Graduation Year

2019

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Communication Sciences and Disorders

Major Professor

Michelle Bourgeois, Ph.D.

Committee Member

R. Michael Barker, Ph.D.

Committee Member

Harleah Buck, Ph.D.

Committee Member

Howard Goldstein, Ph.D.

Committee Member

Kathryn Hyer, Ph.D.

Keywords

decision-making, long-term care, person-centered care

Abstract

Person-centered care is important to the quality of life of nursing home residents with dementia. Preference assessments enable person-centered care by documenting residents’ preferred activities. Residents with severe dementia are less likely to have a role in preference assessment due to communication challenges associated with the disease. External supports (visual and text cues) are effective in improving the communication of residents with dementia, but these cues are often not used in practice. Standard assessment (verbal questioning) places greater demands on short-term memory and attention, which are known deficits in dementia.

Applying a within-subjects design, this study evaluated two conditions (standard and supported) for assessing preferences of residents with severe dementia (N=21). This study examined the effect of these conditions on residents’ consistency over time (1-week) and utterance types in response to preference questions. Naïve judges (N=10) listened to the interviews and rated residents’ communication clarity and their confidence with understanding residents’ preferences.

Results show that residents with severe dementia can report preferences with similar consistency in both assessment conditions; however, residents may comprehend the assessment better when provided in a supported format. In addition, residents successfully engaged in preference interviews without proxy participation. Anecdotally, many residents demonstrated an accurate understanding of their environment and how they would prefer to spend their days. Future studies will optimize visual stimuli, choice options, staff training components, efficiency measures, and examine acceptability by nursing home staff.

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