Apathy is a prevalent neurobehavioral symptom of dementia. Increasing evidence supports the influence of environments on dementia. Yet, how environments impact apathy is understudied. This study examined the association between environmental stimulation and apathy in nursing home residents with dementia. The study was guided by the Need-Driven Dementia-Compromised Behavior Model, which identifies the link between environments and neurobehavioral symptoms in dementia. This repeated measures study analyzed 104 video observations of staff-resident interactions in 12 nursing homes. Second-by-second behavioral coding using Noldus Observer software was conducted to assess apathy and environmental stimulation, using the Person-Environment Apathy Rating scale. The environment subscale includes six items: stimulation clarity, stimulation strength, stimulation specificity, interaction involvement, physical accessibility, and environmental feedback. The apathy subscale includes six items: facial expression, eye contact, physical engagement, purposeful activity, verbal tone, and verbal expression. Multilevel linear models were used for analysis. The video observations included 63 dyads that included 42 staff and 44 residents with moderate to severe dementia. Results showed that apathy was not associated the overall quality of environmental stimulation but was significantly associated with stimulation specificity (β=-2.22, P=.049) and environmental feedback (β=-2.14, P=.001). After controlling for resident age, gender, dementia stage, and functional level, apathy remained associated with environmental feedback (β=-1.59, P=.019). Findings reveal that when environmental stimulation is tailored to the individual and prompts engagement, residents show less apathy. This study highlights the importance of environmental stimulation on apathy. Future research should explore interventions that modify environmental stimulation to reduce apathy and improve dementia care.
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