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Occupational Therapy Capstone Presentations Theses, Dissertations, and Student Projects

Spring 5-2021

Improving Quality of Life among Individuals with Neurocognitive Improving Quality of Life among Individuals with Neurocognitive

Disorders using Occupational Therapy and a Sensory Integration Disorders using Occupational Therapy and a Sensory Integration

Approach Approach

MaKenzie K. Johnson University of South Dakota, Makenzie.Johnson@coyotes.usd.edu

Follow this and additional works at: https://red.library.usd.edu/ot-capstone

Part of the Occupational Therapy Commons

Recommended Citation Recommended Citation Johnson, MaKenzie K., "Improving Quality of Life among Individuals with Neurocognitive Disorders using Occupational Therapy and a Sensory Integration Approach" (2021). Occupational Therapy Capstone Presentations. 56. https://red.library.usd.edu/ot-capstone/56

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Title

Student Name, Faculty Mentor Name

BACKGROUND & PURPOSE

Improving Quality of Life Among Individuals with Neurocognitive Disorders Using Occupational Therapy and a Sensory Integration

ApproachMaKenzie Johnson, OTS

Faculty Advisor: Mackenzie Feldhacker OTD, OTR/L, CLT-LANA

Capstone Mentors: Dawn Reuvers, OTR/L & Jill Gabbert, OTR/L, CAPS

ACKNOWLEDGEMENTS

METHODS

RESULTS / CONCLUSIONS

IMPLICATIONS & RECOMMENDATIONS

REFERENCES

THEORETICAL FOUNDATION

• Currently, 50 million people worldwide are affected by Major Neurocognitive Disorder (MND) (World Health Organization [WHO}, 2017).

• By 2050, it is estimated that 150 million people will be living with MND, three times the number of people living with MND today (WHO, 2017).

• Those with MND experience confusion, memory loss, and changes to mood and behavior, impacting participation in daily activities (WHO, 2017).

• Additionally, there are various sensory processing changes that occur in individuals with MND that have an effect on occupational participation (Andersson, 2020; Champagne, 2018; Christie & Houston, 2018).

• 80% of nursing home residents with MND exhibit behavioral and psychological symptoms such as wandering, agitation, depression, and verbal and/or physical aggression (Zwijsen et al., 2014).

• Overall, the effects of MND increases vulnerability to decreased quality of life (Mazzei, 2013).

• Although the Omnibus Budget Reconciliation Act requires nursing staff education on proper care for residents with cognitive impairments, this education is typically minimal and ineffective and does not include how to properly manage undesired behaviors (Ervin et al., 2013; Office of Inspector General, 2020).

• Providing nursing personnel with adequate training related to MND has shown to increase their knowledge of MND, improve job satisfaction, abilities to manage negative behaviors, and increase residents’ participation in activities of daily living (Bauer et al., 2018; Cimino et al., 2014; McClendon & Smyth, 2013; Tannazzo & Colleagues, 2008).

• Anti-psychotics are commonly used to manage behavioral and psychological symptoms of dementia, although adverse effects, including death, have been demonstrated. (Ballard et al., 2018; Briesacher et al., 2013; Maher et al., 2011).

Project Overview: • Due to the expected, significant rise in the geriatric population within the next 30 years, it

is important that nursing facilities keep up with the continuous demand for proper geriatric care (Abdelfattah et al., 2014).

• The need for a more comprehensive neurocognitive approach for memory care residents is indicated through current literature (Bauer et al., 2018; Daly et al., 2015; Ervin et al, 2013).

• This project aimed to improve overall quality of life in individuals with MND through sensory and occupation-based interventions.

• In addition, education was provided to memory care staff and future occupational therapy students regarding sensory processing changes that accompany MND and appropriate communication strategies.

Abdelfattah, A., Core, M., Cannada, L., & Watson, J. (2014). Geriatric high-energy polytrauma with orthopedic injuries: Clinical predictors of mortality. Geriatric Orthopaedic Surgery & Rehabilitation, 5(4), 173-177. 10.1177/2151458514548578

Allen, C. K. (1992). Cognitive disabilities. In N. Katz (Ed.), Cognitive rehabilitation: Models for intervention in occupational therapy (pp. 1-21). Butterworth-Heinemann.

Andersson, H., Sutton, D., Bejerholm, U., & Argentzell, E. (2020) Experiences of sensory input in daily occupations for people with serious mental illness. Scandinavian Journal of Occupational Therapy, 1-11.

Ayres, A. J. (1972). Types of sensory integrative dysfunction among disabled learners. American Journal of Occupational Therapy, 26, 13-18. Ballard, C., Corbett, A., Orrell, M., Williams, G., Moniz-Cook, E., Romeo, R., Woods, B., Garrod, L., Testad, I., Woodward-Carlton, B,

Wenborn, J., Knapp, M., Fossey, J. M. (2018). Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomised controlled trial. PLoS Medicine, 15(2), E1002500. 10.1371/journal.pmed.1002500

Bauer, M., Fetherstonhaugh, D., Haesler, E., Beattie, E., Hill, K., & Poulos, C. (2018). The impact of nurse and care staff education on the functional ability and quality of life of people living with dementia in aged care: A systematic review. Nurse Education Today, 67, 27-45. 10.1016/j.nedt.2018.04.019

Briesacher, B. A., Tjia, J., Field, T., Peterson, D., & Gurwitz, J. H. (2013). Antipsychotic use among nursing home residents. Journal of the American Medical Association, 309(5), 440-442. 10.1001/jama.2012.211266

Champagne, T. (2018). Sensory modulation in dementia care. Jessica Kingsley Publishers. Christie, J., & Houston, A. (2018). Talking sense: Living with sensory changes and dementia. HammondCare. Cimino, N. M., Lockman, K., Grant, M., McPherson, M.L. (2014). Knowledge, skills, and attitudes in caring for older adults with advanced

illness among staff members of long- term care and assisted living facilities: An educational needs assessment. American Journal of Hospice Palliative Care, 33(4), 327-334. 10.1177/1049909114561996

Daly, J., Bay, C., Levy, B., & Carnahan, R. (2015). Caring for people with dementia and challenging behaviors in nursing homes: A needs assessment geriatric nursing. Geriatric Nursing, 36(3), 182-191. 10.1016/j.gerinurse.2015.01.001

Ervin, K., Finlayson, S., & Cross, M. (2012). The management of behavioural problems associated with dementia in rural aged care. Collegian, 19(2), 85-95. 10.1016/j.colegn.2012.02.003

Maher, A. R., Maglione, M., Bagley, S., Suttorp, M., Hu, J. H., Ewing, B., Wang, Z., Timmer, M., Sultzer, D., & Shekelle, P. G. (2011). Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis. Journal of American Medicine Association, 306(12), 1359-1369. https://doi.org/10.1001/jama.2011.1360

Mazzei, F., Gillan, R., & Cloutier, D. (2013). Exploring the influence of environment on the spatial behavior of older adults in a purpose-built acute care dementia unit. American Journal of Alzheimer’s Disease & Other Dementias, 29(4), 311-319. 10.1177/1533317513517033

McClendon, M. J., & Smyth, K. A. (2015). Quality of in-home care, long-term care placement, and the survival of persons with dementia. Aging & Mental Health, 19(12), 1093–1102. Retrieved from https://doi-org.ezproxy.usd.edu/10.1080/13607863.2014.1003284 .

Office of Inspector General. (2002). State nurse aide training: Program information and data. https://oig.hhs.gov/oei/reports/oei-05-01-00031.pdf

Tannazzo, T., Breuer, L., Williams, S., & Andreoli, N. A. (2008). A dementia training program to benefit certified nursing assistant satisfaction and nursing home resident outcomes. Alzheimer's Care Today, 9(4), 221-229.

World Health Organization. (2017). Global action plan on the public health response to dementia 2017-2025. https://www.who.int/mental_health/neurology/dementia/action_plan_2017_2025/en/

Zwijsen, S., Smalbrugge, M., Eefsting, J., Twisk, J., Gerritsen, D., Pot, A., & Hertogh, C. (2014). Coming to grips with challenging behavior: A cluster randomized controlled trial on the effects of a multidisciplinary care program for challenging behavior in dementia. Journal of the American Medical Directors Association, 15(7), 531. 10.1016/j.jamda.2014.04.007

Objective #1 Increasing Knowledge• Significant knowledge was gained through completion of the Certified Dementia

Practitioner course.• Information gathered through a survey that was distributed to OTs with memory care

experience, included various dementia specific approaches, interventions, and strategies that were utilized throughout this Capstone experience.

• The needs assessment that was completed indicated the need for the implementation of dementia-specific caregiving approach and enhanced staff education of MND.

Objective #2 - Staff Education• A total of 24 memory care staff attended the in-service. • Pre and Post Surveys:

• The staff in-service increased staff’s perceived knowledge of all survey items (see Table 1).

• Perceived knowledge increased the most for knowledge of how environmental factors can impact residents’ behaviors.

• Pre and Post Quizzes: • The staff in-service increased participant’s knowledge of various dementia-related

topics evidenced by a 16% average increase in pre and post quiz scores (refer to Figure 1).

Table 1.

Objective #1: Increasing Knowledge of Occupational Therapy’s Role in Memory Care• Observations were completed in a memory care facility where routine activities and sensory-based interventions

are utilized on a day-to-day basis. • A survey was created and distributed for Occupational Therapists (OTs) with memory care experience to gather

more information on dementia-specific approaches.• I participated in an online course through the National Council of Certified Dementia Practitioners to further

enhance my knowledge of MND and gain status as a Certified Dementia Practitioner. • A needs assessment was completed at the Capstone site consisting of on-site observations of typical daily routines

and common residential behaviors and semi-structured interviews with various staff members to determine the need for sensory and occupation-based interventions.

Objective #2: Education to Other Health Professions with Roles in Memory Care • Education for Staff at Capstone Site

• Memory care staff were educated on various topics related to dementia through a staff in-service.• Pre and post surveys and quizzes were completed by participants to determine impact of in-service on

perceived and acquired knowledge of various dementia-related topics. • Education for Occupational Therapy Students

• A comprehensive presentation was provided to first year OT students regarding OT’s role in memory care.• Students also participated in the Virtual Dementia Tour® (VDT), an evidence-based, scientifically proven

method of enhancing knowledge of dementia through a complete sensory experience (Beville, 2002). • Before and after participating in the VDT, participants completed a five item pre and post survey to rank their

perceived understanding of dementia-related topics, as well as their perceptions of their own abilities, and current state of relaxation.

• In addition, participants’ behaviors were observed with the VDT behavioral checklist.

Objective #3: Development of a Sensory and Occupation Based Program • A program manual was created for the facility that included helpful tools and information related to ACLs, sensory

processing changes, and redirection strategies to enhance caregiving provided to memory care residents. This manual also included all assessment information of the residents who were assessed (a total of seven residents), as well as their developed sensory plans.

• A modified version of the occupational and sensory profile was created as an instrument for staff to use with new residents, in order to ensure that staff are obtaining important information needed to determine appropriate activities.

• Case studies* were completed on two residents of differing ACLs to determine the overall effect of Sensory Plans on their behavior, mood, and overall quality of life.

*Case studies were completed for project and educational purposes.

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Implications• A combination of sensory and occupation-based interventions can be

effective in managing the undesired behavioral and psychological symptoms of MND.

• Occupational therapists (OTs) have a significant role in determining potential factors that aggravate negative behavioral and psychological symptoms of MND through skilled observation.

• In additions, OTs have a significant role in educating others about MND, including the accompanying sensory processing changes and effective strategies and approaches that can improve overall quality of life among those with MND.

• It is important that OTs in skilled nursing facilities advocate for the role within the MND population.

• More formal research is needed regarding the effectiveness of sensory and occupation-based interventions, as well as caregiver education, in alleviating undesired behavioral and psychological symptoms of dementia.

Recommendations• Consistency is an essential component in the implementation of

sensory and occupation-based activities in the memory care setting.• Environmental modifications implemented in the memory care setting

should consider residents’ sensory preferences. • Frequent communication with all staff is important to ensure consistent

follow through of sensory plans and/or a structured daily routine and to enhance awareness of residents’ individual needs and preferences.

• Educating staff on appropriate caregiving strategies on a regular basis should be completed to ensure staff possess adequate knowledge regarding MND and to keep up with the demand of new hires.

• Frequent collaboration with other departments, such as wellness and activities can be helpful to ensure daily activities align with sensory plans.

• It is important for there to be a plan in place in case an uncontrollable external factor occurs that may disrupt sensory plans (ex: fire alarms going off).

• Resident #2 – ACL of 2.6• Interventions included: dimmed lighting, relaxing nature music, warm

towels, soft, weighted blankets, aromatherapy with lavender scented oils, rummage bins, picture books based on interests, folding paper, towels, or blankets, re-arranging and re-organizing items and furniture.

• Interventions had an impact on decreasing the occurrence of undesired behaviors. The sensory plan seemed to have the most impact on decreasing aggressive behaviors (refer to Figures 2 and 3).

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• Cognitive Disabilities Frame of Reference (FOR) (Allen, 1992)• Focuses on promoting optimal function in daily life in individuals with cognitive

impairments• Components of this FOR that were utilized throughout this Capstone experience

include Allen’s Cognitive Levels (ACLs), task equivalence, environmental modifications, the role of habits and routines, and caregiver education.• ACLs: six scale measurement of wellness and occupational performance

• Sensory Integration Frame of Reference (Aryes, 1972)• Consists of organization of sensory information provided in one’s environment• Considers environmental modifications, and recognition of sensory processing

patterns through Winnie Dunn’s Sensory Processing Model• The sensory processing patterns and sensory preferences of each resident were the

focus for all interventions that were provided and incorporated into individualized sensory plans.

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.researchgate.net%2Ffigure%2FQuadrants-of-the-Sensory-Profile_fig1_269876183&psig=AOvVaw22xp5jMkF3wdxLWXIePd9a&ust=1614178260228000&source=images&cd=vfe&ved=0CAIQjRxqFwoTCPjNnu

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Objective #2 – VDT for OT Students• Twenty-six occupational therapy students participated in the VDT. • After the experience, a comparison of pre and post survey results indicated that participants had

more conflicting perceptions of their own understanding of the emotional needs of persons with dementia, felt significantly less capable of their own capabilities of carrying out daily tasks, and reported being more anxious or agitated in comparison to before participation.

• In addition, more participants indicated in that post survey that living with MND would be “unbearable.”

• Participants’ perceptions of whether persons with dementia receive the care they need also changed, with more responses indicating “no” or “never” in the post surveys.

• Several participants reported in the post-survey follow up questions that the experience was eye-opening and that they now have a better understanding of the need for environmental modifications to alleviate these potential impairments.

Objective #3 • The program manual was created and shared with both the director of nursing and onsite

mentor for it to be incorporated into the facility’s memory care units. • Case Studies

• Resident #1 – ACL of 4.6• Interventions included: crafts, use of a daily schedule, re-orientation activities, simple

baking activities and environmental modifications to decrease background noise.• Overall, the developed sensory plan alleviated undesired behavioral symptoms of

MND (refer to Figures 2 and 3).

Figure 3.

Figure 2. Figure 1.

Pre & Post Survey Results

ITEM #Nothing

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understanding (4)extremely good

understanding (5)

TOTAL POINTS

Pre #1 0 0 5 10 1 60Post #1 0 1 3 16 1 80

Item Change #1 +20Pre #2 0 1 5 9 1 58

Post #2 0 1 4 16 0 78Item Change #2 +20

Pre #3 1 0 8 7 0 53Post #3 0 2 2 17 0 78

Item Change #3 +25Pre #4 4 6 6 0 0 34Post #4 1 8 7 5 0 58

Item Change #4 +24Pre #5 0 2 5 9 0 55Post #5 0 0 5 14 2 81

Item Change #5 +26Pre #6 3 0 6 5 1 46Post #6 1 0 10 9 0 67

Item Change #6 +21TOTAL SURVEY POINTS (PRE): 306TOTAL SURVEY POINTS (POST): 442