Induced disability in nursing home patients: a controlled trial

Many performance deficits observed in institutionalized elderly patients may be the results of social and environmental factors rather than disease or the aging process. To test this hypothesis, 72 nursing home residents (mean age, 78 years) were randomly assigned to three groups for training in completion of a simple psychomotor task. In four training sessions, members of Group I ("helped") were given extensive assistance in completing the task; members of Group II ("encouraged only") were given verbal encouragement but minimal assistance; members of Group III ("no contact") received no training sessions and served as controls. All subjects were tested on proficiency in completion of the task (a simple jigsaw puzzle) before and after the intervention period. Completeness of performance by Group II improved during the study, but that of Group I deteriorated significantly (P = 0.04 between groups) to a level even below that of the control group (P = 0.03). Similar differences were found in speed of performance, with Group II performing best, Group I performing worst (P = 0.05), and the control group performing intermediately. Perception of task difficulty was greater (P = 0.02) and self-confidence was less (P = 0.06) for Group I than for Group II. The psychosocial environment of long-term facilities can have important effects on the competence of elderly patients. Excessive infantilization of residents and overly intrusive help in self-care beyond clinical requirements can lead to "learned helplessness," with further disability.