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ENVIRONMENTS IN MANAGING BEHAVIOURS IN ADVANCED DEMENTIA: A MULTISITE STUDY Linda J Garcia, Ph.D.

Has no real or apparent conflicts of interest to report. ENVIRONMENTS IN MANAGING BEHAVIOURS IN ADVANCED DEMENTIA: A MULTISITE STUDY Linda J Garcia, Ph.D. Professor , Director and Associate Dean Interdisciplinary School of Health Sciences University of Ottawa

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ENVIRONMENTS IN MANAGING BEHAVIOURS IN ADVANCED DEMENTIA: A MULTISITE STUDY Linda J Garcia, Ph.D.

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  1. Has no real or apparent conflicts of interest to report. ENVIRONMENTS IN MANAGING BEHAVIOURS IN ADVANCED DEMENTIA: A MULTISITE STUDYLinda J Garcia, Ph.D. Professor,Director and Associate Dean InterdisciplinarySchool of Health Sciences University of Ottawa Scientist, Élisabeth Bruyère Research Institute M. Hébert, J. Kozak, I. Sénécal, S. Slaughter, N. Drummond, F. Aminzadeh, W. Dalziel, J. Charles, M. Eliasziw TEAM – CO-AUTHORS

  2. DEMENTIA COGNITIVE IMP. BEHAVIOUR

  3. Main goal of the study Study the impact of architectural designs and human environments on quality of life of residents with dementia in specially designed units and traditional units.

  4. CALGARY Carewest Signal Pointe (SDU) Bethany Harvest Hill (SDU) TORONTO Dorothy MachamHome (SDU) Map of Sites OTTAWA Peter D. Clark LTC Home (SDU & TU) Centre d’accueilchamplain(SDU & TU) St Patrick’s Home of Ottawa, Inc (TU)

  5. DATA • Data related to the residents • MMSE: Mini-Mental State Examination • CMAI: Cohen-Mansfield Agitation Inventory • NPI: Neuropsychiatric Inventory • AARS: Apparent Affect Rating Scale • MOSES: Multidimensional Observation Scale of Elderly Subjects • FAST: Functional Assessment Staging Test(FAST) • PES: Pleasant Events Schedule • Data related to the units • TESS-NH: Therapeutic Environment Screening Survey • MECQ-LTC: Montreal Evaluation of Communication Questionnaire in Long Term Care • Staff ratio

  6. Sociodemographic profile of residents(N = 143 – 71 in Ottawa; 72 elsewhere) Ottawa statistics are derivedfrom participants in study. Calgary and Toronto sites are facilitystatistics.

  7. Results of tests • FAST: Severely affected in functional status : • ADLs affected, incontinence, trouble with communication, 17% mobility problem • MMSE : moderate-severedementia (mean 14.5/30) • AARS: show interest, pleasure, very little fear/anxiety, anger, sadness • PES: 75% engaged in ≥10 activities on list in the past; 25% currentlyenjoy ≥ 10 or more of theseactivitiesnow. Few (10%) enjoy the samenumber or more activitiescompared to enjoyedactivities in the past

  8. Disruptive Behaviours

  9. The Environment No significant difference between TU and SDU in the global TESS-NH results more homelike but less secure more secure but less clean great outdoor garden … not accessible! best staffing levels not necessarily highest TESS-NH scores

  10. Social environment – communication (MECQ-LTC) • Familiar staff • Perceived nonverbal means of communication significantly more in residents • reported verifying, waiting and giving choice of responses more frequently to understand a message • check understanding and reformulate sentences more

  11. Discussion Groups • Family members (N=45) • 7 Groups (6 – 7 per group) • Regular contact (> 1/ week) • Staff members (N=59) • 8 Groups (7-8 per group) • > 6 months working with resident

  12. Environmental factors influencing quality of life and behaviours Facilitators • Staff approach • Individualized care • Home-like environment • Generalized activities & stimulation • Rules- flexibility Obstacles • Lowstaffinglevels • High noise levels • Reduced staff continuity • Inflexible rules

  13. Staff Family Facilitators • Not mixing groups with different needs • Low noise • Variety of food Obstacles • Over utilization of medication (drugs) • Little privacy • Diminished communication/hearing levels of residents Facilitators • Staff Teamwork • Presence of a safe/supervised environment Obstacles • Physical barrier • No space to care for special needs (health) • Little staff training • Minimal visual stimulation

  14. Observations - • 19 individuals were observed (15 women; 4 men); 20 minutes each • Is ourobservationalsamplerepresentative? YES HIGHLIGHTS OF OBSERVATIONS: • Noise • Breathing room from other residents • Serving the greater community/taking care of others – my home • SAFE Place to wander – exploring • Opportunities for rich human interactions, especially resident interaction • Café de Paris

  15. F.A.C.T.U.R.S.

  16. THANK YOU! MERCI!!! Alzheimer Society of Canada Alzheimer Society of Ottawa and Renfrew Counties ÉlisabethBruyère Research Institute ALL OUR PARTICIPANTS AND SERVICE PROVIDERS Linda.garcia@uottawa.ca

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