A Cross-Over Study to Investigate the Use of Natural Landscape Photographs with Particular Content and Pattern to Reduce Agitation in Nursing Home Residents with Alzheimer’s Dementia
Thesis (Ph.D.)--University of Rochester. School of Nursing. Dept. of Health Practice Research, 2011.
Two questions were examined in a long-term care setting with persons having dementia (N = 22): (1) whether agitation would be reduced after viewing natural landscape photographs with specific pattern (fractal dimension) and content as compared to viewing photographs of facility interior/exterior (cross-over design), and (2) whether there would be less agitation with increased viewing (dose) of the natural landscape images (nonexperimental design). Agitation was measured with the Brief Agitation Rating Scale. Participants (mean age = 85) were residents of a single facility, had an Alzheimer’s diagnosis, and were predominantly Caucasian females. Results were inconclusive. Treatment effect was not statistically significant, but the confidence interval suggested clinical importance. A significant dose effect was found with one formula for change in agitation (as dose increased, agitation decreased; p = .05), but using an alternate formula, no dose effect was seen. Rationale for each approach is included. Qualitative data supported staff, family, and resident preference for the natural landscape photographs versus the alternate selections. Logistic regressions showed females and those with mild-to-moderate agitation at baseline were more likely to show improvement (agitation after viewing nature < agitation after viewing man-made elements). Controlling for group (period effect), gender odds ratio = 14.41, p = .07, 95% CI [0.83, 251.30]. Level of agitation odds ratio = 4.67 p = .09, 95% CI [0.77, 28.47]. Gender difference in response may have related to image selection for the intervention: Recent research indicates males/females may prefer slightly different content. Implications and suggestions for future research are discussed.
A Cross-Over Study to Investigate the Use of Natural Landscape Photographs with Particular Content and Pattern to Reduce Agitation in Nursing Home Residents with Alzheimer’s Dementia
