Why do Research on CE Programs. Published research on CE Activity Programs 9/2/2012

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1 9/2/12 Research on CE Activities for People Living with Dementia Dalia Gottlieb-Tanaka Peter Graf Zorry Belchev Nicholas Whittle Questions/Motivations Why do Research on CE Programs Because we are convinced that CE interventions are beneficial Because we feel strongly about the quality of life of people living with dementia Because the population of seniors with dementia is increasing & is outstripping the resources of the health care system Because we wish to make sure our work/practice/interventions are sound & founded on the best possible evidence What lessons are taught by existing research Two Kinds of Research Published research on CE Activity Programs What has been done (what needs to be done) & what does it teach us? Research on CE Activity Programs in BC Adult Care Facilities What CE activity programs are offered in BC What motivates care facilities to offer CE activity programs to their clients Road Map Part 1: Published Research Review Objective & Library Search Strategy & Findings What CE Activities have been studied For what purposes have CE programs been studied Who has been targeted by CE Activity Programs Conclusions Part 2: Research in BC Adult Care Facilities Survey method Purpose of CE Programs Type of CE Program Duration & Availability of Programs Resourcing of CE Activities Conclusions 1

2 9/2/12 Part 1: Research Review Objective To gain insight into what types of CE activity interventions have been used in research on people with dementia, what has been the focus of this research, and what results/insights have emerged from this effort Search Strategy & Outcome Search for empirical articles related to CE Activity programs, published between and 1. Multi-step process: Step 1: 376 peer-reviewed articles selected from a title search of 6 databases: AgeLine, MEDLINE, Social Works Abstracts, PsycINFO, PsychExtra, etc. Step 2: Step articles selected from a review of abstracts, using criteria for inclusion & exclusion Step 3: 93 articles selected, based on a full review of the articles and inclusion & exclusion criteria Amount of Research is Disappointing What CE Activities Have been Used in Research MIX Mix of 2 or more activities MT Music Therapy AT Art Therapy AA Art Activity DT Dance Therapy/Activity RECT - Recreation Therapy DRT Drama therapy/activity LA Leisure Activity ST Storytelling MTCE Medical Treatment with creative expression component MS Music Activity This figure shows that a MIXture of activities was used most commonly, followed by MT (Music Therapy), RT (Reminiscence Therapy) and AT (Art Therapy). Follow-up analysis of the activity MIXture showed that they consisted of a wide range of combinations, with no combination being more popular than another. Most common involved in the MIXtures were Music Therapy, Unique Activity and Reminiscing Therapy. SA Singing Activity SO Sociability SP Spirituality, faith, religion What purpose was intended with the CE Activity Intervention IN9 Therapeutic/medical benefits IN11 - Support/testing/changing cognition IN2 - Participating in therapeutic treatment IN1 - Reduce suffering, moods, agitation IN3 - To make life more meaningful IN4 - Fill needs of individuals IN12 - Accommodate specific behaviour MTCE- Medical treatment IN8 - Understand effects of program on Q of Life IN1 - Socialization IN7 - Designing a better program IN16 - Change public perception IN18 - Increase verbal/non verbal communication IN22 - Increase enjoyment and happiness ECE - Explore CE-qualitative TEA - Testing/evaluating/measuring CE abilities-quant IN6 - Exploring & stimulating reminiscing abilities IN - Encourage client and caregiver interaction IN14 - Assess behavioural disturbances IN15 - Reduce caregiver s stress & increase staff attention IN3 - Reduce apathy, increase interest IN19 - Improve short and long term memory IN26 - To foster self-esteem, discovery & awareness IN38 - Increase opportunities for creative activities & creative engagement 2

3 9/2/12 Who Participated in Research D Dementia mentioned as a general term ALZ Individuals with Alzheimers Disease MD Mixed types & levels D1 Early dementia D2 Moderate dementia D3 Severe dementia VAS Vascular dementia Conclusions Research on CE Activities is in its infancy In most existing research, CE Activities are used as a means to an end, not used for the purpose of illuminating their effects, their applicability, their mechanism of action Research progress on benefits of CE Activity programs might be hampered by measurement instruments able to track their direct (assumed) benefits (e.g., in quality of life, in enjoyment in life) Other reasons for poverty of research Part 2: Research on CE Activity Programs in BC Adult Care Facilities To learn about 4 aspects of CE Activity Programs: Nature of activity programs & scheduling Activity facilitators Program resources & requirements Facility & Clients Research Method A Survey Survey Development Draft survey V1 Focus group: Activity facilitators & program managers (Langley) Draft survey V2 Focus group: Activity facilitators & program managers (Prince George) Final Revision of survey V3 3

4 9/2/12 Survey Distribution/Returns BC Adult Care Facilities ~ 8 Private vs public; Large vs small; Rural vs urban 4 Distribution cycles Random selection of 6 facilities Current data set 115 Completed Returns; return rate ~ 48% Activity Programs Purpose What are you and your facility trying to achieve with the creative activity programs that you offer? (Item 1.1) Indicate what you view as the 5 most important aims of your programs. Purpose of Activity Purpose of Activity Programs By Facility Type % of releavant facilities Privately funded Publicly funded Both Aims of the programs Aims of programs 4

5 9/2/12 Purpose of Activity Programs By Facility Size What CE Activity Programs Typically Offered Fewer than 75 beds 75 beds or more Which type of activity programs are typically offered? (Item 1.2) By professionals By others Aims of the programs CE Activity Programs by Professional vs Others CE Activity Programs & Aims of Such Programs % of facilities by a professional NOT by a professional Self exp, empower Entertain, interact Type of therapy/activity program Activity program 5

6 9/2/12 Activity Programs Duration of Sessions & Results What is the duration of a typical single activity session? (Item 1.4) 6 min... For about 8% of all sessions 3 min for: Aroma Pet therapy or activity One-on-One touch Healing Touch Activity Programs Availability How often is one client able to participate in each activity program? (Item 1.5) Once per week Two days per week... 7 days per week Once per month... Four times per month Once per year Other CE Activity Program Availability: Results Time Allotted Per Year Average time allotted (hours/year) Session schedule Type of activity 6

7 9/2/12 Resources & Requirements Budget Budget by Different Types of Care Facilities What is the total amount in your monthly budget for all creative activity programs? (Item 3.5) % of facilities Private Public Both Less than and over Monthly budget ($) Less than 75 beds Less than 1 15 Monthly budget ($) % of facilities Item 3.5 & 4.5: Comparison of facility size and monthly budget Resources 75 beds or more 15 and over 3.5 & 4.12: Community size and monthly budget Vlarge/Large Monthly budget Med/Small Limitations Questionnaire reliability Reliance on the knowledge of the person filling it out Many of the questionnaires sent back were only partially finished, or some parts were not filled out as instructed 7

8 9/2/12 Concluding Message Motivated by the desire to make our practice evidence based, we might use this research to introspect about our own work & ask: Are we able to measure/document the benefits of the programs we offer Are we able to measure the outcome we are trying to achieve (e.g., increased QoL) Are the resources (trained facilitators, time per client, etc) allocated to CE Activities adequate for achieving the intended goals more important, do we have evidence to claim that they are not adequate. 8