A randomized controlled trial for an individualized positive psychosocial intervention for the affective and behavioral symptoms of dementia in nursing home residents

Contact Information

Keywords

Kimberly S Van Haitsma

Activity intervention; Behavioral symptoms; Dementia; Nursing home; Positive and negative affect; Preferences; Randomized control trial.

Abstract

Objectives. This randomized controlled study tested the effectiveness of individualized activities, led by certified nursing assistants (CNAs), to increase positive and reduce negative affect and behavior among nursing home residents with dementia. Method. Nursing home residents with mild to advanced dementia (N = 180) were randomly assigned to usual care (UC, n = 93) or 1 of 2 experimental conditions. Residents in the attention control group (AC, N = 43) participated in standardized one-to-one activities with their CNAs. Individualized Positive Psychosocial Intervention (IPPI) participants (n = 44) received a CNA-led activity matched to their interests and ability. Outcomes were residents’ positive and negative affect and verbal and nonverbal behavior. Results. The IPPI and AC groups experienced similar benefits—more pleasure, alertness, engagement, positive touch, and positive verbal behavior—compared with UC. The AC group displayed more anger, uncooperativeness, and very negative verbal behavior than UC or IPPI. Discussion. This study demonstrates the value of individualized activities for nursing home residents with dementia. In a stringent test, residents were happier and less angry during a customized intervention compared with a standardized intervention. Even brief individualized CNA-led activities bring pleasure to nursing home residents and constitute an effective strategy to enhance positive affect and engagement in persons with dementia.

Citation

Van Haitsma, K. S., Curyto, K., Abbott, K. M., Towsley, G. L., Spector, A., & Kleban, M. (2015). A randomized controlled trial for an individualized positive psychosocial intervention for the affective and behavioral symptoms of dementia in nursing home residents. The journals of gerontology. Series B, Psychological sciences and social sciences, 70(1), 35–45. https://doi.org/10.1093/geronb/gbt102

DOI

10.1093/geronb/gbt102

EWB Constructs:

(3) Positive Affect

EWB Measures:

Multidimensional Observation Scale for Elderly Subjects (MOSES;contains positive affect scale

data availability:

data availability details:

N/A

brain imaging paradigm:

N/A

brain region/circuit:

Exclusion Criteria:

(1) Residents were ineligible for the study if they were actively psychotic or receiving end-of-life care.
(2) Residents who had lived on the nursing unit for less than 1 month were also ineligible.

Inclusion Criteria

not stated

Non-EWB Behavioral
Measures:

Mini-Mental State Exam
Multidimensional Observation Scale for Elderly Subjects
Minimum Data Set (MDS; Morris et al., 1990)
Activities of Daily Living (ADL
Preferences for Everyday Living Inventory-Nursing Home (PELI-NH
Multidimensional Observation Scale for Elderly Subjects (MOSES;

First author:

Kimberly S Van Haitsma

species:

Human

sample size:

180

study design:

(5) RCT

longitudinal data?

Yes

younger controls?

interventions:

an Individualized Positive Psychosocial Intervention

study population:

(2) patients with (pre)clinical dementia

sex (% female):

82.22%

ethnicity (%white)

99.40%

Age (mean, sd):

Individualized Positive Psychosocial Intervention: 87.66, 8.37
Activities of Daily Living: 88.71, 6.13
control: 89.21, 6.87

biological/Physiological Measures:

N/A