F2‐02‐03: “Wecare Advisor”: a Clinical Trial of a Caregiver Focused, IPAD Administered Algorithm to Manage Behavioral Symptoms

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152585/1/alzjjalz201606386.pd

An exploration of occupation in nursing home residents with dementia

Objectives: This study evaluated the sitting room environment of two nursing homes in Ireland, using interactive occupation and social engagement as outcome measures and defining these rooms as occupational spaces. Method: Snapshot observational recordings were made in the main sitting rooms during the periods of time when the rooms were in most active use. Narrative information was also recorded. Results: Residents were more likely to occupy their time in the main sitting room passively, rather than in interactive occupation and social engagement. The nursing home residents with dementia spent approximately 70% of their daily time in the main sitting room areas in states of occupational disengagement. Discussion: Additional insight is provided through pragmatic narrative descriptions of the functioning of the main sitting room environment in terms of interactive occupation and social engagement. Relevance: The research study demonstrates a methodology for evaluating the sitting room areas of a care environment, using interactive occupation and social engagement as outcome measures,which can be used for descriptive and comparative insights into the performance of care environments

A non-pharmacologic approach to address challenging behaviors of Veterans with dementia: description of the tailored activity program-VA randomized trial

BACKGROUND: Behavioral symptoms accompanying dementia are associated with increased health care costs, reduced quality of life and daily functioning, heightened family caregiver burden, and nursing home placement. Standard care typically involves pharmacologic agents, but these are, at best, modestly effective, carry serious risks, including mortality, and do not address behavioral symptoms families consider most distressful and which may prompt nursing home placement. Given dementia’s devastating effects and the absence of an imminent cure, the Veterans Administration has supported the development and testing of new approaches to manage challenging behaviors at home. METHODS/DESIGN: The Tailored Activity Program – Veterans Administration is a Phase III efficacy trial designed to reduce behavioral symptoms in Veterans with dementia living with their caregivers in the community. The study uses a randomized two-group parallel design with 160 diverse Veterans and caregivers. The experimental group receives a transformative patient-centric intervention designed to reduce the burden of behavioral symptoms in Veterans with dementia. An occupational therapist conducts an assessment to identify a Veteran’s preserved capabilities, deficit areas, previous roles, habits, and interests to develop activities tailored to the Veteran. Family caregivers are then trained to incorporate activities into daily care. The attention-control group receives bi-monthly telephone contact where education on topics relevant to dementia is provided to caregivers. Key outcomes include reduced frequency and severity of behavioral symptoms using the 12-item Neuropsychiatric Inventory (primary endpoint), reduced caregiver burden, enhanced skill acquisition, efficacy using activities, and time spent providing care at 4 months; and long-term effects (8 months) on the Veteran’s quality of life and frequency and severity of behavioral symptoms, and caregiver use of activities. The programs’ impact of Veterans Administration cost is also examined. Study precision will be increased through face-to-face research team trainings with procedural manuals and review of audio-taped interviews and intervention sessions. DISCUSSION: The Tailored Activity Program – Veterans Administration is designed to improve the quality of life of Veterans with dementia and lessen the burden of care on caregivers. Activities are tailored to reflect the Veteran’s preserved capabilities and interests to enhance active engagement, while not taxing areas of cognition that are most impaired. TRIAL REGISTRATION: ClinicalTrials.gov, NCT0135756

Fracture hospitalizations between years 2000 and 2007 in Switzerland: a trend analysis

Summary: In Switzerland, the total number and incidence of hospitalizations for major osteoporotic fractures increased between years 2000 and 2007, while hospitalizations due to hip fracture decreased. The cost impact of shorter hospital stays was offset by the increasing cost per day of hospitalization. Introduction: The aim of the study was to establish the trends and epidemiological characteristics of hospitalizations for major osteoporotic fractures (MOF) between years 2000 and 2007 in Switzerland. Methods: Sex- and age-specific trends in the number and crude and age-standardized incidences of hospitalized MOF (hip, clinical spine, distal radius, and proximal humerus) in women and men aged ≥45years were analyzed, together with the number of hospital days and cost of hospitalization, based on data from the Swiss Federal Statistical Office hospital database and population statistics. Results: Between 2000 and 2007, the absolute number of hospitalizations for MOF increased by 15.9% in women and 20.0% in men, mainly due to an increased number of non-hip fractures (+37.7% in women and +39.7% in men). Hospitalizations for hip fractures were comparatively stable (−1.8% in women and +3.3% in men). In a rapidly aging population, in which the number of individuals aged ≥45years grew by 11.1% (women) and 14.6% (men) over the study period, the crude and age-standardized incidences of hospitalizations decreased for hip fractures and increased for non-hip MOF, both in women and men. The length of hospital stay decreased for all MOF in women and men, the cost impact of which was offset by an increase in the daily costs of hospitalization. Conclusions: Between years 2000 and 2007, hospitalizations for MOF continued to increase in Switzerland, driven by an increasing number and incidence of hospitalizations for non-hip fractures, although the incidence of hip fractures has decline

How new technology is addressed by researchers in educational studies: approaches from high-performing universities in China and the UK

There is a crisis of expectation in relation to educational technology. This is sometimes interpreted as a failure of academic researchers to disseminate their work to educational practitioners. However, another interpretation dwells on the lack of vision characterising such research. Because teachers often encounter research most intensely during their own pre-service and in-service education, we review academic research here through a snapshot of output from 10 leading university Education departments sampled in the UK and China. Empirical papers with a central interest in new technology were scarce, representing around 10% of the sample. Research was strongly situated in 'classroom' contexts although, as critics have suggested, with limited attention to the wider ecology of those places and with teachers being the focal interest as much as students. An 'outcomes' research orientation was less common than an interest in process. Although this was approached with different methodologies in China and the UK. Discussion addresses the challenge of effective and authoritative dissemination and constraints arising from the political economy of research itself

Fargo: Seeing the significance of style in television poetics?

This article explores the adaptation of the original film to television and how a strain of art or independent cinema contributed to the development of the first series of Fargo (2014–present). By making this comparison, the transition to television of the storyworld established by the Coen brothers raises questions about who is talking in the TV drama – the Coens or makers of the series. At the same time, Fargo can be more easily explained and understood as a strategy by writers, directors and producers that further complicate ideas to do with Noah Hawley, as its showrunner and the show’s single-author status. In Fargo, fidelity to the Coen brothers as a testament to the memory of the original film is set against questions about the reliability of storytelling using complex imagery. By alternating between different levels of narration signified by its stylistic tonal qualities, Fargo succeeds in producing multiple meanings, representations and effects that call attention to textual pleasures in the complex television series

CAPABLE trial: A randomized controlled trial of nurse, occupational therapist and handyman to reduce disability among older adults: Rationale and design

AbstractBackgroundAs the population ages, it is increasingly important to test new models of care that improve life quality and decrease health costs. This paper presents the rationale and design for a randomized clinical trial of a novel interdisciplinary program to reduce disability among low income older adults based on a previous pilot trial of the same design showing strong effect.MethodsThe CAPABLE (Community Aging in Place, Advancing Better Living for Elders) trial is a randomized controlled trial in which low income older adults with self-care disability are assigned to one of two groups: an interdisciplinary team of a nurse, occupational therapist, and handyman to address both personal and environmental risk factors for disability based on participants' functional goals, or an attention control of sedentary activities of choice. Both groups receive up to 10 home visits over 4months.OutcomesThe primary outcome is decreased disability in self-care (ADL). Secondary outcomes are sustained decrease in self care disability as well as improvement in instrumental ADLS, strength, balance, walking speed, and health care utilization. Careful cost tracking and analysis using intervention data and claims data will enable direct measurement of the cost impact of the CAPABLE approach. CAPABLE has the potential to leverage current health care spending in Medicaid waivers, Accountable Care Organizations and other capitated systems to save the health care system costs as well as improving low income older adults' ability to age at home with improved life quality