Journal Club: Behavior Analytic Research In Dementia

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Screen Shot 2014-03-16 at 10.01.29 PMIntroduction

  • Authors open with a description of dementia, including diagnostic criteria, prevalence rates, and symptoms. [For an update on dementia, visit here.]
  • Trahan et al. explain how the medical model emphases pharmacological interventions, which have adverse side effects (e.g., stoke, delirium, increased risk of falls, mortality), whereas the behavior analytic (e.g., environmental; contextual; functional) approach focuses on identifying and then changing environmental influences — a safer, and more effective approach to managing behavioral and psychological symptoms of dementia [For an update on behavioral and psychological symptoms, visit here.]

Purpose

Findings

  • From 1968-2010 JABA published more than 2,000 empirical articles, 34 included one or more older participants (1.7% of all JABA articles)
  • Prior to the 1986 JABA issue, 9 articles included one or more older participants (1.1% of JABA articles)
    • 2 included dementia patients
    • DVs: incontinence, meal preparation, engagement, social interactions
    • IVs: prompts and praise, modifying physical environment (e.g., rearranging furniture)
  • After 1986 JABA issue to 2010, 21 articles included one or more older participants (1.9% of JABA articles)
    • 15 included participants with dementia
    • Settings included nursing homes, assisted living facilities, adult day centers, and home
    • Additional DVs: aggression, wandering, disruptive vocalizations
    • Additional IVs: functional assessments, function-based interventions
  • From 2006-2010, 5 articles included one or more older participants (1.7% of JABA articles)
    • 4 included participants with dementia
    • All 5 conducted in nursing homes
    • 2 articles examined function-based assessment and treatment
      • Baker, Handley, & Mathews (2006) trained a CNA to conduct an experimental functional analysis during shower routines and found that aggression was maintained by escape from demands in a 96-year old woman with dementia. A function-based non-contingent escape intervention decreased rates to near 0 levels.
      • Dwyer-Moore & Dixon (2007) conducted an experimental functional analysis on wandering and disruptive vocalizations in three older adults with dementia. Function-based interventions (differential reinforcement, extinction) for these attention- and escape maintained behaviors lower rates of wandering and disruptive vocalizations for all participants.
    • 3 articles investigated quality of life issues (e.g., mood, leisure) with activities, prompts, praise statements
      • Brenske et al (2006) compared the effects of general (e.g., “There are activities in the room next to the elevators”) and descriptive prompts (e.g., “There will be crossword puzzles”) on recreation attendance and engagement. Authors found that descriptive prompts reliably increased levels of attendance and engagement.
      • Moore et al. (2007) and Dixon et al. (2010) found that various activities (e.g., gambling, ice cream parlor, petting farm) increased happiness (smiling, laughing) in older adults with and without dementia.

Discussion:

  • No research on
    • Generalization
    • Maintenance
    • Caregiver training
    • Other behavioral and psychological symptoms (e.g.,
    • Verbal behavior — word finding, forgetting names (as mands, tacts, intraverbals, listener behavior), derived relational responding
    • Activities of daily living
    • Skill acquisition / maintenance
    • Schedules of reinforcement
    • Delayed discounting
    • In-home care
  • Behavior analytic interventions include non-pharmacologic, individualized, evidence-based procedures to assess and manage dementia symptoms.

 

 

 

 

 

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