Evaluation of simulated presence: A personalized approach to enhance well-being in persons with Alzheimer's disease

OBJECTIVE: To evaluate the efficacy of Simulated Presence, a personalized a pproach to enhance well-being among nursing home residents with Alzheimer's disease and related dementia's (ADRD). DESIGN: Latin-Square, double blinded, 3-factor design with restrictive rand omization of three treatments (the study intervention, a placebo audio tape of a person reading the newspaper, and usual care). The three factors were treatment, time, and facility type. SETTING: Nine nursing homes in Eastern Massachusetts and Southern New Hamps hire. PARTICIPANTS: Fifty-four subjects with documented ADRD who were aged 50 yea rs or older, medically stable, had resided in their current nursing home fo r at least 3 months, and who had no planned discharge. All subjects had a h istory of agitated or withdrawn behaviors. INTERVENTION: The purpose of Simulated Presence is to provide a personalize d intervention for persons with moderate to severe cognitive impairment. Th rough a unique testing process, some of the best loved memories of the ADRD person's lifetime are identified and then those memories are introduced to the patient in the format of a telephone conversation using a continuous p lay audio tape system. The intervention may be used for extended periods of time because each repetition is viewed as a fresh, live telephone call as a result of the short-term memory deficit of the person with ADRD. MEASUREMENTS: Direct observations of outcomes included using a newly develo ped scale, the Scale for the Observation of Agitation in Persons with Demen tia, an agitation visual analog scale, the Positive Affect Rating Scale (mo od and "interest"), a withdrawal visual analog scale, and facial diagrams o f mood. Reported measures included daily staff observation logs of response s to interventions offered, and weekly staff surveys using the short-form C ohen-Mansfield Agitation Inventory and the Multidimensional Observation Sca le for Elderly Subjects (mood and "interest"). Severity of dementia was ass essed by the Mini-Mental State Exam, the Test for Severe Impairment, the Be dford Alzheimer's Nursing Scale, and the ADL Self-Performance Scale.