Study of the wellbeing of people with dementia living in residential care settings with Person Centered Care. The use of a new instrument: List of Indicators of Wellbeing (LIBE).

Abstract

Introduction: In the context of Person-Centered-Care (PCC) in residential care settings, we developed and validated an observational instrument for assessing the wellbeing of the residents. From the PCC perspective, the instrument was designed to highlight the effects that physical and social environments have in the person and how is reflected on wellbeing. The objectives were to generate a number of items for assessing wellbeing in people with dementia living in residential settings, and to obtain its psychometric validity, and interrater reliability. After the validation, the instrument List of Indicators of Wellbeing (LIBE), was applied in all centers in Matia Fundazioa, obtaining the baseline of wellbeing level of our residents with dementia. Within LIBE, behavioral aspects were categorized as wellbeing indicators trying to identify relational events between environmental facts, behavior and expression of satisfaction in the person. Methods: LIBE was generated following an iterative process, involving professionals from interdisciplinary teams working with people with dementia, and gerontology researchers. From that process, a series of behaviors were described and grouped in the following areas: a) Interaction with the environment, b) Interaction with other people, c) Choosing between options, d) Wellbeing expressions. It was validated with 79 people in two successive studies. After its validation, LIBE has been included as an indicator of quality of attention in all gerontological and day centers in Matia Fundazioa, and applied to a sample of 209 people with dementia. The mean MMSE score in the sample is 11.26 (SD=1.4), and almost 40% of them have psychogeriatric profile. Results: The instrument LIBE showed to be valid and reliable. In its application, the following results have been found: 43% and 30.1% of the sample have, respectively, passive or active participation in an activity that takes place it their own unit. 24.9% and 49.3% of the sample participates in a conversation (passive or actively). 38% have been empowered to take decisions. 51.7% show a general expression of wellbeing. Discussion: LIBE is a valid and reliable instrument that offers a different perspective measuring a construct that has not been largely explored in people with dementia. It has been designed to assess wellbeing of people with dementia living in residential settings, highlighting the importance of the environment in those moments along the day that are “between tasks” (breakfast, lunch, dinner). The results found show percentages of people who are in this time “between tasks” on a daily basis showing different wellbeing indicators. Conclusion: In our centers in Matia Fundazioa, LIBE has started to be an instrument used in all the resources, with the objective of having a picture of how wellbeing is in the present moment to create plans and actions to improve it by means of changes of practices in our attention. It is frequent to consider wellbeing of people with dementia as an important indicator of attention, but very few validated instruments have been created, validated and used to measure it. Therefore the present paper shows an innovative practice that we consider can offer a different perspective in the attention to this population.

Keywords

• wellbeing
• dementia
• assessment
• person-centered-care