Alzheimer Study, Research Paper Example

Introduction

Alzheimer’s is a disease in which individuals suffer from cognitive decline, dementia, and depression.  The number of individuals diagnosed with Alzheimer’s disease has been observed to increase with the age of the patient.  However, although there is a known correlation with age, Alzheimer also affects people in their 40s or 50s, which is referred to as early onset (Alzheimer’s Association, 2015)  There is no known cure for the disease as of yet; however, there are studies being conducted in order to improve the quality of life in Alzheimer’s patients.  According to findings from cross-sectional and retrospective studies, there is indication that rich social networks and participation of leisurely activities that involve some sort of cognitive stimulation may forestall the onset of dementia.  There have been studies comparing the pharmacological interventions and non-pharmacological methods, as well as evidence of behavior management therapies, education of the caregiver and the nursing staff, and physical activities that favor non-pharmacological methods. However, there is not much research available on the psychoeducation or the need for the role of Psychologist in nursing homes dealing with Alzheimer’s disease and patients. Previous research has found that relationships of the direct-care professionals and staff within an Alzheimer facility have had positive effects on the quality of care.  (McClean, 2006)  The purpose of this study, therefore, is to examine some of the possibilities that can alleviate elderly patient’s symptoms by employing psychologists in nursing homes that deal with Alzheimer’s or dementia patients. The current paper evaluates three different research designs, such as a quantitative approach, qualitative approach, and a mixed-design approach.  In addition, the paper compares these designs and evaluates the strengths and weaknesses of each of the designs.

Quantitative Study Design

The quantitative objective is to statistically prove or reject the directional Hypotheses: Psychologists guided intervention provides better results, such as a decrease in the symptoms or signs of dementia associated with Alzheimer’s disease in Alzheimer diagnosed patients in nursing homes that care for patients dealing with this disease.  The study conducted will utilize a “between subjects framework” in a randomly assigned nursing institution. A between subjects framework allows for the avoidance of carryover effects of within subjects framework designs.  In addition, the subjects chosen in the study can be either part of the control or treatment group.  Furthermore, this type of study is easy to carry out and requires no pre-testing of the subjects.  (Explorable, 2015)  In order to be more accurate and decrease the probability of differences occurring in the subjects chosen for the study, a randomized nursing home and 30 randomized subjects within the nursing home were randomly selected.  A sample size of thirty was chosen as this is a quantitative research study and the goal is to determine the relationship between an independent variable and a dependent variable in a specific population of dementia patients.  Independent variables in the study include treatment in the study in which the patients receive from the psychologist.  The dependent variable is the outcome of the treatment.  Thirty random patients of the same diagnosis would provide an unbiased outcome for the purpose of the study.  Each subject must have an official diagnosis of Alzheimer’s disease.  The level of Alzheimer’s disease must be at the moderate stage (middle-stage) or Alzheimer’s.  There are three stages of Alzheimer’s disease:  mild (early-stage), moderate (middle-stage), and sever (late-stage).  Most individuals in the mild (early-stage) are still independent and do not reside in nursing homes; therefore, the moderate stage was chosen for two reasons: 1) Individuals in this stage need care and are most likely in a nursing home and 2) The purpose of the study is to determine the effect of a Psychologist on the signs and symptoms of an Alzheimer patient.

Patients will be recruited based on the status of moderate stage Alzheimer’s and permission from the patient’s power of attorney.  The first group will be assigned “A” and will have a psychologist assisted program design, the control Group “B” will adhere to the normal activities the nursing home.  Data collection procedures will employ a score provided by the psychologist before and after the evaluation of each patient.  The psychologist will meet with the patient in both Group A and Group B prior to the first day of the experiment and assign a score of the level of symptoms of dementia (1=mild, 2=moderate, 3=severe). A psychologist will then meet with the subjects assigned to Group A on a daily basis for one month.  At the end of the thirty days, a psychologist will again meet with both Group A and Group B and assign a score of the level of symptoms of dementia (1=mild, 2=moderate, 3=severe). The results of the pre- and post-scores will be inputted into an excel spreadsheet for statistical analysis for averages between groups, as well as a correlation analysis between groups.  The average scores for the groups can be compared to evaluate if the treatment Group A results (predicated at a lower score) is more effective for patient symptoms than Group B results (predicated at a higher score).

Quantitative Design Strengths and Limitations

There are some strengths and limitations to this design in this study.  The strength of this design is that the scores are not influenced by other factors; however, the limitations or threats in this study are that an individual may not have had a good day, perhaps sick or other medical problems, level of fatigue, or personal individual differences.  In addition, there are ethical considerations to consider in this study.  Although, this is to help patients with Alzheimer’s disease, it is important to know that these people may be unable to make decisions for themselves and their entry into research is based on consent by another person.  Furthermore, there is a level of inconvenience in their routine structure for the patient has to undergo daily interaction with a psychologist.

Qualitative Study Design

In order to address the possibility from a qualitative approach that elderly patients with Alzheimer’s disease can exhibit a decrease in symptoms based on the implementation of a psychologist in a nursing home setting, an exploratory qualitative survey will be employed. In this approach, the objective is to conduct an appraisal of the knowledge, expectation and attitude towards Alzheimer Disease and the need for a regular interaction between a mental health practitioner, such as a psychologist, and an Alzheimer patient; however, due to the qualitative approach the independent and dependent variables are not identifiable in this research design.  The target group in this study will be the caregivers of the patients at a randomly chosen Alzheimer nursing facility.  The hypothesis for this study is that caregivers will indicate that there is a behavior change in Alzheimer patients after interaction with medical professional.  Particularly, the study will aim to obtain more direct answers to questions pertaining to the outcome of social interaction between the caregiver and the Alzheimer patient.  For instance, the study will structure around questions and views such as, “What is the current view in regard to the social interaction between an Alzheimer patient?” and “Do you feel that there is a positive response when there is social interaction involved between yourself and an Alzheimer patient?”  In addition, the study will also focus on how the caregivers care for the Alzheimer patient and what they think the needs and expectations of the caregiver is.  Other questions will directly focus on the reaction of the patients after meeting with the professional staff, such as the head psychologist or psychologist involved in the health care of the patient or the psychotherapy of the patient.

In order to obtain this information, the use of individual interviews will be utilized for this qualitative study.  A sample size of 30 caregivers will be used in a series of one hour interviews.  One hour interviews would allow enough time in order to gather details in regard to the exposure and attitude of caregivers towards the Alzheimer patients.  A sample size of 30 caregivers was chosen, as these individuals are known to work with Alzheimer’s patients and have particular experience. In addition, thirty interviews from three different interviewees would provide an unbiased outcome for the purpose of the study.  The goal in this study is to gain an “in-depth understanding” to their attitudes for the needs of this patient.  In addition, three nursing facilities will be utilized in this particular study; therefore, ten caregivers from each facility and one interviewer assigned to one facility each.

For this study, the selected caregivers were defined as the individuals who regularly assisted with the Alzheimer patient in their routine or daily life schedule. None of the caregivers in this study will be a health professional, such as a psychologist, doctor, or nurse.  In addition, the caregivers will be required to meet some requirements to include: 18 years of age or older, not involved in the health decisions of the patient, not involved with the financial obligations of the patient, and are involved with an Alzheimer patient multiple times per week. Each caregiver subject will be interviewed for one hour in a face to face interview using three different interviewers.  Three interviewers will be assigned ten caregivers each.  The interview will be recorded using a voice recorder, as well as notes, in order to obtain all information accurately.  Each caregiver will be given the same questions.  The questions that will be applied to this study are found in Table 1.  In addition, in order to facilitate the questions with the caregivers, a discussion guide will be provided with a list of images and words in order to help answer the question.  (Table 2) All caregivers will be provided a consent form prior to conducting the study.

Once the interviews have been conducted, the data will be analyzed using triangulation of data.  In this data analysis, the interview data will be analyzed using investigator triangulation of data through the cross-referencing of interviews.  The interview data will be analyzed for outcomes that are agreed upon by all three interviewers.  In this particular study, the outcome of whether personal interaction with an Alzheimer patients results in positive behavior for the Alzheimer patient will be compared between interviews.  All interviews and each caregiver will be assessing the questions and answering the question from different points of view; therefore, the outcome will be more than likely a correct outcome.  The findings from each interviewer would be compared and if the interviewers propose the same conclusion, the validity of the study will be established.  If the conclusions of the interview differ significantly, then the need for further evaluation is necessary.

Since the study involves real people, there are ethical concerns to consider.  Researchers must make a clear representation of their goal to all caregivers, as well as the nursing home facility.  In addition, informed consent must be provided to both the caregiver and facility.  It is also important to establish if the nursing facility wants to be indicated in the research report or remain anonymous.  Furthermore, it is important that the design of the study does not either harm or exploit any person involved during or after the study.

Qualitative Design Strengths and Limitations

Although the qualitative design using an exploratory design is an effective measure for establishing validity of the study; there are some limitations to this type of method.  For instance, the practicality of using different interviewers for a specific time period may result in some constraints.  In addition, the need to find similar nursing homes, as well as ten caregivers at each that are willing to participate in the study is also a limitation.  Furthermore, there is no statistical data to help prove or disprove a hypothesis in qualitative research.

Mixed Methods Design

In a mixed methods design, the integration of both the quantitative design and qualitative design will be implemented in order to test the hypothesis that psychologist guided intervention provides better results, such as a decrease in the symptoms or signs of dementia associated with Alzheimer’s disease in Alzheimer diagnosed patients in nursing homes that care for patients dealing with this disease.  The type of mixed methods design that will be implemented is an embedded design.  In this method, the quantitative and qualitative design will be embedded into one another.  In the quantitative part of the study, the independent variables in the study include treatment in the study in which the patients receive from the psychologist.  The dependent variable is the outcome of the treatment.  In the qualitative approach, the independent and dependent variables are not identifiable. The purpose will be to conduct the quantitative study and to embed the qualitative data within the quantitative procedure in order to understand the perspective of a caregiver on the need for guided intervention for an Alzheimer patient.

The study will employ the same type of quantitative method approach indicated in the “Quantitative Method Design” above.  However, this design is implementing a qualitative approach and requires the use of three different random nursing homes.  In order to be more accurate and decrease the probability of differences occurring in the subjects chosen for the study, three randomized nursing homes and 10 randomized subjects within each nursing home will be randomly selected.  A sample size of a total of thirty patients with Alzheimer and a total of thirty interviews (one interview from a caregiver for each patient) was chosen as this is a mixed design study, which requires both qualitative and quantitative approaches and the goal is to determine a relationship between the independent variable and dependent variables in a specific population of dementia patients. For this part of the design, thirty random patients of the same diagnosis would provide an unbiased outcome for the purpose of the study.  Each subject must have an official diagnosis of Alzheimer’s disease.  The level of Alzheimer’s disease must be at the moderate stage (middle-stage) or Alzheimer’s (as indicated above in Quantitative Design section).

Patients will be recruited based on the status of moderate stage Alzheimer’s and permission from the patient’s power of attorney.  As indicated in the quantitative design, there will be two groups assigned as Group “A” or Group “B”.  Each representative nursing home participating will have five subjects in Group A and five subjects in Group B.  Group B will serve as the control group and adhere to normal activities in the nursing home.  Group A will serve as the variable and a psychologist assisted program design will be implemented.  Data collection procedures will employ a score provided by the psychologist before and after the evaluation of each patient.  The psychologist will meet with the patient in both Group A and Group B prior to the first day of the experiment and assign a score of the level of symptoms of dementia (1=mild, 2=moderate, 3=severe). A psychologist will then meet with the subjects assigned to Group A on a daily basis for one month.  At the end of the thirty days, a psychologist will again meet with both Group A and Group B and assign a score of the level of symptoms of dementia (1=mild, 2=moderate, 3=severe). The results of the quantitative approach for pre- and post-scores will be inputted into an excel spreadsheet for statistical analysis for averages between groups, as well as a correlation analysis between groups.

After the completion of the quantitative design part of the embedded design, the caregivers to each of the patients in both Group A and Group B will be interviewed as part of the qualitative approach to help determine if the guided intervention with a psychologist had a positive impact on Alzheimer patients.  A researcher will conduct one hour face-to-face interviews on a caregiver who has more than three interactions with one of the Alzheimer patients per week.  Ten interviews from each of the nursing facilities will occur. All caregivers will be provided with a guide and consent before the research project.  The caregivers will be provided with the questions indicated in Table 1 and will also be provided with the list of words provided in Table 2.  In addition, the facilities will be asked if they want their name published in the work as well.

The results of the study will also be analyzed using a triangulation design.  This type of design is utilized when comparing both quantitative statistical research results with qualitative findings in order to validate the quantitative results or expand on the results.  (Creswell, 2010) For this study, the convergence model of Triangulation Design will be implemented.  The researcher will separately analyze the quantitative data, as indicated above using a statistical approach and then analyze the results of the qualitative interview questions.  The data from the two will be compared and contrasted for any correlation between the two.  The comparison of the two data sets will increase validation of the study, as well as confirm results of both the quantitative and qualitative findings.

Again, since the study involves real people, there are always ethical concerns to consider, such as researchers must make a clear representation of their goal to all caregivers, as well as the nursing home facility.  In addition, in this study, the patients will also be involved and the question to consider is would they have wanted to be a part of this study if they were able to make an informed decision.  Furthermore, informed consent must be provided to both the caregiver and facility.  It is also important to establish if the nursing facility wants to be indicated in the research report or remain anonymous.  Furthermore, it is important that the design of the study does not either harm or exploit any person involved during or after the study

Mixed Method Design Strengths and Limitations

The strength of the mixed method design is that it is efficient.  It allows for two different types of data to be collected concurrently or one after the other.  In addition, it allows for the data to be analyzed separately and then compared.  The limitations to this design, however, are the challenges for the researcher that are present, such as the level of expertise and effort with collecting the data in approximately the same time frame, as well as dealing with the inability of patients or caregivers to undergo the evaluations or interview at the correct time, due to unforeseen circumstances. In addition, the researchers could be faced with problems if the data collected between the qualitative and quantitative research do not agree.  (Creswell, 2010)

Conclusion

The three methods analyzed in this paper all aim to address the possibility that there are methods that can alleviate elderly patient’s symptoms by employing psychologists in nursing homes that deal with Alzheimer’s or dementia patients. In the quantitative approach, the results of the study are assigned a score in regard to the effectiveness of the implementation of a psychologist into the daily routine of an Alzheimer’s patient.  This approach analyzed the results using a statistical analysis and comparison between a control and a variable, in this case a group with and without a psychologist.  These types of results are able to be compared and analyzed for a significant difference, which indicates that there was some significant difference between the group who saw the psychologist and the group who didn’t see the psychologist.  In the qualitative approach, interview of caregivers who are part of the daily routine and who interact with an Alzheimer patient was conducted.  The data from this approach is not able to statistically provide a correlation analysis or significant difference.  The interview questions, however, are analyzed for common answers or conclusions to the research question.  In the mixed methods approach, both quantitative data and qualitative data are compared.  The researchers can then take these data sets and compare them for a common conclusion.

The mixed method design, therefore, can help validate the study at a greater level, as well as end up with a solid conclusion about the research question.  In this case, the question “Does psychologist guided intervention provides better results, such as a decrease in the symptoms or signs of dementia associated with Alzheimer’s disease in Alzheimer diagnosed patients in nursing homes that care for patients dealing with this disease?” can be addressed at both a quantitative and qualitative level.  In the social science field, the mixed methods design has become increasingly popular, as well as a stand-alone research design.  It has also been referred to as “the collection or analysis of both quantitative and qualitative data in a single study in which data are collected concurrently or sequentially (Hanson et al., 2005)”.  In addition, the ability to use two different forms of data allow for the research to simultaneously provide results from the sample population in order to gain a better understanding of the question at hand.  The use of Triangulation Design to the mixed method approach also allows for two different data sets to conclude as a complementary data set on the same topic or question, to further understand the problem and develop a solution.  The strength that outweighs the strengths and weaknesses of the quantitative and qualitative designs mentioned previously in the paper, is that this type of design brings together the strengths and overlapping weakness observed in the quantitative and qualitative approaches, such as sample size, generalizations, details, and lack of numerical data. The mixed method design, therefore, combines these methods and allows for a direct compare and contrast of the data collected.  (Creswell, 2010)

Overall, the analysis of the three methods point to the use of the Mixed Method Design.  The Mixed Method Design allows for the hypothesis to be addressed at both the quantitative and qualitative level.  In addition, the results of the methods can be compared in order to reject or verify the hypothesis.  In this case, the utilization of a Mixed Method Design will enable the research to provide a conclusion of whether or not the implementation of a psychologist in the routine of an Alzheimer patient will decrease the symptoms of the disease.

References

Alzheimer’s Association.  (2015). What Is Alzheimer’s? Retrieved from: http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp

Creswell, J.  (2010). Designing and Conducting Mixed Method Research.  Chapter 4.  Choosing a Mixed Methods Design.  Sage Publications, Inc.  488pgs. Retrieved from: http://www.sagepub.com/sites/default/files/upm-binaries/10982_Chapter_4.pdf

Explorable.  (2015).  Between Subjects Design.  Retrieved from:https://explorable.com/between-subjects-design

Hanson, W. et al.  (2005).  Mixed Methods Research Designs in Counseling Pyschology.

Journal of Counseling Pyschology.  52(2):224-235.  http://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1372&context=psychfacpub&sei-redir=1&referer=http%3A%2F%2Fwww.bing.com%2Fsearch%3Fq%3DMixed%2520Design%2520in%2520Pyschology%26qs%3Dn%26form%3DQBRE%26pq%3Dmixed%2520design%2520in%2520pyschology%26sc%3D0-19%26sp%3D-1%26sk%3D%26cvid%3D1B9DF590300D418CA77A988E234FBA94#search=%22Mixed%20Design%20Pyschology%22

Ipsos.  (2008).  Qualitative study of Alzheimer’s disease among the General Public, Caregivers and Health Professionals (General Practitioners, Nurses and Pharmacists) . Retrieved from: http://alzheimer.inpes.fr/pdf/en/report-qualitative-study.pdf

McClean, A.  (2006).  The Person in Dementia: A Study of Nursing Home Care in the US. Teaching Culture: UTP Ethnographies for the Classroom of Toronto, Higher Education Division. 320pgs.