Developing an Apathy Scale for Persons with Dementia Incorporating Environmental Factors

2.50
Hdl Handle:
http://hdl.handle.net/10755/326059
Category:
Abstract
Type:
Research Study
Level of Evidence:
Cross-Sectional Study
Research Approach:
Pilot/Exploratory Study
Title:
Developing an Apathy Scale for Persons with Dementia Incorporating Environmental Factors
Other Titles:
Developing the Person-Environment Apathy Rating for Persons with Dementia
Author(s):
Jao, Ying-Ling; Algase, Donna L.; Specht, Janet K. Pringle; Williams, Kristine
Lead Author STTI Affiliation:
Gamma
Author Details:
Ying-Ling Jao, PhD, RN, E-mail: yuj15@psu.edu; Donna L. Algase, PhD, RN, FGSA, FAAN, E-mail: Donna.Algase@utoledo.edu; Janet K. Specht, PhD, RN, FGSA, FAAN, E-mail: janet-specht@uiowa.edu; Kristine Williams, PhD, RN, FGSA, FAAN, E-mail: Kristine-n-williams@uiowa.edu
Abstract:

Introduction

Apathy is highly prevalent in dementia but is often clinically ignored. A lack of response to environmental stimulation is a major criterion for apathy diagnosis. Environmental stimulation provided through multisensory stimulation, social interaction, and music therapy has been shown to reduce apathy in patients with dementia. Yet, no established instrument measures influential components of environmental stimulation for apathy in persons with dementia.

Aims/Objectives

Our research team developed the Person-Environment Apathy Rating (PEAR) to measures environmental stimulation and apathy in persons with dementia. The aim of this study was to evaluate the intra-rater and inter-rater reliability of the PEAR scale.

Material & Methods

This study used a cross-sectional correlational design. The PEAR consists of environment and apathy subscales and each subscale has six items scored on a 1-4 scale. Reliability was evaluated using videos from a large dementia study. The parent study enrolled 185 institutionalized elders with dementia from 22 long-term care facilities.

For this study, the sample size was 96 video observations selected from 24 participants. To assure there was adequate variance for psychometric tests, the four videos from each participant included one during mealtime, one containing interpersonal interaction between staff and participant, one containing no interpersonal interaction, and one was random selection.

First, using a random sequence generator, 24 participants were randomly selected. Then, for each participant, available videos were screened and four qualified videos were selected to include the required environmental contexts and to ensure high recording quality. From each video, one segment of one to two minutes with constant environmental context was selected to assess apathy and environments.

Two trained researchers separately viewed each of the 96 videos and coded each video using the PEAR scale. Then, each rater rated 48 of the videos for a second time to test its intra-rater reliability. For analysis, percent agreements and Weighted Kappa were analyzed for the PEAR-Environment and PEAR-Apathy subscales using two observations from the same rater and from two different raters to determine intra- and inter-rater reliability.

Results/Discussion

Of the 24 participants, two thirds lived in a nursing home and the rest of them lived in an assisted living facility. Participants’ average age was 82.4 years and most of them were female. More than 70% of the participants had severe cognitive impairment.

The inter-rater reliability of the PEAR-Environment was 74.0-89.6% for percent agreement and 0.49-0.94 for weighted Kappa, suggesting good to excellent reliability. Its intra-rater reliability was 79.2-92.7% for percent agreement and 0.63-0.94 for weighted Kappa, suggesting good to excellent reliability.

For the PEAR-Apathy, except facial expression and eye contact, the inter-rater reliability was 63.5-85.4% for percent agreement and 0.66-0.86 for weighted Kappa, suggesting good to excellent reliability. Its intra-rater reliability of the PEAR environment subscale showed 75.0-89.6% for percent agreement and 0.74-0.89 for weighted Kappa, suggesting excellent reliability. The inter-rater reliability was fair, but relatively lower than on other items, such as facial expression and eye contact with 51.0% and 56.3% for percent agreement and 0.60 and 0.47 for weighted Kappa, respectively.

Conclusion

Overall, the PEAR-Environment and the majority of the PEAR-Apathy demonstrated good to excellent intra-rater and inter-rater reliability in measuring environmental stimulation and apathy. Facial expression and eye contact in the PEAR-Apathy showed modest inter-rater reliability due to the limitations of the videos that did not clearly capture participants’ facial expression and eye contact status. It is expected that the reliability will be enhanced by using videos that are recorded specifically to evaluate apathy or direct observation. Based on the findings, the PEAR is suggested for use in measuring care environment and apathy via video observation in long-term care residents with dementia. 

In summary, the PEAR is the very first instrument that measures apathy and care environments concurrently for persons with dementia. With established reliability, the PEAR is recommended for assessment of apathy and care environments related to apathy. This scale not only brings the awareness of environmental stimulation to apathy assessment and may help more accurately capture apathy. Additionally, this scale enables study of the relationship between care environment and apathy. Consequently, the findings will guide environment-based interventions targeting apathy. Finally, another advantage of this scale is the ability, through observation, to measure apathy for long-term care residents with advanced dementia, especially for the cases in which assessment via self-report and family informants is not possible. 

Keywords:
dementia; environmental monitoring instrumentation; neurobehavioral testing; long-term care
MeSH:
Dementia; Environmental monitoring--instrumentation; Neuropsychological Tests; Long-Term Care
Repository Posting Date:
11-Sep-2014
Date of Publication:
11-Sep-2014
Conference Date:
2013
Conference Name:
GSA 2013 Annual Scientific Meeting
Conference Host:
Gerontological Society of America
Conference Location:
New Orleans, LA, USA
Sponsors:
Sigma Theta Tau International
Note:
The Sigma Theta Tau International grant application that funded this research, in whole or in part, was completed by the applicant and peer-reviewed prior to the award of the STTI grant. No further peer-review has taken place upon the completion of the STTI grant final report and its appearance in this repository.; This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryAbstracten
dc.typeResearch Studyen
dc.evidence.levelCross-Sectional Studyen
dc.research.approachPilot/Exploratory Studyen
dc.titleDeveloping an Apathy Scale for Persons with Dementia Incorporating Environmental Factorsen_US
dc.title.alternativeDeveloping the Person-Environment Apathy Rating for Persons with Dementiaen_GB
dc.contributor.authorJao, Ying-Ling-
dc.contributor.authorAlgase, Donna L.-
dc.contributor.authorSpecht, Janet K. Pringle-
dc.contributor.authorWilliams, Kristine-
dc.contributor.departmentGammaen
dc.author.detailsYing-Ling Jao, PhD, RN, E-mail: yuj15@psu.edu; Donna L. Algase, PhD, RN, FGSA, FAAN, E-mail: Donna.Algase@utoledo.edu; Janet K. Specht, PhD, RN, FGSA, FAAN, E-mail: janet-specht@uiowa.edu; Kristine Williams, PhD, RN, FGSA, FAAN, E-mail: Kristine-n-williams@uiowa.eduen_GB
dc.identifier.urihttp://hdl.handle.net/10755/326059-
dc.description.abstract<p><strong>Introduction</strong></p> <p>Apathy is highly prevalent in dementia but is often clinically ignored. A lack of response to environmental stimulation is a major criterion for apathy diagnosis. Environmental stimulation provided through multisensory stimulation, social interaction, and music therapy has been shown to reduce apathy in patients with dementia. Yet, no established instrument measures influential components of environmental stimulation for apathy in persons with dementia.</p> <p><strong>Aims/Objectives</strong></p> <p>Our research team developed the Person-Environment Apathy Rating (PEAR) to measures environmental stimulation and apathy in persons with dementia. The aim of this study was to evaluate the intra-rater and inter-rater reliability of the PEAR scale.</p> <p><strong>Material & Methods</strong></p> <p>This study used a cross-sectional correlational design. The PEAR consists of environment and apathy subscales and each subscale has six items scored on a 1-4 scale. Reliability was evaluated using videos from a large dementia study. The parent study enrolled 185 institutionalized elders with dementia from 22 long-term care facilities.</p> <p>For this study, the sample size was 96 video observations selected from 24 participants. To assure there was adequate variance for psychometric tests, the four videos from each participant included one during mealtime, one containing interpersonal interaction between staff and participant, one containing no interpersonal interaction, and one was random selection.</p> <p>First, using a random sequence generator, 24 participants were randomly selected. Then, for each participant, available videos were screened and four qualified videos were selected to include the required environmental contexts and to ensure high recording quality. From each video, one segment of one to two minutes with constant environmental context was selected to assess apathy and environments.</p> <p>Two trained researchers separately viewed each of the 96 videos and coded each video using the PEAR scale. Then, each rater rated 48 of the videos for a second time to test its intra-rater reliability. For analysis, percent agreements and Weighted Kappa were analyzed for the PEAR-Environment and PEAR-Apathy subscales using two observations from the same rater and from two different raters to determine intra- and inter-rater reliability.</p> <p><strong>Results/Discussion</strong></p> <p>Of the 24 participants, two thirds lived in a nursing home and the rest of them lived in an assisted living facility. Participants’ average age was 82.4 years and most of them were female. More than 70% of the participants had severe cognitive impairment.</p> <p>The inter-rater reliability of the PEAR-Environment was 74.0-89.6% for percent agreement and 0.49-0.94 for weighted Kappa, suggesting good to excellent reliability. Its intra-rater reliability was 79.2-92.7% for percent agreement and 0.63-0.94 for weighted Kappa, suggesting good to excellent reliability.</p> <p>For the PEAR-Apathy, except facial expression and eye contact, the inter-rater reliability was 63.5-85.4% for percent agreement and 0.66-0.86 for weighted Kappa, suggesting good to excellent reliability. Its intra-rater reliability of the PEAR environment subscale showed 75.0-89.6% for percent agreement and 0.74-0.89 for weighted Kappa, suggesting excellent reliability. The inter-rater reliability was fair, but relatively lower than on other items, such as facial expression and eye contact with 51.0% and 56.3% for percent agreement and 0.60 and 0.47 for weighted Kappa, respectively.</p> <p><strong>Conclusion </strong></p> <p>Overall, the PEAR-Environment and the majority of the PEAR-Apathy demonstrated good to excellent intra-rater and inter-rater reliability in measuring environmental stimulation and apathy. Facial expression and eye contact in the PEAR-Apathy showed modest inter-rater reliability due to the limitations of the videos that did not clearly capture participants’ facial expression and eye contact status. It is expected that the reliability will be enhanced by using videos that are recorded specifically to evaluate apathy or direct observation. Based on the findings, the PEAR is suggested for use in measuring care environment and apathy via video observation in long-term care residents with dementia. </p> <p>In summary, the PEAR is the very first instrument that measures apathy and care environments concurrently for persons with dementia. With established reliability, the PEAR is recommended for assessment of apathy and care environments related to apathy. This scale not only brings the awareness of environmental stimulation to apathy assessment and may help more accurately capture apathy. Additionally, this scale enables study of the relationship between care environment and apathy. Consequently, the findings will guide environment-based interventions targeting apathy. Finally, another advantage of this scale is the ability, through observation, to measure apathy for long-term care residents with advanced dementia, especially for the cases in which assessment via self-report and family informants is not possible. </p>en_GB
dc.subjectdementiaen_GB
dc.subjectenvironmental monitoring instrumentationen_GB
dc.subjectneurobehavioral testingen_GB
dc.subjectlong-term careen_GB
dc.subject.meshDementiaen
dc.subject.meshEnvironmental monitoring--instrumentationen
dc.subject.meshNeuropsychological Testsen
dc.subject.meshLong-Term Careen
dc.date.available2014-09-11T14:44:38Z-
dc.date.issued2014-09-11-
dc.date.accessioned2014-09-11T14:44:38Z-
dc.conference.date2013en
dc.conference.nameGSA 2013 Annual Scientific Meetingen_GB
dc.conference.hostGerontological Society of Americaen_GB
dc.conference.locationNew Orleans, LA, USAen_GB
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
dc.description.noteThe Sigma Theta Tau International grant application that funded this research, in whole or in part, was completed by the applicant and peer-reviewed prior to the award of the STTI grant. No further peer-review has taken place upon the completion of the STTI grant final report and its appearance in this repository.en
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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