Promoting Health in Early-Stage Dementia Evaluation of a 12-Week Course

This project tested a 12-week health promotion course for older adults with early- stage dementia. In a quasi-experimental design, participants were assigned by site to intervention group or control group and evaluated at two time points. Mini- Mental State Examination scores, Geriatric Depression Scale scores, health behaviors, plus several measures of psychological well-being were used in this study. In the independent samples t-test analysis, significant positive change was found from pretest to posttest for the treatment group on cognition and depression. A chi square analysis found several significant positive differences in health behaviors for the treatment group

A therapeutic cooking program for older adults with dementia: Effects on agitation and apathy

Abstract: This study describes a clinical trial of a recreational therapy cooking program for older adults with dementia and disturbing behaviors living in an assisted living center. After two weeks of daily participation, results indicated a significant improvement in levels of both passivity and agitation. Biographical data collection was useful in identifying the physiological changes that occurred during each session. Implications for service delivery are included. Key words: therapeutic cooking program, agitation, apathy, dementia, Alzheimer's disease Article: Introduction Food-and the act of cooking-have powerful meaning to older adults. Food defines culture, family history, and traditions. For many, cooking signifies basic worth, self-image, and role identity. Food is also connected with feelings of love, pleasure and enjoyment, holidays, celebrations, family, and spirituality. The product of cooking may be regarded as something to share, as family recipes often have a history attached to them. In traditional cultures, cooking, as a practical art, is passed down from mothers and grandmothers to daughters and granddaughters with great pride. This ritual creates strong family relationship bonds. For most of today's older adults, the women in the family were traditionally the cooks and heads of the kitchen. The male cooking role took place outdoors during barbecues, camping, fishing, or hunting trips. Most older adults, both males and females, have fond memories of Mom's, Grandma's, or their spouse's home cooking. Social interactions and normalized experiences improve quality of life by providing individuals with opportunities to attain happiness, a sense of purpose, and a state of well-being. Recreational therapy experiences have been shown to relieve stress, improve physical function, reduce depression, and change behavior in older adults with dementia living in residential settings. 1 Older adults with dementia and disturbing behaviors who live in residential settings frequently have barriers to activities they performed in the past. Some of these barriers include functional, behavioral, and mobility impairments, 2 and a lack of individualized or adapted programs that address these limitations. For older adults with dementia in residential settings, the opportunity to cook or enjoy homemade foods is often limited. Cooking programs have the potential to calm, increase appetite, and entice people to a social gathering, and relieve some of the stress related to living in group settings. These programs provide familiar sensory stimulation with smells, textures, and taste. They also provide cognitive and physical stimulation. Cooking provides the opportunity to take pride in oneself and perform past roles. Providing individuals with cooking opportunities increases socialization as preparing and eating foods is the most social of all activities of daily living (ADLs) and is the glue of our social system. This article reports a study of a prescribed therapeutic cooking program for 12 older adults with dementia who resided in an assisted living center in Florida. Biographical data were collected on all participants, and treatment and control groups were examined for the effects of the therapeutic cooking program on disturbing behaviors

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We studied changes in apathy among 77 community-dwelling older persons with mild memory loss in a randomized clinical trial comparing two nonpharmacological interventions over four weeks. The study used a pre-post design with randomization by site to avoid contamination and diffusion of effect. Interventions were offered twice weekly after baseline evaluations were completed. The treatment group received classroom style mentally stimulating activities (MSAs) while the control group received a structured early-stage social support (SS) group. The results showed that the MSA group had significantly lower levels of apathy (P < .001) and significantly lower symptoms of depression (P < .001). While both groups improved on quality of life, the MSA group was significantly better (P = .02) than the SS group. Executive function was not significantly different for the two groups at four weeks, but general cognition improved for the MSA group and declined slightly for the SS group which produced a significant posttest difference (P < .001). Recruitment and retention of SS group members was difficult in this project, especially in senior center locations, while this was not the case for the MSA group. The examination of the data at this four-week time point shows promising results that the MSA intervention may provide a much needed method of reducing apathy and depressive symptoms, while motivating participation and increasing quality of life

The Iowa Homemaker vol.6 no.6

Table of Contents Christmas in Russia by Elsie Guthrie and Gayle Pugh, page 1 Fascination of Hand Weaving by Barbara Dewell, page 2 Cheese for the Holidays by Margaret Marnette, page 3 Do You Know Your Gas Stove by Grace Harribine, page 4 Southern Cooking and Northern Appetites by Linda Spence Brown, page 5 For that Cold Christmas Evening by Gertrude Brown, page 6 4-H Club, page 7 Iowa State Home Economics Association, page 8 Editorial, page 9 Who’s There and Where by Cleo Fitzsimmons, page 10 Omicron Nu Activities, page 12 The Eternal Question by Emily Jammer, page 14 Bargain Hunting in Persia, page 17 New Reference Books for Teachers, page 1

Activity calendars for older adults with dementia: What you see is not what you get

Abstract: This paper reports on a two-part study of nursing home recreation. In part one, a retrospective activity calendar and chart review was used in this comparative study of 107 long-term care residents with dementia. Data were collected and documented regarding demographics, cognitive and physical functioning, medications, activities listed on facility activity calendars, leisure preferences, and actual involvement in recreation over a two-week consecutive period during baseline. In part two, this information was compared to opportunities offered during a two-week clinical trial of recreational therapy. The results showed that, during baseline, almost 45 percent of the subjects in the sample received little or no facility activities, 20 percent received occasional activities, and 12 percent received daily activities but they were deemed inappropriate based on the functioning levels or interests of the residents. The clinical trial period demonstrated that small group recreational therapy was successful in engaging residents 84 percent of the time. Oct. 31, 2002, by the research staff Introduction Activities structure our lives and, for many older adults, provide a source of satisfaction and meaning. Research shows that activity patterns are highly individualized and based on our early leisure preferences, current abilities, and personality traits, 1 and are stable throughout adulthood

Impact of Underlying Depression on Treatment of Neuropsychiatric Symptoms in Older Adults with Dementia

This article examines the moderating effect of depression on interdisciplinary treatment approaches for behaviors in dementia. A secondary analysis of data collected on tailored treatment of 105 long-term care residents with dementia found a significant relationship between treatment and passivity (p < 0.001), treatment and agitation (p = 0.001), and the mediating effect of change in passivity on change in agitation (p < 0.001). The moderating effect of depression was found as a significant factor. For participants with depression and agitation, a significant change in passive behavior was related to significant change in agitated behavior. Thus, by focusing treatment on passivity, both types of neuropsychiatric behaviors improved. The implications of thoroughly assessing not only a behavior problem such as agitation but also other neuropsychiatric symptoms that complicate the delivery of the intervention are discussed

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Study protocol for the recreational stimulation for elders as a vehicle to resolve delirium superimposed on dementia (Reserve For DSD) trial

<p>Abstract</p> <p>Background</p> <p>Delirium is a state of confusion characterized by an acute and fluctuating decline in cognitive functioning. Delirium is common and deadly in older adults with dementia, and is often referred to as delirium superimposed on dementia, or DSD. Interventions that treat DSD are not well-developed because the mechanisms involved in its etiology are not completely understood. We have developed a theory-based intervention for DSD that is derived from the literature on cognitive reserve and based on our prior interdisciplinary work on delirium, recreational activities, and cognitive stimulation in people with dementia. Our preliminary work indicate that use of simple, cognitively stimulating activities may help resolve delirium by helping to focus inattention, the primary neuropsychological deficit in delirium. Our primary aim in this trial is to test the efficacy of Recreational Stimulation for Elders as a Vehicle to resolve DSD (RESERVE- DSD).</p> <p>Methods/Design</p> <p>This randomized repeated measures clinical trial will involve participants being recruited and enrolled at the time of admission to post acute care. We will randomize 256 subjects to intervention (RESERVE-DSD) or control (usual care). Intervention subjects will receive 30-minute sessions of tailored cognitively stimulating recreational activities for up to 30 days. We hypothesize that subjects who receive RESERVE-DSD will have: decreased severity and duration of delirium; greater gains in attention, orientation, memory, abstract thinking, and executive functioning; and greater gains in physical function compared to subjects with DSD who receive usual care. We will also evaluate potential moderators of intervention efficacy (lifetime of complex mental activities and APOE status). Our secondary aim is to describe the costs associated with RESERVE-DSD.</p> <p>Discussion</p> <p>Our theory-based intervention, which uses simple, inexpensive recreational activities for delivering cognitive stimulation, is innovative because, to our knowledge it has not been tested as a treatment for DSD. This novel intervention for DSD builds on our prior delirium, recreational activity and cognitive stimulation research, and draws support from cognitive reserve theory.</p> <p>Trial registration</p> <p>ClinicalTrials.gov identifier: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01267682">NCT01267682</a></p

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention