Background: Dementia is a degenerative neurological disorder that afflicts a growing proportion of the global population. Complementary alternative medicine (CAM) modalities are under investigation for their therapeutic value in the management of dementia. Purpose: Nursing care of dementia sufferers can include managing agitation and negative behaviors; this study investigates staff appraisal of the Multi-Sensory Stimulation Environment (MSSE) as an intervention for these nursing challenges. Methods: A purposive sample of nursing staff employed in residential care for dementia patients were recruited 10 weeks after the initiation of an open-access MSSE at the facility to complete a confidential self-administered questionnaire. Results: 79% of potential participants returned completed surveys for a total sample of n = 23. 70% of survey respondents felt that residents were utilizing the MSSE "Somewhat Frequently" or "Very Frequently." 77% of the staff felt the MSSE should continue in use at the facility or continue with some alterations. The sample suggested that the MSSE is helpful for mood, specifically anger, sadness, anxiety, and restlessness, but not for boredom. Higher-scoring items in favor of the MSSE intervention included confusion, perseverating, wandering, and interpersonal conflict. Conclusion: Several components of agitation and negative behavior in the dementia population appear to be improved with the use of an MSSE according to this sample. Further research is needed to support the results of this sample and to explore more detailed recommendations regarding the use of MSSE in dementia care.

By the year 2050 it is expected that the number of older adults living with dementia will triple. With 42% of persons with dementia living in residential care, it is vital that we better understand how to maintain high psychosocial well-being for this population, in this setting. The objective of this study was to better understand psychosocial well-being in persons with dementia. The research team observed affect in clients with dementia (n = 22), as well as staff interactions with clients in a residential memory care unit for a total of 6999 minutes. The first purpose was to examine overall proportions of client affect and staff interaction types, both for the whole sample, and in more detail (assessing inter/intraindividual differences) for the five most observed clients. The second purpose was to identify whether proportions of positive affect in clients differed based on staff interaction type. The third purpose was to examine themes emerging from a review of field notes when staff interactions and/or client affect were noted. Analyses identified that the most observed affect type was neutral affect (53.1% of all minutes observed). The most common interaction type was neutral or no interaction (81.1% of all minutes observed). Positive affect accounted for 44.5% of observations, and positive staff interactions for 18.1% of the observations. There was very little negative affect (2.4%) and negative interactions (.8%) observed. When staff had neutral/no/negative interactions, clients were positive 36% of the time, whereas when staff had positive interactions, clients were positive 81% of the time (z = 28.84, p < .001). The review of the field notes identified themes and subthemes related to behavioral problems and other client problems, and the staff either responding to or ignoring these problems. The review also identified occasions when staff engaged clients beyond what was required of them. While quantitative analyses suggested low rates of negative staff interaction, the field notes highlight that sometimes no interaction (ignoring a client) is also problematic. This study suggests that positive social interactions between staff and clients may be important in maintaining positive affect and overall wellbeing in persons with dementia.

The national aging trend suggests that population of those aged 65 and older will reach 83.7 million by the year 2050. With increasing age comes the growing possibility of one getting some form of dementia. The Alzheimer’s Association expects the number of American’s with dementia to triple from the reported 5 million cases in 2014 by 2050. With a rise in this cognitively impaired population there is reason to look closely at the needs of persons with dementia living in residential facilities and whether or not they are being met. The main focus of residential facilities is to provide aid with physical needs. However, research shows that all people also have social and psychological needs that need to be met to have the highest quality of life possible. Other research shows that residents with dementia spend a majority of their days with little to no social interactions. This study aims to uncover what verbal and nonverbal behaviors, if any, Certified Nursing Assistants (CNAs) in residential care facilities find to be important when interacting with persons with dementia. This study includes the analysis of 11 interviews of CNAs from local facilities and home health companies. Analysis of their responses uncovered very few observable verbal and nonverbal behaviors were actually discussed. What was more apparent was that attitudes and internal behaviors participants considered important drove the use of good verbal and nonverbal communication. Five themes were uncovered. They were: Observable Verbal and Nonverbal Behaviors, Valuing Personhood, Get on Their [Cognitive and Reality] Level, Be a Friend, and Compassion. Excerpts from the interviews are included for examples of how these themes presented themselves.

Thesis advisor: Alyssa Goldman / People’s needs for social engagement vary over the life course. Social engagement for individuals residing in memory care facilities is an important topic to research because this population benefits greatly from active participation in the communities in which they reside. This study examines the following research questions: To what extent does the facility in which adults with Alzheimer’s disease reside impact their social ties? How do the facilities differ in facilitating social engagement? I interviewed ten memory care facility employees across seven facilities in Massachusetts and found patterns in visitation for family members and friends of Alzheimer’s residents and social engagement for residents in memory care. Individual factors that affect visitation include family dynamics and disease progression. Structural factors that affect visitation include geographic location and religion. These findings are useful to inform policy and recognize increased opportunities for social engagement as an opportunity for facilities to slow disease progression. / Thesis (BA) — Boston College, 2023. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Departmental Honors. / Discipline: Sociology.

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As the average age of life expectancy continues to rise, so too has the number of elderly individuals seeking long-term care. Performing daily tasks becomes a struggle while those affected by Alzheimer's disease and dementia risk their safety by living alone. Aged individuals lacking the means or faculties to live independently often seek assisted living and memory care facilities as the most viable options for the growing elderly population. Typical facilities are compact and sterile where residents are under watchful supervision to perform basic daily activities. As a result, aged individuals spend every day inside the facility with a structured, monotonous routine. A repetitive lifestyle within the same surroundings and with little autonomy can lead to feelings of isolation, depression, and disengagement from the same facility designed to care for the elderly population. My thesis aims to create an assisted living and memory care village, rather than a facility, that calls upon the comforts of home in a neighborhood setting. Within the village, residents are free to engage, explore, and take part in activities as self-sufficient human beings. Located in Frederick, Maryland, my objective is to design a small-town community that enables both on and off-site engagement. I analyzed architectural design methods that mitigate the struggles of daily activities while maintaining privacy and independence, and also researched a largely overlooked aspect of assisted living facilities: site development. This enabled me to curate a space where residents are free to explore and take part in various activities throughout the site. A monotonous routine leads to a stagnant mind. My thesis aims to create a space where exploration and independence are not only permitted but encouraged. Rather than aging in place, the goal is to live in place while the mind and body are in motion, making new memories and discoveries every day. / Master of Architecture / My aunt faced the challenge of her elderly mother experiencing white coat hypertension: an increase in blood pressure due to anxiety and stress during doctor visits. But it made a remarkable difference after she switched to a specialized geriatric office that emphasized a welcoming, homelike design. The warm ambiance, comforting decor, and personalized care reduced her anxiety, alleviating her white coat hypertension and resulting in regular blood pressure readings. This experience inspired me to emphasize the importance of geriatric-friendly design in assisted living and memory care facilities. In response to this issue, my thesis proposes the creation of an assisted living and memory care village instead of a traditional facility. The village aims to provide a homelike setting where residents can experience a sense of comfort and freedom. I have analyzed architectural design methods that address the struggles of daily activities while maintaining privacy and independence. Additionally, I have explored the often overlooked aspect of site development in assisted living facilities to curate the space thoughtfully where residents are encouraged to explore and engage in various activities throughout the village and evoke feelings of home, community, and comfort.

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There is little known about the current state of professional development and continuing education practices for empowering activity professionals to better enhance environmental enrichment in long term care. The purpose of this qualitative study was to explore the activity professional's perceived role and best strategies for professional development to enrich the long-term care environment. The study used social cognitive theory as its theoretical framework to develop research questions focused on the views of activity professionals concerning professional development and continuing education to support care for long-term care residents. Using a narrative approach, 9 activity professionals were recruited through networking at the 2015 NAAP Education Summit in Kentucky, LinkedIn, and snowball sampling. Eligible participants who provided informed consent were interviewed by phone from August 2015 to February 2016. Data were analyzed using both hand coding and NVivo 10.0 software. Results showed the value of relevant certifications and the importance of training in a range of topics, especially dementia care. Connection to others and the environment emerged as key themes. This study is significant because it explores professional development in the long-term care environment, which can facilitate positive social change to provide the elderly, especially those in cognitive decline, with a comforting environment for special needs. This study contributes to the knowledgebase to inform the development of educational and training opportunities for activities professionals, especially those caring for individuals with severe / end-stage dementia.

Esta tesis surge de la preocupación por las condiciones actuales que deben atravesar los cuidadores de pacientes con enfermedad de Alzheimer en el Perú, quienes en algunos casos llegan a padecer el síndrome del cuidador, lo que impacta significativamente en su capacidad para realizar su trabajo de manera eficiente. Reforzando las preocupaciones, el Instituto Nacional de Estadística e Informática (INEI) prevé que para el 2050 habrá alrededor de 8,7 millones de adultos, la mayoría de los cuales padecerá la enfermedad de Alzheimer. Esta situación no solo es un problema para los pacientes, sino también para sus familias, cuidadores y su entorno social. Así, este proyecto representa una oportunidad para resaltar esta enfermedad y las complejidades que se originan en las familias afectadas al brindar una solución a través de la creación de la primera unidad de memoria integral del país. Este trabajo se desarrolló en diferentes etapas: análisis de contexto y contenedor, diagnóstico, análisis de usuario y función, planteamiento de estrategias de diseño, levantamiento de la preexistencia, propuesta de master plan, detalles del sector y visuales. / This thesis stems from the concern for the current conditions that caregivers of patients with Alzheimer’s disease in Peru must go through, who in some cases come to suffer from caregiver syndrome, which significantly impacts their ability to perform their work efficiently. Reinforcing the concerns, the National Institute of Statistics and Informatics (INEI), foresees that by 2050 there’ll be around 8.7 million adults, most of whom will suffer from Alzheimer’s disease. This situation isn’t only a problem for the patients but also for their families, caregivers, and their social environment. Thus, this project represents an opportunity to spotlight this disease and the complexities that originate in the affected families by providing a solution through the creation of the first integral memory unit in the country. This work will be implemented in different stages: context and container analysis, diagnosis, user and function analysis, approach to design strategies, pre-existence drawings, master plan proposal, details of the sector and visuals. / Trabajo de investigación

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