A randomized controlled trial for an individualized positive psychosocial intervention for the affective and behavioral symptoms of dementia in nursing home residents

Abstract

Objectives: This randomized controlled study tested the effectiveness of individualized activities, led by certified nursing assistants (CNAs), to increase positive and reduce negative affect and behavior among nursing home residents with dementia.

Method: Nursing home residents with mild to advanced dementia (N = 180) were randomly assigned to usual care (UC, n = 93) or 1 of 2 experimental conditions. Residents in the attention control group (AC, N = 43) participated in standardized one-to-one activities with their CNAs. Individualized Positive Psychosocial Intervention (IPPI) participants (n = 44) received a CNA-led activity matched to their interests and ability. Outcomes were residents' positive and negative affect and verbal and nonverbal behavior.

Results: The IPPI and AC groups experienced similar benefits-more pleasure, alertness, engagement, positive touch, and positive verbal behavior-compared with UC. The AC group displayed more anger, uncooperativeness, and very negative verbal behavior than UC or IPPI.

Discussion: This study demonstrates the value of individualized activities for nursing home residents with dementia. In a stringent test, residents were happier and less angry during a customized intervention compared with a standardized intervention. Even brief individualized CNA-led activities bring pleasure to nursing home residents and constitute an effective strategy to enhance positive affect and engagement in persons with dementia.

Keywords: Activity intervention; Behavioral symptoms; Dementia; Nursing home; Positive and negative affect; Preferences; Randomized control trial.