1353 “I’M MY OWN BOSS” - A QUALITATIVE STUDY WITH PEOPLE RECEIVING ADULT DAY SERVICES IN GERMANY ABOUT THEIR UNDERSTANDING OF LEISURE

Introduction

Community-based care such as adult day services (ADS) are preferred by people with dementia. ADS offers the opportunity to support the health and social needs of their clients and provide respite to family members, contributing to a stable care situation at home. The psychological needs of humans according to the self-determination-theory (SDT) (autonomy, competence, and relatedness) can be fulfilled by leisure activities and thus improve well-being and quality of life. The implementation of leisure activities that reflect individual preferences support active participation, preserve autonomy, improve satisfaction with care and consequently can be understood as a core aspect of person-centred care. However, it is currently unknown how people receiving ADS understand leisure and which leisure activities they prefer.

Method

To gain insight, a qualitative design was chosen. We conducted semi-structure interviews with 13 people receiving ADS in Germany. Participants were recruited from two different ADS in one state in Germany. Interviews were recorded, transcribed verbatim and analysed using thematic analysis and categories of the SDT.

Results

The results show that over 90 % of participants were diagnosed with dementia and that the ADS was considered a place to participate in leisure activities. However, this consideration depends primarily on the degree of autonomy they experienced and thus the freedom to choose activities in the ADS according to their individual preferences. The participants mentioned a variety of preferred meaningful leisure activities related to competence and relatedness (e.g., mentoring, socializing, reminiscence).

Conclusion

The results indicate the importance of preference-based service design in ADS to meet clients’ psychological needs and thus provide person-centred care to improve well-being and quality of life. These results can be used to develop an item-based assessment tool to assess the preferences of people with care needs regarding leisure activities in ADS.

The psychosocial preferences of older adults: a pilot examination of content and structure

Individualizing care for older persons depends on knowing about a care recipient's psychosocial preferences. Currently, however, no comprehensive, empirically derived instruments exist to assess these preferences. As part of an effort to develop such an instrument, this pilot study examined the content and structure of psychosocial preferences in older adults using the statistical technique known as concept mapping. Results suggest two underlying dimensions to psychosocial preferences (Enrichment-Self-Maintenance and Extrapersonal-Intrapersonal) and six distinct content domains (Social Contact, Growth Activities, Leisure Activities, Self-Dominion, Support Aids, and Caregivers and Care). Both the dimensions and the content domains provide valuable information for the construction of psychosocial preference instruments. They also might assist formal and informal caregivers in tailoring their interventions to provide individualized care that enhances quality of life for older adults.

A stimulation-retreat special care unit for elders with dementing illness

Two equivalent special care nursing home units for elders with dementing illness were randomly designated as experimental and control units for an intervention called the "stimulation-retreat" model. This model introduced a set of staffing and program changes whose purpose was to diagnose, prescribe, and apply a package of care according to individual needs for additional stimulation or relief from stimulation ("retreat"). A total of 49 experimental and 48 control unit residents completed 12 months of care and were evaluated at baseline, 6 months, and 12 months. It was hypothesized that the intervention would not affect the basic disability (cognitive and activities of daily living functions), would improve negative behaviors and observed affects, and would have maximum impact in increasing positive behaviors and affects. Over time, most functions worsened, including negative attributes and affects. Lesser decline in positive affect and increases in external engagement, however, led to the conclusion that the intervention showed a marginally significant and selective effect on positive behaviors and affect.

Psychometric characteristics of the minimum data set II: validity

OBJECTIVE

To determine the validity of the Minimum Data Set (MDS).

DESIGN

MDS domain scores were correlated with a variety of independently obtained measures of basic behavioral and mental health functions of 513 nursing home residents.

SETTING

All participants were residents of the Philadelphia Geriatric Center.

PARTICIPANTS

One group of residents (n = 260) represented consecutive admissions who were able to respond to formal testing. The other group of residents (n = 253) represented presumably cognitively impaired residents whose data did not depend on self-report.

MEASUREMENTS

MDS item-composite scores based on a confirmatory factor analysis were derived for the domains of cognition, activities of daily living (ADL), time use, depression, and problem behaviors. Hypotheses stating how these MDS domains should be related to standard measures of cognitive function, ADL, depression, agitation, social behavior, and irritability were tested.

CONCLUSIONS

The majority of the hypotheses were upheld, thus suggesting that the MDS is usable as a source of research data. The sizes of the validity coefficients were modest, however. Depression and problem behavior were less well affirmed than cognition, ADL, and Time Use. There is a clear need for improvement in training and probably in the form of MDS measurement in some areas.

Observed affect in nursing home residents with Alzheimer's disease

A method for assessing affect states among older people with Alzheimer's disease was developed for use in a study designed to evaluate a special care unit for such residents of a nursing home. The 6-item Philadelphia Geriatric Center Affect Rating Scale was designed for the use of research and other staff in assessing positive affect (pleasure, interest, contentment) and negative affect (sadness, worry/anxiety, and anger) by direct observation of facial expression, body movement, and other cues that do not depend on self-report, among 253 demented and 43 nondemented residents. Each affect scale was highly reliable, expressed in estimated portions of a 10-minute observation period when the affect expression occurred. Validity estimates were affirmative in showing discriminant correlations between the positive states and various independent measures of social and other outwardly engaged behavior and between negative states and other measures of depression, anger, anxiety, and withdrawal. Limited support for the two-factor dimensionality of the affect ratings was obtained, although positive and negative affect were correlated, rather than independent. Some hope is offered that the preference and aversions of Alzheimer patients may be better understood by observations of their emotional behaviors and that such methods may lead to a better ability to judge institutional quality.