Evidence-Based Practice Guideline: Wheelchair Biking for the Treatment of Depression

The purpose of this evidence-based practice guideline is to describe a specific recreational therapy program, wheelchair biking, for the treatment of depression in older adults with and without cognitive impairment. The goal of the guideline is to reduce depressive mood in older adults and to provide a complementary or alternative treatment to medications

Cognitive Stimulation for Apathy in Probable Early-Stage Alzheimer’s

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

Sensory and Nurturing Nonpharmacological Interventions for Behavioral and Psychological Symptoms of Dementia

This article is part three of a four-part series addressing the use of nonpharmacological interventions in place of or in conjunction with psychotropic medications in older adults with cognitive impairment. Acquiring a better understanding of the mechanics for how each intervention works makes selection of an intervention easier at the time it is needed. Selection of the appropriate nonpharmacological intervention is based on person-centered care and how to adapt and implement it for each individual. Selection also depends on target behavior, behavior triggers, and the physical and cognitive functioning of the individual with the behavioral and psychological symptoms of dementia. Nonpharmacological interventions can be implemented by all staff members, not just recreational and activity personnel. The Centers for Medicare & Medicaid Services initiative would like to see all staff involved with these interventions, which can be implemented on the spot, as they are needed, to prevent, reduce, or stop a particular behavior. The current article will describe sensory and nurturing interventions, present the evidence supporting their use, and provide information on effective implementation

Non-Pharmacological Interventions in Long-term care: Feasibility and Recent Trends

Numerous studies have found excessive or in appropriate use of antipsychotic drugs in nursing home patients with cognitive impairment or perceived behavioral issues. Inappropriately medicating this vulnerable population can lead to several negative outcomes, including failure to have needs met, injury, illness, and even death. In response to recent literature and government reports highlighting this issue, in 2012, the Centers for Medicare and Medicaid Services (CMS) launched an initiative called the National Partnership to Improve Dementia Care. This article discusses the CMS initiative, as well as the feasibility and recent trends in the use of nonpharmacological interventions that could be implemented when working with patients with cognitive impairment and behavioral and psychological symptoms associated with dementia

The Role of Therapeutic Use of Self in the Application of Non Pharmacological Interventions

The Centers for Medicare and Medicaid Services launched a new initiative aimed at improving behavioral health and safeguarding older adults residing in nursing homes from unnecessary antipsychotic drug use. This article is part two of a four-part series on how caregivers working with older adults can implement nonpharmacological interventions. Many different types of nonpharmacological interventions exist, including staff techniques, communication skills, the identification of basic and medical needs, and actual activities, which may be performed alone, one-on-one, or in small groups. To implement nonpharmacological interventions, a trusting relationship must be established. What is done, what is not done, and how one behaves can all precipitate or prevent agitation, anxiety, depression, and apathy in older adults. This article will address the trusting relationship concept that must be actualized for nonpharmacological interventions to be successful

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

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

Animal-Assisted Therapy for Clients with Dementia: Nurses’ Role

The purpose of this article is to increase nurses’ awareness of animal-assisted therapy as a treatment option for older adults with dementia. We describe the differences between animal visitation programs and goal-directed therapy. We also address credentials of human-animal teams and provide an overview of possible therapeutic outcomes for older adults with dementia. Step-by-step methods are outlined for nurses to advocate for clients with dementia to receive these services

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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

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