Poster Presentations: P2 P481

Documented responses are presented to demonstrate increased: 1) self-es-

teem, 2) abilities/capacities, 3) resolution of "disturbing behaviors", 4) qual-

ity of life domains.

P2-333 CAREGIVERS AND MEDICINES: THE UNTOLD

STORY IN DEMENTIA

Figure 1. Four Profiles of Diurnal Cortisol: Caregiver (CG) and Patient (PT)

Patterns

Ian Maidment1, Carolyn Chew-Graham2, Andrea Hilton3, Judy Scully1,

Chris Fox4, Shirley Nurock5, Barbara Woodward-Carlton5, Susan Heap5,

Fiona Poland6, 1Aston University, Birmingham, England, United Kingdom;2Keele University, Keele, England, United Kingdom; 3Hull University, Hull,

England, United Kingdom; 4University of East Anglia Medical School,

Norfolk, England, United Kingdom; 5Alzheimer’s Society, London,

England, United Kingdom; 6UEA, Norwich, England, United Kingdom.

Contact e-mail: i.maidment@aston.ac.uk

Background: Cognitive impairment is a core symptom of dementia and

may affect the sufferer’s capacity to manage their medication. Informal

(family) caregivers may need to support medication-taking, encourage ad-

herence, understand and manage side-effects and thus have a key role ensur-

ing safe and effective medication use. As cognitive impairment increases,

medication management becomes less the personal responsibility of the per-

son with dementia, and more an activity controlled by caregivers, who may

not feel equipped for such an expanded role. T he need for further research,

on the impact of the change in role responsibility, was identified by two for-

mer carers and a task force of approximately 100 carers from the Alzheim-

er’s Society Research Network Volunteers (AS RNV; http://www.

alzheimers.org.uk/site/scripts/download_info.php?downloadID¼988).

Methods: An exploratory qualitative approach to generate indicative data

on the role of informal carers in safe medication management and issues

this raised for them. Firstly, a focus group was conducted involving carers

with experience of caring for a family member with dementia. Secondly, be-

tweenMarch andMay 2012 a survey (n¼20) of AS RNVmembers was con-

ducted. Results: Carers frequently took responsibility for medication

management which required them to make complex judgements. Key issues

were managing side-effects and non-adherence, and assessing the continued

need for medication. Scenarios described included: administering a diuretic

when the person with dementia was de-hydrated and whether to administer

"when required medication." Carers did not feel equipped for this role,

which they experienced as challenging and burdensome, particularly if

the person with dementia was taking four or more medicines. This issue re-

mained largely hidden from care professionals. A high burden is associated

with a lower quality of life for the carer and breakdown in the domestic care

arrangements, with profound consequences for the carer, person with de-

mentia and healthcare systems. Conclusions: Informal carers viewed med-

ication management as a significant issue and were concerned about an

increased risk of medication-related adverse events reducing the well-being

and quality of life of the person with dementia. The burden associated with

medication management also reduced the carer’s quality of life and there-

fore could force them to consider alternative forms of care.

P2-334 IN SICKNESS AND IN HEALTH: COREGULATION

OF SPOUSAL CAREGIVERS’ AND DEMENTIA

PATIENTS’ CORTISOL LEVELS, RELATIONSHIP

QUALITYAND HEALTH OUTCOMES

Nancy Hodgson1, Gena Craemer2, 1Johns Hopkins University, Baltimore,

Maryland, United States; 2Johns Hopkins University, Baltimore, Maryland,

United States. Contact e-mail: nhodgso1@jhu.edu

Background: Spousal caregivers play a critical role in helping persons with

dementia (PWD) remain at home bymanaging day to day needs, but often at

tremendous physical, mental, emotional and financial cost. Evidence sug-

gests a reciprocal relationship between spousal caregivers (CGs) and indi-

viduals with dementia such that the wellbeing of one effects the wellbeing

of the other. Yet, the biosocial mechanisms underlying the reciprocal rela-

tionship involved in dementia caregiving remains poorly understood. This

study examined the extent to which neuroendocrine processes underlying

CG’s stress/burden have implications for the PWD by examining the phys-

iological symmetry of the stress response in PWD and their caregivers.

Methods: Saliva samples were obtained from spousal dyads four times

daily across 4 days. Baseline assessment included measures of: demograph-

ics, caregiver burden (Zarit), anxiety (Hamilton), empathic concern, emo-

tional contagion, symptom distress, neuropsychiatric behaviors (NPI),

function (ADLS), MMSE. Samples were assayed for salivary cortisol by en-

zyme immunoassay (Salimetrics, CISBR). Analysis tested the degree of

symmetry, of neuroendocrine activity in caregivers and PWD, and explore

the relationship between coregulation, and baseline measures Results:

Analysis of dyads diurnal patterns revealed 4 distinct profiles:1) AU-shaped

curve in the PWD and a flat monotonic curve in CG 2) AU-shaped curve in

the PWD and a pulsatile erratic curve in the CG 3) An erratic pattern in the

PWD and an erratic pattern in the CG 4) An erratic pattern in the PWD and

a flat monotonic curve in the CG Chi Square analysis revealed that patients

with U shaped curves had higher symptom distress scores that patients with

erratic patterns (x 2 ¼9.8; p¼.10); CG with flat curves had lower scores on

emotional contagion measures (x 2 ¼15.01; p¼.09); CG with erratic pat-

terns had higher scores of caregiver burden (x 2¼10.2, p¼.10) and empathic

concern (x 2¼9.6; p¼.10).Conclusions:Examination of the process of cor-

egulation revealed unique patterns in dyadic functioning and provides evi-

dence on the reciprocal interchange between PWD and CG. Implications

for future CG interventions are emphasized.

P2-335 ENHANCING SENIOR NURSING STUDENTS’

EDUCATION OFALZHEIMER’S DISEASE: A

PARTNERSHIP WITH THE ALZHEIMER’S

ASSOCIATION

Janet Moore1, Marcia McKenzie2, 1Elms College, Chicopee,

Massachusetts, United States; 2Alzheimer’s Association, Springfield,

Massachusetts, United States. Contact e-mail: moorejanet@elms.edu

Background: The 2012 Alzheimer’s Disease Facts and Figures states that

Alzheimer’s Disease (AD) affects 1 in 8 older Americans and yet fewer

than 1 percent of registered nurses specialize in the care of older adults.

Without adequate knowledge of AD, nurses are ill prepared to care for those

affected by the disease or to educate their caregivers. The purpose of this

project was to increase senior nursing students’ knowledge, skills, and atti-

tudes in caring for people with dementia and their unpaid caregivers.

Method: A partnership has been created that includes Elms College, the

Springfield office of the Alzheimer’s Association, and various healthcare

agencies in Western MA. Eight senior nursing students in a community

health course at Elms College are assigned to the Association. They begin

the semester at the Alzheimer’s Association, learning the needs of the com-

munity, and at the college with expanded education on dementia and com-

munication techniques. Two videos (Accepting the Challenge: Providing the

Best Care for People with Dementia and Complaints of a Dutiful Daughter)

are included as well as a Virtual Dementia Tour. Students select an area of