Helping those who cannot help themselves: Enhancing collaborations in dementia care through individualized assessment and training
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From the contextual perspective of dementia care, affective or behavioral changes associated with degenerative dementias can be prevented or reduced by a) orienting caregivers to the care recipients' performance deficits, b) training individually tailored strategies for effective communication, and c) promoting caregivers' understanding of the functions of the care recipients' behaviors. This study examined the contextual model. Phase 1 compared the performance predictions of 12 caregivers with actual care recipient performance and assistance provided by the caregiver. Phase 2 implemented a brief, three-session intervention on caregiver-reported behavioral problems within a multiple baseline design with three caregiver-care recipient dyads. In addition to the effects of the intervention on the target behaviors, potentially correlated changes in the quality of caregiver-care recipient interactions and in the degree of assistance provided were also monitored. The results of this study suggest that caregivers tend to overestimate the care recipients' performance and that, when caregivers contact the care recipients' deficits, caregivers provide more assistance than needed. The ratios of positive-to-negative dyadic interactions in the task demand situation were similar to those found with highly distressed couples in the couples therapy literature. In Phase 2, the contextual interventions implemented by the caregivers decreased the targeted behaviors (arguing, spending time unsupervised, and driving). Over the course of the study, caregivers adjusted their expectations of the care recipients' abilities to be more congruent with actual performance; however, more accurate expectations were not accompanied by more effective helping in a task demand situation. Although the ratio of positive-to-negative interactions increased for all participants, it remained low. Results are discussed in terms of the heterogeneity of this community-dwelling sample, attrition related to undetected medical illness, the benefits of individualized assessment and intervention, and domain-specificity of treatment effects. While targeted interventions on problematic behaviors are effective, the results point out a need for specialized caregiver training with guided practice in compensatory and relationship-maintaining strategies, to generally promote more positive interactions, decrease ongoing interpersonal strain, and address caregivers' idiosyncratic thoughts, emotions, and behaviors in response to the care recipients' progressive loss of repertoires as potential barriers to effective care.