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Association between environmental stimulation and apathy in nursing home residents with dementia

Published online by Cambridge University Press:  26 June 2019

Ying-Ling Jao ,
Wen Liu ,
Kristine Williams ,
Habib Chaudhury  and
Jyotsana Parajuli
Ying-Ling Jao*
Affiliation:
College of Nursing, Pennsylvania State University, University Park, PA, USA
Wen Liu
Affiliation:
College of Nursing, University of Iowa, Iowa City, IA, USA
Kristine Williams
Affiliation:
School of Nursing, University of Kansas, Kansas City, KS, USA
Habib Chaudhury
Affiliation:
Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
Jyotsana Parajuli
Affiliation:
College of Nursing, Pennsylvania State University, University Park, PA, USA
*
Correspondence should be addressed to: Ying-Ling Jao, Pennsylvania State University, College of Nursing, 307E Nursing Sciences Building, University Park, PA, 16802, USA Email: [email protected].
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Abstract

Objectives:

Prior research and theories established the link between care environments and apathy. Yet, empirical evidence on how environmental stimulation impacts apathy is lacking. This study examined the association between environmental stimulation and apathy in nursing home residents with dementia.

Design:

This repeated-measure study analyzed 104 video observations of staff caregiver–resident interactions.

Setting:

12 nursing homes.

Participants:

63 unique staff caregiver–resident dyads that involved 42 caregivers and 44 residents with moderate to severe dementia.

Measurements:

Second-by-second behavioral coding using Noldus Observer software was conducted to assess apathy and environmental stimulation, using the Person-Environment Apathy Rating scale. The environment subscale includes six items: stimulation clarity, stimulation strength, stimulation specificity, interaction involvement, physical accessibility, and environmental feedback. The apathy subscale includes six items: facial expression, eye contact, physical engagement, purposeful activity, verbal tone, and verbal expression. Multilevel linear models were used for analysis.

Results:

Results showed that apathy was not associated with the overall quality of environmental stimulation but was significantly associated with stimulation specificity (coefficient = −2.23, p = 0.049). However, the association was not significant after controlling for resident characteristics (p = 0.082). In addition, higher levels of environmental feedback were associated with lower apathy levels (coefficient = −2.14, p = 0.001). The association remained significant after controlling for resident characteristics (coefficient = −1.65, p = 0.014).

Conclusion:

Findings reveal that when environmental stimulation is individually tailored and prompts engagement, residents are less apathetic. This study highlights the effect of environmental stimulation on apathy. Future research should explore interventions that modify environmental stimulation to reduce apathy and improve dementia care.

Keywords

Alzheimer’s diseasebehavioral and psychological symptoms of dementia (BPSD)long-term careproblem behaviors
Type
Original Research Article
Information
International Psychogeriatrics , Volume 31 , Issue 8: Issue Theme: Dementia Care , August 2019 , pp. 1109 - 1120
Copyright
© International Psychogeriatric Association 2019 

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References

Bakker, C. et al. (2013). Predictors of the time to institutionalization in young-versus late-onset dementia: results from the Needs in Young Onset Dementia (NeedYD) study. Journal of the American Medical Directors Association, 14, 248–253.CrossRefGoogle ScholarPubMed
Brodaty, H. and Burns, K. (2012). Nonpharmacological management of apathy in dementia: a systematic review. The American Journal of Geriatric Psychiatry, 20, 549–564.CrossRefGoogle ScholarPubMed
Chaudhury, H., Cooke, H. A., Cowie, H. and Razaghi, L. (2017). The influence of the physical environment on residents with dementia in long-term care settings: a review of the empirical literature. The Gerontologist, 58, e325–e337.CrossRefGoogle Scholar
Cipriani, G., Lucetti, C., Danti, S. and Nuti, A. (2014). Apathy and dementia: nosology, assessment and management. The Journal of nervous and mental disease, 202, 718–724.CrossRefGoogle ScholarPubMed
Clarke, D. E. et al. 2008. Apathy in dementia: clinical and sociodemographic correlates. The Journal of Neuropsychiatry and Clinical Neurosciences, 20, 337–347.CrossRefGoogle ScholarPubMed
Colling, K. B. (1999). Passive behaviors in Alzheimer’s disease: a descriptive analysis. American Journal of Alzheimer’s Disease, 14, 27–40.CrossRefGoogle Scholar
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2308.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Hall, G. R. and Buckwalter, K. C. (1987). Progressively lowered stress threshold: a conceptual model for care of adults with Alzheimer’s disease. Archives of Psychiatric Nursing, 1, 399–406.Google ScholarPubMed
Harrison, F., Aerts, L. and Brodaty, H. (2016). Apathy in dementia: systematic review of recent evidence on pharmacological treatments. Current Psychiatry Reports, 18, 103.CrossRefGoogle ScholarPubMed
Hölttä, E. H., Laakkonen, M. L., Laurila, J. V., Strandberg, T. E., Tilvis, R. S. and Pitkälä, K. H. (2012). Apathy: prevalence, associated factors, and prognostic value among frail, older inpatients. Journal of the American Medical Directors Association, 13, 541–545.CrossRefGoogle ScholarPubMed
I.B.M. Corp. (2013). IBM SPSS Statistics for Windows (version 25.0). Armonk, NY: IBM.Google Scholar
Ishii, S., Weintraub, N. and Mervis, J. R. (2009). Apathy: a common psychiatric syndrome in the elderly. Journal of the American Medical Directors Association, 10, 381–393.CrossRefGoogle ScholarPubMed
Jao, Y.-L., Algase, D. L., Specht, J. K. and Williams, K. (2015). The association between characteristics of care environments and apathy in residents with dementia in long-term care facilities. The Gerontologist, 55, S27–S39.CrossRefGoogle ScholarPubMed
Jao, Y.-L., Algase, D. L., Specht, J. K. and Williams, K. (2016). Developing the Person–Environment Apathy Rating for persons with dementia. Aging & Mental Health, 20, 861–870.CrossRefGoogle ScholarPubMed
Jao, Y.-L., Loken, E., MacAndrew, M., Van Haitsma, K. and Kolanowski, A. (2018). Association between social interaction and affect in nursing home residents with dementia. Aging & Mental Health, 22, 778–783.CrossRefGoogle ScholarPubMed
Kaplan, S. and Kaplan, R. (1936). Cognition and Environment: Functioning in an Uncertain world. Ann Arbor, MI: Ulrich’s Bookstore.Google Scholar
Kolanowski, A. et al. (2017). Determinants of behavioral and psychological symptoms of dementia: a scoping review of the evidence. Nursing Outlook, 65, 515–529.CrossRefGoogle Scholar
Lawton, M. P. and Nahemow, L. (1973). Ecology and the aging process. In: Eisdorfer, C. and Lawton, M. P. (Eds.), Psychology of Adult Development and Aging (pp. 619–674). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
Leone, E. et al. (2013). Management of apathy in nursing homes using a teaching program for care staff: the STIM–EHPAD study. International Journal of Geriatric Psychiatry, 28, 383–392.CrossRefGoogle ScholarPubMed
Levy, R. and Dubois, B. (2005). Apathy and the functional anatomy of the prefrontal cortex–basal ganglia circuits. Cerebral Cortex, 16, 916–928.CrossRefGoogle ScholarPubMed
Lyketsos, C. G., Steinberg, M., Tschanz, J. T., Norton, M. C., Steffens, D. C. and Breitner, J. C. (2000). Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. American Journal of Psychiatry, 157, 708–714.CrossRefGoogle Scholar
Marin, R. S. (1996). Apathy: concept, syndrome, neural mechanisms, and treatment. Seminars in Clinical Neuropsychiatry, 1, 304–314.Google ScholarPubMed
Mega, M. S., Cummings, J. L., Fiorello, T. and Gornbein, J. (1996). The spectrum of behavioral changes in Alzheimer’s disease. Neurology, 46, 130–135.CrossRefGoogle ScholarPubMed
Mjørud, M., Kirkevold, M., Røsvik, J., Selbæk, G. and Engedal, K. (2014). Variables associated to quality of life among nursing home patients with dementia. Aging & Mental Health, 18, 1013–1021.CrossRefGoogle ScholarPubMed
Morris, J. C. (1997). Clinical dementia rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type. International Psychogeriatrics, 9, 173–176.CrossRefGoogle ScholarPubMed
Nijsten, J. M., Leontjevas, R., Pat–El, R., Smalbrugge, M., Koopmans, R. T. and Gerritsen, D. L. (2017). Apathy: risk factor for mortality in nursing home patients. Journal of the American Geriatrics Society, 65, 2182–2189.CrossRefGoogle ScholarPubMed
Proitsi, P. et al. 2011. A multiple indicators multiple causes (MIMIC) model of behavioural and psychological symptoms in dementia (BPSD). Neurobiology of Aging, 32, 434–442.CrossRefGoogle Scholar
Reisberg, B. (1988). Functional assessment staging (FAST). Psychopharmacology Bulletin, 24, 653–659.Google Scholar
Robert, P. et al. (2009). Proposed diagnostic criteria for apathy in Alzheimer’s disease and other neuropsychiatric disorders. European Psychiatry, 24, 98–104.CrossRefGoogle ScholarPubMed
Saliba, D., DiFilippo, S., Edelen, M. O., Kroenke, K., Buchanan, J. and Streim, J. (2012). Testing the PHQ-9 interview and observational versions (PHQ-9 OV) for MDS 3.0. Journal of the American Medical Directors Association, 13, 618–625.CrossRefGoogle ScholarPubMed
Samus, Q. M. et al. (2005). The association of neuropsychiatric symptoms and environment with quality of life in assisted living residents with dementia. The Gerontologist, 45, 19–26.CrossRefGoogle ScholarPubMed
Sclan, S. G. and Reisberg, B. (1992). Functional assessment staging (FAST) in Alzheimer’s disease: reliability, validity, and ordinality. International Psychogeriatrics, 4, 55–69.CrossRefGoogle ScholarPubMed
Starkstein, S. E., Ingram, L., Garau, M. L. and Mizrahi, R. (2005). On the overlap between apathy and depression in dementia. Journal of Neurology, Neurosurgery & Psychiatry, 76, 1070–1074.CrossRefGoogle ScholarPubMed
Starkstein, S. E., Jorge, R. and Mizrahi, R. (2006). The prevalence, clinical correlates and treatment of apathy in Alzheimer’s disease. The European Journal of Psychiatry, 20, 96–106.CrossRefGoogle Scholar
van Reekum, R., Stuss, D. T. and Ostrander, L. (2005). Apathy: why care? The Journal of Neuropsychiatry and Clinical Neurosciences, 17, 7–19.CrossRefGoogle ScholarPubMed
Vilalta-Franch, J., Calvó-Perxas, L., Garre-Olmo, J., Turró-Garriga, O. and López-Pousa, S. (2013). Apathy syndrome in Alzheimer’s disease epidemiology: prevalence, incidence, persistence, and risk and mortality factors. Journal of Alzheimer’s Disease, 33, 535–543.CrossRefGoogle ScholarPubMed
Wahl, H. W. and Lang, F. R. (2003). Aging in context across the adult life course: integrating physical and social environmental research perspectives. Annual Review of Gerontology and Geriatrics, 23, 1–33.Google Scholar
Weisman, G. D. (2001). Theory and Practice of Place: Toward an Integrative Model. The Many Dimensions of Aging. New York, NY: Springer Publishing.Google Scholar
Williams, K. N., Ilten, T. B. and Bower, H. (2005). Meeting communication needs: topics of talk in the nursing home. Journal of Psychosocial Nursing and Mental Health Services, 43, 38–45.Google ScholarPubMed
Williams, K. N., Perkhounkova, Y., Herman, R. and Bossen, A. (2016). A communication intervention to reduce resistiveness in dementia care: a cluster randomized controlled trial. The Gerontologist, 57, 707–718.Google Scholar
Wood, S. et al. (2000). The use of the neuropsychiatric inventory in nursing home residents: characterization and measurement. The American Journal of Geriatric Psychiatry, 8, 75–83.CrossRefGoogle Scholar