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Jo and Kim: The Effect of a Dementia Preventive Intervention based on Motivational Interviewing among the Elderly over 75 Years of Age in Nursing Homes
Original Article

J Korean Acad Community Health Nurs 2017;28(3):260-270.

Published online: 12 September 2017

DOI: https://doi.org/10.12799/jkachn.2017.28.3.260

The Effect of a Dementia Preventive Intervention based on Motivational Interviewing among the Elderly over 75 Years of Age in Nursing Homes

Hyun Mi Jo1, Suk-Sun Kim2

1Department of Nursing Science, Vision College of Jeonju, Jeonju · Graduate School, Ewha Womans Univesrity, Seoul, Korea

2College of Nursing, Ewha Womans University, Seoul, Korea

Corresponding author: Kim, Suk-Sun College of Nursing, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea. Tel: +82-2-3277-2885, Fax: +82-2-3277-2850, E-mail: suksunkim@ewha.ac.kr

Received 17 March 2017       Revised 11 July 2017       Accepted 15 July 2017

Copyright © 2017 Korean Academy of Community Health Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to examine the effects of the motivational interviewing (MI) dementia preventive intervention on dementia preventive behaviors, depression and cognitive function among elderly over 75 years of age in nursing homes.

Methods

A nonequivalent control group pretest-posttest design was used. A total of 57 participants were divided into three groups; 18 in the MI dementia preventive intervention (Group A), 20 in the dementia preventive program (Group B) and 19 in the control group. Dementia preventive behaviors, depression, and cognitive function were assessed at pre, post, and 1 month after the intervention. Data were analyzed using descriptive statistics, t-test, ANOVA and repeated measure ANOVA.

Results

The results reported that there were significant differences in dementia preventive behaviors and depression among Group A, B, and C. Also, there were significant differences in dementia preventive behaviors and cognitive function during time periods. There was a significant interaction between groups and times in relation to depression. Results suggested that the effects of MI dementia preventive program was persistent after 1 month following the intervention.

Conclusion

Further research needs to develop dementia preventive programs considering physical and mental traits of the elderly in late years staying at nursing homes.

Keywords: Nursing home, Elderly, Motivational interviewing, Dementia

References

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Table 1.
Motivational Interviewing Sinario
Stage Motivational interviewing Detail skills
1st week Individual Motivational Interview (40 min) : one time
Provide feedback (MMSE-K) Researcher How are you? You participated a simple dementia test last week, and we have results now. Let us see the results together (Observe clients' facial expression).
Participant (reaction)
Researcher According to the results, your score was lower than normal value. You might have some memory problem (30 full mark, 24~30 normal, 20~23 suspicious dementia). In this case, you have to participate in a dementia preventive program to prevent severe dementia. How do you think about dementia? ․Open-ended questions
Participant (reaction)
Researcher
You know about dementia quite well. May I give you more information about dementia?
One in every 10 has dementia, dementia is getting worse therefore you can not perform your role even if you have performed your role very well. For example, taking care of bowel movement and urination, eating foods, communicating with other people and changing clothes. And especially decreasing memories, where you can forget a few minutes of the events (observe clients' facial expressions)
Did you see any dementia cases? Would you like to tell me about the cases?
 ․Affirmations ․Open-ended questions
Participant (reaction)
Ambivalence inquiry Researcher How do you think about your life in nursing homes? ․Open-ended questions
Participant (reaction)
Researcher (give encouragement, give positive feed back, affirmation) Can you tell me about your life from morning till before you sleep. ․Open-ended questions
Participant (reaction)
Researcher What kind of activities do you do for health? ․Open-ended questions
Participant (reaction)
Researcher (give encouragement, positive feed back, affirmation) To prevent dementia, there are activities such as hand exercise, walk, remembering dates and what day it is, communicating with others, read news paper, play Hatoo and etc. What kind of activities do you do? ․Open-ended questions
Participant (reaction)
Researcher After activities, what do you like the most? ․Open-ended questions
Participant (reaction)
Researcher When do you not like to do these activities? ․Open-ended questions
Participant (reaction)
Change talk induce Researcher How important is the healthy life to you? ․Open-ended questions
Participant (reaction)
Researcher If you think healthy life with free from dementia give 10 points and if it is not important then give 0 point. - (importance scale) ․Close-ended questions
Participant (reaction)
Researcher If you would like to be free from dementia life, do you like to participate in a dementia preventive program? Would you give 10 points or 0 point, would you tell us your plan to participate in a dementia preventive program? - (confidence scale) ․Close-ended questions ․Open-ended questions
What is your grade? Did you selected 6 not 3 or 4? What is the reason to select 6. (If you select 3) You did not select 0, you selected 3! (affirmation :A) ․Affirmations
Promise participation Researcher
You realized exercise and other activities are good to your health.
WHO mentioned that 150 m per week exercise (20m per day) is good to you.
You live in nursing home but would you like to do hand exercise, light exercise, hand clapping during a dementia preventive program period. Would you like to do any exercise continuously?
If you would like to participate dementia preventive program, would you sign on the consent form?
What do you think about checking with you in a motivational interview per week? Do you have any question? Thank you for your participation in this session. I hope that you will have happy and free from dementia life.
․Lose-ended questions
․Open-ended questions
․Affirmations
Participant (reaction)
2~8 week Group Motivational Interview (10 min) : 7 times
Repeat Researcher What did you like about participating in the dementia preventive program? ․Open-ended questions
Participant (reaction)
Researcher (Encourage, compliment, affirmations!) What kind of activities did you enjoy? ․Open-ended questions
Participant (reaction)
Researcher (Encourage, compliment, affirmations!) What are you currently doing to prevent dementia in the nursing homes? ․Open-ended questions
Table 2.
Dementia Preventive Program Elderly over 75 Years of Age
Stage Structure Content Min Expected effect
► Period : 1st week Start ․ Introduction of the program 5 - Inform the start
► Individual motivational interview (One time, 40 mins) : Experimental group A only ․ Date, days, hours, formation of the relationship - Improvement of desired of relationship
► Program (3 times per week, 50 mins): Experimental group A & B Education ․ 1st period : Definition, symptoms, stages of dementia 20 - Knowledge about dementia prevention
․ 2nd period : Detection of dementia and maintain the treatment - Motivation
․ 3rd period : Dementia prevention 3.3.3 physical activities, effect of cognitive activities and kinds of cognitive activities
Physical activities ․ Activities of dementia prevention 20 - Improve physical function
- Improve cognitive function
End of the program ․ Healthy clapping with sing a song 5 - Increase motivation
․ Share the experience (distribute the flyer about dementia preventive material) - Improvement relational desire
► Period : 2~8 week Start ․ Introduction of the program 5 - Inform the start
► Group motivational interview (Once per week, 10 mins) : Experimental group A only ․ Date, days, hours, formation of the relationship - Improvement of desired of relationship
► Program (3 times per week, 50 mins): Experimental group A & B Physical activities ․ Activities of dementia prevention 20 - Improve physical function
- Improve cognitive function
Cognitive activity ＜Wednesday＞ 20 - Improve desire of competence
․ Association of words (five questions), finger number counting - Improve memory
․ Add the numbers, Reverse speaking - Stimulate cognitive function
＜Saturday＞
․ Memory improvement exercise (picture cards) - Improve concentration
- Decrease depression
․ Remember the pictures (Hwa Tu pictures) - Develop their interest
＜Sunday＞ - Ability of intelligency, improve memory
․ Chil kyo play
․ Jik jo play
End of the program ․ Healthy clapping with sing a song 5 - Increase motivation
․ Share the experience (good point, different point) - Promote desire of relationship
․ Self activities record (performed or not)
Table 3.
Homogeneity Test of General Characteristics and Outcome Variables (N=57)
Characteristics Categories Total (N=57) Exp. A (n=18) Exp. B (n=20) Cont. (n=19) x2 or F (p)
n (%) or M±SD n (%) or M±SD n (%) or M±SD n (%) or M±SD
Age (year) 85.3±5.56 85.9±5.91 85.1±5.67 85.0±5.35 0.15(.857)
Gender Male 13 (22.8) 6 (33.3) 5 (25.0) 2 (10.5) 2.83 (.278†)
Female 44 (77.2) 12 (66.7) 15 (75.0) 17 (89.5)
Education Uneducated 21 (36.8) 7 (38.9) 6 (30.0) 8 (42.1) 1.93(.748†)
Elementary school 19 (33.3) 5 (27.8) 9 (45.0) 5 (26.3)
≥Middle school 17 (29.8) 6 (33.3) 5 (25.0) 6 (31.6)
Spouse Yes 5 (8.8) 1 (5.6) 2 (10.0) 2 (10.5) 0.53 (1.000)
No 52 (91,2) 17 (94.4) 18 (90.0) 17 (89.5)
Decision to enter nursing homes Self 11 (19.3) 4 (22.2) 3 (15.0) 4 (21.1) 3.61(.467)
A family except for son 15 (26.3) 5 (27.8) 3 (15.0) 7 (36.8)
Son 31 (54.4) 9 (50.0) 14 (70.0) 8 (42.1)
Dementia preventive behaviors 7.65±3.73 8.83±4.45 6.60±2.96 7.63±3.58 1.74(.185)
Depression 7.26±4.08 7.22±3.47 7.15±4.78 7.42±4.02 0.02(.978)
Cognition function 22.74±2.50 22.44±2.15 22.95±2.89 22.79±2.49 0.19(.824)

† Fisher‘s exact test; Exp.=experimental group; Cont.=control group.

Table 4.
Effects of MI Dementia Preventive Intervention (N=57)
Outcome variables Groups Pretest Posttest t(p)
M±SD M±SD
Dementia preventive behaviors Exp. A 8.83±4.45 10.67±3.14 -2.95 (.009)
Exp. B 6.60±2.96 9.10±3.52 -3.04 (.007)
Cont. 7.63±3.58 8.42±3.95 -0.79 (.442)
Depression Exp. A 7.22±3.47 5.78±2.78 2.25 (.038)
Exp. B 7.15±4.78 5.70±3.91 1.18 (.251)
Cont. 7.42±4.02 9.84±4.15 -2.44 (.025)
Cognitive function Exp. A 22.44±2.15 23.89±2.54 -4.91 (＜.001)
Exp. B 22.95±2.89 24.10±2.69 -1.88 (.076)
Cont. 22.79±2.49 23.53±3.67 -1.02 (.320)

Exp.A=experimental group A (n=18); Exp.B=experimental group B (n=20); Cont.=control group (n=19).

Table 5.
Persistent Effects of MI Dementia Preventive Intervention (N=57)
Outcome variables Time Exp.A (n=18) Exp.B (n=20) Cont. (n=19) Sources† F(p)
M±SD M±SD M±SD
Dementia preventive behaviors Pretest 8.83±4.45 6.60±2.96 7.63±3.58 Group 3.56 (.035)
Posttest 1 10.67±3.14 9.10±3.52 8.42±3.95 Time 5.73 (.004)
Follow up 10.11±2.05 8.65±2.89 7.00±3.79 Group*Time 1.30 (.274)
Depression Pretest 7.22±3.47 7.15±4.78 7.42±4.02 Group 5.55 (.006)
Posttest 1 5.78±2.78 5.70±3.91 9.84±4.15 Time 0.82 (.444)
Follow up 4.50±2.46 6.25±4.99 8.74±3.68 Group*Time 2.77 (.031)
Cognitive function Pretest 22.44±2.15 22.95±2.89 22.79±2.49 Group 0.61 (.550)
Posttest 1 23.89±2.54 24.10±2.69 23.53±3.67 Time 4.86 (.011)
Follow up 23.17±1.82 24.75±3.09 23.11±4.92 Group*Time 0.95 (.437‡)

† by one-way repeated measured ANOVA;by mixed ANOVA;

‡ Greenhouse-Geisser adjusted p.

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