Observed Emotion Rating Scale Research Articles

Assessing the Acceptability and Potential Emotional Well-Being Outcomes of a Digital, Intergenerational Music Program for Older Adults Living with Dementia

ABSTRACT Cases of Alzheimer’s disease and Alzheimer’s disease-related dementia are expected to triple in the next thirty years. Consequences of the disease include a decline in emotional well-being, which was exacerbated by the isolation imposed by the COVID-19 pandemic. This study examined the acceptability and potential effects of a digital, intergenerational music intervention delivered by adolescent musicians on the affect and emotions of older adults living with dementia. The study was exploratory, followed a pre- post- test design, and had 14 participants. Affect was examined using the Positive and Negative Affect Schedule and emotion was observed using the Observed Emotion Rating Scale. Additionally, this study assessed acceptability by asking participants about their willingness to continue and gathering qualitative feedback in focus groups. Results showed an increase in positive affect and positive trends in duration of sustained pleasure and alertness, as well as a high percentage of willingness to continue and positive feedback. Digital, intergenerational music is a promising intervention to continue examining in future studies.

The effects of personally preferred music on mood and behaviour in individuals with dementia: An exploratory pilot study

Music has been shown to benefit individuals with dementia. There are, however, limited studies examining how assisted living staff members use preferred music for dementia patients. This controlled pilot study aimed to determine: 1) whether preferred music is effective in improving mood and behaviour and 2) whether a person-centred approach to music-based interventions is feasible for individuals with dementia. The 20 participants (mean age (SD) = 81 (8)) listened to a preferred song or control song in random order over 6 weeks with a five-day wash out period between the exposures. Neurobehavioral Rating Scale (NRS) and Observed Emotion Rating Scale (OERS) were used to measure participants’ emotions and behaviour changes. Blood pressure and heart rate were collected to understand physiological responses to music. NRS was used to measure the behavioural changes in response to a listening intervention comprised of both preferred music and control music over the course of 14 sessions administered over six weeks. We observed no changes in NRS symptoms post-intervention. OERS scores and vital signs did not differ significantly between the preferred music and the control song despite trends. Participants/staff/family expressed the importance of preferred songs to evoke specific memories and increase well-being. Thematic analysis using sentiment components indicated a predominance of positive sentiment in the meaningful music category and a minor occurrence of negative sentiment in the control music.

EMOTIONAL RESPONSES OF ADULTS LIVING WITH DEMENTIA TO AN INTERGENERATIONAL MUSIC INTERVENTION

Abstract Music interventions have shown promise to support emotional well-being in older adults living with dementia. Bolstering emotional well-being could improve the quality of life of the millions of older adults living with dementia. We implemented an intergenerational music intervention at Dementia360, a community program that serves older adults living with dementia. The music intervention featured adolescent musicians performing the preferred music of the older participants and engaging them in interactive musical activities via Zoom. 14 older adult participants attended an average of four sessions, 54 minutes each, of the intervention. We described their positive affect and pleasure as they engaged in the intervention. We compared participants’ scores on the Positive and Negative Affect Schedule (PANAS) pre- and post-intervention. We also assessed the participants’ emotions by rating them using the Observed Emotion Rating Scale (OERS). On average, the participants’ scores increased three points on the Positive Affect subscale of the PANAS. Our computed cohen’s d effect size was 0.5, a moderate effect size that correlates with self-report measures of feeling “a little more” to “much more” positive affect. On the OERS Pleasure subscale, we found that pleasure was shown for more than one minute of the ten-minute sample in over 87% of the observations. Intergenerational music interventions employ the safe, pleasurable, and scalable modality of music. These findings suggest that participation in such an intervention has the potential to influence positive affect and pleasure, critical supports for the emotional well-being of older adults living with dementia.

Emotional Labour and its Outcomes Among Nurses at a Tertiary Hospital – A Proposed Model

Emotional labour is a crucial aspect of nursing, involving the management of emotions to meet organizational and societal expectations. Limited research exists on understanding emotional labour and the outcomes of emotional labour among nurses, which can range from positive outcomes like job satisfaction and patient satisfaction to negative outcomes like emotional exhaustion and job exhaustion. This study aims to assess emotional labour and its outcomes among nurses. It contributes to a better understanding of its impact and informs interventions to enhance nurses' well-being and job performance. To assess the emotional labour performance among nurses, to assess the emotional conflict among nurses, to determine the positive and negative outcomes of the emotional labour performance among nurses and to propose a model for emotional labour performance in healthcare a descriptive study was conducted among a sample population of approximately 270 nurses from Sri Ramachandra Hospital G-Block (Chennai, Tamil Nadu, India). Subjects were recruited from the nursing department, and after obtaining their consent, they were given a questionnaire to collect demographic data and evaluate emotional labour and its outcomes. Additionally, direct observations using the Observed Emotion Rating Scale were conducted. The study utilized systematic random sampling. The sample size was determined to be 270 nurses, with a final response rate of 87%. The reliability of the questionnaire was assessed using Cronbach's alpha, which yielded satisfactory results. The primary data collected was analyzed using Microsoft Excel and SPSS software with appropriate statistical tools. The findings are emotional labour performance; deep acting was more prominent than surface acting among nurses. Emotional harmony was found to be higher than emotional dissonance and emotional excess in emotional labour conflicts. Positive outcomes of emotional labour were more prevalent than negative outcomes. Deep Acting and surface acting significantly affected positive and negative outcomes. This study highlights the significance of emotional labour in nursing and its impact on nurses' well-being and job performance. By prioritizing nurses' emotional well-being and implementing interventions to mitigate the negative outcomes of emotional labour, healthcare organizations can create a supportive work environment that enhances both nurse satisfaction and patient care.

Connecting Today: Feasibility and acceptability of a remote visiting program for people living with dementia in long-term care homes.

Social isolation and loneliness affect the quality of life of people living with dementia, yet few interventions have been developed for this population. The purpose of this study was to assess the feasibility and acceptability of 'Connecting Today', a remote visiting program designed for use with care home residents living with dementia. This was a feasibility study to assess whether Connecting Today can be delivered in care homes, and was acceptable to family and friends and people living with dementia. We used a single-group before/after design and included residents ≥ 65 years old with a dementia diagnosis from two care homes in Alberta, Canada. Connecting Today involved up to 60min per week of facilitated remote visits for 6weeks. To understand feasibility, we assessed rates and reasons for non-enrollment, withdrawal and missing data. We assessed acceptability with the Observed Emotion Rating Scale (residents) and a Treatment Perception and Preferences Questionnaire (family and friends). Data were analyzed with descriptive statistics. Of 122 eligible residents, 19.7% (n = 24) enrolled (mean age = 87.9 years, 70.8% females). Three residents withdrew from the study before the first week of calls. Among 21 remaining residents, 62%-90% completed at least 1 call each week. All the calls were completed by videoconference, rather than by phone. Alertness and pleasure were observed for ≥92% of residents during calls. The 24 contacts rated Connecting Today as logical, effective and low risk. Facilitated, remote visits are feasible and highly acceptable to residents and their family and friend contacts. Connecting Today shows promise to address social isolation and loneliness for people living with moderate to severe dementia because it can promote positive engagement in meaningful interactions with their family and friends while they are living in a care home. Future studies will test effectiveness of Connecting Today in a large sample.

The Utilization of Nature‐Based Virtual Reality (VR) Practice for the Wellbeing of Older Adults with Dementia

AbstractBackgroundDespite abundant evidence supporting the health benefits of nature‐based programs and activities, older adults with dementia experience practical limitations to their participation in these nature‐based activities. Utilizing a Nature‐based Virtual Reality (VR) Program can be a good alternative to outdoor nature activities by minimizing physical and structural barriers that older adults with dementia often encounter. Thus, the purpose of this study was to assess the changes in the emotional health and health‐related quality of life among older adults with dementia after the Nature‐based VR program participation.MethodThis study used a single‐group pre‐post design. Six participants were contacted for recruitment from a memory care unit and five were enrolled. Inclusion criteria were as follows: (a) clinically diagnosed with dementia, (b) have no prior VR experience, (c) basic communication skills, and (d) age between 65‐90 years old. Five participants engaged in the Nature‐based VR program which was offered twice a week for 20‐30 mins during the 5 weeks for a total of 10 sessions. Emotional health and health‐related quality of life were assessed at baseline and immediate‐post intervention. Emotional health was assessed using the Observed Emotion Rating Scale. Caregiver‐observer assessed the levels of five emotions by marking one of six pre‐defined time intervals. Health‐related quality of life was assessed using Alzheimer’s disease‐related quality of life. These items constitute four domains, physical health, mental health, social, and financial domains, and are measured with a 4‐point scale. The summed score of the scale ranges from 13 to 52, and a higher score indicates a higher quality of life for the care recipients.ResultFrom paired t‐test analysis, increased emotional wellbeing was detected. Specifically, the mean score of alertness increased from 4.50 points in pre‐intervention to 5.00 in post‐intervention while anger decreased from 1.67 to 1.00 and anxiety scores decreased from 1.50 to 1.00 points, respectively. Health‐related quality of life improved after the intervention. The QOL‐AD mean scores changed from 38.8 to 41.2 and median value was shifted from 38.5 to 44.0.ConclusionThis study provides preliminary evidence that the Nature‐based VR program may improve emotional health and health‐related quality of life.

DMapp: a developing promising approach to monitor symptoms progression and stimulate memory in Italian people with cognitive impairments.

Based on recent researches on the use of natural language processing techniques for very early detection of cognitive decline and the benefits of cognitive stimulation for people with cognitive impairments, the Dementia Monitoring application (DMapp) is developed inside the Memento project. The aims of this work are: (1) to present DMapp; (2) to report the results of two preliminary studies on DMapp; (3) to describe the clinical and experimental potentiality of DMapp. Italian people with the diagnosis of mild cognitive impairment due to Alzheimer's disease or dementia due to Alzheimer's Disease with a Mini-Mental-State-Examination between 24 and 28 (inclusive) were involved in the DMapp development prototype during the Lab Trial (4 subjects) and Filed Trial (5 subjects) of the Memento project. Qualitative and quantitative data were collected to evaluate participants' opinions, the DMapp ability to perform the automatic analysis of the speech and participants' visible emotional state effective. Ad hoc interviews, the Observed Emotion Rating Scale and performance metrics to solve different tasks were used. The relation between cognitive measures (global cognitive measures) and linguistic indexes values was considered using Euclidean distances between the participants. Linguistic indexes were calculated and seemed to classify the participants' performance as expected from cognitive measures. The DMapp was appreciated by people with cognitive impairment. Positive emotions were present. DMapp seems an interesting approach to monitor dementia symptoms progression and stimulate memory. Possible developments and open questions are discussed.

Photo-elicited conversations about meetings with a therapy dog as a tool for communication in dementia care: An observational study.

It is well-known that people with dementia living in residential care facilities spend most of their time not engaged in meaningful activities. Being involved in activities can improve their quality of life. Animal-assisted therapy is an activity that can evoke engagement and joy. Another way to create engagement and promote communication between people with dementia and caregivers is to use photos. In this observational study, the researchers combined animal-assisted therapy and photobooks in order to explore whether photos of people with dementia who were engaged in animal-assisted therapy could be used as a tool for communication in dementia care. Ten persons (4 men and 6 women; aged 72-92) with dementia were video recorded during photo-elicited conversations with a dog handler/assistant nurse. The recordings were conducted in two residential care facilities in Sweden during 2017-2018. Each participant was video recorded 2-4 times. The recordings were analysed using The Observed Emotion Rating Scale and The Observational Measurement of Engagement-OME Modified. In addition, the video recordings were interpreted from a hermeneutic perspective. The findings showed that the most frequently observed effects were pleasure and general alertness, and the participants were observed to be attentive most of the time. The most common attitude during the conversations was 'somewhat positive'. The hermeneutic interpretations were grouped into four themes: Conveys a structure for the conversation with an inherent beginning and ending; An opportunity to recognise oneself and recall a sense of belonging; Awakens emotions and creates fellowship and Entails confirmation and revitalises their identity. Photobooks can be used by caregivers as a tool for meaningful and joyful communication with people with dementia, even those with severe dementia.

Participatory design and evaluation of virtual reality physical rehabilitation for people living with dementia

Emerging research confirms the need for technologically enhanced solutions to support non-pharmacological interventions which can improve the quality of life, the mental and physical health of demented people. Several types of research examined if virtual reality can be an effective solution. This paper aims to present the cyclic process of prototyping, testing, analysing, and refining the VR system in real-world clinical settings. Seven people with moderate to severe dementia were recruited. The experiment required the patients to attend three virtual reality iterations of rapid prototyping with user testing. All three iterations involved training activities with upper body movements similar to their usual physical training. A mixed-methods design measured affect and emotional behaviour using the Observed Emotion Rating Scale and the Visual Analog Scale. Content analysis was conducted following observations and interviews. During each iteration of rapid prototyping with user testing, quantitative measurements of performance, independence and time were recorded. Eye tracking and movement information were captured by the system. Finally, a simplified version of the presence and usability scales evaluated the system. The results of this study provide further evidence that virtual reality can play a significant role in the improvement of people’s with dementia physical training and emotional health when is appropriately designed. The results present the vital factors which should be incorporated in a virtual reality system which are: 1) a simple interactions modality; 2) visible visual targets and continuous feedback; 3) personalized virtual environments; 4) personalized range of movements.

Caregiver Singing Intervention: Do Expressions of Emotion and Resistance Differ Between Persons with Vascular Dementia and Those with Alzheimer’s Disease? A Pilot Study

Background: The music intervention caregiver singing (CS) has been shown to be beneficial in facilitating care of persons with dementia in residential care, but no studies have focused on possible differences with respect to dementia diagnosis, which might be important due to possible different symptoms. Aim: To describe expressed emotions and resistiveness to care among persons with vascular dementia or Alzheimer’s disease during CS. Method: The study is a pilot intervention of CS which contains pre- and intervention measurements. Participants were persons with vascular dementia or Alzheimer’s disease. Measures were the Resistiveness to Care Scale and the Observed Emotion Rating Scale. Care situations without and with CS were compared of persons with vascular dementia and Alzheimer’s disease. The data are described with descriptive statistics. Results: During CS, positive emotion increased for persons with Alzheimer’s disease and vascular disease, with far longer intervals observed among persons with Alzheimer’s disease. Conclusion: CS may have positive influences regardless of diagnosis, but when targeting different emotional expressions, diagnosis may play an important role. However, larger studies need to be undertaken to confirm the results of this pilot study.

Do Daytime Activity, Mood at Bedtime and Unit Tumult Predict Nighttime Sleep Quality of Long-Term Care Residents?

Sleep quality declines in old age and is particularly poor for long-term care (LTC) residents with dementia. Compromised sleep quality is associated with severe cognitive and neuropsychiatric symptoms, agitation, aggressiveness, and poor quality of life. Based on the premise that stressors can have a cumulative effect on people with dementia throughout the day that contributes to negative consequences later in the day, we examined if daytime activity, mood, and unit tumult were associated with sleep quality. A convenience sample of 53 LTC residents with dementia participated in this correlational study. Objective sleep quality and activity variables were measured using Actigraphy, and mood was measured by the Observed Emotion Rating Scale. Unit tumult was defined as events in the residents living area that are deviations from the typical day (i.e., census changes, being cared for by a certified nursing assistant from a temporary staffing agency, and lower than usual staffing level). Comorbid illness and level of dementia were control variables. Half of the sample had a sleep efficiency that was less than .85 and were awake for more than 90 minutes at night. Comorbid illness, negative mood at bedtime, and daytime activity level accounted for 26.1% of the variance in total sleep minutes. Census changes and the use of temporary agency staff were associated with poor total sleep time and sleep efficiency. Findings suggest that daytime activity, mood at bedtime, and unit tumult should be considered when designing and testing interventions to improve sleep quality among LTC residents with dementia.

Caregiver Singing Intervention: do Emotions and Resistance differ between Vascular dementia and Alzheimer’s?

Persons with dementia in residential care commonly express resistance of aggressiveness. Caregivers Singing (CS) - when caregivers sing for or together with persons with dementia during caring, has shown to reduce these expressions and increase communication and cooperation. Previous studies of CS have included both persons with Alzheimer’s disease (AD) and persons with Vascular dementia (VD), but no studies have been done focusing on possible differences regarding these diagnoses. As disabilities and symptoms differ between these diagnoses, the emotions and expressions, such as resistance may differ regarding response to CS. This polit study aims to describe emotions and resistiveness to care among persons with vascular or Alzheimer’s disease. Participants were five persons with AD and five persons with VD living at two different nursing homes. Video observations (VIO) occurred with them and their caregivers during morning care situations four times without CS and four times with CS. In all, 80 VIOs were rated using the Observed Emotion Rating Scale and the Resistiveness to Care Scale. These were then analyzed with descriptive statistics. Results revealed that for both persons with AD and VD, the positive emotion pleasure were never observed without CS while with CS it increased for both groups. In contrast to the positive emotion effect of CS, the negative emotions and resistiveness decreased more for persons with VD than for persons with AD. For persons with VD, the number of observations without anger increased, while observation without anger or anxiety/fear for persons with AD remind the same.

Improving Behavioral and Psychological Symptoms and Cognitive Status of Participants With Dementia Through the Use of Therapeutic Interactive Pets

In the US, one in three older adults die with Alzheimer’s disease or a related dementia. Currently, there is no cure for the rapidly growing burden, but there are pharmacological treatments to manage the symptoms, which lead to numerous side effects. We tested the effectiveness of a non-pharmacological therapeutic interactive pet (TIP) in improving mood/behavior and cognition among 12 persons with mild-moderate dementia attending an adult day center (ADC) over 12 visits. Mood/behavioral symptoms were assessed using the Alzheimer’s Disease and Related Dementias Mood Scale (AD-RD), Observed Emotion Rating Scale (OERS), and the Cornell Scale for Depression in Dementia (CSDD). Cognition was assessed via Mini Mental State Examination (MMSE). Paired-sample t-tests, Pearson’s correlation, repeated measures t-test, and a post-intervention qualitative inquiry were used to examine the significance of TIP. As a result, all mood scores improved over time, with two showing significance: OERS (M = 73.7/SD = 9.6); conditions t(11) = −19.18, p<.001, and CSDD (M = 8.8/SD = 7.2); conditions t(11) = 4.12, p =.002. Over half (0.67%) scored higher on the MMSE post-test than the pretest: M = 10.7(SD = 5.5) and M = 12.2(SD = 7.1), respectively. Participants stroked and spoke often to their pets. Several family members reported participants sleeping with their pet following the program’s conclusion. TIP proved to be a safe alternative method to improving mood/behavior in persons with dementia attending an ADC. MMSE scores also improved, although confounding factors such as inter-rater reliability and a potential endorphin effect may have impacted scores. Improving Behavioral and Psychological Symptoms and Cognitive Status of Participants with Dementia through the Use of Therapeutic Interactive Pets

Preliminary Research: Virtual Reality in Residential Aged Care to Reduce Apathy and Improve Mood

This study determines the feasibility of using virtual reality (VR) for residents with and without dementia in the residential aged care (RAC) environment (also referred to as nursing homes or long-term care). A mixed-methods study was conducted with 13 residents of varying cognitive capacity in a residential aged care facility (RACF) operated by a not-for-profit organization in Brisbane, Australia. Residents participated in one facilitated VR session, either as a group or individual session. Residents' mood and apathy were measured by the Observed Emotion Rating Scale (OERS) and the Person-Environment Apathy Rating Scale. Residents also completed a structured interview to provide their feedback after the VR session. In addition, four RACF staff members were interviewed about their experience of using the VR in residents and the ongoing feasibility. The experience of VR administered by a researcher and leisure and lifestyle coordinator as a leisure activity, significantly reduced apathy in residents (Z = -2.818, p = 0.005) through observations of increased facial expression, eye contact, physical engagement, verbal tone, and expression. The study did not find a VR impact on the OERS measures; no significant increase in fear/anxiety was observed. Reminiscence was clearly observed in six of the nine residents with the ability to verbally communicate. VR was found not to be helpful in residents during episodes of acute neuropsychiatric and behavioral symptoms. This study suggested feasibility of using fully immersive VR delivered by mobile phone technologies. It provides preliminary data for a controlled trial presently underway examining the effectiveness of VR as a group activity in RAC to improve mood states, behavioral symptoms, and pro re nata psychotropic medication use. Residents indicated that VR was enjoyable with low levels of physical and emotional discomfort reported or observed.

Bringing the outside in: The feasibility of virtual reality with people with dementia in an inpatient psychiatric care setting.

Emerging research supports virtual reality use with people with dementia in the community, but is limited to this area, warranting further investigation in different care settings. The feasibility of virtual reality within an inpatient psychiatric care setting was therefore explored.Research design and methods: Eight people with dementia and 16 caregivers were recruited in January and February 2018 from a UK hospital specialising in progressive neurological conditions. A mixed methods design measured affect and behaviour using the Observed Emotion Rating Scale, Overt Aggression Scale-Modified for Neurorehabilitation and St Andrew's Sexual Behaviour Assessment. Thematic analysis was conducted following semi-structured interviews. Caregivers who worked at the hospital supported people with dementia throughout the process and were interviewed for their views on Head Mounted Display-Virtual Reality (HMD-VR) use with people with dementia. HMD-VR was tried and accepted by people with dementia. Participants viewed HMD-VR positively as a 'change in environment' and would use it again. People with dementia experienced more pleasure during and after HMD-VR compared to before exposure, as well as increased alertness after. Three core themes emerged: 'Virtual Reality Experiences', 'Impact of Virtual Reality' and 'Experiences within the Virtual Environment'. Caregivers discussed preconceptions about virtual reality use and how these changed.Discussion and implications: This is the first study to explore the feasibility of HMD-VR with people with mild to moderately severe dementia in hospital and found that overall HMD-VR is viable. Findings evidence the clinical feasibility of HMD-VR implementation in this environment and inform future research.

Effects of creative expression therapy on Chinese elderly patients with dementia: an exploratory randomized controlled trial.

Purpose: This study aimed to evaluate the effect of creative expression (CE) therapy on cognition, communication, emotion, and quality-of-life in people with dementia.Methods: One hundred individuals were included in this study, of whom 91 completed the study (mean age=84.33). The participants were randomly assigned to an intervention group (n=43) and a control group (n=48), and received the CE program or standard cognitive (SC) training twice a week for 6 weeks, respectively. Both groups were submitted to extensive neuropsychological tests, as follows – Mini-Mental State Examination (MMSE), Quality of Life-Alzheimer’s Disease (QOL-AD), Cornell Scale for Depression in Dementia (CSDD), Functional Assessment of Communication Skills (FACS) at baseline, 1-, and 4 -weeks post-intervention, and the Observed Emotion Rating Scale (OERS) was measured during the intervention period at weeks 3 and 6.Results: The participants demonstrated significant improvements in cognitive function, quality-of-life, depression degree, communication ability, and emotion status (P<0.05) at post-intervention, which were maintained at 1-month follow-up.Conclusion: This study provides preliminary evidence that CE therapy developed in the study benefits elderly Chinese with dementia. The findings indicated that non-pharmacological intervention programs – CE therapy – can be applied in the management of neuropsychiatric symptoms of dementia.

Can a Virtual Nature Experience Reduce Anxiety and Agitation in People With Dementia?

ABSTRACTResearch has found that viewing nature reduces stress and improves mood, but few studies have focused on the potential of viewing nature to reduce negative emotions associated with dementia. Using a counterbalanced design, 14 memory care residents were alternately exposed to a virtual nature experience (treatment) and a generational movie (control). Before and after each exposure, heart rate was measured, and emotions were assessed with the Observed Emotion Rating Scale and the Agitated Behavior Scale. Results are that heart rate declined significantly compared with the generational movie, and anxiety and pleasure showed greater improvements during the nature intervention, although the difference was not significant.

Effectiveness of a Virtual Reality Forest on People With Dementia: A Mixed Methods Pilot Study.

To measure and describe the effectiveness of a Virtual Reality Forest (VRF) on engagement, apathy, and mood states of people with dementia, and explore the experiences of staff, people with dementia and their families. A mixed-methods study conducted between February and May 2016. Ten residents with dementia, 10 family members, and 9 care staff were recruited from 2 residential aged care facilities, operated by one care provider, located in Victoria, Australia. Residents participated in one facilitated VRF session. Residents' mood, apathy, and engagement were measured by the Observed Emotion Rating Scale, Person-Environment Apathy Rating Scale, and Types of Engagement. All participants were interviewed. Overall, the VRF was perceived by residents, family members, and staff to have a positive effect. During the VRF experience, residents experienced more pleasure (p = .008) and a greater level of alertness (p < .001). They also experienced a greater level of fear/anxiety during the forest experience than the comparative normative sample (p = .016). This initial, small-scale study represents the first to introduce the VRF activity and describe the impact on people with dementia. The VRF was perceived to have a positive effect on people with dementia, although, compared to the normative sample, a greater level of fear/anxiety during the VRF was experienced. This study suggests virtual reality may have the potential to improve quality of life, and the outcomes can be used to inform the development of future Virtual Reality activities for people with dementia.

The effect of cognitive-motor dual task training with the biorescue force platform on cognition, balance and dual task performance in institutionalized older adults: a randomized controlled trial.

[Purpose] This study investigates whether cognition, balance and dual task performance in institutionalized older adults improves by a virtual reality dual task training. [Subjects and Methods] Randomized controlled trial; Twenty institutionalized older adults with mild cognitive impairment (13 female, 7 male; average age, 87.2 ± 5.96 years) were randomized to the intervention (i.e. Virtual reality dual-task training using the BioRescue) or control group (no additional training). The intervention group took part in a 6-week training program while the elderly in the control group maintained their daily activities. Balance was measured with the Instrumented Timed Up-and-Go Test with and without a cognitive task. The Observed Emotion Rating Scale and Intrinsic Motivation Inventory were administered to evaluate the emotions and motivation regarding the exergaming program. [Results] The intervention group improved significantly on the total Timed Up-and-Go duration and the turn-to-sit duration during single-task walking in comparison to the control group who received no additional training. Participants found the virtual reality dual task training pleasant and useful for their concentration, memory and balance. Pleasure and alertness were the two emotions which were mostly seen during the intervention. [Conclusion] The BioRescue is a pleasant and interesting treatment method, well suited for institutionalized older adults in need of lifelong physical therapy.

Creative Music Therapy in an Acute Care Setting for Older Patients with Delirium and Dementia

Background/Aims: The acute hospital ward can be unfamiliar and stressful for older patients with impaired cognition, rendering them prone to agitation and resistive to care. Extant literature shows that music therapy can enhance engagement and mood, thereby ameliorating agitated behaviours. This pilot study evaluates the impact of a creative music therapy (CMT) programme on mood and engagement in older patients with delirium and/or dementia (PtDD) in an acute care setting. We hypothesize that CMT improves engagement and pleasure in these patients. Methods: Twenty-five PtDD (age 86.5 ± 5.7 years, MMSE 6/30 ± 5.4) were observed for 90 min (30 min before, 30 min during, and 30 min after music therapy) on 3 consecutive days: day 1 (control condition without music) and days 2 and 3 (with CMT). Music interventions included music improvisation such as spontaneous music making and playing familiar songs of patient's choice. The main outcome measures were mood and engagement assessed with the Menorah Park Engagement Scale (MPES) and Observed Emotion Rating Scale (OERS). Results: Wilcoxon signed-rank test showed a statistically significant positive change in constructive and passive engagement (Z = 3.383, p = 0.01) in MPES and pleasure and general alertness (Z = 3.188,p = 0.01) in OERS during CMT. The average pleasure ratings of days 2 and 3 were higher than those of day 1 (Z = 2.466, p = 0.014). Negative engagement (Z = 2.582, p = 0.01) and affect (Z = 2.004, p = 0.045) were both lower during CMT compared to no music. Conclusion: These results suggest that CMT holds much promise to improve mood and engagement of PtDD in an acute hospital setting. CMT can also be scheduled into the patients' daily routines or incorporated into other areas of care to increase patient compliance and cooperation.