Designing care environments for persons with Alzheimer's disease: visuoperceptual considerations

Effects of lighting variability on locomotion in posterior cortical atrophy

INTRODUCTION

Clinical reports describe patients with Alzheimer's disease (AD) exhibiting atypical adaptive walking responses to the visual environment; however, there is limited empirical investigation of such behaviors or factors modulating their expression. We aim to evaluate effects of lighting-based interventions and clinical presentation (visual- vs memory-led) on walking function in participants with posterior cortical atrophy (PCA) and typical AD (tAD).

METHODS

Participants with PCA (n = 10), tAD (n = 9), and healthy controls (n = 12) walked to visible target destinations under different lighting conditions within two pilot repeated-measures design investigations (Experiment 1: 32 trials per participant; Experiment 2: 36 trials per participant). Participants walked to destinations with the floorpath interrupted by shadows varying in spatial extent (Experiment 1: no, medium, high shadow) or with different localized parts of the environment illuminated (Experiment 2: target, middle, or distractor illuminated). The primary study outcome for both experimental tasks was completion time; secondary kinematic outcomes were proportions of steps identified as outliers (Experiment 1) and walking path directness (Experiment 2).

RESULTS

In Experiment 1, PCA participants overall demonstrated modest reductions in time taken to reach destinations when walking to destinations uninterrupted by shadows compared to high shadow conditions (7.1% reduction [95% confidence interval 2.5, 11.5; P = .003]). Experiment 2 found no evidence of differences in task performance for different localized lighting conditions in PCA participants overall. Neither experiment found evidence of differences in task performance between conditions in tAD or control participants overall. Completion time in both patient groups was longer relative to controls, and longer in PCA relative to tAD groups.

DISCUSSION

Findings represent a quantitative characterization of a clinical phenomenon involving patients misperceiving shadows, implicating dementia-related cortico-visual impairments. Results contribute to evidence-based design guidelines for dementia-friendly environments.

Against environmental anaesthesia: investigating resident engagement with a magnetic participative art installation on a secure care unit

Secure long-term care units come with a unique set of challenges, particularly around exit-seeking behaviour. Arts-based environmental interventions on secure units successfully reduce problematic behaviours, while simultaneously ensuring resident safety and improving resident quality of life. The present arts-based project enhanced a distraction mural intervention to incorporate magnets as a participative arts feature. The project was evaluated through a roundtable discussion with unit staff. Findings showed that in addition to reducing exit-seeking behaviour, the magnets provided an aesthetically engaging set of objects for residents to gather up and hold, to pause and explore, and to create order. Challenges with direct care staff are identified and future ideas for arts-based projects on secure units are considered.

A meta-review of stress, coping and interventions in dementia and dementia caregiving

Background

There has been a substantial number of systematic reviews of stress, coping and interventions for people with dementia and their caregivers. This paper provides a meta-review of this literature 1988-2014.

Method

A meta-review was carried out of systematic reviews of stress, coping and interventions for people with dementia and their caregivers, using SCOPUS, Google Scholar and CINAHL Plus databases and manual searches.

Results

The meta-review identified 45 systematic reviews, of which 15 were meta-analyses. Thirty one reviews addressed the effects of interventions and 14 addressed the results of correlational studies of factors associated with stress and coping. Of the 31 systematic reviews dealing with intervention studies, 22 focused on caregivers, 6 focused on people with dementia and 3 addressed both groups. Overall, benefits in terms of psychological measures of mental health and depression were generally found for the use of problem focused coping strategies and acceptance and social-emotional support coping strategies. Poor outcomes were associated with wishful thinking, denial, and avoidance coping strategies. The interventions addressed in the systematic reviews were extremely varied and encompassed Psychosocial, Psychoeducational, Technical, Therapy, Support Groups and Multicomponent interventions. Specific outcome measures used in the primary sources covered by the systematic reviews were also extremely varied but could be grouped into three dimensions, viz., a broad dimension of “Psychological Well-Being v. Psychological Morbidity” and two narrower dimensions of “Knowledge and Coping” and of “Institutionalisation Delay”.

Conclusions

This meta-review supports the conclusion that being a caregiver for people with dementia is associated with psychological stress and physical ill-health. Benefits in terms of mental health and depression were generally found for caregiver coping strategies involving problem focus, acceptance and social-emotional support. Negative outcomes for caregivers were associated with wishful thinking, denial and avoidance coping strategies. Psychosocial and Psychoeducational interventions were beneficial for caregivers and for people with dementia. Support groups, Multicomponent interventions and Joint Engagements by both caregivers and people with dementia were generally found to be beneficial. It was notable that virtually all reviews addressed very general coping strategies for stress broadly considered, rather than in terms of specific remedies for specific sources of stress. Investigation of specific stressors and remedies would seem to be a useful area for future research.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-016-0280-8) contains supplementary material, which is available to authorized users.

Using the Pool Activity Level instrument to support meaningful activity for a person with dementia: A case study

Statement of context

Activity participation is beneficial for the wellbeing of people with dementia; however, care staff and caregivers experience difficulties with facilitating activity for this client group.

Critical reflection on practice

This practice analysis outlines the therapy process conducted by an occupational therapist using the Pool Activity Level instrument, to support meaningful activity for a person with dementia, in an acute inpatient environment.

Implications for practice

The Pool Activity Level instrument enables people with dementia to engage in meaningful activity. Occupational therapists are well positioned to integrate this tool within daily care, to enable all staff and caregivers to engage alongside a person with dementia in activity at an appropriate level.

Exploring staff perceptions on the role of physical environment in dementia care setting

This study explored staff perceptions of the role of physical environment in dementia care facilities in affecting resident’s behaviors and staff care practice. We conducted focus groups with staff (n = 15) in two purposely selected care facilities in Vancouver, Canada. Focus group participants included nurses, care aides, recreation staff, administrative staff, and family. Data analysis revealed two themes: (a) a supportive physical environment contributes positively to both quality of staff care interaction and residents’ quality of life and (b) an unsupportive physical environment contributes negatively to residents’ quality of life and thereby makes the work of staff more challenging. The staff participants collectively viewed that comfort, familiarity, and an organized space were important therapeutic resources for supporting the well-being of residents. Certain behaviors of residents were influenced by poor environmental factors, including stimulation overload, safety risks, wayfinding challenge, and rushed care. This study demonstrates the complex interrelationships among the dementia care setting’s physical environment, staff experiences, and residents’ quality of life.

'Once I had money in my pocket, I was every colour under the sun': using 'appearance biographies' to explore the meanings of appearance for people with dementia

Appearance and the work invested in it by and for people with dementia are a neglected issue within dementia studies. In policy and practice there exists an assumption that the role of supporting a person to manage their appearance is easily assumed by another within caring encounters, only to be subsumed within the daily task-oriented provision of care. This paper reports on interviews conducted as part of the Hair and Care project, which explored questions of appearance and the meanings it holds with people with dementia. The research used 'appearance biographies', a method which allows for a range of topics to be considered about appearance throughout the life course, acting as a conduit for reminiscence and life story work. The paper reports on the key themes and findings from these interviews, discussing them in the context of a wider debate on dementia, self-expression and agency. A key question posed by the authors is whether appearance and the work invested in it are legitimate considerations for dementia care policy and practice. And if so, how should we make sense of this work and what significance should we attach to it? In seeking to answer these questions the authors position the perspectives and experiences of people with dementia as central to their analysis. A narrative framework is suggested as a useful basis on which to understand the work of managing appearance over the life course. The implications for policy and practice are outlined.

Embodiment and dementia: exploring critical narratives of selfhood, surveillance, and dementia care

In the last decade there has been a notable increase in efforts to expand understandings of dementia by incorporating the body and theorizing its interrelationship with the larger social order. This emerging subfield of dementia studies puts the body and embodied practices at the center of explorations of how dementia is represented and/or experienced. This shift towards a greater recognition of the way that humans are embodied has expanded the horizon of dementia studies, providing the intellectual and narrative resources to examine experiences of dementia, and their interconnections with history, culture, power, and discourse. Our aim in this paper is to critically explore and review dimensions of this expanding research and literature, specifically in relation to three key narratives: (1) rethinking selfhood: exploring embodied dimensions; (2) surveillance, discipline, and the body in dementia and dementia care; and (3) embodied innovations in dementia care practice. We argue that this literature collectively destabilizes dementia as a taken-for-granted category and has generated critical texts on the interrelationship between the body and social and political processes in the production and expression of dementia.

Visual functioning in nursing home residents: information in client records

AIM AND OBJECTIVES

To improve (eye)care in nursing homes by reporting and assessing visual functioning to enhance professional caregivers' awareness of visual problems.

BACKGROUND

Older adults experience visual problems owing to biological ageing or eye disease. In the Netherlands, the prevalence of visual impairments is the highest in the subgroup of nursing home residents (41.3%). These impairments influence quality of life in terms of limiting daily activities and participation in social activities. Furthermore, 63% of visual problems are defined as 'avoidable blindness'. For this reason, screening of visual functioning in the nursing home is of major importance. Moreover, visual functioning should also be taken into account to prevent the incidence of falls.

DESIGN

A field study on recorded information of visual functioning and visual assessment in nursing homes.

METHODS

Assessment of visual functioning of 259 residents in nursing homes. Subsequently, recorded information in client files is related to the assessment outcome.

RESULTS

Only in 101 (39%) of the 259 client records was some information on visual functioning found in client files. Whether a prescription for new glasses was dispensed made no difference in reporting on visual functioning in the client record. In more than half of the cases assessed as 'low vision or blindness', no information about visual functioning was found. Furthermore, no information was found in 31% (80/259) cases of suspected visual problems (referrals). A significant proportion of client records (p < 0.05) showed no recorded information in cases of referral for further check-up.

CONCLUSIONS

In this study, one-third of nursing homes residents have visual problems, needing examination by an ophthalmologist. Problems with visual functioning should be assessed and captured in client records. Awareness of residents' visual functioning is a prerequisite for adapting basic daily care to the residents' needs.

Effectiveness of Interventions Designed to Modify and Maintain Perceptual Abilities in People With Alzheimer’s Disease and Related Dementias

An evidence-based review was undertaken to answer the question, “What is the evidence for the effect of interventions designed to modify and maintain perceptual abilities on the occupational performance of people with Alzheimer’s disease and related dementias?” A systematic search of electronic databases and application of inclusion and exclusion criteria guided the selection of 31 articles. Each article was critically appraised, and the evidence was synthesized. Some interventions use remaining perceptual abilities to enable people to find their way in a facility and decrease attempts at exiting. Preliminary evidence has supported use of visual stimulation and barriers. We found some evidence for the use of auditory stimuli and group therapy that aim to change perceptual abilities. Research with high-level evidence is required to validate these findings. Evidence on the benefits of Snoezelen® is not conclusive for occupational performance outcomes; further research to justify its use as an occupational therapy intervention may be warranted.