jay (2011) improving way finding

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

0

10

20

30

40

50

60

70

80

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

Thank  you  for  your  attention.

Questions?

Email:  Ajay@uccs.edu