A great video showcasing a sensory garden designed for people living with dementia by Dementia Australia.
A great video showcasing a sensory garden designed for people living with dementia by Dementia Australia.
Pop metaphorical ‘brain bubbles’ by grounding your brain in the here and now.
Unlike the effervescent bubbles that stream to the top of champagne flutes on New Year’s Eve, what I call brain bubbles are far from celebratory. These bubbles are metaphorical rather than physical, and they distort the stream of reality processed by our brains. Like a real estate bubble that reflects an inflated perception of home values, a brain bubble twists your perception of the world around you. And when either of these bubbles bursts, the results can be devastating.
Problems arise when distorted information results in flawed decisions that negatively affect our lives. As a neuroscientist who’s worked closely with laboratory rats for over three decades, I’ve gleaned from them a few good strategies people can use to burst brain bubbles and enhance well-being in the year ahead. Rat brains are small but have the same general areas and neurochemicals we have, so these rodents are valuable laboratory models for human behavior.
Psychoactive drug use, aspects of privilege and poverty, psychiatric illness and, in some cases, religious and political beliefs can all create brain bubbles. Even daily excursions to the virtual world of apps, social media and cybergames sever our connections to concrete aspects of the real world and let distorting brain bubbles develop.
This is especially problematic for children’s brains that are still developing. An ongoing National Institutes of Health study suggests that two hours of screen time each day distorts language and thinking abilities in these junior digital users.
As our attention is hijacked by the closest screen while a Roomba cleans the floor and Alexa orders pizza to be delivered to the front door, what’s left for our brains to do? Sure, we likely face cognitive challenges at work each day, but human brains are built for sophisticated and complex activity – even though we’re often lulled into mindlessly scrolling through a virtual feed. In fact, a brain area often associated with reward and pleasure, the nucleus accumbens, is smaller in people who spend more time checking Facebook posts on their smartphones.
Obviously, some of these distortion-generating circumstances are out of our control. But a heightened awareness of our authentic world can move us toward a more reality-based, well-grounded brain – free of those brain bubbles.
The rats that my students and I train in our studies to physically work for coveted treats (Froot Loops cereal is a favorite) develop healthier emotional responses than the animals we call “trust-fund rats” because they’re merely given their sweet rewards. The harder-working rats have healthier stress hormone levels and engage in more sophisticated search strategies when they encounter a surprise challenge – such as when we move their expected Froot Loop rewards. They’re more persistent as they spend time trying to solve the problem, rather than quickly giving up and walking away.
So whereas one popular New Year’s resolution involves saving up to build financial capital, we can keep our brains in peak condition for the year ahead by building up experiential capital. Real-world experiences represent the best currency for our brain circuits, providing neural security for our future decisions in the coming year. Spending time engaged in hobbies such as knitting or gardening, for example, with complex movements and rich sensory experiences, provides a valuable yield for our brains.
When the calendar flips to a new year, it’s common to reflect on the past and look to the future. According to the neuroscience literature, this anticipation could be one of the most pleasurable – and healthy – tasks our brains engage in all year long.
Dopamine is the poster neurotransmitter for the cognitive endeavor of anticipating. Traditionally known for its role in pleasure, this neurochemical system can be hijacked by psychoactive drugs such as cocaine that serve as potent creators of reality-distorting brain bubbles.
Rodent research provides fascinating insights here, however. Researchers use sophisticated techniques to measure dopamine activity as rats press laboratory levers that reward them with drugs. Surprisingly, this neurochemical system surges when the animal merely anticipates taking the drug as it approaches the drug lever, as well as when the drug is actually infused into the brain.
Anticipating a new start and a new year may be a scaled-down version of approaching the experimental lever for a hit of cocaine – a legal and healthy dopamine dose in this case. You can try to keep this emotional high going through the year by amping up the anticipation in your daily life: Focus more on delayed than immediate gratification. Buying and planning for experiences is more satisfying than material purchases. Mapping out a menu, shopping for ingredients and cooking a meal provides more dopamine time – and brain-engaging behaviors – than nuking a frozen meal and eating it three minutes later.
Another way to enhance our well-being through the year is to gain some sense of control over the stress in our lives. Real-time and authentic interactions with the environment can help us gain a sense of control over the inevitable uncertainty and unpredictability we face each day.
I see evidence of this in the lab. When I furnish my rats’ housing with natural elements such as dirt, hollowed-out logs and rocks, they’re busier and less likely to sit around the edge of the cage than animals in boring empty cages. After building their experiential capital, these enriched rats have healthier stress and resilience hormone profiles and engage in bolder behaviors, such as diving to the bottom of swim tanks instead of staying on the top doing their best impression of a dog paddle. As I watch these animals in various tasks, they appear to be gaining control over the challenges they encounter.
Perhaps this is why retired U.S. four-star admiral William McRaven emphasized simple life strategies in his 2014 University of Texas commencement speech, declaring that “if you want to change your life and maybe the world, start off by making your bed.” Then, even if you have a terrible day, you will come home to a made bed, evidence that you had a positive impact in at least one area of your life that day.
And, considering that over 70 percent of the brain’s nerve cells are in the cerebellum, which is involved in movement coordination, any activity that gets us up and moving – whether household chores or hitting the gym – engages the brain in healthy ways.
Lessons from the laboratory rats also provide potential explanations for some of my own personal favorite New Year’s Day traditions – including the mundane tasks of cooking a familiar southern meal, cleaning my closet and watching HGTV’s Dream House giveaway with my family while we all declare what we would do if we won the beautiful house. Move in? Sell it? Make it an Airbnb rental?
Thinking like a neuroscientist, I know that cooking and cleaning are active endeavors with clear outcomes that allow me to gain a small sense of control, decreasing stress hormones. Playfully anticipating winning a new home taps into that feel-good dopamine system as we contemplate more serious options for the new year. And, perhaps the best neurochemical hit of all is the spike in oxytocin, the neurochemical involved in positive social connections, as I spend time with loved ones.
Although it’s common to turn to pharmaceuticals to lift our emotions and improve our mental health, the emotional benefits of many New Year’s traditions remind me that basic responses can serve as what I call “behaviorceuticals” that enhance well-being. New Year’s resolutions may take the form of New Year’s Rx’s as we consider healthy lifestyle choices for the coming year: Shrink those distorting brain bubbles and build realistic connections to enrich life’s simple pleasures.
December 2018 | University of Exeter – Research highlights what helps people live well with dementia
New research has identified the factors that enable people with dementia and their carers to live as well as possible.
Led by the University of Exeter, the research seeks to inform support services and guide policy on where resources should be spent to support the 50 million people worldwide that have been diagnosed with a dementia to optimise their ability to “live well”.
Now, a large-scale study has produced two new papers published in Alzheimer Disease & Associated Disorders. A wide range of factors were found to play a role in living well. The team found that psychological aspects, such as optimism, self-esteem and whether they encountered loneliness and depression was closely linked to the ability to optimise quality of life and wellbeing in both people with dementia and carers. Experience in other areas of life influences psychological well-being and perceptions of living well. Physical health and fitness was important for both groups. For both carers and people with dementia social activity and interaction also ranked highly.
For people with dementia, their social situation and their ability to manage everyday life were important factors.
Carers rated their caregiving experience, and whether they felt trapped or isolated, as a key indicator in whether they could live well.
The research was conducted in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort. Funded by the National Institute for Health Research and the Economic and Social Research Council. The study comprised 1,547 people diagnosed with mild to moderate dementia and 1283 carers. Both groups of participants provided ratings of their quality of life, satisfaction with life and wellbeing, in relation to dementia and to overall health.
The research team combined the findings into one overall “living well” score for people with dementia, and one for carers.
Lead author Professor Linda Clare, of the University of Exeter, who also leads the IDEAL study, said: “It’s so important to find ways for the 50 million people worldwide who have dementia to live as well as possible. Our research sheds new light on what factors play a key role in maximising factors such as wellbeing and quality of life. This must now translate into better ways to support people with dementia.”
Co author Dr Anthony Martyr, of the University of Exeter, said: “Our research gives more specific guidance on where we should focus efforts to help people live as well as possible with dementia. For example, looking at how we can help people with dementia to avoid depression or stay physically and socially active. For carers it could involve strengthening community ties and building strong networks. We now need to develop and research programmes to establish what really works in these areas.”
Dr James Pickett, Head of Research at Alzheimer’s Society, said: “People with dementia have the right to live well – however without clear definition it can be hard to determine what ‘living well’ really means. After looking at several factors, the IDEAL programme has found that psychological health has the biggest impact on people affected by dementia living well. Too many people face dementia alone without adequate support, and interventions that improve self-esteem, challenge negative perceptions towards ageing and reduce depression or loneliness could all help improve the psychological health of people affected. Research will beat dementia and while we strive to find a cure, we also need to improve life for the 850,000 people with dementia in the UK today. Alzheimer’s Society is proud to be supporting this study and looking further into these interventions – as well funding over £12m of other research to improve dementia care.”
The paper on people with dementia is entitled ‘A Comprehensive Model of Factors Associated With Subjective Perceptions of “Living Well” With Dementia‘.
Both papers stem from the IDEAL programme. IDEAL is a major longitudinal cohort study of 1547 people with dementia and their family members or friends funded by the Economic and Social Research Council and the National Institute for Health Research. The IDEAL study is survey- and interview-based and aims to understand what makes it easier or more difficult for people to live well with dementia. The findings from the study will help to identify what can be done by individuals, communities, health and social care practitioners, care providers and policy-makers to improve the likelihood of living well with dementia. , The study involved collaboration with the London School of Economics, the Research Institute for the Care of the Elderly (RICE), the universities of Bangor, Bradford, Brunel, Cardiff, Kings College London, Sussex, Newcastle, and New South Wales in Australia, and the charities Innovations in Dementia and Alzheimer’s Society.
Since 2018 the project has been extended as an Alzheimer’s Society Centre of Excellence, making it possible to follow the experiences of participants for several more years.
The strain of life — from everyday conflicts to major losses — can stretch our well-being to the breaking point. Here’s what scientists know, and still don’t know, about the stress-illness connection.
It’s no secret that stress is bad for your health.
Everybody knows that “life stress events” — things like loss of a job, death of a loved one and getting divorced (or married) raise the risk of getting sick.
All sorts of other life events also generate stress, with possible negative health effects ranging from catching a cold to major depression to a fatal heart attack.
Of course, knowing about the link between stress and sickness just gives you something else to worry about, adding even more stress. If you value your health, perhaps you should stop reading now.
On second thought, don’t. Much of the lore about stressful events impairing health is certainly true, but some research is reassuring. There are some secrets about the stress-disease connection that aren’t all bad.
If you’ve read the psychological, psychiatric and medical scientific literature over the last several decades, you might already be aware of these “secrets.” If not, they’ve been nicely summarized in a paper to appear in the next issue of Annual Review of Psychology, in which Sheldon Cohen, Michael L.M. Murphy and Aric A. Prather analyze (in no particular order) what they call the “Ten surprising facts about stressful life events and disease risk.”
Nobody disputes that certain events inflict severe psychological (and physiological) stress. Death of a spouse, getting diagnosed with a terminal illness and (ahem) separation of children from parents are indisputably “major stressful life events.” But no clear rules have been established to define what features place an event in that category (which makes stress research complicated, with often ambiguous results).
Some researchers hold that stress magnitude hinges on how much “adaptation” is required to cope with it (which is why marriage can be considered especially stressful). A second theory gauges stressfulness as the amount of threat or harm an event poses. Some experts view stress as a mismatch between demands and resources. (If you have the resources — say, money — to address and control a demanding situation, it’s less stressful; if your boss expects you to complete a three-person project all by yourself under an impossible deadline, you’re stressed.) A fourth view regards “interruption of goals” as the prime feature of a life stress event; diabolically, one of the goals most commonly interrupted is the goal to be psychologically well.
These theories about stress-event criteria aren’t mutually exclusive, of course. “There is obvious overlap among these approaches,” Cohen and colleagues write. On the whole, though, they suggest the “threat or harm” perspective is the most commonly accepted.
Depression and heart disease are commonly associated with stressful events, but stress’s influence extends to other health problems as well. Many, perhaps even most, diseases can be linked to life stress in some way. Stress can boost anxiety, mess with your hormones and discourage healthy practices such as exercising and eating well. At the same time stress can instigate bad behaviors such as smoking and drinking. All these responses can have negative impacts on important organs (brain, heart, liver), possibly resulting in multiple health problems either by triggering the onset or accelerating the progression of a disease. Stress events can reduce resistance to infections, and even cancer may be linked to stress. But the evidence on cancer is less clear. Stress might influence the development of cancer, but the strongest research shows that a more likely effect of stress is reducing cancer survival rates rather than initiating cancer onset.
There’s no doubt that trauma and stressful events can harm your health. But not always. “On the whole,” Cohen and colleagues write, “most people who experience stressful events do not get sick.” Experiments exposing stressed and nonstressed people to a common cold virus found that more of the stressed people caught the cold than those in the nonstressed group, but nevertheless half the members of the stressed group remained healthy. Even depression is not an inevitable effect of major life stress; some people are more resilient than others. Positive self-image and sense of control are signs of resilience; negative attitude and excessive rumination tip the scales toward depression.
Apart from the relatively rare natural disasters, fatal accidents and a few other nasty exceptions, stressful events are not equal-opportunity assailants. Your personal traits and situation and the circumstances in which you live make you more or less at risk for life stress. Neighborhoods with low socioeconomic status are sites of higher-than-average levels of stressful events, and people with low personal socioeconomic status have more risk of encountering violence, death of a child and divorce. Even personality can boost your stress risk (neurotic, unconscientious and disagreeable people are more likely to get divorced, for some reason). One study found that “individuals characterized by negative attributional style” (i.e., jerks) encounter more “interpersonal conflicts,” raising the risk of stressful events. Furthermore, one stressful event — such as loss of a job — can lead to others (such as loss of income, moving or divorce).
Evidence is strong that stressful events make a disease you already have worse.
While some evidence supports the notion that stress can initiate various diseases, this may not be the case in truly healthy people. “Rather, events may influence risk for disease by either suppressing the body’s ability to fight invading pathogens or exacerbating the progression of ongoing premorbid processes,” Cohen and colleagues write. What looks like a disease triggered by stress “may actually be stressor-triggered progression of previously unidentified disease.” So in some cases stress might not be responsible for the disease itself, just for making a previously unnoticed disease worse.
The magnitude of a stressful event’s impact depends a lot on the nature of the stress. Most damaging, research indicates, are “experiences that threaten an individual’s sense of competence or status,” striking at a person’s “core identity.” Loss of status, losing a job and interpersonal conflict with spouses or close friends can all exacerbate health problems, from raising the risk of depression to worsening high blood pressure and reducing resistance to respiratory infection.
It’s not necessarily obvious that chronic, long-lasting or recurrent stress is worse than one-shot stress events. It may be possible to adapt to ongoing stress — once you’re used to it, maybe it won’t bother you so much (or harm your health). On the other hand, ongoing stress may be worse for health because it’s always there, ready to attack whenever your body is vulnerable for some other reason. Overall, chronic stress is probably worse, as it may have a persistent detrimental effect on the body’s disease-fighting immune system. Acute stress, like single traumatic events, may trigger a dramatic worsening of an existing condition, such as heart disease. In that case, a sufficiently powerful stress event can induce a fatal heart attack.
Effects from stressful events may add up over time; simple checklists of how many stressful events a person has experienced over the past year show that experiencing more events predicts worse health. But it’s too complicated to say exactly why that is, or even if it is really generally true. (The checklist method of gathering data might be faulty.) In fact, if a single event is strong enough to increase health risk substantially, additional events don’t necessarily increase that risk further. For that matter, it isn’t clear how events should be counted; a divorce followed by changing residences and reduced income might count as one event or three, Cohen and colleagues point out. And it may not be the number of events but rather the number of “life domains” in which you’re experiencing stress that’s more important. (Job, home life, medical issues and financial issues all represent different domains in which stress may occur.)
Just as some events are stressful, so are some nonevents — things that don’t happen when they’re supposed to in a typical course of life. People generally expect to graduate from school (high school or maybe college), get a job, get married, have kids and then retire. Failure to graduate, inability to get a job or rejection of marriage proposals can all be very stressful during the time of life when success at those things is expected. It may also be that different times of life are more susceptible than others to the ill effects of stress. Trauma in childhood, for instance, has been linked to higher risk of chronic diseases much later in life. Such trauma may induce long-lasting biological changes that contribute to disease in later years. In addition, “adversity during childhood may set an individual on a trajectory to being exposed to more stressors over the life course,” Cohen and coauthors write.
Men and women respond differently to stress, both in their behavior and their physiological response. And women are apparently exposed more frequently to stressful experiences than men are. Partly that may be because “men tend to only report stressful events that occur directly to them” while women consider themselves stressed also when the actual event happens to someone close to them. Men and women may also differ in their vulnerability to stress-induced illness. Women seem more prone to stress-related depression, for instance.
All these “secrets” sketch a still incomplete picture of the stress-illness connection. Some things are clear: Evidence is strong that stressful events make a disease you already have worse, but the research is iffy about whether stress can make you sick to begin with. There are clues about how stressful events exacerbate disease — by altering your biology, your mood and your behavior. Chronic, ongoing stress (like working for a psychopath boss) generates a more general susceptibility to the kinds of physiological and emotional changes that promote disease, while acute immediate stressful events can be effective triggers for turning underlying conditions like cardiovascular disease into heart attacks.
Still many questions about the stress-disease relationship remain unanswered. Experts don’t even know exactly why stressful events are stressful. And evidence is meager on whether particular types of stress are especially likely to promote specific diseases. Much remains to be learned about how a stress event’s effects vary with your stage in life.
Nailing down those details remains a major research challenge. It’s not easy for researchers to answer all these questions, because the obvious experiments would be somewhat unethical. You’d have to give one big group of people a bad job with a bad boss and then make sure bad things happened to them all the time, while rigging conditions for another group to enjoy stress-free luxury. It would be kind of like The Truman Show, only with manipulating enough characters to get statistical significance.
Family care of an older adult has emerged as an essential element of the U.S. health care system, with 83 percent of long-term care provided to older adults coming from family members or other unpaid helpers. As the population of older adults grows, so too does the expectation of family care for persons living with dementia.
We have engaged in decades of research, documenting the impact of dementia caregiving on the health and well-being of the caregiver. We have also conducted research to create evidence-based interventions that can be defined as structured programs with positive results that have been scientifically proved through clinical trials.
We have learned much from family caregivers who report that the amount and type of care expected of them is growing, and have concluded that caregiving demands should be matched by community-based support systems. We have advocated for the adoption of one evidence-based intervention, called REACH II (Resources for Enhancing Alzheimer’s Caregiver Health II), which is designed to help caregivers manage daily care into health care and community-based organizations.
Family caregivers experience multiple challenges daily when caring for a person with dementia, whose care needs steadily increase as cognitive abilities decline. Care burdens can have high physical, emotional and financial costs. An overview, or a meta-analysis, of 84 studies found that caregivers experienced more depression and stress than non-caregivers.
More recently, AARP reported that more than one in three, or 36 percent to be specific, of family caregivers who were not currently in the labor force said they retired early or quit their jobs because of family caregiving concerns.
Despite the critical role that family caregivers play, support programs based on evidence based interventions are not widely available. The National Academies report Families Caring for an Aging America concluded that “few of the nation’s millions of family caregivers of older adults have access to evidence-based interventions.” Moreover, caregivers are often marginalized or ignored by formal health care providers of the person with dementia.
Interventions that combine education about dementia and advice about specific “do’s and don’t’s” of dementia care with guided training and practice appear to be of greatest value to family caregivers. This approach of providing multiple types of support and training allows the intervention to address the vast spectrum of challenges faced by caregivers and allows support and training activities to be tailored to the unique needs of each family.
While scientific research has demonstrated the value of providing education, skills training and support to family caregivers, we have found in our research that health care and social service providers do not routinely provide support programs based on evidence-based interventions. Thus, for the vast majority of family caregivers, caregiving support services remain extremely fragmented if not elusive. Family caregivers are often left alone to provide care that can be complicated and exhausting 24/7.
From our experience, the lack of caregiving support services that are evidence-based is not solely driven by neglect from health care and social support service providers. Rather, existing evidence-based interventions require dedicated personnel who must be trained to deliver the intervention, yet the delivery of the intervention are not covered by Medicare and other third-party payers.
Additionally, family caregivers are often either unaware of existing services, or they are unable to participate due to emotional stresses, time commitments or scheduling concerns. Finally, there are systemic barriers associated with the failure to translate research into practice, resulting in limited program implementation by community-based agencies that provide care to older adults and assistance to dementia caregivers.
We believe that forging strong partnerships between health care systems that frequently see patients with dementia and the community-based organizations that provide ongoing supportive services that help caregivers develop skills to deal with negative behaviors associated with memory loss (e.g., agitation or wandering) is necessary to bridge the gap in caregiving services.
Leveraging technology, such as offering online information and support to increase educational opportunities and perhaps even automating some aspects of intervention delivery, will help ensure access to services to the widest possible audience. Working directly with employers to provide proven services to the workforce could mitigate the negative economic impact of premature employment reduction.
While changes in the health care system and workplace are important, we believe that all sectors of our society need to more formally recognize family caregiver services. Such an approach can change attitudes, reduce stigma and foster caring and supportive behavior toward those living with dementia. One example is the Dementia Friendly America initiative, a national effort to support and serve those who are living with dementia, their caregivers and families.
Communities are also taking action by leveraging tailored resources in business, community-based services and supports, faith communities, health care communities, legal and financial services, local government and residential settings.
While improvements are needed in all community sectors recognized by the Dementia Friendly America model, this is especially so in the health care sector. Family caregivers are the source of greatest impact on the health of a person living with dementia, yet are often excluded in conversations with the person’s health care providers. Health care providers should be encouraged to document the role of the family caregiver in the a patient’s electronic health record.
Also, health care providers should make every attempt to involve the family caregiver in all health care interactions, especially in discharge planning after a hospital stay. As a sector, health care systems can also facilitate a dementia friendly approach by directing families to community-based social support services to address common challenges such as getting medications and transportation to health care appointments.
There is a role for higher education as well. Colleges and universities could help prepare a dementia-friendly health care work force to meet the needs of the growing numbers of persons with dementia, estimated to nearly triple by midcentury with an American being diagnosed with dementia every 33 seconds. Attention to dementia-friendly practices such as differentiating dementia from normal aging, early investigation of dementia symptoms by a health care professional and basic training in how to communicate with a person with dementia should be encouraged across the social and health disciplines.
Our care system depends heavily on family caregivers. If their needs are not recognized and addressed, family caregivers risk burnout from the prolonged distress and physical demands of caregiving, and the nation will bear the costs.
Alan Stevens, Professor of Medicine; Director, Center for Applied Health Research, Texas A&M University ; Carole White, Professor and Nancy Smith Hurd Chair in Geriatric Nursing and Aging Studies, University of Texas at Austin; Marcia G. Ory, Regents and Distinguished Professor, Associate Vice President for Strategic Partnerships and Initiatives, Texas A&M University , and Sandhya Sanghi, Assistant Investigator, Texas A&M University
A challenge facing the recently announced Royal Commission into Aged Care Quality and Safety will be to define “quality”.
Everyone has their own idea of what quality of care and quality of life in residential aged care may look like. The Conversation asked readers how they would want a loved one to be cared for in a residential aged care facility. What they said was similar to what surveys around the world have consistently found.
Characteristics that often appear as the basis for good quality of life include living in a home-like rather than an institutionalised environment, social connection and access to the outdoors. Good quality of care tends to focus on providing assistance that is timely and appropriate to individual needs.
A mature judgment to determine good quality requires us to recognise that many people have an instinctive and distressingly bleak view of ageing, disability, dementia and death. Some people express this as death being preferable to living in aged care, as the tweet below shows.
This doesn’t necessarily reflect an objective assessment of the actual care being delivered in residential facilities, but it does speak to the fear of losing independence, autonomy and identity.
In a survey of patients with serious illnesses hospitalised in the US, around 30% of respondents considered life in a nursing home to be a worse fate than death. Bowel and bladder incontinence and being confused all the time were two other states considered worse than death.
Aged care facilities will be the final residence for most before they die. This means the residents’ sense of futility and the notion one is simply waiting to die can and should be addressed.
Our reason for being is usually expressed through social connections. This a recurring theme for residents who define quality of care as whether or not residents have friendships and are allowed reciprocity with their caregivers.
A systematic review that drew together a number of studies of quality in aged care found residents were most concerned about the lack of individual autonomy and difficulty in forming relationships when in care.
The need for positive social connections for residents extends to the relationships between staff and families. Achieving this requires staff with a positive attitude who work to build trust and involve family in their loved one’s care. They must also engage on issues that have meaning to the individuals.
Good staff should be both technically proficient and, perhaps more importantly, good with people.
A home-like setting – which may include having a pet and enjoying time in nature, as the Tweet below describes – may seem idyllic. However, more contemporary models of care are moving towards smaller home-like environments that accommodate fewer people and are more like a household than a large institution.
The ability to relate and personalise care to a small group of 10-12 residents is surely easier than catering to 30-60 residents. Some studies in the US have shown residents in such smaller units have an enhanced quality of life that doesn’t compromise clinical care or running costs.
This cluster-style housing still has limitations that need to be addressed. These include selecting residents who are suitable together and catering for the changing clinical and care needs of each individual.
Research into the value of pets in aged care has largely focused on the benefits to people living with dementia. Introducing domestic animals, typically dogs, has been shown to have positive effects on social behaviours, physical activity and overall quality of life for residents.
Similarly, providing accommodation where the physical environment and building promote engagement in a range of indoor and outdoor activities, and allow for both private and community spaces, is associated with a better quality of life.
Another major determinant of quality of life in residential aged care is the quality of food. This becomes even more important as people age. Providing high-quality food and enriching meal times is more challenging as many diseases such as dementia and stroke affect older people’s dentition and swallowing.
Aged care services need proactive and innovative approaches to overcome these deficits and better promote general health.
A key feature often overlooked is the cultural significance of food. Providing traditional foods to residents strengthens their feeling of belonging and identity, helping them hold on to their cultural roots and enhance their quality of life.
While the focus is often on preventing abuse, neglect and restrictive practices in aged care, the absence of these harmful events doesn’t equate to a positive culture. Residents want and have a right to feel safe, valued, respected and able to express and exercise choice. Positive observation of these rights is essential for quality of life.
Time is a factor in aged care, as staff often don’t have enough time to spend with each resident. A recent ABC Four Corners investigation into quality in aged care found personal care assistants had only six minutes to help residents shower and get dressed. No wonder, then, that staff often don’t have the personal time to be able to spend with residents who need life to be a little slower, as the Facebook comment below shows.
Clinical care is another important aspect of quality aged care. A resident cannot enjoy a good quality of life if their often multiple and chronic conditions such as diabetes, heart failure and arthritis are poorly managed by their doctors and nurses.
Residents in aged care are the same as those who live in the community. They are people with the same needs and wants. The only difference is they need the community to give the time, effort and thought to achieve a better life.
October 2018 | USA – Exercise May Lessen Risk of Falling for Older Adults who have Alzheimer’s Disease and Mental Health Challenges
Journal of the American Geriatrics Society Research Summary
Alzheimer’s disease (AD) is a brain disease that causes changes that kill brain cells. AD is a type of dementia, which causes memory loss and problems with thinking and making decisions. People with AD and other forms of dementia have difficulties performing the daily activities others might consider routine.
Dementia takes a toll on those who live with it—and it also places a burden on caregivers. Along with problems connected to memory, language, and decision-making, dementia can cause neuropsychiatric symptoms, such as depression, anxiety, changes in mood, increased irritability, and changes in personality and behavior. People who have AD/dementia also have twice the risk for falls compared to people without dementia. About 60 percent of older adults with dementia fall each year.
Researchers suggest that having neuropsychiatric symptoms might predict whether an older person with AD/dementia is more likely to have a fall. We also know that exercise can reduce the number of falls in older adults with dementia. However, we don’t know very much about how neuropsychiatric symptoms may increase the risk of falls, and we know even less about how exercise may reduce the risk of falls for people with dementia and neuropsychiatric symptoms. A research team decided to explore whether exercise could reduce the risk of falling among community-dwelling people with AD who also had neuropsychiatric symptoms.
To learn more, the researchers reviewed a study that investigated the effects of an exercise program for older adults with AD (the FINALEX trial). The study included a range of people living with different stages of AD/dementia and with neuropsychiatric symptoms. Their findings were published in the Journal of the American Geriatrics Society.
The original FINALEX study examined and compared older adults who had home- or group-based exercise training with people who didn’t exercise but who received regular care. The researchers learned that the people who exercised had a lower risk for falls than those who didn’t exercise. There was also a higher risk for falls among those who had lower scores on psychological tests and who didn’t exercise.
This study revealed that people with AD/dementia and neuropsychiatric symptoms such as depression and anxiety have a higher risk for falls. Exercise can reduce the risk of falling for older adults with these symptoms. Further studies are needed to confirm these results.
This summary is from “Relationship of neuropsychiatric symptoms with falls in Alzheimer’s disease—Does exercise modify the risk?” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Hanna-Maria Roitto, MD; Hannu Kautiainen, biostatistician; Hannareeta Öhman, MD; Niina Savikko, RN, PhD; Timo E. Strandberg MD, PhD; Minna Raivio MD, PhD; Marja-Liisa Laakkonen MD, PhD; and Kaisu H. Pitkälä, MD, PhD.
This entry was posted in JAGS Research Summaries and tagged Alzhe, dementia, exercise, physical activity by HIA Guest Blog.