People with dementia are less likely to be apathetic if they live in an appropriately stimulating environment, according to nursing researchers.
According to a report by The Centers for Disease Control, about half the people in nursing homes have dementia. 90% of them experience apathy at some point, one of the most common neurobehavioral symptoms in dementia. Those with mild dementia will decline more quickly into severe dementia if they also suffer from apathy.
A stimulating environment made all the difference in this revealing study of 5 factors. Specifically, moderate stimulation did the most to lift people out of their apathy, while none or too much made it worse.
Help Them Stay EngagedYing-Ling Jao, assistant professor of nursing, Penn State, identified 4 negative consequences of apathy in dementia:
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- Persons with dementia who are also apathetic won't be curious about the world around them;
- They are not motivated to carry out activity nor engage with those around them, in either a positive or a negative way.
- The individuals' cognitive function will likely decline faster.
- Caregivers will have more difficulty with their caregiving and are more likely to become depressed.
- One taken at a mealtime,
- One during a direct interaction between the resident and staff
- One that was randomly selected.
'The purpose of this study was to examine the relationship between environmental characteristics and apathy in long-term care residents with dementia. My interest in apathy was mainly driven by my clinical observations in nursing homes when I was a nurse practitioner student. I remember that no matter which nursing home I visited, I often saw a crowd of residents sitting in the living room or hallway with no interest in the surroundings and no emotional expression.'
5 Influences on Apathy in DementiaJao zoomed in on five key characteristics that affect the quality of life in nursing homes:
- Environmental stimulation
- Staff familiarity
- Light and sounds.
Strong Stimulation, No Stimulation, Overwhelming StimulationAssistant Professor Jao said,
'Interestingly, our results showed that clear and strong environmental stimulation is related to lower apathy, while no stimulation or an overwhelming environment with no single clear stimulation is related to higher apathy.'Jao plans to continue this research by replicating the study with a larger sample size and by looking more closely at the quality of interaction and communication between nursing home residents and their caregivers.
'One of the innovative features of this study is that we used the Person-Environment Apathy Rating scale to measure environmental stimulation at an individual level. I believe that the same stimulation may be perceived differently or bring about different responses for different individuals in the same environment based on the individual's characteristics, interests and relevance to the stimulation. In fact, a stimulus may be clear to one person but unclear to another because of differences in hearing or visual abilities, especially in older adults.'
'One of the most important implications of these findings is that they will guide us in designing appropriate physical and social environments for dementia care that helps prevent or decrease apathy. We need more people to care about apathy for older adults with dementia.'
- Y.-L. Jao, D. L. Algase, J. K. Specht, K. Williams. The Association Between Characteristics of Care Environments and Apathy in Residents With Dementia in Long-term Care Facilities. The Gerontologist, 2015; 55 (Suppl 1): S27 DOI: 10.1093/geront/gnu166