Project Summary/Abstract This K23 application describes the background and experience of the applicant, Justine S. Sefcik, PhD, RN. It details her plan to acquire the training necessary to achieve her long-term goal to be an independent investigator developing and testing adaptive, non-pharmacological environmental and sensory interventions involving technology to reduce persistent vocalizations (PVs), a common behavioral and psychological symptom of dementia. PVs refer to vocal sounds or inappropriate use of words which are repetitive, persistent, and are upsetting to persons exhibiting them or to others in the same environment. There are known profound negative effects to persons residing in nursing homes (NH) living with dementia and exhibiting PVs, including physical exhaustion, reduced quality of life, and some NH staff using inappropriate interventions (e.g., administering chemical restraints). Unmet needs, such as a need for sensory stimulation and engagement in meaningful activities, may be a contributor to PVs, according to the Need-driven Dementia-compromised Behavior model. Innovative non-pharmacological interventions are urgently needed to reduce PVs. This proposal includes a new application of a nature-based intervention that includes the projection of person- centered nature images with the playing of associated nature sounds for NH residents with dementia and PVs. The intervention, Environmental And Sensory Experience (EASE), was designed based on evidence that engaging with nature elements is a meaningful activity, has a calming effect, and contributes to better moods in people with dementia. Participants (n = 32) will wear a wrist sensor collecting heart rate and electrodermal activity (measures of stress) and be observed 30 minutes prior to-, 30 minutes during-, and 30 minutes immediately after the EASE. The research aims are to: 1) Examine the feasibility and preliminary efficacy of EASE to reduce PVs among NH residents; 2) Evaluate the staff perception of the acceptability of EASE within 48 hours post-intervention, and 3) Examine the mechanism of action of EASE. In the short term, this proposal will allow Dr. Sefcik to: 1) build on her dissertation focused on NH residents with dementia and PVs; 2) gain new skills with behavioral intervention research; and 3) obtain NIH Phase 1 clinical trial data to determine preliminary efficacy of the EASE. The specific training objectives within this application include: 1) Develop skills in designing and implementing tailored, person-centered environmental and sensory behavioral interventions for clinical trials; 2) Acquire skills in biobehavioral measurement, analysis, and dissemination of clinical trial research; and 3) Examine the role of technology for environmental and sensory intervention approaches and measurement for clinical trial research. The University of Pennsylvania is a research-intensive environment with rich resources that will facilitate Dr. Sefcik’s development. This proposal aligns with NINR’s strategic mission to build evidence toward successful symptom management and will be foundational for a R- level submission that will build on these study findings and evaluate the effectiveness of the EASE.

Project Narrative Persistent vocalizations, a common behavioral and psychological symptom of dementia, exhibited by nursing home residents with dementia represents a significant public health burden in terms of negative effects experienced by the person exhibiting this behavior and the distress experienced by staff, other residents, and family members witnessing the behavior. This research is designed to test a behavioral intervention that incorporates the use of projected nature images and the playing of associated nature sounds as a cost- effective solution to potentially reduce persistent vocalizations. The findings of this research will inform a future, larger scale clinical trial to evaluate the effectiveness of this theory based, low-cost, person-centered Environmental And Sensory Experience (EASE) intervention which has the potential to increase quality of life for residents with dementia and PVs and promote a more therapeutic nursing home environment.