Article

Tourism as a dementia treatment based on positive psychology

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Abstract

No research in tourism or medicine has addressed the potential relationship between travel and the medical treatment of dementia. Given tourism's increasingly important role in society, a cross-disciplinary team of tourism and dementia experts provide insight into the potential benefits of tourism for individuals with dementia. This conceptual effort critically reviews the tourism and dementia literature and addresses pertinent knowledge gaps. Tourism is presented as a possible way to improve dementia patients' well-being as an adjunct to non-pharmacological interventions. Accordingly, a conceptual framework is proposed to highlight the nexus between tourism experiences and dementia interventions. Future interdisciplinary research directions are also described.

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... Tourism and hospitality represents one of the industries most affected by COVID-19 due to travel restrictions and social safety measures [17]. Interestingly, however, tourism' s role in public health has been largely neglected, despite documented benefits [18]. For instance, taking part in vacation activities has been shown to boost travellers' physical and psychological well-being [19]. ...
... Tourism is no longer merely a means for people to pursue recreation and relaxation; it now plays a role in combating global health crises and promoting wellbeing (Wen et al., 2022). The tourism industry is intrinsically associated with public health. ...
... We have highlighted a nexus between tourism and public health/global health (eg, the pandemic and vulnerable travellers) and provided evidence of tourism's updated roles in modern society (eg, healing after a war). After years of learning from other fields, tourism scholars do have a product to sell and a story to share about tourism's place in people's lives, by combining knowledge from disciplines such as public health, psychology, and epidemiology [18][19][20]. After enduring the COVID-19 pan-Photo: Source: https://www.pexels.com/photo/close-up-shot-ofscrabble-tiles-on-a-map-8372640/. ...
... We have highlighted a nexus between tourism and public health/global health (eg, the pandemic and vulnerable travellers) and provided evidence of tourism's updated roles in modern society (eg, healing after a war). After years of learning from other fields, tourism scholars do have a product to sell and a story to share about tourism's place in people's lives, by combining knowledge from disciplines such as public health, psychology, and epidemiology [18][19][20]. After enduring the COVID-19 pan-Photo: Source: https://www.pexels.com/photo/close-up-shot-ofscrabble-tiles-on-a-map-8372640/. ...
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Despite a growing body of tourism research, two critical issues continue to confound this academic community: 1) What knowledge can tourism produce and/or sell? and 2) What role does tourism play in modern society, especially regarding collaboration with other fields (e.g., public health and psychology)? This research letter highlights the connection between tourism and public health/global health (e.g., the COVID-19 pandemic and vulnerable travellers) and provides evidence of tourism’s updated role in modern society. After experiencing the COVID-19 pandemic and considering possible tourism support for individuals living in war zones (e.g., the Russia–Ukraine conflict and potential solidarity tourism), discussions around whether tourism is associated with global and/or public health can promote tourism research within a much broader context.
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We are inviting chapter proposal submissions for a book entitled Handbook of Tourism and Consumer Behavior. This edited book will be part of the Research Handbooks in Tourism series (please see https://www.e-elgar.com/shop/gbp/book-series/geography/research-handbooks-in-tourism-series.html for details), to be published by Edward Elgar by early 2024. Please see the attached Call for Chapters.
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We expressed treatment effects as standardised mean differences or risk ratios. Where possible, we pooled data using a fixed-effects model. We used GRADE methods to assess the certainty of the evidence behind each result. Main results: We included 29 studies with 2599 participants. They were all published between 1997 and 2020. There were 15 trials of cognitive behavioural therapies (4 CBT, 8 BA, 3 PST), 11 trials of supportive and counselling therapies, three trials of MBCT, and one of interpersonal therapy. The comparison groups received either usual care, attention-control education, or enhanced usual care incorporating an active control condition that was not a specific psychological treatment. There were 24 trials of people with a diagnosis of dementia, and five trials of people with MCI. Most studies were conducted in community settings. We considered none of the studies to be at low risk of bias in all domains. Cognitive behavioural therapies (CBT, BA, PST) Cognitive behavioural therapies are probably slightly better than treatment as usual or active control conditions for reducing depressive symptoms (standardised mean difference (SMD) -0.23, 95% CI -0.37 to -0.10; 13 trials, 893 participants; moderate-certainty evidence). They may also increase rates of depression remission at the end of treatment (risk ratio (RR) 1.84, 95% CI 1.18 to 2.88; 2 studies, with one study contributing 2 independent comparisons, 146 participants; low-certainty evidence). We were very uncertain about the effect of cognitive behavioural therapies on anxiety at the end of treatment (SMD -0.03, 95% CI -0.36 to 0.30; 3 trials, 143 participants; very low-certainty evidence). 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Travel vlogging is gaining popularity and studying the practice of travel vlogging can provide insights into tourist behaviour, communication, and management. The notion of practice was adopted as the theoretical base and the analytical framework. A qualitative approach was employed, including interviews with 12 strategically sampled vlogger tourists and analysis of their vlog productions. The findings suggested that travel vlogging is a practice bundle constructed by four sequential practices; designing, filming, editing, and posting. Through a collaborative relationship, the four practices achieve the shared meanings of self-concept expressions, a sense of documentation and ritual, and pleasures in vlogging. Moreover, travel vlogging affects tourist experiences; it creates a self-other divide, mediates the experiences of the ‘self’, and moderates the experiences of the ‘others’. Such impacts vary across the dimensions of travel stages, materiality, and engagement. Theoretically, the study offers fresh insights into the practice of vlogging and the creation of travel vlog content; pragmatically, understandings and implications for quality experiences of vlogger tourists are addressed.
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As the global average age increases, the incidence of dementia is also rising. Given improvements in diagnosis and life expectancies, people now live longer with dementia. Thus, the wellbeing and quality of life among people living with dementia are increasingly important areas for research. Research with Western populations has recently begun to apply positive psychology concepts to understand wellbeing in people with dementia. Positive psychology focuses on positive emotions and traits that allow individuals to flourish and thrive—it highlights the possibility of positive subjective experiences in the face of loss and functional decline, and contrasts the traditional deficit-focused perception of dementia. Despite being a major driver in the global growth of dementia prevalence, there is a dearth of research using such positive concepts to understand people with dementia in non-Western communities. This review contains discussion of research on positive constructs in Chinese older adults, and parallels between traditional Chinese cultural values and positive psychology. On this basis, we propose the applicability of a positive psychology framework to Chinese people with dementia, and that ‘harmony’ is an important culturally specific concept to consider in this area of research. A positive psychology approach acknowledges that strengths and positive experiences can endure after dementia diagnosis. This not only adds to the under-researched area of lived experience of dementia in Chinese people, but highlights areas that could be the focus of interventions or measured as outcomes. By improving understanding, this approach also has potential to reduce carer burden and stigma around dementia.
Article
Background: The increasing prevalence of Alzheimer's disease (AD), along with the associated burden on healthcare systems, presents a substantial public health challenge. Objective: This study aimed to investigate trends in AD mortality and the relevant burden across the United States (U.S.) from 1999 to 2018 and to predict mortality trends between 2019 and 2023. Methods: Data on AD-related deaths between 1999 and 2018 were collected from the WONDER database administered by the U.S. Centers for Disease Control and Prevention (CDC). The Joinpoint Regression Program was used to analyze mortality trends due to AD. Years of life lost (YLL) were calculated to explore the burden of AD deaths. An autoregressive integrated moving average (ARIMA) model was employed to forecast mortality trends from 2019 to 2023. Results: Over a recent 20-year period, the number of AD deaths in the U.S. increased from 44,536 (31,145 females and 13,391 males) to 122,019 (84,062 females and 37,957 males). The overall age-adjusted mortality rate increased from 16.5/100,000 in 1999 to 30.5/100,000 in 2018. AD mortality is projected to reach 42.40/100000 within the year 2023. Overall, AD resulted in 322,773.00 YLL (2.33 per 1000 population) in 1999 and 658,501.87 YLL (3.68 per 1000 population) in 2018. Conclusion: Our findings demonstrate an increase in AD mortality in the U.S. from 1999 to 2018 as well as a rapid increase from 2019 to 2023. The high burden of AD deaths emphasizes the need for targeted prevention, early diagnosis, and hierarchical management.
Article
Travel vlogs are popular, but how audiences get involved while watching remains unclear. This study explored audience involvement along with expressions of travel intention. A systematic sampling procedure was developed, filtering 132 ‘highly involving sessions’ from 25 videos in Bilibili, a Chinese video-sharing platform. Qualitative analyses were applied, and the findings were threefold. Firstly, a five-category video content typology was highlighted, including frame aesthetics, video editing, fandom, humour, and tourist experiences. Secondly, bullet comments were deconstructed into six dimensions through examining concepts of ‘audience involvement’. Lastly, to address possible patterns of travel intention linked to the video content types, three propositions were made. This work serves as an exploration of audience involvement in the travel vlog phenomenon, an elaboration of travel intention expression in this context, and a method of assessing tourist-generated videos through bullet comments. Practical implications were discussed.
Article
Mental and social health outcomes from a portfolio of women's outdoor tourism products, with ~100,000 clients, are analysed using a catalysed netnography of >1000 social media posts. Entirely novel outcomes include: psychological rescue; recognition of a previously missing life component, and flow-on effects to family members. Outcomes reported previously for extreme sports, but not previously for hiking in nature, include psychological transformation. Outcomes also identified previously include: happiness, gratitude, relaxation, clarity and insights, nature appreciation, challenge and capability, and companionship and community effects. Commercial outdoor tourism enterprises can contribute powerfully to the wellbeing of women and families. This will be especially valuable for mental health recovery, following deterioration during COVID-19 coronavirus lockdowns worldwide.
Article
Self-determination theory (SDT) offers a robust and globally adopted evidence-based foundation from which explorations of increasingly popular forms of travel, like spiritual tourism, can be analyzed for their potential contributions to well-being. This paper draws on SDT to examine outcomes of well-being within spiritual tourism. It draws on autoethnography, a thick data approach to qualitative inquiry, which allows for the emergence of experiential and self-reflective processes engendered by forms of travel like spiritual tourism. The autoethnographic narrative is based on the author's spiritual tourism experience at a yoga/meditation retreat in Rishikesh, India. The narrative is transcended through theory-based linkages to broader social phenomena (i.e., well-being, SDT), by so doing, the legacy of theoretical development, characteristic of interpretive inquiry, is sustained.
Article
The concept of customer experience has received increasing attention in different disciplines. However, the pathway for handling experience has not been clearly set forth due to divergent conceptualizations and insufficient measures of customer experience. This study critically analyzes empirical and conceptual literature on experience, provides a holistic definition of experience, proposes an experience model with four main components (emotional, cognitive, sensorial, and conative), and suggests using a combination of several measures to capture the totality of tourism experience at pre-visit, onsite, and post-visit stages. These suggestions provide important implications for researchers and practitioners by offering new ways to explore customer interaction with tourist products, detect affective and sensory components leading to important consumption outcomes, investigate individual impacts of anticipation, onsite experience, and recall, as well as analyze effectiveness of destination marketing practices.
Article
Due to the increasing concern with physical and mental wellbeing, people realize the need to get away from the routines of domestic life and travel to tourist destinations. We propose the notion of tastescape to demonstrate one specific task—tea drinking in a tourist setting—to promote wellbeing. Through the lens of tastescape, as a combination of material elements, practices, and places, we emphasize that tea drinking offers a way to understand the spatial, temporal, and social relations through which wellbeing unfolds in the therapeutic qualities of tourist destinations. The study case is Lijiang Old Town, a well-known destination in Yunnan province, southwestern China. Specifically, this paper has two objectives. First, it explores why and how guesthouse owners in Lijiang organize tea activities to socialize with tourists. Second, we examine why some tourists favor tea drinking for relaxation and comfort. The tastescapes of wellbeing are threefold: spatially, building closeness to nature, sparked by absorption into the place that tourists visit; temporally, slowing down to taste tea and thus enjoy a different rhythm of life; and socially, building connection with hosts and other tourists through tea conversations. The tastescapes of wellbeing spell out the relational nature of wellbeing as something that actually happens between human beings and their surroundings rather than an intrinsic set of qualities. The emphasis on tastescape in this paper offers a valuable means to understand wellbeing as the outcome of interactions that happen in the timespace of tourism through the dynamic interplay of tourists, tea, and socionatural environments.
Article
Poor mental health costs about a tenth of global GNP. For many people, nature exposure improves mental health. This generates a newly recognised health service value for national parks worldwide, estimated at trillions of dollars annually. It creates a correspondingly large potential new market for commercial nature tourism, as a provider of nature therapies, especially in national parks. Before this opportunity can be realised, however, we must establish whether voluntary park visits generate mental health gains for everyone. Currently, psychology researchers and protected area managers hold opposing views. I therefore interviewed 238 outdoor nature and adventure tourists of all ages and backgrounds, at subtropical national parks in Queensland, Australia, to determine whether they visit parks because they are happy, or they are happy because they visit parks. A large majority, 82%, picked the latter. Of those asked, 87.5% reported short-term emotional benefits; 60%, medium-term recovery from stress; and 20%, long-term changes in worldview. Each timescale corresponds to a different opportunity for commercial nature tourism. Future research priorities include: economic scale; experiential components and commercial design for different market segments; comparisons of individual benefits for people with different personalities; and tests of mental health benefits for other types of tourism.
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This paper examines the global trade of Thai tourism and related service industries such as restaurant, spa and hospital – service activities in which the body and bodily emotions of both service consumers and providers are central. I will demonstrate how the Thai state and private sector market Thai services to the world and construct Thailand as a destination for bodily and spiritual fulfilment. Analysing Thailand as an exporter of care and body labour, this article highlights the important role the nation-state and local socioeconomic structures play in shaping global care chains. State policy that promotes tourism and related service industries as a key economic development strategy has shaped current interrelated forms of transnational mobilities between Thailand and more affluent countries – marriage migration, health and medical tourism, and retirement migration. I also explore the interface between Thai state policies on the export of care and lived experiences of Thailand-Europe transnational migrants. Through their occupation choices, marital relocation decisions and care arrangements, Thai migrants in Europe and European migrants in Thailand both resist and reproduce the commodification of care and body work.
Article
It is nearly impossible to consider a destination without also acknowledging its people as well as the relationship visitors have with such residents. Employing a hierarchical structure of destination image, this study examined how emotional solidarity along with cognitive and affective image explain conative image of Greece among Serbian visitors who had recently visited. Targeting Serbians living in Novi Sad, survey data were collected on-site as well as through online means, resulting in 401 completed questionnaires for analysis. Structural equation modeling revealed that five of the six proposed hypotheses were supported from the developed theoretical model. Overall, emotional solidarity, cognitive image and affective image were able to predict 70% (R² = 0.70) of the variance in conative image. Implications for theory and practice along with limitations and future research opportunities are discussed at the close of the paper.
Article
This paper examines the current state of research on well-being from tourism from the lens of positive psychology. A systematic review of 82 peer-reviewed articles published in English-language tourism journals indicate that tourist well-being is predominantly examined as a consequence of travel, rather than linked to tourism marketing and management. This study presents a conceptual framework of the antecedents, episodes and consequences of tourist well-being. Practically, results suggest strategies on how well-being can be used to generate better outcomes for tourism marketers and managers. By mapping what is known in the intersection between positive psychology and tourist well-being, this study identifies existing gaps and opportunities for future research in this area.
Article
Positive psychology provides an approach to understand different aspects of tourist's well-being. This study investigated the wellbeing associated with snow-sport tourism among women. As part of a larger mixed-methods study, the utility of the PERMA framework (positive emotion, engagement, relationships, meaning, and accomplishment) as a tool for measuring well-being in the context of active sport tourism was assessed. Subsequently, PERMA was applied to investigate the well-being of female snow-sport participants in relation to their sport-related travel. Principle Component Analysis revealed only one dimension for well-being instead of the previously suggested five PERMA domains. One-way ANCOVA indicated that women who travelled to participate in snow-sports had a higher sense of well-being than those who participated locally. Hierarchical Multiple Regression showed a positive relationship between shorter frequent trips and higher well-being. Recommendations for encouraging participation in snow-sport tourism, focusing on well-being are made.
Article
Purpose: Research shows that people with disabilities have same desire for travel and tourism as others, but many constraints prevent them from independent travelling. Although the disabled tourism market is expanding, still there is lack of empirical research on impact analysis of assistive technology (AT) assisted travel and tourism with focus on the people with dementia (PWD). This study investigates the impacts of AT assisted travel and tourism for the PWD. Methods: The questionnaire-based survey gathered data from 327 PWD. SPSS is used to perform exploratory factor analysis and canonical coefficient analysis for investigating the usability of AT assistance in travel and tourism. Results: Results reveal four motivational (facilitated travel and tourism, cost effectiveness, easier communication and needs compatibility) and three achievements dimensions (improved achievements, improved independence and improved safety). Independent travel is desired by the PWD without any external help and ATs can help them in doing so. The use of AT can further accommodate in choosing the tourism activities, attractions and leisure management. The PWD feel improvements in their achievements through the use of ATs in travel and tourism. Conclusions: AT support, resultantly improves the confidence and self-esteem of the PWD and motivate them towards rehabilitation and independent living. • Implications for rehabilitation • This study provides finer empirical understanding of the needs, motivations and achievements of the people with dementia (PWD) who use assistive technologies (ATs) for travel and tourism. • Usually PWD have different motivations and accessibility needs, their travel and tourism related behaviours might also differ from the people not identified as having dementia. • The ATs (facilitated travel and tourism, cost effectiveness, easier communication and needs compatibility) are the motivational factors for the PWD and should be focused during the development of ATs. These factors will allow PWD to better plan their travel and tourism activities without the help of their caregivers. The AT assisted communication opportunities will help PWD to eliminate their feeling of social isolation from rest of the community. • AT supported travel and tourism results into sense of improved achievements, improved independence and improved safety on the part of the PWD. Resultantly, they feel more motivated to do activities, which otherwise they might be reluctant to perform. The sense of safety, independence and achievement does impact PWD psychologically and would help them towards rehabilitation. • This study provides pointers for the dementia policy makers related to AT supported travel and tourism based on the real needs of the PWD.
Article
Introduction The effect of transcutaneous electrical nerve stimulation (TENS) for functional management in patients with dementia has not been reported yet. Thus, the aim of present study was to investigate the effect of TENS on pain, muscle strength, balance, and gait ability in patients with dementia who have difficulty exercising independently. Methods Thirty-two subjects with dementia were randomly allocated into either a TENS group (n = 16) or a placebo-TENS group (n = 16). TENS (4 Hz), above motor threshold intensity, was applied to both calf muscles for 20 min, 2 times per day. Placebo-TENS was applied for 30 s and then ramped down to zero for 15 s at the same location. The intervention was performed 5 days per week for 2 weeks. Pain was quantified with pain pressure threshold (PPT). Strength of the calf muscles was assessed using a hand-held dynamometer. To assess balance and gait, functional reach test (FRT), 10-m walk test (10MWT), and timed-up and go test (TUG) were used. Results There were significant differences in PPT (p = 0.001) after TENS application, and the PPT was significantly increased in TENS group compared with placebo-TENS group (p = 0.0495). TENS group showed significant improvements of plantarflexor strength (p = 0.008). Balance and gait were also significantly affected in TENS group, as assessed by 10MWT (p = 0.018) and TUG (p = 0.007). The placebo-TENS group did not show significant improvements for any outcome measures. Conclusions These results suggest that TENS application can be used for functional maintenance of patients with dementia. Further research is needed to underpin these preliminary results.
Article
Ageing and dementia are major societal challenges affecting many countries, with around 46.8 million people worldwide estimated to be living with dementia. These estimates suggest that the worldwide population of people living with dementia will double every 20 years to reach 131.5 million by 2050. Recognition that dementia is a significant challenge for the travel and tourism sector is starting to develop. This paper contributes to this emerging agenda on ageing and dementia focusing on the accessibility needs of this group through a two-stage research study that demonstrates the practical needs and leadership challenges this poses for the tourism sector. Using the UK as an exemplar of dementia-readiness, the study examines Destination Management Organisation (DMO) website provision of advice for people with dementia and their carers. It then reports the findings of a survey DMO managers attitudes towards creating dementia-friendly destinations.
Article
Objective: Aged care services increasingly respond to the needs of people with dementia. Non-pharmacological approaches are preferable to reduce responsive behaviours, improve/maintain functional capacity and reduce emotional disorders. This rapid review of systematic reviews aimed to consolidate the evidence for non-pharmacological interventions and determine outcome effectiveness. Methods: Systematic review literature was comprehensively searched for non-pharmacological interventions for dementia in residential care. Quality ratings used adapted GRADE methodology, and ease of implementation assessed. Results: Of 629 abstracts screened, 81 full-text articles were retrieved, 38 articles included. The strongest evidence for reducing responsive behaviours was music, sensory stimulation, simulated presence and validation therapies. Exercise and light therapy improved/maintained activities of daily living, while cognitive stimulation and reminiscence improved cognition. Strongest evidence for reducing emotional disorders was music, psychological interventions and reminiscence. Conclusion: Much evidence of varying quality exists, with resource-constrained residential care providers now able to make evidence-based decisions about non-pharmacological interventions.
Article
Objective The aim of this review is to make a state of the art of the potential influence of neuropsychiatric symptoms (NPs) on caregiver stress and vice versa. Methods We searched PubMed and Google Scholar for potential eligible articles. Results Patients with Alzheimer's disease (AD) usually need high levels of care in all activities of daily living, most of them provided by family members, friends, or informal caregivers. Caregivers have to cope with both age‐related conditions and dementia‐related factors. Therefore, caregiving in dementia is more difficult and stressful than caregiving for older adults, affected by other conditions. Neuropsychiatric symptoms, such as anxiety, agitation, disinhibition, aggressive behavior, and sleep disturbances are more closely related to caregiver burden, and associated with more negative outcomes such as decline in their general health, quality of life, and social isolation. Caregiver burden worsens relationship between caregiver and patients with AD. Thus, this relationship may increase the frequency and severity of NPs. Predictors of burden were being a woman, a spouse, and old person with immature coping mechanisms, social isolation, with insufficient knowledge about dementia, poor premorbid relationship with patient, and high levels of negative expressed emotions. Conclusion Because of the bidirectional relationship between caregiver burden and NPs, the active management strategies of dementia care should include early identification and treatment risk factors for both caregiver stress and NPs in patients with AD. Therefore, to improve one of them can be exert beneficial for the other.
Article
Tourism and depression disorder are both common phenomena in the 21st century. Research has pointed out the varying mental health effects of engaging in tourism, with most studies suggesting a positive correlation between participant wellbeing and going on vacation (Chen, Lehto, & Cai, 2013). The present research sheds light on the impact of tourist activity on clinical depression levels as assessed by semi-structured interview. Major Depressive Disorder (MDD) is defined as poor mood, a lack of interest and joy in daily activities, changes in body weight or appetite, changes in sleep cycles and activity levels, feelings of guilt and uselessness, an inability to concentrate, and suicidal thoughts that are not attributable to the physiological effects of a substance or another medical condition (American Psychiatric Association, 2013). MDD is the leading cause of disability worldwide. According to the World Health Organization, 322 million people suffer from depression around the globe (World Health Organization, 2017). Chen et al. (2013) have shown that vacations spent in an environment that is different from one’s own have helped tourists detach psychologically from work and mundane concerns. Bimonte and Faralla (2012) have found a positive correlation between participant lifestyle and subjective self-satisfaction ratings, with higher levels of happiness recorded for participants who engage in tourist activities. De Bloom et al. (2010) have found that physical health, mood, and life satisfaction levels improved, and mental stress levels were alleviated after a ski vacation. Other studies have shown that planning a trip may increase levels of mental stress associated with route planning, coordinating work tasks for the period of absence, and travelling to the vacation destination (De Bloom et al., 2010). Additionally, tourists may experience disorientation, an inability to predict the outcome of future encounters, and worry – a negative condition described as an uncontrollable series of thoughts and feelings of increased insecurity about future events. Worry is related to depression and anxiety disorders (Larsen, Brun, & Øgaard, 2009). Furthermore, De Bloom et al. (2010) have found that all positive vacation effects on health and wellbeing vanish within the first week after returning home, as participants are compelled to immediately return to work and resume their daily routine, resulting in elevated levels of mental stress. Kirillova and Lehto (2015) have noted that residing within a new environment may force individuals to confront existential authenticity, a mental state in which individuals are clearly aware of their needs, thoughts, and wishes. This mental state can trigger anxiety and fear as a result of comparing daily life to vacation. The authors measured participant happiness levels before, during, and after vacation, and identified a positive impact on post-vacation happiness levels. Engaging in tourism provides a safe space for reflection, self-awareness, and decision making. According to the study, mentally healthy individuals experience less anxiety and fear during the existential authenticity period and remain aware of their needs. By contrast, a person suffering from MDD might prolong the anxiety-fear stage into post-vacation daily life, exacerbating depression symptoms. The goal of the present study was to investigate the impact associated with the engagement in tourism activity on the severity of depressive symptoms in a population suffering from MDD that is receiving psychotherapy.
Article
The purpose of this Editorial is to summarise the key recommendations of the Lancet Commission on Dementia Prevention, Intervention, and Care, reporting on the best available evidence to date on what we can do to prevent and intervene for dementia. We briefly describe the new life-course model of dementia prevention incorporating nine modifiable risk factors and their potential effect in reducing individuals’ risk of dementia. We also summarise the recommendations of the report about which pharmacological, psychological, and social interventions are effective, and improve outcomes for people with dementia and their families. Recent developments highlight that there is good potential for the prevention of dementia. Progress in evidence-based approaches indicate the potential for dementia care to be of high-quality and widely accessible. Acting upon this knowledge now will reduce the global burden of dementia and improve the lives of people living with dementia and their families.
Article
Cerebral function in humans is critically dependent upon continuous oxygen delivery, metabolic nutrients and active regulation of cerebral blood flow (CBF). As a consequence, cerebrovascular function is precisely titrated by multiple physiological mechanisms, characterised by complex integration, synergism and protective redundancy. At rest, adequate CBF is regulated through reflexive responses in the following order of regulatory importance: fluctuating arterial blood gases (in particularly partial pressure of carbon dioxide [PaCO2 ]), cerebral metabolism, arterial blood pressure, neurogenic activity and cardiac output. Unfortunately, the magnitude that these integrative and synergistic relationships contribute to governing the CBF during exercise remains unclear. Despite some evidence indicating that CBF regulation during exercise is dependent on the changes of blood pressure, neurogenic activity and cardiac output, their role as a primary governor of the CBF response to exercise remains controversial. In contrast, the balance between PaCO2 and cerebral metabolism continues to gain empirical support as the primary contributors to the intensity dependent changes in CBF observed during submaximal, moderate and maximal exercise. The goal of this review is to summarize the fundamental physiology and mechanisms involved in regulation of CBF and metabolism during exercise. The clinical implications of a better understanding of CBF during exercise and new research directions are also outlined. This article is protected by copyright. All rights reserved.
Article
Acting now on dementia prevention, intervention, and care will vastly improve living and dying for individuals with dementia and their families, and in doing so, will transform the future for society. Dementia is the greatest global challenge for health and social care in the 21st century. It occurs mainly in people older than 65 years, so increases in numbers and costs are driven, worldwide, by increased longevity resulting from the welcome reduction in people dying prematurely. The Lancet Commission on Dementia Prevention, Intervention, and Care met to consolidate the huge strides that have been made and the emerging knowledge as to what we should do to prevent and manage dementia. Globally, about 47 million people were living with dementia in 2015, and this number is projected to triple by 2050. Dementia affects the individuals with the condition, who gradually lose their abilities, as well as their relatives and other supporters, who have to cope with seeing a family member or friend become ill and decline, while responding to their needs, such as increasing dependency and changes in behaviour. Additionally, it affects the wider society because people with dementia also require health and social care. The 2015 global cost of dementia was estimated to be US$818 billion, and this figure will continue to increase as the number of people with dementia rises. Nearly 85% of costs are related to family and social, rather than medical, care. It might be that new medical care in the future, including public health measures, could replace and possibly reduce some of this cost.
Article
Many older people enjoy travelling for leisure, air travel included. To increase the self-determination and independence of people living with dementia we need to reduce the barriers to participation in all areas of life, including leisure. We used an exploratory, mixed method research design to learn about the experiences of people with dementia when they travel. This included online surveys with 82 people (7 people with dementia, 41 travel companions, 21 flight crew and 13 security staff). Ten of the companions who completed the survey volunteered to participate in a qualitative telephone interview. This was followed by an assessment of the physical environment of an airport in a major Australian city using the Dementia Friendly Communities Environmental Assessment Tool (DFC-EAT) (Fleming & Bennett, 2015). The survey results showed that people with dementia and their travelling companions found navigating airport processes and designs the most challenging part of air travel, in particular security and immigration procedures. Using the DFC-EAT we identified problematic design features such as poor signage and blurred boundaries between retail and travel spaces that contributed to confusion at the airport. Efforts have been made to modify built environments to promote accessibility for people with physical disability, yet there has been comparatively little done for those with cognitive impairments. People with dementia need to have access to physical spaces that allow them to participate in a wide range of social activities. Improving the accessibility of transport hubs, such as airports, is an important way to facilitate social inclusion.