Journal of Gerontological Nursing

Care Intervention for Older Adults with Alzheimer's Disease and Related Dementias: Effect of Family Involvement on Cognitive and Functional Outcomes in Nursing Homes

Rita A Jablonski, PhD, RN, ANP; David Reed, PhD; Meridean L Maas, PhD, RN, FAAN

Abstract

ABSTRACT

The purpose of this quasi-experimental study was to examine the effect of an intervention for caregivers of individuals with Alzheimer's disease and related dementias (ADRD) on nursing home residents' functional and cognitive status. Fourteen special care units (SCUs) in 14 midwestern nursing homes were paired according to size, ownership, and staff turnover. The paired nursing homes were randomly assigned to either experimental or control groups. The intervention consisted of the Family Involvement in Care (FIC) protocol. The FIC intervention was designed to help family caregivers of nursing home residents with dementia negotiate and establish a partnership with the staff caregivers for the care of residents. One hundred sixty-four residents participated in the study, 71 in the control group and 93 in the experimental group. Sixty-three residents were lost to attrition (38%).

The experimental group exhibited less global deterioration throughout the study. Inappropriate behavior, cognition, and functional status remained relatively unchanged over time within and between the groups, Increased family involvement did slow global deterioration in individuals with ADRD. The findings of the study show that more factors need to be examined to discover those interventions that preserve functional and cognitive abilities.

Abstract

ABSTRACT

The purpose of this quasi-experimental study was to examine the effect of an intervention for caregivers of individuals with Alzheimer's disease and related dementias (ADRD) on nursing home residents' functional and cognitive status. Fourteen special care units (SCUs) in 14 midwestern nursing homes were paired according to size, ownership, and staff turnover. The paired nursing homes were randomly assigned to either experimental or control groups. The intervention consisted of the Family Involvement in Care (FIC) protocol. The FIC intervention was designed to help family caregivers of nursing home residents with dementia negotiate and establish a partnership with the staff caregivers for the care of residents. One hundred sixty-four residents participated in the study, 71 in the control group and 93 in the experimental group. Sixty-three residents were lost to attrition (38%).

The experimental group exhibited less global deterioration throughout the study. Inappropriate behavior, cognition, and functional status remained relatively unchanged over time within and between the groups, Increased family involvement did slow global deterioration in individuals with ADRD. The findings of the study show that more factors need to be examined to discover those interventions that preserve functional and cognitive abilities.

Declining cognition and functional status is a problem among nursing home residents with Alzheimer's disease and related dementias (ADRD). Eighty percent of the 2 million adults currently residing in nursing homes have some degree of memory impairment, with half of the nursing home population bearing the diagnosis of dementia (Krauss & Altman, 1998). Residents with ADRD are more likely to require assistance with activities of daily living (ADLs), substantiated by the fact that 75% of all nursing home residents required assistance with three or more ADLs (Gabrel, 2000; Gabrel & Jones, 2000). As the population ages and more individuals with ADRD require nursing home care, these numbers will continue to increase. It is imperative to address the needs of current and future individu- als with ADRD by discovering interventions that ideally halt, or perhaps simply slow, the cognitive and functional losses in this population.

The purpose of the quasi-experimental study reported in this article was to examine the effects of a formalized family and staff partnership on the level of cognitive and functional abilities of institutionalized elderly individuals diagnosed with ADRD. The study reported in this article was part of a larger study conducted by Maas et al. (2001) at the University of Iowa. Investigators who participated in the larger study also examined the effects of the formalized family and staff partnership on informal caregivers of institutionalized elderly individuals with ADRD and on the nursing staff of special care units. The findings from these other components of the study are reported elsewhere (Kelley, Specht, & Maas, 2000; KeIley, Swanson, Maas, & Tripp-Reimer, 1999; Maas et al., 2001; Specht et al., 2000; Teri et al., 1999).

LITERATURE REVIEW

Researchers have examined the effect of caregiver-specific interventions on the cognitive and functional status of individuals with ADRD. Much of the research has occurred with caregiver and care receiver dyads who reside in the community. Caregiverspecific interventions have included psychoeducational family group programs (Gerdner, Buckwalter, & Reed, 2002; Ostwald, Hepburn, Caron, Burns, & Mantell, 1999), educational programs (Hepburn, Tornatore, Center, & Ostwald, 2001), direct support through home visits (Gitlin, Corcoran, Boyce, & Hauck, 2001), or a combination of all three (Burgener, Bakas, Murray, Dunahee, & Tossey, 1998; Chang, 1999). The findings of these studies were similar. Individuals with ADRD in the experimental groups often demonstrated one of two outcomes: either they improved their scores on cognitive tests, but the scores were not statistically better than their counterparts in the control groups (Ostwald et al., 1999), or their cognitive and functional states declined in a manner similar to those in the control groups (Burgener et al., 1998; Chang, 1999; Gerdner et al., 2002; Gitlin et al., 2001; Hepburn et al., 2001).

Family and resident dynamics are different in nursing homes. Family caregivers struggle with their change in roles after the individual with ADRD becomes a permanent nursing home resident, and disagreements with nursing home staff are not uncommon (Kelley et al., 1999; Ryan & Scullion, 2000; Specht et al., 2000). Several researchers have postulated that tension between nursing home staff and family members may be detrimental to the care of individuals with ADRD (Kelley et al., 2000; Maas, Buckwalter, & Kelley, 1991; Specht et al., 2000).

Nursing home staff members often believe family visits increase agitation in nursing home residents and may discourage such interactions. This belief is not unfounded. One study found that agitated behaviors exhibited by nursing home residents with ADRD dropped during the actual visit but immediately returned to baseline after the visit was finished, creating the appearance of escalated agitation (Martin-Cook, Hynan, Chafetz, & Weiner, 2001). Furthermore, family caregìvers may be unsure as to how to maintain their relationship with the institutionalized individual, and may inadvertently withdraw from the relationship, hastening the resident's functional and cognitive decline.

In one study, researchers developed a program in which they trained family members in effective verbal and non-verbal communication techniques specific to individuals with ADRD (McCaIlion, Toseland, & Freeman, 1999). Upon evaluation, the researchers discovered that the intervention reduced some disruptive behaviors and depression in nursing home residents with ADRD. In another study, family members were involved with the construction and use of activity items (e.g., tetherballs, activity aprons). As a result, family members increased their visits, but agitated behaviors only diminished in one of the two sites (Colling & Buettner, 2002). A third study sought family caregiver involvement in care plan meetings and discussions. The researchers concluded that family caregiver intervention resulted in more family interactions and the use of less as-needed medication (Anderson, Hobson, Steiner, & Rodel, 1992).

Table

TABLE 1DEMOGRAPHIC VARIABLES FOR EXPERIMENTAL AND CONTROL GROUPS

TABLE 1

DEMOGRAPHIC VARIABLES FOR EXPERIMENTAL AND CONTROL GROUPS

Many of the studies examining the effect of the caregiver-care-recipient dyad on functional and cognitive outcomes occurred in the community (Burgener et al., 1998; Chang, 1999; Gerdner et al., 2002; Gitlin et al., 2001; Hepburn et al., 2001; Ostwald et al., 1999). The studies conducted in nursing homes demonstrated some effects of family involvement on the residents* functional or cognitive outcomes, but the findings were contradictory and limited by small sample sizes (Anderson et al., 1992) or varied operationalizations of cognitive and functional indices, making comparisons and conclusions difficult (Colling & Buettner, 2002; McCallion et al., 1999). Furthermore, none of the studies examined the effect of their interventions beyond 6 months. To address these disparities in the literature, a randomized clinical study was needed to examine the effect of caregiver interventions on specific functional and cognitive outcomes of nursing home residents with ADRD over a significant time period. This study asks the question, "What is the effect of an intervention for caregivers of ADRD nursing home residents on their functional and cognitive status?"

Table

TABLE 2FUNCTIONAL STATUS OF RESIDENTS IN EXPERIMENTAL AND CONTROL GROUPS

TABLE 2

FUNCTIONAL STATUS OF RESIDENTS IN EXPERIMENTAL AND CONTROL GROUPS

DATA AND VARIABLES

Setting

Fourteen nursing homes in the Midwest were identified. All of these nursing homes had special care units (SCUs) for individuals with dementia. The SCUs ranged from 15 to 60 beds, and the nursing home sizes ranged from 350 to 600 beds. The facilities were paired according to the following characteristics, resulting in seven pairs: SCU size, legal status (nonprofit vs. profit), and staff turnover. The pairs were randomly assigned to the experimental or control group, and the residents' exposure to the intervention was determined by their residence in an experimental or control site.

Participants

One hundred sixty-four residents participated in the study, 71 in the control group and 93 in the experimental group. The ages ranged from 51 to 100, mean 81.8 years (SD = 8.27 years). Demographic information is shown in Table 1 and functional status information is shown in Table 2. Both groups were statistically similar, with one exception - members of the experimental group had better bowel control (Mann-Whitney U = 2699.50, p = .033).

Intervention

The Family Involvement in Care (FIC) intervention was a protocol designed to help family caregivers of nursing home residents with dementia negotiate and establish a partnership with the staff caregivers. The intervention was composed of four key elements:

* Orientation of a primary family caregiver to the facility, the SCU, and the proposed partnership role.

* Education of the primary family caregiver for involvement in resident care.

Table

TABLE 3COMPARISON OF BASELINE GLOBAL DETERIORATION SCALE SCORES AND FUNCTIONAL ASSESSMENT CHECKLIST (FAC) SUBSCALE SCORES

TABLE 3

COMPARISON OF BASELINE GLOBAL DETERIORATION SCALE SCORES AND FUNCTIONAL ASSESSMENT CHECKLIST (FAC) SUBSCALE SCORES

* Formation and negotiation of the partnership agreement (i.e., the family caregiver completes a contract and agrees to participate in X activities for X amount of time).

* Follow up with family member and evaluation of staff for the renegotiation of the partnership agreement.

The activities family members agreed to perform ranged from the simple provision of information about the resident to active participation in physical care and assistance with psychosocial modalities. To assist with the negotiation of activities, a manual was developed and provided to family members and the nursing home staff. The manual contained activities and interventions designed for individuals with ADRD. Selected categories of these activities and interventions were:

* Exercise.

* Art therapy.

* Personal care.

* Music therapy.

* Environmental fit.

* Eating and nutrition.

* Behavior management.

* Therapeutic recreation.

* Medication management.

The manual provided the rationale for each activity and intervention as well as guidelines. Thus, one family member may agree to participate in telephone care planning conferences for 10 minutes every month, another may agree to manicure her mother's nails while helping her to perform hand exercises every 2 weeks, and another may agree to eat dinner with his father every Wednesday and visit for an hour every Sunday.

The dosage of the FIC intervention was calculated by summing scores for the type of activity engaged in between family member and resident, the participation level, the duration of the activity, and the frequency of the activity. The values were obtained from the negotiation contracts, not from actual observations of the family members or nursing home residents.

Resident Outcomes

Several measurements were obtained to calculate the overall deterioration of residents with dementia and functional abilities. All measurements were obtained at baseline (when the resident was enrolled in the study), 2 months later prior to the intervention (Month 3), and then at Months 5, 7, and 9. Baseline mean measurements are reported in Table 3.

Global Deterioration Scale (GDS). This instrument provides a quantification of overall dementia by placing it in one of seven stages (Reisberg, Ferris, de Leon, & Crook, 1982):

* No cognitive decline: normal.

* Very mild cognitive decline: forgetfulness.

* Mild cognitive decline: early confusional.

* Moderate cognitive decline: late confusional.

* Moderately severe decline: early dementia.

* Severe cognitive decline: middle dementia.

* Very severe cognitive decline: late dementia.

The GDS was used in the study as an inclusion-exclusion criterion (only residents with a GDS score between 4 and 6 were included) and as a marker of dementia progression. The GDS exhibited moderate to significant correlations with 13 out of 19 items in the Inventory of Psychic and Somatic Complaints in the Elderly (Reisberg et al., 1982). The GDS has been used extensively in the geriatric literature (Choi et al., 2003; Farlow, Potkin, Koumaras, Veach, & Mirski, 2003; Ferman et al., 1999) and is considered an eminent measure of cognitive status in nursing homes (Cohen-Mansfield, Taylor, McConnell, & Horton, 1999). GDS scores were collected upon enrollment in the study (baseline) and 2 months later (Month 3). The intervention began immediately after the Month 3 scores were collected. As the intervention continued, GDS scores for Months 5, 7, 9 were collected.

Functional Abilities Checklist (FAC). The FAC was originally developed by two of the investigators of this study, Maas and Buckwalter. The FAC is a 28-item instrument used to measure four domains of functional abilities of individuals with ADRD:

Table

TABLE 4GLOBAL DETERIORATION SCALE (CDS) SCORES, REPEATED MEASURES ANOVA

TABLE 4

GLOBAL DETERIORATION SCALE (CDS) SCORES, REPEATED MEASURES ANOVA

* Self-care.

* Inappropriate behavior.

* Cognitive status.

* Agitation.

Hence, the four subscales can be analyzed separately. The FAC uses a 4-point scale (1 = never, 2 = seldom [less than 7 times per week], 3 = frequently [daily], 4 = all of the time [multiple times per day]) for each of the seven components of each subscale. The higher the score, the less functional the resident. Multi-collinearity was not found to be a problem. The Cronbach's alpha for the total scale in this study was .85. For the subscales, reliability was .85 (selfcare), .84 (inappropriate behavior), .74 (cognitive status), and .72 (agitation). The FAC scores were collected upon enrollment in the study (baseline) and 2 months later (Month 3). The intervention began immediately after the Month 3 scores were collected. As the intervention continued, FAC scores for Months 5, 7, 9 were collected.

Other variables. Variables related to ADLs (e.g., bowel and bladder continence) and demographic information were also collected.

Hypothesis

There will be differences in final GDS scores and FAC subscale scores between residents with ADRD in SCUs where the FIC was implemented and residents with ADRD on SCUs where the FIC was not implemented.

DATA ANALYSIS

Parametric inferential and noninferential statistics were employed to compare the attributes of the control and experimental groups. Independent samples i tests were used for variables with continuous data (e.g., age). Mann-Whitney U analyses were conducted for nominal and ordinal level data (e.g., level of urinary incontinence). The group of nursing home residents lost to attrition and the group completing the study were compared for similarity using both independent samples i tests and Mann-Whitney U tests. Chi-square tests were performed to ascertain the probability of one group being more susceptible to attrition than the other group.

GDS scores and FAC subscale scores were analyzed using repeated measures ANOVA. The Greenhouse-Geiser F-statistic was used to determine significance changes between scores over time (within groups) and between scores over time and by group (experimental vs. control). The Greenhouse-Geiser F-staristic was used because the assumption of sphericity was violated in all occasions (Munro, 2001).

The dosage of the FIC intervention was calculated by summing scores for the type of activity engaged in between family member and resident, the participation level, the duration of the activity, and the frequency of the activity. The data were examined to determine if any correlations existed between the dosage of the FIC intervention and the final GDS and FAC subscales.

Six nursing home residents received cholinesterase inhibitors (e.g., donepezil HCL [Aricept]) - four in the experimental group and two in the control group. Given the small number, no analyses were conducted to determine the effect of the cholinesterase inhibitors on the outcome of the study.

RESULTS

The control and experimental groups were extremely similar in spite of the fact that the residents themselves were not randomly assigned to the control or experimental group, but were assigned according to residence in a particular SCU. For continuous variables (e.g., days in facility at baseline, GDS, FAC scores), independent samples i tests indicated no difference between the control and experimental groups except for the baseline FAC inappropriate subscale score (p = .011, i = 2.57, df= 152). In that case, the comparison group scored higher (mean = 1.88) than the control group (mean = 1.65). Thus, the comparison group exhibited more inappropriate behaviors than the experimental group. Non-parametric tests (MannWhitney U) indicated no difference between groups related to gait, fall history, toileting supervision, and bladder continence. The experimental group, however, exhibited better bowel control (Mann-Whitney U = 2699.50, p = .033).

Table

TABLE 5FUNCTIONAL ASSESSMENT CHECKLIST (FAC) COGNITIVE STATUS SUBSCALE SCORES, REPEATED MEASURES ANOVA

TABLE 5

FUNCTIONAL ASSESSMENT CHECKLIST (FAC) COGNITIVE STATUS SUBSCALE SCORES, REPEATED MEASURES ANOVA

Attrition because of death and transfer from the SCUs was a factor in this study. Sixty-four residents (38%) did not complete the study (28 control, 36 experimental). The attrition did not affect the control group more than the experimental group (chi-square = .001,/; = .981). Residents were not always available during data collection times because of hospitalizations, physician appointments, and other absences from the unit. Missing data trimmed the experimental and control groups, resulting in a sample size of 85 residents for final data analyses (35 control, 50 experimental).

Independent samples i tests were performed to compare the baseline measurement scores of the two groups. There were no differences between the group lost to attrition or missing data and the group that remained in the study for the following variables: FAC inappropriate behavior subscale scores, FAC cognitive status subscale scores, and FAC agitation subscale scores. There were differences, however, between the two groups on the baseline GDS score and FAC self-care subscore. The group lost to attrition had higher GDS scores (mean = 6.11, = 2.197, ? = .029) and higher self-care subscale scores (mean = 3.03, = 2.835, ? = .005). In other words, the group lost to attrition was more cognitively impaired and less functional than the group that remained in the study. Given these results, a decision was made to analyze the data with the remaining cases instead of assigning scores (such as the mean) to missing data.

The dosage of the FIC intervention ranged from 8 to 85 (mean = 36.04, SD = 15.38). No correlations between dosage and final scores were noted. There were no changes in selfcare ability, inappropriate behavior, and agitation as measured by the FAC subscales between the experimental and control groups, with one exception. An independent samples i test, controlling for group membership, revealed that the control group initially exhibited more inappropriate behavior than the experimental group at baseline (i = 2.42, df = 159, ? = .017). As the study progressed, both groups became more homogenous with respect to inappropriate behavior. There were some changes in GDS scores and in the cognitive status subscale of the FAC within the experimental group.

The GDS scores are listed in Table 4. GDS scores differed over time, but not by group. That is, residents in the experimental group had statistically significant lower GDS scores by the end of the study compared to their baseline scores (GreenhouseGeiser F = 20.34, df= 3.59, /> < .001). The GDS scores in the experimental group dropped from 5.94 (severe cognitive decline) at baseline to 5.72 (moderately severe cognitive decline) at Month 5. The difference between the scores of the experimental and control groups at Month 5 was also statistically significant (i = 2.26, df = 124, p = .026). In other words, global deterioration as measured by the GDS was initially reversed in the experimental group, but continued to creep toward pre-intervention levels of deterioration throughout the duration of the study. Meanwhile, global deterioration among participants in the control group remained fairly stable. By Month 9, the GDS scores of the experimental group remained below that of the control group but the difference was not statistically significant (i = 1.5, p = .14).

The FAC cognitive status subscale differed over time within the experimental and control groups (Table 5). Although there were no statistically significant overall differences between the control and experimental groups at each measurement interval, there were differences in scores over time within the experimental group and within the control group. Cognition improved slightly by Month 5 in the experimental group, but the improvement was not statistically significant (t = 1.77, df =61, p = .082). Between Months 5 and 9, cognition deteriorated in the experimental group (f = -4.58, df= 5\,p < .001). A similar but more dramatic pattern was observed in the control group. Cognition improved for the experi- mental group members between baseline and Month 5 (f = 2.74, df = 59, ? = .008), but worsened between ? Months 5 and 9 (t = ' -4.29, df = 40, p < .001).

DISCUSSION

The hypothesis for this study was that there would be differences in final GDS scores and FAC subscale scores between residents with ADRD in SCUs where the FIC was implemented, and residents with ADRD on SCUs where the FIC was not implemented. The results of this study did not completely support the hypothesis. The intervention had no effect on self-care ability, inappropriate behavior, or agitation, echoing the findings of other researchers (Beck et al., 2002; Martin-Cook et al., 2001). One possible reason for the lack of effect on self-care ability was that many of the activities supported by the FIC intervention encouraged family members to perform ADLs for nursing home residents, as opposed to supervising and promoting independence. As for inappropriate behavior and agitation, family members of individuals who exhibited inappropriate behavior and agitation may have opted for brief FIC activities requiring low levels of participation.

In retrospect, it would have been useful to include a qualitative piece of data specific to family members of nursing home residents scoring high on the FAC subscales of inappropriate behavior and agitation. Family members could have been asked to describe how and why they chose specific FIC interventions in light of the nursing home residents' inappropriate behavior or agitation, and to describe any obstacles to engaging in FIC-related activities.

Global deterioration in the experimental group, as measured by the GDS, improved in the month immediately following the intervention (Month 5), but the improvement slowly eroded for the duration of the study. The FIC intervention seemed to have slowed, but not diminished, the overall decline in the experimental group. This finding is intriguing. Other researchers using a family visit intervention with nursing home residents noted a similar pattern - that their intervention prevented symptoms of depression and irritability from progressing, as opposed to reducing or eliminating these problems (McCallion et al., 1999). Given the finding from the present study and the findings stated in the literature, it is entirely possible that family involvement slows the overall progression of ADRD.

The results were likely affected by a culmination of factors. Family members initially approached the FIC intervention enthusiastically, but may not have been able to maintain their level of involvement during the following several months. As the study progressed, the research assistants noted that the nursing home staff in some of the facilities became less supportive of the study and less inclined to engage family members in continued FIC negotiations. Without continued nursing home staff support, family members may have become discouraged and may have inadvertently diminished the dosage of the FIC intervention.

A second factor involved the 9month duration of this study. With the exception of one study (Gerdner et al., 2002), most researchers conducted their studies within a 6-month time frame. If this study had followed the same pattern, the results may have appeared more impressive. Instead, the longer duration of this study provided opportunities for examining the interaction between the disease trajectory and the FIC intervention.

Lastly, the disease trajectory of ADRD is decidedly poor. This disease is associated with progressive and irreversible declines in cognitive and functional status (Antuono & Beyer, 1999). In fact, the graphed FAC cognitive status subscale scores for the control group in Figure 2 hint that a curvilinear or quadratic trajectory of behavior may exist in ADRD regardless of interventions. Perhaps it is time to re-evaluate the literature and examine interventions that were initially deemed unsuccessful because they failed to improve cognitive and functional outcomes in individuals with ADRD, to determine if the "failed" interventions slowed the progression of the troublesome behaviors associated with ADRD.

LIMITATIONS

There were limitations to this study. The dosage of the intervention was calculated from information on the contracts between family members and SCU nursing staff. Without clearer information related to the actual dosage of the intervention, it was difficult to determine the full efficacy of the intervention. Furthermore, no data were obtained regarding the quantity and quality of interactions between SCU residents and their families.

Only six residents used cholinesterase inhibitors during the course of the study (four in the experimental group, two in the control group). Cholinesterase inhibitors are helpful in reducing cognitive decline, especially when used early in ADRD (Antuono & Beyer, 1999; DaIy, 1999). There is evidence that stopping cholinesterase inhibitors, even in cases of moderate and severe dementia, may hasten cognitive and functional decline (Antuono & Beyer, 1999; DaIy, 1999). Because of the extremely small size of this subsample, no analyses were conducted to determine the effect, if any, of the cholinesterase inhibitors on the outcome of the study. Additional studies are needed to control for the use of cholinesterase inhibitors and to determine if a synergistic effect exists with the combined use of non-pharmacologic and pharmacologie interventions.

A final limitation to generalizability was the exclusive use of residents from SCUs. The literature is divided related to whether or not SCUs provide a therapeutic environment for individuals with ADRD (Broughton & McDonnell, 1996; Leon, Cheng, & Alvarez, 1997; Maas, Specht, Weiler, Buckwalter, & Turner, 1998; Phillips et al., 1997). There is no consensus as to what constitutes a SCU. Although the nursing homes were matched according to specific characteristics, the SCUs were not matched. It is possible that the milieu of some SCUs may be more beneficial than others to individuals with ADRD. However, the randomization should have controlled for this limitation. The use of a SCU sample limits generalizability to the nursing home population of ADRD elderly individuals, but the results should have strong external validity of results for SCUs in general.

IMPLICATIONS FOR NURSES

A challenge facing clinicians is the determination of whether statistically significant results equate to clinically significant outcomes. In the case of ADRD, the answer is yes. Any intervention that slows the overall decline seen in residents with ADRD may prolong the quality of life for such individuals and increase the amount of meaningful time for families to interact with their loved ones. Nurses can help to slow the decline of their residents with ADRD by actively engaging family members in physical, psychological, and social activities with nursing home residents.

First, family members must feel welcomed by the nursing home staff. Simple courtesies, such as conversing with a family member away from the busy nurses* station or returning telephone inquiries promptly help families to feel included and important. Second, nurses can assist family members by providing opportunities for familial involvement and education pertaining to helpful strategies for interacting with individuals with dementia. Finally, nurses are in a unique position to coordinate unit-based activities, in conjunction with occupational, physical, and recreational therapists, that provide family-resident dyads opportunities for meaningful and satisfactory interactions.

CONCLUSION

The intervention did not completely improve the trajectory of ADRD in the study sample, but it did slow overall deterioration. The results of this study should not be presented as proof that individuals with ADRD are oblivious to familial interactions and therefore no effort should be made to maintain relationships. Instead, the results of this study underscore that individuals with ADRD offer unique challenges to health care clinicians and researchers. For future studies, researchers may be well served to broaden the focus of their quests to examine interventions that slow or halt the progression of the troublesome symptoms associated with ADRD, in addition to searching for interventions that improve cognitive and functional abilities.

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TABLE 1

DEMOGRAPHIC VARIABLES FOR EXPERIMENTAL AND CONTROL GROUPS

TABLE 2

FUNCTIONAL STATUS OF RESIDENTS IN EXPERIMENTAL AND CONTROL GROUPS

TABLE 3

COMPARISON OF BASELINE GLOBAL DETERIORATION SCALE SCORES AND FUNCTIONAL ASSESSMENT CHECKLIST (FAC) SUBSCALE SCORES

TABLE 4

GLOBAL DETERIORATION SCALE (CDS) SCORES, REPEATED MEASURES ANOVA

TABLE 5

FUNCTIONAL ASSESSMENT CHECKLIST (FAC) COGNITIVE STATUS SUBSCALE SCORES, REPEATED MEASURES ANOVA

10.3928/0098-9134-20050601-10

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