Poster Presentations: P3 P561

Ontario, Canada; 6Young Carers Initiative, St. Catharine’s, Ontario,

Canada.

Background:Children living at home with an early-onset dementia par-

ent, especially if frontotemporal dementia, call for unique support, yet

no educational materials have existed. On Nov. 15, 2011, we launched

a website to address this need among adolescent caregivers. Methods:

A total of 14 participants ranging in age from 11-18 years and covering

an average of 3 years of hands-on caregiving connected to Skype for

a semi-structured interview administered to small groups. A thematic

analysis approach toward the transcripts identified themes through

a coding scheme. Consultants from the Young Carers Initiative and

McMaster University’s Montessori Learning program for the aging

then provided input re the emerging themes to shape web content. Fo-

cus group participants and other stakeholders then critiqued the beta

version of the website before its launch.

P3-289 A STUDY OFADOPTING PEAP ENVIRONMENTAL

MODIFICATION METHODOLOGY IN JAPAN:

ACASE OFA NURSING HOME FOR DEMENTIA IN

TAIWAN

Szu-Yu Tzeng, National Yunlin University of Science and Technology,

Yunlin, Taiwan.

Background: According the survey of Taiwan Aizheimer’s Disease Asso-

ciation in 2004, the percentage of residents with dementia was over

65.7% in nursing homes. Among Care Environmental Evaluation Scales,

the Professional Environmental Assessment Protocol developed by Weis-

man in 1996 is the most famous one.Methods: This research will combine

the theory and process of PEAP in Japan version, by case-study and carrying

out workshop in a nursing home for the elderly with dementia.There are

main purposes: (1) Utilizing the Professional Environmental Assessment

Protocol (PEAP) to integrate the theory of user-participation design, and

guide one nursing home to carry out workshop of care environmental im-

provement for the elderly and (2) to evaluate the effects after environmental

modification. Results: In order for staff to get some degree of expertise and

specialized training of using the PEAP, we carry out a workshop once

a month from 2009/11 until 2010/12. The ideas and plan of environmental

improvement were developed, discussed and rating by care staff. After

conducting the modification plan, and evaluated the effectiveness after

environmental improvement by questionnaire. The whole process is staff-

participant and pleasant. For the staff is main care power, and takes part

in the PEAP workshop, making decisions, sharing and discussing ideas,

and changed the environment by them. Most furniture is recycled from

staffs, residents’ family and volunteers. Effectiveness of Modification: Be-

fore modification, the atmosphere of nursing home is institutional with mo-

notonous setting. Aftermodification, to form a home-like environment and

residential setting, and helpstaff monitor residents easily. And, residents,

staff and family used the spaces more actively, and with high value of the

space. Conclusions: Through the workshop and study, we found for

the staffs is lacking spatial concept, in stage of development modified

plan, with the aids of 2D plan or 3D model will help them very

much. PEAP theory is not popular and familiar to care staff in Taiwan.

But after coming over the workshop, staffs became more actively to ob-

serve inconvenient of space usage, and adapted the space. We could

conclude that PEAP is a useful skill and method to help care facility

to execute environmental improvement.

P3-290 MEASURING TRANSITIONS INTO DEMENTIA

AND COGNITIVE IMPAIRMENT: EVALUATING

THE EFFICACY OF LONGITUDINAL SURVEY

DATA IN THE PUBLIC DOMAIN

James McNally, Martha Sayre, University of Michigan, Ann Arbor,

Michigan, United States.

Background: There is a long-standing interest in understanding indi-

vidual transitions from unimpaired health to cognitive impairment. It

has only been since the late 1980 that national longitudinal surveys

have evolved that allow us follow healthy elders into later life and

measure some of the risk patters associated with those who are af-

flicted with forms of dementia including Alzheimer’s. A numbers of

such studies now offer enough repeat measures that social and bio-

medical researchers can examine these populations and seek useful in-

dicators of health changes associated with cognitive impairments. We

have also seen an exciting increase in the limited number of studies

that once looked at childhood health, cognition and socioeconomic

status now extending their studies to follow their respondents into

later life outcomes. Methods: NACDA, the largest repository of sec-

ondary data on aging and health in the U.S., reviewed data collections

in the public domain that allow for the examination of transitions

among respondents across time from good health to various levels

of cognitive impairment including diagnoses of Alzheimer’s. We

ranked these studies by the level of detail they provided, the number

of repeat measures they provided and the ability to analyze long term

outcomes among the respondents. Results: NACDA identified several

very useful studies, including the Health and Retirement Survey

(HRS), the National Long Term Care Survey (NLTCS) as well as

new studies such as the National Social Life, Health, and Aging Project

(NSHAP) among others which offer opportunities for multidisciplinary

research. NACDA also identified several emerging studies that may

have a major impact on our understanding of early life impacts on later

life outcomes such as Alzheimer’s. NACDA will use these studies as

examples of what could be done to promote multidisciplinary research

in cognitive decline and the onset of Alzheimer’s in the U.S. popula-

tion. Conclusions: While not large in number, there are enough longi-

tudinal studies that follow respondents as they transition from good

health to cognitive impairment to allow researchers to work across so-

cial and biomedical disciplines in trying to understand social and envi-

ronmental impacts on the risks of cognitive decline as part of the aging

lifecourse.

P3-291 INCREASED SENSITIVITY TO PAIN IN PATIENTS

WITH ALZHEIMER’S DISEASE

Christina Jensen-Dahm1, Mads Werner2, Martin Ballegaard2,

Jørgen B. Dahl3, Troels Staehelin Jensen4, Gunhild Waldemar5,1Rigshospitalet, Copenhagen University Hospital, Copenhagen,

Denmark; 2Copenhagen University Hospital, Rigshospitalet,

Copenhagen, Denmark; 3Copenhagen University Hospital,

Rigshospitalet, Denmark; 4Aarhus University Hospital, Danish Pain

Research Center, Aarhus, Denmark; 5Copenhagen University Hospital,

Rigshospitalet, Copenhagen, Denmark.

Background: Previous studies have shown a reduced reporting of pain

and a lower use of analgesics in patients with Alzheimer’s disease (AD)

compared to healthy controls (HC). Previous experimental pain studies

have shown that AD patients have an increased tolerance to pain, which

may explain fewer complaints. We wished to investigate the perception

of pain using heat and pressure stimuli in a population of mild-moder-

ate AD. Methods: 28 patients with probable AD (MMSE 16-26) and 28

sex- and age -matched cognitively intact HC were examined using

quantitative sensory testing with determination of warmth detection

threshold (WDT), heat pain threshold (HPT) and suprathreshold stim-

uli. The participants were also tested using a pressure algometer with

determination of pain threshold and tolerance. Results: We found no

significant difference between groups for WDT (AD: 35.48 �C [33.88�C - 37.15 �C]; HC: 34.83 �C [34.12 �C - 35.56 �C], p ¼ 0.26) and

HPT (AD: 40.27 �C [37.07 �C - 43.65]; HC: 41.78 �C [40.46 �C -

43.15 �C], p ¼ 0.14). We found a similar threshold for pressure algo-

metry (AD: 112.59 kPa [87.8 kpa - 144.38 kPa]; HC: 135.21 kPa

[114.18 kPa - 159.92 kPa], p ¼ 0.15), but a significantly lower

Poster Presentations: P3P562

tolerance (AD: 214,73 [180.05 kPa - 254.08 kPa]; HD: 283.14 kPa

[251.19 kPa - 319.15 kPa] p¼ 0.0031). Conclusions: Contrary to previ-

ous results, which have shown an increased tolerance for pain, we found

that patients with AD have an increased sensitivity to pain. Our results

are in line with a recent fMRI study showing increased brain activity in re-

sponse to pain (1). Our results suggest that the reduced pain reporting in

AD, compared with HC, cannot be explained by impaired pain processing

resulting in increased tolerance. Alternative explanations may include im-

paired communication, memory problems or anosognosia associated with

AD. (1) Cole LJ, Farrell MJ, Duff EP, Barber JB, Egan GF, Gibson SJ. Pain

sensitivity and fMRI pain-related brain activity in Alzheimer’s disease.

Brain 2006 Nov;129:2957-2965.

P3-292 HEALTH CARE EXPERIENCES OF PERSONS

WITH DEMENTIA AND THEIR CAREGIVERS:

A META-ETHNOGRAPHY OF QUALITATIVE

STUDIES

Dallas Seitz1, Jeanette Prorok2, Salinda Horgan2, 1Queen’s University,

Kingston, Ontario, Canada; 2Providence Care Mental Health Services,

Kingston, Ontario, Canada.

Background:Understanding the health care experience (HE) of persons

with dementia (PWD) and their caregivers is important in order to op-

timize the care for this population and to improve upon current clinical

practice. Qualitative research is ideally suited to exploring the HE of

patients and caregivers. We completed a meta-ethnography of qualita-

tive studies exploring the HE of PWD and their caregivers and devel-

oped a conceptual framework for understanding their experience.

Methods: Searches of the electronic databases MEDLINE, Embase,

PsychINFO were undertaken using key words and medical subject

headings for dementia, healthcare experience, and qualitative research

methods. Studies involving PWD or their caregivers which described

their primary care HE using either individual interviews or focus

groups were included. Information on the study participants and study

designed were recorded. Two authors extracted direct quotations from

primary studies along with the interpretations of the primary study au-

thors. Data from individual studies were extracted until saturation was

reached. Meta-ethnography was utilized to synthesize the included

studies into an overall HE framework. The quality of studies was sum-

marized using the consolidated criteria for reporting qualitative

research (COREQ). Results: A total of 46 studies were identified that

met inclusion criteria. These studies included 7 studies of PWD, 25

studies of caregivers and 14 studies combining both caregivers and

PWD (total N ¼ 1866). These studies included 30 studies using inter-

views, 10 using focus groups and 6 studies combining both methods.

Several factors acted as barriers or facilitators to a positive HE includ-

ing: the diagnostic process; amount of information provided about de-

mentia; assistance with finding supports and services for dementia;

management of dementia symptoms; and, ethical issues. Healthcare

professional’s attitudes and communication also had an important im-

pact on the HE for this group. The methodological quality of studies

varied. Conclusions: The HE of PWD and their caregivers could be en-

hanced through addressing common areas of dissatisfaction and build-

ing upon positive interactions. Providers of services for PWD should

ensure that programs address the common areas of concerns for this

population. Future studies are required to understand interventions

that may improve the HE of PWD and their caregivers.

P3-293 IDENTIFICATION OF THE MAJOR

DIFFICULTIES OF CAREGIVERS/FAMILY

MEMBERS OF ELDERLY WITH DEMENTIA IN

THE DAILY LIVING SITUATION: PRELIMINARY

RESULTS

Juliana Antunes, Marcia Novelli, UNIFESP, Santos, Brazil.

Background:Cognitive impairment from dementia will affect a signif-

icant social and occupational performance of the elderly. The activity

of caring is often crossed by a number of difficulties such as a lack

of technical knowledge, having to manage their own emotions that

come from living with the elderly, increasing the functional loss

and the consequent increase of the amount and duration of tasks

and moreover, difficulties in relationships with family members.Ob-

jectives - The objective of these study was to identify the main dif-

ficulties of caregivers of demented elderly in daily management of

the elderly based in the client-centered occupational therapy in the

Service in Dementia Care, which as an extension project of the Fed-

eral University of Sao Paulo - Campus Santos and the Brazilian As-

sociation of Alzheimer’s - Santos Regional. Methods: Fifteen

caregivers of elderly with dementia answered three assessment tools:

a socio-demographic description of the caregiver and the elderly, a de-

scription of the relationship of care and finally a survey of difficulties

in daily care. Results: The main difficulties encountered and reported

by the caregivers were the proposition interesting and stimulating ac-

tivities, as reported by 64.28% of the caregivers, the difficulty in

dealing with aggression and mood of the elderly reported by 50%

of the caregivers, difficulty in communication mentioned by 42.85%

them and finally tie the score and, 35.71%, difficulty in getting out

and walking with the patient. Conclusions: The client-centered occu-

pational therapy can be a proposed lifting of the difficulties for the

caregivers in the daily living situation with the elderly and the knowl-

edge of these problems allows us to propose actions directed to map-

ped demand.

P3-294 A STUDY OF THE LIFE WORLD OF THE

SPOUSES OF PEOPLE WITH ALZHEIMER’S

DISEASE

Mette Bergman1, Marja Schuster2, Caroline Graff3,

Maria Eriksdotter Jonhagen4, 1KI-Alzheimer Disease Research Center,

Stockholm, Sweden; 2The Red Cross University College, Stockholm,

Sweden; 3KI-Alzheimer Disease Research Center, Huddinge, Sweden;4Division of Clinical Geriatrics, Stockholm, Sweden.

Background:Few studies focus on the life world of a spouse to a person

who is affected by early-onset Alzheimer’s disease (AD). There is no

evidence for how health care professionals can ease their situation.

The aim of the study was to explore the meaning of being a spouse

to a person with AD. The lived experiences of spouses were focused.

Methods: The study had an existential phenomenological hermeneutic

perspective. The theoretical underpinnings consist of life world experi-

ences explored by means of four life existentials: lived space, lived

body, lived time and lived relation. Ten narrative interviews were per-

formed with five women and five men at age between 40 and 64. The

interviews were recorded and transcribed and the analysis of the texts

evolved through phenomenological hermeneutical reflection, following

the four life existentials. Results: The results showed that the spouses’

being-in- the world changed with the diagnosis. The weakness of the

person affected by AD was compensated by the spouse and their life

became tightly interlaced. The spouses’ feeling of responsibility and

dependence, on one hand, and the longing for freedom and indepen-

dence on the other hand, was apparent in the texts. The future made

the spouses feel deprived of their dreams, their beloved, and all their

plans and they remained fixed in the moment to ease their existential

anxiety. The role of a secure home became central while it was per-

ceived as limiting at the same time. Conclusions: The results of the

study indicate an ambivalent and complex picture of the existential

conditions of the spouses. It therefore appears to be important for

healthcare professionals to get a deeper understanding of these condi-

tions in order to be able to support spouses in their struggle for new

meaning in their lives.