Environmental effects on the assessment of people with dementia: a pilot study

The purpose of this pilot study was to use a standardized assessment of independent living skills to explore the effects of environment on functional performance of individuals with dementia.

Twelve participants (6 males, 6 females), diagnosed with dementia, were given the Structured Assessment of Independent Living Skills (SAILS), a standardized assessment of functional motor, cognitive, instrumental, and social performance. Participants were assessed in their homes, in an adult day-services facility they regularly attended, and in an occupational therapy clinic.

Data were analyzed using repeated measures analysis of variance (ANOVA). There was no evidence of a learning effect from repeated assessments. Participants' performances did not differ among the home, clinic, and adult day-services settings on the total SAILS score (F = 1.22; df = 2,20; p = 0.3176), nor on three of its subscales: cognitive score (F = 0.80; df = 2,20; p = 0.4648), instrumental activities (F = 1.37; df = 2,20; p = 0.2777), and social interaction (F = 0.34; df = 2,20; p = 0.7147). However, participants' performance on the SAILS motor score was significantly higher in the home than in the clinic (t = 2.925, df = 11, p = 0.0138). CONCLUSION. Participants' motor performance was significantly better at home than in an unfamiliar environment. Effects of environment on motor performance, and absence of effects on cognitive, instrumental, and social performances, can be explained through ecological theory. These results suggest that the ability to adapt movement to an unfamiliar environment may decline with the onset and progression of dementia.