Katherine Abbott, PhD, MGS

Scripps Gerontology Center, Miami University

Testing the Feasibility of the Individualized Positive Psychosocial Intervention

Health Care Systems

United Church Homes

Dr. Abbott is executive director of the Scripps Gerontology Center and a professor of gerontology at Miami University in Oxford, OH. Her research and teaching focus on preference-based person-centered care and the social networks and health of older adults receiving long-term services and supports (LTSS). She co-founded Preference Based Living, a collaborative organization with the mission to conduct studies that build understanding of individual preferences through a valid and reliable assessment called the Preferences for Everyday Living Inventory for people receiving LTSS. Also, she leads an interdisciplinary team providing training and guidance to LTSS providers on ways to integrate preferences into care, communicate preferences to care partners across disciplines and shifts, and evaluate efforts through quality improvement frameworks.

RATIONALE: Over 75% of people living with dementia (PLWD) experience psychological and behavioral symptoms of distress, and their care partners (e.g., certified nursing assistants) struggle to prevent or positively respond to their distress. Research shows that nursing home residents experience more pleasure, alertness, engagement, and positive verbal behavior when engaging in IPPI activities delivered by a trained care partner.

OBJECTIVE: Our goals with this pilot study for an embedded pragmatic clinical trial (ePCT) are to effectively deploy the IPPI program into routine care within nursing homes while assessing implementation fidelity, barriers and facilitators, and the impact on distress in PLWD over 6 months, knowledge of emotion-focused communication for care providers, and self-efficacy for using emotion-focused communication for care providers.

SETTING: Nine nursing home communities that are owned and/or managed by United Church Homes.

POPULATION: Nursing home residents living with dementia and experiencing symptoms of distress (e.g., psychical/verbal behaviors, rejection of care) or depressive symptoms (e.g., sad mood, poor self-esteem, restlessness), and their direct care partners.

INTERVENTION: The IPPI is an evidence-based program that engages PLWD in brief (i.e., 10 minute) one-to-one preference-based activities 2 times a week, with the goal of decreasing communication of distress and enhancing well-being among residents.

OUTCOMES: The primary clinical outcome is an improvement in a resident’s targeted distressing mood or behavior. The secondary clinical outcome is an increase in staff knowledge of emotion-focused communication and self-efficacy in applying the skills in care. Implementation endpoints include the acceptability, feasibility, and appropriateness of the intervention, completing IPPIs, and obtaining MDS 3.0 data from United Church Homes to examine impact on distress for PLWD.

IMPACT: Findings from this study will guide any needed adaptions to the implementation as well as estimates of power needed for a full-scale Stage IV effectiveness ePCT. If successful, this IPPI pilot study could have significant impact on nursing home staff’s ability to provide PLWD with preference-based, person-centered care to improve their mood and reduce communication of distress.