"'The Chitchatters': a leisure activity for people with dementia to stimulate social interaction" as presented at Medicine 2.0'10 in Maastricht

1. ‘The Chitchatters’: a leisure activity for people with
dementia to stimulate social interaction.
N. Nijhof Msc., dr. J.E.W.C.van Gemert-Pijnen, H. van Rijn Msc., dr. J. van Hoof, prof. dr. E.R.Seydel
30 november 2010
6-12-2010 Presentatietitel: aanpassen via 1
Beeld, Koptekst en voettekst

2. Introduce…
 PhD student University of Twente
www.eHealthresearchcentre.com
 Projectmanager Focus Cura
www.focuscura.nl
Research results ‘the Chitchatters’ 6-12-2010 2

3. Dementia worldwide
If dementia care were a country, it would be the world’s 18th largest
economy, ranking between Turkey and Indonesia.
If it were a company, it would be the world’s largest by annual
revenue exceeding Wal-Mart (US$414billion) and Exxon Mobil
(US$311 billion).1
1. Alzheimer’s Disease International. World Alzheimer Report, The Global impact of dementia, 2010

4. Dementia
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5. Use of leisure activities for people with dementia
 Use of technology innovative in leisure activities
 Use of technology focus on safety and monitoring for people with
dementia
 Scientific research shows us that leisure activities can support:
- make someone feel comfortable
- create social contact
- prevent boredom
- prevent isolation
- prevent agitation 1
1. Sterns HL, Camp CJ. Applied gerontechnology. Applied Psychology. 1998;47:175-198.

6. The Chitchatters (www.deklessebessers.nl)
Movie
http://www.klessebessers.nl/
?page_id=6
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7. Research question
How does the Chitchatters game
differentiate in terms of social interaction
compared to the Questiongame and are
their differences in behavior in relation to
the MMSE score?
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8. Research
Morning: Chitchatters (45 min) Afternoon: Questiongame (45 min)
(with technology) (without technology)
Social interaction
(Oshkosh Behavior Coding Scale)1
1. McFadden SH, Lunsman M, Andel R. Comparative analysis and interrater reliability of the Oshkosh
Social Behaviors Checklist (OSBC) for persons with dementia. Poster session presented at: the meeting
of the Gerontological Society of America; 2007 November; San Francisco, CA.

9. Study and Research design
 Study design
 4 different groups from 3 to 8 persons assisted by 1 or 2 activity therapists
 Games were played twice in period October and November 2009
 Research design
 Two researchers observed
 Video taped all the sessions
 Oshkosh: verbal/nonverbal/activism (category) and person-/other-initiated
(21 behavioral codes)
 Analyzed by SPSS 16.0; paired sample t-test (quantitative)
 Semi structured interviews 6 therapists (qualitative)
 Participants: N=21, 9 males, 12 females, Mean MMSE= 17, Range MMSE
3-28
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10. Method: Oshkosh (behavior scale)
 Verbal, non-verbal and activism
 Behavior; person initiated, therapist initiated and activity initiated
 21 codes:
- comments
- questions
- smiling
- touching
- sleeping
- wandering
- etc. -> cross the codes
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11. Method: Oshkosh
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12. Method: Oshkosh
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13. Results data analysis
Person level:
 Significant differences for 3 persons between games:
• Less handling objects for KB (p=0,049, MMSE=14; p=0,042,
MMSE=28)
• Less talking to self for KB (p=0,042, MMSE=14)
• Less sentences responses for KB (p=0,049, MMSE=3)
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14. Results data analysis
 Behavioral code differences between games:
• Less comments for KB (p=0,005)
• Less sentences responses for KB (p=0,000)
• More story responses for KB (p=0,011)
• Less questions for KB (p=0,028)
• Less sing/hum/whistle for KB (p=0,002)
• Less talking to self for KB (p=0,035)
• More observing/listening for KB (p=0,007)
• More wandering for KB (p=0,020)
• Less handling objects for KB (p=0,000)
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15. Results data analysis
 Behavioral category differences between games:
• Less verbalism for KB (p=0,000)
• Less activism for KB (p=0,000)
 Behavior initiated differences between games:
• Less person initiated for KB (p=0,043)
• Less activity therapist initiated for KB (p=0,005)
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16. Results data analysis
 MMSE differences for the Chitchatters:
MMSE <10 = low
• Less comments for low MMSE (p=0,028)
• Less story responses for low MMSE (p=0,0045)
• More fidgeting/rocking for low MMSE (p= 0,0045)
• More non verbal behavior for low MMSE (p=0,016)
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17. Results coding interviews
 Easy to use, sometimes checking ‘how it works’
 Supportive in work
 Supports interaction
 Lights aren’t noticed by the patients
 Choosing fragments is desirable
 Explanation fragments is desirable
 Hasn’t been used that much
 Teaching patient is necessary
 Unnatural not pointing out to object
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18. Conclusions
 The Chitchatters:
• stimulate more and more advanced conversations without distraction
• makes people more wandering during the game
• prompts communication
• supports activity therapists in their work
• stimulate especially for persons with high MMSE (>10)
• is easy to use and easy to understand
The Chitchatters is a suitable leisure activity to stimulate social
interaction, it supports activity therapist in their work, but the
content of the Chitchatters should be focused more on younger
people with dementia as well.
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19. Contact and questions?
Nienke Nijhof
n.nijhof@utwente.nl
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20. Discussion
Technology shouldn’t be used in leisure
activities for people with dementia, it
causes stress and agitation, cause
they’re not used to it.
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