Associate Professor Northern Illinois University NAPERVILLE, Illinois, United States
Disclosure(s):
Jamie Mayer, PhD, CCC-SLP: No financial or non-financial relationships to disclose
Abstract:
It is well-known that the toll of the COVID-19 pandemic on residents in long-term care settings has reached far beyond virus-induced morbidity and mortality to include prolonged effects of loneliness and social isolation, caused by the very restrictions put into place to maximize health and safety. In response, we describe a pilot outreach program, “ZoomPals,” a service-learning paradigm for undergraduate students in Communicative Disorders designed to address ongoing social isolation for local long-term care residents with dementia. Initial program data collection was focused on three interrelated outcomes: (1) program feasibility, (2) effects on participants with dementia, (3) outcomes for student volunteers. Results and clinical implications for each outcome will be discussed.
Summary:
The COVID-19 toll on residential long-term care (LTC) settings has been described as “a humanitarian crisis” (Kontos et al., 2021), with mortality rates compounded by high morbidity stemming from effects of prolonged social isolation (SI) on psychosocial well-being. Many LTC residents have experienced increased frailty in the context of cognitive decline, depression, anxiety, refusal of care, and failure to thrive (Chu et al., 2020). For persons with dementia (PWD), SI has been found to exacerbate memory decline and neuropsychiatric symptoms (Friedler et al., 2015); correlating with cortisol stress responses and worsening of hippocampal asymmetry (Muntsant & Giménez-Llort, 2020). Thus, interventions designed to target SI are necessary to mitigate the massive physiological and psychological health effects of the ongoing pandemic.
Although reports of phone- or video-chat programs for older adults have begun to surface (e.g., Office et al., 2020), most have been designed for community-dwelling residents, with a very small proportion targeting local LTC residents. Fewer still have examined specifically the effects of such a program for PWD in LTC. Accordingly, the aims of this exploratory study included: - RQ 1. Is a zoom-based outreach program feasible in terms of: (a) obtaining technology, (b) PWD learning new technology, (c) logistics for facility staff, and (d) recruiting and training student volunteers? - RQ 2. What are the effects of the program on PWD, as indexed by (a) direct observation and (b) semi-structured interviews? - RQ 3. What are the effects of the program on student volunteers?
Participants Twenty PWD meeting the following criteria were recruited from a local long-term care facility: (1) presence of dementia as verified by facility staff from intake paperwork, (2) ability to verbalize and respond to language as verified by facility staff, and (3) consent from POA for recording conversations. Dementia severity ranged from mild (n = 10) to moderate (n = 10); etiologies included Alzheimer disease, Parkinson disease, and fronto-temporal dementia types.
Student volunteers were recruited from the Allied Health & Communicative Disorders program at Northern Illinois University. All volunteers were provided basic instruction about dementia via required coursework and were given additional training (via zoom) regarding communication strategies.
ZoomPals The ZoomPals program, initiated in early fall, 2020 and continuing through fall 2022, was held 2x/week for 45-60 minutes. Due to the staffing logistics, approximately 5-8 PWD participated in each session, with residents rotating through the program each week.
The first 5-10 minutes of each session included informal, large-group conversation. Each PWD was then paired with a student volunteer in a breakout room. The student-PWD dyad conversations were designed to be flexible and open-ended. Students were trained to ask questions about the distant past (e.g., hobbies); if the PWD had trouble engaging, students shared their screen to provide topic-related visual supports (e.g., images), or videos (e.g., favorite music). Following these 1:1 interactions (25 min.), breakout rooms were closed and a second large-group conversation was held (5 min.). Once staff had collected all tablets from participating PWD, students and the supervising faculty member stayed on the call for an additional 15 min. to review communication strategies and encourage student reflection (ACUE, 2022).
Data collection Study data were collected via the following methods: (1) recording and transcribing selected conversational dyads to analyze PWD engagement, language, and affect; (2) semi-structured interviews with facility staff; (3) semi-structured interviews with a small sample of PWD participants (n=5); and (4) student surveys.
Results & Discussion Student surveys were consistent with significant gains in both comfort levels and self-perceived ability to communicate with PWD, whereas gains in knowledge did not reach statistical significance. Preliminary content analysis indicated that students also learned about the complexity of the disease and discovered shared enjoyment in the program. Students also pointed out the difficulty of connecting with individuals with more severe dementia via zoom. Finally, the experience increased their empathy for this population by driving home how isolating living in an LTC facility can be, especially during a pandemic. Analysis of resident responses indicated high levels of engagement, pleasure, and communicative initiation throughout the program, at levels similar to comparable in-person programming. In sum, our mixed-methods analysis of Zoom Pals suggests that video chats are not only feasible but beneficial for both PWD in local care facilities and for undergraduate student volunteers. Clinical implications and guidelines for implementation, including outcomes measurement, will be discussed.
Learning Objectives:
At the completion of this activity, participants should be able to:
Describe the impact of social isolation on PWD
Describe the feasibility of virtual programming for PWD and summarize the critical components of successful service-learning programs
Propose feasible outcome measures for intergenerational service learning experiences