The Effects of Neuropsychological Assessment Feedback on Older Adults and Their Carers

Natasha S. Squelch (). The Effects of Neuropsychological Assessment Feedback on Older Adults and Their Carers Professional Doctorate, School of Psychology, The University of Queensland.

       
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Author Natasha S. Squelch
Thesis Title The Effects of Neuropsychological Assessment Feedback on Older Adults and Their Carers
School, Centre or Institute School of Psychology
Institution The University of Queensland
Thesis type Professional Doctorate
Supervisor Nancy Pachana
Annette Broome
Total pages 199
Abstract/Summary Neuropsychological assessment feedback (NAF) has received very limited attention in the literature (Allen et al., 1986; Gass & Brown, 1992; Gorske & Smith, 2008; Pope, 1992). This is surprising given the importance that has been placed on the provision of feedback in clinical practice (e.g., Gass & Brown, 1992; Smith, Wiggins, & Gorske, 2007). Approaches to NAF delivery, and the effects of feedback on clients and their families, remain relatively unexplored across age groups. In particular, to date no study has examined the effects of NAF on older adults and their carers presenting for investigation of dementia. Further, no study has examined or directly compared the effects of different NAF approaches in the older population. To fill this void in the literature, the primary aim of the current study was to examine the effects of two different approaches to neuropsychological assessment and feedback, namely Information Gathering (IG) and Collaborative Neuropsychological Assessment (CNA) on older adults referred for dementia investigations and their carers. Outcome variables included: patient and carer depression, anxiety, and service satisfaction; patient insight; and carer burden. Study 1 investigated the effects of IG and CNA approaches to neuropsychological assessment and feedback on 44 patients aged 60-89 years (M = 72.55) referred for dementia investigation by specialist practitioners at the Geriatric and Rehabilitation Unit, Princess Alexandra Hospital, Brisbane, Australia. Participants were systematically allocated to an IG group or a CNA group. All patients attended a neuropsychological assessment interview session, testing session, and feedback session. Outcome variables included the following self-report instruments: the Geriatric Depression Scale – 30 item (GDS-30; Brink et al., 1982); the Geriatric Anxiety Inventory (GAI; Pachana, Byrne, Siddle, Koloski, Harley, & Arnold, 2007); the Deficit Awareness Questionnaire (DAQ; Green, Goldstein, Sirockman, & Green, 1993); the Pre-Feedback Questionnaire and the Post-Feedback Questionnaire (Pre-FQ; Post-FQ respectively); and the Neuropsychological Assessment Objective Questionnaire (NAOQ; completed by the CNA group only). In addition, outcome variables included the clinician-rated Impaired Self-Awareness scale (ISA; Prigatano & Klonoff, 1998) and the Denial of Disability scale (DD; Prigatano & Klonoff, 1998). Nonparametric analyses were conducted due to low participant numbers and violations of statistical assumptions. Results indicated significant time effects amongst the CNA group on depression levels as measured by the GDS-30 (c2 = 6.911, df = 2, p < .05) and on overall self-awareness as measured by the DAQ total discrepancy score (c2 = 8.970, df = 2, p < .05). No significant time effects amongst the IG group, and the CNA group, were indicated on anxiety levels as measured by the GAI. Significant time effects were demonstrated amongst the IG group, and the CNA group, on overall feedback satisfaction as measured by the Pre-FQ and the Post-FQ total scores (IG: z = -3.128, N-Ties = 3, p = .002, two-tailed; CNA: z = -3.426, N-Ties = 7, p = .001, two-tailed). Significant time effects were indicated amongst the IG group on four of the eight individual questions comprising the Pre-FQ and the Post-FQ, and amongst the CNA group on seven of the eight individual questions comprising the Pre-FQ and the Post-FQ. The majority of patients in the IG group, and the CNA group, were very satisfied or satisfied with aspects of the neuropsychological assessment feedback session and overall neuropsychological assessment process, as measured by the individual questions comprising the Post-FQ. Group comparisons revealed no significant main effect for time, and no significant main effect comparing the two approaches on any of the outcome measures, with the exception of a main effect for time on two of the eight individual questions comprising the Pre-FQ and the Post-FQ. Study 2 examined the effects of IG and CNA approaches to neuropsychological assessment and feedback on 44 carers of the patients recruited for Study 1. Carers were aged 60-89 years (M = 69.80) and in conjunction with the patient were allocated to an IG group or a CNA group. All carers participated in the patient neuropsychological assessment interview session and feedback session. Outcome variables included the following self-report measures: the Geriatric Depression Scale – 15 item (GDS-15; Sheikh & Yesavage, 1986); the GAI (Pachana et al., 2007); the DAQ (Green et al., 1993); the Revised Memory and Behaviour Problems Checklist (RMBPC; Teri et al., 1992); the Pre-FQ; the Post-FQ; and the NAOQ (completed by the CNA group only). Due to low participant numbers and violations of statistical assumptions, nonparametric analyses were performed. Results indicated significant time effects amongst the IG group on overall burden as measured by the RMBPC Reaction total score (c2 = 7.588, df = 2, p < .05). No significant time effects amongst the IG group, and the CNA group, were indicated on depression levels as measured by the GDS-15, or on anxiety levels as measured by the GAI. Results indicated significant time effects amongst the IG group, and the CNA group, on overall feedback satisfaction as measured by the Pre-FQ and the Post-FQ total scores (IG: z = -3.833, N-Ties = 3, p = .000, two-tailed; CNA: z = -3.626, N-Ties = 2, p = .000, two-tailed) and on all of the eight individual questions comprising the Pre-FQ and the Post-FQ. The majority of carers in the IG group, and the CNA group, were very satisfied or satisfied with aspects of the neuropsychological assessment feedback session and overall neuropsychological assessment process, as measured by the individual questions comprising the Post-FQ. Group comparisons revealed no significant main effect for time, and no significant main effect comparing the two approaches on any of the outcome measures, with the exception of a large main effect for time on overall feedback satisfaction as measured by the Pre-FQ and the Post-FQ total scores, Wilks Lambda = .67, F (1, 41) = 20.18, p < .05, partial eta squared = .330, and on four of the eight individual questions comprising the Pre-FQ and the Post-FQ. The results for Study 1 and 2 are discussed in relation to existing literature. The clinical implications of these findings are considered, followed by a discussion of study limitations and suggestions for future research.
Keyword Effects of Neuropsychological Assessment Feedback
Older Adults
Carers

 
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Created: Tue, 17 Nov 2009, 15:04:13 EST by Ms Natasha Squelch