Availability and Maintenance of Preferences of Older Adults With Dementia

Abstract

Individuals with neurocognitive impairment may have serious difficulties verbalizing their preferences for activities or objects. Additionally, institutional settings may provide little stimulation for expressing these preferences. Therefore, the objective of this study was to evaluate 1) the effectiveness of paired-stimulus preference assessment in providing a hierarchy of preferences for older adults with cognitive impairment living in long-term care, and 2) the maintenance of preferences after one and four months based on the initial hierarchy of interests. The study included six participants, with an average age of 81.5 years. The preference assessment implemented was paired-stimulus assessment, which consists of the simultaneous presentation of two items for the individual to choose one. Regarding the procedure, participants were initially selected (Phase 1), followed by the selection of items/ stimuli for preference assessment (Phase 2). Finally, the preference assessment itself was performed (Phase 3). Further assessments were conducted one month and four months after the initial assessment (Phase 4) to verify preference maintenance/ stability. Overall, the assessment of paired stimulus preferences produced an initial hierarchy of preferences for each participant. Furthermore, observing subsequent assessments reveals variability in participant preferences, with items that were not chosen in the initial assessment being chosen in subsequent assessments, and items that decreased in frequency of choice throughout the assessments; the exception was participants P1, P4, and P5, whose most preferred items remained the same throughout all assessments. These data contribute to the literature in this field by demonstrating that preference assessments applied to older adults with different economic, social, and cultural profiles, among others, can also provide a hierarchy of preferences. Furthermore, as a general shift in participants’ hierarchy of interests is observed, it is clear that preference assessments need to be conducted more frequently to identify their true interests. Finally, it is concluded that conducting preference assessments helps to include both older adults with cognitive impairment and those with developmental delays and verbal limitations in the hierarchy of their preferences, and this action promotes autonomy and dignity for these individuals.