Class 9 - Assessment & Management in Typical Aging

Direct interventions:

• Patients themselves participate in–

  • strategy instruction

  • compensatory programs

What are indirect interventions?

• Clinicians provide training to professional & personal caregivers, modifying the physical or social environment to ease demands on cognitive function, & developing stimulating, engaging, & meaningful therapeutic activities in collaboration w/ others

What is spaced retrieval training (SRT)?

• Spaced retrieval training or SRT is a shaping paradigm for facillitating recall of information or procedures

• Rationale for using SRT

  • Significant published evidence

  • Robust outcomes for dementia patients

  • Strong data from other clinical populations w/ language/memory impairments (e.g., TBI, aphasia)

What are the steps in SRT?

• Incorporate a shaping paradigm that gradually builds on successful recall

• Allow frequent rehearsal

• Build-in errorless learning

• Embed learning within a structured, consistent procedure for attempting recall

What can SRT be used to train?

• Compensatory strategies

• Meaningful info

Compensatory strategies:

• Using a calendar or schedule

• Learning a safety strategy (e.g., small bites → chin tuck → swallow, using visual tool is one intervention, learning how to use it in daily life is a different intervention)

Meaningful information:

• Room #

• Address

• Face-name associations

Vanishing Cues:

• cues or prompts are gradually faded in relation to the learning progress

• Errorless learning is a principle of learning that is achieved via vanishing cues (VC) & some forms of SRT

Verbal Instruction Strategy:

• Provision of verbal prompts to complete an ADL

• Prompts delivered by electronic memory aids

• Prompts provide specific steps to complete ADL-task

• Reported improvements in performance within task

What is metamemory?

• a multidimensional construct that includes what people believe about their own memory & how they control & monitor their memory processes

What is the Multifactorial Memory Questionnaire (MMQ)?

• consists of 3 scales measuring separate aspects of metamemory.

• Items are rated on a 5-point Likert scale based on the test taker’s experiences over the previous 2 weeks

MMQ Satisfaction:

• measures satisfaction, concern, & overall appraisal of one’s own memory

MMQ Ability:

• measures self-perception of everyday memory ability

MMQ Strategy:

• measures the use of practical memory strategies & aids in day-to-day life

AAC as Direct Compensatory &/or Indirect Treatment:

• AAC interventions have shown promise

• Low or high-tech options available

• Important to begin training before significant cognitive deficits emerge

• AAC options & goals might change w/ time & deterioration of skills

Memory & Communication Books & Wallets:

• Personalized visual memory & communication aids, such as book, wallets, & signs, can help w/ memory loss recall info that is important to them

• Books & wallets may contain:

  • Photos from LTM to help w/ reminiscence

  • Important info to help w/ orientation & daily schedule

  • Answers to repetitive questions

  • Key words, names, & photos to help word recall

  • Scripts for daily conversations

Memory Books/Wallets:

• One of the best validated strategies for maximizing verbal communication & retention of personal biographical info

• Positive treatment outcomes when used by clinicians as well as personal & professional caregivers

• Allow control of the type & amount of info

• Make use of the memory aid as a ‘routine procedure’ during everyday tasks

What can Memory Books/Wallets be used to train?

• Improved recall of personal biographical info & independent initiation of conversation

• Improved recall of compensatory techniques

• Reduction in the frequency of undesirable behaviors

• Improved communication between personal caregivers & persons w/ dementia

What are Montessori-Based Interventions (MI)?

• Montessori activities involve everyday practical tasks

• Engage the learning-by-doing system

• Relies on implicit memory (usually spared) rather than explicit or declarative memory

Reading Roundtable:

• Montessori-based group activity, aimed at increasing positive engagement & verbal discussion

• Capitalizes on relatively spared oral reading skills in many PWD

• Specifically developed stories, designed & adapted w/ ease of communicative access:

  • Stories have a supportive sensory format (e.g., large font, high-contrast printing),

  • Accompanying questions to spark discussion

• Positively engaged residents & fosters reminiscence

• Participate in conversation (e.g., turn taking, listening, making on-topic statements)