Fill - Free fillable Applying the PersonEnvironmentOccupation Model to Improve Dementia Care PDF form

Applying the Person–Environment–Occupation

Model to Improve Dementia Care

Earn .1 AOTA CEU

(one contact hour and

1.25 NBCOT PDU).

See page CE-5 for details.

Carin Wong, MS

USC Mrs. T.H. Chan Division of Occupational Science and Occupational

Therapy in the Herman Ostrow School of Dentistry

University of Southern California, Los Angeles

Natalie E. Leland, PhD, OTR/L, BCG, FAOTA

USC Mrs. T.H. Chan Division of Occupational Science and Occupational

Therapy in the Herman Ostrow School of Dentistry

University of Southern California, Los Angeles

This CE Article was developed in collaboration with the AOTA’s

Productive Aging Special Interest Section.

ABSTRACT

The purpose of this article is to introduce the Person–Environ-

ment–Occupation (PEO) Model as a framework to improve

dementia care in nursing homes and provide examples from

literature that can be framed within the model. The interaction

between the person, environment, and occupation is described

to promote participation and provide quality care for residents

with dementia. The PEO model can be used by occupational

therapy practitioners to develop innovative approaches to

dementia care and improve quality of life.

LEARNING OBJECTIVES

After reading this article, you should be able to:

1. List the components of the PEO Model

2. Differentiate the relationships within the PEO Model

3. Identify the different components that consist of the person,

environment, and occupation

4. Identify strategies for engaging nursing home residents with

dementia within the PEO Model

CASE EXAMPLE

The charge nurse on the nursing home unit entered the dining

room at lunchtime and observed Mrs. Jones sitting at her table,

but she was not eating. The food on her plate had not been

touched. Mrs. Jones had previously been able to eat inde-

pendently after food was set up in front of her, although she

required additional time to do so. After observing Mrs. Jones

for a few minutes, the charge nurse approached the certified

nursing assistant (CNA) and asked about Mrs. Jones’s status.

The CNA stated that this pattern of behavior had been occurring

for a few weeks. The CNA and other CNAs had tried to feed her,

but Mrs. Jones would get agitated, start yelling, and try to hit the

staff. The CNA went on to describe that this behavior disrupted

the other residents trying to eat in the dining room. In response

to the escalation of behaviors, the CNA reported that they had

stopped trying to feed her and left her alone. Concerned about

Mrs. Jones’ risk for weight loss, an occupational therapy screen

was requested.

On observing Mrs. Jones in the dining room, the occupa-

tional therapist (OT) noticed that she was sitting at a table with

a white tablecloth, and her food included mashed potatoes,

cauliflower, and diced chicken served on a white plate. When

observing Mrs. Jones and the CNA staff, the OT also noticed

that the staff positioned themselves to either Mrs. Jones’ left or

right when trying to encourage her to eat, as they were often

also encouraging other residents to eat and/or feeding other

residents at the same time. When interacting with Mrs. Jones, it

was evident that the staff had startled her, which then triggered

her agitation and yelling. The OT determined that the barriers

to feeding included lack of contrast among the table, plate, and

food, as well as staff being positioned outside of Mrs. Jones’

line of sight, thereby limiting initiation of self-feeding and

facilitating the negative behaviors. On completing the occupa-

tional therapy evaluation, the therapist determined three areas

relating to feeding that needed to be addressed: (1) the environ-

ment (e.g., adding more color contrast to the place setting), (2)

Mrs. Jones’ positioning during meals, and (3) staff training on

strategies for feeding.

Occupational therapy addressing the environment. Based

on her knowledge of dementia and understanding of the envi-

ronment’s role in self-feeding for persons with dementia, the OT

identified that limited color contrast was an issue. Specifically,

as dementia progresses, an individual’s vision changes, resulting

in greater difficulty distinguishing objects of similar color. Thus,

a white plate on a white tablecloth with mostly white food was

difficult to see. To address this barrier, the OT worked with the

kitchen and CNA staff to provide a colored plate for Mrs. Jones

to create contrast between the food and table.

Occupational therapy enhancing resident-staff interac-

tions during eating—positioning and approach. Based on

her clinical training, the OT knew that it was more effective to

sit directly in front of the individual with dementia so as not

to startle them. As dementia progresses, peripheral vision can

decrease over time. Thus, sitting to the side of the resident is

confusing, as the staff person is not in a direct line of sight and

has an unfamiliar voice, which triggers anxiety and resistance.

In response, the OT educated and trained the day shift CNAs on

the recommended place to sit when working with Mrs. Jones,

WWW.AOTA.ORG CE-1

ARTICLE CODE CEA0518

CE-2 MAY 2018

ARTICLE CODE CEA0518

Continuing Education Article

Download the CE Exam

Click here to purchase and take the exam for CE credit.

including suggestions for positioning for the CNAs and Mrs.

Jones.

Specifically, in the dining room, there were tables set for up

to six people as well as smaller café tables for two people. The

OT and CNAs tried having Mrs. Jones eat at one of the café

tables during her meals, which was deemed successful, as the

agitation and yelling decreased and feeding improved. To ensure

follow through, the therapist worked with the various CNA

shifts to promote carryover and ensure that the staff sat directly

in front of her, providing one-step prompts to eat. Finally, a

training session was scheduled with the family members that

came in each weekend for Sunday lunch to educate them on the

new strategies for meals. Before discharge from occupational

therapy services, the therapist provided one-on-one training

sessions with each of the CNAs in the facility and documented

the resulting maintenance program, summarizing the recom-

mendations for Mrs. Jones. Copies of the detailed document

were placed in the CNA communication log as well as Mrs.

Jones’ chart and served as a guide for CNA staff caring for her in

the future. The guidance included:

• Using a colored plate for all meals

• Sitting at one of the café tables for two, with the CNA

sitting across from Mrs. Jones, directly in her line of sight

• Limiting communication to simple, one-step commands

in an effort to prompt Mrs. Jones to eat, thereby limiting

excessive side conversations, which were a distraction and

confusing

INTRODUCTION

As the U.S. population ages, the number of people with demen-

tia will continue to increase (Alzheimer’s Association, 2014;

Ortman et al., 2014). As dementia progresses from the early

to late stages of the disease, it causes cognitive decline, the

inability to make decisions or communicate, and a decrease in

functional and cognitive abilities (McDonald et al., 2010). As

the disease advances, people require more assistance with their

ADLs and other unmet care needs, which can lead to long-term

nursing home placement (Zimmerman et al., 2013). As of 2012,

residents with dementia made up 48.5% of the nursing home

population, a percentage that is expected to increase as the pop-

ulation ages (Harris-Kojetin et al., 2013; Ortman et al., 2014).

This client population is at risk for poor outcomes, including

weight loss, accidental falls, morbidity, and mortality (Navar-

ro-Gil et al., 2014; Sylliaas et al., 2012). Thus, the Centers for

Medicare & Medicaid Services (CMS; 2013) has identified indi-

viduals with dementia as a high priority population in need of

quality improvement. The CMS initiative emphasizes enhancing

client outcomes and overall quality of life through person-cen-

tered approaches. To this end, federal priorities are bringing

client-centered care to the forefront of health care delivery.

Client-centered care is an important component to provid-

ing quality dementia care by enabling the individual to retain

personal worth, decision-making opportunities, and a feeling

of independence (Nazarko, 2009). To understand and identify

the best interventions to inform a person-centered approach

to dementia care in a nursing home, the purpose of this article

is to situate occupational therapy practitioners’ approaches to

dementia care within the context of the person–environment–

occupation (PEO) theoretical framework.

PEO MODEL

The PEO Model was developed to provide a framework for deliv-

ering services that encompass a client-centered approach (Law

et al., 1996). There are three components to the model: the

person, the environment, and the occupation (Law et al., 1996).

The person is an individual with a unique set of identities, expe-

riences, and abilities. The environment is a broad domain that

comprises physical, social, cultural, and socio-economic factors.

Occupation refers to the functional tasks and activities that the

individual engages in. The PEO Model is built on the theory

that interaction of the person, environment, and occupation

facilitates participation. If there is a good fit of these constructs,

meaningful participation increases, whereas a poor fit can

threaten engagement or performance. The fit between the PEO

interaction is defined by the quality of a person’s experience

with regard to their level of satisfaction and functioning (Strong

et al., 1999).

Consequently, the interconnected relationship presented in

the PEO Model can provide a framework for understanding peo-

ple with dementia and provide client-centered care. By encom-

passing the person with the occupation and nursing home

environment, different factors interact as a barrier or facilitator

to providing quality care. Specifically, the PEO Model can be

used to understand and develop person-centered interventions

for people with dementia.

DEMENTIA WITHIN THE PEO MODEL

Within each domain, several factors interact with and influence

dementia care (see Figure 1 on p. CE-3). The person domain

includes the physical and cognitive levels of people with demen-

tia as well as their attitudes, preferences, and personality before

the diagnosis. Individuals with dementia may experience mem-

ory loss, confusion, unclear thinking, decline in problem-solv-

ing skills, loss of interest in usual activities, and behavioral

symptoms (e.g., aggression, agitation, anxiety), which can affect

their ability to participate in activities and overall quality of life

(Torpy et al., 2004). The environment domain focuses on both

the physical and social contexts. The physical environment for

a long-term nursing home resident with dementia includes the

physical structure of the nursing home, such as the indoor and

outdoor space, including lighting, noise, placement of furniture,

and outdoor resident areas (Degenholtz et al., 2006). The social

environment in this context incorporates the facility policy;

administrative and nursing staff; other residents in the facility;

and family, caregiver, and friend support (McFadden & Lun-

sman, 2010). For people with dementia, the occupation domain

CE-3MAY 2018

ARTICLE CODE CEA0518

Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-5 for details.

includes the activities provided in the nursing home, routines,

and the timing and required abilities for these tasks.

The degree of overlap among the person, environment, and

occupation factors reflects the ability of participation among

residents with dementia. When the environment and occupa-

tion adjust to the abilities of the person, then participation is

considered successful.

RELATIONSHIP BETWEEN PERSON AND ENVIRONMENT

The primary focus of research exploring the person and envi-

ronment interaction has been on the physical environment.

The physical environment of a nursing home includes the

resident’s bedroom and bathroom, common areas, lounges, and

dining rooms as well as the lighting, space, and life-enriching

features in these areas (Degenholtz et al., 2006). According to

Degenholtz and colleagues (2006), residents with lower levels

of cognitive or functional abilities report a higher quality of life

when living in an environment with life-enriching features and

less noxious stimuli. As shown in the PEO Model, the environ-

ment is able to promote the person’s functional and cognitive

skills, and allow the individual to adapt to their health declines.

This is reflective of Mrs. Jones’ case example, where the OT

recommended changes to her environment to accommodate her

visual impairment.

Research has evaluated the effect of physical environment

modifications on the negative behavioral symptoms among

individuals with dementia, specifically symptoms of agitation,

aggression, and anxiety (Maseda et al., 2014; Milev et al.,

2008). Intervention approaches include altering the appearance

of a typical nursing home to create multiple small-scale and

home-like facilities and creating multisensory stimulation envi-

ronments, which were found to improve the quality of life for

residents (Maseda et al., 2014; Milev et al., 2008; Verbeek et al.,

2009). Implementing a multisensory stimulation environment

increased activity engagement and improved behavior and mood

for residents in nursing homes (Maseda et al., 2014; Milev et al.,

2008). The multisensory stimulation environment can adjust to

the preferences and the abilities of the individual to reflect the

person–environment interaction.

Research has also demonstrated improvement in client

outcomes when the social environment is modified to support

individuals with dementia. When equipped with the knowl-

edge to understand dementia symptoms, the progression of the

disease, and the cause of negative behaviors, nursing staff were

Figure 1: The Person-Environment-Occupation

Model for dementia

Environment

• Physical environment:

• Nursing home

residence

• Social environment:

• Nursing Staff

• Residents

• Family/caregiver

support

Occupation

• Routine

• Frequency

• Methods

• Tasks

• Meaning

Participation

Person

• Physical Level

• Cognitive Level

• Preferences

• Attitudes

• Personality

CE-4 MAY 2018

ARTICLE CODE CEA0518

Continuing Education Article

Download the CE Exam

Click here to purchase and take the exam for CE credit.

Continuing Education Article

Download the CE Exam

Click here to purchase and take the exam for CE credit.

able to implement behavioral management programs to provide

better care for the residents and reduce behavioral symptoms

(DeYoung et al., 2002; Galik et al., 2008). The person–envi-

ronment interaction between the nursing staff and the individ-

ual’s health status ameliorated some of the negative effects of

dementia.

For residents with dementia, their family and caregivers are

also an integral component of the social environment. Having

contact and meaningful engagement with family can contribute

to the psychosocial well-being of residents, even those with

limited cognitive abilities (Bauer & Nay, 2003). To maintain the

relationship between the resident and their family, one study

incorporated family participation into the activity program at

the nursing home (Cochran et al., 2001). Family and significant

others were invited to attend certain activity programs, which

were found to increase engagement and interaction among the

resident, family members, and staff.

Research on the relationship between the person and envi-

ronment has shown that the environment encompasses differ-

ent factors (physical and social). The different components that

make up the environment can influence the person’s abilities

and functional level. When the environment is adapted to meet

the needs of the person, it can improve participation among

residents with dementia.

THE RELATIONSHIP BETWEEN PERSON AND OCCUPATION

The person–occupation relationship examines how the activity

affects the individual with dementia. Residents with dementia

usually prefer activities that address their psychological and

social needs (Harmer & Orrell, 2008). However, inactivity

and lack of interest in activities is common among residents

with dementia (Altus et al., 2002). In addition, as the condi-

tion progresses, cognitive and functional ability declines; this

can reduce engagement in activities and lower quality of life

(McDonald et al., 2010). Many of the activities that are offered

in nursing homes are inappropriate, and residents do not find

them meaningful, which is a key component for quality of

life (Harmer & Orrell, 2008). Using the person–occupation

interaction, activities can be designed based on the individual’s

personal preferences and abilities, to increase engagement.

Engagement can be achieved when activities are modified

to accommodate the residents’ cognitive and functional ability,

personality, and previous interests (Buettner et al., 2006;

Cohen-Mansfield et al., 2006; Kolanowski et al., 2011; van der

Ploeg et al., 2013). These interventions engaged residents in an

individually tailored activity. Designing activities that consider

the person domain of the PEO model allows for an increase in

participation.

However, research is limited on the daily routines of resi-

dents in nursing homes with dementia and how the routines

affect the activities they participate in. Alterations or disrup-

tions in an individual’s daily routines can create stress that

triggers behavioral symptoms, such as agitation, aggression,

and wandering (Kovach, 2000). Kovach and colleagues (2004)

believed arousal imbalance, defined as being awake in an arousal

state for 1.5 hours or longer without any change, causes those

behavioral symptoms. Lack of activity for a period of time or

overstimulation results in imbalance. After observing the Mrs.

Jones’ daily routines, the OT adjusted her daily activity schedule

accordingly to reduce the occurrence of arousal imbalance.

Within the PEO framework, occupations take into the

account the timing and frequency of the task, and how it can

affect the person. If an activity is given when a resident is over-

stimulated, then negative outcomes can occur, such as aggres-

sion. However, if there is a fit with the timing and frequency

of the activity, then the resident will become engaged (Kovach,

2000; Kovach et al., 2004). For Mrs. Jones, understanding her

routines and the best time to have meals could affect whether

she engaged in eating.

RELATIONSHIP BETWEEN ENVIRONMENT AND OCCUPATION

Changes in the environment can be facilitators of or barriers

to the outcomes of occupations. A few studies have examined

the effects of environmental design on activities as occupa-

tions. Cutler and colleagues (2006) evaluated a set of nursing

home facilities and found that many of the residents’ rooms and

other parts of the facility were often bare. Living in facilities

that cause sensory deprivation have been found to exacerbate

negative behavioral symptoms, which can lower overall quality

of life and cause inactivity (Cutler et al., 2006). Similarly, some

facilities do not have the resources to provide quality activity

programs that could improve the quality of life for residents

(Kolanowski et al., 2006). When the environment is unable to

provide the positive characteristics for activity participation,

adjustments need to be made in the PEO model (Strong et al.,

1999).

Having an environment that promotes participation can

cause positive environment–occupation interaction. One

intervention moved the structured activity program of a facility

from an indoor program to an outdoor program (Connell et al.,

2007). The purpose of this change in environment was to allow

the residents to be exposed to bright light, while participating

in an activity to promote participation. Mrs. Jones’s situation

also illustrated this type of interaction. The plate and food

lacked contrast (environment), which contributed to her lack of

engagement in eating (occupation). Thus, changing the color of

the plate to match her current abilities was needed.

THE PEO INTERACTION

The studies of dementia care in nursing homes that were

reviewed focused on fragments of the PEO model. When

looking at dementia care, there were no studies that imple-

mented the entire PEO model. However, there was one study

that looked at the PEO interaction when evaluating meaning-

ful activities within nursing homes, although not specifically

on residents with dementia (Green & Cooper, 2000). Twenty

CE-5MAY 2018

ARTICLE CODE CEA0518

Earn

.1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page below for details.

nursing home matrons from different facilities in the United

Kingdom were interviewed regarding their nursing home and

how they facilitated meaningful activities for their residents.

Framing their analysis within the PEO framework, Green and

Cooper (2000) were able to recognize how the PEO interaction

played a role in engagement of meaningful activities. The per-

son focus consisted of the decline in health, increase in frailty,

and preference of choosing their activities. The environment

focus included the organizational level (e.g., control by the

matron, creativity, resourcefulness, flexibility) and the physical

level (e.g., home comforts, characteristics of the nursing home).

The occupation focus consisted of the activity being individual-

ized, varied, familiar, and broad in range. To accommodate for a

decline in the residents’ abilities (the person), the nursing home

staff (the environment) had to be flexible and creative when

designing an individualized activity (the occupation). Green

and Cooper (2000) advocated for further research and using the

model to encourage purposeful activities.

FUTURE DIRECTIONS FOR DEMENTIA CARE USING THE PEO

MODEL

Areas of research still need to be evaluated within the PEO

interaction for dementia care in nursing homes. Interventions

have been developed that address separate components of the

model. However, these interventions are not specific for the

whole progression of dementia and how the PEO interaction

changes as dementia progresses. As an individual reaches the

advanced stages of dementia, their functional and cognitive

abilities decline further and they are generally bedridden, with

sensory deprivation and complete dependence on care (Lussier

et al., 2011). The environment and occupation would have to

adapt to the changes in the person, and research should exam-

ine whether these interactions can exist when the abilities of

the person have become even more limited.

Additionally, within the nursing home setting, more research

is needed to examine the interplay of the social environment

and the person and occupation components. Limited studies

were found on the organizational level and specifically how

the nursing home organization interacted with residents with

dementia and their participation in activities. With the CMS

(2013) initiative to provide quality dementia care, it is import-

ant to evaluate how the higher organizational environments

(e.g., federal policies) affect the other factors of the PEO model.

CONCLUSION

Occupational therapy practitioners can use the PEO model to

provide client-centered care and engage individuals residing

in nursing homes. By understanding the PEO interaction for

persons with dementia, occupational therapy practitioners are

better able to provide high-quality care. Practitioners can also

use the PEO model to evaluate innovative approaches to caring

for residents with dementia in nursing homes.

REFERENCES

Altus, D. E., Engelman, K. K., & Mathews, R. M. (2002). Finding a practical

method to increase engagement of residents on a dementia care unit. Ameri-

can Journal of Alzheimer’s Disease & Other Dementias, 17, 245–248.

Alzheimer’s Association. (2014). 2014 Alzheimer’s disease facts and figures.

Alzheimer’s & Dementia, 10, e47–e92.

Bauer, M., & Nay, R. (2003). Family and staff partnerships in long-term care: A

review of the literature. Journal of Gerontological Nursing, 29(10), 46–53.

Buettner, L. L., Fitzsimmons, S., & Atav, A. S. (2006). Predicting outcomes of

therapeutic recreation interventions for older adults with dementia and

behavioral symptoms. Therapeutic Recreation Journal, 40(1), 33–47.

Centers for Medicare & Medicaid Services. (2013). CMS national partnership to

improve dementia care in nursing homes national provider call. Retrieved from

https://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Pro-

vider-Calls-and-Events-Items/2013-01-31-Dementia-Care-.html

Cochran, V., Tice, P., Clair, A. A., Otto, D. W., & Johnson, G. E. (2001). Family

ties: Activities for family and significant others dealing with late stage

dementia. Activities, Adaptation & Aging, 26(2), 45–60.

Cohen-Mansfield, J., Parpura-Gill, A., & Golander, H. (2006). Utilization of

self-identity roles for designing interventions for persons with dementia.

Journals of Gerontology: Series B, 61, P202–P212.

Connell, B. R., Sanford, J. A., & Lewis, D. (2007). Therapeutic effects of an

outdoor activity program on nursing home residents with dementia. Journal

of Housing For the Elderly, 21, 195–209.

Cutler, L. J., Kane, R. A., Degenholtz, H. B., Miller, M. J., & Grant, L. (2006).

Assessing and comparing physical environments for nursing home residents:

Using new tools for greater research specificity. Gerontologist, 46, 42–51.

Degenholtz, H. B., Miller, M. J., Kane, R. A., Cutler, L. J., & Kane, R. L. (2006).

Developing a typology of nursing home environments. Journal of Housing For

the Elderly, 20, 5–30. https://doi.org/10.1300/J081v20n01_02

DeYoung, S., Just, G., & Harrison, R. (2002). Decreasing aggressive, agitated, or

disruptive behavior: Participation in a behavior management unit. Journal of

Gerontological Nursing, 28(6), 22–31.

Galik, E. M., Resnick, B., Gruber-Baldini, A., Nahm, E.-S., Pearson, K., &

Pretzer-Aboff, I. (2008). Pilot testing of the restorative care intervention for

the cognitively impaired. Journal of the American Medical Directors Association,

9, 516–522.

Green, S., & Cooper, B. A. (2000). Occupation as a quality of life constituent:

A nursing home perspective. British Journal of Occupational Therapy, 63(1),

17–24.

How to Apply for

Continuing Education Credit

A. To get pricing information and to register to take the exam

online for the article Applying the Person–Environment–

Occupation Model to Improve Dementia Care

, go to

http://store.aota.org, or call toll-free 800-729-2682.

B. Once registered and payment received, you will receive instant

email confirmation.

C. Answer the questions to the final exam found on pages CE-6 &

CE-7 by May 31, 2020.

D. On successful completion of the exam (a score of 75% or more),

you will immediately receive your printable certificate.

CE-6 MAY 2018

ARTICLE CODE CEA0518

Continuing Education Article

Download the CE Exam

Click here to purchase and take the exam for CE credit.

Harmer, B. J., & Orrell, M. (2008). What is meaningful activity for people with

dementia living in care homes? A comparison of the views of older people

with dementia, staff and family carers. Aging & Mental Health, 12, 548–558.

Harris-Kojetin, L., Sengupta, M., Park-Lee, E., & Valverde, R. (2013). Long-term

care services in the United States: 2013 overview. Retrieved from https://www.

cdc.gov/nchs/data/nsltcp/long_term_care_services_2013.pdf

Kolanowski, A., Buettner, L., Litaker, M., & Yu, F. (2006). Factors that

relate to activity engagement in nursing home residents. American

Journal of Alzheimer’s Disease & Other Dementias, 21, 15–22. https://doi.

org/10.1177/153331750602100109

Kolanowski, A., Litaker, M., Buettner, L., Moeller, J., & Costa, P. T. (2011).

A randomized clinical trial of theory-based activities for the behavioral

symptoms of dementia in nursing home residents. Journal of the American

Geriatrics Society, 59, 1032–1041.

Kovach, C. R. (2000). Sensoristasis and imbalance in persons with dementia.

Journal of Nursing Scholarship, 32, 379–384. https://doi.org/10.1111/j.1547-

5069.2000.00379.x

Kovach, C. R., Taneli, Y., Dohearty, P., Schlidt, A. M., Cashin, S., & Silva-Smith,

A. L. (2004). Effect of the BACE intervention on agitation of people with

dementia. Gerontologist, 44, 797–806.

Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The

Person–Environment–Occupation Model: A transactive approach to occu-

pational performance. Canadian Journal of Occupational Therapy, 63, 9–23.

https://doi.org/10.1177/000841749606300103

Lussier, D., Bruneau, M.-A., & Villalpando, J. M. (2011). Management of end-

stage dementia. Primary Care: Clinics in Office Practice, 38, 247–264. https://

doi.org/10.1016/j.pop.2011.03.006

Maseda, A., Sánchez, A., Marante, M. P., González-Abraldes, I., Buján, A., &

Millán-Calenti, J. C. (2014). Effects of multisensory stimulation on a sample

of institutionalized elderly people with dementia diagnosis: A controlled

longitudinal trial. American Journal of Alzheimer’s Disease & Other Dementias,

29, 463–473.

McDonald, R. J., Craig, L. A., & Hong, N. S. (2010). The etiology of age-related

dementia is more complicated than we think. Behavioural Brain Research,

214(1), 3–11. https://doi.org/10.1016/j.bbr.2010.05.005

McFadden, S. H., & Lunsman, M. (2010). Continuity in the midst of change:

Behaviors of residents relocated from a nursing home environment to small

households. American Journal of Alzheimer’s Disease & Other Dementias, 25,

51–57. https://doi.org/10.1177/1533317508320088

Milev, R. V., Kellar, T., McLean, M., Mileva, V., Luthra, V., Thompson, S.,

& Peever, L. (2008). Multisensory stimulation for elderly with demen-

tia: A 24-week single-blind randomized controlled pilot study. American

Journal of Alzheimer’s Disease & Other Dementias, 23, 372–376. https://doi.

org/10.1177/1533317508316681

Navarro-Gil, P., González-Vélez, A. E., Ayala, A., Martín-García, S., Martínez-

Martín, P., Forjaz, M. J., & Spanish Research Group on Quality of Life and

Ageing. (2014). Which factors are associated with mortality in institution-

alized older adults with dementia? Archives of Gerontology and Geriatrics, 59,

522–527.

Nazarko, L. (2009). Providing high quality dementia care in nursing homes.

Nursing & Residential Care, 11, 296–300.

Ortman, J., Velkoff, V., & Hogan, H. (2014). An aging nation: The older population

in the United States. Retrieved from https://www.census.gov/prod/2014pubs/

p25-1140.pdf

Strong, S., Rigby, P., Stewart, D., Law, M., Letts, L., & Cooper, B. (1999).

Application of the Person–Environment–Occupation Model: A practical

tool. Canadian Journal of Occupational Therapy, 66, 122–133. https://doi.

org/10.1177/000841749906600304

Sylliaas, H., Selbæk, G., & Bergland, A. (2012). Do behavioral disturbances

predict falls among nursing home residents? Aging Clinical and Experimental

Research, 24, 251–256.

Torpy, J., Lynm, C., & Glass, R. (2004). Dementia. JAMA, 292, 1514. https://doi.

org/10.1001/jama.292.12.1514

van der Ploeg, E. S., Eppingstall, B., Camp, C. J., Runci, S. J., Taffe, J., &

O’Connor, D. W. (2013). A randomized crossover trial to study the effect of

personalized, one-to-one interaction using Montessori-based activities on

agitation, affect, and engagement in nursing home residents with dementia.

International Psychogeriatrics, 25, 565–575.

Verbeek, H., van Rossum, E., Zwakhalen, S., Ambergen, T., Kempen, G., &

Hamers, J. (2009). The effects of small-scale, homelike facilities for older

people with dementia on residents, family caregivers and staff: Design of a

longitudinal, quasi-experimental study. BMC Geriatrics, 9, Article 3. https://

doi.org/10.1186/1471-2318-9-3

Zimmerman, S., Anderson, W. L., Brode, S., Jonas, D., Lux, L., Beeber, A. S., …

Sloane, P. D. (2013). Systematic review: Effective characteristics of nursing

homes and other residential long-term care settings for people with demen-

tia. Journal of the American Geriatrics Society, 61, 1399–1409.

Final Exam

Article Code CEA0518

Applying the Person–Environment–Occupation Model to

Improve Dementia Care

May 2018

To receive CE credit, exam must be completed by

May 31, 2020

Learning Level: Intermediate

Target Audience:

Occupational Therapists and

Occupational Therapy

Assistants

Content Focus: OT Process: Intervention

1. Client-centered dementia care allows the individual with

dementia to have all of the following except:

A. Personal worth

B. Decision-making opportunities

C. Access to health care

D. Independence

2. What are the components of the Person–Environment–

Occupation (PEO) model?

A. Person, environment, and organization

B. Person, environment, and occupation

C. Policy, environment, and organization

D. Public spaces, extrinsic factors, and occupation

3. All the following from the Mrs. Jones case example are

examples of the “person” in the PEO model except:

A. Having visual impairment

B. Having dementia

C. Living in a nursing home

D. Expressing negative behavioral symptoms

CE-7MAY 2018

ARTICLE CODE CEA0518

Earn

.1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page 5 for details.

4. A good fit between the person, environment, and

occupation:

A. Promotes participation

B. Increases social support

C. Improves cognition

D. Decreases risk for falls

5. All the following make up the environment domain of

the PEO model except:

A. Nursing staff

B. Dining room

C. Facility policy

D. Eating meals

6. Research has shown that the following type of environ-

mental modification can reduce negative behavioral

symptoms:

A. Having a multisensory stimulation room

B. Placing residents in the dining room

C. Having multiple certified nursing assistants attend to the

resident

D. None of the above

7. Which of the following statements best describes the

person–environment relationship?

A. The environment has no effect on a resident’s function or

cognitive abilities

B. Only the social environment can reduce negative behav-

ioral symptoms

C. Different components of the environment can influence

a person’s abilities and functional levels

D. The physical environment affects a person’s cognition

8. Residents with dementia usually prefer activities that:

A. Are physical exercises

B. Address their psychological and social needs

C. Are provided in a group program

D. Affect their daily routines

9. Engagement in nursing homes can be achieved when activ-

ities are modified to accommodate the activities to all the

llowing resident characteristics except:

A. Cognitive ability

B. Past experiences

C. Personality

D. Social support

10. What environmental intervention was shown to have a

positive effect on engagement in an occupation in the

environment and occupation relationship?

A. Having an activity program outdoors instead of indoors

B. Providing exercises in a larger activity room

C. Dimming the lights in the activity room

D. Hiring a new activity provider

11. Which of the following are barriers in the relationship

between environment and occupation?

A. Facilities that lack resources

B. Having an outdoor area for activities

C. Using a multisensory stimulation environment

D. Having a larger population of residents who are cogni-

tively impaired

12. Which recommendation made by the occupational

therapist in Mrs. Jones’ case example addressed the

environment?

A. Changing the color of the plate at meal times

B. Encouraging Mrs. Jones to eat with other residents

C. Having Mrs. Jones eat her meals inside her room so as

not to disrupt the other residents

D. Changing the food that was made for Mrs. Jones

Now that you have selected your answers, you are

only one step away from earning your CE credit.

Click here to earn your CE

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

Applying the PersonEnvironmentOccupation Model to Improve Dementia Care

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank Applying the PersonEnvironmentOccupation Model to Improve Dementia Care Form

Related forms

Fillable Applying the PersonEnvironmentOccupation Model to Improve Dementia Care

Fill Online, Printable, Fillable, Blank Applying the PersonEnvironmentOccupation Model to Improve Dementia Care Form

Related forms

First 20 documents completely FREE!