Volunteers Adding Life in Dementia: A Case Series of Volunteer Visits to Reduce Behavioral Symptoms of Dementia in Long‐Term Care

To the Editor: The majority of residents in long-term care (LTC) settings are older adults with dementia. Neuropsychiatric symptoms (NPS), including behaviors such as agitation, depression, and psychosis, are common in older adults with dementia, particularly those with advanced dementia typical of the LTC population.1 Management of NPS can include pharmacological and nonpharmacological approaches. Given concerns about medications such as antipsychotics there is increasing interest in identifying feasible and effective nonpharmacological treatment options for NPS. Although nonpharmacological approaches are recommended as first-line treatments for NPS, a review identified the need for practical and feasible nonpharmacological interventions for NPS in LTC settings.2 One of the best-supported approaches to NPS is the provision of personalized pleasant events provided one-to-one.2 One method of delivering these pleasant events is through the use of volunteers. Although volunteers have been shown to be effective at delivering psychosocial interventions to older adults in acute care,3 there is limited information on the use of volunteers in LTC settings with older adults with dementia.4 The present study evaluated whether volunteer-led visits could reduce symptoms of NPS in LTC residents with dementia. Older adults with dementia who were identified as having NPS from a single LTC facility in Kingston, Ontario were included. The LTC facility was provided with an activities cabinet and materials that could be used to facilitate volunteer visits (e.g., age-appropriate music, crafts). Volunteers were recruited from advertisements placed online, in local newspapers, and at local educational institutions. Volunteers were screened and interviewed to ensure suitability for the program and completed required health and background assessments required for all LTC volunteers. Volunteers were provided with training consisting of an educational session about dementia and suggested strategies for providing customized pleasant activities for individuals with dementia. Each person with dementia received up to 90 minutes of volunteer time per week over 12 weeks. The primary outcome was change in Cohen-Mansfield Agitation Inventory (CMAI) score. Secondary outcomes included other measures of NPS, including the Neuropsychiatric Inventory, Cornell Scale for Depression in Dementia, measures of nursing strain, and volunteer-related quality of life measured on the Medical Outcomes Study 12-item Short-Form Survey. Paired t-tests were used to examine change in outcome measures over time in the study population. Ten participants with dementia and 14 volunteers were enrolled during this pilot study. The mean age of participants with dementia was 83.8, nine were female, and their mean Mini-Mental State Examination Score was 7.6 ± 5.1. The mean age of volunteers was 28.9 ± 12.4, 79% were female, and 71% were university or high school students. Volunteers provided 103.9 hours of volunteer time, with each person with dementia receiving an average of 10.8 ± 6.2 visits and an average of 10.5 ± 7.8 hours of volunteer visit time. Overall, CMAI scores declined during the intervention, with significant differences in agitation noted at Week 4 (mean difference −14.2, P = .008) and 8 (mean difference −14.7, P = .04). Although CMAI total scores were lower at all other time points, these differences were not statistically significant. There were small reductions in Neuropsychiatric Inventory total score (Week 12 mean difference −4.2, P = .7) and Cornell Scale for Depression in Dementia (Week 12 mean difference −0.8, P = .7) over the course of the trial. There were no significant changes noted in nursing stress or volunteer quality of life measures during the intervention. Interviews with volunteers indicated that there were many perceived benefits from participating in the program, including developing a sense of personal connection to the residents they served and a feeling of responsibility to help older adults with dementia. In conclusion, this open-label study of volunteer-led pleasant activities demonstrated that volunteer visits are a feasible method of providing personalized one-on-one nonpharmacological interventions for older adults with dementia in LTC. The small sample size limited the statistical power, but benefits of the volunteer program were evident from multiple perspectives. Randomized controlled trials are underway to evaluate the effectiveness of volunteer visits to reduce NPS in LTC. Further information is needed to identify the characteristics of older adults, volunteers, and methods of program delivery associated with the greatest benefit. Volunteer visits may also prove to be an effective method of delivering psychosocial interventions to older adults with other mental health conditions and in settings outside of LTC. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Dr. Seitz has received honoraria from Eli-Lilly Canada for participating on an advisory board. This study was supported by a Southeastern Ontario Academic Medical Organization Alternated Funding Plan Innovation Fund Grant and a New Investigator Research Grant from the Alzheimer's Association (NIRG-12–236827). The authors acknowledge the contribution of the staff at Extendicare, Kingston, for their participation in the study. Author Contributions: All authors: design, methods, analysis, drafting the manuscript, revisions. Seitz, Knuff, Prorok: data collection. Sponsor's Role: Queen's University and the Alzheimer's Association contributed funding to this project, although neither organization had any direct involvement with the design, methods, recruitment of subjects, analysis, or preparation of the manuscript.

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