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An aging presentation at the 37th Annual Association for Behavior Analysis International Conference in Denver, CO .
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Improving Wayfindingin Older Adults with
DementiaAllison A. Jay, M.A., BCBA, Leilani Feliciano, Ph.D.,
Kaitlyn Eller, Scott Hanneman, & Sarah Anderson, B.A.
University of Colorado at Colorado Springs
2011 ABA International ConventionDenver, Colorado
Wayfinding
More than 66% of residents with severe dementia have difficulties with wayfinding (Passini et al., 2000)
Poor wayfinding abilities influence:
Safety risks for resident that wanders (Rosswurm, Zimmerman, Schwartz-‐Fulton, & Norman, 1986)
Conflict with other residents (Rosswurmet al.)
Burden to nursing home staff (Everitt, Fields, Soumerai, & Avorn, 1991)
Previous Research
Combination text + photo stimulus hung outside bedroom improved room finding for older adults with dementiaUnclear what aspects of stimulus were
responsible for the change(Nolan, Mathews, & Harrison 2001)
Printed names recognized marginally more than current pictures (Gross et al., 1994)
JOE SHMOE
Previous ResearchBetter recognition of younger photos compared to older photos (Hehman, German, & Klein, 2005)
Recognition of photographs was not enough to produce room finding improvement when photographs were removed between observationsSuggests that recognition of items is not enough to facilitate room finding when controlling for naturally occurring learning trials
(Jay, Feliciano, Anderson & LeBlanc, 2009)
Purpose of the Study
Determine whether personal relevance and recognition of memory box items is necessary to improve room finding
Method
1. Stimulus Recognition Assessment
2. Family Interview & Stimulus Preference Assessment
3. Room Finding Analysis
ParticipantsN = 14 older adults
Mean Age = 86 yrs (range 79 to 93)
13 females, 1 male
Mean MMSE = 9 (range 1 to 19)
SettingMemory care communities in Michigan and Colorado
Experiment 1: Stimulus Recognition Assessment
Opportunity to choose self out of an array of 3 choicesFour stimulus groupsYoung adult photograph (20-‐40 yrs old)Middle adult photograph (40-‐60 yrs old)Current photograph Printed name
Experiment 1: Stimulus Recognition AssessmentAccuracy of selection recorded
No feedback provided on accuracy
6 trials of each stimulus type = 24 trials
Stimuli counterbalanced to prevent selection based on side bias
Order of stimulus type counterbalanced to prevent order effects
Experiment 2: Stimulus Preference Assessment
Paired stimulus preference assessment procedureItems selected based on Semi-‐structured family interviewPleasant Events Schedule Disease (PES-‐AD)
3 preferred items, 3 non-‐preferred itemsHierarchy of relative preference used to design memory boxes
Experiment 3: Room Finding Assessment
Multiple Baseline Across ParticipantsBaseline
Intervention random assignment to eitherPersonalized Memory BoxBest recognized stimulus
Theme based on top 1-‐2 preferred items
General Landmark BoxNeutral stimulus
Theme based on bottom
1-‐2 items
Direct observation of room finding abilities
Dependent VariablesAccuracy
Latency
Experiment 3: Room Finding Assessment
Results
Results: Stimulus Recognition Assessment
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10
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90
100
Current Middle Young Text
Percen
tage Accuracy
Stimulus Type
71%
51%
67%
80%
Results: Stimulus Preference AssessmentFour participants completed preference assessments
Findings revealed hierarchy of preferences for each person
Hierarchy of preferences for each person used to design memory boxes in Experiment 3
0
10
20
30
40
50
60
70
80
90
100
Necklaces Hawaii material
Crosswords Cards Sewing stuff Baseball
Percen
tage Selection
Items
Results: Room Finding Analysis
DiscussionTextual stimuli recognized best, followed by photographs from earlier in life, then current photosReplication of previous research
More learning experience with earlier photographs
Congruent with profile of memory loss associated with
Birth Death
Development of AD
DiscussionIndividuals with dementia can communicate preferencesStructured choice-‐making assessments
Limited choices
Simplified language prompts
Personalization of memory box items may not be necessary to promote room finding
Anecdotal evidence suggests there may be some benefit to personalization of boxes Staff identification of room
Opportunities for engagement and conversation
DiscussionIndividuals with dementia can learnLess emphasis on rules governed behavior
Greater emphasis on learning trials, naturally occurring discrimination training, and contingencies of reinforcement
Implications for Environmental Design
Resources should be directed at creation ofLarge stimuli that are easily visible from a distance
Distinctive landmarks to enhance the salience of the stimuli
ConsiderationsOngoing study
Environmental design factors may influence room finding
Gender considerations associated with assessment question
Motivation factors involved in room finding assessment may be different from natural environment (Michael, 1982)
Try to capture observation while relevant motivational variables present