Tailored to Me: Adapting Preference Assessments to Make Them More Acceptable and Effective for People Living with Dementia

Abstract

For individuals living with dementia, meaningful engagement with preferred activities is a vital component in maintaining quality of life. It is important to provide individuals with dementia effective methods to support their decision making, to ensure they have access to preferred activities and that their environment is tailored to them. Preference assessments have been found to be effective for people living with dementia. However, most evidence based behavioural assessments, such as preference assessments, have been predominantly validated for individuals with intellectual or developmental disabilities. Therefore, there are likely aspects of the assessment that need to be adapted to better suit the needs of adults living with dementia. The current study aimed to explicitly measure aspects of the assessment that need to be taken into consideration. We asked behavioural practitioners to identify practice issues in conducting preference assessments with people living with dementia, and then empirically evaluated the standard and the adapted versions in an alternating treatments design. Adaptations were also designed with input from our participants with dementia and their carers. Our measures included, choice and engagement, direct observation of indices of affect and verbal behaviour, and indirect social validity questionnaires. Our results varied across participants, however, based on common themes, we were able to develop some prompts for professionals conducting these assessments in the future. These themes varied from changing the language used, incorporating social attention, and creating a more natural environment, to align more with the social rules common amongst this population. Through incorporating these adaptations into the assessment, we observed increases in social validity measures of happiness, as well as a decrease in confusion levels amongst some participants. Our findings support that determining what is going to be more acceptable or effective for someone is completely variable, however, our study provides a helpful guide of social rules and environmental contingencies that may make preference assessments more valuable for people with dementia.