Effects of Visual Cues and Education for People Who Live Within Long Term Care Communities to Assist in Wayfinding

NCT03537729 | Completed Results DMC

• 1 other identifier: P17203009
• Study Type: interventional
• Target: 172
• Locations: 1 country
• Sites: 2

Brief Summary

The ability to find one's way in the world is known as wayfinding. Many older adults who live in senior communities, such as independent living and assisted living residences, find wayfinding very challenging. Often times, these communities are not designed in a way that helps people find their way very easily. When people cannot find their way, they can get lost, be dependent upon others for getting out and about, or even be afraid to leave their rooms. The purpose of this study is to find out if distinctive signs and decorative elements, along with a special type of education called Spaced-Retrieval education, help residents in these communities find their way more effectively. Twelve senior communities will be assigned by chance to one of three conditions, including: 1) control - no change (the community stays the same); 2) signs and decorative elements enhanced; and 3) signs, decorative elements, and special education added. After agreeing to be in the study, the participants will be asked to find their way to certain places in their community four times over a year. Some people will be asked to participate in educational sessions on wayfinding. In addition, some people will be asked to wear a location tracker, (like a fitness tracker), for four weeks during the year. How well people find their way, along with how much they travel about within the communities, will be compared between the three groups. It is hypothesized that those in the communities with special signs and decorative elements will find their way more effectively than those in the control communities. It is also hypothesized that participants in the communities with the special education intervention will find their way better than those without the education. Finally, it is hypothesized that participants in the communities with signs and cues and education will travel about further distances than those in the control communities. The results of the study can help people who have a tendency to get lost find their way more effectively in their community, and this could result in more independence.

Conditions

Alzheimer Disease; Alzheimer Dementia; Age-Related Memory Disorders; Dementia

Keywords

Alzheimer's disease; Age related memory disorders; Environment design; Long term care; Dementia

Outcome Measures

Primary Outcomes (3)

• Adjusted Wayfinding Speed (Feet Per Second)

  Subjects walked three pre-specified routes in the senior living community (simple, moderate, and complex). They were timed as they walked the route using a computer application called DOTT. Rest periods, elevator wait times and errors (wrong turns) were indicated in DOTT as the participant traversed the route. The adjusted wayfinding speed was calculated as the length of the route in linear feet divided by time in seconds the subject took to walk the route, minus rest periods and elevator wait times, plus 120 seconds added per error.

  Average over months 1, 3, 6, and 12

• Wayfinding Accuracy on Simple Route

  Accuracy was measured via proportion of errors, calculated as number of errors made by a participant when walking a pre-specified route divided by number of possible errors on a route. Errors were defined as a subject making a wrong turn at a decision point, or a U-turn in a hallway the wrong direction. Higher value reflects lower accuracy (higher proportion of errors).

  Average over months 1, 3, 6, and 12

• Wayfinding Accuracy on Moderate and Complex Routes

  Accuracy was measured via proportion of errors, calculated as number of errors made by a participant when walking a pre-specified route divided by number of possible errors on a route. Errors were defined as a subject making a wrong turn at a decision point, or a U-turn in a hallway the wrong direction. Higher value reflects lower accuracy (higher proportion of errors).

  Average over months 1, 3, 6, and 12

Secondary Outcomes (1)

• Life Space

  Average over months 1, 3, 6, and 12

Study Arms (3)

Control

NO INTERVENTION

There will be no modifications to décor or signage in the existing care community, and no education on wayfinding. However, subjects will receive the same testing that is provided for the other arms at the designated time periods.

Salient Cues

EXPERIMENTAL

Special signs and salient cues will be added to the community along the routes being measured for wayfinding. The cues will be comprised of pictures, objects, and signage.

Behavioral: Salient Cues

Spaced retrieval education

EXPERIMENTAL

This condition will have signage and cues as in Arm 2 added to the care communities. In addition, a spaced retrieval (SR) memory intervention strategy will be implemented individually for each resident participating in the study to help them remember the presence and function of the environmental wayfinding cues.

Behavioral: Salient Cues; Behavioral: Spaced Retrieval Education

Interventions

Salient Cues BEHAVIORAL

Salient cues are those that capture the individual's attention. Information that is complex, novel, and difficult to identify takes more processing resources than those that are simple and familiar. Cues such as pictures and wall hangings, along with bright and meaningful signs, will be placed at key decision points within the senior communities.

Salient Cues; Spaced retrieval education

Spaced Retrieval Education BEHAVIORAL

Spaced Retrieval (SR) is an evidence-based memory strategy that is used to teach individuals with memory loss new or previously known information. In this study, participants in Arm 3 will receive twelve 30-minute educational sessions to help them use the salient cues to find their way.

Spaced retrieval education

Eligibility Criteria

• Age: 62 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 62 or older;
• Wayfinding impairment identified by the subject or staff and exhibited at baseline, including problems finding their way among three defined locations (these may differ among care communities);
• Ability to move self either independently by walking or using mobility aids (self-mobile; any mobility aids are acceptable)
• Ability to communicate with researchers and follow directions
• Ability to see and read signs in English.

You may not qualify if:

• Chronic health conditions that impair the ability to participate in the study, such as severe chronic obstructive pulmonary disease (COPD) (limiting movement) or terminal illness;
• Signs of rapid deterioration in health during the past 6 months as evidenced by staff communication or medical records.

Sponsors & Collaborators

• Grand Valley State University: lead
• Michigan State University: collaborator

Study Sites (2)

Grand Valley State University

Allendale, Michigan, 49401, United States

Location

Brush Development

Chardon, Ohio, 44024, United States

Location

MeSH Terms

Conditions

Alzheimer Disease; Memory Disorders; Dementia

Condition Hierarchy (Ancestors)

Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Tauopathies; Neurodegenerative Diseases; Neurocognitive Disorders; Mental Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Limitations and Caveats

The study was conducted during a world-wide pandemic, causing cessation of study activities and participant attrition. The sample was a convenience sample; those who participated may be different than those who did not. We were unable to recruit a diverse sample due to the lack of diversity in the independent living and assisted living settings; this limits generalizability of the findings. The intraclass correlation was higher than expected due to the routes being community specific.

Results Point of Contact

• Title: Dr. Rebecca Davis
• Organization: Grand Valley State University

davirebe@gvsu.edu

616.331.3079

Study Officials

• Rebecca Davis, PhD

  Grand Valley State University

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: May 4, 2018
• First Posted: May 25, 2018
• Study Start: June 12, 2019
• Primary Completion: August 30, 2023
• Study Completion: October 23, 2023
• Last Updated: November 4, 2024
• Results First Posted: November 4, 2024

Record last verified: 2024-08

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR, ANALYTIC CODE
• Time Frame: Within six months of final publication of the data.
• Access Criteria: We will make the data and associated documentation (code book, description of variables) available to users in Scholarworks. ScholarWorks@GVSU is an open-access repository maintained by the GVSU Libraries. It is anticipated that the data would be available after the PI has published the final results, or within two years of the completion of the study. The repository will have the de-identified data set, along with a description of each variable and any statistical formulas used to create the variable.

Locations

US (2)