... SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 1 Implementation of a sensory-based program for older adult with dementia in a long-term care setting A. Dresden Glover May 4, 2022 A capstone project submitted in partial fulfillment for the requirements of the Doctor of Occupational Therapy degree from the University of Indianapolis, School of Occupational Therapy. Under the direction of the faculty capstone advisor: Brenda S. Howard, DHSc, OTR, FAOTA SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 2 Abstract Many older adults with dementia experience neuropsychiatric symptoms such as depression, anxiety, agitation, and more (Silva et al., 2018). Due to changes in how their brains interpret the world around them, caregivers must adapt how they create a safe and engaging environment with appropriate activities (Houston & Christie, 2018). To facilitate this environment, I have created a training manual to help staff understand how the sensory systems change for people with dementia, and an intake questionnaire to help staff know their residents daily preferences to provide individualized care. I also provided sensory-based activities made specifically for residents with dementia. Following an in-service presentation of the training manual, 3 out of 7 staff members demonstrated increased understanding of using a sensory-based approach when working with residents with dementia. The site could benefit from future occupational therapy services to facilitate increased quality of life and activity engagement of residents with dementia. SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 3 Implementation of a sensory-based program for older adults with dementia in a long-term care setting People with dementia experience problems with memory, difficulty learning new information, and can have mood disturbances such as agitation, aggressive behavior, and apathy (Silva, 2018). For people with dementia, their brains change the way they interpret the sensory input from the world around them (Champagne, 2018). As the condition progresses, people with dementia become less and less able to complete their activities of daily living (ADL), such as bathing, grooming, toileting, and eating independently, and their quality of life can decrease significantly (Silva et al., 2018). Four Seasons Senior Living Community in Columbus, Indiana is a retirement community with independent apartments, long-term care, and skilled nursing (A. Sands, personal communication, January 10, 2022). Within the Health Center of the facility, there are approximately 55 beds for residents, many of whom require assistance for their daily activities due to decreased safety awareness secondary to progressive dementia. Although the residents at Four Seasons are welcome to participate in daily activities in groups or individually, the activities director sometimes finds it difficult to find appropriately engaging activities for residents with dementia (L. Ludwig, personal communication, January 13, 2022). Some residents wander or become anxious or agitated, and can sometimes disrupt the activities of other residents. Researchers report that engaging people with dementia using individualized sensory-based activities can help them reduce their agitation, aggression, and increase their mood and their ability to participate in their ADLs (Bernardo, 2018; Jensen & Padilla, 2017; Silva et al., 2018). This scholarly report will describe how dementia affects older adults in an assisted living SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 4 facility, and how using a sensory-based approach can increase wellness and quality of life. Specifically, this report will detail the creation of a daily preferences questionnaire, the creation of a training manual on the use of a sensory-based approach to working with residents with dementia, and the development of sensory-based activities. Together, these three components target the quality of life of residents with dementia at Four Seasons Health Center. I will describe the design, the implementation, and the outcomes of the use of these interventions. Background Alzheimers Disease AD is the most common form of dementia and irrevocably changes the brain over several years (Alzheimers Association, 2022; World Health Organization, 2020). As the condition progresses, symptoms manifest as memory loss, confusion, personality changes, and a loss of interest. People with dementia experience deficits in orientation, learning capacity, language, and judgment (Strm et al., 2016). Ultimately, the condition affects basic bodily functions such as swallowing. As the condition progresses, people with dementia become less and less able to complete their ADLs (American Occupational Therapy Association [AOTA], 2020; Silva et al., 2018). In addition to problems with memory and a limited capacity to learn new information, common symptoms of dementia include eating problems, abnormal or repetitive vocalizations, wandering, and mood disturbances such as agitation, aggressive behavior, and apathy (Silva, 2018; Strm et al., 2016). In long-term care facilities, many residents with dementia spend a lot of time asleep, withdrawn, and apathetic (Sposito et al., 2017). People with AD can experience changes in mood and personality. These changes include symptoms of depression and anxiety, and the person can become irritable, agitated, and aggressive (Alzheimers Association, 2022). SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 5 Sometimes people with dementia can experience an increased agitation in the late afternoon or early evening known as sundowning (Forbes & Gresham, 2011). These symptoms result in a decrease in quality of life for the person with dementia and an increase in the burden of caregivers (Silva et al., 2018). Non-pharmacological therapy includes occupational therapy (OT), in which the practitioner develops individualized treatment sessions targeted toward behavioral and mood management, increasing ADL participation, and ultimately, quality of life (Bernardo, 2018; Jensen & Padilla, 2017). OT practitioners can help older adults with dementia engage in their daily occupations, which help bring a sense of purpose and identity to a persons life (AOTA, 2020). Sensory modulation in older adults with dementia Throughout the progression of dementia, the brains of older adults change and interpret the world around them differently than older adults without dementia (Champagne, 2018; Houston & Christie, 2018). Their brains interpret the visual, auditory, and other sensory input in ways that can be confusing for the person with dementia, and because they have difficulty communicating, they may not be able to describe what they perceive (Champagne, 2018). What they perceive may make them feel unsafe, disoriented, and confused, which can lead to agitation, anxiety, or depression (Champagne, 2018). It is important to create a home-like environment which provides safety and comfort for the residents with dementia (Champagne, 2018). When using a sensory-based approach, the caregiver can set up the environment in a way that makes it easy for the brain to interpret correctly (Champagne, 2018; Padilla, 2011). For example, increasing lighting to reduce shadows can help the person with dementia who may interpret the shadowy corner as a stranger standing in the coroner. Caregivers who use a SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 6 sensory-based approach can also identify triggers of agitation, and either mitigate these triggers or avoid the particular activity altogether. For example, a person with dementia may become agitated during bathing. The caregiver realizes that the person becomes especially agitated during transfers into the shower, which leads to a very difficult bathing session. The caregiver might decide in the future that avoiding these transfers is best, and that a sponge bath may be a better option. Utilization of a sensory-based approach helps reduce the aspects of dementia which decrease the quality of life of the person with dementia (Champagne, 2018). Older adults with dementia in a long-term care setting may also experience sensory deprivation. When the brain of a person with dementia has little or no sensory input, the person can experience confusion, disorientation, and emotional dysregulation (Champagne, 2018). Researchers report that sensory-based activities are effective in decreasing symptoms of anxiety and depression for people with dementia (Moghaddasifar et al., 2018). Sensory stimulation can help reduce behavioral problems such as agitation, wayfinding, and aggressions (Kim et al., 2012). These types of activities can be useful for people with a neurocognitive condition because they do not require high levels of cognition to participate (Moghaddasifar et al., 2018). Researchers found that residents demonstrated increased engagement in their tasks following sensory-based activities (Sposito et al., 2017). These activities can also improve mood, emotional wellbeing, and occupational engagement (Haigh & Mytton, 2016; Snchez et al., 2016). Although the effects are typically short-lived, researchers found that residents demonstrated increased engagement in their tasks following sensory-based activities (Snchez et al., 2016; Silva et al., 2018; Sposito et al., 2017). A critical component of sensory stimulation is the focus on individualization. Researchers SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 7 report strong evidence for person-centered interventions (Jensen & Padilla, 2017). When caregivers in institutions use person-centered care, they account for hearing or vision loss and play the music that residents prefer (Lopis et al., 2021). Maseda et al. (2018) found participants experienced immediate improvements in mood and behavior when the therapist took into account each participants preferences and interests. Researchers report that personalized care helps staff learn more about their residents and their abilities, which leads to better communication and trust between caregivers and residents (Bunn et al., 2018). When caregivers and therapists understand their residents interests and values, they can help their residents engage more with their environment and increase their quality of life (AOTA, 2020). Needs Assessment Four Seasons Senior Living Community is a retirement community with independent apartments, long-term care, and skilled nursing (A. Sands, personal communication, January 10, 2022). Within the Health Center of the facility, there are approximately 55 beds for residents, some of whom require skilled nursing while recovering from surgery, illness, or hospitalization. Other residents require assistance for their daily activities due to decreased safety awareness secondary to progressive dementia. My interest relating to dementia lies in improving mood among residents with dementia by using a sensory-based approach to increase quality of life. Residents within the Four Seasons Health Center can participate in daily scheduled activities in groups, or use the activity room individually (L. Ludwig, personal communication, January 13, 2022). The activities director, Loni, reported she requires assistance with providing appropriately engaging activities for residents of varying levels of cognition and physical ability. Sometimes residents experience bouts of agitation and require considerable effort from staff to reduce these moods. Wintertime is particularly difficult because residents cannot participate in SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 8 outdoor activities which Loni finds to be a favorite activity for her residents (L. Ludwig, personal communication, January 20, 2022). Additionally, Loni reported staff occasionally will ask her for advice on activities to do during weekends. Not all residents participate in scheduled activities, which can lead to being socially withdrawn and experiencing a physical decline (L. Ludwig, personal communication, January 20, 2022; Sposito et al., 2017). With this project, I developed a three-pronged program which addresses the sensory needs of residents with dementia. I developed a questionnaire to determine the daily preferences, which includes a sensory-based component, of the residents. This questionnaire ensures that activities are individualized for the residents. I also provided a training manual to educate staff on how to provide a safe and engaging environment using a sensory-based approach, and to instruct on the use of the activities. I created activities to assist the activities director and staff to find appropriate, individualized, sensory-based interventions to help reduce agitation, depression, apathy, and to increase wellbeing. The sensory-based activities addressed tactile, proprioceptive, vestibular, visual, auditory, and olfactory senses (Champagne, 2018). I created these components specific to the needs of residents and staff at Four Seasons Health Center, while also being sustainable for future individuals with dementia at this site. Theoretical Framework Lived Environment Life Quality Model In order to guide my professional reasoning in my Doctoral Capstone Experience (DCE), I used the Lived Environment Life Quality Model (LELQ) and the Sensory Integration frame of reference. Researchers developed the LELQ model to help occupational therapy (OT) practitioners who work with people with dementia in institutions (Wood et al., 2017). In the LELQ model, OT practitioners focus on the lived environment and context in order to improve SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 9 the quality of life for the people with dementia. The lived environment includes the caregiving microsystem, the person with dementia, and the environmental press (Wood et al., 2017). The caregiving microsystem describes the activity situations, such as meals and activity groups. The person with dementia represents the occupational profile and the current preferences and needs of the resident. The emergent environmental press describes the interaction between the person with dementia and the environment (Wood et al., 2017). The quality of life outcomes and indicators include time use (i.e. occupational engagement), the ability to function, and relative being (e.g. positive emotional experiences). Sensory Integration Frame of Reference People with dementia interpret the world through their senses differently than people without dementia (Champagne, 2018; Houston & Christie, 2018). For my project, I viewed the residents lived environment and personal contexts through the frame of reference of Sensory Integration. I determined which sensory aspects of the environment and context minimize distractions or maximize stimulation to promote calm alertness (Cole & Tufano, 2008). As a result, my goal will be to increase quality of life by increasing the frequency of positive experiences (Cole & Tufano, 2008; Wood et al., 2017). Project Design and Implementation This project fills a gap in the needs of the activities director to provide individualized, meaningful, engaging, and appropriate activities for the residents with dementia. Residents with dementia can exhibit symptoms of anxiety, depression, or agitation, and engagement with activities can help alleviate these negative symptoms (Baker et al., 2001; Silva, 2018). I designed and implemented this project to assist staff in choosing appropriate and individualized activities, and to train staff on using a sensory-based approach when interacting with residents with SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 10 dementia. To maintain organization, I used a weekly timeline (see Appendix A). To determine the baseline status of residents with dementia, I chose the Functional Behavior Profile (FBP) to understand how residents engage in their occupations. Baum et al. (1993) developed this assessment, which was to be completed by caregivers of people with dementia, to determine a persons behaviors relating to task performance, solving problems, and interacting socially. This assessment has 3 categories which can be used as a total score or as individual scales: performance of tasks, socialization, and problem solving (Baum et al., 1993). Because my project focuses on symptoms of anxiety, agitation, and apathy, among other symptoms, I chose to focus on the performance of tasks and socialization scales. I administered this questionnaire to spouses and staff who are regular caregivers of the residents with dementia. Resident Daily Preferences After gathering information about the residents with dementia, staff, and the day-to-day operations of the facility, I began implementing the program. To address individualized care, I chose to create a questionnaire which could be completed by staff, family members, or the resident. At the request of my site mentor, I created an all-encompassing questionnaire to gather information about each resident, not simply those with dementia. First, I determined what the site currently uses to gather information about residents daily preferences. I identified gaps in the current system using the Preferences for Everyday Living (PELI) and the Occupational Therapy Practice Framework (OTPF) (AOTA, 2020). In the questionnaire, I included a section on how the residents prefer to deal with stress. I based those questions on the Sensory Processing Caregiver Checklist (SPCC) (Champagne, 2018). I also spoke to residents with dementia about their leisure and self-care preferences. After my first draft of the questionnaire, I requested feedback from social services, the activities director, and my site mentor. SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 11 Sensory-based Activities I provided appropriate, sensory-based activities for the residents with dementia at Four Seasons. First, I needed to inventory what the site currently had. I spoke to the activities director about the activities she uses for people with dementia. I organized and cleaned out the various locations where the activities director keeps supplies for activities. Using Champagnes (2018) book as a guide, I determined gaps in appropriate activities for people with dementia, for both current residents, and as those residents might progress in their condition. Sensory-based Approach Training Manual To ensure sustainability of the sensory-based activities I created, I chose to compile a manual which would provide information about the activities. I gave context to the activities by providing education on the sensory systems and how dementia affects sensory processing. At the request of my site mentor, I included a section on environment and approach using a sensory-based perspective. I observed staff interactions with residents with dementia to determine areas for improvement to increase quality of life. I also spoke to residents with dementia about their experiences with sensory changes. I researched the literature on providing a safe and comfortable environment and how to approach people with dementia. Throughout the manual, I strove for readability because different positions at the site require various levels of education. In the manual, I included information about the sensory-based activities I implemented, and information about how and when to use the activities. At the end of the DCE, I conducted 2 in-service sessions to train current staff members on the sensory-based approach and activities. During these 2 sessions, I administered a 3-question pre- and post-quiz to determine how effective my presentation was, and asked for feedback through a Likert scale and short-answer survey. SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 12 By using three components, I ensured the project would sustain after I leave by educating staff on the importance of individualization in choosing sensory-based activities, and the importance of using a sensory-based approach when working with people with dementia. Project Outcomes To decrease neuropsychiatric symptoms in people with dementia at Four Seasons, I created for my DCE project three components to provide the site a sensory-based program for caring for people with dementia. I created the means to determine the residents daily preferences, which includes a sensory preferences element. Using existing and purchased items, I created sensory-based activities for the residents with dementia. Finally, I created a manual to train staff on using a sensory-based approach when working with people with dementia. Before creating this binder, I needed to understand the population of current residents with dementia. I used the Functional Behavior Profile (FBP) to understand their task performance and social interactions (Baum et al., 1993; Shirley Ryan Ability Lab, n.d.). I talked to certified nursing assistants (CNA), spouses, the activities director, and used my own observations to complete the assessments. These assessments were especially valuable to promote discussion about behaviors and other observations from staff and caregivers (Baum & Edwards, 2000). I inquired about 6 residents with dementia, including 4 women and 2 men. I focused on the task performance and the socialization domains of the FBP. For each domain, residents can score 44 points, and a higher score indicates higher performance and independence with daily tasks (Shirley Ryan Ability Lab, n.d.). Residents scores ranged from 16 to 43 out of 44 for task performance, and 23 to 37 out of 44 for socialization. Staff and spouses reported behaviors and habits of residents such as: She is up a lot at night and sleeps during the day, he prefers late morning activities, and she SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 13 seems to prefer physical activities, such as exercise group, rather than cognitive activities, such as Bingo or Yahtzee. These scores indicate a wide variety of abilities with some residents requiring constant verbal and tactile cueing and other residents requiring supervision (Baum et a., 1993). Because of these wide ranges, the activities described in the activities binder will need to be applicable for many different kinds of people. To understand the sensory preferences and needs of the residents, I used observation and the SPCC (Champagne, 2018) to determine their needs during structured group activities and during independent activities. I frequently noticed an increased need in the late afternoons to early evenings, when some residents became more agitated, anxious, and disoriented. This increased agitation during this time of day is frequently referred to as sundowning (Forbes & Gresham, 2011). During these times, residents would display behaviors such as perseverating, pacing, and wayfinding. Resident Daily Preferences For Four Seasons Health Center, I created a comprehensive questionnaire to help staff learn more about the daily preferences of their residents (see Appendix B). The questions are mostly checkbox options with some opportunities for short answers. I based this questionnaire off the PELI, the SPCC, and the OTPF (AOTA, 2020; Champagne, 2018; Preference Based Living, 2020, October 2). With the OTPF in mind, I adjusted questions from the PELI and reframed them to focus on daily habits and routines. I used the SPCC to formulate questions to determine how a resident deals with stress. These questions ask the resident about their gustatory, auditory, visual, tactile, proprioceptive, and vestibular preferences. Examples of questions include When you are upset, stressed or overwhelmed, how do you make yourself feel better? Eat or drink something? Receive a hug? Watch TV? Hold a special object? SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 14 I asked for feedback from staff and my site mentor after my first draft of the questionnaire. For example, in the PELI, they give an option for smoking as an activity someone might like to do outside. My facility, however, is a smoke-free campus. Other staff members recommended small additions to options in self-care tasks and leisure activities, such as including social media. After making adjustments, my questionnaire was six pages long. Because of high family involvement at this facility, my site mentor believed that family will gladly fill this assessment out. However, some residents come to Four Seasons for short-term skilled nursing, or do not have frequent contact with loved ones who might live out of state. In this case, my site mentor asked that I create an abbreviated version of the questionnaire that can be completed by the resident or by a facility representative. This abbreviated questionnaire was one page long with more opportunities for short-answers rather than all checkbox options. Sensory-based Activities During my time exploring the available activities at Four Seasons, I inventoried and organized the activities closet and cabinets. I found the department already had many items which could be used in sensory-based activities for residents with dementia. For example, there were already several sensory fidget quilts. These quilts provide tactile, visual, and sometimes auditory sensory input for people with dementia (Champagne, 2018). However, I found these quilts to be poorly constructed and I did not think they would survive a cycle through the washing machine. I deconstructed the quilts and recreated a quilt using the components. This quilt could be washed and used many times. I included visual, tactile, and auditory sensory inputs (see Appendix C). From other items in the closet and items bought at a store, I created sensory rummage kits based on ideas from Champagne (2018) and on the leisure preferences from current residents.. I SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 15 also found many sewing supplies in the closet, including buttons, spools of thread, and other notions typically used when sewing. From my interactions with the residents with dementia, I knew that at least two enjoyed sewing as a leisure activity. I compiled these items into a container, and included squares of fabric of various tactile sensations. Other rummage kits included a fishing kit, household maintenance kit, office worker kit, and a jewelry kit. For the fishing kit, I included lures among the items, but removed the barbed hooks for safety. Other activities I compiled include folding laundry, sorting activities, and a dart-throwing game which uses hook and loop balls on a fabric board. To ensure sensory-based activities were appropriate and applicable to the residents with dementia at Four Seasons Health Center, I implemented some activities during different times of the day. Sometimes, residents were already calm and alert, and other times, residents were agitated and anxious. During one instance of particular agitation, a resident demonstrated increased respiration rate and frequent vocalizations. When spoken to, she would frequently reply with what? indicating decreased auditory processing (Champagne, 2018). Using the SPCC, I determined it would be beneficial to focus on visual and tactile sensory input rather than auditory input (e.g. conversation). After about 30 minutes, the resident was calmer with a normalized breathing rate, and had fewer vocalizations. In another instance, a resident was worried about her spouse who was recovering from a health incident. Due to her dementia and stress, she repetitively asked about her spouse every two to three minutes. She reported she did not want to rest because she was too worried about her spouse. I brought a basket of laundry to fold, and asked her if she would help me fold it. She agreed, and while we folded laundry, I asked her questions about her past to distract her from her worries (Fraker et al., 2014). Shortly after I left her, a CNA reported that the resident was more SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 16 agreeable to resting before dinner. My attempts at implementing sensory-based activities was trial-and-error at times, however, and did not always help ease a residents agitation. One resident was anxious before lunch one day, and had difficulty becoming calm. I knew she liked to sew, so I showed her the sewing rummage kit I created. Despite encouragement and questions to prompt conversation about sewing, her ability to attend to the activity was approximately 15 to 30 seconds before she would begin repeating I dont know what Im supposed to do. I switched to reading her the newspaper and discussing with her the headlines. This form of sensory stimulation seemed to be more engaging for the resident, and we continued this activity until lunch. Sensory-based Approach Training Manual To accompany the sensory-based activities, I created a training manual entitled Caring for People with Dementia: a Sensory-based Approach (see Appendix D). Throughout the manual, I included evidence-based research to justify information provided. It included information about the types of dementia, the signs and symptoms of dementia, and how dementia affects sensory processing. I included information on how a person with dementia interprets their environment, and how to approach a person with dementia. Other sections of the manual include sensory overload, calming strategies, and sensory deprivation. I also included information about the sensory-based activities and when to use them. For example, I suggested staff try the activities during times when the person with dementia is agitated and anxious, such as during sundowning. I ended the manual with suggestions for specific sensory-based activities. I included information about the activity kits and other sensory-based activities to try. For example, I suggested that some residents may appreciate going for a walk, listening to music, or going SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 17 outside (Champagne, 2018; Ridder et al., 2013). I also included a section of activities which may be more appropriate for residents further along in their progression of dementia. These sensory-based activities include the fidget quilt, a glitter lava lamp, scented lotions for hand massage, and more. These activities require less participation and cognition as appropriate for these residents (Moghaddasifar et al., 2018). In-service Presentation I presented this manual as two in-service sessions for staff. A total of 7 staff members attended the sessions, and all completed a pre- and post-quiz to gauge how well staff already knew the sensory-based techniques, and how well I educated them in these techniques. Audience members included a certified occupational therapy assistant, a speech language pathologist, the regional director of the facility, and higher-level staff such as the director of nursing and director of social services. No CNAs attended the sessions. For the quiz, 3 out of 7 staff members demonstrated improvement by answering 2 answers correctly on the pre-quiz, and 3 answers correctly on the post-quiz. One person made no improvement on the post-quiz, and 3 people answered all questions correctly before and after the presentation. Because almost half of the staff members demonstrated increased knowledge in using a sensory-based approach when working with people with dementia, I am confident the binder will educate future employees in providing excellent care and improving the quality of life for the residents with dementia. However, my data is limited because I did not get a variety of education levels from other staff members such as CNAs. After the presentation, I asked for feedback in the form of a Likert scale survey and a short-answer to elicit other feedback. All participants rated the presentation highly in terms of usefulness, understandability, whether objectives were met, and whether they were likely to use a SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 18 sensory-based approach in the future. Audience members wrote simple and well-organized, and great presentation. Summary At Four Seasons, there are many residents with dementia among a population of approximately 55 residents of varying cognition levels. As the sole staff member of the activities department, the activities director must manage the leisure activities for all residents. Oftentimes while she is leading games, she is interrupted by someone with dementia who is wayfinding, agitated, or anxious. She tries to find a way to get the person with dementia to participate, but this attempt often takes her attention away from the other residents playing the game. Sometimes residents experience bouts of agitation and require considerable effort from staff to reduce these moods. Because it can be difficult to understand how older adults with dementia experience the world, I created a manual to educate staff on using a sensory-based approach when working with residents with dementia. In this manual, I included information about approach, environment, and sensory-based activities which may help with alleviating sensory overload and sensory deprivation. I also created sensory-based activities, including themed rummage kits, which staff can easily obtain from the activities closet. They will use choose kits relating to the residents leisure preferences, prior career, and reported stress-reducing strategies which would be detailed on the intake questionnaire I also created for the site. I presented this manual to staff during two in-service presentations. A total of 7 staff members attended, and all completed pre- and post- presentation quizzes, and a feedback survey. 3 of the 7 attendees demonstrated improvement on the quiz, 3 answered all answers correctly on both quizzes, and one person showed no improvement. With feedback and the quiz results, I am SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 19 confident that this manual will be beneficial to new staff who may not have worked with people with dementia. With this sensory-based approach to determining the daily preferences, to interacting, and to providing sensory-based activities, residents with dementia can live a more fulfilled and higher quality life. Conclusion Throughout my time working on this project, I have learned on a day-to-day basis how much effort it takes to care for people with dementia. As described by many researchers, many of the residents with dementia demonstrated agitation, aggression, anxiety, and depression (Alzheimers Association, 2022; Silva et al., 2018; Strm et al., 2016). Although the products of this project will not fix all the negative neuropsychiatric behaviors of residents with dementia, the staff will be able to use the techniques and supplies I have provided to ameliorate these symptoms. There is still more work to be done for the site to better the quality of life for the residents with dementia. In the future, an occupational therapy practitioner could work with residents and staff to develop an individualized sensory-based activity plan to mitigate sensory deprivation, sensory overload, and behaviors relating to agitation, anxiety, depression, and other symptoms (Champagne, 2018). An occupational therapy practitioner could also increase participation in leisure activities and ADLs by addressing the sensory-based aversions that some older adults with dementia can develop (Champagne, 2018; Houston & Christie, 2018). In the meantime, the products I have made for the residents with dementia at Four Seasons Health Center will contribute to their quality of life. SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 20 References Alzheimers Association. (2022). 2022 Alzheimers disease facts and figures. https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 1-87. https://doi.org/10.5014/ajot.2020.74S2001 Baker, R., Bell, S., Baker, E., Gibson, S., Holloway, J., Pearce, R., Dowling, Z., Thomas, P., Assey, J., & Wareing, L. A. (2001). 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Dementia. https://www.who.int/news-room/fact-sheets/detail/dementia SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 24 Appendix A Weekly Planning Guide Week DCE Stage Weekly Goal (orientation, screening/evalu ation, implementation, discontinuation, dissemination) 1 Orientation Complete orientation by end of week Objectives Meet with site mentor Monday Tasks Obtain necessary log-ins for documentation, resident information Check in with site mentor Wednesday Adjust MOU to new setting (which does not contain a designated memory care unit) 2 Orientation Identify patients with dementia who might benefit from sensory-based interventions Identify patients with dementia who might benefit from sensory-based interventions 1/10/22 1/12/22 Meet with activities director to identify possible patients with dementia 1/12/22 Meet with COTA to identify possible patients with dementia Attend activity to observe patients (Bingo) Meet with site mentor Tuesday Establish means to document Date complete Meet with new therapy manager (starts this position Monday) on Thursday Meet with activities director to continue to identify needs of residents 1/18/22 1/17/22 1/18/22 SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 25 Screening / Evaluation Develop sensory profiles for residents with dementia 3 Screening / Evaluation 3 Screening / Evaluation Develop sensory profiles for residents with dementia Develop sensory profiles for residents with dementia Inventory supplies Screening / Evaluation Prepare questionnaire to identify individualized interventions for residents Adjust sensory preferences checklist Confer with activities director to develop questionnaire appropriate to administer to residents Administer questionnaire Administer FBP and adjusted sensory preferences checklist to 2 residents and their spouses 1/24/22 Cabinets 1/28/22 meet with site mentor 4 Screening / Evaluation Screening / Evaluation Inventory supplies Adjust MOU goals Sensory profile 5 6 Implementation Implementation Review MOU goals Develop sensory profiles for residents with dementia Develop profiles for residents with dementia Sensory-based activities 1/21/22 Closet confer with site mentor about goals 1/26/22 2/4/22 2/4/22 meet with site mentor 2/2/22 2/4/22 meet with faculty mentor update 2/11/22 2/11/22 continue to adjust sensory profile questionnaire continue observing residents during planning, group activities and individual activities; build rapport administer FBPs speak to CNAs during and adjusted lunch sensory profiles for 4 residents continue organizing supplies 2/11/22 2/11/22 2/18/22 SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 26 identify gaps in sensory-based activities develop list of items to purchase 7 Implementation Develop profiles for residents get to know residents during activities 2/18/22 meet with site mentor lead exercise class and trivia 2/15/22 2/21/22 meet with site mentor 2/21/22 2/21/22 refer to Preferences for Everyday Living Inventory, per site mentor 2/25/22 Update goals: daily preferences questionnaire (include sensory preferences, nix sensory-based profiles) begin work on intake questionnaire for site 8 Implementation Resident profiles Sensory based activities binder 9 Implementation Intake questionnaire Intake questionnaire 10 Implementation Intake questionnaire begin work on binder of sensory-based activities Create sensory-based activities organize FBPs, prepare 3/3/22 for outcomes section of scholarly report meet with site mentor 3/4/22 use inventory of sites 3/4/22 activities closets / cabinets using components from existing fidget quilts, create better quality fidget quilt give site mentor draft of intake questionnaire, get feedback give activities director and social services intake questionnaire for feedback get feedback back from social services 3/5/22 3/10/22 3/11/22 3/14/22 SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 27 Intake questionnaire 11 Implementation Sensory-based intervention binder Intake questionnaire submit draft to site mentor feedback: include environment & approach to sensory-based approach to working with people with dementia obtain letterhead for questionnaire from site mentor Sensory-based activities 12 13 Implementation Implementation / discontinuation Prepare to disseminate to facility Sensory-based approach binder Intake questionnaire implement feedback on questionnaires; adjust formatting create abbreviated intake questionnaire get feedback Talk to director of nursing to schedule in-service draft pre- and post-quiz for in-services draft survey to get feedback from staff after inservice scan letterhead 3/18/22 3/18/22 3/22/22 3/23/22 3/22/22 Go to Walmart with activities director to purchase supplies put together kits (elicit help from residents with dementia) remove barbs from fishing lures schedule for tuesday of week 14, 2 sessions, at shift changes; per site mentor 3/24/22 3/24/22 3/25/22 3/30/22 4/1/22 4/1/22 photograph sensory-based activities to include in binder finish formatting, include directions for completing questionnaire, present 3/31/22 4/6/22 SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 28 Intake questionnaire In-service In-service 14 Dissemination In-service Sensory-based approach binder ensure binder prints as desired print binder In-service In-service In-service In-service final draft of full and abbreviated forms to site mentor, receive last feedback per site mentor, email copy of both questionnaires to director of social services; Goal considered met Per site mentor, reschedule in-service for Thursday of week 14 scope out presentation room to ensure technology, etc, works in prep for in-service finish presentation test print binder purchase last supplies for binder put final touches Goal met for on binder sensory-based approach binder obtain necessary technology in prep for presentation practice practice presentation to ensure conciseness, brevity pre- and print post-quiz, feedback survey Present 7AM and 2:15PM Review quizzes & feedback for outcomes 4/6/22 4/6/22 4/7/22 4/8/22 4/11/22 4/12/22 4/13/22 4/12/22 4/13/22 4/13/22 4/14/22 4/15/22 SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 29 Appendix B Daily Preferences Questionnaire Sample SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 30 SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 31 Appendix C Pictures of Sensory-based Activities SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 32 SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 33 SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 34 SENSORY-BASED PROGRAM FOR OLDER ADULTS WITH DEMENTIA 35 Appendix D Sample Pages of Sensory-based Approach Training Manual ...