Appendix C: Example of Evidence-Based Practice Project

INTRODUCTION

This chapter describes the geographical location and the practice setting in which the evidence-based practice project was conducted. It provides background information related to managing problematic negative behaviors in patients with dementia within the skilled nursing facility and the rationale for considering use of a multisensory environment as a viable solution. Potential opportunities and threats to implementation of the project as well as its impact on the field of occupational therapy are also discussed.

Description of Evidence-Based Practice Setting

Woody Pines, located in a rural community in southwestern Pennsylvania, is a geriatric care center that includes a 109-bed skilled nursing facility, a 70-bed assisted living facility, and an on-site adult day care. The rustic log home, built in the early 1900s, originally served as a private family home, but was purchased in 1988 by a management services company and renovated to function as it does today. The facility offers pharmacy, medical supply, hospice care, and rehabilitation services primarily to adults over the age of 65 years.

A brief statistical description of the population and geographical location serves to set the scene for this intervention. The rural community, nestled in the foothills of the Laurel Highlands in southwestern Pennsylvania, boasts a population of just over 11,000, with approximately 17% of the population over the age of 65 according to the 2000 U.S. Census. The borough itself has a population of 4,728, with the remainder of the population residing in primarily single-family dwellings within its more rural township. The U.S. Census Bureau projects a significant increase in the population of those 65 and older from the year 2000 to 2030. Statistical projections for the state of Pennsylvania suggest an increase from 4% to 50.6% in the elderly population during this period (U.S. Census Bureau, 2007).

Background Supporting the Evidence-Based Practice Intervention

Dementia is the significant loss of intellectual abilities, such as memory capacity, which is severe enough to interfere with social or occupational functioning (MedicineNet). The Alzheimer’s Association (2007) reports Alzheimer’s disease is the primary form of dementia, affecting over 5 million Americans. It is the seventh-leading cause of death and limits cognitive and behavioral abilities, thereby affecting one’s ability to engage in meaningful work, self-care, leisure, and social activities. In the skilled nursing facility, these residents often exhibit inappropriate behaviors including “severe mood swings, verbal or physical aggression, combativeness, repetition of words and wandering” (Alzheimer’s Association, 2007). Staff often become frustrated and respond by raising their voices, trying to reason with the residents, requesting medication changes from the doctor, and physically restraining the residents; however, many of these responses only stand to exacerbate the symptoms of dementia.