Interventions
Engaging in actions and activities meaningful to the person is the motor that drives the nonpharmacological approach
A broad range of specific treatment techniques can be incorporated under this umbrella concept. People with dementia who spend long periods doing nothing—apathy—tend to experience more psychiatric symptoms, such as depression, anxiety, paranoia, delusions and hallucinations. For them, engaging in meaningful activities is not valuable merely because they fill time. They are valuable because they change negative emotions and promote feelings of purpose and accomplishment.
From another perspective, positive activities maintain connections between healthy neurons. Drawing on a person's remaining skills, success-oriented activities that focus on each individual's cognitive strengths, can slow the rate of decline of those skills. Such therapeutic activities also confront an unfortunate but persistent myth that because people with dementia and Alzheimer’s may not remember friends or initiate a relationship, they no longer need relationships or social interaction. In fact, as people lose friends, they increasingly need the social benefits that derive from relationships. Where some people living with dementia may not have been very sociable before, doing things in a group after they develop dementia can counteract feelings of alienation and isolation and support feelings of belonging and safety.
Such interventions can take on many shapes and forms. Each touches and engages the senses, activates brain locations in which memories and skills lie, and provides the person, carer and family with a vehicle upon which vital relationships can be built.
Harnessing people’s capabilities, reconnecting through creative activities and generating meaningful communication through self-expression all connect people with dementia to life. Music, painting, sculpture, comedy, drama, poetry, storytelling, movement, dancing, participation in cultural experiences in the community and environmental design all help to enhance the persons general sense of well-being, reduce the 4 “A”s of anxiety, agitation, aggression and apathy and improve quality of life.
Creative interventions
Using Acupressure and Montessori-Based Activities to Decrease Agitation for Residents with Dementia
learn moreAgitated behavior in cognitively impaired elderly people has generated considerable attention over the last 2 decades. Of particular interest is the effect of nonpharmacological intervention techniques such as acupressure, Montessori methods, and massage, which have all been used to manage agitation and increase relaxation in patients with dementia.1–8 Acupressure is a noninvasive variation of acupuncture involving constant pressure to stimulate meridians or acupoints of the human body to balance energy (qi), thus promoting individual well-being.
The objective of this trial is to explore the effectiveness of acupressure and Montessori-based activities in decreasing the agitated behaviors of residents with dementia.
Case Study: The ARTZ Museum Network, Massachusetts, United States
learn moreThe ARTZ Museum Network (AMN) was formed in 2007 with the goal of developing researchbased, dementia-specific access programming at museums and cultural institutions in Massachusetts and beyond. Funded through a generous grant from the McCance Family Foundation, the AMN seeks to enhance and improve the quality of life for people living with dementia and their care partners. The AMN has formed a coalition of seven Massachusetts museums,each of which has participated in the AMN sponsored six-month research pilot program, which followed with the AMN public opening in the Fall of 2008. The participating institutions include: the Peabody Essex Museum, Fuller-Craft Museum, DeCordova Museum & Sculpture Park, Museum of National Heritage, the Springfield Museums, Larz Anderson Auto Museum, and the Harvard Museum of Natural History in Cambridge.
The Funshops by John Killick
learn moreI ran Funshops in five day centres in Scotland during 2009 and 2010. Each group was made up of 8 or 9 persons with dementia (many belonging to a younger age group than is usual) and 2 to 3 members of the staff of Alzheimer Scotland Branches. I called them Funshops because they were workshops devoted to fun. Running them has been a steep learning curve for me. I begin with a brief analysis of the advantages of this kind of approach.
Funshops provide an opportunity for people to relax into a carefree state of mind. Time and again people say that they are freed up to say and do things spontaneously. It’s a relief to let go and enjoy the freedom within limits that the various exercises and sketches give them, and they also appreciate the opportunity to enjoy other people’s release of thoughts and feelings.
Group Poems and Stories
learn moreThese can be very satisfying activities for those who still have language and can contribute verbally. The poems or stories which emerge will, of course, not be as personal or consistent in terms of voice as those which emerge from a one-to-one, but there is the compensating quality of sharing in the creative experience. The difference between the two approaches is solely one of the differences between verse and prose, and there can be some overlap. And again, with the poetry, we are aiming for a free verse composition, only here the speech rhythms will be more various.
Poetry or Storytelling groups work best with six to ten participants. Any more would become unwieldy, and those with less verbal facility might find it difficult to make their contributions heard. Fewer than six participants puts too much of the spotlight on the individual. If this activity is taking place in a day centre, care home or hospital and some of the participants have more severe word-finding problems than others it is helpful to include some members of staff in the group on the understanding that they are there not to contribute themselves but to encourage others and act as intermediaries for those with language difficulties.
Old Lives Tale - Season of Mists and Mellow Fruitfulness
learn moreLately, I have been pondering Keats’s poem To Autumn, which opens with the venerable description of fall as a ‘‘Season of mists and mellow fruitfulness’’. By blending the soft, sorrowful language of the maturating season with imagery of ripening and fulfillment, Keats demonstrates the oppositional nature of aging, a process that gives even as it takes away. When it comes to dementia, our age-phobic culture dwells mostly on the ‘‘mists’’ of brain aging - its mental fogginess, drifting moods, and gathering decrements. Seldom do we allow ourselves to see through the melancholic mists and appreciate the subtle harvest of late life still ripening in aging older adults.
Last summer, I traveled from Cleveland, Ohio, to Oxford University in England to write up my doctoral research, which was based on a study at The Intergenerational School (TIS) in Cleveland, which serves 175 low-income children from the city and welcomes older community members as mentors. For this project, I had worked closely with eight residents of a local assisted living home called Judson Park - all with mild to moderate dementia - who volunteered as mentors once a week at TIS, reading with students and sharing their life histories through guided interviews. My aim was to evaluate whether the intergenerational volunteering experience would enhance quality of life for these folks.
Intergenerational Volunteering and Quality of Life for Persons With Mild to Moderate Dementia
learn moreDementia incidence is rising precipitously in industrialized nations and in low- and middleincome countries. In the absence of a powerful pharmacological treatment for age-related neuro- degeneration, there has emerged a renewed interest both in promoting quality of life (QOL) for persons with dementia and in developing nonpharmacological, psychosocial interventions that can postpone the onset and progression of dementia.
An immense volume of multicountry, retrospective studies have demonstrated the preventative effects that social engagement can have on incidence of dementia, and volunteering has been one form of engagement commonly associated with improved QOL outcomes in the elderly. A small but emerging evidence base has demonstrated that there may be a range of biopsychosocial benefits for older adults who form relationships with children through intergenerational volunteering programs. However, most existing data have largely been derived from cross-sectional and retrospective observational studies, and only a few intergenerational volunteering programs have been evaluated using randomized models.
There are, at present, no known studies that use a randomized design to evaluate the effects of intergenerational volunteer programs on QOL. This study reports the results of a 5-month intervention in Cleveland, OH, that evaluated whether a structured intergenerational volunteering program could enhance the QOL of persons with mild to moderate dementia by affecting five biopsychosocial variables that quantitative and qualitative studies have established as important markers for QOL in dementia: cognitive functioning, stress, depression, sense of purpose, and sense of usefulness.
Meet Me at the Movies…and Make Memories™ Interactive Film Program
learn more‘Meet Me at the Movies…and Make Memories’ (MMATM) is a replicable film‐based treatment program for people living with Alzheimer’s and related dementia. The therapeutic aim is to reduce symptoms through reminiscence, group discussion, and image recognition. MMATM is an ARTZ created program, but is done in collaboration with film institute’s and theatres. Since the program’s inception, ARTZ has primarily worked with the Tribeca Film Institute in New York
City (www.TribecaFilmInstitute.org) and the Coolidge Corner Theatre in Brookline, Massachusetts (www.Coolidge.org).
Both of these institutions are not‐for‐profit/charity organizations. In June of 2006, MMATM held its first public showing at the Tribeca Film Institute (TFI). Since then, ARTZ and the TFI hold an annual spring program. In 2009, ARTZ began a quarterly MMATM program with the Coolidge Corner Theatre. This quarterly program serves more than one thousand people living with dementia per year.
Neuropsychological rehabilitation in mild and moderate Alzheimer’s disease patients
learn moreSubstantial progress has been made in relation to neuropathology and diagnostic criteria of Alzheimer’s disease (AD) over the last decades and also regarding molecular biology, geriatrics and pharmacological treatment. Nevertheless, thousands of patients and their relatives across the world still have to learn how to overcome the difficulties that arise with the progression of the disease.
Recent studies suggested that the combination of Neuropsychological Rehabilitation (NR) or Cognitive Rehabilitation (CR) alongside medication could be more effective in treating AD than medication alone, and maybe this might be the most effectiveway of treating these patients. However, in spite of several accounts suggesting that rehabilitation is useful in treating patients with mild and moderate AD, there is insufficient scientific evidence in the literature from randomized controlled trials that have shown statistically significant results. Although some of these studies showed a slower decline or actual improvement on specific cognitive tests, the studies have not shown statistically significant benefits from the NR interventions.
The goal of this study is to report the effects of three different memory techniques and ADL training, in combination with medication in mildly to moderately impaired AD patients using three different intervention groups, all of which receive the same training but in different contexts.
Using spaced retrieval and Montessori-based activities in improving eating ability for residents with dementia
learn moreEating difficulty in dementia may involve impaired food transfer from the meal tray to the mouth, impaired transfer of food from the mouth into the stomach, or both. Once self-feeding is impaired, the patient becomes at risk for malnutrition and its sequelae. When self-feeding ceases altogether, the patient becomes dependent on the motivation,
commitment, and skill of caregivers for adequate nutrition and hydration. Maintaining the eating ability of patients with dementia is a major concern of health professionals, but only a few published training programs for nurses and nursing assistants focusing on feeding institutionalized residents with dementia exist. Moreover, the myth that patients with dementia cannot learn limits the training of patients with dementia to deal with their eating problems.
Spaced retrieval (SR) training is regarded as one method for patients with dementia that can enhance learning and retention of information by recalling that information over increasingly longer periods of time involves the use of well-learned processes and the unconscious, relatively effortless acquisition, and retrieval of new information. Several studies have reported the efficacy of SR in improving eating difficulties among patients with dementia. However, the few
studies about SR as a treatment for eating difficulty of patients with dementia were all limited in that they did not use an adequate sample size, had no control group, no assessor blinding, no statistical comparison between pre- and post intervention, no standardized protocol, and/or no objective outcome measure to reflect improvement in eating difficulty, such as self-eating ability and nutritional status.
The TimeSlips™ creative storytelling process
learn moreTimeSlips is an evidence-based creative storytelling method that opens storytelling to everyone by replacing the pressure to remember with encouragement to imagine. Since its inception in 1998, TimeSlips has become a way for people to grow and connect across the challenges of cognitive disability. TimeSlips is currently based at the University of Wisconsin-Milwaukee’s Center on Age & Community.
Environmental design
Applying evidence to practice: Australian initiatives
learn moreWhile the ageing of the Australian population lags a little behind the demographic changes that are taking place in Europe, Australia still faces the challenge of a rapidly increasing number of people with dementia. It is estimated that there will be three times as many people with dementia in 2040 than there was in 2010.
The New South Wales and Australian Capital Territory Dementia Training Study Centre, NSW/ACT DTSC or the Centre as we usually call it, is one of five centres established by the Australian Government to improve the quality of care and support provided to these people. The main foci for all centres is the education of the dementia care workforce and the transfer of knowledge into practice.
The Dementia Design Audit Tool
learn moreOver the last six years, the Dementia Services Development Centre (DSDC) at the University of Stirling, has developed and used a Dementia Design Audit Tool. This aims improve the awareness of dementia friendly design and to promote good examples. It is designed for both health and social care premises. The audit tool can serve as a checklist for architects, commissioners, owners and any others concerned to make buildings more dementia friendly. It also provides a means of assessing the extent to which a building is dementia friendly.
Gradmann House, Stuttgart-Kaltental
learn moreThe Gradmann House in Stuttgart-Kaltental combines a variety of services for the elderly. It offers a community meeting point and assisted living for the elderly as well as long-term care, respite care and day-care for people with dementia. The facility is designed according to the village street concept: the one-storied gazebos for longterm care and the three-storied building with day-care and assisted living are situated along the inner street, a glass-roofed promenade. This facilitates legibility and orientation.
The center is particularly suited to the needs of mobile persons with medium to severe dementia. For this group, a Special Care Unit is considered necessary since behavioral problems and a lack of well-being could be a result of a traditional ward environment. The milieutherapy concept was the main guideline for planning and design; the approach rests on the premise that a milieu that is socially, organizationally and physically suitable for dementia is a decisive factor for the quality of life of people with dementia.
Design of the Living Arrangements for people with Dementia (LAD)-study
learn moreThis manuscript describes the design of the Living Arrangements for people with Dementia study (LAD-study). The aim of this study is to include living arrangements from every part of this spectrum, ranging from large scale nursing homes to small group living homes. The LAD-study exists of quantitative and qualitative research.
Primary outcomes of the quantitative study are wellbeing of care staff, quality of care and quality of life of residents. Furthermore, data concerning staff ratio and characteristics of the living arrangements such as group living home care characteristics are assessed. To get more in-depth insight into the barriers and facilitators in living arrangements for people with dementia to provide good care, focus groups and Dementia Care Mapping are carried out.
Technology
An intervention study with assistive technology
learn moreIn Norway, approximately 70.000 people suffer from dementia, and more than 30.000 live at home. Family carers; mainly spouses and children, experience an increasing responsibility as the dementia progress, and before transition to a nursing home is inevitable.
Usually, it takes a couple of years from the first symptoms manifest until a dementia diagnosis is a fact. Many will continue to live at home, but will, as time goes by, need increasing support in one way or another. The spouses are often the main supporting person. In this situation, many may benefit from assistive technology (AT). Earlier research projects have demonstrated that AT has the potential to support persons with dementia and their carers; Enabling Technologies for persons with dementia, Dementia and technology in the Nordic countries, Middleware Platform for eMPOWERing cognitively disabled and elderly, are some of them.
The proportion of older people is increasing, and more older people will live alone due to widowhood or changed family patterns (Statistics Norway). The prevalence of dementia increases age, and is one of the most important risk factors that require permanent supervision and care. Also, the number of people in the work stock is expected to be reduced in the future, compared to today . As a consequence, family carers will get a bigger responsibility for support and care for old and frail family members than they have today. Assistive technology may be one way of supporting the care.
Older people with and without dementia participating in the development of an individual plan with digital calendar and message board
learn moreThe EU-funded project 'Middleware Platform for eMPOWERing older people and people with cognitive impairments - MPOWER' is aimed at developing a technical middleware platform that enables rapid development of flexible, domain-specific applications that can be personalised for individual use. We focused on creating a set of reusable components that can easily be combined in order to provide the most relevant services in the user's home, ego calendar services, messaging services and different sensor technologies. In order to evaluate the feasibility of the platform, two full-scale proof of concept applications (POCAs) were developed and deployed to real-life environments; one 'smart home' solution in Poland and one individual internet-based digital plan in Norway. This paper presents the findings from the POCA development and trial in Norway.
Seven older people and their family carers from the municipality of Trondheim participated in the pilot trial (February 2008-April 2009), which aimed to evaluate the services provided through an individual internet-based digital plan displayed as a calendar page. Both family carers and staff from domiciliary services could, from their home computer, add appointments and messages on the user's digital calendar. The respondents were five women and two men, aged between 65 and 92, and only three of them, the two men and one of the women, had used a computer before getting involved in the MPOWER trial. Data collection regarding use, usability, utility and acceptance took place on a regular basis after a preset schedule. Analysis followed the developmental evaluation theory, which is useful when there is uncertainty about the effects (value) of an intervention, and when it is uncertain what causes or influences these effects.
Results were presented as case histories, and the analysis of the causes of the observed effects are presented in a discussion section and divided into personal, technical and structural issues.
The main conclusion is that the digital calendar with a message board demonstrated the potential to support older people at home, particularly older people with memory problems who need support in structuring the day and keeping an overview of their daily activities and appointments.
The use of augmented reality to annotate the living environment of people suffering from dementia
learn moreThe Ambient Notification System (ANS) uses video-based augmented reality to assist persons suffering from memory impairments. The system allows caregivers to create text-based or auditory tags by selecting objects from images captured in the home of the patient. A mobile phone, worn by the user, captures images that are sent to a server to identify tags. Once a tag is located, the user is notified of its presence through an audio cue or vibration.
There are a number of strategies that AD patients and their caregivers adopt to maintain their executive functions and independence. Placing paper tags in the home of patients with dementia is a strategy recommended to help the patient navigate the environment. For instance, the National Institute of Health in the US, include, in its list of recommendations for home safety for people with AD, placing signs such as “DO NOT TOUCH”, in potentially hot appliances such as the oven or coffee maker, or placing pictures on doors of important rooms to simplify their identification. Other adaptations to the physical environment include removing cabinet doors or placing transparent plastic on drawer files to make items visible.
The Ambient Notification System aims at assiting caregivers to create textual or auditory tags on objects from images captured at the home of the person suffering from dementia. The person, for whom the tag was created, wears a mobile phone, with the camera pointing in his line of sight, which records images that are matched with a collection of photographs taken apriory. Once an object is discovered an audio, vibration or visual cue is given to the user who can then read the tag for that object on the screen of the mobile phone, or listen to the audio note left by the caregiver. The Ambient Notification System (ANS) has two main components, the Tag Manager, used by the caregiver, and the Mobile Notification System, used by the person suffering from dementia.
Technology Studies to Meet the Needs of People With Dementia and Their Caregivers
learn moreThe aim of this article is to present the findings of a review of studies that focused on technology supporting people with dementia and their caregivers. A literature search was carried out in eight scientific literature databases covering literature published between January 1992 and February 2007. A total of 46 studies providing original data and one review were included in this review. Analyses covered the aims of the studies, the technology used, study design, methods, outcome variables, and results.
Most studies were carried out in residential care and focused on the needs of formal caregivers. Only a few studies involved people with dementia actively using the technology. The studies are difficult to compare because of the large variety of aims, technologies, design, and outcome measurements. There is a need for more research in this area, in particular, with people who have a mild stage dementia living in the community.
Evaluation of a time aid for people with dementia
learn moreAs dementia progresses problems in distinguishing and perceiving dates, days of the week, and the time of day becomes more difficult. As a consequence the person with dementia can become more disorientated in time, missing appointments, doing things on the wrong day or at the wrong time, or they may begin to feel insecure with time. We carried out an assessment trial in which 50 persons with dementia tested automatic Night and Day calendars (NDC) at home in Lithuania, Norway, Ireland, the United Kingdom and Finland over one year.
The aim of testing the NDC was to help people with dementia with time orientation. Aims of this study were to find out how persons with dementia and their family carers describe time disorientation; what coping mechanisms, if any, they had implement to combat this; what were their expectations of the time-aid; how the time-aid was used; and did they find it useful.
Findings from the first three months show that most respondents with dementia used the NDC and found it useful as did their carers. Our conclusion is that it is possible to compensate for problems in time orientation by using an assistive aid. However a thorough assessment of individual and family needs is required, fitting the technology around these needs. Usefulness of the time-aid is also dependent on the motivation of individuals to use the device.
A pilot study on the use of tracking technology
learn moreA significant problem faced by people in early stages of dementia is getting lost while they are outside alone. A survey showed that 43% of people with dementia had been lost at some point. Most lost persons were quickly found. However, 28% of them had been lost on more than five occasions and 14% had been lost for six or more hours on at least one occasion. This substantially increases the risk for involvement in dangerous situations or even death. Finally, research shows that in people with dementia, those who often get lost are much more likely to be placed in nursing homes.
Caregivers of people with dementia are keenly aware of the risks and consequences of disorientation and getting lost. Specifically, knowing that a care receiver with dementia may get lost is an independent stressor, an extra burden for the caregiver, leading to the onset of symptoms such as depression and/or anxiety. At the moment, regular ways to cope with these problems are providing permanent supervision, psychotropic drugs or restraints reducing the mobility of the person with dementia. Reduced mobility particularly affects the person’s autonomy, self esteem and well-being, and all important aspects of quality of life.
Caregivers and clinicians are confronted with the dilemma of balancing the tendency to get lost with the need for autonomy. To this end, newly available technology may be helpful in allowing the person with dementia to go outside independently while the caregiver is able to monitor his or her location. Several tracking and communication devices designed to support people with dementia and their caregivers are available.
One of the most promising devices is the ‘Global Positioning System’ (GPS). The GPS was initially developed for the US Army. Through contact with satellites at high altitude, the system can quickly determine the position of a transmitter box which is carried by the individual. Given the frequent recurrence of the positioning, the system can track the person carrying the transmitter box with minimal margin of error.
Others
The Affective Bond after Institutionalization of the Elderly - Brazil
learn moreConsidering the family as a source of intergenerational care, the decision to institutionalize the elderly is usually a hard one to be taken, because the common prevailing stereotype it that asylum is due to the family’s disinterest.
The results of this study indicated high frequency of visitors per resident in the institution. Through this study it was concluded that when the ILPI promotes the link between a resident and family by adopting inclusive conduct rather than restrictive conduct, ensuring a partnership with the family in caring for the elderly, the affective relationship between those involved can be maintained or can even improve after the admission of elderly at the institution.
Rehabilitative biopsychosocial models
learn moreThe Don Carlo Gnocchi Foundation is a non-lucrative organization devoted to rehabilitation of children, adults and elderly people affected by chronic diseases. It was founded by a person (a catholic clergyman) who first in Italy understood the fundamental role of rehabilitation in recovering a social role and dignity for people living with disabling diseases. In the founder vision, science and love had to be merged in helping “the struggle for life”. The Don Gnocchi Foundation has 28 centers in Italy, and a few centers in developing countries. Our center is a Clinical Research Hospital located in Milan, the more important Italian city from the economic point of view. Our operational group is formed by behavioral neurologists who have been working in the field of dementia from many years (I prefer do not detail how many years…), neuropsychologists and rehabilitation therapists. We deal mostly with ambulatory people in the first and middle phases of dementia.
We began working in the domain of Nonpharmacological Therapies in Alzheimer’s disease in the latest nineties. At that time knowledge in this field was very poor, and only a few professionals in Italy were interested in the domain. Skepticism was high, above all in the medical world. But at the same time, neuropsychological and cognitive psychology studies had started showing that people with Alzheimer’s were still having learning capabilities, and- if put in a facilitating and stimulating condition and milieu- they were able to perform meaningful, creative activities taking pleasure from them. This was even truer for people in the mild-moderate phase we usually treat. Our first study was inspired to an Italian seminal work by Orazio Zanetti’s group showing that Alzheimer’s people improved their performance in activities of daily living with training, thanks to conservation of procedural memory. We first treated patients individually but we quickly realized that socialization was fundamental and as an added value for obtaining positive results and making people happy and participating. Therefore we soon opted for a group therapy. The group therapy invites to confrontation with other people, so that Alzheimer’s persons become aware of their possibilities and limits. It also recreates a real social life so that the excess of disability due to isolation is suppressed.
Peter Pan: Play therapy for patients with moderate dementia
learn morePeter Pan is a cognitive training program promoting functional, cognitive and kinetic enhancement. It can be either directed or not directed and is applied in groups of patients with moderate dementia.
The game is a mean for education, therapy and entertainment not only for children but also for adults. Many researchers have shown correlation between playing and cognitive ability. The game and the related creativity can constitute an effective tool for the practice of cognitive abilities.
Relaxation techniques with multisensory stimuli
learn moreThe program “relaxation techniques with multisensory stimuli” takes place once per week for 1 hour and a half and the groups are consisted of both men and women. The groups are formed of persons who have similar results in the neuropsychological tests.
The session begins with relaxation techniques that last approximately 20 to 30 minutes. The participants sit comfortably while they relax one by one all body parts according to the guidelines given by the psychologist. The neuromuscular relaxation is accompanied with relaxing music, orchestral music or sounds of the nature. The relaxation part is over with a brief feedback of the participants concerning how much they relaxed each day and the difficulties they may have met.
