Linda L. Buettner

Efficacy of Theory-Based Activities for Behavioral Symptoms of Dementia

BackgroundAgitation and passivity are behavioral symptoms exhibited by 90% of nursing home residents with dementia. They account for many poor health outcomes, caregiver burden, and increased costs of long-term care. ObjectivesThis study tested the efficacy of recreational activities derived from the Need-driven Dementia-compromised Behavior (NDB) model: activities matched to skill level only; activities matched to style of interest only; and a combination of both (NDB-derived) for responding to the behavioral symptoms of dementia. MethodsThirty participants were randomly assigned to 1 of 6 possible order-of-condition presentations in this crossover experimental design with repeated measures of dependent variables. Trained research assistants, blind to condition match, implemented each condition for 12 consecutive days. Measures of engagement (time on task and participation), affect, and behavioral symptoms (agitation and passivity) were taken from videotape recordings of each session. Mood was measured with the Dementia Mood Picture Test. The primary analysis method was mixed-model analysis of variance. ResultsSignificantly more time on task, greater participation, more positive affect, and less passivity were found under NDB-derived and matched to interest only treatments compared with the matched to skill level only treatment or baseline. Agitation and negative affect improved under all treatments compared with baseline. There was no significant change in mood. DiscussionThe NDB-derived activities are tailored to meet individual needs and improve behavioral symptoms associated with dementia. These findings help to explain factors that produce behavioral symptoms and the mechanisms that underlie their successful treatment.

Factors that relate to activity engagement in nursing home residents

Many nursing home residents are unoccupied and at risk for poor health outcomes because of inactivity. The purpose of this study was to identify characteristics of residents with dementia that predict engagement in activities when activities are implemented under ideal conditions. Data from a clinical trial that tested the efficacy of individually prescribed activities were used to address the study aim. Thirty subjects were videotaped daily for 12 days during 20-minute activity sessions. Measures of engagement (time on task and level of participation) were taken from these videotapes. Univariate logistic regression analyses indicated that cognitive status and physical function explained a significant amount of variance in engagement. Efforts to promote function may facilitate even greater benefits from prescribed activities by improving capacity for engagement.

Simple Pleasures: A multilevel sensorimotor intervention for nursing home residents with dementia

The Simple Pleasures research team investigated the effects of 30 handmade recreational items on the behavior of nursing home residents with dementia. The impact on family visits, staff knowledge, and volunteer involvement also was examined during the course of this study. Twenty-three items were found therapeutically valuable and acceptable for nursing home use. Family visits, use of recreational items, and satisfaction with visits significantly improved during the intervention. Residents were significantly less agitated at one nursing home and slightly less agitated at the other nursing home. More than 540 volunteers of all ages were trained and made Simple Pleasures recreational items during this project.

Therapeutic recreation as an intervention for persons with dementia and agitation: An efficacy study

Thirty-six long term care residents with dementia and agitation were selected for participation in this eight week study. During the eight week J period, the participants received two different four week therapeutic recreation interventions in a clinical crossover design. These interventions included a sensorimotor program and a traditional activity program. The effects of these two programs were evaluated in terms of the effect on strength, flexibility, over all functioning, and agitation. The analysis showed that there was a significant improvement of grip strength, flexibility, and a reduction in agitation during the sensorimotor segment of the treatment. The results of this study indicate a new direction for therapeutic recreation specialists working with older adults with dementia and agitation.

Activity calendars for older adults with dementia: What you see is not what you get

This paper reports on a two-part study of nursing home recreation. In part one, a retrospective activity calendar and chart review was used in this comparative study of 107 long-term care residents with dementia. Data were collected and documented regarding demographics, cognitive and physical functioning, medications, activities listed on facility activity calendars, leisure preferences, and actual involvement in recreation over a two-week consecutive period during baseline. In part two, this information was compared to opportunities offered during a two-week clinical trial of recreational therapy. The results showed that, during baseline, almost 45 percent of the subjects in the sample received little or no facility activities, 20 percent received occasional activities, and 12 percent received daily activities but they were deemed inappropriate based on the functioning levels or interests of the residents. The clinical trial period demonstrated that small group recreational therapy was successful in engaging residents 84 percent of the time.

Therapeutic recreation interventions for need-driven dementia-compromised

This study describes a clinical trial of at-home recreational therapy for community dwelling older adults with dementia and disturbing behaviors. After two weeks of daily, individualized recreational therapy interventions (TRIs), results indicated a significant decrease in levels of both passivity and agitation. Biograph data collection was useful in identifying the physiological changes that occurred with each intervention technique. Specific information is included on the time of day each behavior occurred and the most effective interventions, as well as implications for service delivery.

Cognitive Training for Early-Stage Alzheimer's Disease and Dementia

The purpose of this article is to critically review and synthesize the literature on the effects of nonpharmacological cognitive training on dementia symptoms in early-stage Alzheimers disease (AD) and related dementia. Electronic databases MEDLINE (PubMed), CINAHL, PsycInfo, and the Cochrane Library were searched using the keywords cognition, reality orientation, Alzheimers disease, psychosocial factors, cognitive therapy, brain plasticity, enriched environments, and memory training. The findings support that cognitive training improves cognition, activities of daily living, and decision making. Interventions are more effective if they are structured and focus on specific known losses related to the AD pathological process and a persons residual ability, or are combined with cognitive-enhancing medications. Nursing implications are also discussed.

AD-venture program: therapeutic biking for the treatment of depression in long-term care residents with dementia.

This project tested an innovative intervention in a controlled clinical investigation of a nonpharmacological treatment of depression in long-term care residents with dementia. This treatment utilized a wheelchair bicycle in a recreation therapy protocol, which combined small group activity therapy and one-to-one bike rides with a staff member. Depression levels were significantly reduced in the two-week portion of the study with levels maintained in the 10-week maintenance period. Improvements were also found in sleep and levels of activity engagement.

Prescribing Activities that Engage Passive Residents: An Innovative Method

Individuals with dementia are often passive, which places them at risk for further cognitive and functional decline. Recreational activities have been used in research to reduce passive behaviors, but systematic reviews of these studies have found modest effect sizes for many activities. In this article, we describe the further theoretical development of an innovative method for prescribing activities that have a high likelihood of engaging nursing home residents who are passive and present examples for research application and clinical practice. This method may increase the effect size of activity interventions and encourage more widespread adoption of nonpharmacological interventions in practice.

Treatment Fidelity Plan for an Activity Intervention Designed for Persons with Dementia

The testing of psychosocial interventions in a clinical trial poses many challenges to maintaining a rigorous experimental protocol and to delivering the interventions uniformly throughout the project. These challenges directly affect the reported effectiveness of psychosocial interventions. In this article, the authors describe the treatment fidelity plan developed by an interdisciplinary research team from recreational therapy and nursing for implementing recreational activities during a clinical trial funded by the National Institute of Nursing Research. The trial tests the efficacy of activities for responding to the behavioral symptoms of dementia. The authors report treatment fidelity strategies to allow comparison of their intervention with that of other studies, to improve effect size in similar studies, and to facilitate replication and translation of this work into clinical practice.