Rest-activity rhythms in small scale homelike care and traditional care for residents with dementia

Abstract

BackgroundAn enriched environment for residents with dementia may have a positive effect on the rest-activity rhythm. A small scaled homelike special care unit might be such an enriched environment. The present study shows whether the rest-activity rhythm of residents with moderate to severe dementia responds positively to a transfer from a regular Special Care Unit (SCU) to a small scaled homelike SCU.MethodsInitially, a group of 145 residents living in a regular SCU participated. Out of this group, 77 residents moved to a small scaled homelike SCU. This group was compared to the group of 68 residents that remained at the regular SCU. Rest-activity rhythm was assessed by means of actigraphy and observation scales before and after relocation.ResultsNo significant main effects nor significant interaction effects in intradaily and interdaily activity were found for the data of 38 residents in the small scaled homelike SCU and 20 residents of the regular SCU. The effect sizes, however, ranged from small to large.ConclusionsConsidering the effect sizes, a new study with a larger number of participants is necessary before firm conclusions can be drawn.Trial registrationCurrent Controlled Trials ISRCTN11151241. registration date: 21–06-2017. Retrospectively registered.

Sense of Self among Persons with Advanced Dementia

“…Research has shown that the Self 1 is preserved among persons with advanced dementia. Even when they almost entirely answer "yes" or "no" to questions, they still show that they can experience themselves as "I" (32,60). Still it seems reasonable to suggest that we can help persons preserve their feeling of being an I by making them feel that they are seen and listened to, that is that they are.…”

“…The understanding of how important the experience of at-homeness is for our sense of self and well-being has led to an endeavor to create care environments where persons with advanced dementia can feel at home. However, although carers try to furnish the rooms as homely as possible it is often hard to document positive effect on the persons' daily life (59). Observation of nursing home residents with advanced dementia showed that they alternated between expressing feeling at home (at-homeness) and not feeling at home (homelessness) both verbally and nonverbally.…”

“…Another resident said that she was only living at the ward temporarily until she would meet her deceased spouse again and another one said that she wanted to listen to gospels while dying. Some did not speak about death and dying but reasoned about their funeral (60). At the last stages of life persons with advanced dementia often experience eating difficulties, especially swallowing problems (84)(85).…”

“…Thinking about or even experiencing that one interacts with deceased dear loved ones can provide satisfaction (60). This finding seems to represent a tendency to gerotranscendence (107) and can be understood as related to the fact that among persons with advanced dementia memory for past events is better preserved than memory of recent events (12).…”

“…The most important ingredient in consolation for these persons certainly is communion (69,111) and it may provide them a feeling of being at home (112). However, it is most probable that they can get some moments of homecoming (60).…”