The underlying meaning of stimuli: Impact on engagement of persons with dementia

Feasibility and Effects of Namaste Care for Persons with Advanced Dementia in Canadian Long-Term Care Homes

OBJECTIVE

To evaluate the feasibility and effects of the Namaste Care intervention for persons with advanced dementia (ie, moderate and late-stage) in long-term care (LTC) and their family carers.

DESIGN

A pre-posttest study design. Staff carers delivered Namaste Care for residents with the support of volunteers in a small group setting. Activities provided included aromatherapy, music, and snacks/beverages.

SETTING AND PARTICIPANTS

Residents with advanced dementia and family carers from 2 Canadian LTC homes, located in a midsize metropolitan area, were included.

METHODS

Feasibility was evaluated using a research activity log. Outcome data for residents (ie, quality of life, neuropsychiatric symptoms, pain) and family carers (ie, role stress, quality of family visits) were collected at baseline and 3 and 6 months of the intervention. Descriptive analyses and generalized estimating equations were used for quantitative data.

RESULTS

A total of 53 residents with advanced dementia and 42 family carers participated in the study. Mixed findings were found for feasibility as not all intervention targets were met. There was a significant improvement in resident neuropsychiatric symptoms at the 3-month time point only (95% CI -9.39, -0.39; P = .033) and family carer role stress at both time points (3-month 95% CI -37.40, -1.80; P = .031; 6-month 95% CI -48.90, -2.09; P = .033).

CONCLUSIONS AND IMPLICATIONS

Namaste Care is an intervention with preliminary evidence of impact. Feasibility findings revealed that not all targets were met as the intended number of sessions were not delivered. Future research should explore how many sessions per week are required to lead to an impact. It is important to assess outcomes for both residents and family carers, and to consider enhancing family engagement in delivering the intervention. Given the promise of this intervention, a large-scale randomized controlled trial with a longer follow-up should be conducted to further evaluate its outcomes.

Measuring engagement among older adults using a multidimensional approach to communication

Characterizing older adult engagement is important to determine the effectiveness of interventions. Engagement refers to the occupying of oneself in external stimuli and is observable across multiple dimensions of behavior. Engagement of older adults is commonly investigated using a single behavioral dimension. There is a dearth of analytical methods that can simultaneously quantify both verbal and non-verbal forms of communication as proxies for engagement. In this article, we present a multidimensional technique to measure engagement of older adults using techniques appropriate for people with varying degrees of dementia. The new analytical approach measures facial movement, lexical use, and prosodic patterns of speech as indices of affective and behavioral outcomes of engagement. Contexts for engagement included a dyadic reminiscence therapy interview and a 12-week technology-driven group reminiscence therapy. Illustrative examples of the technique are described by two participants from two different groups in a naturalistic setting. Application of these analytical techniques can enhance measurement precision and further develop the science and evidence base, especially for, but not confined to, non-pharmacological interventions.

The Impact of a Dementia-Friendly Garden Design on People With Dementia in a Residential Aged Care Facility: A Case Study

BACKGROUND

There is a paucity of evidence on the efficacy of garden design based on dementia-friendly environment (DFE) characteristics on the level of agitation, apathy, and engagement of people with dementia in residential aged care facilities (RACFs).

OBJECTIVE

To investigate the effect of a garden improved according to DFE characteristics on agitation, apathy, and engagement of people with dementia in one RACF.

METHODS

A case study design with a mixed-method approach was used.

RESULTS

There was no significant improvement in the level of participants' agitation following visits to the improved garden, χ²(2) = 5.167, p = .076. A high level of engagement was found in participants during the intervention (Week 1-1, p < .01; Week 1-2, p < .01; Week 2, p < .01; Week 3, p < .05; and Week 4, p < .05) when compared to before intervention (Week 0). A higher level of apathy was found in participants at Week 0 when compared to during the intervention (Week 1-1, p < .05; Week 1-2, p < .01; Week 2, p < .05; Week 3, p < .01; and Week 4, p < .01). Five themes emerged from participant interviews: the presence of sensory-provoking elements in the garden, meaningful engagement in the garden, accessibility of the garden, garden impacts, and garden experiences that demonstrated the effectiveness of the garden.

CONCLUSIONS

The garden promoted engagement and decreased apathy of people with dementia living in the RACF with the researcher's partial facilitation of the intervention sessions. The qualitative findings indicated the effectiveness of the garden in reducing agitation.

The association among apathy, leisure activity participation, and severity of dementia in nursing home residents with Alzheimer's disease: A cross-sectional study

The purpose of this study was to examine 1) the relationship between apathy and leisure activity participation in nursing home residents with Alzheimer disease (AD) and 2) the moderator effect of the severity of dementia on this relationship. Data were collected from 290 residents with AD using the Apathy Evaluation Scale-informant version (AES-I), Leisure Activities Questionnaire (LAQ), and Clinical Dementia Rating scale (CDR). The multiple linear regression model showed that leisure activity participation (β=-0.452, p<0.001) was negatively associated with apathy, while the severity of dementia (β=0.515, p<0.001) was positively associated with apathy. The severity of dementia moderated the effect of leisure activity participation on apathy (β=-0.108, p=0.015). The results indicate that the effects of leisure activity participation on apathy diminish with the aggravation of AD. The severity of dementia should be considered when designing and delivering leisure activity interventions to manage apathy in nursing home residents with AD.

Dog visits in nursing homes - increase complexity or keep it simple? A randomised controlled study

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: F_1,85 = 5.17, P < 0.05) and talking to it directly (period 1: F_1,90 = 4.60, P < 0.05; period 3: F_1,87 = 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: F_1,89 = 7.89, P < 0.01; period 2: F_1,97 = 6.76, P = 0.01; period 3: F_1,92 = 13.57, P < 0.001) and talking about the activities (period 1: F_1,89 = 13.78, P <0.001; period 2: F_1,88 = 3.27, P = 0.07; period 3: F_1,86 = 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.

What are the elements needed to create an effective visual art intervention for people with dementia? A qualitative exploration

BACKGROUND

This article aimed to advance the understanding of 'what works' in visual art interventions from the perspective of key stakeholders, including people with dementia, their family members and visual art professionals.

METHOD

Semi-structured interviews were conducted with 22 participants, exploring their perceptions on barriers, facilitators, perceived benefits, experiences of delivering/attending a visual art intervention and any recommendations for implementation.

RESULTS

Five factors were identified within the interviews that indicated important considerations for intervention structure and implementation, including benefits of group work, a skilled facilitator, participant choice, artistic ability and activity content. While art therapists expressed a clear protection of professional boundaries, the success of all of the visual art interventions was largely attributed to the supportive facilitator who possessed certain core values such as empathy and compassion and had knowledge in both artistic practice and the impact of living with dementia. It was clear the group dynamic was valued, and it was important to provide enjoyable, failure-free activity content with a strong focus on the creative process.

CONCLUSION

These findings offer a direction for evidence-based practice when implementing visual art interventions.

The Rights of Persons With Dementia and Their Meanings

Concern about the lack of human rights afforded to persons living with dementia has emerged in recent years. Although the literature addresses certain rights, it does not include a holistic framework of rights in terms of the lived experience of older persons with cognitive impairment. Inspired by the 20 rights advocated for children by physician-educator Janusz Korczak, this article analyzes his formulation of rights in the context of persons with dementia, linking them to the ethical principles of Beneficence, Autonomy, and Justice. The analysis thus provides a holistic framework for addressing the human rights of persons with dementia, and their meanings for the lived experiences of persons with dementia and their caregivers. It offers new insights into the philosophy and practice of care, with implications for dementia care research, public health policy, practice guidelines for health care professionals, and the instruction of family and other caregivers of persons with dementia.

Apathy in Nursing Home Residents with Dementia: Results From A Cluster-Randomized Controlled Trial

Purpose:

Here we evaluate an interdisciplinary occupational and sport therapy intervention for dementia patients suffering from apathy.

Subjects and methods:

A prospective, controlled, rater-blinded, clinical trial with two follow-ups was conducted as part of a larger cluster-randomized trial in 18 nursing homes in Berlin. n = 117 dementia patients with apathy, defined as a score of 40 or more on the apathy evaluation scale (AES) or presence of apathy on the Neuropsychiatric Inventory (NPI), were randomly assigned to intervention or control group. The intervention included 10 months of brief activities, provided once a week. The primary outcome measure was the total score on the AES scale measured directly after the intervention period and again after 12 months.

Results:

We found significant group differences with respect to apathy during the 10 month intervention period (F2,82 = 7.79, P < 0.01), which reflected an increase in apathy in the control group, but not in the intervention group. Within one year after the intervention was ceased, the treatment group worsened and no longer differed significantly from the control group (P = 0.55).

Conclusions:

Our intervention was effective for the therapy of apathy in dementia, when applied, but not one year after cessation of therapy.

Namaste care in the home setting: developing initial realist explanatory theories and uncovering unintended outcomes

INTRODUCTION

The End-of-Life Namaste Care Program for People with Dementia, challenges the misconception that people with dementia are a 'shell'; it provides a holistic approach using the five senses, which can provide positive ways of communicating and emotional responses. It is proposed Namaste Care can improve communication and the relationships families and friends have with the person with dementia. Previously used in care homes, this study is the first to explore the pioneering use of Namaste Care in people's own homes.

OBJECTIVE

To develop initial programme theories detailing if, how and under which circumstances Namaste Care works when implemented at home.

DESIGN

A qualitative realist approach following the RAMESES II guidelines was employed to understand not only whether Namaste Care has positive outcomes, but also how these are generated, for whom they happen and in which circumstances.

SETTING

A hospice in the North East of England, operating in the community, through volunteers.

PARTICIPANTS

Programme theories were developed from three focus groups with volunteers implementing Namaste Care (n=8; n=8; n=11) and eight interviews with family carers (n=8).

RESULTS

Four refined explanatory theories are presented: increasing engagement, respite for family carers, importance of matched volunteers and increasing social interaction. It was identified that while Namaste Care achieved some of the same goals in the home setting as it does in the care home setting, it could also function in a different way that promoted socialisation.

CONCLUSIONS

Namaste Care provides holistic and personalised care to people with both moderate and advanced dementia, improving engagement and reducing social isolation. In the present study carers often chose to use Namaste Care sessions as respite. This was often linked to their frustration of the unavoidable dominance of task-focussed care in daily life. Individualised Namaste Care activities thus led to positive outcomes for both those with dementia and their carers.

Are We There Yet? Immersive Virtual Reality to Improve Cognitive Function in Dementia and Mild Cognitive Impairment

Background and Objectives

Cognitive training therapies may delay cognitive deterioration in dementia. There is potential to enhance delivery through immersive virtual reality (IVR), as removing potential distractors for cognitively impaired individuals can enhance their experience, resulting in increased engagement. Evidence in this field is emerging and not yet synthesized. We aimed to summarize research investigating the use of IVR in dementia to evaluate the current extent of use, acceptability, feasibility, and potential effectiveness. We also aimed to identify gaps in current research and to create a set of recommendations in utilizing this therapy.

Research Design and Methods

A systematic literature review was conducted. Our review was registered with PROSPERO, registration number: CRD42019122295. We undertook searches of five databases, article references, and citations. Key authors in the field of health care VR were also contacted to identify additional papers. Articles were assessed for inclusion by two researchers independently. Data were extracted using standardized forms.

Results

Our search identified a total of 2,824 citations, following screening for duplicates and application of inclusion and exclusion criteria, five studies were included for analysis. Included studies were heterogeneous, with small sample sizes and mixed outcomes.

Discussion and Implications

We were unable to reach definitive conclusions over the use, acceptability, and effectiveness of IVR for dementia and mild cognitive impairment. Future studies should focus on ensuring their interventions are truly immersive, developing more robust controls and account for the rapid rate of obsolescence in digital technologies.

Digging into the experiences of therapeutic gardening for people with dementia: An interpretative phenomenological analysis

Gardening programmes aim to promote improved engagement and quality of life in persons with dementia. Although a substantial literature has amassed documenting the overall positive outcomes associated with therapeutic gardening and horticulture for persons with dementia, little is known about the specific aspects of the gardening process that engender these benefits, and how and why they are important. The purpose of this research was to explore, using interpretative phenomenological analysis, the experiences of therapeutic gardening for persons with dementia, and their perspectives on the senses and emotions elicited in the gardening process that promote well-being. The themes that emerged in our analysis are to varying degrees substantiated in the literature: the usefulness of activating the senses, particularly those of touch and smell; the significance of being occupied in meaningful, productive work; the importance of cultivating a sense of curiosity, wonder, and learning; the positive gains derived from socialization in a group context; the peace and hope derived from being 'in the moment'; and the positive mental and physical well-being derived from participating in the outdoor garden. Our findings support the integration of therapeutic gardening as a valuable practice for people with dementia.

The development of positive psychology outcome measures and their uses in dementia research: A systematic review

Positive psychology is gaining credence within dementia research but currently there is a lack of outcome measures within this area developed specifically for people with dementia. Authors have begun adopting positive psychology measures developed with other populations but there is no consensus around which are more appropriate or psychometrically robust. A systematic search identified measures used between 1998 and 2017 and an appraisal of the development procedure was undertaken using standardised criteria enabling the awarding of scores based on reporting of psychometric information. Twelve measures within the constructs of identity, hope, religiosity/spirituality, life valuation, self-efficacy, community and wellbeing were identified as being used within 17 dementia studies. Development procedures were variable and scores on development criterion reflected this variability. Of the measures included, the Herth Hope Index, Systems of Belief Inventory and Psychological Wellbeing Scale appeared to be the most robustly developed and appropriate for people with dementia.

Predictors of activity involvement in dementia care homes: a cross-sectional study

Background

Despite the finding that involvement in activities is one of the most important needs of residents with dementia living in care homes, care facilities struggle to fulfill this need. Over the years, various factors are suggested which may contribute to or disable activity provision in dementia care homes. These include limited financial resources, task oriented staff and disease-related characteristics of residents. This study aims to further clarify which of these factors predict higher activity involvement.

Methods

Data were derived from the second measurement (2011) of the Living Arrangements for people with Dementia study. One thousand two hundred eighteen people residing in 139 dementia care homes were involved. Forty predictors of higher involvement were studied. Multilevel backward regression analyses were performed.

Results

The most important predictors of higher involvement were: absence of agitation, less ADL dependency, and a higher cognitive status of the residents, higher staff educational level, lower experienced job demands by care staff and a smaller number of residents living in the dementia care wards of a facility. More social supervisor support as perceived by staff was found to predict less activity involvement.

Conclusions

To increase the activity involvement of care home residents with dementia it seems vital to: 1) reduce staff’s experienced job demands; 2) elevate their overall educational level; 3) train staff to provide suitable activities, taking account of the behavior and preserved capabilities of residents; and 4) foster transition towards small-scale care. In order to achieve these aims, care organizations might need to evaluate the use of their financial means.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-017-0564-7) contains supplementary material, which is available to authorized users.

Group engagement in persons with dementia: The concept and its measurement

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.

Qualitative study of affective identities in dementia patients for the design of cognitive assistive technologies

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.

[Study of engagement in a group of people with dementia in traditional care settings and a group with person centred care]

INTRODUCTION

People with dementia in the residential care setting have a high level of apathy and disengagement. The lack of stimulation and customised activities, a common aspect in residential centres, could be contextual elements that promote these behaviours. The person-centred care model (PCCM) promotes the participation of people in their daily activities in relation to their resources, interests, and needs. The aim of this study is to compare the frequency of engagement behaviours in the daily activities in two groups of users residing in Psychogeriatric Units, one receiving a traditional care model and the other assisted under PCCM.

METHODOLOGY

The study involved 28 patients with cognitive impairment in Psychogeriatric Units, 14 of whom were in a traditional unit (control group), and 14 were in a unit where PCCM (experimental group) was implemented. Groups were equivalent in cognitive impairment, functional capabilities, and years in the long-term care institution. The Registering Engagement Instrument (REI) was used to observe the frequency of 12 categories of engagement behaviour in two distinct periods in both groups: before the interventions associated with PCCM, and 18 months after starting them.

RESULTS

Both groups increased the frequency of their engagement behaviours in the post-evaluation, but the experimental group decreased their disengagement behaviours while the control group increased them.

CONCLUSIONS

According to the data, PCCM interventions could reduce disengagement behaviours in the residential context, and could facilitate the participation and involvement in the activities of daily living.

Engagement in elderly persons with dementia attending animal-assisted group activity

The need for meaningful activities that enhance engagement is very important among persons with dementia (PWDs), both for PWDs still living at home, as well as for PWDs admitted to a nursing home (NH). In this study, we systematically registered behaviours related to engagement in a group animal-assisted activity (AAA) intervention for 21 PWDs in NHs and among 28 home-dwelling PWDs attending a day care centre. The participants interacted with a dog and its handler for 30 minutes, twice a week for 12 weeks. Video-recordings were carried out early (week 2) and late (week 10) during the intervention period and behaviours were categorized by the use of an ethogram. AAA seems to create engagement in PWDs, and might be a suitable and health promoting intervention for both NH residents and participants of a day care centre. Degree of dementia should be considered when planning individual or group based AAA.

A Feasibility Study with Image-Based Rendered Virtual Reality in Patients with Mild Cognitive Impairment and Dementia

Virtual Reality (VR) has emerged as a promising tool in many domains of therapy and rehabilitation, and has recently attracted the attention of researchers and clinicians working with elderly people with MCI, Alzheimer’s disease and related disorders. Here we present a study testing the feasibility of using highly realistic image-based rendered VR with patients with MCI and dementia. We designed an attentional task to train selective and sustained attention, and we tested a VR and a paper version of this task in a single-session within-subjects design. Results showed that participants with MCI and dementia reported to be highly satisfied and interested in the task, and they reported high feelings of security, low discomfort, anxiety and fatigue. In addition, participants reported a preference for the VR condition compared to the paper condition, even if the task was more difficult. Interestingly, apathetic participants showed a preference for the VR condition stronger than that of non-apathetic participants. These findings suggest that VR-based training can be considered as an interesting tool to improve adherence to cognitive training in elderly people with cognitive impairment.

A systematic review of strategies to foster activity engagement in persons with dementia

Dementia is a growing public health issue. Activity, a positive therapeutic modality, has potential to enhance quality of life and reduce behavioral symptoms in persons with dementia--outcomes eluding pharmacological treatments. However, it is unclear how to effectively engage persons with dementia in activities for them to derive desired benefits. We present a systematic review of 28 studies involving 50 tests of different ways of modifying activities to enhance engagement and reduce behavioral and psychological symptoms for this group. Of 50 tests, 22 (44%) evaluated changes to objects and properties (e.g., introducing activities with intrinsic interest), 6 (12%) evaluated changes to space demands (e.g., lighting, noise levels), 8 (16%) evaluated changes to social demands (e.g., prompts, praise), and 14 (28%) combined two or more activity modifications. No modifications were made to the sequence and timing of activities. Although modifications to objects and properties were the most common, outcomes for engagement and behaviors were mixed. Modifications to space and social demands were less frequently tested, but consistently yielded positive outcomes. No modifications resulted in negative behavioral outcomes or decreased engagement. Methodological strengths of studies included direct observation of outcomes and fidelity assessments. Few studies however involved persons with dementia at home. Our review revealed a growing evidentiary base for different modifications to foster engagement in activities and reduce behavioral and psychological symptoms. Future studies should evaluate how contextual factors (e.g., physical environment, activity type) and caregiver ability to employ activity modifications affect engagement.

Wellbeing-enhancing occupation and organizational and environmental contributors in long-term dementia care facilities: an explorative study

BACKGROUND

Occupation remains an unmet need in long-term dementia care. To increase residents' occupation, knowledge of types of occupation related to wellbeing, and organizational and environmental characteristics encouraging involvement in these types of occupation, is indispensable.

METHODS

In this explorative study, Dementia Care Mapping was used to study involvement in different types of occupation and wellbeing among 57 residents of 10 dementia care facilities. For each type of occupation, mean experienced wellbeing was studied. Occupation types with high mean wellbeing scores were classified as "wellbeing-enhancing occupation." Care facilities were ranked according to the mean time residents spent in types of wellbeing-enhancing occupation. Using information on staff-to-resident ratio, individual space, and items of the Physical Environment Evaluation Component of Dementia Care Mapping, organizational and environmental characteristics of the facilities were compared to study their relationship with wellbeing-enhancing occupation.

RESULTS

Reminiscence, leisure, expression, and vocational occupation had greatest potential to enhance wellbeing, but these types were seldom offered. Much variation existed in the extent to which wellbeing-enhancing occupation was provided. Long-term care facilities that did so more frequently generally had a more homelike atmosphere, supported social interaction through the environment, and had no central activity program.

CONCLUSIONS

This study suggests that it is possible to engage residents in wellbeing-enhancing occupation, within current means of budget and staff. The physical environment and care organization might play a role, but the key factor seems to equip staff with skills to integrate wellbeing-enhancing occupation into care practice.

Comparison of iPad applications with traditional activities using person-centred care approach: Impact on well-being for persons with dementia

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.

Management of apathy in nursing homes using a teaching program for care staff: the STIM-EHPAD study

OBJECTIVE

This study aimed to evaluate the effectiveness of a nursing home (NH) staff education to manage apathy in older individuals with a diagnosis of dementia.

METHODS

Sixteen NHs agreed to participate, and 230 demented apathetic residents were randomly assigned to the reference group (RG) or the intervention group (IG). IG received a month of weekly 4-h training. Qualitative evaluation was performed through interviews and questionnaires regarding work practices and knowledge about dementia. Quantitative evaluation was at baseline, at the end of the training program (week 4), and 3 months after the end of it with the use of the Neuropsychiatric Inventory (NPI), the Apathy Inventory, and two observation scales.

RESULTS

In the qualitative evaluation, very few staff responded to the questionnaire. Concerning the difficulty that managing residents' behavioral symptoms presented, aggressiveness was ranked as the most difficult behavior to manage and apathy as the least difficult. In the quantitative evaluation, the results are as follows. NPI: the IG scores increased from baseline to week 4 more than the RG for symptoms belonging to the affective and the psychotic NPI item subgroup. Apathy Inventory: there was a significant decrease of the emotional blunting score dimension in the IG. Group Observation Scale: significant improvement was observed for the emotional blunting dimension in the IG only.

CONCLUSIONS

Apathy is rarely identified as a problem in NH. Emotional blunting was the only dimension sensitive to change. Failure to improve residents' level of interest could be explained by the difficulties encountered in accessing information regarding the subjects' personal interests. But it remains possible to modify residents' emotional reactivity and staff's perceptions of residents' behaviors and emotions.

Nursing home residents' challenges with socialisation: can nurses help?

Nursing home residents experience significant changes in their social and emotional connections as a result of the unique challenges associated with their environment. One of the greatest changes is with whom they communicate on a day-to-day basis. It is essential that social integration and, subsequently, social bonds develop in order to reinforce a sense of person, confidence, and hope. However, there are multiple and varied factors, such as cognitive impairment of other residents, which make building meaningful relationships especially challenging. This article investigates the challenges confronting cognitively intact nursing home residents and their impact toward successful socialisation in their environment. Based on findings in the literature, recommendations for strategies that nurses can use to promote a sense of community and feelings of being at home for residents are explored and areas for research identified.

AwareCare: development and validation of an observational measure of awareness in people with severe dementia

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.

The comprehensive process model of engagement

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.

The impact of past and present preferences on stimulus engagement in nursing home residents with dementia

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.