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Wellbeing-enhancing occupation and organizational and environmental contributors in long-term dementia care facilities: an explorative study

Published online by Cambridge University Press:  20 September 2013

Dieneke Smit*
Affiliation:
Department of Clinical Psychology, Faculty of Psychology and Education, Vrije Universiteit, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands
Bernadette Willemse
Affiliation:
Department of Clinical Psychology, Faculty of Psychology and Education, Vrije Universiteit, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands Program on Aging, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, the Netherlands
Jacomine de Lange
Affiliation:
Program on Aging, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, the Netherlands
Anne Margriet Pot
Affiliation:
Department of Clinical Psychology, Faculty of Psychology and Education, Vrije Universiteit, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands Program on Aging, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, the Netherlands
*
Correspondence should be addressed to: Dieneke Smit, Trimbos-instituut, PO Box 725, 3500 AS Utrecht, the Netherlands. Phone: +31 (0)61-4123943. Email: [email protected].

Abstract

Background:

Occupation remains an unmet need in long-term dementia care. To increase residents’ occupation, knowledge of types of occupation related to wellbeing, and organizational and environmental characteristics encouraging involvement in these types of occupation, is indispensable.

Methods:

In this explorative study, Dementia Care Mapping was used to study involvement in different types of occupation and wellbeing among 57 residents of 10 dementia care facilities. For each type of occupation, mean experienced wellbeing was studied. Occupation types with high mean wellbeing scores were classified as “wellbeing-enhancing occupation.” Care facilities were ranked according to the mean time residents spent in types of wellbeing-enhancing occupation. Using information on staff-to-resident ratio, individual space, and items of the Physical Environment Evaluation Component of Dementia Care Mapping, organizational and environmental characteristics of the facilities were compared to study their relationship with wellbeing-enhancing occupation.

Results:

Reminiscence, leisure, expression, and vocational occupation had greatest potential to enhance wellbeing, but these types were seldom offered. Much variation existed in the extent to which wellbeing-enhancing occupation was provided. Long-term care facilities that did so more frequently generally had a more homelike atmosphere, supported social interaction through the environment, and had no central activity program.

Conclusions:

This study suggests that it is possible to engage residents in wellbeing-enhancing occupation, within current means of budget and staff. The physical environment and care organization might play a role, but the key factor seems to equip staff with skills to integrate wellbeing-enhancing occupation into care practice.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2013 

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References

American Psychiatric Association (2007). American Psychiatric Association practice guideline for the treatment of patients with Alzheimer's disease and other dementias. Second edition. American Journal of Psychiatry, 164, 556. doi:10.1176/appi.books.9780890423967.152139Google Scholar
Bradford Dementia Group (2005). DCM 8 User's Manual. Bradford: University of Bradford.Google Scholar
Brooker, D. (2005). Dementia Care Mapping: a review of the research literature. The Gerontologist, 45, 1118.CrossRefGoogle ScholarPubMed
Brooker, D. and Surr, C. (2006). Dementia Care Mapping (DCM): initial validation of DCM8 in UK field trials. International Journal of Geriatric Psychiatry, 21, 10181025. doi:10.1002/gps.1600CrossRefGoogle Scholar
Brooker, D. J., Wooley, R. J. and Lee, D. (2007). Enriching opportunities for people living with dementia in nursing homes: an evaluation of a multi-level activity based model of care. Aging and Mental Health, 11, 361370. doi:10.1080/13607860600963679CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J., Thein, K., Dakheel-Ali, M. and Marx, M. S. (2010a). The underlying meaning of stimuli: impact on engagement of persons with dementia. Psychiatry Research, 177, 216222. doi:10.1016/j.psychres.2009.02.010CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J., Thein, K., Dakheel-Ali, M. and Marx, M. S. (2010b). Engaging nursing home residents with dementia in activities: the effects of modeling, presentation order, time of day and setting characteristics. Aging and Mental Health, 14, 471480. doi:10.1080/1360780903586102CrossRefGoogle ScholarPubMed
Chaudhury, H., Cooke, H. and Frazee, K. (2013). Developing a physical environmental evaluation component of the Dementia Care Mapping (DCM) Tool. In Rowles, G. and Bernard, M. (eds.), Environmental Gerontology: Making Meaningful Places in Old Age. New York: Springer.Google Scholar
Cook, C., Fay, S. and Rockwood, K. (2008). Decreased initiation of usual activities in people with mild-to-moderate Alzheimer's disease: a descriptive analysis from the VISTA clinical trial. International Psychogeriatrics, 20, 952963. doi:10.1017/S1041610208007230CrossRefGoogle ScholarPubMed
Dobbs, D., Munn, J., Zimmerman, S., Boustani, M., Williams, C. S., Sloane, P. D. and Reed, P. S. (2005). Characteristics associated with lower activity involvement in long-term care residents with dementia. The Gerontologist, 45 (Suppl. 1), 8186. doi:10.1093/geront/45.suppl_1.81CrossRefGoogle ScholarPubMed
Dröes, R. M.et al. (2006). Quality of life in dementia in perspective. An explorative study of variations in opinions among people with dementia and their professional caregivers, and in literature. Dementia, 5, 533558. doi:10.1177/1471301206069929CrossRefGoogle Scholar
Elliot, G. M. (2011). Montessori Methods for Dementia: Focusing on the Person and the Prepared Environment. Hamilton, Ontario, Canada: McMaster University.Google Scholar
Ettema, T. P., Dröes, R. M., de Lange, J., Mellenbergh, G. J. and Ribbe, M. W. (2007). QUALIDEM: development and evaluation of a dementia specific quality of life instrument – validation. International Journal of Geriatric Psychiatry, 22, 424430. doi:10.1002/gps.1692CrossRefGoogle ScholarPubMed
Fossey, J., Lee, L. and Ballard, C. (2002). Dementia Care Mapping as a research tool for measuring quality of life in care settings: psychometric properties. International Journal of Geriatric Psychiatry, 17, 10641070. doi:10.1002/gps.708CrossRefGoogle ScholarPubMed
Fritsch, T., Kwak, J., Grant, S., Lang, J., Montgomery, R. R. and Basting, A. D. (2009). Impact of TimeSlips, a creative expression intervention program, on nursing home residents with dementia and their caregivers. The Gerontologist, 49, 117127. doi:10.1093/geront/gnp008.CrossRefGoogle ScholarPubMed
Harmer, B. J. and Orrell, M. (2008). What is meaningful activity for people with dementia living in care homes? A comparison of the views of older people with dementia, staff and family carers. Aging and Mental Health, 12, 548558. doi:10.1080/1360786080234019CrossRefGoogle Scholar
Innes, A. and Surr, C. (2001). Measuring the well-being of people with dementia living in formal care settings: the use of Dementia Care Mapping. Aging and Mental Health, 5, 258268. doi:10.1080/13607860120065023CrossRefGoogle ScholarPubMed
interRAI (2005). Resident Assessment Instrument. interRAI LTC. Available at www.interrai.org.Google Scholar
Kitwood, T. (1997). Dementia Reconsidered, the Person Comes First. Buckingham: Open University Press.Google Scholar
Kolanowski, A., Buettner, L., Litaker, M. and Yu, F. (2006). Factors that relate to activity engagement in nursing home residents. American Journal of Alzheimer's Disease and Other Dementias, 21, 1522. doi:10.1177/153331750602100109CrossRefGoogle ScholarPubMed
Knight, T. and Mellor, D. (2007). Social inclusion for older adults in care: is it just a question of providing activities? International Journal of Qualitative Studies on Health and Well-being, 2, 7685.CrossRefGoogle Scholar
Kuhn, D., Fulton, B. R. and Edelman, P. (2004). Factors influencing participation in activities in dementia care settings. Alzheimer's Care Quarterly, 5, 144152.Google Scholar
Lintern, T., Woods, B. and Phair, L. (2000). Before and after training: a case study of interventions. Journal of Dementia Care, 8, 1517.Google Scholar
Maslach, C. and Jackson, S. E. (1986). MBI: Maslach Burnout Inventory: Manual Research Edition, 2nd edn. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
National Collaborating Centre for Mental Health (2007). Dementia. A NICE-SCIE Guideline on Supporting People with Dementia and Their Carers in Health and Social Care. Leicester and London: The British Psychological Society and The Royal College of Psychiatrists.Google Scholar
Orrell, M., Hancock, G. A., Galboda Liyanage, K. C., Woods, B., Challis, D. and Hoe, J. (2008). The needs of people with dementia in care homes: the perspectives of users, staff and family caregivers. International Psychogeriatrics, 20, 941951. doi:10.1017/S1041610208007266CrossRefGoogle ScholarPubMed
Passos, J., Sequeira, C. and Fernandes, L. (2012). The needs of older people with mental health problems: a particular focus on dementia patients and their carers. International Journal of Alzheimer's Disease, article ID 638267. doi:10.1155/2012/638267CrossRefGoogle ScholarPubMed
Perrin, T., May, H. and Anderson, E. (2008). Wellbeing in Dementia, an Occupational Approach for Therapists and Carers, 2nd edn. Edinburgh: Churchill Livingstone Elsevier.Google Scholar
Phinney, A., Chaudhury, H. and O'connor, D. L. (2007). Doing as much as I can do: the meaning of activity for people with dementia. Aging and Mental Health, 11, 384393. doi:10.1080/1360786061086470CrossRefGoogle Scholar
Schreiner, A. S., Yamamote, E. and Shiotani, H. (2005). Positive affect among nursing home residents with Alzheimer's dementia: the effect of recreational activity. Aging and Mental Health, 9, 129134. doi:10.1080/13607860412331336841CrossRefGoogle ScholarPubMed
Scottish Intercollegiate Guidelines Network (2006). Management of Patients with Dementia. A National Clinical Guideline. Edinburgh: Scottish Intercollegiate Guidelines Network.Google Scholar
Sloane, P. D.et al. (2002). The therapeutic environment screening survey for nursing homes (TESS-NH): an observational instrument for assessing the physical environment for institutional settings for persons with dementia. Journal of Gerontology: Social Sciences, 57B, S69–S78. doi:10.1093/geronb/57.2.S69CrossRefGoogle Scholar
Sloane, Ph. D.et al. (2007). Dementia Care Mapping as a research tool. International Journal of Geriatric Psychiatry, 22, 580589. doi:10.1002/gps.1721CrossRefGoogle ScholarPubMed
Smit, D., de Lange, J., Willemse, B. and Pot, A. M. (2012). The relationship between small-scale care and activity involvement of residents with dementia. International Psychogeriatrics, 24, 722732. doi:10.1017/S1041610211002377CrossRefGoogle ScholarPubMed
Smith, R., Mathews, R. M. and Gresham, M. (2010). Pre- and postoccupancy evaluation of new dementia care cottages. American Journal of Alzheimer's Disease and Other Dementias, 25, 265275. doi:10.1177/1533317509357735CrossRefGoogle ScholarPubMed
Train, G. H., Nurock, S. A., Manela, M., Kitchen, G. and Livingston, G. A. (2005). A qualitative study of the experiences of long-term care for residents with dementia, their relatives and staff. Aging and Mental Health, 9, 119128. doi:10.1080/13607860412331310236CrossRefGoogle ScholarPubMed
van der Doef, M. and Maes, S. (1999). The Leiden quality of work questionnaire: its construction, factor structure, and psychometric qualities. Psychological Reports, 85, 954962.CrossRefGoogle ScholarPubMed
Vollicer, L., Simard, J., Heartquist Pupa, J., Medrek, R. and Riordan, M. E. (2006). Effects of continuous activity programming on behavioral symptoms of dementia. Journal of the American Medical Directors Association, 7, 426431. doi:10.1016/j.jamda.2006.02.003CrossRefGoogle Scholar
Willemse, B., Smit, D., De Lange, J. and Pot, A. M. (2011). Nursing home care for people with dementia and residents’ quality of life, quality of care and staff well-being: design of the living arrangements for people with dementia (LAD) – study. BMC Geriatrics, 11, 11. doi:10.1186/1471-2318-11-11CrossRefGoogle ScholarPubMed
Williams, C. L. and Tappen, R. M. (2007). Effect of exercise on mood in nursing home residents with Alzheimer's disease. American Journal of Alzheimer's Disease and Other Dementias, 22, 389397. doi:10.1177/1533317507305588CrossRefGoogle ScholarPubMed
Wood, W., Harris, S., Snider, M. and Patchel, S. A. (2005). Activity situations on an Alzheimer's disease special care unit and resident environmental interaction, time use, and affect. American Journal of Alzheimer's Disease and Other Dementias, 20, 105118. doi:10.1177/153331750502000210CrossRefGoogle Scholar