Computer engagement reduces antipsychotic usage, improves quality of life

It’s widely recognized that engagement programs can make a positive difference for people with dementia. The lack of meaningful focus can lead to boredom, depression and frustration, and even to behavioral expressions that result in administration of antipsychotic drugs that may otherwise not be needed. But across long-term care, providers face the dilemma of how time-stretched staff can offer the amount of personalized activities required to have impact.

Now, a recent research project involving dementia residents of the Hoy Nursing Care Center, located at our non-profit life plan community Westminster-Canterbury on Chesapeake Bay in Virginia Beach, Va. has shown the promising potential of bedside technology to provide one-on-one engagement. The initiative improved quality of life and produced a clinically significant reduction in antipsychotic drug doses. The latter is especially compelling as their negative side effects are better understood, leading to the Center for Medicare & Medicaid Services’ mandate that nursing homes reduce the use of these pharmaceuticals by 30 percent.

The research project was conducted in partnership with Eastern Virginia Medical School and Virginia Wesleyan College. It was funded by Westminster-Canterbury Foundation board member Sue Birdsong and her husband George, who donated $228,000 to fund the project. We named it The Birdsong Initiative in their honor.  

The Birdsong Initiative took place over a 24-week period between June and December of 2015. During this time, 31 Hoy Center residents whose dementia makes it difficult to participate in social activities used specially-designed computers to regularly access enriching content customized to their personal interests and cognitive ability. Meantime, another 31 residents with dementia took part in routine personalized therapeutic recreation programs that were non-computerized. Twelve weeks into the initiative, the two groups switched roles, so that by the time the study concluded, all of the participants had engaged with the computer. Its touchscreen technology has been devised to be easy for seniors and offers Skype, social networking and a spectrum of content. It offers over 3,000 experiences through applications that involved wellness in spiritual, physical, social, emotional and intellectual capacities.  It was developed by Colorado-based It’s Never 2 Late (iN2L).

At The Birdsong Initiative’s conclusion, researchers found a clinically significant reduction of antipsychotic drug doses among four in 10, or 40 percent, of the people in the intervention group across the 24-week period who had been taking the medications throughout the study. In addition the study was proven to significantly improve the quality of life of the participants when engaged with the computer by:

●     Reducing the frequency of behavioral episodes for 54 percent of participants, ceasing entirely for 30 percent of those.  They became less intense for 75 percent of the participants.

●     Decreasing depression symptoms by 41 percent as indicated in the Geriatric Depression Scale.

●     Increasing cognitive / brain power scores for nearly 23.5 percent, with an average increase of 4.86 points on a 30-point scale of the Montreal Cognitive Assessment.

●     Lowering stress indicators for 47 percent of caregiving staff according to the Perceived Stress Scale.

Just as important as these findings about the impact on residents is what we learned about how to best incorporate technology into daily care. We needed to firmly establish it as part of our caregivers’ routines, something that we achieved through upfront education and discussions involving therapeutic recreation and nursing staff.  In particular, the following steps were essential:

• Familiarizing the staff with the technology so they were comfortable with it.
• Training residents, families, staff and volunteers on the computers.
• Providing staff with manuals on the “what-if” scenarios for use of the computers.
• Ensuring a consistent, reliable Internet connection.

The Alzheimer’s Association projects that the number of Americans with dementia will rise by 40 percent in the coming decade. This anticipated increase is commonly described as an “epidemic.” It rightly has the senior care community across the globe concerned about how society will be able to provide the high quality services and meaningful life that each memory-impaired person deserves.

Traditional thinking has been that ever more human interaction will be needed to offer the engagement programs that are so essential for excellent care. However, The Birdsong Initiative shows technology can help fulfill this requirement. Human connection will always be important for those with dementia, as it is for everyone, but not all engagement activities, or even the lion’s share, need to be led by people. 

In fact, technology allows residents to take control of these programs and use them as often and for as long as they wish. Meantime, staff can focus more of their time on care duties that require a hands-on personal touch. Westminster-Canterbury President and CEO Ben Unkle says he believes “One day, families will expect this kind of bedside technology to be a standard feature in dementia care.”

The 2015 research through The Birdsong Initiative was just the first of what will ultimately be three projects. The second and third, expected to take place within about a year, will examine technology’s impact on the quality of life for Westminster-Canterbury’s independent and assisted living residents.  We look forward to publicly sharing the results of those studies too, as part of Westminster-Canterbury’s dedication to the collective goal of transforming the aging experience. With people 65 or above expected to comprise 20 percent of America’s population by 2030, compared to about 14 percent in 2012, finding new approaches is vital and we are excited to be part of that effort.

Amy Chidester, MS, LNH., is director of The Birdsong Initiative and special projects for Westminster-Canterbury on Chesapeake Bay, a non-profit life plan community in Virginia Beach, Va. 

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