Spaced Retrieval (SR) is a technique during which retrieval of information is practiced at increasingly longer intervals of time. The focus of this study was to determine whether SR could be an effective intervention during speech-language therapy. Participants incIuded two clients with a diagnosis of cerebral vascular accident and seven clients with dementia. During therapy sessions SR was used as a memory intervention for three learning tasks; learning a therapist's name, learning one piece of information which was important to the individual client, and learning a compensatory technique. Spaced retrieval enabled clients to learn and use information in a functional manner which facilitated achievement of the speech-language therapy goals. [Article copies available for a fee fmm f i e ffaworrh Docurnenl Delivery Service: 1-800-342-9678. E-mail address: getimfo@haworIh.com]Rehabilitation for speech-language pathologies is an increasingly important concern in long-term care, a setting in which speech therapy is Jennifer A. Brush is affiliated with the Menorah Park Center for the Aging, Beachwood, OH. Cameron J. Camp is affiliated with the Myers Research Institute of the Menorah Park Center for the Aging, Beachwood, OH. Center for the Aging, 27 I00 Cedar Road, Beachwood, OH 44 122.The authors wish to express their thanks to Patricia Stickler for her assistance in data collection, to Ruth Plautz (Director of Rehabilitation) for her support in all phases of the project, and to Dr. Julius Fishman (Director of Medicine) and Denise Trun (Director of Nursing) for their assistance in the selection of the participants. 52 CLINICAL GERONTOLOGISTrapidly expanding its presence. Speech therapy for older adults is covered by a variety of third-party payers, including Medicare, Medicaid, HMOs, PPOs, and growing numbers of older adults, both outpatients and longterm care residents, are being seen by speech-language pathologists through such programs.Many older adults encountered by speech-language pathologists have dementia as a primary or secondary presenting condition. It has been estimated that the majority of persons in long-term care have dementia, with some estimates reaching 60%-80% of residents. Dementia is often accompanied by language disturbances such as aphasia and anomia, in addition to neurological dysfunctions such as agnosia, apraxia, and problems with executive functioning. However, a distinctive feature of all

Communication dysfunction that results from dementia can be exacerbated by environmental barriers such as inadequate lighting, noisy conditions, poor or absent environmental cues, and visual clutter. Speech-language pathologists (SLPs) should address these environmental barriers as part of a comprehensive treatment plan for clients with dementia. The Environment and Communication Assessment Toolkit for Dementia Care (ECAT) was evaluated by SLPs to determine: (1) changes in awareness of environmental factors prior to and after training; (2) impact of the ECAT on practice as measured by changes in the number of environmental modifications recommended and made prior to and after training; (3) utility of the information as measured by the helpfulness, amount of new information, and usefulness of the ECAT; and (4) usability of the ECAT materials based on ease of use. The SLPs used the ECAT with clients with dementia who had functional limitations and required substantial assistance with daily activities. Results indicate that the ECAT is an effective tool for SLPs, providing information about the impact of the environment on communication and supplying sufficient resources to make recommendations and implement effective interventions. The ECAT successfully increased awareness of environmental modifications, influenced the practice of recommending environmental modifications, and had utility in diverse aspects of clinical practice.

Research has shown that communication is affected by the environment and that modifications can improve communication skills in individuals with dementia. Poorly designed environmental features contribute to unsatisfactory responses or behaviors in individuals with cognitive impairment. Environmental modifications must be customized to the person, setting, and activity. Assessment provides a practical means of systematically acquiring that information, translating it into appropriate recommendations, and evaluating the success of those recommendations. This indicates the need for an environmental assessment that is individualized, not only to enhance clinical reasoning and judgment, but also to provide a basis for evidence-based, person-centered practice.

Nursing homes that are working on adopting person-centered care (PCC) practices express concerns about giving residents the freedom to make their own decisions and the accompanying risks. This challenge is especially true for those who are at the beginning of the PCC change process. Although the Centers for Medicare and Medicaid Services regulations are clear that residents have the right to a dignified existence and self-determination, and that the facility must protect and promote their rights, examples abound of care communities coercing, cajoling, or requiring residents to do things they do not want to do (e.g., take medications), or the reverse of not letting them do what they want (e.g., eat a regular diet). The current article discusses a process that helps care communities follow the regulations about education and offering choices while honoring resident preferences and documenting the process for surveyors. [Journal of Gerontological Nursing, 42(8), 12-17.].

In the next two decades, there will be advances in the diagnosis and treatment of the disorders of aging that have the potential to change the way speech-language pathologists (SLPs) are trained and provide services to individuals with a continuum of cognitive communication challenges. SLPs will address the needs of the aging adult who continues to reside in the community and desires to maintain an independent and meaningful life, as well as those who require a supportive residential setting to achieve a satisfying quality of life. Evidence-based strategies and intervention approaches for the range of goals that will address the desired functions of a meaningful life for individuals faced with cognitive communicative challenges are outlined. Institutional barriers to the implementation of documented evidence-based approaches will need to be reduced through a variety of organizational and systems changes. The projected outcome of these changes will be the creation of a person-centered culture of care that promotes dignity, choice, and engagement in meaningful activities through the end of life.