Association between environmental stimulation and apathy in nursing home residents with dementia

OBJECTIVES

Prior research and theories established the link between care environments and apathy. Yet, empirical evidence on how environmental stimulation impacts apathy is lacking. This study examined the association between environmental stimulation and apathy in nursing home residents with dementia.

DESIGN

This repeated-measure study analyzed 104 video observations of staff caregiver-resident interactions.

SETTING

12 nursing homes.

PARTICIPANTS

63 unique staff caregiver-resident dyads that involved 42 caregivers and 44 residents with moderate to severe dementia.

MEASUREMENTS

Second-by-second behavioral coding using Noldus Observer software was conducted to assess apathy and environmental stimulation, using the Person-Environment Apathy Rating scale. The environment subscale includes six items: stimulation clarity, stimulation strength, stimulation specificity, interaction involvement, physical accessibility, and environmental feedback. The apathy subscale includes six items: facial expression, eye contact, physical engagement, purposeful activity, verbal tone, and verbal expression. Multilevel linear models were used for analysis.

RESULTS

Results showed that apathy was not associated with the overall quality of environmental stimulation but was significantly associated with stimulation specificity (coefficient = -2.23, p = 0.049). However, the association was not significant after controlling for resident characteristics (p = 0.082). In addition, higher levels of environmental feedback were associated with lower apathy levels (coefficient = -2.14, p = 0.001). The association remained significant after controlling for resident characteristics (coefficient = -1.65, p = 0.014).

CONCLUSION

Findings reveal that when environmental stimulation is individually tailored and prompts engagement, residents are less apathetic. This study highlights the effect of environmental stimulation on apathy. Future research should explore interventions that modify environmental stimulation to reduce apathy and improve dementia care.

Profile of nursing home residents with dementia who require assistance with mouth care

The majority of nursing home residents require assistance with activities of daily living, including oral care. Poor oral health is common in the nursing home because residents are not given appropriate assistance to support this aspect of their care. The purpose of this study was to describe the demographic, functional, and behavioral profile of nursing home residents with dementia who require verbal or physical assistance with mouth care. Residents who required verbal support to complete mouth care exhibited higher levels of physical function, higher levels of cognitive functioning in the domains of language and executive function, lower levels of passivity, and higher scores for the personality trait of openness than residents who required physical assistance. Best practices for implementing verbal and physical assistance during mouth care to persons with dementia are presented on the basis of these profiles.

Caregiver interventions for passive behaviors in dementia: links to the NDB model

Passive behavior (PB) in persons with Alzheimer's disease (PWAD) has been overlooked despite recognition that it occurs on a daily basis and is often resistant to interventions. The purpose of this study was to describe how the experience of passivity was for the caregiver and the PWAD, factors that precipitated PB, caregiver responses that promoted engagement, and caregiver responses that intensified PB, as well as activities initiated by caregivers over the past month that reduced passivity in the person with dementia (PWD). Fifty caregivers of community-dwelling persons with mild (n = 15), moderate (n = 16), and severe (n = 19) Alzheimer's disease participated in a semi-structured interview. Data were analyzed using Colaizzi's Phenomenological Thematic Extraction and descriptive statistics. Caregivers identified decreased levels of activity, decreased verbalization, withdrawal, less socialization, and decreased interest in activities as examples of PBs. For caregivers, the experience of coping with PBs engendered frustration with their loved ones' cognitive deterioration, difficulty in watching and accepting loss of function, fatigue, sadness, and using coping skills. Paradoxically, both being alone and increased environmental stimuli precipitated PB. Feelings of helplessness and loss of control by the person also caused PB. The most successful interventions to promote engagement were: giving cues and assistance, initiating the task, giving guidance, and providing enjoyable activities. Responses that hindered engagement included: 'correcting' or putting stress on the person, rushing activities, and repeating directions. Faith, humor, patience, and contact with friends and family were identified as positive approaches. Caregiver interventions demonstrated synchrony with selected background and proximal variables in the Need-driven Dementia-compromised Behavior (NDB) model.

Using measures of agreement to develop a taxonomy of passivity in dementia

A comprehensive taxonomy categorizing passive behaviors in people with dementia was developed and revised through the use of expert raters. The taxonomy was first derived from the synthesis of 15 empirical studies that addressed this phenomenon, then was rated by an expert panel of six nurse-scientists with expertise in dementia and neuroscience research. This article describes the application of two measures of agreement, multiple rater kappa and proportion of agreement for multiple raters, calculated using Stata and SPSS, to evaluate and revise the taxonomy. The method proved useful for estimating the content validity of the taxonomy and provided evidence of stronger agreement among raters for the revised and final forms of the taxonomy. Nurse researchers will find this methodology to be an efficient, practical approach to applying measures of agreement for a variety of purposes, including taxonomy development.