College of Nursing, Pennsylvania State University, University Park, PA, USA.
College of Nursing, University of Iowa, Iowa City, IA, USA.
Int Psychogeriatr. 2019 Aug;31(8):1109-1120. doi: 10.1017/S1041610219000589.
Prior research and theories established the link between care environments and apathy. Yet, empirical evidence on how environmental stimulation impacts apathy is lacking. This study examined the association between environmental stimulation and apathy in nursing home residents with dementia.
This repeated-measure study analyzed 104 video observations of staff caregiver-resident interactions.
12 nursing homes.
63 unique staff caregiver-resident dyads that involved 42 caregivers and 44 residents with moderate to severe dementia.
Second-by-second behavioral coding using Noldus Observer software was conducted to assess apathy and environmental stimulation, using the Person-Environment Apathy Rating scale. The environment subscale includes six items: stimulation clarity, stimulation strength, stimulation specificity, interaction involvement, physical accessibility, and environmental feedback. The apathy subscale includes six items: facial expression, eye contact, physical engagement, purposeful activity, verbal tone, and verbal expression. Multilevel linear models were used for analysis.
Results showed that apathy was not associated with the overall quality of environmental stimulation but was significantly associated with stimulation specificity (coefficient = -2.23, p = 0.049). However, the association was not significant after controlling for resident characteristics (p = 0.082). In addition, higher levels of environmental feedback were associated with lower apathy levels (coefficient = -2.14, p = 0.001). The association remained significant after controlling for resident characteristics (coefficient = -1.65, p = 0.014).
Findings reveal that when environmental stimulation is individually tailored and prompts engagement, residents are less apathetic. This study highlights the effect of environmental stimulation on apathy. Future research should explore interventions that modify environmental stimulation to reduce apathy and improve dementia care.
先前的研究和理论确立了护理环境与冷漠之间的联系。然而，缺乏关于环境刺激如何影响冷漠的实证证据。本研究调查了环境刺激与痴呆养老院居民冷漠之间的关系。
这项重复测量研究分析了 104 个工作人员照顾者-居民互动的视频观察。
12 家养老院。
63 对独特的工作人员照顾者-居民二人组，涉及 42 名照顾者和 44 名患有中度至重度痴呆症的居民。
使用 Noldus Observer 软件进行逐秒行为编码，使用“人-环境冷漠评估量表”评估冷漠和环境刺激。环境子量表包括六项：刺激清晰度、刺激强度、刺激特异性、互动参与度、身体可达性和环境反馈。冷漠子量表包括六项：面部表情、眼神接触、身体参与度、有目的的活动、语气和语言表达。使用多层线性模型进行分析。
结果表明，冷漠与整体环境刺激质量无关，但与刺激特异性显著相关（系数=-2.23，p=0.049）。然而，在控制居民特征后，相关性不显著（p=0.082）。此外，较高的环境反馈水平与较低的冷漠水平相关（系数=-2.14，p=0.001）。在控制居民特征后，相关性仍然显著（系数=-1.65，p=0.014）。
研究结果表明，当环境刺激是个性化的并促使参与时，居民的冷漠程度较低。本研究强调了环境刺激对冷漠的影响。未来的研究应该探索干预措施，以改变环境刺激，减少冷漠，改善痴呆症护理。
