Annals of Long Term Care

Families’ Influence on End-of-Life Care
Family and friends are considered the predominant providers of long-term and end-of-life care, although nationally representative data are lacking. This study draws from the 1999 National Long-Term Care Survey and its Informal Caregivers Survey to characterize caregivers’ experiences in caring for community-dwelling, chronically disabled older adults. The authors studied 1149 primary informal caregivers, stratified by care recipients’ survival or death during the following 12 months. Results showed that an estimated 11.2% of the chronically disabled community-dwelling older adults died within 1 year of being interviewed. Among persons who died, 72.3% were receiving help from an informal caregiver at the time of the interview. End-of-life primary informal caregivers helped an average of 43 hours per week, 84.4% provide daily assistance, and caregiver support services were infrequently used. While end-of-life caregivers reported significant emotional, physical, and financial strains, more than two-thirds endorsed personal rewards related to their helping role. Compared with primary informal caregivers of persons who survived the following 12 months, end-of-life caregivers provided significantly higher levels of assistance and reported more challenges and strains, but they were no less likely to endorse rewards related to their helping role. The investigators concluded that end-of-life caregivers provide frequent and intense assistance with few supportive services. These data underscore the relevance of families to end-of-life care, and the potential benefit of better integrating families in patient care.

Wolff JL, Dy SM, Frick KD, Kasper JD. End-of-life care: Findings from a national survey of informal caregivers. Arch Intern Med 2007;167:40-46.

Long-Term Effects of Cognitive Training on Functional Outcomes
Cognitive training has been shown to improve cognitive abilities in older adults; however, the effects of the training on everyday function have not been demonstrated. Prior interventions with older adults have targeted those with cognitive deficicits or functional disabilities and have focused on remediation rather than prevention. Prior studies have shown that cognitive interventions can improve cognitive abilities in normal elderly persons but have not included functional outcome measures and have been limited by small, homogeneous samples and lack of randomization.

This study sought to determine the effects of cognitive training on daily function and durability of training on cognitive abilities. It was a five-year follow-up of a randomized controlled single-blind trial with four treatment groups. A volunteer sample of 2832 persons (mean age, 73.6 yr; 26% black), living independently in six U.S. cities, was recruited from senior housing, community centers, and hospitals and clinics. The study was conducted between April 1998 and December 2004. Five-year follow-up was completed in 67% of the sample. The interventions were a 10-session training for memory (verbal episodic memory), reasoning (inductive reasoning), or speed of processing (visual search and identification); 4-session booster training at 11 and 35 months after training in a random sample of those who completed training. Main outcome measures were self-reported and performance-based measures of daily function and cognitive abilities.

Results showed that the reasoning group reported significantly less difficulty in the instrumental activities of daily living (IADL) than the control group (effect size, 0.29; 99% confidence interval [CI], 0.03-0.55). Neither speed of processing training (effect size, 0.26; CI, -0.002 to 0.51) nor memory training (effect size, 0.20; 99% CI, -0.06 to 0.46) had a significant effect on IADL.