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Int Psychogeriatr. 2019 Jun 26:1-12. doi: 10.1017/S1041610219000589. [Epub ahead of print]

Association between environmental stimulation and apathy in nursing home residents with dementia.

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College of Nursing, Pennsylvania State University, University Park, PA,USA.
College of Nursing, University of Iowa,Iowa City, IA,USA.
School of Nursing, University of Kansas,Kansas City, KS,USA.
Department of Gerontology, Simon Fraser University,Vancouver, British Columbia,Canada.


ABSTRACTObjectives:Prior research and theories established the link between care environments and apathy. Yet, empirical evidence on how environmental stimulation impacts apathy is lacking. This study examined the association between environmental stimulation and apathy in nursing home residents with dementia.


This repeated-measure study analyzed 104 video observations of staff caregiver-resident interactions.


12 nursing homes.


63 unique staff caregiver-resident dyads that involved 42 caregivers and 44 residents with moderate to severe dementia.


Second-by-second behavioral coding using Noldus Observer software was conducted to assess apathy and environmental stimulation, using the Person-Environment Apathy Rating scale. The environment subscale includes six items: stimulation clarity, stimulation strength, stimulation specificity, interaction involvement, physical accessibility, and environmental feedback. The apathy subscale includes six items: facial expression, eye contact, physical engagement, purposeful activity, verbal tone, and verbal expression. Multilevel linear models were used for analysis.


Results showed that apathy was not associated with the overall quality of environmental stimulation but was significantly associated with stimulation specificity (coefficient = -2.23, p = 0.049). However, the association was not significant after controlling for resident characteristics (p = 0.082). In addition, higher levels of environmental feedback were associated with lower apathy levels (coefficient = -2.14, p = 0.001). The association remained significant after controlling for resident characteristics (coefficient = -1.65, p = 0.014).


Findings reveal that when environmental stimulation is individually tailored and prompts engagement, residents are less apathetic. This study highlights the effect of environmental stimulation on apathy. Future research should explore interventions that modify environmental stimulation to reduce apathy and improve dementia care.


Alzheimer’s disease; behavioral and psychological symptoms of dementia (BPSD); long-term care; problem behaviors


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