Pool Activity Level Research Articles

Assessing the pool activity level (PAL) checklist for use with people with hearing and vision loss

BackgroundThe PAL is a career-completed assessment that indexes cognitive functional ability to inform individualised support. As hearing and vision loss are prevalent, we assessed the PAL for potential bias with hearing or vision impairment. MethodsWe collected PAL responses for 333 adults aged over 60 years in the UK, France, Canada, Greece and Cyprus. All participants had normal cognition based on self-reported status and normal range scores on a cognitive screening test. Using a Kruskal-Wallis test, we compared PAL item response distributions for people with assessed hearing or vision loss compared to those with normal sensory function. ResultsThere were no differences in response distributions between hearing or vision impaired groups versus those with normal sensory function on any PAL item. ConclusionThe PAL reliably indexes cognitive functional ability and may be used to inform support tailored to individual cognitive level amongst older adults with prevalent hearing and vision impairments.

The feasibility of increasing physical activity in care home residents: Active Residents in Care Homes (ARCH) programme

ObjectivesMaintaining physical activity for older residents in care homes maximises their physical and mental health and wellbeing, independence, dignity and quality of life. Unfortunately, most residents do not participate in regular physical activity. Active Residents in Care Homes, ARCH, was designed to increase physical activity by facilitating whole-system change in a care home. We evaluated whether ARCH can be delivered, its effects on resident’s physical activity, wellbeing and costs. DesignFeasibility study. SettingThree residential care homes. ParticipantsCare home residents and staff. InterventionOccupational and physiotherapists implemented ARCH over 4 months with an 8-month follow-up. Main outcome measuresAssessment of Physical Activity, Pool Activity Level, EQ5D-5L, Dementia Care Mapping, cost of implementing ARCH, health and social care utilisation. ResultsAfter implementing ARCH, residents displayed more positive behaviours, better mood and engagement and higher physical activity levels, but these improvements were not sustained at 8-month follow-up. The cost (2016 prices) of implementing ARCH was £61,037, which equates to £1,650/resident. Healthcare utilisation was £295/resident (SD320) in the 4 months prior to ARCH, £308/resident (SD406) during the 4-month implementation and £676/resident (SD438) in the 8-month follow-up. ConclusionsThe ARCH programme can be delivered, it may have some short-term benefits and is affordable. Rather than have unrealistic increases in the health and longevity of older care home residents, ARCH may slow the decline in physical, mental and emotional well-being usually seen in older people in care homes, return some dignity and improve their quality of life in their last months or years.

Special Issue: Dimensions of dementia

Living well with dementia is often perceived as challenging for individuals and those who support them. Joy Watson, herself living with dementia, defines it as finding peace, contentment and having fun, but says this is hard to achieve when your ‘brain doesn’t work’ (Watson, 2016). Such comments are a challenge to occupational therapists, who have the knowledge and skills to enable individuals to participate in meaningful activity but may be constrained by practice or confidence limitations. The national and international articles in this special issue on ‘dimensions of dementia’ illustrate the potential for occupational therapists to support those living with dementia to achieve well-being. Dudzinski (2016) demonstrates in a single case study how engagement in meaningful activity resulted in an increased sense of well-being. Using the Pool Activity Level (PAL) Instrument she describes how a graded intervention can be structured to the individual’s level of ability and also recognises the importance of involving staff and other care givers in utilising this approach. Mattock and McIntyre (2016) explore how occupations might contribute to the transition from dementia care giving before and after the death of a partner. The importance of sustaining occupations and roles to maintain identity are highlighted as a focus for occupational therapists. This is an exciting emerging role for the profession both at a national and international level. In contrast, Griffiths and Bunrayong (2016) identify the challenges of care givers in Thailand when supporting people with dementia. The activity performance and difficulties experienced by care givers led the authors to develop an educational package for carers to support individuals to engage in activities of daily living. In a scoping survey in the United Kingdom, Swinson et al. (2016) investigate the role of community occupational therapists. Their review provides not only a national picture of practice but also contributes to the development of a community occupational therapy intervention as part of the NIHR-funded research programme, Valuing Active Life in Dementia (VALID) (https://www.ucl.ac.uk/valid and see also Swinson et al. (2016)). The final four papers focus on interventions. Raber et al.’s (2016) phenomenological study of occupational therapy practitioners’ use of the Remotivation Process highlights the need for therapists to be knowledgeable and confident in methods for motivating individuals with dementia to participate in therapy programmes. This is particularly relevant to the article by Unsworth and Chan (2016), who demonstrate the importance of using a reliable and valid tool to determine fitness to drive among drivers with Alzheimer’s disease. Having such a tool reinforces the importance of identifying retained skills rather than relying on diagnosis. Depending only on a diagnosis can be demotivating and become a self-fulfilling prophesy.

Active Residents in Care Homes (ARCH): study protocol to investigate the implementation and outcomes of a whole-systems activity programme in residential care homes for older people

ObjectivesTo evaluate the effectiveness, acceptability and costs of Active Residents in Care Homes, ARCH – a programme aiming to increase opportunities for activity in older care home residents. DesignFeasibility study. SettingResidential care homes for older people. Participants10–15 residents, staff and family members will be recruited in each of the three participating care homes. InterventionARCH is a 12-month ‘whole-systems’ programme implemented by occupational therapists and physiotherapists. They will conduct a comprehensive assessment of each care home, considering the physical environment, working practices and organisation structure as well as residents’ individual needs, and recommend ways to address barriers and increase residents’ activity levels. The therapists will then work with staff to improve understanding of the issues, instigate training, environmental, organisational and working practice changes as necessary. Main outcome measuresResidents’ activity levels, health and quality of life will be tested using several measures to see which are practicable and appropriate for this population in this context. This includes: Assessment of Physical Activity in Frail Older People; Pool Activity Level Checklist; Dementia Care Mapping observations; and EQ-5D-5L. Residents will be assessed prior to programme implementation then 4- and 12-months post-implementation. Semi-structured interviews will explore the experiences of residents, staff, family members and therapists. ConclusionsProviding evidence of effectiveness and acceptability of ARCH, and documenting factors that impede/facilitate implementation will help us identify ways to enhance the care and quality of life of older people in residential care, and our understanding of how to implement them.Trial registration: ISRCTN24000891.

Using simple technology to prompt multistep tasks in the home for people with dementia: An exploratory study comparing prompting formats.

ObjectivesTo investigate the relative effectiveness of different prompts for people with dementia during multistep tasks in the home, to inform prompting technology design.MethodsNine pairs of participants (one with dementia and a partner or relative) participated at home. The participants with mild to moderate dementia (5M/4F, aged 73–86 years) functioned at the Planned or Exploratory levels of the Pool Activity Level instrument. A touchscreen computer displayed different prompts during two set tasks: “card-and-envelope” and “CD player.” The trials were scored to establish the relative effectiveness of the prompts. Individual tasks were also explored.ResultsText and audio prompts were each more effective than video or picture prompts for a card-and-envelope task, but this was not seen in a CD player task. The differences may be related to the type of actions within the tasks; the card-and-envelope actions were easier to convey verbally; the CD player actions lent themselves to visual prompts.ConclusionsDesigners of technology-based prompts for people with dementia should consider that the effectiveness of different prompts is likely to be task dependent. Familiar, unambiguous language can increase the success of tailored prompts. There are significant practical challenges associated with choosing and deconstructing everyday tasks at home.

Using the Pool Activity Level instrument to support meaningful activity for a person with dementia: A case study

Statement of context Activity participation is beneficial for the wellbeing of people with dementia; however, care staff and caregivers experience difficulties with facilitating activity for this client group. Critical reflection on practice This practice analysis outlines the therapy process conducted by an occupational therapist using the Pool Activity Level instrument, to support meaningful activity for a person with dementia, in an acute inpatient environment. Implications for practice The Pool Activity Level instrument enables people with dementia to engage in meaningful activity. Occupational therapists are well positioned to integrate this tool within daily care, to enable all staff and caregivers to engage alongside a person with dementia in activity at an appropriate level.

Does a Structured Gardening Programme Improve Well-Being in Young-Onset Dementia? A Preliminary Study

Introduction: Young-onset dementia affects about 1 in 1500 people aged under 65 years in the United Kingdom (UK). It is associated with loss of employment, independence and an increase in psychological distress. This project set out to identify the benefits of a 2 hours per week structured activity programme of gardening for people with young-onset dementia. Method: A mixed methods (qualitative and quantitative) study of therapeutic gardening for people with young-onset dementia, measuring outcomes for both participants with young-onset dementia and their carers, was used. Twelve participants were recruited from a county-wide mental health service for older adults, based on onset of dementia being before the age of 65 years (range 43–65 years). Of these, two participants dropped out and one died during the project. Measures included the Mini Mental State Examination (MMSE), Bradford Well-Being Profile, Large Allen Cognitive Level Screen (LACLS) and Pool Activity Level (PAL). Findings: Over a 1-year period the carers of the people with young-onset dementia found that the project had given participants a renewed sense of purpose and increased well-being, despite cognitive functioning continuing to decline during this period. Conclusion: This study suggests that a meaningful guided activity programme can maintain or improve well-being in the presence of cognitive deterioration.

Book Review: The Pool Activity Level (PAL) Instrument for Occupational Profiling

Book Review: The Pool Activity Level (PAL) Instrument for Occupational Profiling

Book review: The Pool Activity Level (PAL) Instrument for Occupational Profiling: A Practical Resource for Carers of People with Cognitive Impairment, 3rd Edition, by Jackie Pool. London: Jessica Kingsley Publishers, 173 pp. ISBN: 978-1-84310-594-7

Book review: The Pool Activity Level (PAL) Instrument for Occupational Profiling: A Practical Resource for Carers of People with Cognitive Impairment, 3rd Edition, by Jackie Pool. London: Jessica Kingsley Publishers, 173 pp. ISBN: 978-1-84310-594-7

Exploring the multi-sensory environment as a leisure resource for people with complex neurological disabilities

The problems experienced by people with neurological disabilities create barriers to participation in leisure activities. Particular common features include cognitive deficits (attention, executive functioning, language and memory), functional difficulties (in activities of daily living), psychomotor impairment (dyspraxia and poor co-ordination), and behavioural difficulties (aggression, agitation, and wandering). The Multi-sensory environment (MSE) has the potential to accommodate some of these problems experienced by people with neurological disabilities and, as such, is a valuable leisure resource. Multi-sensory activity can address individual sensory needs, such as offering a stronger stimulus if initial attempts are unnoticed, and be offered alongside familiar activities and routines to enhance sensory awareness. If the complexity of the activity, individual needs, and MSE demands are matched, engagement in this activity may be achieved. The Pool Activity Level Occupational Profiling Tool can provide a protocol from which MSE activity may be facilitated. By using this tool the MSE fits well within the World Health Organisation International Classification of functioning, Disability and Health by facilitating participation and reducing environmental barriers.

Assessing the validity and reliability of the Pool Activity Level (PAL) Checklist for use with older people with dementia

Activity is key to maintaining physical and mental health and well-being. However, as dementia affects the ability to engage in activity, care-givers can find it difficult to provide appropriate activities. The Pool Activity Level (PAL) Checklist guides the selection of appropriate, personally meaningful activities. The aim of this study was to assess the reliability and validity of the PAL Checklist when used with older people with dementia. A postal questionnaire sent to activity providers assessed content validity. Validity and reliability were measured in a sample of 60 older people with dementia. The questionnaire response rate was 83% (102/122). Most respondents felt no important items were missing. Seven of the nine activities were ranked as ‘very important’ or ‘essential’ by at least 77% of the sample, indicating very good content validity. Correlation with measures of cognition, severity of dementia and activity performance demonstrated strong concurrent validity. Inter-item correlation indicated strong construct validity. Cronbach's alpha coefficient measured internal consistency as excellent (0.95). All items achieved acceptable test-retest reliability, and the majority demonstrated acceptable inter-rater reliability. We conclude that the PAL Checklist demonstrates adequate validity and reliability when used with older people with dementia and appears a useful tool for a variety of care settings.

The pool activity level (PAL) instrument: a practical resource for carers of people with dementia. Jackie Pool. Jessica Kingsley Publishers, 1999. Price £19.95. 62 pp.

The pool activity level (PAL) instrument: a practical resource for carers of people with dementia. Jackie Pool. Jessica Kingsley Publishers, 1999. Price £19.95. 62 pp.

Promoting independence in dementia care

Involving carers in providing activity-based care and improving independence and functional activity in people with dementia are areas of interest to many nursing and residential care facilities. A project trialled at Ashminster House, Ashford, involving the use of the Pool Activity Level instrument, aimed to do just that.

The pool activity level (pal) instrument: a practical resource for carers of people with dementia

The pool activity level (pal) instrument: a practical resource for carers of people with dementia