The impact of the environment on activity engagement of persons diagnosed with moderate stage Alzheimer's disease residing in a long-term care facility

Covington, Najiyyah
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Individuals who have been diagnosed with moderate stage Alzheimer’s disease typically require assistance for the completion of daily activity secondary to pervasive cognitive dysfunction. Moderate stage Alzheimer’s disease is a phase that can last the longest due to steady decline coupled with continued physical functioning. By age 80, 75% of these individuals will be admitted to a long-term care facility (Staples & Killian, 2012), leading to the proposed dissertation topic.

The purpose of this dissertation was to examine the effect of the environment upon activity engagement of persons diagnosed with moderate stage Alzheimer’s disease within a long-term care facility. This dissertation is comprised of three studies involving formal caregivers and OT practitioners. The first study was completed using a mixed method design to observe residents during activity participation while using a standardized instrument, the Volitional Questionnaire. The results of this study showed that individuals with moderate stage Alzheimer’s disease are able to display volition for activities of interest. These residents were able to engage in activity and make their interests and motivations known using nonverbal and verbal indicators. The second study employed a qualitative design using a structured interview to gather information from a focus group comprised of formal caregivers. The focus group revealed that formal caregivers have a vested interest in the well-being of the residents and how they participate in activities. Notably, an impact on occupational performance by the physical, social, and temporal environment was evident. Formal caregivers shared that if more time was available, they could engage with residents for longer amounts of time and enhance their rapport with residents. The third study involved a focus group with OT practitioners using a semi-structured interview derived from items on the Volitional Questionnaire. The OT practitioners shared that engagement in daily activity can be enhanced through positive conversation and a focus on the interests of the residents. OT practitioners indicated that the environment has an effect on participation of residents in daily activities and that interactions with formal caregivers can play an important role in occupational performance.

The focus of this dissertation was to provide information from the perspectives of formal caregivers and occupational therapy practitioners about the impact of the environment on participation. The data gathered through these three studies provide insight into how these two groups interpret the environment and what the environmental impact is upon activity engagement. The information provides support for OT practitioners and formal caregivers to provide services that are cognizant of the resident with moderate stage Alzheimer’ disease and their occupational performance within a long-term care facility.

Mental health, Aging, Occupational therapy, Health and environmental sciences, Activity, Alzheimer's dementia, Engagement, Moderate stage, Occupational therapy, Skilled nursing facility