Developing the Person–Environment Apathy Rating for persons with dementia

Abstract

Objectives: To develop the Person–Environment Apathy Rating (PEAR) scale that measures environmental stimulation and apathy in persons with dementia and to evaluate its psychometrics.

Method: The PEAR scale consists of the PEAR-Environment subscale and PEAR-Apathy subscales. The items were developed via literature review, field testing, expert review, and pilot testing. The construct validity and reliability were examined through video observation. The parent study enrolled 185 institutionalized residents with dementia. For this study, 96 videos were selected from 24 participants. The PEAR-Environment subscale was validated using the Ambiance Scale and the Crowding Index. The PEAR-Apathy subscale was validated using the Neuropsychiatric Inventory (NPI)-Apathy, Passivity in Dementia Scale (PDS), and NPI-Depression.

Results: The PEAR-Environment subscale and PEAR-Apathy subscales each consists of six items rated on a 1–4 scale. For validity, the Crowding Index slightly, yet significantly, correlated with the PEAR-Environment subscale total score and three of the individual scores. Ambiance Scale scores, both engaging and soothing, did not correlate with the PEAR-Environment subscale. The PEAR-Apathy highly correlated with the PDS and NPI-Apathy and moderately correlated with the NPI-Depression, suggesting good convergent validity and moderate discriminant validity. For reliability, both environment and apathy subscales demonstrated excellent internal consistency. Although facial expression and eye contact showed moderate inter-rater reliability, all other items showed good to excellent inter-rater and intra-rater reliability.

Conclusion: This study has successfully developed the PEAR scale and established its psychometrics based on the compatible scales available. The PEAR scale is the first scale that concurrently assesses apathy and environmental stimulation, and is recommended for use in persons with dementia.

Keywords:

• dementia and cognitive disorders
• Alzheimer's disease
• apathy
• neuropsychiatric symptom
• care environment

Acknowledgement

This work was supported by the Honor Society of Nursing, Sigma Theta Tau (STT) International and the STT Gamma Chapter (PI: Ying-Ling Jao). The parent study that provided the study sample and partial data for this study was funded by the National Institutes of Health (NIH)/National Institute of Nursing Research (NINR), Grant R01 NR04569 (PI: Donna L. Algase).

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

National Institutes of Health (NIH)/National Institute of Nursing Research (NINR) [Grant R01 NR04569] (PI: Donna L. Algase).