Tracking dementia engagement successes – or failures

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Tracking dementia engagement successes – or failures

Posted on August 26, 2014

The goal of dementia engagement is to provide the individual with the best quality of life possible.  To achieve this, the person centered care requires ongoing fine tuning of the programs & interventions based on the interests and capabilities of the person. Because cognitive impairment makes feedback difficult to obtain, it can be hard to know whether the engagement offered is actually effective or not. Adding to this low staffing levels and an overload of other work requirements in the senior care environment and it becomes almost impossible to know if an individual is engaged at the right level with the right tools. This underlines the need to establish success measurements in dementia engagement. There are two types of items that can be tracked to achieve this: Frequency of events that need to be avoided and occurrence of positive events

Reduction of unwanted events:

1. Behavior reduction: Appropriate dementia engagement should effectively reduce unwanted behaviors. Tracking the behaviors should indicate the quality of the overall engagements. To understand what different types of behaviors exist and how to qualify them, the Cohen-Mansfield Agitation Inventory is commonly used. It classifies behaviors as follows:

  • Physically aggressive: For example, hitting, pushing, kicking, biting, scratching, or grabbing people or things
  • Physically non-aggressive: For example, handling things inappropriately, hiding things, dressing or undressing inappropriately, pacing, repeating mannerisms or sentences, acting restless, or trying to go elsewhere
  • Verbally aggressive: For example, cursing, making strange noises, screaming, or having temper outbursts
  • Verbally non-aggressive: For example, complaining, whining, constantly requesting attention, not liking anything, interrupting with relevant or irrelevant remarks, or being negative or bossy

2. Use of anti-psychotic drugs: Use of anti-psychotic drugs: Anti-psychotic drugs are used to treat behavioral and psychological symptoms in dementia (BPSD). Nearly 40 percent of dementia residents receive anti-psychotic drugs. These are alarmingly high numbers, given how ineffective — or even dangerous — the drugs can be. Anti-psychotics have not been approved by the FDA to treat dementia and only about 20 to 30 percent of dementia residents who take an anti-psychotic drug show even marginal improvement. In addition, for every 53 patients treated with such a pharmaceutical, 1 will die. And for every 9 to 25 patients that benefit from an anti-psychotic drug, 1 will die. Dementia engagement has been proven to be the most effective way to avoid unacceptable behaviors. Its effectiveness should be tracked by measuring anti-psychotic drug reduction.

3. Falls: It has been documented that people with dementia are four to five times more likely to experience falls than older people without significant cognitive impairment. Beyond the inappropriate use of anti-psychotic drugs that can cause imbalance, dementia engagement has a direct impact on falls by reducing behaviors and keeping the individual busy.  

On a positive note, dementia engagement also has very positive outcomes that can be tracked as well:

1. Capacity improvement: Dementia engagement directly and immediately impacts the quality of life of the individual. This can be seen in the reduction of depression, an increased sense of wellbeing and an increase of capacity, such as managing more activities of daily living (ADL’s).

2. Attendance: As pleasure and success are derived from programs and activities, successful dementia engagement shows an increase in program attendance. Tracking which residents come to which programs or how many one on one’s the resident gets should show a correlation between quality and attendance.

3. Participation: Beyond attendance, the level of participation is also an indicator of the engagement quality. Two items can be observed to measure this: the length of participation and its intensity:  Work by Dr Cohen Mansfield explains that the attention to the stimulus occurs when the individual is focused on the stimulus, i.e., eye tracking, visual scanning, facial, motoric or verbal feedback, or eye contact. Attention can be measured on a 4-point scale: not attentive, somewhat attentive, attentive, and very attentive.

4. Satisfaction: As dementia engagement has direct impact on care and shows improved outcomes, it also has and an impact on client and family satisfaction. It has been documented that increased level of activities and programming have a positive impact on satisfaction.