Use of multisensory stimulation in institutionalized older adults with moderate or severe dementia

Machado, Bento Miguel; Castro, Carla da Silva Santana

doi:10.1590/1980-5764-DN-2021-0022

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Dementia & Neuropsychologia

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Original Article • Dement. neuropsychol. 16 (2) • Apr-Jun 2022 • https://doi.org/10.1590/1980-5764-DN-2021-0022 copy

Use of multisensory stimulation in institutionalized older adults with moderate or severe dementia

USO DA ESTIMULAÇÃO MULTISSENSORIAL EM IDOSOS INSTITUCIONALIZADOS COM DEMÊNCIA MODERADA OU GRAVE

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT.

The Multisensory Stimulation Program can help manage behavioral and psychological symptoms of dementia.

Objective:

The objective of this study was to investigate the effects of the Multisensory Stimulation Program on behavioral, mood, and biomedical parameters of older adults with moderate and severe dementia compared to a control group not submitted to this program.

Methods:

This study is an interventional, parallel, open-label, quasi-experimental clinical trial, which is quantitative and qualitative in nature and is also an exploratory type. The sample was divided for convenience into intervention group (IG) and control group (GC) that did not participate in the Multisensory Stimulation Program. Data analysis included descriptive statistics, nonparametric tests (two-tailed alpha value of 0.1 was applied), and thematic content analysis.

Results:

The sample consisted of 20 older adults (IG=10 and GC=10), with a mean age of 83 years, an average of 3 years of education, and moderate or severe dementia. Reduction in intervention group behavioral changes (p=0.059) and numerical improvement in intervention group cognition were observed. A decrease in heart rate (p<0.05) and diastolic blood pressure (p<0.05) was observed before and immediately after the session in the intervention group. The caregivers described engaged behavior in intervention group, while they reported apathetic behavior in control group. Session records described verbal and nonverbal communication and sustained attention for more than 3 min regarding the sensory resource explored.

Conclusions:

The Multisensory Stimulation Program could be a new look at the health care practices performed in the nursing homes that consider the older adults’ sensory preferences and may help with dementia behavior management.

Keywords:
Dementia; Complementary Therapies; Behavior; Health of Institutionalized Elderly

Categories		IG	CG	Total
Categories		n=10	n=10	n=20
Age	Mean	84.4	80.7	82.7
Age	SD	6.8	8.5	7.7
Sex	Female	10	7	17
Sex	Male	0	3	3
Education level	0 years	4	1	5
	1-4 years	5	8	13
	Over 8 years	1	1	2
Time in the institution	Up to 1 year	3	2	5
	1-4 years	4	4	8
	Over 4 years	3	4	7
Types of dementia	NS	6	8	14
	Mixed	3	1	4
	Alzheimer	1	1	2
Stages of dementia	Moderate	4	2	6
Stages of dementia	Severe	6	8	14
Comorbidities	Depression	3	0	3
	Parkinson	1	1	2
	Prior stroke	1	1	2
	COPD	1	2	3
Dependence on BADL	0-1	1	3	4
	2-4	7	3	10
	5-6	2	4	6

		IG		CG
Behavior (NPI)	Score: (0-144 points)	Pre	Post	Pre	Post
	Mean	43.3	28	32.5	29.8
	Median	41.5	18.5	28	25.5
	Standard deviation	25.9	31	20.1	17.9
	Pre and post by groups*	p=0.059		p=0.918
	Between groups*	p=0.161
Mood (CSDD)	Score: (0-38 points)	Pre	Post	Pre	Post
	Mean	11.1	9.4	10.3	8
	Median	9.5	9.5	11	7
	Standard deviation	7.1	6.1	4.2	4
	Pre and post by groups	p=0.406		p=0.235
	Between groups	p=0.97
Cognition (MMSE test)	Score: (0-30 points)	Pre	Post	Pre	Post
	Mean	11.1	12.2	6.8	5.8
	Median	11.5	14	7.5	4.5
	Standard deviation	3.2	3.8	4.6	5.4
	Pre and post by groups	p=0.153		p=0.441
	Between groups	p=0.109

Biomedical parameters		Pre	Post
SBP (mmHg)	Mean	12.85	12.65
	Median	13	12.55
	Standard deviation	2.05	1.79
	Pre and post	p=0.177
DBP (mmHg)	Mean	7.62	7.18
	Median	7	6.8
	Standard deviation	2.04	1.84
	Pre and post	p<0.01
HR (bpm)	Mean	80.76	78.72
	Median	80	80
	Standard deviation	12.48	11.99
	Pre and post	p<0.01*

Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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[1] Correspondence: Bento Miguel Machado; Email: bento.machado@usp.br.

Behavior	Thematic units	Observed actions
	Decrease in apathy	Greater resources exploration, whether requested by a therapist or on their initiative.
	Relaxation response	Naps, slow movements, and relaxed posture.
	Excitatory response	Body and dance movements, smiles, and waves of laughter.
Mood	Euthymic mood	Feeling of well-being.
	Adverse effects on mood.	They were not observed.
	Labile or irritable mood	It was rare, softened with the course of the session.
	Promotion of volition	As the participants knew the environment, they requested more materials of their preferences. Resource exploration and decision-making initiatives without therapist’s interference.
Interaction	Verbal communication	Verbalization of preferences and interests.
	Nonverbal communication	Reactions and facial expression, body language, eye contact, and sensory exploration of objects.
	Stuffed animals	When entering the room, visual search for the object, change in the timbre of the voice and serene facial expression, and presence of hugs and caresses to the thing.
	Ambient music	Recognition of sounds, closing of the eyes, singing pieces of music, dance movements, clapping and foot tapping along with the musical rhythm, and storytelling of life.
Cognition	Cognitive abilities	Stimulation of long-term memory and sensory perception. Sustained attention for more than 3 min in specific resources of the participant’s interest, especially tactile and visual ones, which were usually offered in the foreground.