill Logical Sequence under Reasoning, and Acknowledgment under Appreciation. Overall, the judges' ratings validated these outcomes; the judges' ratings reflected greater agreement in the visual condition than in the verbal condition. Conclusions Findings indicated that visual aids (a) improved the decision-making capacity of individuals with dementia in comprehending medical information, employing supportive reasons, and relating this information to his or her own situation and (b) contain the potential for judges who majored or are majoring in speech-language pathology to reach a stronger consensus when determining the decision-making capacity of individuals with dementia.

Spaced Retrieval Using Static and Dynamic Images to Improve Face-Name Recognition: Alzheimer's Dementia and Vascular Dementia

Purpose The primary objective of this study examined whether spaced retrieval (SR) using dynamic images (video clips without audio) is more effective than SR using static images to improve face-name recognition in persons with dementia. A secondary objective examined the length of time associations were retained after participants reached criterion. A final objective sought to determine if there is a relationship between SR training and dementia diagnosis. Method A repeated-measures design analyzed whether SR using dynamic images was more effective than SR using static images for face-name recognition. Twelve participants diagnosed with Alzheimer's dementia or vascular dementia were randomly assigned to 2 experimental conditions in which the presentation of images was counterbalanced. Results All participants demonstrated improvement in face-name recognition; there was no significant difference between the dynamic and static images. Eleven of 12 participants retained the information from 1 to 4 weeks post training. Additional analysis revealed a significant interaction effect when diagnoses and images were examined together. Participants with vascular dementia demonstrated improved performance using SR with static images, whereas participants with Alzheimer's dementia displayed improved performance using SR with dynamic images. Conclusions SR using static and/or dynamic images improved face-name recognition in persons with dementia. Further research is warranted to continue exploration of the relationship between dementia diagnosis and SR performance using static and dynamic images.

Caregiving for Persons with Dementia: Evidence-based resources for SLPs

Speech–language pathologists (SLPs) have an important role in supporting the caregivers of persons with dementia from diagnosis through the end of life in 4 major areas: education, training to use effective cognitive communication strategies identified for clients with dementia, psychosocial/emotional support, and counseling. Speech–language pathologists may be involved in this process from the initial diagnosis when families need guidance to navigate the vast amounts of information on the Internet and elsewhere, until they need assistance in making end-of-life decisions. Speech–language pathologists must recognize that caregivers have needs, and differing needs, depending on the stage of dementia of the person to whom they are providing care. The research in caregiving interventions for family, professional, and paraprofessional caregivers provides an understanding of effective, evidence-based approaches, resources, and promising caregiver outcomes for the SLP working with individuals with dementia and their caregivers. It is important for SLPs to know that these interventions exist and to seek out appropriate services to which to refer the caregivers of their clients. Other person-centered interventions specifically developed for SLPs to implement with their clients with dementia and their family and professional caregivers are crucial for ensuring a quality life for clients and caregivers and for meeting the demands of a quality dementia care workforce.

Progressive Support for Activities of Daily Living for Persons Living With Dementia

Background and Objectives

Dementia is accompanied by increasing need for support in activities of daily living (ADLs). This brief report/literature review summarizes the practices to care for early stage, middle stage, and late stage ADL needs (dressing, toileting, and eating/nutrition), and examines commonalities across ADL needs and the extent to which practices are reflected in guidelines and/or evidence.

Research Design and Methods

A review of the grey and peer-reviewed literature, using some but not all procedures of a systematic review. Key terms were identified for ADLs overall and for each of the 3 ADLs, and a search was conducted using these words in combination with (a) dementia, Alzheimer's disease, and similar terms, and (b) practices, interventions, guidelines, recommendations, and similar terms. Searches were conducted using databases of peer-reviewed literature as well as the Grey Literature Reports and Google search engine. Sources were included if they provided evidence or recommendations on interventions to address ADL functioning for dressing, toileting, and feeding for persons living with dementia.

Results

As cognitive and functional impairment increases, the number of care practices and themes that embody care practices increases. The majority of practices are evidence-based, and most evidence is incorporated into guidelines.

Discussion and Implications

Virtually all practices reflect person-centered care principles. Five recommendations summarize the evidence and recommendations related to providing support to persons living with dementia in relation to dressing, toileting, and eating/nutrition.

Interprofessional Care in the Management of Alzheimer's Dementia: Leaving Our Silos

As speech-language pathologists (SLPs), we are poised to become leaders in the caring of adults with dementia; however, because of the complexity of this health condition, and its impact on patients and families, we must move beyond discipline-specific approaches to intervention and embrace the opportunities that arise when working across professional silos. The application of principles of interprofessional education (IPE) and interprofessional practice (IPP) can be applied to maximize Alzheimer's dementia care. In this paper, the organizational characteristics supporting IPP will be highlighted, an outline of applications of training procedures to promote IPP in a rehabilitation environment will be reviewed, and real-world case studies will be provided to highlight salient principles.