The Volunteering-in-Place Program for Apathetic Assisted Living Residents with ADRD

ABSTRACT Apathy, defined as a reduction of self-generated voluntary and purposeful behaviors, affects approximately two thirds of adults with Alzheimer’s disease and related dementias (ADRD). Apathy is associated with increased disability, poorer quality of life and mortality among adults with ADRD. Apathetic adults with ADRD are also more likely to be sedentary for long periods of time, which results in declines in function, and has a negative impact on overall health and quality of life. The underlying mechanisms for apathy in ADRD include a disruption in the neurocircuitry in the prefrontal cortex plus an increased vulnerability to stressors. The stressors include patient factors (e.g. poor self-efficacy to engage, and loss of usefulness), caregiver knowledge and skills (e.g. ability to restructure complex activity into simple components) and social and physical environmental factors (e.g. lack of opportunities for meaningful activities, lack of rewards such as positive reinforcement). Engagement in volunteering benefits all adults including those with ADRD. However, such activities are rarely tailored to individual strengths and interests and are not designed to support engagement and completion for apathetic adults with ADRD. Our prior research has repeatedly shown that assisted living (AL) residents with ADRD are interested in volunteering, but they encounter challenges including: 1) lack of access to appropriate volunteer opportunities, 2) cognitive challenges that make it difficult to complete volunteer tasks without support, and 3) low self-efficacy to volunteer. We developed the Volunteering-in Place (VIP) Program to overcome the challenges to volunteering and create personalized volunteer activities available to AL residents with mild to moderate ADRD based on their abilities and interests. The VIP Program was conceptualized using the Social Ecological Model to address the stressors that contribute to apathy, and addresses intrapersonal (e.g., age, gender, cognition), interpersonal (e.g., self-efficacy based interactions between the resident and caregivers), institutional (policies and environments within the setting), and community factors (e.g., volunteer opportunities that can be done in the AL setting that benefit the community), that influence volunteering among AL residents. Social Cognitive Theory guides the interpersonal motivational approach to strengthen self-efficacy and outcome expectations. The purpose of this proposed pilot study is to test the preliminary efficacy of the VIP Program to improve apathy and decrease sedentary behavior. Additionally, we will test that the mechanisms underlying apathy are due to feelings of usefulness and self-efficacy to engage in volunteer activities. We will test the VIP Program in a cluster randomized controlled trial [VIP Program vs. time equivalent recreational activities (RA)] with 110 residents from 4 assisted living communities. The long-term goal of this research is to decrease apathy by increasing self-efficacy for volunteering and feelings of usefulness and decrease time spent in sedentary activity among apathetic older adults in AL living with ADRD.