Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-23T23:30:03.700Z Has data issue: false hasContentIssue false
  • English
  • Français

The Functional Transitions Model: Maximizing Ability in the Context of Progressive Disability Associated with Alzheimer's Disease*

Published online by Cambridge University Press:  31 March 2010

Susan Slaughter  and
Jane Bankes
Get access Rights & Permissions [Opens in a new window]

Abstract

The Functional Transitions Model (FTM) integrates the theoretical notions of progressive functional decline associated with Alzheimer's disease (AD), excess disability, and transitions occurring intermittently along the trajectory of functional decline. Application of the Functional Transitions Model to clinical practice encompasses the paradox of attempting to minimize excess disability while anticipating the progressive functional decline associated with AD. It is suggested that times of functional transition are times of decision making and opportunities for interdisciplinary collaboration to identify and minimize excess disability, for revision of goals and expectations, and for provision of support to patients and caregivers. The model also is applicable as a conceptual framework for education and research.

Résumé

Le modèle de transition fonctionnelle est conçu selon les principes théoriques du déclin fonctionnel progressif survenant dans la maladie d'Alzheimer (MA), de l'incapacité découlant de la maladie et des phases de transition intermittentes tout au long du déclin fonctionnel. L'application du modèle dans la pratique clinique s'inscrit dans la volonté double de réduire au minimum l'incapacité tout en prévoyant le déclin fonctionnel progressif dans la MA. L'hypothèse étudiée ici veut que les périodes de transition fonctionnelle soient des moments opportuns de prise de décision et de collaboration multidisciplinaire en vue de cerner et de limiter l'incapacité, de revoir les objectifs et les attentes thérapeutiques et d'offrir du soutien aux malades, aux dispensateurs de soins et aux aidants naturels. Le modèle peut également être utile en éducation et en recherche en tant que cadre conceptuel.

Keywords

agingAlzheimer diseasefunctiontransitionexcess disabilitydementiaconceptual frameworkvieillissementmaladie d'Alzheimerétat fonctionneltransitionincapacitédémencecadre conceptuel
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 26 , Issue 1 , Spring/Printemps 2007 , pp. 39 - 47
Copyright
Copyright © Canadian Association on Gerontology 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

This work is funded in part by a Ph.D. studentship held by the first author from the Alberta Heritage Foundation for Medical Research. We acknowledge and appreciate the review and comments made on earlier drafts of the paper by Marlene Reimer, R.N., Ph.D., Neil Drummond, Ph.D., and the anonymous reviewers; however, the views expressed in this paper are those of the authors and not necessarily those of our reviewers.

References

Aguero-Torres, H., Qui, C., Winblad, B., & Fratiglioni, L. (2002). Dementing disorders in the elderly: Evolution of disease severity over 7 years. Alzheimer Disease and Associated Disorders, 16(4), 221–227.CrossRefGoogle ScholarPubMed
Albert, M., & Cohen, C. (1992). The test for severe impairment: an instrument for the assessment of patients with severe cognitive dysfunction. Journal of the American Geriatrics Society, 40, 449–453.CrossRefGoogle ScholarPubMed
Albert, S.M., Jacobs, D.M., Sano, M., Marder, K., Bell, K., Devanand, D., et al. (2000). Longitudinal study of quality of life in people with advanced Alzheimer's Disease. American Journal of Geriatric Psychiatry, 9(2), 160–168.CrossRefGoogle Scholar
Allen, N.H., Burns, A., Newton, V., Hickson, F., Ramsden, R., Rogers, J., et al. (2003). The effects of improving hearing in dementia. Age and Ageing, 32, 189–193.CrossRefGoogle ScholarPubMed
Ashford, J.W., & Schmitt, F.A. (2001). Modeling the time-course of Alzheimer dementia. Current Psychiatry Reports, 3, 20–28.CrossRefGoogle ScholarPubMed
Baltes, M.M. (1996). The many faces of dependency in old age. Cambridge, UK: Cambridge University Press.Google Scholar
Baltes, M.M., Burgess, R.L., & Stewart, R.B. (1980). Independence and dependence in self-care behaviours in nursing home residents: An operant-observational study. International Journal of Behavioral Development, 3, 489–500.CrossRefGoogle Scholar
Barberger-Gateau, P., Alioum, A., Peres, K., Regnault, A., Fabrigoule, C., Nikulin, M., et al. (2004). The contribution of dementia to the disablement process and modifying factors. Dementia and Geriatric Cognitive Disorders, 18, 330–337.CrossRefGoogle Scholar
Barton, E.M., Baltes, M.M., & Orzech, M.J. (1980). Etiology of dependence in older nursing home residents during morning care: The role of staff behaviour. Journal of Personality and Social Psychology, 38(3), 423–431.CrossRefGoogle Scholar
Berg, L. (1988). Clinical dementia rating (CDR). Psychopharmacology Bulletin, 24, 637–639.Google ScholarPubMed
Bourgeois, M.S., Dijkstra, K., Burgio, L.D., & Allen, R.S. (2004). Communication skills training for nursing aides of residents with dementia: The impact of measuring performance. Clinical Gerontologist, 27(1/2), 119–138.CrossRefGoogle Scholar
Bridges, W. (1980). Transitions: Making sense of life's changes. Boston, MA: Addison-Wesley.Google Scholar
Brodaty, H., & Gresham, M. (1989). Effect of a training programme to reduce stress in carers of patients with dementia. British Medical Journal, 299, 1375–1379.CrossRefGoogle ScholarPubMed
Brody, E.M., Kleban, M.H., Lawton, M.P., & Silverman, H.A. (1971). Excess disabilities of the mentally impaired aged: Impact of individualized treatment. Gerontologist, 11, 124–133.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J., Werner, P., Culpepper, W.J., & Barkley, D. (1997). Evaluation of an inservice training program on dementia and wandering. Journal of Gerontological Nursing, 23(10), 40–47.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J., Werner, P., & Reisberg, B. (1995). Temporal order of cognitive and functional loss in a nursing home population. Journal of the American Geriatrics Society, 43, 974–978.CrossRefGoogle Scholar
Connell, B.R., & McConnell, E.S. (2000). Treating excess disability among cognitively impaired nursing home residents. Journal of the American Geriatrics Society, 48(4), 454–455.CrossRefGoogle ScholarPubMed
Dawson, P., Kline, K., Crinklaw-Wiancko, D., & Wells, D. (1986). Preventing excess disability in patients with Alzheimer's disease. Geriatric Nursing, 7, 289–301.Google ScholarPubMed
Dawson, P., Wells, D.L., & Kline, K. (1993). Enhancing the abilities of persons with Alzheimer's and related dementias: A nursing perspective. New York: Springer.Google Scholar
Eisdorfer, C., Cohen, D., Paveza, G.J., Ashford, J.W., Luchins, D.J., Gorelick, P.B., et al. (1992). An empirical evaluation of the Global Deterioration Scale for staging dementia. American Journal of Psychiatry, 149(2), 190–194.Google Scholar
Espiritu, D.A.V., Rashid, H., Mast, B.T., Fitzgerald, J., Steinberg, J., & Lichtenberg, P.A. (2001). Depression, cognitive impairment and function in Alzheimer's disease. International Journal of Geriatric Psychiatry, 16, 1098–1103.CrossRefGoogle ScholarPubMed
Feldman, H., Sauter, A., Donald, A., Gelinas, I., Gauthier, S., Torfs, K., et al. (2001). The disability assessment for dementia scale: A 12-month study of functional ability in mild to moderate severity Alzheimer disease. Alzheimer Disease and Associated Disorders, 15(2), 89–95.CrossRefGoogle Scholar
Fick, D.M., Agostini, J.V., & Inouye, S.K. (2002). Delirium superimposed on dementia: A systematic review. Journal of the American Geriatrics Society, 50, 1723–1732.CrossRefGoogle ScholarPubMed
Fougeyrollas, P., Noreau, L., Bergeron, H., Cloutier, R., Dion, S.A., & St-Michel, G. (1998). Social consequences of long-term impairments and disabilities: Conceptual approach and assessment of handicap. International Journal of Rehabilitation Research, 21, 127–141.CrossRefGoogle ScholarPubMed
Glass, T.A. (1998). Conjugating the “tenses” of function: Discordance among hypothetical, experimental, and enacted function in older adults. Gerontologist, 38(1), 101–112.CrossRefGoogle ScholarPubMed
Green, C.R., Mohs, R.C., Schmeidler, J., Aryan, M., & Davis, K.L. (1993). Functional decline in Alzheimer's disease: A longitudinal study. Journal of the American Geriatrics Society, 41, 654–661.CrossRefGoogle ScholarPubMed
Haupt, A., Karger, A., & Janner, M. (2000). Improvement of agitation and anxiety in demented patients after psychoeducative group intervention with their caregivers. International Journal of Geriatric Psychiatry, 15, 1125–1129.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
Hébert, R., Lévesque, L., Vézina, J., Lavoie, J.P., Ducharme, F., Gendron, C., et al. (2003). Efficacy of a psychoeducative group program for caregivers of demented persons living at home: A randomized controlled trial. Journal of Gerontology: Social Sciences, 58B(1), S58–S67.CrossRefGoogle Scholar
Hogan, D.B. (1994). Progression and outcome of patients in a Canadian dementia clinic. Canadian Journal of Neurological Sciences, 21, 331–338.CrossRefGoogle Scholar
Holtzer, R., Scarmeas, N., Wegesin, D.J., Albert, M., Brandt, J., Bubois, B., et al. (2005). Depressive symptoms in Alzheimer's disease: Natural course and temporal relation to function and cognitive status. Journal of the American Geriatrics Society, 53(12), 2083–2089.CrossRefGoogle ScholarPubMed
Hughes, C.P., Berg, L., Danziger, W.L., Coben, L.A., & Martin, R.L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566–572.CrossRefGoogle ScholarPubMed
Katz, S. (1983). Assessing self-maintenance: Activities of daily living, mobility, and instrumental activities of daily living. Journal of the American Geriatrics Society, 31, 721–727.CrossRefGoogle ScholarPubMed
Katz, S., Ford, A.B., Moskowitz, R.W., Jackson, B.A., & Jaffe, M.W. (1963). Studies of illness in the aged: The index of ADL—A standardized measure of biological and psychological function. Journal of the American Medical Association, 185, 914–919.CrossRefGoogle Scholar
Larson, E.B. (1997). Minimizing excess disability: A common strategy for chronic disease management. Journal of Geriatric Psychiatry and Neurology, 10, 49–50.CrossRefGoogle ScholarPubMed
Lawton, M.P., & Brody, E.M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179–186.CrossRefGoogle ScholarPubMed
Liken, M.A. (2001). Managing transitions and placement of caring for a relative with Alzheimer's Disease. Home Health Care Management and Practice, 14(1), 31–39.CrossRefGoogle Scholar
Malloy, D.C., & Hadjistavropoulos, T. (2004). The problem of pain management among persons with dementia, personhood, and the ontology of relationships. Nursing Philosophy, 5, 147–159.CrossRefGoogle ScholarPubMed
McKeith, I.G., Galasko, D., Kosaka, K., Perry, E.K., Dickson, D.W., Hansen, L.A., et al. (1996). Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy Bodies (DLB): Report of the consortium on DLB international workshop. American Academy of Neurology, 47, 1113–1124.CrossRefGoogle Scholar
Neary, D., Snowden, J.S., Gustafson, L., Passant, U., Stuss, D., Black, S., et al. (1998). Frontotemporal lobar degeneration: A consensus on clinical diagnostic criteria. American Academy of Neurology, 51, 1546–1554.CrossRefGoogle ScholarPubMed
Neumann, P.J., Araki, S.S., Arcelus, A., Longo, A., Papadopoulos, G., Kosik, K.S., et al. (2001). Measuring Alzheimer's disease progression with transition probabilities. Neurology, 57, 957–964.CrossRefGoogle ScholarPubMed
Njegovan, V., Man-Son-Hing, M., Mitchell, S.L., & Molnar, F.J. (2001). The hierarchy of functional loss associated with cognitive decline in older persons. Journal of Gerontology: Medical Sciences, 56A(10), M638–M643.Google Scholar
Nygard, L. (2004). Responses of persons with dementia to challenges in daily activities: A synthesis of findings from empirical studies. American Journal of Occupational Therapy, 58(4), 435–445.CrossRefGoogle ScholarPubMed
Ostwald, S.K., Hepburn, K.W., & Burns, T. (2003). Training family caregivers of patients with dementia. Journal of Gerontological Nursing, 29(1), 37–44.CrossRefGoogle ScholarPubMed
Phinney, A. (2002). Fluctuating awareness and the breakdown of the illness narrative in dementia. Dementia, 1(3), 329–344.CrossRefGoogle Scholar
Proctor, R., Burns, A., Powell, H.S., Tarrier, N., Faragher, B., Richardson, G., et al. (1999). Behavioural management in nursing and residential homes: A randomized controlled trial. Lancet, 354, 26–29.CrossRefGoogle Scholar
Reifler, B.V., Larson, E.B., & Teri, L. (1987). An outpatient geriatric psychiatry assessment and treatment service. Clinics in Geriatric Medicine, 3(1), 203–209.CrossRefGoogle ScholarPubMed
Reimer, M.A., Slaughter, S., Donaldson, C., Currie, G., & Eliasziw, M. (2004). Special care facility compared with traditional environments for dementia care: A longitudinal study on quality of life. Journal of the American Geriatrics Society, 52, 1085–1092.CrossRefGoogle Scholar
Reisberg, B. (1986). Dementia: A systematic approach to identifying reversible causes. Geriatrics, 41(4), 30–46.Google ScholarPubMed
Reisberg, B. (1988). Functional assessment staging (FAST). Psychopharmacology Bulletin, 24(4), 653–659.Google ScholarPubMed
Reisberg, B., & Ferris, S.H. (1988). Brief cognitive rating scale (BCRS). Psychopharmacology Bulletin, 24(4), 629–636.Google ScholarPubMed
Reisberg, B., Ferris, S.H., De Leon, M.J., & Crook, T. (1982). The global deterioration scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139(9), 1136–1139.Google ScholarPubMed
Rogers, J.C., Holm, M.B., Burgio, L.D., Hsu, C., Hardin, J.M., & McDowell, B.J. (2000). Excess disability during morning care in nursing home residents with dementia. International Psychogeriatrics, 12(2), 267–282.CrossRefGoogle ScholarPubMed
Román, G.C., Tatemichi, T.K., Erkinjuntti, T., Cummings, J.L., Masdeu, J.C., Garcia, J.H., et al. (1993). Vascular dementia: Diagnostic criteria for research studies. Neurology, 43, 250–260.CrossRefGoogle ScholarPubMed
Ryden, M.B. (1998). A theory of caring and dementia. American Journal of Alzheimer's Disease, 13(4), 203–207.CrossRefGoogle Scholar
Schumacher, K.L., Jones, P.S., Meleis, A.I. (1999). Helping elderly persons in transition: A framework for research and practice. In Swanson, E.A., & Tripp-Reimer, T. (Eds.), Life transitions in the older adult: Issues for nurses and other health professionals (pp. 1–26). New York: Springer.Google Scholar
Silva-Smith, A.L., & Kovach, C.R. (2006). Positive gain: Rethinking the outcomes of dependency. Journal of Gerontological Nursing, 32(5), 36–41.Google ScholarPubMed
Slaughter, S. (2000). Dementia education: Staff, families and volunteers report the benefits. Health and Healing (Autumn), 11.Google Scholar
Smith, M., Gerdner, L.A., Hall, G.R., & Buckwalter, K.C. (2004). History, development, and future of the progressively lowered stress threshold: A conceptual model for dementia care. Journal of the American Geriatrics Society, 52, 1755–1760.CrossRefGoogle ScholarPubMed
Tanguay, A. (2003). The progressive course of Alzheimer disease: A training tool for caregivers. Geriatrics and Aging, 6(5), 56–58.Google Scholar
Volicer, L., Hurley, A.C., Lathi, D.C., & Kowall, N.W. (1994). Measurement of severity in advanced Alzheimer's disease. Journal of Gerontology: Medical Sciences, 49(5), M223–M226.CrossRefGoogle ScholarPubMed
Wald, C., Fahy, M., Walker, Z., & Livingston, G. (2003). What to tell dementia caregivers: The rule of threes. International Journal of Geriatric Psychiatry, 18, 313–317.CrossRefGoogle ScholarPubMed
Walstra, G.J., Teunisse, S., van Gool, W.A., & van Crevel, H. (1997). Symptomatic treatment of elderly patients with early Alzheimer's disease at a memory clinic. Journal of Geriatric Psychiatry and Neurology, 10(1), 33–38.CrossRefGoogle ScholarPubMed
Webster's New Collegiate Dictionary. 1973 Toronto: Thomas Allen.Google Scholar
Wells, D.L., Dawson, P., Sidani, S., Craig, D., & Pringle, D. (2000). Effects of an abilities-focused program of morning care on residents who have dementia and on caregivers. Journal of the American Geriatrics Society, 48(4), 442–449.Google ScholarPubMed
World Health Organization (2001). International Classification of Functioning, Disability and Health. Retrieved 19 July 2006 from http://www3.who.int/icf/icftemplate.cfm.Google Scholar