Familiar Physical Activity to Familiar Music: The Effects on Apathy, Agitation, Eating Ability, and

150 Pages·2017·1.96 MB·English

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Open Access Dissertations
2-2010
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Janet Ruth Moore
University of Massachusetts Amherst
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Moore, Janet Ruth, "Familiar Physical Activity to Familiar Music: The Effects on Apathy, Agitation, Eating
Ability, and Dietary Intake in Institutionalized Older Adults with Dementia" (2010). Open Access
Dissertations. 174.
https://doi.org/10.7275/1264917 https://scholarworks.umass.edu/open_access_dissertations/174
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FAMILIAR PHYSICAL ACTIVITY TO FAMILIAR MUSIC: THE EFFECTS ON
APATHY, AGITATION, EATING ABILITY, AND DIETARY INTAKE IN
INSTITUTIONALIZED OLDER ADULTS WITH DEMENTIA

A Dissertation Presented

by

JANET R. MOORE

Submitted to the Graduate School of the
University of Massachusetts Amherst in partial fulfillment
of the requirements for the degree of

DOCTOR OF PHILOSOPHY

February 2010

School of Nursing
© Copyright by Janet R Moore 2010
All Rights Reserved
FAMILIAR PHYSICAL ACTIVITY TO FAMILIAR MUSIC: THE EFFECTS ON
APATHY, AGITATION, EATING ABILITY, AND DIETARY INTAKE IN
INSTITUTIONALIZED OLDER ADULTS WITH DEMENTIA

A Dissertation Presented

by

JANET R. MOORE

Approved as to the style and content by:

____________________________________________
Dorothy Ann Gilbert, Chair

____________________________________________
Cynthia S. Jacelon, Member

____________________________________________
Rebecca A. Ready, Member

____________________________________________
Jean Swinney, Dean
Nursing Department
DEDICATION

To my parents, who saw me start and who were always proud of me, but who were not
able to see me finish and to my husband Bill who was always positive and supportive
throughout the process.
ACKNOWLEDGEMENTS
Many people have been involved in this study and it would not have been possible
without their assistance. First I’d like to thank Jessica Mongeau who made the music CD
and Mike Dialessi for making multiple copies of the music. I’d like to thank the staff and
administration of Keystone Woods Assisted Living (Joan Roche, Deanna Lawrence,
Becky) for allowing me to conduct the pilot study and the staff and administration of
Jewish Geriatric Authority (Linda Donoghue, Lois White, Donna Campbell, Maria
DeRosa, Deb Aberdale, and Gina Francis-Wilson) and the Atrium (Susan Brooks,
Heather) who opened their facilities for the study and assisted in contacting families and
mailing the consent form.
I owe much gratitude to the nursing students, class of 2009 from Elms College,
who were trained to conduct the intervention, collect data, and take digital photos and
who were conscientious and devoted to the research as well as to Eva Goldwater who
provided statistical consultation. Financial support was partially provided by a grant from
Beta Zeta Chapter of Sigma Theta Tau.
I’d like to thank my committee: Becky Ready who provided insights into implicit
memory and apathy, Cynthia Jacelon for her knowledge of the Functional Independence
Measure (FIM™) and for her guidance with the nursing home and the dining room
environment, and lastly, and most especially, to Dorothy Gilbert, who has been my
mentor for years, who holds me to a high standard, and who has been available and
forever encouraging and supportive.

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ABSTRACT
FAMILIAR PHYSICAL ACTIVITY TO FAMILIAR MUSIC: THE EFFECTS ON
APATHY, AGITATION, EATING ABILITY, AND DIETARY INTAKE IN
INSTITUTIONALIZED OLDER ADULTS WITH DEMENTIA
FEBRUARY 2010
JANET R. MOORE, B.S., AMERICAN INTERNATIONAL COLLEGE
M.S., UNIVERSITY OF MASSACHUSETTS AMHERST
Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST
Directed by: Professor Emeritus Dorothy Ann Gilbert

Background: Many older adults with dementia residing in nursing homes or
assisted living facilities exhibit behavioral disturbances such as agitation and apathy. In
addition they lose their ability to feed themselves and often suffer serious malnutrition as
their dietary intake decreases. Music has been linked to decreased agitation in this
population and physical activity to music linked to a slower decline in eating ability.
Purpose: The purpose of this study was to examine whether a familiar physical
activity to familiar music would reduce apathy and agitation and increase eating ability
and dietary intake among institutionalized older adults with dementia.
Method: Eighty four older residents with early to late-stage dementia were
randomly assigned to a usual activity or to a group that received a 25-minute intervention
(seated chair exercises and beach ball toss to music of the 1920’s to 1950’s) offered 30
minutes before the noon meal twice a week for three weeks. Prior to the intervention,
research assistants observed and recorded participants’ apathy using the Frontal Systems
Behavior Scale and agitation using the Cohen-Mansfield Agitation Inventory. Trained
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research assistants (RAs) conducted the intervention, and then escorted participants in
both groups to their noon meals. A second group of RAs, blinded to group, observed
apathy and agitation as residents began their meals. At the end of the meals, RAs
recorded eating ability using the Functional Independence Measure and the percentage of
dietary intake for all participants. Digital photos of trays, pre- and post-meal, were also
used to document the percentage.
Results: Participants, whose mean age was 85.92 and whose Mini Mental Status
Exam scores ranged from 0 to 24, resided in two sites: a nursing home with assisted
living and a separate assisted living facility. Repeated measures ANOVA revealed
significant differences between groups for apathy (p=.01) and dietary intake (p=.01).
There was no significant difference in agitation or eating ability.
Discussion: Participation in the intervention was associated with more positive
outcomes for apathy and dietary intake. There is evidence that a familiar physical activity
to familiar music is an effective approach for institutionalized older adults with dementia.

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TABLE OF CONTENTS
Page
ACKNOWLEDGMENTS...................................................................................................v
ABSTRACT.......................................................................................................................vi
LIST OF TABLES.............................................................................................................xi
LIST OF FIGURES.........................................................................................................xiii
CHAPTER
1. INTRODUCTION.......................................................................................1
Dementia, Alzheimer’s Disease, and Memory............................................2

Dementia and Alzheimer’s Disease.................................................2
Memory............................................................................................4
Apathy..............................................................................................6
Agitation..........................................................................................8
Eating Ability and Dietary Intake..................................................10

Research Questions....................................................................................13
Hypotheses.................................................................................................14
Conceptual and Operational Definitions....................................................16

2. REVIEW OF THE LITERATURE...........................................................18
Current Interventions.................................................................................18

Physical Activity............................................................................18
Music..............................................................................................23
Physical Activity to Music.............................................................25
Timing of Intervention...................................................................27

Conceptual Framework..............................................................................29

3. METHODS................................................................................................32
Design........................................................................................................32
Sample........................................................................................................33

Eligibility criteria...........................................................................33
Sample size....................................................................................34
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Instruments.................................................................................................36

Modified Apathy Subscale of the Frontal Systems Behavior
Scale...................................................................................36
Cohen-Mansfield Agitation Inventory...........................................37
Participation Form.........................................................................39
Functional Independence Measure. (FIM™).................................39
Percentage of Dietary Intake..........................................................40
Mini-Mental Status Exam..............................................................41
Demographic Data Form................................................................41

Procedure...................................................................................................42

Human Subjects Protection............................................................42
Training..........................................................................................44
Random Assignment......................................................................45
Setting............................................................................................45
Protocol..........................................................................................46
Data Analysis.................................................................................53

4. RESULTS..................................................................................................56
Description of the Data..............................................................................56

Characteristics of the Sample.........................................................56
Description of the Main Study Variables.......................................56

Baseline Apathy.................................................................56
Baseline Agitation..............................................................57
Baseline Eating Ability and Dietary Intake.......................58
Participation in the Intervention.........................................59

Characteristics of the Sample by Type of Institution.....................60
Characteristics of the Sample by Group........................................63

Analysis of the Data...................................................................................69

Hypothesis 1...................................................................................69
Hypothesis 2...................................................................................70
Hypothesis 3...................................................................................72
Hypothesis 4...................................................................................73
Hypothesis 5...................................................................................74
Hypothesis 6...................................................................................76
Hypothesis 7...................................................................................78
Hypothesis 8...................................................................................81
Hypothesis 9...................................................................................83
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