|
| Observation and Assessment in Dementia Care Settings |
| Sunday, May 24, 2009 |
| 9:00 AM–10:20 AM |
| North 132 BC |
| Area: DEV/OBM; Domain: Applied Behavior Analysis |
| Chair: R. Mark Mathews (University of Sydney) |
| Abstract: People with dementia in residential care rarely engage in daily life activities, however, their inappropriate or aggressive behavior can create problems for direct care staff. This symposium includes four data-based presentations on observation and assessment strategies conducted with dementia-care residents and direct care staff. The first study provides a five-year longitudinal analysis of the effects of a popular environmental and staff training intervention on engagement and problem behaviors exhibited by dementia care residents in two Michigan nursing home units. The second study provides and evaluation of physical environmental changes using similar behavioral observation strategies in a nursing home in Sydney, Australia. The third presentation provides a meta-analysis of published findings of an alternative observational strategy used in 91 residential care facilities. The final presentation examines caregiver’s acceptability ratings of with a range of behavioral, pharmacological, and sensory interventions designed to reduce the incidence of problem behaviors in persons with dementia. |
| |
| Longitudinal Analysis of Staff Training in the “Eden Alternative” on Engagement of Residents in Dementia Care |
| R. MARK MATHEWS (University of Sydney), Linda A. LeBlanc (Auburn University), Allison A. Jay (Western Michigan University), Jonathan C. Baker (Western Michigan University), Brian J. Feeney (Western Michigan University) |
| Abstract: The Eden Alternative is an increasingly popular approach to making nursing facilities more home-like environments. Opportunities for residents to interact with and care for a wide range of plants, animals, birds, and even children is viewed as a means of improving the quality of life of nursing home residents and their care providers. Direct care staff from two dementia care units participated in Eden training; both programs received certification. Five years of observational data were collected using behaviour maps to record resident engagement (both appropriate and inappropriate) and affect (positive, neutral, or negative). Staff behavior and voice tone during interactions with residents were similarly collected. Prior to the Eden immersion training, residents were appropriately engaged during 71% of observations in unit A and 60% in unit B. During the first year after immersion training engagement increased to 85% in each unit. Lower levels of engagement (50% in unit A and 30% in unit B) during the following year. Additional Eden training in 2006 and 2007 results in small increases in engagement in one unit, but the increases were short-lived and an overall decline in engagement was observed. |
| |
| Pre and Post-Occupancy Evaluation of Dementia Care Cottages |
| RONALD SMITH (University of Sydney), R. Mark Mathews (University of Sydney) |
| Abstract: Persons with severe dementia rarely engage in activities. New dementia cottages were designed to provide a more home-like environment for nursing home residents, with the intent of promoting independence and activity. Fifty-eight, high care residents of a traditional-style dementia care facility moved to new, purpose built, dementia-specific cottages, with 15 residents in each cottage. Resident behavior was directly observed using both behavior maps and time sampling observation procedures. Observational data were analysed by the percentage of time residents were engaged, not engaged, or distressed. Resident affect and activity were also noted whenever residents were observed to be appropriately engaged. Resident engagement increased by 44% (t = 2.65; p < .05) and levels of distress declined by 50% (t = -2.37; p < .05) after the relocation. Two forms of environmental assessment were also conducted; results showed that the newly built cottages provided greater levels of privacy, comfort, choice, and personalisation. Family satisfaction with the environment, food, and staff also increased. The smaller, restraint-free, home-like environment provides residents with more independence, privacy, and choice. The move has resulted in more frequent engagement and fewer problem behaviors. This environment could provide a model for increasing activity in dementia facilities. |
| |
| Meta-analysis of Dementia Care Mapping |
| RONALD SMITH (University of Sydney), R. Mark Mathews (University of Sydney) |
| Abstract: Dementia Care Mapping (DCM) has become a popular tool in the direct observation of people with dementia. Participants are observed in 5-minute intervals for a total of six hours. After each interval, the resident is assigned a mutually-exclusive code (from a predetermined list) based on their behavior. An affect score, ranging from -5 to +5, is also recorded for each interval. A meta-analysis was conducted on the results of 26 published journal articles that reported DCM results. In total, DCM observations of 2,360 participants with dementia in 91 different facilities (including day care centres, hospital wards, dementia units, and residential facilities) were included in the analysis. Published studies reported a wide variety of different DCM measures, however, key variables included in the meta-analysis were the percentage of time that each behavior code was observed and average affect scores. Composite scores of appropriate (high potential for well-being) and inappropriate (low potential for well-being) were computed. Results of the meta-analysis will be reported and both strengths and weaknesses of this observational took will be discussed |
| |
| Acceptability of Interventions to Staff in Long-Term Care Settings for Older Adults: Comparing Ratings and Hierarchical Selection |
| JONATHAN C. BAKER (Western Michigan University), Linda A. LeBlanc (Auburn University) |
| Abstract: Older adults and their caregivers generally prefer behavioral interventions over medications in treatment acceptability studies. However, previous studies primarily examined acceptability ratings, which did not force the responder to select between treatment options. Additionally, recent advances in behavioral treatment technologies and other treatments previously presented to raters create a need to revisit treatment acceptability for older adults. The present investigation examined treatment acceptability of behavioral, pharmacological, and sensory interventions using a treatment acceptability rating scale, treatment selection rankings, and direct report of treatments used. Sixty staff from nursing homes in the Midwest who actively participate in treatment decisions for older adults with dementia who engage in aggression were recruited. Participants saw a video vignette and completed an internet-based treatment acceptability rating and ranking of each of the treatments. One-way ANOVAs indicated no statistically significant differences in ratings between treatments. Pearson-Product Moment Correlations indicated only medication ratings and rankings were significantly related. Neither ratings nor rankings were correlated with treatment use. Implications for treatment acceptability ratings as evidence for treatment adoption of behavioral interventions from both a practical and conceptual perspective, as well as directions for future studies will be discussed. |
|
| |