A proven, economical strategy can help frontline staff improve the nursing home experience for patients with dementia while also giving caretakers more rewarding interactions, says a researcher behind a growing body of related findings.

Individualized Positive Psychosocial Interactions are designed to be 10-minute, intentional engagement activities for patients with moderate-to-severe dementia. 

They include caregiver training on emotional-focused communication, which teaches staff how to recognize and manage emotions in their patients; flipbooks that guide staff through 60 specific interactions based on patients’ preferences; and tools to assess how the interactions have improved patient mood.

Katherine Abbott, PhD, executive director of the Scripps Gerontology Center and professor of gerontology at Miami University of Ohio, initially researched the concept in 2013. After finding that residents responded well to IPPIs, she’s spent the last several years studying how feasible the interventions are for nursing homes and their time-strapped staff.

She and fellow researchers, including Penn State’s Kimberly Van Haitsma, offered the interactions they designed as a quality improvement project for 15 nursing homes. Participants were asked to choose three residents and conduct eight to ten interventions, called IPPIs for short, with each.

Not only did certified nurse aides and other staff members conduct more IPPIs than they were asked, Abbot said, but they often chose to try them with residents who were previously seen as challenging to engage.

“We fully intended people to start easier, to let them get their bearings and then work with harder residents,” Abbott told McKnight’s Long-Term Care News. “But they really went after the folks who were struggling and who were having responses of distress, or maybe they can’t communicate that they’re bored or they can’t communicate that they’re lonely.”

Almost frown-free work

The interventions — which might include conversation or short activity around anything from cooking to dressing to hunting — didn’t agitate residents with dementia, according to the research.

Residents were asked to point to a series of illustrated faces depicting their moods before and after each activity, and 47% indicated the engagement led to a positive improvement. Another 54% had had a neutral reaction, while 1% reported a negative change. Anecdotally, staff said the results might have been better.

“Many of the staff told us that they saw an improvement in the resident’s mood, even though the resident didn’t [necessarily] pick that,” Abbott said. “This is not going to aggravate somebody because it’s preference-based, so there’s no risk … If I offered a medication to somebody that improved mood 47% of the time, there’s a good chance they’d probably all take it.”

In a study published in Aging & Mental Health last week, one participant noted that “staff members will get really excited because the staff would notice a huge amount of relaxation in our residents afterwards. … Many providers noticed their residents performing more independent tasks like traveling independently to attend services or praying the rosary.”

‘Good time’ for all

In addition, IPPIs in the trial often exceeded the expected 10-minute duration. Abbott said that was because staff became invested in the activities and “having a good time.”

“This was an opportunity for them to do what most direct care workers want most, which is to spend time providing comfort and meaning and calm for folks,’ she said. “And 98% said this was a meaningful use of their time.”

Families also responded well to the interventions and sometimes bought supplies so that they could repeat them during visits.

As for feasibility, Abbott said, neither cost nor interest in the program appeared to be barriers. But providers could use better ways to document the work and demonstrate its worth.  The researchers worked with United Church Homes, for instance, to put several of related data items into their electronic medical records.

Researchers are also refining the initial training to make it less time-intensive, another step likely needed for wider adoption.

Regardless of the buy-in, many of the early adapters are now full supporters of the strategy.

“It was an absolute pleasure to do this program, and I highly recommend it,” said one provider cited in the study. “And I hope some other facilities really get to benefit from it … it brings happiness, and, you know, that ray of sunshine that a lot of us are looking for.”

More about IPPIs and the related training is available here.