Investigating the Impact of Multi-sensory Environments on Behavior During Assisted Bathing for Veterans With Dementia

Dementia is a debilitating and increasingly pervasive condition impacting cognitive decline
across the globe. Behavioral and psychological symptoms of dementia (BPSD) impact quality of
life (QoL) for people with dementia and are key interventional targets. Pharmacological
interventions for BPSD can be costly, ineffective or life-threatening prompting law makers
and the Federal Drug Administration (FDA) to support non-pharmacological interventions like
multi-sensory environments (MSE) as the preferred first line of treatment. Despite this
support for non-pharmacological interventions like MSE, there has been inconsistency in
evaluative methodologies and application of MSE interventions, impeding the widespread use of
MSE in dementia-care settings. Therefore, there is a critical need for empirical
investigation of well-defined MSE in non-pharmacological dementia-care. The purpose of this
study is to investigate the impact of MSE on aggression/agitation during assisted bathing,
showering and/or tub bathing for veterans with dementia. The VA has implemented MSE therapy
for veterans with dementia since 2010 and the impact of MSE on aggression remains to be
evaluated. In 2013, due to favorable initial results, the VA installed both fixed-room and
mobile cart MSE applications in 53 VA community living centers (CLCs) across the US,
including one in Lake City, Florida which received mobile MSE carts and waterproof MSE
equipment for use during assisted bathing, showering, and/or tub bathing. Most acts of
aggression/agitation for people with dementia occur during assisted bathing and there is a
strong need for evidence-based research of non-pharmacological interventions to reduce
problem behaviors, decrease healthcare provider burden and improve quality of life (QoL) for
people with dementia. The overall goal of this study is to investigate the effectiveness of
MSE in the reduction of agitation/aggression during assisted bathing, showering, and/or tub
bathing for veterans with dementia.

Veterans being bathed and the healthcare providers providing the bath will be consented in
this study.

Inclusion Criteria Veteran with dementia: A veteran with dementia is eligible to
participate if they meet the following inclusion criteria:

1. Medical diagnosis of advanced stage dementia (MMSE rating 0-20)

2. Residing within the VA CLC in Lake City, Florida for at least three months

3. Consistently demonstrate high levels of aggression/agitation during assisted bathing,
showering, and/or tub bathing.

4. Must have legally authorized representative (LAR) on record

Exclusion criteria Veteran with dementia: A veteran with dementia is ineligible to
participate if they meet one of the following exclusion criteria:

1. Predominant diagnosis of psychosis including schizophrenia

2. Patients whom care staff believe would not benefit from MSE.

Inclusion Criteria VA healthcare provider: VA healthcare provider is eligible to
participate if they meet the following inclusion criteria:

1. Provides assisted bathing, showering, and/or tub bathing to veterans with dementia at
the VA CLC in Lake City, Florida

2. Has worked at the VA CLC in Lake City, Florida for at least three months

3. Speaks English

Exclusion criteria VA healthcare provider: VA healthcare provider is ineligible to
participate if they meet one of the following exclusion criteria:

1. Has any limitations that will prevent him/her from providing assisted bathing,
showering, and/or tub bathing within a MSE

2. Has any condition which could, in the opinion of the investigator, place the
participating veteran at risk or interfere with data integrity