Although researchers stress the importance of encouraging independent behavior in persons with dementia, institutional practices often foster dependence. This study took place in a six-resident locked dementia care unit that followed the common institutional practice of serving meals on prepared plates. The purpose of this study was to examine if changing the mode of meal delivery to "family-style," where residents were presented with serving bowls and empty plates, would increase resident communication and participation in mealtime tasks. An ABAB' reversal design revealed very low rates of appropriate communication (5% of intervals) and mealtime participation (10% of tasks) during baseline, when residents received prepared plates (A). Communication and participation doubled when family-style meal delivery was introduced (B) and dropped back to baseline levels when it was withdrawn (A). Because the levels of communication and participation during family-style meals were still low, the nursing assistant was provided with instruction on prompting and praising appropriate mealtime behaviors (B'). After instruction was provided and family-style meals were reintroduced, resident participation rose to 65% of tasks and appropriate communication increased to 18% of observations. This study suggests family-style meals may result in modest increases in mealtime participation and communication of residents with dementia, but staff training in prompting and praising may be necessary to see large changes in these behaviors.
When people with disabilities, ethnic minorities, older adults, women, and others lack power, they usually experience adverse conditions disproportionate to other members of society. Empowerment--the process by which people gain some control over valued events, outcomes, and resources--is an important construct for understanding and improving the lives of people of marginal status. This manuscript presents a contextual-behavioral model of empowerment and its application in collaborative research with people with physical disabilities. The eight case studies illustrate 18 tactics for promoting empowerment that flow from the model. The case studies show the use of different combinations of empowerment tactics in a variety of contexts: (a) setting improvement agendas from the perspective of people with disabilities, (b) enforcing ordinances that preserve access to parking spaces designated for people with disabilities, (c) enabling access to homes through housing modifications, (d) enhancing support available through mutual-aid groups, (e) developing skills for recruiting mentors, (f) promoting self-directed behavior change with personal and health concerns, (g) enhancing skills for personal self-advocacy, and (h) building the capacities of groups of people with disabilities for systems advocacy. Finally, we discuss issues that may contribute to research and action related to empowerment.
Wandering away from home, or elopement, is a behavior that places persons with dementia at risk of serious injury and may lead family caregivers to place their loved ones in institutions or to severely restrict their independence. Funding from the National Institute on Aging (NIA) was used to evaluate the Mobile Locater, an electronic device designed to help caregivers quickly locate a person who has eloped. This 6-month pilot study included case studies of seven users and an opinion survey of family caregivers, professional caregivers and search and rescue workers. The survey results showed that respondents were positively impressed by the device, only identifying cost as a potential drawback. Case studies revealed that the equipment was easy to use, effective, and helpful to caregivers' peace of mind. These results suggest that the Mobile Locater is a valuable tool deserving of further study.
The Internet opens new options for communication and may change the extent to which older people use other modes of communication. The importance of older adults' participation in cyberspace has increased as Internet use for commerce and communication has increased. The present study explores how older adults' Internet use affects their sense of community. An online survey was conducted at the University of Sydney to determine the associations between Internet use and seniors' sense of community and well-being. Participants were recruited online. There was a positive association between a sense of belonging to an online community, sense of community, and well-being. Seniors' use of the Internet for communication and information, and the frequency and history of their Internet use, were consistently related to a greater sense of community.
This study analyzed the effects of nursing assistants' use of prompts and praise to increase the engagement of older adults with dementia in daily living activities. The multiple baseline design across morning and afternoon work shifts showed consistent increases in engagement by each of the 5 residents during the intervention. These results suggest that increasing prompts and praise by nursing assistants may, in turn, increase the rate of engagement of older adults with dementia.
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