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Bott A, Meyer C, Hickson L, Pachana NA. "It's Huge, in a Way." Conflicting Stakeholder Priorities for Managing Hearing Impairment for People Living with Dementia in Residential Aged Care Facilities. Clin Gerontol 2022; 45:844-858. [PMID: 32807024 DOI: 10.1080/07317115.2020.1805537] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aims of this study were to a) explore the impact of hearing impairment on people living with dementia in residential aged care facilities (RACFs) and b) investigate management of hearing impairment for this population. METHODS A descriptive qualitative approach, consisting of semi-structured interviews, was conducted with 23 participants across four stakeholder groups (audiologists, care staff, family members and individuals with dementia and hearing impairment living in RACFs). RESULTS Thematic analysis revealed an overarching theme of "different priorities for managing hearing impairment" that emerged from the data. Audiologists and care staff prioritized different practices for managing hearing impairment: audiologists emphasized hearing aids and care staff emphasized communication strategies. Care staff also identified that current management of hearing impairment was sub-optimal as they do not prioritize managing it. CONCLUSIONS Residents with dementia and hearing impairment living in RACFs are not receiving optimal hearing management. Further research is required to understand the factors that influence this. CLINICAL IMPLICATIONS Changes in practices of both care staff and audiologists are required to improve hearing impairment management for this population.
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Affiliation(s)
- Anthea Bott
- The HEARing Cooperative Research Centre, Melbourne, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Carly Meyer
- The HEARing Cooperative Research Centre, Melbourne, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Louise Hickson
- The HEARing Cooperative Research Centre, Melbourne, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
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Thodberg K, Videbech PB, Hansen TGB, Pedersen AB, Christensen JW. Dog visits in nursing homes - increase complexity or keep it simple? A randomised controlled study. PLoS One 2021; 16:e0251571. [PMID: 34038451 PMCID: PMC8153477 DOI: 10.1371/journal.pone.0251571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/25/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To compare the immediate response of nursing home residents to dog visits with or without an activity, and the impact of cognitive ability. Methods In a randomly controlled trial, 174 nursing home residents were allocated to 12 bi-weekly 10-minute visits: either ordinary dog visits (D, n = 57, 49 analysed), dog visits with an activity (DA, n = 56, 48 analysed), or visits with activity but no dog (A, n = 61, 54 analysed). We recorded frequency and duration of residents’ verbal and physical interactions with the dog and persons. Data were analysed in three periods of four visits (period 1–3) as binomial variables (generalised linear models) or durations (non-parametric statistics). Results Both visit type and impairment level affected the likelihood of interacting with the dog (D and DA). In some periods increased cognitive impairment lowered odds of touching the dog in DA visits (period 1: F1,85 = 5.17, P < 0.05) and talking to it directly (period 1: F1,90 = 4.60, P < 0.05; period 3: F1,87 = 5.34, P < 0.05). Throughout, residents talked less to persons during DA visits compared to D and A (P = 0.01–0.05), and level of cognitive impairment correlated negatively with talk duration (P < 0.001). Generally, high cognitive impairment level lowered odds of interacting with (period 1: F1,89 = 7.89, P < 0.01; period 2: F1,97 = 6.76, P = 0.01; period 3: F1,92 = 13.57, P < 0.001) and talking about the activities (period 1: F1,89 = 13.78, P <0.001; period 2: F1,88 = 3.27, P = 0.07; period 3: F1,86 = 3.88, P = 0.05). Conclusion Visits without specific activities stimulated residents to interact with the dog, whereas increasing the complexity of dog visits by adding activities resulted in less interaction with the dog for severely impaired residents. The optimal dog visit for the less cognitively impaired residents could include activities and thereby a possibility to interact with the dog in different ways, whereas for severely impaired residents, just being with the dog seems more appropriate.
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Affiliation(s)
- Karen Thodberg
- Department of Animal Science, Aarhus University, Aarhus, Denmark
- * E-mail:
| | | | - Tia G. B. Hansen
- Center for Developmental and Applied Psychological Science, Aalborg University, Aalborg, Denmark
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Tanaka H, Umeda R, Shoumura Y, Kurogi T, Nagata Y, Ishimaru D, Yoshimitsu K, Tabira T, Ishii R, Nishikawa T. Development of an assessment scale for engagement in activities for patients with moderate to severe dementia. Psychogeriatrics 2021; 21:368-377. [PMID: 33650269 DOI: 10.1111/psyg.12678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Various types of therapy, including occupational therapy, are utilised for the treatment of moderate to severe dementia. In order to determine the optimal rehabilitation strategy for such patients and examine the treatment efficacy, an assessment scale for engagement in various group activities that can be easily applied in clinical situations is required. We herein report the development of the Assessment Scale for Engagement in Activities (ASEA) and its clinical utility. METHODS The ASEA was developed by nine occupational therapists and a psychiatrist with experience in developing measures for dementia, in accordance with the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) checklist. This assessment comprises 10 items covering four domains: Engagement in the Activity, Interaction, Arousal, and Affect. Participants with moderate to severe dementia who resided in a psychiatric acute phase hospital in Japan were assessed in terms of engagement in activities using the ASEA and Todai-shiki Observational Rating Scale (TORS), and in terms of cognitive function using the Mini-Mental State Examination (MMSE). We examined the internal consistency, inter- and intra-rater reliability, content validity, and concurrent validity of the ASEA. RESULTS Cronbach's alpha of the ASEA was 0.889. The overall inter-rater reliability was 0.937 (Spearman rank correlation, P < 0.001), and the intraclass correlation (ICC) for each item was 0.490-0.965 (P < 0.018-0.001). The overall test-retest reliability was 0.778 (Spearman's rank correlation, P < 0.001), and the ICC for each item was 0.498-0.863 (P < 0.023-0.001). The test-retest correlations were significant for almost all items, aside from 'Interaction with others' (P = 0.051). The concurrent validity, examined using the TORS and MMSE, was 0.920 and 0.304 (Spearman's rank correlation, P < 0.001-0.006). CONCLUSIONS The ASEA has confirmed reliability and validity, aside from 'Interaction with others' regarding test-retest reliability. Generally, this assessment tool has clinical utility and allows the evaluation of activity engagement among patients with moderate to severe dementia.
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Affiliation(s)
- Hiroyuki Tanaka
- Osaka Prefecture University Graduate School of Comprehensive Rehabilitation, Osaka, Japan
| | - Ren Umeda
- Hokutokai Sawa Hospital Department of Rehabilitation, Osaka, Japan
| | - Yuko Shoumura
- Hokutokai Sawa Hospital Department of Rehabilitation, Osaka, Japan
| | - Tatsunari Kurogi
- Osaka Prefecture University Graduate School of Comprehensive Rehabilitation, Osaka, Japan.,Hokutokai Sawa Hospital Department of Rehabilitation, Osaka, Japan
| | - Yuma Nagata
- Osaka Prefecture University Graduate School of Comprehensive Rehabilitation, Osaka, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daiki Ishimaru
- Osaka Prefecture University Graduate School of Comprehensive Rehabilitation, Osaka, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koji Yoshimitsu
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Takayuki Tabira
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Ryouhei Ishii
- Osaka Prefecture University Graduate School of Comprehensive Rehabilitation, Osaka, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Nishikawa
- Osaka Prefecture University Graduate School of Comprehensive Rehabilitation, Osaka, Japan.,Division of Occupational Therapy, Department of Rehabilitation, Faculty of Health Sciences, Naragakuen University, Nara, Japan
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Höbler F, McGilton KS, Wittich W, Dupuis K, Reed M, Dumassais S, Mick P, Pichora-Fuller MK. Hearing Screening for Residents in Long-Term Care Homes Who Live with Dementia: A Scoping Review. J Alzheimers Dis 2021; 84:1115-1138. [PMID: 34633326 PMCID: PMC8673512 DOI: 10.3233/jad-215087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hearing loss is highly prevalent in older adults, particularly among those living with dementia and residing in long-term care homes (LTCHs). Sensory declines can have deleterious effects on functioning and contribute to frailty, but the hearing needs of residents are often unrecognized or unaddressed. OBJECTIVE To identify valid and reliable screening measures that are effective for the identification of hearing loss and are suitable for use by nursing staff providing care to residents with dementia in LTCHs. METHODS Electronic databases (Embase, Medline, PsycINFO, CENTRAL, and CINAHL) were searched using comprehensive search strategies, and a stepwise approach based on Arksey & O'Malley's scoping review and appraisal process was followed. RESULTS There were 193 scientific papers included in the review. Pure-tone audiometry was the most frequently reported measure to test hearing in older adults living with dementia. However, measures including self- or other-reports and questionnaires, review of medical records, otoscopy, and the whisper test were found to be most suitable for use by nurses working with older adults living with dementia in LTCHs. CONCLUSION Although frequently used, the suitability of pure-tone audiometry for use by nursing staff in LTCHs is limited, as standardized audiometry presents challenges for many residents, and specific training is needed to successfully adapt test administration procedures and interpret results. The whisper test was considered to be more suitable for use by staff in LTCH; however, it yields a limited characterization of hearing loss. There remains an urgent need to develop new approaches to screen hearing in LTCHs.
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Affiliation(s)
- Fiona Höbler
- KITE – Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katherine S. McGilton
- KITE – Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Walter Wittich
- École d’optométrie, Université de Montréal, Montréal, QC, Canada
- Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, QC, Canada
- Centre de réadaptation Lethbridge-Layton-Mackay du CIUSSS du Centre-Ouest-de-l’Île-de-Montréal, Montréal, QC, Canada
| | - Kate Dupuis
- Sheridan Centre for Elder Research, Sheridan College, Oakville, ON, Canada
| | - Marilyn Reed
- Audiology, Baycrest Health Sciences, Toronto, ON, Canada
| | - Shirley Dumassais
- École d’optométrie, Université de Montréal, Montréal, QC, Canada
- Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, QC, Canada
| | - Paul Mick
- Department of Surgery, Faculty of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Neils-Strunjas J, Crandall KJ, Ding X, Gabbard A, Rassi S, Otto S. Facilitators and Barriers to Attendance in a Nursing Home Exercise Program. J Am Med Dir Assoc 2020; 22:803-808. [PMID: 33132017 DOI: 10.1016/j.jamda.2020.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/26/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
Women and residents in Certified Nursing Homes (CNHs) with higher star ratings had better attendance in exercise and social engagement programming (ie, Bingocize) than men and residents in CNHs with lower ratings. OBJECTIVE The purpose of the current study was to determine whether resident factors and nursing home star ratings influenced attendance in Bingocize, a therapeutic exercise program that incorporates opportunities for social engagement in nursing homes. DESIGN This is a descriptive study of data collected across multiple nursing homes over 17 months. SETTING AND PARTICIPANTS Data were collected from residents in 25 certified nursing homes in the mid-southern United States. METHODS The program consisted of two 45-60-minute sessions each week. Bingocize attendance was recoded as number of sessions attended each month from September 2017 to February 2019 in 25 nursing homes. The impact of gender, age, cognitive functioning, and Nursing Home Star Ratings on adherence to the program based on percentage of Bingocize sessions attended was analyzed. RESULTS A total of 1165 residents of certified nursing homes were recruited and participated in Bingocize; 55% of participants attended Bingocize infrequently or had poor attendance, 21% of the participants had average attendance, and 24% had good attendance. The association between gender and level of attendance was significant (P = .045). The star rating of the nursing home also affected attendance. As star level of the nursing home increased, the percentage of good attendance increased (P < .001): 19.12% (1 star), 20.69% (2 stars), 23.57% (3 stars), 33.76% (4 stars), and 36.63% (5 stars). Neither age nor cognitive functioning [based on Brief Interview of Mental Status (BIMS)] had a significant impact on attendance. CONCLUSIONS AND IMPLICATIONS We examined adherence to an exercise program called Bingocize based on percentage of sessions attended in 25 nursing homes. Women and residents in nursing homes with higher star ratings were reported to have better attendance in Bingocize than men or residents in nursing homes with lower ratings, respectively. Residents of all ages and cognitive ability can successfully participate in the Bingocize program.
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Affiliation(s)
- Jean Neils-Strunjas
- College of Health and Human Services, Western Kentucky University, Bowling Green, KY, USA; Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - K Jason Crandall
- College of Health and Human Services, Western Kentucky University, Bowling Green, KY, USA
| | - Xiuhua Ding
- College of Health and Human Services, Western Kentucky University, Bowling Green, KY, USA
| | - Annika Gabbard
- College of Health and Human Services, Western Kentucky University, Bowling Green, KY, USA
| | - Sepehr Rassi
- College of Health and Human Services, Western Kentucky University, Bowling Green, KY, USA
| | - Spencer Otto
- College of Health and Human Services, Western Kentucky University, Bowling Green, KY, USA
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Renom A, Möhler R, Renom H, Meyer G. Personally-tailored activities for improving psychosocial outcomes for people with dementia in community settings. Hippokratia 2020. [DOI: 10.1002/14651858.cd010515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anna Renom
- School of Nursing Science, Faculty of Health; Witten/Herdecke University; Witten Germany
| | - Ralph Möhler
- School of Nursing Science, Faculty of Health; Witten/Herdecke University; Witten Germany
| | - Helena Renom
- Physical Medicine and Rehabilitation (MFRHB); Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - Gabriele Meyer
- School of Nursing Science, Faculty of Health; Witten/Herdecke University; Witten Germany
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Gnanamanickam ES, Dyer SM, Harrison SL, Liu E, Whitehead C, Crotty M. Associations between Cognitive Function, Hospitalizations and Costs in Nursing Homes: A Cross-sectional Study. J Aging Soc Policy 2020; 34:552-567. [PMID: 32600162 DOI: 10.1080/08959420.2020.1777824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In an Australian nursing home population, associations between cognitive function and 12-month hospitalizations and costs were examined. Participants with dementia had 57% fewer hospitalizations compared to those without dementia, with 41% lower mean hospitalization costs; poorer cognition scores were also associated with fewer hospitalizations. The cost per admission for those with dementia was 33% greater due to longer hospital stays (5.5 days versus 3.1 days for no dementia, p = .05). People with dementia were most frequently hospitalized for fractures. These findings have policy implications for increasing investment in accurate and timely diagnosis of dementia and fall and fracture prevention strategies to further reduce associated hospitalization costs.
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Affiliation(s)
- Emmanuel Sumithran Gnanamanickam
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, Australia.,Health Economics and Social Policy, Australian Centre for Precision Health, University of South Australia, Adelaide, Australia.,Health Data Science and Clinical Trials, Flinders University, Adelaide, Australia
| | - Suzanne Marie Dyer
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, Australia
| | - Stephanie Lucy Harrison
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, Australia.,Registry of Older South Australians, Health Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Enwu Liu
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, Australia.,Bone Health and Fractures Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Craig Whitehead
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, Australia
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Ishimaru D, Tanaka H, Nagata Y, Takabatake S, Nishikawa T. Physical Activity in Severe Dementia Is Associated With Agitation Rather Than Cognitive Function. Am J Alzheimers Dis Other Demen 2020; 35:1533317519871397. [PMID: 31533445 PMCID: PMC10624062 DOI: 10.1177/1533317519871397] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The authors examined associations between physical activity, cognitive function, activities of daily living, and behavioral and psychological dementia symptoms (BPSD) in severe and moderate dementia. METHODS A cross-sectional study was conducted to assess severe and moderate dementia groups according to the Clinical Dementia Rating. An actigraphy measured physical activity. Other measures included Mini-Mental State Examination, Cognitive Test for Severe Dementia, Hyogo Activities of Daily Living Scale, and Neuropsychiatric Inventory-Nursing Home. RESULTS Sixty-three participants were assessed (mean age = 89.3 ± 6.4). Physical activity was not associated with cognitive function among participants with severe dementia, although there was a trend-level association with cognitive function among those with moderate dementia. Physical activity was significantly associated with BPSD, specifically agitation/aggression symptoms, for participants with severe dementia, and there was a trend-level association with anxiety for participants with moderate dementia. CONCLUSIONS Physical activity appears to be associated with BPSD among individuals in the advanced stages of dementia.
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Affiliation(s)
- Daiki Ishimaru
- Course of Comprehensive Rehabilitation, Osaka Prefecture University Graduate School, Habikino-City, Osaka, Japan
- Department of Rehabilitation, Healthcare Corporation Seifuuen Imai Hospital, Kitataharaaza, Inagawacho, Kawabegun, Hyogo, Japan
| | - Hiroyuki Tanaka
- Course of Comprehensive Rehabilitation, Osaka Prefecture University Graduate School, Habikino-City, Osaka, Japan
| | - Yuma Nagata
- Course of Comprehensive Rehabilitation, Osaka Prefecture University Graduate School, Habikino-City, Osaka, Japan
- Department of Rehabilitation, Healthcare Corporation Seifuuen Imai Hospital, Kitataharaaza, Inagawacho, Kawabegun, Hyogo, Japan
| | - Shinichi Takabatake
- Course of Comprehensive Rehabilitation, Osaka Prefecture University Graduate School, Habikino-City, Osaka, Japan
| | - Takashi Nishikawa
- Course of Comprehensive Rehabilitation, Osaka Prefecture University Graduate School, Habikino-City, Osaka, Japan
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Petrovsky DV, Sefcik JS, Hanlon AL, Lozano AJ, Cacchione PZ. Social Engagement, Cognition, Depression, and Comorbidity in Nursing Home Residents With Sensory Impairment. Res Gerontol Nurs 2019; 12:217-226. [PMID: 31283831 DOI: 10.3928/19404921-20190627-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/22/2019] [Indexed: 11/20/2022]
Abstract
Sensory impairment, explicitly vision and hearing impairment, among nursing home (NH) residents decreases their ability to socially engage. However, it is not known to what extent visual, hearing, or dual impairment is associated with social engagement. The aims of the current retrospective, cross-sectional descriptive study were to determine the relationship between social engagement and (a) levels of sensory impairment (vision, hearing, and dual); (b) depression; and (c) cognition. The authors analyzed baseline data from 213 NH residents with sensory impairment from the I-SEE study. Multivariable model results demonstrated that sensory impairment was not associated with social engagement when adjusting for all covariates. Greater social engagement was associated with less depression, better cognition, and greater comorbidity. Clinicians should be aware of these risks to social engagement in NH residents with sensory impairment and monitor for decreased social engagement and isolation in residents with less comorbidities, higher depression levels, and poorer cognition. [Res Gerontol Nurs. 2019; 12(5):217-226.].
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S Gnanamanickam E, M Dyer S, Milte R, Liu E, Ratcliffe J, Crotty M. Clustered domestic model of residential care is associated with better consumer rated quality of care. Int J Qual Health Care 2019; 31:419-425. [PMID: 30169780 PMCID: PMC6804479 DOI: 10.1093/intqhc/mzy181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 06/24/2018] [Accepted: 08/06/2018] [Indexed: 12/28/2022] Open
Abstract
Objective To compare consumer rated quality of care among individuals living long-term in homelike clustered domestic and standard models of residential care in Australia. Design Cross-sectional study. Setting Seventeen residential aged care facilities in four Australian states providing alternative models of care. Study participants A sample of individuals with high prevalence of cognitive impairment living in residential care for 12 months or longer, not immediately in palliative care and having a proxy available to provide consent and assist with data collection. Of 901 eligible participants, 541 consented and participated in the study. Main outcome measure Consumer rated quality of care was measured using the Consumer Choice Index–6 Dimension instrument (CCI-6D) providing a preference weighted summary score ranging from 0 to 1. The six dimensions of care time, shared-spaces, own-room, outside and gardens, meaningful activities and care flexibility were individually evaluated. Results Overall consumer rated quality of care (Mean ∆: 0.138, 95% CI 0.073–0.203 P < 0.001) was higher in clustered domestic models after adjusting for potential confounders. Individually, the dimensions of access to outside and gardens (P < 0.001) and flexibility of care (P < 0.001) were rated significantly better compared to those living in standard model of care. Conclusions Homelike, clustered domestic models of care are associated with better consumer rated quality of care, specifically the domains of access to outdoors and care flexibility, in a sample of individuals with cognitive impairment. Including consumer views on quality of care is feasible and should be standard in future evaluations of residential care.
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Affiliation(s)
- Emmanuel S Gnanamanickam
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Health Economics and Social Policy, Australian Centre for Precision Health, University of South Australia, Adelaide, SA, Australia
| | - Suzanne M Dyer
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
| | - Rachel Milte
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Institute for Choice, University of South Australia, Adelaide, SA, Australia
| | - Enwu Liu
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Musculoskeletal Health and Ageing Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Julie Ratcliffe
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Flinders Health Economics Group, Flinders University, Adelaide, SA, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
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11
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Bott A, Meyer C, Hickson L, Pachana NA. Can adults living with dementia complete pure-tone audiometry? A systematic review. Int J Audiol 2019; 58:185-192. [PMID: 30663914 DOI: 10.1080/14992027.2018.1550687] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE It is estimated that over 60% of adults with dementia will also have a hearing impairment, resulting in a dual sensory-cognitive communication disability. Hearing interventions may lessen the impact of hearing impairment on a communication disability; yet, for audiologists to recommend appropriate hearing interventions, the individual's hearing thresholds must first be accurately established. The gold standard test for establishing hearing thresholds is pure-tone audiometry (PTA). However, the ability of adults with dementia to successfully complete PTA is uncertain. This systematic review examined studies of adults with dementia to better determine the proportion who could complete PTA. DESIGN Systematic review. STUDY SAMPLE Studies were included that assessed hearing in older adults who were reported as having mild and greater dementia. From a total of 1,237 eligible studies, only three were found to meet all inclusion criteria. RESULTS Across these three studies, the proportion of adults with dementia who could successfully complete PTA ranged from 56% to 59%. CONCLUSIONS Further research is needed in this area, particularly for adults with moderate and severe stages of dementia. Future research should also consider the feasibility of complementary, non-behavioural hearing tests. This systematic review was registered with the PROSPERO database, registration number CRD42017073041.
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Affiliation(s)
- Anthea Bott
- a The HEARing Cooperative Research Centre , Melbourne , Australia.,b School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
| | - Carly Meyer
- a The HEARing Cooperative Research Centre , Melbourne , Australia.,b School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
| | - Louise Hickson
- a The HEARing Cooperative Research Centre , Melbourne , Australia.,b School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane , Australia
| | - Nancy A Pachana
- c School of Psychology, The University of Queensland , Brisbane , Australia
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Cohen-Mansfield J, Jensen B. Attendance in Recreational Groups for Persons With Dementia: The Impact of Stimulus and Environmental Factors. Am J Alzheimers Dis Other Demen 2018; 33:471-478. [PMID: 30012002 PMCID: PMC10852413 DOI: 10.1177/1533317518788158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Participation in group activities can benefit persons with dementia, alleviating boredom, improving affect, maintaining function, and decreasing problematic behaviors. METHODS We describe patterns of attendance of residents with dementia at nursing home activity groups and investigate stimulus and environmental factors that may affect attendance. RESULTS Residents participated in 60.8% of the activities, with reasons for nonattendance including refusal (9.7%), not being on the unit (7.8%), being asleep (6.8%), and being involved in activities of daily living and other activities (8.3%). On average, 3.5 other residents not recruited for the study chose to participate in each group session. Group attendance was significantly related to group topic. IMPLICATION The need for activities was evident by the attendance of both invited and other residents. Understanding the factors that affect attendance is the first step toward developing procedures to maximize participation in activities in order to decrease loneliness and boredom in this population.
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Affiliation(s)
- Jiska Cohen-Mansfield
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, and Minerva Center for Interdisciplinary Study of End of Life, Tel Aviv University, Tel Aviv, Israel
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13
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Harrison SL, Kouladjian O'Donnell L, Bradley CE, Milte R, Dyer SM, Gnanamanickam ES, Liu E, Hilmer SN, Crotty M. Associations between the Drug Burden Index, Potentially Inappropriate Medications and Quality of Life in Residential Aged Care. Drugs Aging 2018; 35:83-91. [PMID: 29322470 DOI: 10.1007/s40266-017-0513-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Inappropriate polypharmacy may negatively impact the quality of life of residents in aged care facilities, but it remains unclear which medications may influence this reduced quality of life. OBJECTIVE The objective of this study was to examine whether the Drug Burden Index and potentially inappropriate medications were associated with quality of life in older adults living in residential care with a high prevalence of cognitive impairment and dementia. METHODS We conducted cross-sectional analyses of 541 individuals recruited from 17 residential aged care facilities in Australia in the Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study. Quality of life was measured using the EuroQol Five Dimensions Questionnaire (a measure of generic quality of life) and the Dementia Quality of Life Questionnaire completed by the participant or a proxy. RESULTS In the 100 days prior to recruitment, 83.1% of the participants received at least one anticholinergic or sedative medication included in the Drug Burden Index and 73.0% received at least one potentially inappropriate medication according to the Beers Criteria. Multi-level linear models showed there was a significant association between a higher Drug Burden Index and lower quality of life according to the EuroQol Five Dimensions Questionnaire [β (standard error): - 0.034 (0.012), p = 0.006] after adjustment for potential confounding factors. Increasing numbers of potentially inappropriate medications were also associated with lower EuroQol Five Dimensions Questionnaire scores [- 0.030 (0.010), p = 0.003] and Dementia Quality of Life Questionnaire-Self-Report-Utility scores [- 0.020 (0.009), p = 0.029]. Exposure to both Drug Burden Index-associated medications and potentially inappropriate medications was associated with lower Dementia Quality of Life Questionnaire-Self-Report-Utility scores [- 0.034 (0.017), p = 0.049]. CONCLUSION Exposure to anticholinergic and sedative medications and potentially inappropriate medications occurred in over three-quarters of a population of older adults in residential care and was associated with a lower quality of life.
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Affiliation(s)
- Stephanie L Harrison
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia. .,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.
| | - Lisa Kouladjian O'Donnell
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, 2065, NSW, Australia
| | - Clare E Bradley
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Infection and Immunity-Aboriginal Health, SAHMRI, Adelaide, 5001, SA, Australia
| | - Rachel Milte
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Institute for Choice, University of South Australia, Adelaide, 5001, SA, Australia
| | - Suzanne M Dyer
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
| | - Emmanuel S Gnanamanickam
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
| | - Enwu Liu
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, 3001, VIC, Australia
| | - Sarah N Hilmer
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, 2065, NSW, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
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14
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Möhler R, Renom A, Renom H, Meyer G. Personally tailored activities for improving psychosocial outcomes for people with dementia in long-term care. Cochrane Database Syst Rev 2018; 2:CD009812. [PMID: 29438597 PMCID: PMC6491165 DOI: 10.1002/14651858.cd009812.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND People with dementia who are being cared for in long-term care settings are often not engaged in meaningful activities. Offering them activities which are tailored to their individual interests and preferences might improve their quality of life and reduce challenging behaviour. OBJECTIVES ∙ To assess the effects of personally tailored activities on psychosocial outcomes for people with dementia living in long-term care facilities.∙ To describe the components of the interventions.∙ To describe conditions which enhance the effectiveness of personally tailored activities in this setting. SEARCH METHODS We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's Specialized Register, on 16 June 2017 using the terms: personally tailored OR individualized OR individualised OR individual OR person-centred OR meaningful OR personhood OR involvement OR engagement OR engaging OR identity. We also performed additional searches in MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science (ISI Web of Science), ClinicalTrials.gov, and the World Health Organization (WHO) ICTRP, to ensure that the search for the review was as up to date and as comprehensive as possible. SELECTION CRITERIA We included randomised controlled trials and controlled clinical trials offering personally tailored activities. All interventions included an assessment of the participants' present or past preferences for, or interests in, particular activities as a basis for an individual activity plan. Control groups received either usual care or an active control intervention. DATA COLLECTION AND ANALYSIS Two authors independently checked the articles for inclusion, extracted data and assessed the methodological quality of included studies. For all studies, we assessed the risk of selection bias, performance bias, attrition bias and detection bias. In case of missing information, we contacted the study authors. MAIN RESULTS We included eight studies with 957 participants. The mean age of participants in the studies ranged from 78 to 88 years and in seven studies the mean MMSE score was 12 or lower. Seven studies were randomised controlled trials (three individually randomised, parallel group studies, one individually randomised cross-over study and three cluster-randomised trials) and one study was a non-randomised clinical trial. Five studies included a control group receiving usual care, two studies an active control intervention (activities which were not personally tailored) and one study included both an active control and usual care. Personally tailored activities were mainly delivered directly to the participants; in one study the nursing staff were trained to deliver the activities. The selection of activities was based on different theoretical models but the activities did not vary substantially.We found low-quality evidence indicating that personally tailored activities may slightly improve challenging behaviour (standardised mean difference (SMD) -0.21, 95% confidence interval (CI) -0.49 to 0.08; I² = 50%; 6 studies; 439 participants). We also found low-quality evidence from one study that was not included in the meta-analysis, indicating that personally tailored activities may make little or no difference to general restlessness, aggression, uncooperative behaviour, very negative and negative verbal behaviour (180 participants). There was very little evidence related to our other primary outcome of quality of life, which was assessed in only one study. From this study, we found that quality of life rated by proxies was slightly worse in the group receiving personally tailored activities (moderate-quality evidence, mean difference (MD) -1.93, 95% CI -3.63 to -0.23; 139 participants). Self-rated quality of life was only available for a small number of participants, and there was little or no difference between personally tailored activities and usual care on this outcome (low-quality evidence, MD 0.26, 95% CI -3.04 to 3.56; 42 participants). We found low-quality evidence that personally tailored activities may make little or no difference to negative affect (SMD -0.02, 95% CI -0.19 to 0.14; I² = 0%; 6 studies; 589 participants). We found very low quality evidence and are therefore very uncertain whether personally tailored activities have any effect on positive affect (SMD 0.88, 95% CI 0.43 to 1.32; I² = 80%; 6 studies; 498 participants); or mood (SMD -0.02, 95% CI -0.27 to 0.23; I² = 0%; 3 studies; 247 participants). We were not able to undertake a meta-analysis for engagement and the sleep-related outcomes. We found very low quality evidence and are therefore very uncertain whether personally tailored activities improve engagement or sleep-related outcomes (176 and 139 participants, respectively). Two studies that investigated the duration of the effects of personally tailored activities indicated that the intervention effects persisted only during the delivery of the activities. Two studies reported information about adverse effects and no adverse effects were observed. AUTHORS' CONCLUSIONS Offering personally tailored activities to people with dementia in long-term care may slightly improve challenging behaviour. Evidence from one study suggested that it was probably associated with a slight reduction in the quality of life rated by proxies, but may have little or no effect on self-rated quality of life. We acknowledge concerns about the validity of proxy ratings of quality of life in severe dementia. Personally tailored activities may have little or no effect on negative affect and we are uncertain whether they improve positive affect or mood. There was no evidence that interventions were more likely to be effective if based on one specific theoretical model rather than another. Our findings leave us unable to make recommendations about specific activities or the frequency and duration of delivery. Further research should focus on methods for selecting appropriate and meaningful activities for people in different stages of dementia.
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Affiliation(s)
- Ralph Möhler
- Medical Center, Faculty of Medicine, University of FreiburgInstitute for Evidence in Medicine (for Cochrane Germany Foundation)Breisacher Str. 153FreiburgGermany79110
| | - Anna Renom
- Parc de Salut MarDepartment of GeriatricsCarrer Llull, 410BarcelonaSpain08019
| | - Helena Renom
- Hospital de la Santa Creu i Sant PauPhysical Medicine and Rehabilitation (MFRHB)Carrer Sant Antoni Maria Claret, 167BarcelonaBarcelonaSpain08025
| | - Gabriele Meyer
- Martin Luther University Halle‐WittenbergInstitute of Health and Nursing SciencesMagdeburger Straße 8Halle (Saale)Germany06112
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15
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Harrison SL, Kouladjian O'Donnell L, Milte R, Dyer SM, Gnanamanickam ES, Bradley C, Liu E, Hilmer SN, Crotty M. Costs of potentially inappropriate medication use in residential aged care facilities. BMC Geriatr 2018; 18:9. [PMID: 29325531 PMCID: PMC5765623 DOI: 10.1186/s12877-018-0704-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 01/01/2018] [Indexed: 01/25/2023] Open
Abstract
Background The potential harms of some medications may outweigh their potential benefits (inappropriate medication use). Despite recommendations to avoid the use of potentially inappropriate medications (PIMs) in older adults, the prevalence of PIM use is high in different settings including residential aged care. However, it remains unclear what the costs of these medications are in this setting. The main objective of this study was to determine the costs of PIMs in older adults living in residential care. A secondary objective was to examine if there was a difference in costs of PIMs in a home-like model of residential care compared to an Australian standard model of care. Methods Participants included 541 participants from the Investigation Services Provided in the Residential Environment for Dementia (INSPIRED) Study. The INSPIRED study is a cross-sectional study of 17 residential aged care facilities in Australia. 12 month medication costs were determined for the participants and PIMs were identified using the 2015 updated Beers Criteria for older adults. Results Of all of the medications dispensed in 1 year, 15.9% were PIMs and 81.4% of the participants had been exposed to a PIM. Log-linear models showed exposure to a PIM was associated with higher total medication costs (Adjusted β = 0.307, 95% CI 0.235 to 0.379, p < 0.001). The mean proportion (±SD) of medication costs that were spent on PIMs in 1 year was 17.5% (±17.8) (AUD$410.89 ± 479.45 per participant exposed to a PIM). The largest PIM costs arose from proton-pump inhibitors (34.4%), antipsychotics (21.0%) and benzodiazepines (18.7%). The odds of incurring costs from PIMs were 52% lower for those residing in a home-like model of care compared to a standard model of care. Conclusions The use of PIMs for older adults in residential care facilities is high and these medications represent a substantial cost which has the potential to be lowered. Further research should investigate whether medication reviews in this population could lead to potential cost savings and improvement in clinical outcomes. Adopting a home-like model of residential care may be associated with reduced prevalence and costs of PIMs. Electronic supplementary material The online version of this article (10.1186/s12877-018-0704-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S L Harrison
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia. .,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.
| | - L Kouladjian O'Donnell
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - R Milte
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Institute for Choice, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - S M Dyer
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
| | - E S Gnanamanickam
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
| | - C Bradley
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Infection & Immunity - Aboriginal Health, SAHMRI, PO Box 11060, Adelaide, SA, 5001, Australia
| | - E Liu
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - S N Hilmer
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - M Crotty
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
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16
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Cohen-Mansfield J. Activity groups for persons with dementia: Personal predictors of participation, engagement and mood. Psychiatry Res 2017; 257:375-380. [PMID: 28806713 DOI: 10.1016/j.psychres.2017.07.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/16/2017] [Accepted: 07/25/2017] [Indexed: 11/28/2022]
Abstract
This study examined the relationship between personal characteristics and attendance, engagement, sleep, and mood outcomes of persons with dementia participating in group activities. The purpose of this study is to examine which persons with dementia benefit most from group interventions. Sixty-nine persons with dementia were observed by research and therapeutic recreation staff during 10 types of group activities (reading aloud with discussion, choral-singing, baking, creative storytelling, brain games, active games, exercise, reminiscence poetry, holiday newsletter, and holiday discussions) on multiple outcomes (attendance duration, sleep, engagement, active participation, attitude, and positive mood). Correlations between these outcomes and personal characteristics (demographics, functional and medical characteristics, personal preferences for group activities) were conducted. Variables with significant correlations were then entered into regression analyses. Many of the personal characteristics were significantly correlated with the outcomes. Cognitive function was the most consistent predictor of all outcomes. Personal characteristics, particularly cognitive function, can predict the responses of persons with dementia during group activities.
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Affiliation(s)
- Jiska Cohen-Mansfield
- School of Public Health, Sackler Faculty of Medicine, and Minerva Center for Interdisciplinary Study of End of Life, Tel Aviv University, P.O.B. 39040, Ramat Aviv, Tel-Aviv 6139001, Israel.
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17
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Dombrowsky TA. Relationship between engagement and level of functional status in older adults. SAGE Open Med 2017; 5:2050312117727998. [PMID: 28904793 PMCID: PMC5588797 DOI: 10.1177/2050312117727998] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 07/31/2017] [Indexed: 12/23/2022] Open
Abstract
Functional status is an important component of quality of life for older adults and for their caregivers. Factors associated with level of functional status include age, comorbidity, cognitive status, depression, social support, and activity. Of the types of activity linked with functional status, the strongest evidence is for physical exercise, with weaker evidence for social and productive activity. Engagement is a construct including motivation, commitment, and participation.
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Affiliation(s)
- Thomas A Dombrowsky
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, TX, USA
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18
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Cohen-Mansfield J, Hai T, Comishen M. Group engagement in persons with dementia: The concept and its measurement. Psychiatry Res 2017; 251:237-243. [PMID: 28214783 DOI: 10.1016/j.psychres.2017.02.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/29/2016] [Accepted: 02/05/2017] [Indexed: 11/30/2022]
Abstract
Although a few papers documented benefits of group therapeutic activities for individuals with dementia, there is a dearth of studies that have investigated the effects of group activities on persons with dementia. This paper introduces a theoretical framework of studying group therapeutic recreational activity, the Comprehensive Process Model of Group Engagement, and an assessment tool, the Group Observational Measurement of Engagement (GOME). We also report the psychometric properties of this assessment. One hundred and four persons with dementia took part in ten different group activities, with each activity conducted twice at random order so that 20 activities were observed for each group of participants. Following each group activity, research and therapeutic recreation staff members used the GOME assessment to independently rate participants on individual-level measures of attendance duration and engagement, and group level measures (e.g., positive and negative interactions among group members). Reliability and validity analyses comparing observer ratings for each group activity on the individual-level measures of attendance and engagement showed good psychometric properties. Different measures collected on a group level differed with respect to their psychometric quality. We present a theoretical framework to understand group engagement and present measures that could be used in future research and practice.
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Affiliation(s)
- Jiska Cohen-Mansfield
- Department of Health promotion, School of Public Health, Sackler Faculty of Medicine, Minerva Center for Interdisciplinary Study of End of Life, Herczeg Institute on Aging and Igor Orenstein Chair for the Study of Geriatrics, Tel Aviv University, Tel Aviv, Israel.
| | - Tasmia Hai
- Baycrest Health Sciences, Toronto, Canada
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19
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Regier NG, Gitlin LN. Psychosocial and Environmental Treatment Approaches for Behavioral and Psychological Symptoms in Neurocognitive Disorders: an Update and Future Directions. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2017; 4:80-101. [PMID: 37465053 PMCID: PMC10353767 DOI: 10.1007/s40501-017-0105-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Nearly all persons with dementia will exhibit behavioral and psychological symptoms (BPSD) at some point during the course of the disease. These symptoms often pose significant challenges for formal and informal caregivers, and their treatment is unclear. Current guidelines recommend implementing nonpharmacological interventions as the first-line approach to managing BPSD. Given the recent proliferation of research evaluating the use of nonpharmacological interventions for BPSD, there is a continuing need to reevaluate and synthesize the findings in this area. The current review examines the evidence for using psychosocial and environmental strategies, focusing on the past 3 years of research efforts and assessing how this research augments what is known from prior reviews. We conclude that the results in the recent literature concerning the efficacy of psychosocial and environmental treatment approaches to behavioral symptoms in dementia continue to be promising, yet results are also mixed. We recommend the consideration of music therapy and tailored activities when utilizing a nonpharmacological approach, as these appear particularly promising throughout the literature. We also find that multisensory stimulation and animal-assisted therapy warrant further evaluation. In contrast, in this and previous reviews, approaches such as bright light therapy and aromatherapy have consistently been shown to be ineffective and, thus, cannot be recommended with confidence based on the evidence. We discuss limitations of current research studies and make recommendations for future research in the area of psychosocial and environmental interventions for BPSD.
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Affiliation(s)
- Natalie G. Regier
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, 525 North Wolfe Street, SON House Room 301, Baltimore, MD, 21205, USA
- Department of Community and Public Health, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Suite 316, Baltimore, MD, 21205, USA
| | - Laura N. Gitlin
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, 525 North Wolfe Street, SON House Room 301, Baltimore, MD, 21205, USA
- Department of Community and Public Health, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Suite 316, Baltimore, MD, 21205, USA
- Department of Psychiatry, Johns Hopkins School of Medicine, 525 N. Wolfe Street, Suite 316, Baltimore, MD, 21205, USA
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König A, Francis LE, Joshi J, Robillard JM, Hoey J. Qualitative study of affective identities in dementia patients for the design of cognitive assistive technologies. J Rehabil Assist Technol Eng 2017; 4:2055668316685038. [PMID: 31186921 PMCID: PMC6453059 DOI: 10.1177/2055668316685038] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 11/25/2016] [Indexed: 11/16/2022] Open
Abstract
Our overall aim is to develop an emotionally intelligent cognitive assistant
(ICA) to help older adults with Alzheimer's disease (AD) to complete activities
of daily living more independently. For improved adoption, such a system should
take into account how individuals feel about who they are. This paper
investigates different affective identities found in older care home residents
with AD, leading to a computational characterization of these aspects and, thus,
tailored prompts to each specific individual's identity in a way that
potentially ensures smoother and more effective uptake and response. We report
on a set of qualitative interviews with 12 older adult care home residents and
caregivers. The interview covered life domains (family, origin, occupation,
etc.), and feelings related to the ICA. All interviews were transcribed and
analyzed to extract a set of affective identities, coded according to the
social–psychological principles of affect control theory (ACT). Preliminary
results show that a set of identities can be extracted for each participant
(e.g. father, husband). Furthermore, our results provide support for the
proposition that, while identities grounded in memories fade as a person loses
their memory, habitual aspects of identity that reflect the overall “persona”
may persist longer, even without situational context.
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Affiliation(s)
- Alexandra König
- Computational Health Informatics Laboratory (CHIL), David R. Cheriton School of Computer Science, University of Waterloo, Canada.,Intelligent Assistive Technology and Systems Lab (IATSL), University of Toronto, Canada
| | - Linda E Francis
- Department of Sociology and Criminology, Cleveland State University, USA
| | - Jyoti Joshi
- Computational Health Informatics Laboratory (CHIL), David R. Cheriton School of Computer Science, University of Waterloo, Canada
| | - Julie M Robillard
- National Core for Neuroethics, University of British Columbia, Canada
| | - Jesse Hoey
- Computational Health Informatics Laboratory (CHIL), David R. Cheriton School of Computer Science, University of Waterloo, Canada
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21
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Baker JR, Harrison F, Low LF. Development of two measures of client engagement for use in home aged care. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:363-374. [PMID: 25721569 DOI: 10.1111/hsc.12213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/11/2015] [Indexed: 06/04/2023]
Abstract
The aim of the study was to develop and validate measures of client engagement in aged homecare. The Homecare Measure of Engagement-Staff questionnaire (HoME-S) is a self-complete measure of six dimensions of client engagement: client acceptance, attention, attitude, appropriateness, engagement duration and passivity. The Homecare Measure of Engagement-Client/Family report (HoME-CF) is a researcher-rated interview which obtains client and/or family perspectives regarding frequency and valence of conversational and recreational engagement during care worker visits. Care workers (n = 84) completed the HoME-S and a measure of relationship bond with client. Researchers interviewed clients (n = 164) and/or their family (n = 117) and completed the HoME-CF, and measures of agitation, dysphoria, apathy and cognitive functioning. The HoME-S and HoME-CF demonstrated good test-retest and inter-rater reliability, and showed significant negative correlations with apathy, agitation and non-English-speaking background. Controlling for client and care service characteristics, a stronger care worker-client relationship bond and English-speaking background were independently associated with higher HoME-S scores, and apathy was independently associated with higher HoME-CF scores. In conclusion, the HoME-S and HoME-CF are psychometrically sound engagement measures for use in homecare. Clients who are apathetic or from non-English-speaking backgrounds may be less responsive to traditional care worker engagement strategies. Engagement may be augmented in clients who have stronger relationships with their care workers.
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Affiliation(s)
- Jess Rose Baker
- Dementia Collaborative Research Centre, School of Psychiatry, Faculty of Medicine, UNSW Australia, Sydney, New South Wales, Australia
| | - Fleur Harrison
- Dementia Collaborative Research Centre, School of Psychiatry, Faculty of Medicine, UNSW Australia, Sydney, New South Wales, Australia
| | - Lee-Fay Low
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
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22
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Lazar A, Thompson HJ, Demiris G. Design Recommendations for Recreational Systems Involving Older Adults Living With Dementia. J Appl Gerontol 2016; 37:595-619. [PMID: 27106883 DOI: 10.1177/0733464816643880] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
As the population ages, an increasing number of people will be diagnosed with dementia. Studies have found that insufficient activities are offered in memory care units to people with dementia, even though people benefit tremendously from participating in recreational activities. Information and communication technologies (ICT) can potentially facilitate activities in this setting, yet there is little guidance for designers to develop systems that can support people with dementia in engaging in recreational activities. To fill this gap, recommendations were generated through fieldwork and refined in two rounds of expert feedback. Areas covered include hardware, content, applications, and navigation. Systems should be usable by people with dementia, in addition to staff, to counter disempowerment by not enabling people to use their full abilities. In addition, a diversity of materials is needed to appeal to individuals with dementia who have widely varying backgrounds, abilities, interests, and preferences.
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Leng FY, Yeo D, George S, Barr C. Comparison of iPad applications with traditional activities using person-centred care approach: Impact on well-being for persons with dementia. DEMENTIA 2013; 13:265-73. [DOI: 10.1177/1471301213494514] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Professionals working with people with dementia need to develop new activities that occupy patients and increase positive emotions. Dementia care mapping is a reliable method of measuring well-being during activities with people with dementia. The iPad has many applications that may be suitable as a group activity for persons with dementia. Six people with dementia took part in two traditional and two iPad activities over two days. Well-being was recorded using dementia care mapping. Subjects displayed similar or better levels of well-being during iPad activities than traditional activities. A larger variation of behaviors was seen during iPad activities than traditional activities. With detailed planning using a person-centred care approach, iPad group activity has the potential to be as effective and engaging as other conventional activities in achieving well-being.
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Affiliation(s)
- Fong Yoke Leng
- Flinders University of South Australia, Adelaide, South Australia
| | | | - Stacey George
- Flinders University of South Australia, Adelaide, South Australia
| | - Christopher Barr
- Flinders University of South Australia, Adelaide, South Australia
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Kang H. Correlates of Social Engagement in Nursing Home Residents with Dementia. Asian Nurs Res (Korean Soc Nurs Sci) 2012; 6:75-81. [DOI: 10.1016/j.anr.2012.05.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 05/15/2012] [Accepted: 05/15/2012] [Indexed: 11/16/2022] Open
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Clare L, Whitaker R, Quinn C, Jelley H, Hoare Z, Woods B, Downs M, Wilson B. AwareCare: development and validation of an observational measure of awareness in people with severe dementia. Neuropsychol Rehabil 2012; 22:113-33. [PMID: 22264147 DOI: 10.1080/09602011.2011.640467] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Signs of sensory and perceptual awareness can be observed in people with very severe dementia, and may be influenced by the extent to which the environment offers appropriate stimulation. We developed an observational tool, AwareCare, which care staff can use to identify signs of awareness in residents with very severe dementia, based on the concept of the Wessex Head Injury Matrix (WHIM). Using WHIM items as a guide, and following focus groups with care staff and family members, an expert panel identified 28 environmental stimuli and 35 response categories for the initial version of AwareCare. After baseline assessments of cognition, well-being and quality of life were taken, 40 residents were observed individually for 30 minutes on 5 occasions. Based on the observational data, 10 stimulus categories and 14 response categories were identified for further analysis and formed the final version of AwareCare. All participants showed awareness to varying degrees. Social stimuli elicited the most responses. Greater awareness was associated with better cognitive function, self-care, mobility, and responsiveness, but not with proxy-rated quality of life. Understanding the nature of awareness in this group is an important element in ensuring appropriate levels of interaction and stimulation, and hence enhancing quality of care.
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Affiliation(s)
- Linda Clare
- School of Psychology, Bangor University, UK.
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Cohen-Mansfield J, Thein K, Marx MS, Dakheel-Ali M. What are the barriers to performing nonpharmacological interventions for behavioral symptoms in the nursing home? J Am Med Dir Assoc 2012; 13:400-5. [PMID: 21872537 PMCID: PMC3262905 DOI: 10.1016/j.jamda.2011.07.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 07/07/2011] [Accepted: 07/07/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Behavioral symptoms are common in persons with dementia, and nonpharmacological interventions are recommended as the first line of therapy. We describe barriers to conducting nonpharmacological interventions for behavioral symptoms. DESIGN A descriptive study of barriers to intervention delivery in a controlled trial. SETTINGS The study was conducted in six nursing homes in Maryland. PARTICIPANTS Participants were 89 agitated nursing home residents with dementia. INTERVENTION Personalized interventions were developed using the Treatment Routes for Exploring Agitation decision tree protocol. Trained research assistants prepared and delivered the interventions. Feasibility of the interventions was determined. MEASUREMENTS Barriers to Intervention Delivery Assessment, activities of daily living, cognitive functioning, depressed affect, pain, observed agitation, and observed affect. RESULTS Barriers were observed for the categories of resident barriers (specifically, unwillingness to participate; resident attributes, such as unresponsive), barriers related to resident unavailability (resident asleep or eating), and external barriers (staff-related barriers, family-related barriers, environmental barriers, and system process variables). Interventions pertaining to food/drink and to 1-on-1 socializing were found to have the fewest barriers, whereas higher numbers of barriers occurred with puzzles/board games and arts and crafts activities. Moreover, when successful interventions were presented to participants after the feasibility period, we noted fewer barriers, presumably because barrier identification had been used to better tailor interventions to each participant and to the environment. CONCLUSION Knowledge of barriers provides a tool by which to tailor interventions so as to anticipate or circumvent barriers, thereby maximizing intervention delivery.
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Affiliation(s)
- Jiska Cohen-Mansfield
- Research Institute on Aging of Charles E. Smith Life Communities, Rockville, MD 20852, USA.
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Möhler R, Renom A, Renom H, Meyer G. Personally-tailored activities for improving psychosocial outcomes for people with dementia in long-term care. Hippokratia 2012. [DOI: 10.1002/14651858.cd009812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ralph Möhler
- Witten/Herdecke University; School of Nursing Science, Faculty of Health; Stockumer Straße 12 Witten Germany 58453
| | - Anna Renom
- Witten/Herdecke University; School of Nursing Science, Faculty of Health; Stockumer Straße 12 Witten Germany 58453
| | - Helena Renom
- Hospital de la Santa Creu i Sant Pau; Physical Medicine and Rehabilitation (MFRHB); Carrer Sant Antoni Maria Claret, 167 Barcelona Barcelona Spain 08025
| | - Gabriele Meyer
- Witten/Herdecke University; School of Nursing Science, Faculty of Health; Stockumer Straße 12 Witten Germany 58453
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Kolanowski A, Bossen A, Hill N, Guzman-Velez E, Litaker M. Factors associated with sustained attention during an activity intervention in persons with dementia. Dement Geriatr Cogn Disord 2012; 33:233-9. [PMID: 22652933 PMCID: PMC3560398 DOI: 10.1159/000338604] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Are the noncognitive factors of self-reported mood and personality related to sustained attention in nursing home residents with dementia during an activity intervention? METHODS Intervention data from a randomized clinical trial were used to address the aim of this project. Subjects were 128 nursing home residents who were assessed for mood, personality, behavioral indicators of attention, time on task and number of disengagements during an activity intervention. RESULTS More positive self-reported mood was associated with greater behavioral displays of attention during activities, greater time spent engaged in the activities and less disengagement. CONCLUSION To our knowledge, this is the first study to report on the association of mood, personality and sustained attention in nursing home residents with dementia. While the findings are preliminary, they can be used to inform the design of future research.
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Affiliation(s)
- Ann Kolanowski
- School of Nursing, Pennsylvania State University, University Park, PA 16802-6508, USA.
| | - Ann Bossen
- College of Nursing University of Iowa Iowa City, Iowa
| | - Nikki Hill
- School of Nursing The Pennsylvania State University University Park, PA
| | | | - Mark Litaker
- Associate Professor/Director of Biostatistics School of Dentistry University of Alabama Birmingham, AL
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Abstract
BACKGROUND Engagement refers to the act of being occupied or involved with an external stimulus. In dementia, engagement is the antithesis of apathy. OBJECTIVE The Comprehensive Process Model of Engagement was examined, in which environmental, personal, and stimulus characteristics impact the level of engagement. METHODS : Participants were 193 residents of 7 Maryland nursing with a diagnosis of dementia. Stimulus engagement was assessed via the Observational Measure of Engagement, measuring duration, attention, and attitude to the stimulus. Twenty-five stimuli were presented, which were categorized as live human social stimuli, simulated social stimuli, inanimate social stimuli, a reading stimulus, manipulative stimuli, a music stimulus, task and work-related stimuli, and two different self-identity stimuli. RESULTS All stimuli elicited significantly greater engagement in comparison to the control stimulus. In the multivariate model, music significantly increased engagement duration, whereas all other stimuli significantly increased duration, attention, and attitude. Significant environmental variables in the multivariate model that increased engagement were: use of the long introduction with modeling (relative to minimal introduction), any level of sound (especially moderate sound), and the presence of between 2 and 24 people in the room. Significant personal attributes included Mini-Mental State Examination scores, activities of daily living performance and clarity of speech, which were positively associated with higher engagement scores. CONCLUSIONS Results are consistent with the Comprehensive Process Model of Engagement. Personal attributes, environmental factors, and stimulus characteristics all contribute to the level and nature of engagement, with a secondary finding being that exposure to any stimulus elicits engagement in persons with dementia.
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Cohen-Mansfield J, Marx MS, Thein K, Dakheel-Ali M. The impact of stimuli on affect in persons with dementia. J Clin Psychiatry 2011; 72:480-6. [PMID: 21527124 PMCID: PMC3142768 DOI: 10.4088/jcp.09m05694oli] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Accepted: 02/11/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine how presentation of different stimuli impacts affect in nursing home residents with dementia. METHOD Participants were 193 residents aged 60 to 101 years from 7 Maryland nursing homes who had a diagnosis of dementia (derived from the medical chart or obtained from the attending physician). Cognitive functioning was assessed via the Mini-Mental State Examination (MMSE), and data pertaining to activities of daily living were obtained through the Minimum Data Set. Affect was assessed using observations of the 5 moods from Lawton's Modified Behavior Stream. Baseline observations of affect were performed for comparisons. During the study, each participant was presented with 25 predetermined engagement stimuli in random order over a period of 3 weeks. Stimuli were categorized as live social, simulated social, manipulative, work/task-related, music, reading, or individualized to the participant's self-identity. The dates of data collection were 2005-2007. RESULTS Differences between stimulus categories were significant for pleasure (F(6,144) = 25.137, P < .001) and interest (F(6,144) = 18.792, P < .001) but not for negative affect. Pleasure and interest were highest for the live social category, followed by self-identity and simulated social stimuli for pleasure, and for manipulative stimuli in terms of the effect on interest. The lowest levels of pleasure and interest were observed for music. Participants with higher cognitive function had significantly higher pleasure (F(1,97) = 6.27, P < .05). Although the general trend of the impact of the different categories was similar for different levels of cognitive function, there were significant differences in pleasure in response to specific stimuli (interaction effect: F(6,92) = 2.31, P < .05). Overall, social stimuli have the highest impact on affect in persons with dementia. CONCLUSIONS The findings of the present study are important, as affect is a major indicator of quality of life and this study is the first to systematically examine the impact of specific types of stimuli on affect. As live social stimuli are not always readily available, particularly in busy nursing home environments, simulated social stimuli can serve as an effective substitute, and other stimuli should have a role in the activity tool kit in the nursing home. The relative ranking of stimuli was different for interest and pleasure. The findings demonstrate the differential effect of presentation of different types of stimuli on the affect of persons with dementia, and that, while the impact is greater on persons with higher levels of cognitive function, there is a different effect of varying stimuli even in persons with MMSE scores of 3 or lower. Future research should attempt to ascertain a person's degree of interest in stimuli prior to developing an intervention.
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Affiliation(s)
- Jiska Cohen-Mansfield
- Research Institute on Aging, Charles E. Smith Life Communities, 6121 Montrose Rd, Rockville, MD 20852, USA.
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Cohen-Mansfield J, Thein K, Dakheel-Ali M, Marx MS. Engaging nursing home residents with dementia in activities: the effects of modeling, presentation order, time of day, and setting characteristics. Aging Ment Health 2010; 14:471-80. [PMID: 20455123 PMCID: PMC3139216 DOI: 10.1080/13607860903586102] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We examined the impact of setting characteristics and presentation effects on engagement with stimuli in a group of 193 nursing home residents with dementia (recruited from a total of seven nursing homes). Engagement was assessed through systematic observations using the Observational Measurement of Engagement (OME), and data pertaining to setting characteristics (background noise, light, and number of persons in proximity) were recorded via the environmental portion of the Agitation Behavior Mapping Inventory (ABMI; Cohen-Mansfield, Werner, & Marx, (1989). An observational study of agitation in agitated nursing home residents. International Psychogeriatrics, 1, 153-165). Results revealed that study participants were engaged more often with moderate levels of sound and in the presence of a small group of people (from four to nine people). As to the presentation effects, multiple presentations of the same stimulus were found to be appropriate for the severely impaired as well as the moderately cognitively impaired. Moreover, modeling of the appropriate behavior significantly increased engagement, with the severely cognitively impaired residents receiving the greatest benefit from modeling. These findings have direct implications for the way in which caregivers could structure the environment in the nursing home and how they could present stimuli to residents in order to optimize engagement in persons with dementia.
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Affiliation(s)
- Jiska Cohen-Mansfield
- Research Institute on Aging, Charles E. Smith Life Communities, Rockville, MD 20852, USA.
| | - Khin Thein
- Research Institute on Aging, Charles E. Smith Life Communities, Rockville, MD 20852, USA
| | - Maha Dakheel-Ali
- Research Institute on Aging, Charles E. Smith Life Communities, Rockville, MD 20852, USA
| | - Marcia S. Marx
- Research Institute on Aging, Charles E. Smith Life Communities, Rockville, MD 20852, USA
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Cohen-Mansfield J, Marx MS, Thein K, Dakheel-Ali M. The impact of past and present preferences on stimulus engagement in nursing home residents with dementia. Aging Ment Health 2010; 14:67-73. [PMID: 20155522 PMCID: PMC3131104 DOI: 10.1080/13607860902845574] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES We examined engagement with stimuli in 193 nursing home residents with dementia. We hypothesized that activities and stimuli based on a person's past and current preferences would result in more engagement than other activities/stimuli. METHOD The expanded version of the self-identity questionnaire [Cohen-Mansfield, J., Golander, H. & Arheim, G. (2000)] was used to determine participants' past/present interests (as reported by relatives) in the following areas: art, music, babies, pets, reading, television, and office work. We utilized the observational measurement of engagement (Cohen-Mansfield, J., Dakheel-Ali, M., & Marx, M.S. (2009). RESULTS Analysis revealed that residents with current interests in music, art, and pets were more engaged by stimuli that reflect these interests than residents without these interests. CONCLUSION Our findings demonstrate the utility of determining a person's preferences for stimuli in order to predict responsiveness. Lack of prediction for some stimuli may reflect differences between past preferences and activities that are feasible in the present.
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Affiliation(s)
- Jiska Cohen-Mansfield
- Research Institute on Aging, Charles E. Smith Life Communities, Rockville, MD 20852, USA.
| | - Marcia S. Marx
- Research Institute on Aging, Charles E. Smith Life Communities, 6121 Montrose Road, Rockville, MD 20852, USA
| | - Khin Thein
- Research Institute on Aging, Charles E. Smith Life Communities, 6121 Montrose Road, Rockville, MD 20852, USA
| | - Maha Dakheel-Ali
- Research Institute on Aging, Charles E. Smith Life Communities, 6121 Montrose Road, Rockville, MD 20852, USA
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