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The influence of everyday acoustic environments on the challenging behavior in dementia: A participatory observation study in nursing homes

December 2023
The Center For Health Design


Why does this study matter?
Unmet needs frequently manifest as challenging behavior for individuals with dementia. This kind of behavior places undue burden on caregivers, reduces quality of living, and increases the risk of institutionalization. Everyday acoustic environments may be leveraged as an alternative to pharmacological interventions. Research is needed to understand the behavioral reactions of persons with dementia to their sonic environments in order to develop soundscape interventions.


How was the study done?
The researchers conducted this exploratory acoustic environment study as a part of a larger soundscape intervention study to address behavioral and psychological symptoms of dementia. Nine nursing homes in the Dutch-speaking part of Belgium were selected based on convenience sampling. The nursing homes had similar acoustic environments and layouts with private rooms, a dining room, a sitting area and a cafeteria. Thirty-five persons with dementia (PwD) who had been living with their diagnosis for one year or longer were selected in consultation with the head of each NH based on purposeful, homogeneous group characteristics’ sampling. Data was collected in two waves by two occupational therapists on wards during all activities (e.g., eating, washing, resting, watching TV as well as when there was no activity). Consistent with the participant observation method, researchers blended in with the care team in attire as well as the provision of care services during three consecutive eight-hour shifts over a 24-hour period resulting in 420 hours’ worth of observations. No audio or video recordings were used. Researchers discretely recorded time-stamped “field note” observations. For each behavioral incident, the situation and the environment were described, followed by a description of the behavior, the incident, the interaction and how the participants responded.            


What do we learn from the study?
Data analysis followed a phenomenological–hermeneutical method in three phases: naïve understanding, structural analysis, and comprehensive understanding. Field note transcripts that documented daily activities in typical sonic environmental conditions were divided into event-based ‘meaning units’ using the ABC model to identify the Antecedent–Behavior–Consequence. Researchers independently coded and thematically condensed 125 meaning units. Condensed meaning units were cross-validated for consensus and examined for similarities and differences to form subthemes and themes. Condensed subthemes and themes were compared to identify sound and behavior relational patterns. The interaction between a person’s capacity to interpret sounds and their capacity to react to them resulted in four acoustic patient personas.


Can we say the results are definitive?
This study was conducted during COVID-19 pandemic conditions which impacted participation and small sample sizes always present challenges for generalizability… but in this case I believe that the homogeneity of the nursing home sites as well as the sample population also pose limitations for generalizing to other places and populations. Furthermore, participants did not undergo audiological testing prior to data collection which may have impacted their sensitivity to sound events.         


What’s the takeaway?
There is both the opportunity to identify the most supportive sonic environments as well as develop supportive soundscapes based on the four personas that emerged from this study.

Summary of:
Talebzadeh, A., Decoutere, I., Vander Mynsbrugge, T., Botteldooren, D., Devos, P., Aletta, F., Van de Velde, D., & De Vriendt, P. (2023). The influence of everyday acoustic environments on the challenging behavior in dementia: A participatory observation study in nursing homes. International Journal of Environmental Research and Public Health, Issue 5, Volume 20, Pages 4191.  https://doi.org/10.3390/ijerph20054191




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