Center for Gerontology

ADI London, 2012, 0C070

HOME CARE RESPITE FILMSOffering relief for caregivers by simulated multimodal presence and activation for persons with dementia?

Respite films potentially offer a brief timeout for caregivers and can act as a stimulus for positive behaviours for persons with dementia.

Adapted on the basis of Prof. Dr. Dale A. Lund’s work on respite films (U.S.A.) .

S. OppikoferCenter for Gerontology, University of Zurich, Switzerland

Center for Gerontology

ADI London, 2012, 0C070

ObjectivesThe objective of the study was to evaluate the impact of a purpose-made respite film on the following aspects:

(1) the quality of life and behaviour of persons with dementia,

(2) the respite for caregiving family members and

(3) a potential intervention with patients exhibiting agitated behaviours.

Center for Gerontology

ADI London, 2012, 0C070

Respite Film «A Musical Hike»«A Musical Hike» simulates the presence of a friendly visitor who directly addresses the viewers in a positive manner with familiar activities and topics.

•The musical therapist Antoinette Niggli engages the person with dementia during 38 minutes in a virtual musical hike.•She stimulates conversation by asking direct questions, pausing for answers, inviting for simple movements and an easy memory training.

Center for Gerontology

ADI London, 2012, 0C070

Methods DesignThe effectiveness of the respite film was tested in a short-term longitudinal study involving 29 caregiver-patient dyads.

InterventionPersons with dementia watched the respite or the control film on a regular basis during a four week intervention phase.

Center for Gerontology

ADI London, 2012, 0C070

Data Collection

Person living with dementia•Observed Emotional Rating Scale (Lawton, M. P. et al., 1996)

•Mini-Mental-State Examination, Version Zurich (Folstein et al., 1975, modified by Brühwiler, 1986)

•Smiley-Analogue-Scale

Caregiver•Multidimensional Caregiver Burden Inventory (Novak & Guest,1989)

•Functional Assessment Staging (FAST), (Reisberg, 1984; German version Ihl & Fröhlich (1991)

•Cohen-Mansfield Agitation Inventory CMAI- Long Form (Cohen-Mansfield, Marx & Rosenthal (1989)

•Questionnaire of Satisfaction and effectiveness of the film

•Single Item Quality of Life

Center for Gerontology

ADI London, 2012, 0C070

Sample persons living with dementia

Groups(dyads)

Gender Age KognitionMMSE

Functional Assessment Staging FAST

Women n

Man n

M (Range) M (SD) M (SD)

Experimentaln=24

12 12 77 (60-92) 10.75 (9.29) 8.04 (2.96)

Controln=5

2 3 78 (69-82) 16.40 (6.47) 7.60 (3.36)

Dyad: person living with dementia and their caregiverMMSE: Mini-Mental-Status Examination (Folstein et al., 1975), values scale: 0-30FAST: Functional changes through aging and dementia (Reisberg, 1984), values scale: 1-16

Center for Gerontology

ADI London, 2012, 0C070

ResultsControl FilmThe control group participants demonstrated a lack of interest in watching the film (four out of five refused to watch it regularly).

The Film’s Applicability •During the four-week intervention, the caregivers showed the film to their relative with dementia regularly with a minimum of 10 viewings.

•Most persons with medium to severe dementia did not remember they had already seen the home care film and were repeatedly pleased to watch it.

Center for Gerontology

ADI London, 2012, 0C070

Results Participants’ general reactions to:Questions•30% of the participants answered all or some of the questions•42% rarely and about 8% showed only some non-verbal reactions•21% never reacted verbally or non-verbally

Songs•44% of the participants sang along always or sometimes, while 6% showed only non-verbal reactions, •44% did not show any reactions

Movements•8% of the viewers imitated most of the movement instructions,•22% performed some movements, 16% reacted rarely, •54% did not respond at all.

Center for Gerontology

ADI London, 2012, 0C070

ResultsCaregivers’ Benefits•62% of caregiving family members reported respite, while 38% did not experience any change during the intervention.

Reasons for the experienced relief: caregivers

(a)had more time for themselves to rest and to briefly do some activities.

(b)considered their relative with dementia to be occupied with an enjoyable activity.

•No significant reduction of caregivers’ burden (CBI) was found in the pre- and post-test comparison,

Center for Gerontology

ADI London, 2012, 0C070

ResultsParticipants’ Quality of Life

•38% of the caregivers recognized a visible increase in the participants’ quality of life, 52% did not

•Participants evaluated their subjective well-being on a five-point smiley-analogue scale (from 1 = “not good at all” to 5 = “very good”)directly before and after the presentation of the film.

However, ceiling effects made it impossible to analyse whether the film had a positive effect on the viewers’ quality of life or not.

Center for Gerontology

ADI London, 2012, 0C070

Results

Agitation

• The hypothesis that agitated behaviours would be reduced due to the intervention could not be confirmed with the CMAI.

• 81% of the participants remained quiet whilst watching the film, 14% showed agitated behaviours.

Center for Gerontology

ADI London, 2012, 0C070

Results – Summary

(1)the respite film is appropriate for most persons with dementia;

(2)62% of the caregivers reported receiving relief as a result of the film;

(3)the quality of life remained stable for participants watching the film on a regular basis;

(4)most persons with dementia were calm while watching the respite film; and

(5)caregivers expressed a need for further respite films.

Center for Gerontology

ADI London, 2012, 0C070

Outlook•Second respite film selecting Love for a recurrent theme.

•Intervention study in six care facilities for people with dementia in Switzerland.

•Preliminary Results: Respite films are also useful in care facilities.