ENVIRONMENTS IN MANAGING BEHAVIOURS IN ADVANCED DEMENTIA A MULTISITE STUDY Linda J Garcia PhD M Hébert J Kozak I Sénécal S Slaughter N Drummond F Aminzadeh W Dalziel J Charles M ID: 764546
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ENVIRONMENTS IN MANAGING BEHAVIOURS IN ADVANCED DEMENTIA: A MULTISITE STUDYLinda J Garcia, Ph.D. M. Hébert, J. Kozak, I. Sénécal, S. Slaughter, N. Drummond, F. Aminzadeh, W. Dalziel, J. Charles, M. Eliasziw Professor,Director and Associate DeanInterdisciplinary School of Health SciencesUniversity of OttawaScientist, Élisabeth Bruyère Research Institute TEAM – CO-AUTHORS Has no real or apparent conflicts of interest to report.
DEMENTIA COGNITIVE IMP. BEHAVIOUR
Main goal of the study Study the impact of architectural designs and human environments on quality of life of residents with dementia in specially designed units and traditional units.
Map of Sites CALGARY Carewest Signal Pointe (SDU) Bethany Harvest Hill (SDU) TORONTO Dorothy Macham Home (SDU) OTTAWA Peter D . Clark LTC Home (SDU & TU) Centre d’accueil champlain (SDU & TU) St Patrick’s Home of Ottawa, Inc (TU)
DATA Data related to the residentsMMSE: Mini-Mental State ExaminationCMAI: Cohen-Mansfield Agitation InventoryNPI: Neuropsychiatric InventoryAARS: Apparent Affect Rating ScaleMOSES: Multidimensional Observation Scale of Elderly Subjects FAST: Functional Assessment Staging Test (FAST) PES: Pleasant Events Schedule Data related to the units TESS-NH: Therapeutic Environment Screening Survey MECQ-LTC: Montreal Evaluation of Communication Questionnaire in Long Term Care Staff ratio
Sociodemographic profile of residents (N = 143 – 71 in Ottawa; 72 elsewhere) Age Gender Language of use LOS PDC Bung 84 14F 7M 81% E 40.5 (9-150) PDC Willow 83.8 6F 6M 75% E 40.3 (2-126) CAC-2 84.9 13F 5M 94% F 28.4 (9-91) CAC-4 86.6 3F 2M 80% F 49 (28-100) St. Pats 84.9 13F 2M 73% E 51.3 (16-146)Bethany78.927F 9M66% E42.4 (3-85)Carewest82.520F7M30% E33 (4-67)DMH86.10F9M78% E17.4 (11-40) Ottawa statistics are derived from participants in study . Calgary and Toronto sites are facility statistics .
Results of tests FAST: Severely affected in functional status : ADLs affected, incontinence, trouble with communication, 17% mobility problemMMSE : moderate -severe dementia (mean 14.5/30)AARS: show interest, pleasure, very little fear/anxiety, anger, sadness PES: 75% engaged in ≥10 activities on list in the past; 25% currently enjoy ≥ 10 or more of these activities now . Few (10%) enjoy the same number or more activities compared to enjoyed activities in the past
Disruptive Behaviours
No significant difference between TU and SDU in the global TESS-NH results more homelike but less secure more secure but less clean great outdoor garden … not accessible!best staffing levels not necessarily highest TESS-NH scores The Environment
Social environment – communication (MECQ-LTC) Familiar staffPerceived nonverbal means of communication significantly more in residentsreported verifying, waiting and giving choice of responses more frequently to understand a message check understanding and reformulate sentences more
Family members (N=45)7 Groups (6 – 7 per group) Regular contact (> 1/ week)Staff members (N=59)8 Groups (7-8 per group) > 6 months working with residentDiscussion Groups
Environmental factors influencing quality of life and behaviours FacilitatorsStaff approachIndividualized care Home-like environmentGeneralized activities & stimulationRules- flexibilityObstaclesLow staffing levelsHigh noise levelsReduced s taff continuity Inflexible rules
Staff FacilitatorsStaff TeamworkPresence of a safe /supervised environmentObstaclesPhysical barrierNo space to care for special needs (health)Little staff trainingMinimal visual stimulation Facilitators Not mixing groups with different needs Low noise Variety of food Obstacles Over utilization of medication (drugs) Little privacy Diminished communication /hearing levels of residents Family
Observations - 19 individuals were observed (15 women; 4 men); 20 minutes eachIs our observational sample representative? YES HIGHLIGHTS OF OBSERVATIONS:NoiseBreathing room from other residentsServing the greater community/taking care of others – my homeSAFE Place to wander – exploringOpportunities for rich human interactions, especially resident interactionCafé de Paris
F.A.C.T.U.R.S.
THANK YOU! MERCI!!! Alzheimer Society of Canada Alzheimer Society of Ottawa and Renfrew Counties Élisabeth Bruyère Research Institute ALL OUR PARTICIPANTS AND SERVICE PROVIDERS Linda.garcia@uottawa.ca