Nancy E. Richeson

Effects of animal-assisted therapy on agitated behaviors and social interactions of older adults with dementia

The effects of a therapeutic recreation intervention using animal-assisted therapy (AAT) on the agitated behaviors and social interactions of older adults with dementia were examined using the Cohen-Mansfield Agitation Inventory and the Animal-Assisted Therapy Flow Sheet. In a pilot study, 15 nursing home residents with dementia participated in a daily AAT intervention for three weeks. Results showed statistically significant decreases in agitated behaviors and a statistically significant increase in social interaction pretest to post-test.

Evidence supporting nutritional interventions for persons in early stage Alzheimer's disease (AD)

The purpose of this paper is to grade research evidence supporting nutritional interventions for persons with early stage dementias and to report the recommendations of a consensus panel. Thirty four studies were reviewed in the areas of dietary restriction, antioxidants, and Mediterranean diet with strong support from epidemiological studies found in all three areas. The body of evidence to support nutritional interventions in the prevention and treatment of AD is growing and has potential as a treatment modality following translational studies.

Cognitive Training for Early-Stage Alzheimer's Disease and Dementia

The purpose of this article is to critically review and synthesize the literature on the effects of nonpharmacological cognitive training on dementia symptoms in early-stage Alzheimers disease (AD) and related dementia. Electronic databases MEDLINE (PubMed), CINAHL, PsycInfo, and the Cochrane Library were searched using the keywords cognition, reality orientation, Alzheimers disease, psychosocial factors, cognitive therapy, brain plasticity, enriched environments, and memory training. The findings support that cognitive training improves cognition, activities of daily living, and decision making. Interventions are more effective if they are structured and focus on specific known losses related to the AD pathological process and a persons residual ability, or are combined with cognitive-enhancing medications. Nursing implications are also discussed.

Effects of a Pedometer-Based Physical Activity Program on Older Adults' Mobility-Related Self-Efficacy and Physical Performance

Abstract The purpose of this pilot study was to examine the influence of a pedometer-based intervention on physical activity and functional status in older adults (M = 80 years old). The sample (N = 15) was randomly assigned to an experimental or control group. The pre-and posttest measures included the Physical Activity Scale for the Elderly, the Physical Performance Battery, the Mobility-Related Self-Efficacy Scale, and a 7-day pedometer assessment. The 4-week intervention consisted of weekly counseling sessions and pedometer assessments. The data were analyzed using a t-test for independent samples and a repeated measures ANCOVA. There were no significant differences between the groups. However, a serendipitous finding was an improvement in all measures for the control group.

Education for Older Adults with Early-Stage Dementia: Health Promotion for the Mind, Body, and Spirit.

The purpose of this study was to examine the effects of a 13-week adult education class for older adults with early-stage dementia titled Health Promotion for the Mind, Body, and Spirit. The mixed method research design (N = 14) used a quasiexperimental one-group pretest/posttest and the qualitative methods of focus group and phone interview with caregivers. Pre and posttest measures included the Mini-Mental State Exam, Geriatric Depression Scale–Short Form, and the General Perceived Self-Efficacy Scale. There were significant changes in general perceived self-efficacy scores and a reported increase in “growth through confidence” from the participants and caregivers. Age range of the participants was 67 to 89 years of age (M = 78.8, SD = 5.9) The course was theoretically driven by the Corbin and Strauss Trajectory Model for Chronic Illness Management (Corbin & Strauss, 1991). The study highlights the inclusion of an adult education course for people with early stage dementia as part of the Osher Life Long Learning Institute (OLLI) at the University of Southern Maine.

Using pedometers as a strategy to increase the daily steps of older adults with chronic illness: from research to practice.

A. J., a 75-year-old widow living independently in her own downtown apartment, appears very discouraged when the home health clinician encourages her to get more “exercise.” A.J. knows that more “exercise” would benefit her diabetes, arthritis, and now coronary artery disease, but she exclaims that she does not know where to start. In addition, she admits that she has always “hated” exercise. “I am a hopeless case,” she sighs and begins to cry. The clinician shares his patients frustration and thinks that there must be a better way to reach older adults with chronic illness who need to increase their physical activity levels. What can he do to help his older client increase her levels of physical activity?

A brief review of loneliness: Correlates, consequences, and considerations for recreational therapists

Loneliness is a complex human experience that most people experience in their lifetimes. The authors review how the construct of loneliness is defined and how it is distinguished from the concept of social isolation. Common risk factors that predict loneliness such as gender, marital status, and age are discussed. Potential consequences for people who are lonely can be emotional, physical, and cognitive. Research on these functional outcomes is reviewed. Because loneliness is a prevalent human experience, recreational therapists are likely to encounter individuals who may be dealing with loneliness. The authors discuss how recreational therapists can use this information in clinical practice.

Geriatric, Ethics, and Palliative Care: Tending to the Mind & Spirit

The purpose of this paper was to examine the outcomes from the William Randolph Hearst Scholars Program (HSP) conducted at Maine Medical Center, Portland, Maine from September 2005 to September 2006. The HSP was an interdisciplinary (nursing, rehabilitation therapies, social work, clergy, pharmacy, physicians, respiratory therapy, physicians assistant) educational opportunity (12 months, 50 hours of education) with the goal of improving the quality of care for older adults in an acute care medical setting. The focus group participants (21 out of 39 Hearst Scholars) participated in a 1.5-hour focus group immediately following completion of the program. After analyzing the data, the results revealed an overarching theme of empowerment in four specific topical areas: knowledge, connection, barriers, and hopeful trends, with specific themes emerging from each topic. This demonstrated the importance of the HSP for the participants.

Book review: Dementia Practice Guidelines for Treating Disturbing Behaviors

The disturbing behaviors associated with dementia are a significant problem for older adults, their families, and their caregivers. By the year 2050, the incidence of dementia in the US is expected to climb to 14 million, according to the Alzheimer’s Association. The associated rise in disturbing behaviors will further affect the afflicted’s interpersonal relationships and quality of life, as well as opportunities to experience leisure. Dementia Practice Guidelines for Treating Disturbing Behaviors, a 400-page document, provides a long overdue systematic approach that will help recreational therapists treat these disturbing behaviors. The authors’ focus on the importance of including the best available evidence when formatting treatment decisions distinguishes this text from previous approaches to treatment in recreational therapy. The foundation of the dementia practice guidelines (DPG) is the merging of the Need-Driven DementiaCompromised Behavior (NDB) model and the Neurodevelopmental Sequencing Theory of Prescription (NDSP). The NDB model suggests that the disturbing behaviors of persons with dementia are not a symptom of the disease but rather an unmet need. The NDSP, developed by Buettner in the 1980s, is a comprehensive approach for treating the disturbing behaviors of frail older adults with dementia. While the Omnibus Budget Reconciliation Act of 1987 has long promoted a nonpharmacologic approach to treatment, little has been done to promote alternative treatment interventions. The DPG promotes recreational therapy as the first line of defense, ahead of prescribed psychoactive medication, with its negative side effects. The section on recreational therapy outlines the 10 steps in treating disturbing behaviors, referencing them with appendix materials such as behavior checklists, physician order forms, and evaluation materials. The tools provided in the appendices will ensure a place for the DPG on the practitioner’s desk. Also helpful is a chart of more than 80 protocols that can help the practitioner select the appropriate intervention based on factors such as behavior, stage, level of dementia, and research findings. The criteria for selecting an intervention to decrease a behavior illustrates the application of evidence-based practice. DPG’s literature review incorporates an evidencebased grading system that lets the reader determine the strength of the research. The reference section includes a key to inform the reader if the article is research, literature, national guidelines, or theory. The life work of two researchers, the DPG demonstrates a groundbreaking contribution not just to the therapeutic recreation profession but also to healthcare in general. The focus on evidence-based practice using a nonpharmological approach to treating disturbing behaviors for persons with dementia is an important one. As the authors note, there are many unanswered questions, and for that reason, Dementia Practice Guidelines for Treating Disturbing Behaviors may be considered a work in progress . . . but a very useful one.