PUBLICATIONS

Care for Alzheimer's Disease at Sites for Elders 

It is estimated that four million Americans age 65 and older currentlysuffer from a dementia (Evans, 1996). While the overall rate of dementia has been estimated to range between five and ten percent, prevalence rates in excess of 40% have been reported in those age 85 and older (Evans, et. al., 1989), suggesting that the incidence of dementia is not uniformly distributed. Indeed several risk factors associated with dementia are more concentrated in rural communities. For example, previous studies have identified higher incidence of dementia in the "old-old" (Anthony & Aboraya, 1992) and among those with lower levels of formal education (Friedland, 1993), both characteristics which are over-represented in rural populations (Clifford & Lilley, 1993). In addition, the single most important risk factor for vascular dementia is hypertension, a condition that is also more common in rural communities (Forette & Boller, 1991). Therefore, while the overall prevalence of dementia is predicted to increase over the next several decades, the rate of increase may be disproportionately higher in rural communities. 

Various service delivery models have been proposed to enhance the availability and utilization of dementia-related services in rural communities. Most models encourage collaborative efforts between providers already involved with, and accepted by, rural residents and University-based tertiary care facilities offering specialized diagnostic and treatment services. These programs emphasize the need to train community-based personnel in methods that will enhance their abilities to evaluate, monitor and, when appropriate, refer rural elders with cognitive problems for more specialized services (Connell, Kole, Benedict, Nolmes, Gilman & Beane, 1994). To this end, a formal program was developed to train community based staff in detecting cognitive impairment in community-dwelling seniors and, when appropriate, make care arrangements.

The CASE (Care for Alzheimer's Disease at Sites for Elders) Project was developed to help senior center staff members who work with the elderly detect cognitive impairment in their clients and when appropriate, facilitate referrals for further evaluation. From previous experience (Rankin, Keefover & Nichols, 1996), we have learned that one of the greatest obstacles interfering with senior center staff performing cognitive assessments has been their sense of personal discomfort. It was their self-report of awkwardness at having to administer the cognitive screen to a client that prevented these individuals from assessing their clients for cognitive impairment even though they were able to demonstrate adequate skill to perform the assessment protocol in an analogue setting. In order to address these feelings a formal mentoring program was proposed. It was hypothesized that the incorporation of a mentor to a supplement the training program would improve staff participation in two ways. First, it was anticipated that the on-site presence of a mentor would increase opportunities/expectations among staff to practice administering the protocol until it was more likely to become "second nature". And second, through individual one-to-one contact with the mentor, staff could address areas of personal concern and ambivalence regarding the administration of the screening protocol.

Table of Contents

Overview of CASE	2
Project Goals	3
Project Activities	4
Project Results	5
Findings and Conclusions	6
Dissemination of Project Results	7
References Appendices A. Appendix A (Examples of Single Subject Data)	8
B. Appendix B (Harrison County Aggregate Data)	9
C. Appendix C (Client Summary Sheet and case examples).	12
D. Appendix D (Chart Review (audit) Form)	16
E. Appendix E (Chart audit results)	17