Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Community-dwelling adults with mild cognitive impairment or dementia participated in this mixed-methods study. Assessment of sensory processing and observations of environmental factors were conducted. Results describe adaptations between the person and their environment in terms of sensory processing patterns. Implications highlight opportunities for OTs to assess and intervene in environmental adaptation using a sensory-based approach.
Primary Author and Speaker: Elizabeth Rhodus
Additional Authors and Speakers: Elizabeth G. Hunter
Contributing Authors: Graham Rowles, Shoshana Bardach, Gregory Jicha
PURPOSE: Aging with mild cognitive impairment (MCI) or dementia while living in the community creates need for environmental modification and adaptation for optimal behavior and functioning. Success of such approaches relies on sensory processing systems, personal preferences, and environmental congruence. There is limited evidence describing the relationship among these components and cognitive impairment, yet significant opportunity for occupational therapy assessment and intervention. The purpose of this study was to investigate use a sensory-based approach for environmental assessment in community-dwelling older adults with MCI or dementia in comparison to their home environment.
DESIGN: This study used a mixed methods design. Inclusion criteria include diagnosis of MCI or early-stage dementia, community-dwelling, over the age of 65 years, and living with a primary care partner. Participants were recruited from the University of Kentucky Alzheimer's Disease Research Center longitudinal cohort.
METHODS: The Adult Sensory Profile was used to collect information on sensory processing patterns and preference. Each participant had two in-home observations occurring at opposite times of the day (morning vs. afternoon). Observations focused on behaviors and features of the physical, social, and sensorial environment within the home. Items for observation were adopted from validated assessments including the Neuropsychiatric Inventory (behavioral observation) and In-Home Occupational Performance Evaluation (environmental observation). The researcher acted as a participant-observer, meaning that verbal interaction between the participant and observer occurred, if appropriate, but was not solicited. Data analysis included scoring of the Adult Sensory Profile and qualitative description of field observations and field notes from dialog with participants. Description of observed behaviors, home environment characteristics, and sensory profile results are illustrated in case vignettes.
RESULTS: Nine participants with cognitive impairment (MCI n = 8, dementia = 1) enrolled in the study. All participants had at least one area of sensory processing outside of normative ranges for their age. Sixteen home observations were conducted (two participants were married and observed simultaneously). Participants and care partners self-initiated adaptations (i.e., increased aromas in the home or increased lighting) in some cases, while others had limited adaptations of the environment (i.e., need for decreased visual clutter). Participants with limited environmental adaptations were more likely to present with behavioral disruption, such as agitation. Results identified unique environmental adaptations that were tailored to personal and sensory preferences for each participant.
CONCLUSION: Aging with MCI or dementia while living in the community creates need for environmental adaptation which can be enhanced using a sensory-based approach. Results of this study identified that all participants had sensory processing difficulties. Participants and their care partners demonstrated self-initiated adaptations in some areas but additional opportunity for environmental adaptation to improve environmental congruence remained. Occupational therapists have unique skills in sensory and environmental assessment and intervention. By increasing utilization of a sensory-based approach to environmental adaptation, occupational therapists may be able to substantially improve behavior and function for those living with cognitive impairment in old age.
IMPACT STATEMENT: Implications highlight opportunities to improve environmental adaptation using a sensory-based approach for improved function in community-dwelling older adults with cognitive impairment.
References
Marshall, A., Myers, C., & Pierce, D. (2017). A Century of Therapeutic Use of the Physical Environment. Am J Occup Ther, 71(1), 1-10. https://doi.org/10.5014/ajot.2017.023960
Park S, Lee S. Age-friendly environments and life satisfaction among South Korean elders: person–environment fit perspective. Aging & mental health. 2017;21(7):693-702.
