Depressed Nursing Home Residents' Activity Participation and Affect as a Function of Staff Engagement

Abstract

Behavioral interventions for depression target activity engagement and increased positive reinforcement, particularly from social interaction. Nursing homes provide limited opportunity for meaningful social engagement, and have a high prevalence of depression. Often residents obtain most of their social contacts from staff members. We present intra-individual correlations among positive staff engagement, resident affect, and resident activity participation from behavior stream observations of residents who were participants in an ongoing trial of an intervention for depression. Sixteen residents were observed 6 times weekly for 8-45 weeks, five minutes per observation. Positive staff engagement during the observations was significantly correlated with resident interest and pleasure. Positive staff engagement was related to resident participation in organized group activity, however, residents tended to be more engaged and show more pleasure when in informal group activities, especially those residents receiving the behavioral treatment. Positive staff engagement was not related to time in activities of daily living. Results have implications for understanding mechanisms and potential targets of interventions for depression. Depressed Nursing Home Residents' Activity Participation and Positive Affect as a Function of Staff Positive EngagementDepression is a major focus of mental health care in nursing homes because of its high prevalence among the frail elders who reside in them (e.g., Katz & Parmelee, 1997; Teresi, Abrams, Holmes, Ramirez, & Eimicke, 2001). Although there is relatively little empirical evaluation of interventions for depression in nursing home residents, behavioral interventions have received some attention and appear to be promising (e.g., Lichtenberg, Kimbarow, Wall, Roth, & MacNeill, 1998;Meeks & Depp, 2002;Meeks, Looney, Van Haitsma, & Teri, 2008). Behavioral interventions for depression derive primarily from the work of Peter Lewinsohn, whose model emphasized the importance of response-contingent positive reinforcement, or increasing pleasant events that result in positive affect (Lewinsohn, 1975;Lewinsohn, Hoberman, Teri, & Hautzinger, 1985). Lewinsohn's original formulation privileged social interaction as a critical aspect of behavior that can lead to necessary positive reinforcement (Lewinsohn, 1975;Lewinsohn & Graf, 1973). Depressed individuals have been found to engage in fewer interpersonal interactions that can lead to positive reinforcement from others (Achterberg et al., 2003;Libet & Lewinsohn, 1973), and lack of positive social interaction might be particularly problematic among older adults with physical and cognitive impairments. Nursing homes are unique social environments; nursing home residents may have fewer contacts with friends and family members in their natural social networks, and traditional nursing home rooms offer limited privacy in a medicalized environment. Social interactions and activity are relatively infrequent (e.g., Kolanowski & Litaker, 2006;Logsdo...

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