Improving Meaningful Engagement (ME) in LTC Residents with Dementia: Applying the MemPics Program

Transcription

1 Improving Meaningful Engagement (ME) in LTC Residents with Dementia: Applying the MemPics Program Presented by Dr. William Mansbach Founder & CEO, Mansbach Health Tools, LLC Home of the BCAT at Presented by Sarah Kneisler, RMT/NHA, Background of the Grant Cognitive and mood assessment are essential in personcentered care Office of Health Care Quality (OHCQ), the Beacon Institute & BCAT have teamed to create a project funded by OHCQ to: Improve resident care outcomes by engaging cognitively impaired residents in recreational programs resulting in purposeful and meaningful engagement. Reduce behavioral and psychological symptoms of dementia 2 1

2 Data Collection Process Meetings and training, pre instruction testing Individual resident data collection Online staff survey Data analysis 3 Background: National Meaningful Engagement (ME) Survey Total Completed Surveys: 138 Job Titles (Top three): Speech Therapist 27.9% Social Work 12.3% Occupational Therapist 12.1% Age: range = 24 60, (± 12.49) Average Years Working in Geriatrics (± 10.93) Representing 30 states plus Washington, D.C. 4 2

3 National ME Survey (continued) Typically, respondents strongly agreed with the following statements regarding ME activities: Can improve mood functioning in individuals with dementia. Can improve well being in individuals with dementia. Can have an impact on the life quality of individuals with dementia. Can reduce agitation in individuals with dementia. 5 National ME Survey (continued) Typically, respondents strongly agreed with the following statements regarding ME activities: Can improve person centered care. Can improve the general health of individuals with dementia. Can reduce reliance on antipsychotics and other medications in people with dementia. 6 3

4 National ME Survey (continued) Typically, respondents strongly agreed with the following statements regarding ME activities: Verbal individuals with dementia are capable of benefitting from ME activities. Nursing homes that plan ME activities create more positive living environments for individuals with dementia. Assisted living facilities that plan ME activities create more positive living environments for individuals with dementia. 7 National ME Survey (continued) Who can facilitate ME? Activities/Recreation staff 97% Spouses 94% Non spousal relatives 94% Friends 88% Healthcare professionals 97% Professional caregivers 94% Informal caregivers 88% Other (volunteers, clergy, etc.) 19% 8 4

5 National ME Survey (continued) How often would you recommend ME activities to individuals with dementia? More than once daily (55%) Daily (42%) Once a week (3%) 9 National ME Survey (continued) MemPics Interest Inventory Typically, respondents strongly agreed or agreed with the following statements regarding MemPics : I would find MemPics useful within the scope of my practice. I am interested in learning more about MemPics. 10 5

6 National ME Survey (continued) MemPics Interest Inventory Typically, respondents strongly agreed or agreed with the following statements regarding MemPics : I believe many of my patients/residents would enjoy MemPics. I would likely recommend MemPics or a similar program to my patients/residents. 11 Describing the Resident Sample 128 individuals met criteria for inclusion in the study Inclusion Criteria: Participants (Age 60) residing in an ALF or SNF BCAT SF suggestive of mild or moderate dementia Appear to be capable of participating in ME activities Exclusion Criteria: Non English speaking residents Residents who were fully blind or non verbal Specific cognitive diagnoses (e.g., Korsakoff s dementia) 12 6

7 Participant Demographics Average age (± 9.33) years old Gender Male 23.4% Female 76.6% Race White 73.4% African American 26.6% 13 Participant Demographics Education < 6 th 6.3% 7 11 th 18.8% High school or GED 31.3% Trade 1.6% Some college 11.7% Bachelors degree 22.7% Graduate degree 6.3% Post graduate degree 1.6% 14 7

8 Participant Demographics Marital Status Widowed 57.8% Divorced 14.8% Single, Never Married 14.1% Married 11.7% Separated 1.6% 15 BCAT Report Statistics BCAT SF Score Statistics BCAT SF Total (± 2.74) Cognitive stages (based on BCAT SF scores) Mild dementia 42.2% Moderate dementia 57.8% 16 8

9 BCAT Report Statistics BADS Anxiety Factor Score Statistics BADS Anxiety Factor Total 2.72 (± 2.69) Anxiety levels (based on BADS Anxiety Factor scores) No clinical anxiety 73.4% Clinical anxiety 26.6% 17 BCAT Report Statistics BADS Depression Factor Score Statistics BADS Depression Factor Total 2.19 (± 1.75) Depression levels (based on BADS Depression Factor scores) No clinical depression 62.5% Clinical depression 37.5% 18 9

10 Behavioral and Psychological Symptoms of Dementia Irritability Has not occurred 56.3% Occurred in the last month 37.5% Occurred but not in the last month 6.3% Agitation Has not occurred 60.9% Occurred in the last month 35.2% Occurred but not in the last month 3.9% 19 Behavioral and Psychological Symptoms of Dementia Verbal aggression Has not occurred 79.7% Occurred in the last month 17.2% Occurred but not in the last month 3.1% Physical aggression Has not occurred 91.4% Occurred in the last month 6.3% Occurred but not in the last month 2.3% 20 10

11 Behavioral and Psychological Symptoms of Dementia Uncooperativeness Has not occurred 68.8% Occurred in the last month 27.3% Occurred but not in the last month 3.1% Abandonment Has not occurred 75.8% Occurred in the last month 18.0% Occurred but not in the last month 4.7% 21 Behavioral and Psychological Symptoms of Dementia Changes in emotion Has not occurred 76.6% Occurred in the last month 20.3% Occurred but not in the last month 3.1% Total number of symptoms in the past month % % 2 or more 40.8% 22 11

12 Satisfaction with Life Extremely dissatisfied 1.6% Dissatisfied 7.9% Slightly dissatisfied 19.7% Neutral 3.1% Slightly satisfied 26.8% Satisfied 28.3% Extremely satisfied 12.6% 23 Satisfaction with Life: Consolidated Responses Dissatisfied 29.2% Neutral 3.1% Satisfied 67.7% 24 12

13 Participant Random Group Assignment Intervention groups Experimental (MemPics ) 70 participants Control (Linguistic Activity) 58 participants Participants between the two groups did not differ with respect to race, age, gender, education, marital status, cognitive level, depression, anxiety, agitation, irritability, satisfaction with life, or ability to complete the intervention. 25 ME Activity Completion ME Activity 1 MemPics 66 (94.3%) completed Other 54 (93.1%) completed Dropout (2), cannot complete or rate (8), refused (2) ME Activity 2 MemPics 51(72.9%) completed Other 48(82.8%) completed Dropout (2), cannot complete (3), refused (2), protocol N/A (12), incomplete data (10) 26 13

14 ME Scores by Group Participants who completed both ME activities MemPics 50 participants Other 48 participants MemPics group scores M= 47.51, SD = 6.07 Control group scores M = 44.94, SD = 4.82 Overall, ME scores between the two groups were significantly different. t(96) = 2.32, p =.02, d = ME Scores by Group MemPics Control ME Activity 1 ME Activity

15 Comparison to Normative ME Levels Study participants had comparable levels of ME to a community dwelling sample of older adults (N = 154) MemPics M = 47.51, SD = 6.07 Control M = 44.94, SD = 4.82 Community sample M = 48.2, SD = 6.50 Eakman, Carlson, & Clark (2010) 29 Additional ME Items Item #14: Compared to other activities in the facility, the activity that I just completed was more meaningful. After the second ME activity, MemPics participants rated this item significantly higher than the control group. t(93) = 3.37, p =.00, The effect size for this difference is medium to large (d =.75) 30 15

16 Additional ME Items Item #15: Compared to other activities in the facility, the activity that I just completed encouraged me to participate more. After the second ME activity, MemPics participants rated this item significantly higher than the control group. t(93) = 2.39, p =.02, d = Relationship Between ME and Other Variables Overall ME scores were not significantly correlated with levels of cognitive functioning, mood functioning, satisfaction with life, or behavioral and psychological symptoms of dementia (ps >.05 for all)

17 Other Correlations Satisfaction with life was significantly and negatively associated with levels of cognitive and mood functioning. BCAT SF scores (r = 0.26, p = 0.01) BADS Anxiety Factor scores (r = 0.33, p = 0.00) BADS Depression Factor scores (r = 0.37, p = 0.01) 33 Post MemPics Facility Staff Online Survey Completed surveys: 33 Training only 12% Pre assessment only 26% Recreation assessment only 32% Both pre assessments and recreation assessments 29% 34 17

18 Post MemPics Facility Staff Survey Respondents Job Titles (top three): Social Work 35.3% Recreation 35.3% Director, Manager, Administrator 14.5% Average Years in Geriatrics (± 10.89) Average Years in Long term Care (± 11.34) Average Years in Short term Rehabilitation 7.68 (± 8.35) 35 MemPics Project Interest Reasons for participation (top three): Providing ME is part of my facility s long term initiative 70.6% Providing non pharmacological interventions is part of my facility s long term initiative 52.9% Wanted to learn more about the BCAT Approach 52.9% 36 18

19 Clinical Application of MemPics Typically, respondents strongly agreed or agreed with the following statements: There is a need for an intervention like MemPics. MemPics can improve the mood of individuals with dementia. MemPics can have a positive impact on the life quality of individuals with dementia. 37 Clinical Application of MemPics Typically, respondents strongly agreed or agreed with the following statements: Nursing homes that use MemPics can create a more positive living environment for residents with dementia. Assisted living facilities that use MemPics can create a more positive living environment for residents with dementia. Verbal individuals with dementia are cognitively capable of participating in MemPics

20 Clinical Application of MemPics Typically, respondents strongly agreed or agreed with the following statements: I would find MemPics useful within the scope of my practice. I will likely recommend MemPics to my patients/ residents. I will likely recommend MemPics to my patients / residents responsible party. 39 Clinical Application of MemPics Typically, respondents agreed with the following statements: MemPics can improve the general health of individuals with dementia. MemPics can improve the cognitive functioning in individuals with dementia. MemPics can reduce agitation or irritability in individuals with dementia

21 Clinical Application of MemPics Typically, respondents agreed with the following statements: MemPics can improve the general health of individuals with dementia. MemPics can improve the cognitive functioning in individuals with dementia. MemPics can reduce agitation or irritability in individuals with dementia. 41 Clinical Application of MemPics Typically, respondents agreed with the following statements: MemPics can reduce the need for antipsychotic and other psychotropic medications for residents with dementia. MemPics can improve person centered care

22 In general, MemPics can Facilitate ME in residents with dementia. Strongly agree 53% Agree 38% Neither agree nor disagree 9% Disagree 0% Strongly disagree 0% 43 In general, MemPics Is more effective in facilitating ME in residents with dementia than a majority of other activities in which residents can participate. Strongly agree 21% Agree 41% Neither agree nor disagree 24% Disagree 12% Strongly disagree 3% 44 22

23 Recommendation of MemPics How often would you recommend MemPics for individuals with dementia? I would not recommend MemPics 0% Once a month 5% Once a week 48% Daily 43% More than once daily 5% 45 Recommendation of MemPics How often would you recommend MemPics for individuals with dementia? I would not recommend MemPics 0% Once a month 5% Once a week or more frequently 95% 46 23

24 Recommendation of MemPics Would you recommend MemPics to another professional or colleague? Yes 100% No 0% 47 Staff Experience using MemPics Average Grade: A+ A A B+ B B C+ C Respondent MemPics Grading 48 24

25 BCAT Insight Activities that tend to be high in Meaningful Engagement are interpersonal, here and now, have relatable content, and activate old memories. 49 BCAT Insight MemPics TM was found to be high in ME, and significantly higher in ME than the control group facility activities

26 BCAT Insight The value of MemPics TM was found for both residents with mild and moderate dementia. That is, residents with moderate dementia can still benefit from MemPics TM and meaningfully engage. 51 BCAT Insight 95% of facility staff would recommend MemPics TM once a week or more frequently for residents with dementia. 100% of facility staff would recommend MemPics TM to another professional or colleague

27 Improving Meaningful Engagement (ME) in LTC Residents with Dementia: Applying the MemPics TM Program Dr. William Mansbach CEO, The BCAT Izzy Firth President, The Lifespan Network network.org Kristen Clark Sr. Vice President 54 27

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29 57 MemPicsTMMusic and Memories Book Two By William E. Mansbach Ph.D. and Sarah Kneisler, RMT/NHA Chapters: Frank Sinatra, Bill Haley, Louis Armstrong, Buddy Holly, Julie Andrews, John Philip Sousa Same Format: Colorful picture, Fun Facts, Prompting Questions and Story Let s do an impromptu group: Dame Julie Andrews 58 29

30 Questions Thank You For more information contact or Sarah Kneisler at 59 30