P3‐405: The effect of vignette activity on the neuropsychiatric behaviours expressed by individuals with dementia, living in long‐term Care

Currently 500,000 individuals in Canada are living with dementia with a predicted increase to 1-1.3 million by 2035. Related care costs are expected to be 872 billion dollars by 2038. The prevalence of dementia in Canadian nursing homes was 45.4% in 2008. The greatest contributors to cost and challenges for caregivers are neuropsychiatric behaviors. Current pharmaceutical approaches demonstrate only modest success and clinical significance is questioned. Antipsychotics and anxiolytics used in severe cases may produce serious side effects and their limited modification of neuropsychiatric behaviors has led to severe use restrictions. The relationship between activity and neuropsychiatric behaviors in normal participants demonstrates a relationship between a sense of well-being and the opportunity to engage in autonomous activity. The absence of autonomy may lead to depression, agitation and aggression. Engagement in autonomous activity is severely restricted in locked nursing home units where meal times, sleep times and activities are highly programmed. It is proposed that this restriction creates a potential for increased agitation, aggression or apathy. Lawton, Cohen-Mansfield, Wilson and Hartig have clearly established the ability of the environment to impact behavior for both normal and dementia residents. Living in a nursing home where ‘going outside’ is prevented by locks; where diminishing cognitive ability reduces independence in activities of daily living; and where objects for interaction are limited by safety concerns, results in normal experiences of engagement, exploration and autonomy being seriously limited. Individuals with dementia living in a nursing home have been found to spend between 65%-85% of their time doing nothing. Further, 45% of individuals with dementia living in a nursing home receive little or no facility activities; 20% receive occasional activities and while 12 % received daily activities, those activities were deemed inappropriate for functional level and stated interests. It is during unoccupied time that most residents display neuropsychiatric behaviors. Impoverished environments contribute to the neuropsychiatric behavior that is expressed by those living with dementia in institutions. Objective: To identify the effect of resident interactions at a garden vignette, (a cluster of objects designed to both attract attention encourage self-determined activity interaction and exploration) on neuropsychiatric behaviors observed in individuals suffering with dementia, living in long-term care settings. Hypothesis: Time spent in activity at a garden vignette would be associated with a decrease in the frequency of neuropsychiatric behaviors and a decrease in medication used to control behavior. This study used a quasi-experimental within-subjects repeated measures block design to examine both intra-individual (within-subjects) and time-effect changes in behavior. The sample included 28 residents living on two special care nursing units who had been resident on the unit for a minimum of 4 weeks, had an MMSE score of 18 or less, or GDS/FAST stage of 4,5,6, or 7 with a minimum of one documented difficult to manage behavior e.g. agitation/aggression, depression /dysphoria, apathy/indifference. Excluded were all residents dependent on others for mobility and those with uncontrolled pain. Behavior measures included the Neuropsychiatric Inventory: Nursing Home, Single Question Depression Test, the Cornell Scale for Depression in Dementia, the Ryden Aggression Scale 2 and the Apathy Inventory. Exposure to the garden vignette was for 14 days followed by a 14-day washout period with each phase being repeated once. Behavior measurement occurred at baseline before vignette insertion and the second week of both the vignette intervention and washout phases. The process remained the same for the repeated intervention and washout phases. Video recordings 24/7 of interactions at the vignette noted: time of day, length of stay, objects interacted with, whether came by self or assisted, and level ofengagement. Chart audit identified age, gender, diagnosis, previous occupation, hobbies and interests, medications, current neuropsychiatric behaviors. Data analysis examines time effect in both control and intervention phases. Relationships between medication use, previous occupation, level of dementia, self-determined engagement and previous interests and hobbies will also be examined. Results are currently not available as data collection is in process. Data and analysis are expected to be complete by May 30, 2011. As this research is the thesis for PhD completion, results will be subjected to crtitical analysis by the PhD committee. Conclusions will not be drawn until data collection is complete.

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