Article

Effects of a Creative Expression Intervention on Emotions, Communication, and Quality of Life in Persons With Dementia

Article

Effects of a Creative Expression Intervention on Emotions, Communication, and Quality of Life in Persons With Dementia

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Abstract

Effective nonpharmacological interventions are needed to treat neuropsychiatric symptoms and to improve quality of life for the 5.3 million Americans affected by dementia. The purpose of this study was to test the effect of a storytelling program, TimeSlips, on communication, neuropsychiatric symptoms, and quality of life in long-term care residents with dementia. A quasi-experimental, two-group, repeated measures design was used to compare persons with dementia who were assigned to the twice-weekly, 6-week TimeSlips intervention group (n = 28) or usual care group (n = 28) at baseline and postintervention at Weeks 7 and 10. Outcome measures included the Cornell Scale for Depression in Dementia, the Neuropsychiatric Inventory-Nursing Home Version, the Functional Assessment of Communication Skills, the Quality of Life-Alzheimer's Disease, and the Observed Emotion Rating Scale (this last measure was collected also at Weeks 3 and 6 during TimeSlips for the treatment group and during mealtime for the control group). Compared with the control group, the treatment group exhibited significantly higher pleasure at Week 3 (p < .001), Week 6 (p < .001), and Week 7 (p < .05). Small to moderate treatment effects were found for Week 7 social communication (d = .49) and basic needs communication (d = .43). A larger effect was found for pleasure at Week 7 (d = .58). As expected, given the engaging nature of the TimeSlips creative storytelling intervention, analyses revealed increased positive affect during and at 1 week postintervention. In addition, perhaps associated with the intervention's reliance on positive social interactions and verbal communication, participants evidenced improved communication skills. However, more frequent dosing and booster sessions of TimeSlips may be needed to show significant differences between treatment and control groups on long-term effects and other outcomes.

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... Fritsch et al., 2009) continue to form a prominent strand within research on arts-based interventions with people living with dementia. This is, perhaps, partially driven by ambitions to evidence the effectiveness of specialised visual arts dementia programmes, such as Memories in the Making!, Opening Minds through Art and TimeSlips!, a storytelling activity (Gross et al., 2015;Kinney & Rentz, 2005;Phillips, Reid-Arndt, & Pak, 2010;Sauer, Fopma-Loy, Kinney, & Lokon, 2016). In particular, researchers favouring concepts such as quality of life (Lawton, 1997) and subjective well-being tend to employ scales such as the researcher-completed Greater Cincinnati Chapter Well-Being Observation Tool (Gross et al., 2015;Kinney & Rentz, 2005;Sauer et al., 2016) or the participantcompleted Canterbury Well-being Scale (Camic et al., 2017;Johnson et al., 2015). ...
... Other quality of life scales for people with dementia such as DEMQoL and QoL-AD have also been used (e.g. Camic, Williams, & Meeten, 2011;Phillips et al., 2010) and with varying degrees of 'success' when the arts-based trial is unblinded (see for example: Woods et al., 2016). ...
... Bannan & Montgomery-Smith, 2008;Camic et al., 2017), and note improvements in relationships between either informal or formal carers and people with dementia (e.g. Camic et al., 2011;Phillips et al., 2010), the focus of arts-based interventionist research, whether conducted in the qualitative or quantitative domain, is predominantly individualised. Where family members are involved, their role often amounts to little more than providing proxy data on the benefits of an intervention for the person with dementia. ...
Article
In recent years there has been a growing interest in person-centred, ‘living well’ approaches to dementia, often taking the form of important efforts to engage people with dementia in a range of creative, arts-based interventions such as dance, drama, music, art and poetry. Such practices have been advanced as socially inclusive activities that help to affirm personhood and redress the biomedical focus on loss and deficit. However, in emphasizing more traditional forms of creativity associated with the arts, more mundane forms of creativity that emerge in everyday life have been overlooked, specifically as regards how such creativity is used by people living dementia and by their carers and family members as a way of negotiating changes in their everyday lives. In this paper, we propose a critical approach to understanding such forms of creativity in this context, comprised of six dimensions: everyday creativity; power relations; ways to operationalise creativity; sensory and affective experience; difference; and reciprocity. We point towards the potential of these dimensions to contribute to a reframing of debates around creativity and dementia.
... Of the 31 eligible studies, 19 were randomized controlled studies (Advocat et al., 2016;Andrewes et al., 2014;Bahrani et al., 2017;Bedard et al., 2013;Bogosian et al., 2015;Emmons & McCullough, 2003;Grossman et al., 2010;Innes et al., 2016;Johansson et al., 2012;Madden et al., 2010;Mills & Allen, 2000;Mohamadpour et al., 2017;Phillips et al., 2010;Simpson et al., 2017;Thompson et al., 2015Thompson et al., , 2010Wang, 2007;Wells et al., 2014). Two were non-randomized controlled studies (Pickut et al., 2015;Tavee et al., 2011). ...
... increase in outcomes measures; ↔ = no change in findings. Cohen et al., 2008;Grossman et al., 2010;Innes et al., 2016;Johansson et al., 2012Johansson et al., , 2014Joo et al., 2010;Mills & Allen, 2000;Phillips et al., 2010;Simpson et al., 2017;Tavee et al., 2011;Thompson et al., 2010Thompson et al., , 2015Wells et al., 2014). Of all age groups, middle-aged adults (35 to 59 years old) accounted for the majority, followed by older adults (age > 60 years old). ...
... Among the 21 controlled intervention studies, four studies assigned no intervention to the control group (Bedard et al., 2013;Emmons & McCullough, 2003;Phillips et al., 2010;Wang, 2007). Three studies had an active control (social-support/attention intervention) (Innes et al., 2016;Madden et al., 2010;. ...
Article
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Objectives: Psychological well-being in people with neurological diseases can be compromised due to brain damage or psychological reactions towards chronic disabilities. This systematic review evaluated the efficacy of positive psychological intervention (PPI) in neurological populations. Methods: Previous studies relevant to this topic were identified by searches in PUBMED, EMBASE, MEDLINE, and PSYCINFO databases from Jan 1980 to August 2017. Results: Of 1361 articles identified, 31 studies were included. Nineteen studies were randomized controlled trials. Sixteen studies had sample sizes of less than 30. Twelve studies were rated as high quality using the National Heart, Lung, and Blood Institute (NHLBI) quality assessment tools. Six therapies were found: mindfulness-based approaches, positive savoring, life summary, expressive-based, hopebased interventions, and character strengths. These interventions were shown to improve quality of life, reduce symptomatic distress, and depressive symptoms. Conclusion: PPIs promote well-being among patients with neurological deficits. For PPIs to be considered as an evidence-based practice, more trials with adequate statistical power are required.
... TimeSlips is an evidence-based, creative expression approach that engages individuals with and without dementia in improvised storytelling. TimeSlips has been shown to improve emotional well-being and quality of life in people with dementia across the dementia severity spectrum (Chen et al., 2016;Fritsch et al., 2009;George & Houser, 2014;Phillips et al., 2010;Vigliotti et al., 2018). TimeSlips interventions reported to date ranged from 6 to 21 weeks with 1-or 2-hr group sessions per week . ...
... TimeSlips interventions reported to date ranged from 6 to 21 weeks with 1-or 2-hr group sessions per week . Significant improvements were observed on measures of depression (Chen et al., 2016) and self-and proxy-reports of quality of life (Fritsch et al., 2009;George & Houser, 2014;Phillips et al., 2010). Authors of studies who interviewed caregivers and residents after the intervention reported increased levels of engagement and increased quality and frequency of interactions between residents and staff, leading to improved quality of life for participants (Bahlke et al., 2010;Fritsch et al., 2009;George & Houser, 2014). ...
... Furthermore, communicative behaviors not observed in initial sessions, such as requesting clarification from one participant to another, making statements of agreement or disagreement, seeking out another's opinion or perspective, and engaging another through use of humor were observed more often over time. In a second study, Phillips et al. (2010) used the American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults (Fratalli et al., 1995) among other outcome measures to index intervention effects. The 6-week program of TimeSlips was associated with increased expressions of pleasure and better communication for the treatment group compared with the control group who did not participate in TimeSlips. ...
Article
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Purpose Future speech-language pathologists are often unprepared in their academic training to serve the communicative and cognitive needs of older adults with dementia. While negative attitudes toward older adults are prevalent among undergraduate students, service learning has been shown to positively affect students' attitudes toward older adults. TimeSlips is an evidence-based approach that has been shown to improve health care students' attitudes toward older adults. The purpose of this study is to explore the change in attitudes in speech-language pathology students toward older adults using TimeSlips in service learning. Method Fifty-one students participated in TimeSlips service learning with older adults and completed the Dementia Attitude Scale (DAS) before and after service learning. In addition, students completed a reflection journal. The DAS data were analyzed using nonparametric statistics, and journal entries were analyzed using a qualitative analysis approach. Results The service learners exhibited a significant increase in positive attitude as indexed on the DAS. The reflective journal entries supported the positive change in attitudes. Conclusions A noticeable attitude shift was indexed in reflective journals and on the DAS. TimeSlips is an evidence-based, patient-centered approach well suited to address challenges in the preparation of Communication Sciences and Disorders students to work with the growing population of older adults.
... The vast majority (20/22) of the final papers, however, only included participants with cognitive impairment. The largest proportion of papers (11 out of 22) included residents with mild to moderate dementia Batini, 2019a, 2019b;Capotosto et al., 2017;Lin et al., 2019;Orrell et al., 2005;Phillips et al., 2010;Siverová and Bužgová, 2018;Spector et al., 2001Spector et al., , 2003Spector et al., , 2010Winningham and Pike, 2007). Four papers included participants with moderate to severe dementia (Hutson et al., 2014;Okumura et al., 2008;Santo Pietro and Boczko, 1998;Strøm et al., 2017). ...
... In the studies that featured active tasks, participants were involved in the exploration of narrative themes and structure, and/or story creation. These interventions ranged from a highly structured format, based on the narrative phases of traditional Italian fairy tales and four designated emotional states (Cesetti et al., 2017) to the more spontaneous, but responsive and carefully facilitated, creative expression fostered in the TimeSlips story telling intervention (Lin et al., 2019;Phillips et al., 2010). ...
... Just over half of the papers (12) related to RCTs (Capotosto et al., 2017;Haslam et al., 2010;Hutson et al., 2014;Lin et al., 2019;Orten et al., 1989;Rattenbury and Stones, 1989;Spector et al., 2001Spector et al., , 2003Spector et al., , 2010Strøm et al., 2017;Tabourne, 1991Tabourne, , 1995. The remaining 10 studies were non-RCTs Batini, 2019a, 2019b;Cesetti et al., 2017;Okumura et al., 2008;Orrell et al., 2005;Phillips et al., 2010;Santo Pietro and Boczko, 1998;Siverová and Bužgová, 2018;Winningham and Pike, 2007;Zhang et al., 2018). ...
Article
Background The communication skills of older adults living in care homes is an underexplored topic. Ageing can lead to reduced communication ability and activity; and in the care home environment there may also be fewer communication opportunities. This situation is likely to negatively impact well-being. Previous reviews have found evidence of the effectiveness of behavioural interventions in increasing well-being, but no systematic review to date has focused specifically on the evidence base for group language and communication interventions in this population. Aims To identify and evaluate the evidence for behavioural interventions with older adults, delivered in groups in care homes, that specifically included a language or communication activity. To explore the impact of such intervention on the specific domains of language, communication and social interaction. To determine whether behavioural mechanisms of action can be identified. Methods & Procedures Embase, Medline, Ovid Nursing database, Psych info and CINAHL complete were searched and produced 158 records for screening, of which 22 remained for review. In order to identify and evaluate the quality of the evidence base presented the following research questions were posed: What research has been conducted in this area? What is the methodological quality of the studies identified? How complete is the intervention reporting? How was change measured in the domains of language, communication and social interaction? Is there evidence of efficacy, indicated by statistically significant improvement, in these domains? How did the interventions work? Synthesis tools employed included the PEDro-P Scale, the TIDieR checklist and the ITAX. Main contribution A total of 22 studies met the criteria for review. One study used solely language or communication interventions, but the remaining 21 studies used behavioural interventions which incorporated language and communication activities to varying degrees. Studies fell into four broad intervention types: reminiscence or life review; cognitive stimulation; narrative or storytelling; and multi-modality group communication. The majority of studies were of fair methodological quality, with a moderate level of detail provided in treatment reporting. Statistically significant improvement was reported by authors in all four intervention types and across language, communication and social domains. Social interaction, social support and behavioural skills were the most consistent mechanisms of action in the reviewed behavioural interventions. Conclusions & Implications Despite limitations in the evidence base, there are important positive signs for the beneficial effects of supporting language and communication in care homes. Blinding of assessors, and the accuracy and accessibility of statistical reporting are important areas to address in order to improve the quality of the evidence base. What this paper adds • Ageing can lead to reduced communication ability and activity, and in the care home setting there may also be fewer communication opportunities. This situation is likely to negatively impact well-being. Previous reviews have found evidence of the effectiveness of behavioural interventions in increasing well-being. The communication skills of older adults living in care homes is an underexplored topic. No systematic review to date has focused specifically on the evidence base for group language and communication interventions in this population. This review reveals important positive signs for the beneficial effects of supporting language and communication in care homes. Social interaction, social support, and behavioural skills were the most consistent mechanisms of action in the reviewed behavioural interventions.
... Wellbeing was also higher for reminiscence therapy than for general group activities. The superiority of activity over unstructured time was also demonstrated by Phillips et al. [6], who found significantly more pleasure during a group storytelling than during an unstructured control condition. ...
... While persons with higher level of cognitive function manifested more positive effects in response to the groups, the relative responses to the various group contents did not differ by cognitive function. The superiority of group activities to control observations concords with Brooker and Duce's [5] and Phillips et al.'s [6] findings that wellbeing was higher during activities than during unstructured time. In contrast, our findings of differential effects of groups based on their contents differ from those of some previous studies [7][8][9]. ...
Article
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Background: Individuals suffering from dementia and residing in nursing homes often feel lonely and bored. This study examined the engagement and mood of people with dementia in group activities, and how personal characteristics, such as cognitive function, may impact on an individual's responses to group activities. Methods: The study included 102 participants, who took part in group activities while their mood and engagement levels were observed. Participants were invited to attend 10 different types of group activities, each of which was offered twice. Results: Results found improved engagement and mood during group activities as compared to control no-group times. Significant relationships between the type of activity and ratings of engagement and mood were also found. Although participants with higher levels of cognitive functioning manifested greater responsiveness to groups, the pattern of response to different contents did not differ by cognitive function. Conclusions: This study shows the potential utility of group activities for improving quality of life of persons with dementia and demonstrates a methodology that can be used for quality improvement to optimize group contents. Future research should expand the range of contents of group activities in order to enhance the options for improving mood and engagement of individuals with dementia.
... Literary arts interventions have included storytelling, poetry and reading, with reading groups being associated with a reduction in severity of BPSD, increased enjoyment and renewed sense of identity (Billington et al., 2013). Storytelling has been shown to improve communication skills, increase positive affect and expressions of pleasure for PWD (Phillips et al., 2010). The arts also have the potential to create enjoyable, non-stigmatising and non-clinial activities for caregivers and PWD to jointly engage (Chatterjee et al., 2017). ...
... There was, however, a lack of studies evaluating the impact of dyadic literary arts interventions such that none met the criteria for this review. Given the evidence suggesting that individually delivered literary arts interventions may be associated with positive outcomes in PWD (Billington et al., 2013;Phillips et al., 2010), and the reported positive effects of other dyadic arts interventions, further research into dyadic literary arts interventions is warranted. ...
Article
Dementia is a neurodegenerative syndrome that can lead to profound psychological and social challenges for people with dementia and their informal caregivers. Previous research has found positive effects of arts‐based interventions for people with dementia and caregivers that have been dyadic in nature and the present article sought to review these findings. A systematic literature review was conducted to investigate psychosocial outcomes of dyadic arts interventions. PsychINFO, Medline, Web of Science and ASSIA databases (from journal inception to March 2020) were searched as well as Google Scholar and reference lists of relevant studies were searched. Interventions were delivered to people with dementia and their caregivers in community‐based settings across five countries. Thirteen peer‐reviewed journal articles met the criteria for inclusion in this review, six focusing on performing arts and seven on visual arts. The findings suggested that choral singing and visual arts interventions may have positive effects on psychosocial outcomes for both people with dementia and their informal caregivers. Improved well‐being, quality of life, mood, enhanced identity and decreased social isolation were found in some studies. Importantly, across all studies, participants reported enjoying arts activities. This is the first review to systematically assess dyadic arts activities in a dementia context. These activities offer enjoyable and engaging experiences for many person with dementia and caregivers and were generally found to have positive results but mostly small sample size, lack of control groups and different outcome measures made comparisons challenging. Future research recommendations include further theoretical development, identifying key intervention components, and specifying relevant and measurable theoretically informed outcomes within dyadic interventions for this population.
... Unlike most individual-targeted programs, CSP provides a unique avenue for the participants to collectively create an end-product (i.e., story) and engage in meaningful social interactions. Indeed, storytelling as a social activity focuses on communication, improvisation, and collective creativity (Basting, 2011), and has shown to improve relationship quality (Vigliotti, Chinchilli, & George, 2018), communication (Fritsch et al., 2009;Phillips, Reid-Arndt, & Pak, 2010), alertness (Fritsch et al., 2009), and mood (Phillips et al., 2010). The activity is also known for improving well-being by creating a social role (Whitehouse & George, 2008). ...
... Unlike most individual-targeted programs, CSP provides a unique avenue for the participants to collectively create an end-product (i.e., story) and engage in meaningful social interactions. Indeed, storytelling as a social activity focuses on communication, improvisation, and collective creativity (Basting, 2011), and has shown to improve relationship quality (Vigliotti, Chinchilli, & George, 2018), communication (Fritsch et al., 2009;Phillips, Reid-Arndt, & Pak, 2010), alertness (Fritsch et al., 2009), and mood (Phillips et al., 2010). The activity is also known for improving well-being by creating a social role (Whitehouse & George, 2008). ...
Article
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Background and Objectives Creative group storytelling as utilized in TimeSlips is a social activity that focuses on communication, improvisation, and creativity among its participants with dementia. A collective narrative is a channel through which participants express themselves, and it thus signifies clues about their identities, values, and experiences. No study to date, however, has examined the contents of the stories. Using the generativity model as a theoretical underpinning for analysis, this paper examines the emergent themes of such collective stories. Research Design and Methods This study used the data collected in a memory care community where a research team recruited and engaged 21 out of approximately 80 residents with dementia in 6 weekly creative storytelling sessions; 4 small groups of 4 to 6 participants created a total of 24 collective stories. Three researchers analyzed these stories by open-coding emergent themes. Once coded manually, the narratives were managed and analyzed in NVivo. Results Consistent with the concept of generativity, a thematic analysis of collective narratives revealed various aspects of participants’ generative concerns. Three themes related to generativity: (1) caring and promoting the well-being of others, (2) family values, and (3) positivity. Discussion and Implications The narratives show that participants living with dementia continue to express their generative values and concerns. The findings reveal generative identities held by persons living with dementia, which help destigmatize dementia. The findings also shed light on why creative group storytelling may affect multiple positive outcomes for its participants.
... By engaging PWDs in a creative, failure-free activity in which there are no "right" or "wrong" answers and all contributions are considered valuable and significant, TimeSlips aims to support remaining strengths and capacities while creating a meaningful social role for residents in an institutional setting. Although evidence of the program's efficacy is limited, preliminary studies have shown that participation positively benefits PWD, improving engagement and alertness while fostering more frequent staff-resident interactions and more positive staff views of the residents, 8,9 engendering pleasure and positive affect in participants, 10 increasing creativity, reducing agitation and anxiety, 11 improving quality of life (QOL), and positively altering behavior while further producing benefits for the morale of staff members and nursing home community as a whole. 8,12 There are, however, no known studies that have analyzed the effects of TimeSlips beyond a 10-week period or brought mixed methods to bear in carrying out such an analysis. ...
... Table 1 describes the demographic information of each participant and their mental status throughout the study as determined by the MMSE. Given the small sample size, MMSE categories of "questionably significant dementia" (scores of 25-30), "mild dementia" (scores of 20-25), "moderate dementia" (scores of [10][11][12][13][14][15][16][17][18][19][20], and "severe dementia" (scores of 0-10) were combined into 2 groups: mild-moderate dementia (scores of 10-30) and severe dementia (scores of 0-10). Of note, all participants were categorized as "Caucasian" and were between the ages of 80 and 97. ...
Article
Objectives: To evaluate the benefits of TimeSlips, a group creative storytelling intervention used in residential care settings, on quality of life (QOL), interactions with caregivers, and Mini-Mental State Examination (MMSE) scores for persons with varying degrees of dementia severity. Design: A mixed-methods approach was used weekly over a 6-month period to measure QOL and resident-caregiver relationships. Setting: A dementia care unit in Pennsylvania. Participants: Twenty-two residents with mild-to-severe dementia. Measurements: Dementia severity and QOL were assessed using the MMSE and Greater Cincinnati Chapter Well-Being Observational Tool. Resident-caregiver interactions were analyzed using a modified version of the Quality of Interactions Schedule. Semistructured interviews were conducted upon the study's conclusion. Results: Quantitatively, participants initially classified with mild-moderate dementia were significantly more likely to experience positive benefits compared to those initially classified with severe dementia. There were no significant changes in dementia severity over time. There was also no change in QOL or resident-caregiver relationships for those with mild-moderate dementia over time, although there was a decrease in certain measures of QOL and resident-caregiver relationships for those with severe dementia. Qualitative analysis identified consistent benefits for residents with both mild-moderate and severe dementia over time. Conclusions: Mixed-methods analyses helped identify benefits of TimeSlips for persons at all levels of dementia severity, but particularly for those with milder dementia. Such an observation helps demonstrate how arts-based programs like TimeSlips can uniquely benefit people with advanced memory impairments and thereby support QOL.
... Skewed distributions of the negative expressions were commonly reported (FACS/EMFACS; Asplund et al., 1995;ODAS;Beck et al., 2002;Beerens et al., 2016;BEAM;Casey et al., 2014;MEDLO-tool;de Boer et al., 2016;MPES;Judge et al., 2000;GCWOT;Kinney and Rentz, 2005;OERS;Lawton et al., 1999;SM-GCWOT;Lokon et al., 2019;MAX;Magai et al., 1996Magai et al., , 2002PRS;Perrin, 1997;Phillips et al., 2010;ACT;Wood, 2005). For AwareCare, infrequent items were removed during fieldwork to avoid skewness (Clare et al., 2012). ...
... First, it will decrease the labor intensiveness of the observational assessment because less items are assessed. Second, it will bring about data better fitted for statistical approaches because the distribution of ill-being items in the clinical studies using these instruments often were skewed and not normally distributed (see Asplund et al., 1995;Magai et al., 1996Magai et al., , 2002Perrin, 1997;Lawton et al., 1999;Judge et al., 2000;Beck et al., 2002;Kinney and Rentz, 2005;Wood, 2005;Phillips et al., 2010;Casey et al., 2014;Beerens et al., 2016;de Boer et al., 2016;Lokon et al., 2019). Lastly, it will increase the likelihood of correct conclusions about the positive effects of the psychosocial interventions because this is operationally defined as an increase in positive expressions and not as a decrease in negative expressions. ...
Article
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Optimizing the possibility to lead good lives is at the core of treatment and care for people with dementia. This may be monitored by assessing well-being and quality of life. However, cognitive impairment following dementia may complicate recall-based assessment with questionnaires, and proxy-ratings from family-caregivers do not correspond well to self-reports. Thus, using observational measures represents a potentially advanced option. Systematic reviews evaluating measurement properties, interpretability and feasibility of observational instruments assessing well-being in people living with dementia are lacking. Thus, this review performed systematic searches to find peer reviewed validated instruments of relevance in the databases MEDLINE, EMBASE, PsycINFO, Web of Science, CINAHL and ProQuest. Twenty-two instruments assessing well-being were included for evaluation of measurement properties based on the systematic approach of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The evaluation included risk of bias on study level, and assessment of measurement properties on instrument level including content validity, construct validity, structural validity, internal consistency, measurement invariance, cross-cultural validity, measurement error and inter-rater/intra-rater/test–retest reliability and responsiveness. Additionally, the feasibility and interpretability of the measures were evaluated. No single instrument could be recommended based on existing publications. Thus, we provide general recommendations about further assessment and development of these instruments. Finally, we describe the most promising instruments and offer guidance with respect to their implementation and use in clinical and research contexts.
... Finally, (Fritsch et al., 2009) through randomised matched pairs incorporated storytelling as a creative intervention with nursing home residents with dementia and their carers, and discovered, compared to the control group, those using the creative intervention showed significant increases in pleasure, engagement and alertness, interacted more with nursing home staff, and socialised more. In a followup study with the same intervention, significantly improved communication skills both with carers and peers were also observed in people with a dementia who had participated in a creative expression intervention through storytelling (Phillips et al., 2010). ...
Article
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Creativity research has a substantial history in psychology and related disciplines; one component of this research tradition has specifically examined artistic creativity. Creativity theories have tended to concentrate, however, on creativity as an individual phenomenon that results in a novel production, and on cognitive aspects of creativity, often limiting its applicability to people with cognitive impairments, including those with a dementia. Despite growing indications that creativity is important for the wellbeing of people living with dementias, it is less well understood how creativity might be conceptualised, measured and recognised in this population, and how this understanding could influence research and practise. This paper begins by exploring prevailing concepts of creativity and assesses their relevance to dementia, followed by a critique of creativity and dementia research related to the arts. Perspectives from researchers, artists, formal and informal caregivers and those with a dementia are addressed. We then introduce several novel psychological and physiological approaches to better understand artistic-related creativity in this population and conclude with a conceptualisation of artistic creativity in the dementias to help guide future research and practise.
... 32,33 ADL is intimately linked to working memory and executive and visuospatial functioning, which can be facilitated through sustained cognitive training. 34 The significant improvement in ADL performance in the CrExp group may be attributed to an enhancement in working memory through the practice of imaging, storytelling, and drawing exercises. More studies are needed to explore factors that correlate with improved ADL. ...
Article
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Objective Elderly people with mild cognitive impairment (MCI) are at high risk for dementia. This study compared the effects of standard cognitive training with a creative expression (CrExp) program. Methods Adult patients with MCI aged 60 years and older (N=93) were randomly assigned to either CrExp therapy (n=48) or a control group who received standard cognitive training (n=45) for 16 weeks. The Montreal Cognitive Assessment, Chinese Version of the Auditory Verbal Learning Test, Chinese Version of the Category Verbal Fluency Test, Digit Span Test, Trail Making Test, Chinese Version of Activities of Daily Living scale, and Memory Satisfaction Questionnaire were used to measure cognitive functioning and daily living abilities. Assessments were administered at baseline, postintervention, and 6 months follow-up. Results At postintervention, patients receiving CrExp therapy scored significantly higher than patients receiving standard cognitive training, in general cognitive functioning, memory, executive function, functional status, and everyday living ability. The improvements in cognitive functioning were maintained at the 6 month follow-up. Conclusion CrExp therapy has greater positive effects on cognitive functions and daily living ability than standard cognitive training. This unique therapy may serve as a cost-effective adjunct to standard interventions for older adults with mild cognitive impairment.
... The OERS is a well-used observational tool. It is one of the outcome measures used in an evaluation of TimeSlips, a storytelling programme for PwD (Phillips, Reid-Arndt, & Pak, 2010). The intervention group were observed during the programme and the control group during meal time. ...
... Benefits may be carried over to other areas of everyday life, and improve attention, appetite, communication and social engagement [7][8][9]. Promising positive effects have been evidenced across a range of activities including visual art [10,11], music or singing [12,13] and storytelling [14]. Participatory arts have been found to lead to significant positive effects in the mental wellbeing, general health and social functioning of older people [15,16]. ...
Article
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Abstract Background: Direct involvement in creative activities can have benefits in terms of improved attention and positive engagement for older people. We used the Social Return on Investment approach (SROI) to explore the social and economic benefits of arts activities for older people living in residential homes in England. Methods: We complied with the CHEERS checklist and followed the six stages of SROI as reported in the literature. Results: We identified three main stakeholders: care home residents, care home personnel, and activity co-ordinators. For residents, the outcomes of interest were: community inclusion, mental and physical health, improved cognition and decreased social isolation. For care home personnel and activity co-ordinators the outcomes were: improved skills in caring for older people and increased confidence in using arts intervention. The analysis yielded an SROI of £1.20 for every £1 of expenditure. The sensitivity analysis revealed that when we consider a displacement rate of 15% for all the outcomes of all participating stakeholders, the Imagine study is unlikely to report a ratio that is less than £1.02 for every £1.00 invested. Conclusions: Findings could inform policy decisions about investment in the arts and health or social care.
... To develop a deeper understanding of the problem in the initial stages of codesign, we used creative tasks such as developing 'ideal' home care worker personas, narratives and storytelling. Creativity plays an important role for people living with dementia (Camic et al., 2018), as it is an engaging social activity that can provide a conversation model for people with dementia, even in more advanced stages (Fels & Astell, 2011) and has been shown to improve communication and affect in people with dementia, relationship quality (Vigliotti et al., 2018), communication and mood (Phillips et al., 2010), and alertness (Fritsch et al., 2009 (Miller et al. 2001). ...
Article
Undertaking co-design with the end users of services has rapidly evolved as the best-practice approach to program design, development and implementation. Increased interest in using participatory co-design in dementia care has drawn attention to the need for evidence-informed methods for facilitating the meaningful involvement of people with dementia and their family carers in co-design activities. The aim of this paper is to describe the co-design framework used in the co-design of a dementia specialist training program for home care workers. The Promoting Independence Through quality dementia Care at Home program is a successful example of co-design methodology used across multiple project stages and with various stakeholder groups, including people living with dementia, family carers, home care workers, managers and researchers. Co-design methods were tailored to each stage, purpose, and stakeholder group, and to facilitate the involvement of people living with dementia. Findings provide unique insights into optimising input from co-design partners, including people living with dementia; the methodology, conditions and requirements for participants to co-design and implement ideas; and perspectives on the enablers and challenges of using co-design in this population. In this paper, we present a comprehensive approach for involving people living with dementia as active and equal contributors in inclusive and meaningful participatory co-design.
... A randomized, controlled trial among 28 elderly patients with dementia demonstrated that CE therapy had a positive effect on patients with Alzheimer's mood, communication ability, and depression symptoms. 40 However, the results did not reach the statistically significant level. Some studies indicated that participants in the test group receiving CE therapy once a week for 10 weeks were more active, positive, and communicative than those in the control group receiving routine nursing intervention. ...
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Purpose: This study aimed to evaluate the effect of creative expression (CE) therapy on cognition, communication, emotion, and quality-of-life in people with dementia. Methods: One hundred individuals were included in this study, of whom 91 completed the study (mean age=84.33). The participants were randomly assigned to an intervention group (n=43) and a control group (n=48), and received the CE program or standard cognitive (SC) training twice a week for 6 weeks, respectively. Both groups were submitted to extensive neuropsychological tests, as follows - Mini-Mental State Examination (MMSE), Quality of Life-Alzheimer's Disease (QOL-AD), Cornell Scale for Depression in Dementia (CSDD), Functional Assessment of Communication Skills (FACS) at baseline, 1-, and 4 -weeks post-intervention, and the Observed Emotion Rating Scale (OERS) was measured during the intervention period at weeks 3 and 6. Results: The participants demonstrated significant improvements in cognitive function, quality-of-life, depression degree, communication ability, and emotion status (P<0.05) at post-intervention, which were maintained at 1-month follow-up. Conclusion: This study provides preliminary evidence that CE therapy developed in the study benefits elderly Chinese with dementia. The findings indicated that non-pharmacological intervention programs - CE therapy - can be applied in the management of neuropsychiatric symptoms of dementia.
... Now being replicated across the country, these evidencebased programs demonstrate that arts participation can connect or reconnect persons with dementia by improving communications, increasing social engagement, and reducing agitation. For example, Philips, Reid-Arndt, and Pak [8] demonstrated that a TimeSlips storytelling intervention increased pleasure and improved communication skills for people with dementia at one-week post-intervention. Other studies have demonstrated the effectiveness of TimeSlips interventions in substantially improving caregiver attitudes towards people with dementia, including those of medical students [9,10]. ...
Article
A diagnosis of dementia profoundly impacts a person in terms of both the functional progression of the disease and the social stigma associated with the diagnosis. A growing body of research demonstrates the effectiveness of innovative programs such as the Alzheimer's Poetry Project, Meet Me at MoMA, and TimeSlips™ in counterbalancing social stigma by building a social and emotional framework for strength-based living for people diagnosed with dementia through arts participation. These programs focus on supporting autonomy and generativity through creative expression to help sustain the social, emotional, and community fabric of people's lives in the face of significant counterbalancing forces (e.g., the disease itself, stigma, and institution-centered approaches to care).
... The Observed Emotion Rating Scale, which has been validated in elderly populations (Lawton, 1999) and extensively used for observations of older adults with dementia (e.g., (Moyle et al., 2013;Phillips, Reid-Arndt, & Pak, 2010), was adapted for coding affective states; choices included "pleasure," "anger," "anxiety/fear," and "neutral." The Menorah Park Engagement Scale, which has been validated in nursing home populations (Camp & Skrajner, 2004) and used in observations of residents with dementia (e.g., Camp & Skrajner, 2004;Skrajner & Camp, 2007), was employed to code engagement; its choices were: "actively engaged," "engaged in other activity," "staring into space," and "eyes closed/sleeping." ...
Article
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Background and Objectives Several studies suggest that to substantially improve residents’ psychosocial well-being, traditional-model nursing homes should redesign themselves as small, homelike “households” along with comprehensively adopting other aspects of “culture change,” a set of reforms meant to improve residents’ quality of life. But this evidence mainly comes from qualitative studies. This comparative, observational study tested quantitatively whether residents in a household-model nursing home that had comprehensively adopted culture change reforms displayed greater positive affect, increased cognitive engagement, more extensive social interactions with staff and greater use of the environment than did residents at partial culture-change-adopting facilities with traditional, institutional environments. Research Design and Methods Household-model residents were matched on clinical and demographic factors with residents at two institutional control facilities that had partially adopted culture change and were observed for 8 hours each. To provide potentially converging evidence, aides and nurses were also observed. Finally, a culture change implementation assessment was conducted. Results The implementation assessment showed that the household-model home had implemented culture change beyond national norms, whereas the control facilities were U.S.-typical partial adopters. It also revealed that household-model staff cared for residents in a more person-centered manner. Observation analyses revealed that household-model residents spent less time idle and less time stationary at wheelchair hubs. Moreover, although household-model residents did not spend the most time in the dining area overall, they spent the greatest percentage of time there talking with staff, displaying positive affect, and displaying active engagement. Finally, household-model residents and staff spent the most time in task-oriented interactions, including personal care. Discussion and Implications These results suggest that the intended psychosocial benefits materialize in household-model facilities, particularly in the dining area and in resident–staff relationships. The findings raise the possibility that facilities may be able to achieve these outcomes without entirely redesigning their environment.
... Furthermore, evidence from psychological and affective reports suggests that arts interventions can be beneficial to the mental wellbeing of people with dementia, as well as create positive personal experiences (Chancellor et al., 2014;Hattori et al., 2011;Flatt et al., 2015;Phillips et al., 2010). Relatedly, it has been suggested that music may evoke complex emotional states via the entrainment of areas of the brain outside emotional systems, and that activation and enhancement of attention and memory related networks by music may contribute to a reduction in confusion (Vuilleumier and Trost, 2015). ...
Article
The dementias are a group of progressive symptoms that have multiple causes, usually caused by disease or injury of the brain, affecting higher brain functions such as language, perception, memory, reasoning and mood; they can also be associated with changes in personality. Arts interventions and interaction with the arts can create meaningful, positive experiences for people with a dementia, as well as improve quality of life. Qualitative research in particular, has been able to describe the emotional responses the arts can produce, but quantifiable changes have not been well documented. Physiological measurements such as stress hormone levels and galvanic skin response show promise in being able to quantify such responses. When taken together, these can give a picture of the kinds of physiological outcomes that are associated with positive affect and improvements in mental wellbeing in the context of arts interventions. This review provides a critical overview of the studies which measure some form of physiological outcome in response to the arts or an arts intervention in people with dementia, and indicates how future research in this area can help to broaden our understanding of the effects of the arts in dementia research and care.
... Las actividades artísticas mejoran la atención, la comunicación, la autoestima, la satisfacción personal, la socialización y la oportunidad de tomar decisiones y actuar de manera autónoma, incrementando el bienestar físico y emocional de los ancianos que viven con demencia (Kinney & Rentz, 2005;Phillips, Reid-Arndt, & Pak, 2010;Rusted, Sheppard, & Waller, 2006). ...
Article
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Dementia is a progressive health condition, affecting an increasing number of people, characterised by the cognitive impairment and the presence of neuropsychiatric symptoms that limit daily life and diminish the quality of life of the person. The goal of this systematic review is to analyse those investigations related to the impact of visual arts interventions on the health and well-being of people with dementia. This review has been done using Medline, PsycINFO and Cinalh databases. Out of 84 publications found, 18 met the inclusion criteria. The results highlight the current relevance of research on visual arts intervention in dementia, but the studies included small samples and showed important methodological weaknesses. Nevertheless, current literature suggests that with adequate supports people with dementia can produce and appreciate visual art, and improve the perception of physical and emotional well-being.
... The latter term includes a vast span of creative activities many of which are used in different forms of cognitive training and therapies. Those activities include various forms of art, such as painting, designing, crafts, music (Hannemann 2006), and also storytelling (Phillips et al. 2010), and innovative thinking (Rritter and Mostert 2017). Creative activities can improve cognitive and daily living abilities. ...
... Few studies included communication outcome measures. Specifically, Phillips et al. (2010) used American Speech-Language-Hearing Association's Functional Assessment of Communication Skills for Adults (Frattali et al., 1995) as a caregiver-report measure, and Bahlke et al. (2010) included an observational, communicative participation measure, the Conversational Acts Profile (Fey, 1986). While the systematic review did not target speech-language pathology interventions in particular, several interventions were language based (e.g., TimeSlips and museums visits) designed to foster communicative interactions, yet communicative participation was rarely assessed. ...
Article
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Purpose The purpose of this study was to determine how quality of life (QoL) is measured in people with dementia involved in interventions designed to improve well-being and to explore how those measures align with principles of person-centered care. Method A systematic literature review was conducted utilizing PsychInfo, CINAHL, and PubMed and combinations of the search terms: “dementia,” “outcome measure,” “creative engagement,” “creative intervention,” “TimeSlips,” “art,” “quality of life,” and “well-being.” The search was limited to studies published in peer-reviewed journals that reported outcomes for people with dementia in response to a creative intervention. Results Across the 24 reviewed studies, 30 different outcome measures were reported including eight self-reported, nine observational, and 13 proxy-reported measures. Self-report of QoL was elicited 16 times, observational measures were reported 17 times, and proxy-reported measures were used 28 times. All measures were used with participants across the dementia severity spectrum. Conclusion Current clinical practice of QoL evaluation does not align well with person-centered care principles of self-determination based on the low proportion of self-report. The previously reported limitations of proxy-report have been in part confirmed with this study. Implications of the findings for speech-language pathologists are discussed.
... 9 Conjoint arts activities for both the patients and their caregivers can provide nonverbal means to communicate sensitive topics related to life and death and facilitate sharing of different ideas and rejuvenate relationships. 2 The EXA activities are also applicable to enhancing the quality of life and reducing distress among patients with different levels of cognitive impairment. [10][11][12] Despite the ubiquity of arts in our daily lives, the use of EXA in EOLC should be backed up by training in the basic physical properties of art materials, characteristics of arts modalities, and techniques of planning and organizing arts-based counseling sessions. However, it may not be practical for most health and social care services to dispense EXA activities solely by professionally trained and registered art therapists. ...
Article
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In the recent decades, expressive arts (EXA) has been used in end-of-life care (EOLC) for facilitating the quality of life of the patients and the caregivers. However, it may not be practical for every EOLC service to dispense EXA activities solely by extensively trained art therapy specialists. There is currently a lack of brief training for nonart therapists, which may have stifled the application of the techniques in clinical settings. The current study therefore described and evaluated the effectiveness of a 2-day EXA training workshop in enhancing practice, knowledge, and self-competence among health and social care professionals working in EOLC using a mixed-method approach. The quantitative findings show significant improvement in perceived competence of providing services per holistic and person-centered EOLC objectives, nonpharmaceutical management of symptoms, and evidence-based psychosocial care as well as self-competence in death work (SCDW) after the workshop. The qualitative findings corroborated the quantitative results by suggesting that the improvement in competence could be associated with enhanced communication, meaning reconstruction, and therapeutic relationship with the clients as well as the improvement in mood, socialization, and self-esteem among the clients through the learned EXA activities. Our findings support the efficacy of a brief training of EXA activities for nonart therapists in enhancing multifaceted intervention competence. Further research on brief training will be needed to promote the use of EXA activities in the EOLC context.
... Although few studies have explored play in the context of dementia (Killick & Allan, 2012; Perrin et al., 2000), there is a growing body of work on meaningful engagement through the participatory arts (i.e., programs involving active creation like storytelling) (de Medeiros & Basting, 2014). Research focused on participatory arts programs has centered on measurable outcomes of health, cognition, and behavior to evaluate their effectiveness (Fritsch et al., 2009; Phillips, Reid-Arndt, & Pak, 2010 ), thereby overlooking the opportunities to socialize, use imagination, and temporarily escape the realities of the day-to-day world (e.g., the role of " patient " ) that the arts offer (Basting, 2009; de Medeiros & Basting, 2014). Our paper uses humanistic inquiry (HI) to explore play as an experience of being human. ...
Article
This paper is a humanities-based inquiry, applying Huizinga’s framework of homo ludens (“man the player”) to consider “play” in the context of two participatory arts programs (TimeSlips and the Alzheimer’s Poetry Project) for people living with dementia. “Play,” according to this Dutch historian, is at the heart of human activity and what gives meaning to life. Despite empirical research on play across the life course, play in dementia care is a relatively new idea. In addition, there is a dearth of reports based on humanistic inquiry which has slightly different goals than the growing body of qualitative and quantitative studies of participatory arts interventions. Play is not used to infantilize and trivialize people living with dementia but as a way to explore potential for expression, meaning-making, and relationship-building in later life. The arts programs were conducted at two residential care facilities, Scharwyerveld and De Beyart, in the Netherlands over 10 weeks. Close readings of the transcripts and notes from the programs resulted in three observations: people learned to play again, there is power in playing together, and play often led to expressions of joy. Overall, the notion of play may be a helpful framework for future research into innovative arts-based approaches to dementia care.
... It was also observed that TimeSlips has the potential to alleviate frustration and agitation in individuals with dementia due to the fact that the environment is a free expression area and thus alleviates the pressure associated with everyday conversation [40]. Phillips, Reid-Arndt, & Pak [41] also found that TimeSlips improves the ability to communicate while simultaneously increasing quality of life both during and post TS intervention. ...
Article
Dementia is a syndrome characterized by the progressive degeneration of one's cognitive function. The syndrome inflicts one in every nine individuals 65 and older; and 200,000 individuals under the age of 65. Currently, no cure exists; thus, finding the highest quality treatment to reduce the symptoms of the disease must become priority. Maintaining or increasing one’s quality of life is the utmost goal of any therapy for individuals with dementia. Currently, non-pharmacological approaches for suppressing concomitant symptoms of the disease have become highly debated and researched for their usefulness and for their ability to achieve this goal. Several therapeutic methods that can be considered non-pharmacological - music therapy, narrative telling , poetry, art therapy, technological interventions, and exercise and dance movement programs. A literature review was completed in order to determine the role of theseapproaches on dementia. Findings indicate that there is a small effect on cognition during these therapies presently, but there is still insufficient research in the area to conclude a sufficient difference. Non-pharmacological treatments yield potential quality of life benefits while additionally being cost-effective compared to medical interventions. Due its prevalence, further research on this topic is warranted and necessary.
... Group activities can be effective in engaging individuals with dementia 1 and eliciting positive mood, 2 particularly when compared to unstructured time. 3,4 However, the factors that facilitate or hinder engagement and mood in group activities are just beginning to be defined. ...
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Background This paper describes barriers to engagement in the context of group activities attended by nursing home residents with dementia. Objective The goal is to clarify the presence and types of barriers to group activities for persons with dementia. Methods Therapeutic recreation staff (TRs) who conducted the group activities, and trained research observers (ROs) independently identified barriers occurring during group activity sessions through ratings and open-ended comments, which were analyzed via a mixed-method approach. Results Barriers were related to specific participant, environmental, and group session characteristics. Most frequently noted barriers were participant-related, pertaining to apathy and challenging behavior. Noise was the most frequent environmental barrier. Overall, ROs reported more barriers than TRs, yet TRs reported the barrier of inappropriate topic more frequently than ROs. Conclusions The study suggests that the number and specific types of barriers are associated with negative engagement outcomes. Insight into these barriers is the first step toward addressing them and minimizing their effects.
... In countries outside of China, in the late 1990s, art therapy as a psychosocial therapy that combines art and human elements was beginning to find application in the field of dementia research. 2 In art therapy, through stimulating cognition with lines and colors, the patients are provided with a non-verbal channel of communication and are able to overcome inadequacies of self-expression due to impaired language ability and can vent negative emotions, thereby making significant achievements in improving attention and reducing behavioral and psychological symptoms; patient quality of life and social skills are also improved. 3 Currently, nursing intervention with dementia patients in China is still limited to cognitive training, independent-living skills training and guiding family caregivers, 4 and the application of art therapy requires further development. ...
Article
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In this article, the theoretical basis and development status of art therapy are introduced, and the intervention methods and effectiveness of art therapy in patients with dementia are reviewed. To date, nursing intervention via art therapy with dementia patients in China has been rarely investigated, and the design of this type of investigation must be improved.
... Estos son divididos en estados de ánimo positivos (placer y estado de alerta) y negativos (ira, ansiedad/miedo y tristeza). Esta escala ha demostrado tener una fiabilidad muy variable, de pobre a excelente (0,25 -0,81) (15). La experiencia vivida durante la intervención fue evaluada mediante la herramienta Non-Pharmacological Therapy Experience Scale (NPT-ES). ...
Article
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Objective: To identify the effectiveness of dog-assisted therapy with institutionalized older people with dementia. Methods: Quasi-experimental study, which it was implemented an assisted cognitive therapy with dogs together with conventional cognitive intervention in a group of seven residents for three months. It was evaluated mood and experience during the intervention. Descriptive analysis of the main variables and inferential analysis using t-Student for both interventions. Results: It was not found significant inter-intervention differences regarding the experience of the intervention, but it was found almost significant difference in short term (p = 0.09). In the long term, it was observed improvement in positive moods and reduction in negative ones after the joint implementation of both interventions. Conclusion: Dog-assisted therapy seems to improve the experience of cognitive intervention with institutionalized people with dementia and could be an ideal complement of intervention to improve mood. Future clinical trials, with a larger number of participants, would be necessary to confirm these trends.
... Mr. B was also engaged in exercise at the time, which could have contributed to the studied factors. Responses by both veterans could also be interpreted as responses to the opportunity for creative efforts and use of imagination in the here-and-now, rather than recollection or use of cognition for expression (Phillips et al., 2010;Fritsch et al., 2009). ...
Article
Prior studies have described positive behavioral, emotional, and social responses to dolls in persons with dementia (PWD), but most have examined formal doll therapy in institutional settings and primarily included women. This study describes two cases of spontaneous doll interactions in male veterans who were participating in a research study of a gentle group movement program at an adult day center. A doll was present at the study site, and two participants chose to interact with it. Researchers analyzed class videos and thematically coded behavioral, emotional, and social responses to the doll. Mr. B was a 90-year-old World War II-era veteran with moderate Alzheimer's disease. Behavioral responses (n = 83) toward the doll included gazing, holding, and caressing. Emotional responses (n = 46) included chuckles, smiles, and laughter. Social responses (n = 59) involved conversations about the doll in which his ability to communicate verbally was markedly improved. Mr. C was a 68-year-old Vietnam veteran with mild Lewy body dementia. He also exhibited frequent behavioral (n = 10), social (n = 11) and emotional (n = 8) responses toward the doll. In addition, he reported having an intense, cathartic dream about the doll, crying "it brings me back to holding my son or my daughter." These case studies add to the literature supporting the benefits of doll use by PWD by describing the effects of spontaneous doll use in two male veterans. Results suggest that having dolls available and providing a nonjudgmental environment where doll use is encouraged and supported may have profound beneficial effects to diverse populations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... The OERS ranges from 0 to 10, with higher scores indicating higher levels of positive emotions. After training the interrater-reliability of the OERS showed Cohen's Kappa values between 0.63 and 0.86 [31]. The other items of the MEDLO-tool are regarded as valid and feasible, with Cohen's Kappa values for interrater-reliability ranging between 0.5 and 1 [28]. ...
Article
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Background: Persons with dementia spend most time of their day not engaging in activities or social interactions. A care concept of a dementia special care unit that promotes activities and social interaction through a household-like design and individualised stimuli is studied. Aim: To evaluate the main outcomes of the care concept of a dementia special care unit, namely, engagement in activities and social interactions. Methods: We conducted an observational study as part of a theory-driven evaluation. The Maastricht Daily Life Observation Tool was used to collect momentary assessments multiple times per participant, including engagement in activity, type of activity, engagement in social interaction, interaction partners, location, agitation and mood. Thirty-three residents of the dementia special care units that implemented the care concept and 54 residents with dementia of two traditional nursing homes participated in the study, resulting in 2989 momentary assessments. Results: Residents of both settings did not engage in activities or social interaction in approximately half of the observations. Compared to residents of traditional nursing homes, residents of special care units had a significantly higher chance for engagement in activities and social interaction in the afternoon but not in the morning or evening. Conclusion: The care concept of the special care unit facilitated engagement but had its limitations. Further research is needed to develop and evaluate appropriate interventions to enhance engagement of persons with dementia.
... The ability of processing emotions is fundamental for an appropriate social interaction and may cause distress in both patients and caregivers. It can lead to a poor quality of life due to reducing interpersonal communication [3,4] and can influence social behavior in patients [4]. ...
Article
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Objective: Patients affected by Alzheimer’s disease show deficits in emotion processing and inappropriate social behaviors during emotional situations were clinically observed. Aim of our study was to explore the ability of patients with Alzheimer’s disease in ascribing emotional meaning to environmental or human emotional sounds, to understand if environmental sounds are impaired in their meaning or in their emotional attribute. Methods: Thirty participants were included in the study. The sample comprised two groups: 1) 15 patients with a diagnosis of probable Alzheimer’s disease; 2) 15 healthy comparison matched with the experimental group. Participants were submitted to a neuropsychological evaluation that included standardized (Mini-Mental State Examination, Boston Naming Test and the Token Test) and experimental tasks. The experimental battery was composed of four tasks: the Noise Recognition Task, the Emotion Naming Task, the Emotion Discrimination Task and the Sound and Emotion Association Task. These tasks were chosen to mirror ecologic situations, in which patients have to infer feelings elicited by sounds. Results: Analysis of variance showed that patients affected by Alzheimer’s disease had significantly worse performance than healthy comparison subjects (p <.001) in the experimental battery. Conclusion: The findings suggested, as expected, that Alzheimer’s Disease patients was less efficient than healthy comparison subjects in processing emotion, even if the two groups showed a similar trend. When patients have to associate visual and auditory stimuli, they have more difficulties in establishing among facial expressions the one to which the sound belong, rather than in identifying the meaning of the facial expressions or of the sounds.
Article
Background: There are no sufficient findings from synthesized evidence for the effectiveness of psychosocial interventions to improve mental health in inpatient care. Methods: A systematic literature search in the databases of MEDLINE, The Cochrane Library, EMBASE, CINAHL, and PsycINFO was carried out, as well as a manual search in Google Scholar and reference lists. Studies which focused on physical or individual activities or therapy or other groups and settings were excluded. The heterogeneity of the studies did not allow meta-analysis. Results: Seven primary studies were included, whose interventions were assigned to the intervention types activation of memories, leisure activities, and social participation. Overall, the quality of studies was rather low. Compared to usual care or the alternative interventions of memory therapy or leisure activities, the positive effects on depressive symptoms, as well as externally assessed and self-reported quality of life or life satisfaction, were not significant. The absence of these measures lead to deterioration of depressive symptoms among residents with dementia. In contrast to memory activation, common leisure activities led to an improvement in wellbeing. One intervention for social participation increased wellbeing and reduced the occurrence of depressive symptoms. Conclusion: There is a considerable need for conceptual-theoretical work and research on the effectiveness of psychosocial interventions, particularly for raising participation among persons in inpatient care facilities.
Article
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Background: The ability to participate in valued activities, whether for work, leisure or family, is an important aspect of personal identity. In dementia, progressive memory loss means that abilities developed over a lifetime begin to be lost as well, contributing to the loss of self and identity. Some studies have reported that activities or interventions tailored to be meaningful to the person with dementia (defined as any activity important to the individual) are more effective in addressing behavioral and psychological symptoms of dementia (BPSD) and improving quality of life (QoL) than those that are not so tailored. However, the effectiveness of individualizing interventions or activities for this population is not known. Objectives: In response to consumer feedback by the Consumer Dementia Research Network that this question ought to be addressed, this review was undertaken, the aim of which was to determine the effectiveness of meaningful occupation interventions for people living with dementia in residential aged care facilities (RACFs). Inclusion criteria: People living with dementia in RACFs (nursing homes).Any intervention that was individualized to be meaningful to the participant, versus any active control condition or usual care.Experimental and observational studies. Types of outcomes: Quality of life, BPSD (such as agitation, aggression, depression, wandering and apathy), mood, function, cognition and sleep. Search strategy: The search strategy aimed to identify both published and unpublished studies, with the following 12 databases extensively searched: PubMed, CINAHL, PsycINFO, ISI Web of Science, OTSeeker, Embase, Cochrane CENTRAL, clinicaltrials.gov, Mednar, OpenSIGLE, New York Academy of Medicine Library Gray Literature Report, ProQuest Dissertations and Theses. The search strategy was limited to papers published in English between 2004 and January 31, 2015. Methodological quality: All studies were assessed independently by two reviewers for relevance, eligibility and methodological quality. Data extraction: Data from included papers were extracted using a standard data extraction tool. Data synthesis: Where possible, study results were pooled in statistical meta-analysis. Alternatively, results are presented in narrative and tabular form. Results: A total of 5274 citations were identified; after removal of duplicates, assessment for relevance and eligibility, 61 studies underwent critical appraisal. Thirty-four studies met the quality criteria and were included in a quantitative synthesis. A wide range of interventions were evaluated including individualized recreational activities (13 studies), reminiscence therapy (RT) (seven studies), music therapy interventions (six studies), training staff to develop individual care plans using person-centered care (PCC) or similar approaches (three studies), animal-assisted therapy (two studies), multi-sensory interventions (MSIs) (two studies) and social interaction (one study), all of which measured a number of different outcomes. Overall, and in spite of most studies being small-scale and of relatively brief duration, all interventions with the exception of Snoezelen therapy (a MSI) reported some benefits for people with dementia living in RACFs. The most frequently reported benefits were reductions in agitation (the most frequently assessed outcome), passivity and depression, improved QoL and increases in pleasure and interest. However, the majority of studies generally implemented the intervention, whether it was individualized activities, music or RT or other, in conjunction with one-to-one social interaction, and the relative importance of the intervention in comparison to one-to-one social contact for effectiveness cannot be determined from this review. Conclusion: Providing meaningful or individualized tailored activities for people with dementia living in RACFs appears to be effective for a range of behavioral and psychological symptoms. The strongest evidence was for individualized activities/recreational interventions for a range of BPSD; preferred music for agitation, depression and anxiety; and RT for mood and cognitive functioning. Insufficient evidence precluded making recommendations regarding animal-assisted (dog) therapy and training staff to develop individual care plans using PCC or similar approaches, while there was no good quality evidence to show that Snoezelen was effective for any outcome. What remains unclear, however, is whether any of these interventions is more effective than the provision of one-to-one social interaction.
Article
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Dementia and delirium are common in medical and surgical inpatients. Neuropsychiatric symptoms can be challenging to manage. Non-pharmacological interventions such as music therapy have been used to manage symptoms in psychiatric hospitals and nursing homes but are not routine in general hospitals. We performed a systematic literature review to establish whether music therapy improves neuropsychiatric symptoms in adults with dementia and/or delirium in the general hospital. We searched CINAHL, Medline and PsycINFO in November 2015. Search terms included music therapy, dementia, delirium. We screened 5054 titles, and read 142 full text articles. None of these met inclusion criteria for our review. To inform future research in music in general hospitals for people with dementia and/or delirium, we qualitatively reviewed 8 articles involving 239 patients. Music delivery was feasible and had a positive effect on some aspects of neuropsychiatric symptoms in various settings, but the studies were generally small, at high risk of bias, and did not use recognized frameworks for evaluating complex interventions. We found no robust published evidence for the use of music therapy in the treatment of neuropsychiatric symptoms in patients with dementia and/or delirium in the general hospital. Well-designed studies of this promising intervention are needed.
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Purpose – Although there is a growing evidence base for the value of psychosocial and arts-based strategies for enhancing well-being amongst adults living with dementia, relatively little attention has been paid to literature-based interventions. The purpose of this paper is to assess the impact of shared reading (SR) groups, a programme developed and implemented by The Reader Organisation, on quality of life for care home residents with mild/moderate dementia. Design/methodology/approach – In total, 31 individuals were recruited from four care homes, which were randomly assigned to either reading-waiting groups (three months reading, followed by three months no reading) or waiting-reading groups (three months no reading, followed by three months reading). Quality of life was assessed by the DEMQOL-Proxy and psychopathological symptoms were assessed by the Neuropsychiatric Inventory Questionnaire. Findings – Compared to the waiting condition, the positive effects of SR on quality of life were demonstrated at the commencement of the reading groups and were maintained once the activity ended. Low levels of baseline symptoms prevented analyses on whether the intervention impacted on the clinical signs of dementia. Research limitations/implications – Limitations included the small sample and lack of control for confounding variables. Originality/value – The therapeutic potential of reading groups is discussed as a positive and practical intervention for older adults living with dementia.
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Background Given the aging population worldwide and the COVID-19 pandemic, which has been found to be associated with a deterioration in Alzheimer’s disease (AD) symptoms, investigating methods to prevent or delay cognitive decline in preclinical AD and AD itself is important. The trial described in this protocol aims to evaluate the effects of a staged integral art-based cognitive intervention (SIACI) in older adults with CIs (preclinical AD [SCD or MCI] and mild AD), in order to gather evidence on the effects of SIACI on cognition and psychological/psychosocial health gains and determine the mechanisms. Methods The planned study is a single-center, parallel-arm, randomized controlled trial with allocation concealment and outcome assessor blinding. A total of 88 participants will be randomized to two groups: (i) an intervention group that receives the 16-week, 24-session SIACI program and (ii) a waitlist control group (which will receive the SIACI program after completing the follow-up assessment). Global cognitive function, specific domains of cognition (memory, language, executive function, and visuospatial skills), and other health-related outcomes (quality of life, anxiety, depression, sleep quality, and physical activity level) will be measured at baseline, immediately after the intervention, and at the 6-month follow-up. Blood biomarkers, event-related potential (ERP)-P300, and magnetic resonance imaging (MRI) data will be collected at baseline and immediately after the intervention to explore the mechanisms of SIACI. Discussion The trial will elucidate the immediate and long-term effects of SIACI based on neuropsychological testing and blood biomarkers, and neuroscience involving ERP-P300 and MRI parameters will make it possible to explore the mechanisms of SIACI in older adults with CIs. The results will provide evidence on the effectiveness of an AT-based cognitive intervention, which may delay or even halt cognitive decline in preclinical AD and AD itself. Trial registration ChiCTR, ChiCTR2100044959. Registered 03 April 2021.
Article
The study, funded by the Pennsylvania Council on the Arts and the Pennsylvania Department of Aging, measured the effect that an artist in residence program (conducted by state-vetted professional teaching artists) had on self-reported loneliness in senior citizens. All participants were aged 60 years or older and participated in programming in state-funded senior community centers located in 14 sites throughout the Commonwealth of Pennsylvania. Artists offered 10 sessions in creating and critiquing art to senior citizens in their respective art forms including performing arts, visual arts and multidisciplinary/interdisciplinary arts. Through pre and post-tests, changes in loneliness were measured using the Revised UCLA Loneliness Scale. The data revealed that there was a significant correlation between a self-reported decrease in feelings of loneliness and participation in a program conducted by professional artists.
Article
Care home populations frequently feature older people who often experience poor physical health and cognitive difficulties, along with vulnerability to psychological and social stressors. To date there has been no systematic review which focuses on the impact of arts for health activities to the care home population. Evidence was sourced from several databases and 71 studies were deemed eligible for inclusion in this review. These studies underwent data extraction and quality appraisal and the findings associated with health, wellbeing and quality of life are presented within this paper.
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Aim The positive effects of animal‐assisted interventions (AAIs) in people with dementia have been frequently reported in the literature. However, it remains unclear if the positive effects are directly due to the presence of the animal. The aim of this study was to investigate if the inclusion of an animal adds value to psychosocial interventions for people with dementia. Methods The study followed a within‐subject design with two studied conditions (AAI and control intervention) and several measurement points (baseline (i.e. at beginning of the intervention), after 3 months, and after 6 months). Nineteen nursing home residents with dementia participated in the AAI (with a dog) and the control intervention. Both interventions were delivered as weekly group sessions over a period of 6 months. Outcomes examined were social interaction, emotional expression, and behavioural and psychological symptoms. These outcomes were evaluated by using video recordings at baseline and after 3 and 6 months. Results Nineteen patients with moderate to moderately severe dementia who lived in two nursing homes in Germany were included. During the AAI, we detected significantly longer and more frequent periods of positive emotions (pleasure) and social interaction (e.g. touch, body movements) than during the control intervention. Conclusion The presence of a dog appears to have beneficial effects on psychosocial intervention for people with dementia.
Article
Objectives: The Comprehensive Process Model of Group Engagement posits that personal factors (e.g., cognitive function), stimulus factors (e.g., group activity content, group size) and environmental factors (e.g., light, noise) impact the response to group activities. This paper reports the impact of environmental and group characteristics on engagement, mood, and sleepiness of persons with dementia attending group activities. Methods/design: The sample included 69 nursing home residents. Environmental contexts of activities included time of day, location, noise, light and temperature. Outcome variables captured engagement, mood, and sleepiness, observed during 20 group activity sessions. Mixed model analyses were used to examine the impact of environmental and group attributes on the outcome variables. Results: Background noise and time of day significantly affected outcome variables after controlling for participants' cognitive functioning and group topic. Background noise was related with decreased engagement and increased sleepiness. Activities conducted before noon were associated with increased sleepiness. Group size did not affect the outcome variables. There was little variation concerning temperature and light. Conclusions: These findings have implications for architectural and ongoing planning. The methodology presents a model for continuous quality improvement. The main components of the Comprehensive Process Model of Group Engagement significantly impacted group activity engagement.
Article
Background: Day care centers provide supportive services to older individuals with disability and dementia. Those who suffer from cognitive impairment typically also suffer from depression. Purpose: To explore whether TimeSlips, a reminiscence creative storytelling approach, improves depressive symptoms and quality of life (QoL) in older individuals of day care centers who have mild to moderate cognitive impairment. Methods: A randomized non-blind controlled trial design was conducted. A total of 20 older individuals who met the inclusion criteria were recruited and randomly assigned to the experimental group and control group using the Internet randomization system, with 10 subjects in each group. The experimental group participated in the one-hour TimeSlips intervention once a week for six consecutive weeks, while the control group maintained their normal daily activities. We used the Cornell Scale for Depression in Dementia (CSDD) to measure depressive symptoms and used EQ-5D (EuroQol-5 dimensions) VAS (visual analogue scale) and utility values to measure QoL. Results: (1) With the exception of age, there were no significant differences in the demographic data between two groups. (2) Under ANCOVA, when age was used as the covariate and the change in CSDD before and after the intervention was used as the dependent variable, the score of the experimental group was significant lower than that of the control group (p < .05). The interaction between group and age was also a significant difference in the change of CSDD before and after the intervention (p < .05). In terms of QoL, the EQ-5D VAS and EQ-5D utility value both decreased after the intervention in the experimental group. ANCOVA was performed separately using the change of EQ-5D VAS and the ranked change of EQ-5D utility values as dependent variables, with no significant differences found between the groups (p = .37 and p = .20, respectively). Conclusions: The results indicate that using TimeSlips may significantly improve depressive symptoms in mild to moderate cognitively impaired older individuals of day care centers. However, no evidence was found to support an effect of TimeSlips on QoL. Our findings provide information to help day care centers staffs design related activities.
Article
Aims To develop an understanding of what a storytelling intervention entails, its main effects and how this causes the promotion of physical activity in chronically ill patients. Methods An integrative review was undertaken in three stages; a) search b) appraisal c) synthesis. Studies were included if they represented participants with a chronic illness and used a storytelling approach for the intervention as well as including physical activity as a component of the intervention. Findings: Fourteen articles were identified that included a total of 818 participants (191 male, 348 female, 279 unknown). No articles were identified as flawed and all were included in the synthesis. Four themes were identified: (1) ideal processes within interventions, (2) psychosocial factors which influenced storytelling, (3) perceived outcomes relating to storytelling. And (4) the perceived benefits of physical activity. Conclusions: This review develops a deeper understanding of the required processes, associated factors and outcomes of storytelling interventions for people with chronic illness. It provides evidence of how storytelling can be used to promote physical activity. Further research into storytelling interventions is required.
Article
Background The effective management of agitation and other neuropsychiatric and behavioural symptoms in people with dementia is a major challenge, particularly in care home settings, where dementia severity is higher and there is limited training and support for care staff. There is evidence for the value of staff training and the use of psychosocial approaches; however, no intervention currently exists that combines these elements into an intervention that is fit for purpose and effective in these settings based on evidence from a randomised controlled trial. Objective The objective was to develop and evaluate a complex intervention to improve well-being, reduce antipsychotic use and improve quality of life in people with dementia in care homes through person-centred care, management of agitation and non-drug approaches. Design This was a 5-year programme that consisted of six work packages. Work package 1 consisted of two systematic reviews of personalised psychosocial interventions for behavioural and psychological symptoms for people with dementia in care homes. Work package 2 consisted of a metasynthesis of studies examining implementation of psychosocial interventions, in addition to developing a draft Well-being and Health for people with Dementia (WHELD) programme. Work package 3 consisted of a factorial study of elements of the draft WHELD programme in 16 care homes. Work package 4 involved optimisation of the WHELD programme based on work package 3 data. Work package 5 involved a multicentre randomised controlled trial in 69 care homes, which evaluated the impact of the optimised WHELD programme on quality of life, agitation and overall neuropsychiatric symptoms in people with dementia. Work package 6 focused on dissemination of the programme. Setting This programme was carried out in care homes in the UK. Participants Participants of this programme were people with dementia living in care homes, and the health and care professionals providing treatment and care in these settings. Results Work package 1: reviews identified randomised controlled trials and qualitative evidence supporting the use of psychosocial approaches to manage behavioural symptoms, but highlighted a concerning lack of evidence-based training manuals in current use. Work package 2: the meta-analysis identified key issues in promoting the use of interventions in care homes. The WHELD programme was developed through adaptation of published approaches. Work package 3: the factorial trial showed that antipsychotic review alone significantly reduced antipsychotic use by 50% (odds ratio 0.17, 95% confidence interval 0.05 to 0.60). Antipsychotic review plus social interaction significantly reduced mortality (odds ratio 0.36, 95% confidence interval 0.23 to 0.57), but this group showed significantly worse outcomes in behavioural and psychological symptoms of dementia than the group receiving neither antipsychotic review nor social interaction (mean difference 7.37 symptoms, 95% confidence interval 1.53 to 13.22 symptoms). This detrimental impact was reduced when combined with social interaction (mean difference –0.44 points, 95% confidence interval –4.39 to 3.52 points), but with no significant benefits for agitation. The exercise intervention significantly improved neuropsychiatric symptoms (mean difference –3.58 symptoms, 95% confidence interval –7.08 to –0.09 symptoms) but not depression (mean difference –1.21 points, 95% confidence interval –4.35 to 1.93 points). Qualitative work with care staff provided additional insights into the acceptability and feasibility of the intervention. Work package 4: optimisation of the WHELD programme led to a final version that combined person-centred care training with social interaction and pleasant activities. The intervention was adapted for delivery through a ‘champion’ model. Work package 5: a large-scale, multicentre randomised controlled trial in 69 care homes showed significant benefit to quality of life, agitation and overall neuropsychiatric symptoms, at reduced overall cost compared with treatment as usual. The intervention conferred a statistically significant improvement in quality of life (Dementia Quality of Life Scale – Proxy z -score of 2.82, mean difference 2.54, standard error of measurement 0.88, 95% confidence interval 0.81 to 4.28, Cohen’s d effect size of 0.24; p = 0.0042). There were also statistically significant benefits in agitation (Cohen-Mansfield Agitation Inventory z -score of 2.68, mean difference –4.27, standard error of measurement 1.59, 95% confidence interval –7.39 to –1.15, Cohen’s d effect size of 0.23; p = 0.0076) and overall neuropsychiatric symptoms (Neuropsychiatric Inventory – Nursing Home version z -score of 3.52, mean difference –4.55, standard error of measurement 1.28, 95% confidence interval –7.07 to –2.02, Cohen’s d of 0.30; p < 0.001). The WHELD programme contributed to significantly lower health and social care costs than treatment as usual (cost difference –£4740, 95% confidence interval –£6129 to –£3156). Focus groups were conducted with 47 staff up to 12 months after the end of work package 5, which demonstrated sustained benefits. Work package 6: the outputs of the programme were translated into general practitioner workshops and a British Medical Journal e-learning module, an updated national best practice guideline and a portfolio of lay and care home outreach activities. Limitations Residents with dementia were not involved in the qualitative work. Conclusions The WHELD programme is effective in improving quality of life and reducing both agitation and overall neuropsychiatric symptoms in people with dementia in care homes. It provides a structured training and support intervention for care staff, with lower overall costs for resident care than treatment as usual. Future work It will be important to consider the long-term sustainability of the WHELD programme and cost-effective means of long-term implementation. Trial registration Current Controlled Trials ISRCTN40313497 and ISRCTN62237498. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research ; Vol. 8, No. 6. See the NIHR Journals Library website for further project information.
Article
Objectives: Engagement in personally relevant and pleasant activity is a facet of many theories of well-being. This integrated review and narrative synthesis explored the hypothesis that activity participation improves well-being for nursing home residents. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE, PsycINFO, Academic Search Complete, Psychology and Behavioral Sciences Collection, Embase, and CINAHL for research published between 2006 and 2018. We included peer-reviewed, English-language studies of nursing-home residents, with interventions focused on activities and on well-being or affect outcomes. Results: After screening, the search yielded 45 studies: 15 reviews of specific activities and 30 empirical articles. We found consistent support for tailored activity interventions and less consistent support for specific or generic activity interventions with the possible exception of music therapy. Research focused on specific activity types had methodological limitations and confounds with activity preferences. Conclusions: Participation in activities may improve well-being in residents of nursing homes. Tailored activities are likely to be superior to those provided indiscriminately to all residents. Clinical Implications: Improving quality of life in long-term care should include opportunities to engage in activities; those most effective will be tailored to individuals and no single activity will be effective for everyone.
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Introduction Early non-pharmacological interventions can prevent cognitive decline in older adults with mild cognitive impairment (MCI). Creative expression (CrExp) can potentially mitigate cognitive decline and enhance the physical and mental health of older people. However, it is unclear whether activities involving CrExp can improve cognitive function and other health-related outcomes in older adults with MCI. The aim of the present study is to develop a Creative Expressive Arts-based Storytelling (CrEAS) programme that integrates verbal and non-verbal expressive activities and evaluate its effectiveness in improving cognitive function and other outcome indicators so as to explore its possible mechanism from the perspective of neuroimaging. Methods and analysis This parallel randomised controlled trial with three arms (one intervention and two control arms) will be conducted over a 24-week period. A total of 111 participants will be enrolled and randomised to the CrEAS, recreation and usual activity groups. The CrEAS programme combines visual arts therapy and storytelling (TimeSlips) under the Expressive Therapy Continuum theoretical framework and provides an opportunity for people with MCI to actively engage in activities to improve cognitive function through verbal and nonverbal CrExp. Global cognitive function, specific domains of cognition (memory, executive function, language and attention) and other health-related outcomes (anxiety, depression and quality of life) will be measured at baseline, at the end of the intervention, and at the 24-week follow-up. Structural/functional brain MRI data will be collected at baseline and immediately after the intervention. Ethics and dissemination Ethics approval was obtained from the Ethics Committee of Fujian Provincial Hospital (K2018-03-061). The study results will be disseminated through peer-reviewed journals and at academic conferences. Trial registration number ChiCTR1900021526.
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Objectives Good social connection is associated with better health and wellbeing. However, social connection has distinct considerations for people living in long-term care (LTC) homes. The objective of this scoping review was to summarize research literature linking social connection to mental health outcomes, specifically among LTC residents, as well as research to identify strategies to help build and maintain social connection in this population during COVID-19. Design Scoping review. Settings and Participants Residents of LTC homes, care homes and nursing homes. Methods We searched MEDLINE(R) ALL (Ovid), CINAHL (EBSCO), PsycINFO (Ovid), Scopus, Sociological Abstracts (Proquest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid) and AgeLine (EBSCO) for research that quantified an aspect of social connection among LTC residents; we limited searches to English-language articles published from database inception to search date (July 2019). For the current analysis, we included studies that reported: (1) the association between social connection and a mental health outcome; (2) the association between a modifiable risk factor and social connection; or (3) intervention studies with social connection as an outcome. From studies in (2) and (3), we identified strategies that could be implemented and adapted by LTC residents, families and staff during COVID-19 and included the papers that informed these strategies. Results We included 133 studies in our review. We found 61 studies that tested the association between social connection and a mental health outcome. We highlighted 12 strategies, informed by 72 observational and intervention studies, that might help LTC residents, families and staff build and maintain social connection for LTC residents. Conclusions and Implications Published research conducted among LTC residents has linked good social connection to better mental health outcomes. Observational and intervention studies provide some evidence on approaches to address social connection in this population. Although further research is needed, it does not obviate the need to act given the sudden and severe impact of COVID-19 on social connection in LTC residents.
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Expressive arts therapy (EAT) can potentially improve cognition and mental health in patients with dementia. However, limited studies have been conducted for older adults with mild cognitive impairment (MCI). The aim of this study was to examine the effects of EAT in older adults with MCI. A total of 48 participants with MCI were assigned to the EAT intervention (n = 24) or waiting list control (n = 24) group. The former received 60–90 min of EAT twice a week for 6 weeks. The findings showed that the EAT program had a high retention and attendance rate and a high level of general satisfaction. Moreover, the intervention group showed significant improvements in general cognitive function, language function, anxiety, depression, and the psychological and social relationship domains of quality of life. The results provide preliminary evidence for the feasibility and efficacy of EAT intervention in older adults with MCI.
Article
Résumé Loin d’être seulement une neuropsychopathologie dégénérative individuelle, la maladie d’Alzheimer apparaît aussi conjugale et familiale. Alors qu’elle désagrège les réseaux neuronaux du sujet, tout en induisant une déliaison psychique de son Moi, le conjoint subit aussi cette détérioration et se voit attribuer un rôle d’aidant principal. Cette situation traumatogène peut donner naissance à une conjugopathie. Malgré une atteinte des mémoires cognitives, la mémoire sensorielle demeure intacte ; c’est la raison pour laquelle une approche thérapeutique avec des médiations sensorielles constitue une bonne indication. Dans une double approche neuroscientifique et psychodynamique, cet article présente un dispositif original de traitement par la prise en charge du couple avec des médiations sensorielles. Cette solution palliative pour le couple reconsoliderait le lien conjugal défaillant et préserverait le maintien à domicile.
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Purpose – The purpose of this paper is to evaluate the impact on health and well-being of participation in dance and arts activities by older people living in the community. Design/methodology/approach – A small-scale, mixed methods research design comprising pretest-posttest evaluation of a three month dance and arts programme. Two groups of older people underwent physical measures and completed a self-report quality of life questionnaire. Written comments and interview data were also gathered. Findings – Physical tests (n=14) demonstrated improvements in posture, shoulder mobility and balance in both groups following the intervention, with some measures reaching statistical significance. Quality of life evaluations (n=21) also showed improvement, with the mental health subscale reaching statistical significance. Qualitative data showed that participants enjoyed the programme and felt physical, psychological and social benefits. Research limitations/implications – The research involved only a small sample of volunteers and a limited programme length which limits its generalisability. The absence of a control group means that causality cannot be inferred. Future research should extend recruitment to a wider geographical area and a longer intervention which includes a control group. Practical implications – Future arts interventions for older people should include consultation prior to, and throughout the project. Commissioners should consider supporting arts for health projects, building in additional funding for evaluative work. Originality/value – This study has added to the evidence base through combining art forms within a mixed methods framework, illustrating the interplay between the art forms, the outcomes and the potential role of social context.
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This article discusses the ongoing attempt to develop a rating of observed emotion in persons with dementia. The comprehension of the emotional signals of the person with dementia has significant implication for caregiving. The purpose of the present report was twofold: first, to explore training and utilization of the Apparent Affect Rating Scale (AARS) by certified nursing assistants (CNAs) rather than trained research personnel; and second, to test whether the scale showed intraindividual variations in people's affective responses as they moved from one environmental context to another. Results also suggested that the instrument does possess sufficient sensitivity to the behavioral context. Clinical implications for the utilization of the instrument are discussed. CNAs' reliability was less than desirable, suggesting the need for more investment in training, repeated practice, and a commitment to quality improvement.
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Assessed 13-item self- and caregiver-report measures from the Quality of Life in Alzheimer's Disease (QoL-AD) and explored the relationship of QoL to demographic characteristics, cognitive and functional status, depression, and pleasant activity level in 77 patients (mean age 78.3 yrs) with AD. Each AD S and a family caregiver completed the assessment. Internal consistency and test-retest reliability, assessed over a 1-wk interval, were adequate on both patient- and caregiver-report QoL-AD measures. Validity, as indicated by correlational analysis of QoL-AD scores and other measures that assessed cognitive and functional ability, mood, and pleasant events, was also good. High QoL-AD scores were explained by low levels of depressive symptoms, more independent functioning in Activities of Daily Living, and more years of education. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Creative expression (CE) programs are emerging interventions to improve the quality of care and life of persons with dementia (PWDs) in long-term care settings. However, limited empirical evidence exists to support the effectiveness of these programs. Here, we report the findings from an assessment of the impact of TimeSlips (TS), a group storytelling program that encourages CE among PWDs and those who care for them. Instruction in TS was provided through a 10-week on-site training. An observational study using an experimental design was conducted in 20 nursing home facilities in 2 states, 10 of which were randomly selected to implement TS. Two weeks after the implementation of TS at the intervention sites, we conducted 4 days of direct observation, using a time-sampling approach, of residents and staff in each facility. Using surveys, we also assessed staff job satisfaction, attitudes toward residents, and burnout. Compared with residents in the control facilities, those in the TS facilities were more engaged and more alert. In TS facilities, there were more frequent staff-resident interactions, social interactions, and social engagement. Also, staff who participated in the TS program had more positive views of residents with dementia and devalued residents less than did the control group staff. There were no differences in staff job satisfaction and burnout among staff in the TS and non-TS facilities. Implementing the TS program in nursing facilities improves the care environment for PWDs. However, additional studies are needed to offer further insights into the mechanisms by which TS improves both staff and resident outcomes.
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To evaluate the validity of the Cumulative Illness Rating Scale (CIRS) in a geriatric institutional population by examining its associations with mortality, hospitalization, medication usage, laboratory findings and disability. A validation of the CIRS using self- and physician-report surveys, with archival data drawn from medical charts and facility records. Long-term care facility with skilled nursing and congregate apartments. Four hundred thirty-nine facility residents selected on the basis of completeness of self-report data and physician ratings. Composite measures of illness severity and comorbidity, based on physicians' CIRS ratings; time to death or acute hospitalization after assessment; medication use, drawn from pharmacy records; medical chart data on laboratory tests; self-reported functional disability. CIRS illness severity and comorbidity indices, as well as individual CIRS items, were significantly associated with mortality, acute hospitalization, medication usage, laboratory test results, and functional disability. The CIRS showed good divergent validity vis a vis functional disability in predicting mortality and hospitalization. The CIRS appears to be a valid indicator of health status among frail older institution residents. The illness severity and comorbidity composites performed equally well in predicting longitudinal outcomes. Item-level analyses suggest that the CIRS may be useful in developing differential illness profiles associated with mortality, hospitalization, and disability.
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Dementias, such as Alzheimer's disease, include a progressive deterioration of language functioning. While some researchers have reported an increase in patients' self-expression following music therapy, it is not clear whether these changes specifically reflect improved language skills or whether simple interpersonal interaction with a therapist could account for the improvement. In this study, the effects of music therapy were compared to conversational sessions on language functioning in dementia patients. Participants were selected according to the following criteria: (a) residing in a facility specializing in Alzheimer's and related disorders; (b) possessing sufficient verbal ability to answer simple questions and to comply with requests to speak, participate, or sit down; and (c) attaining the written consent of the patient's guardian or representative. All participants had been in music therapy twice per week for at least 3 months prior to the study onset. One week prior to the beginning of the study, subjects were assessed for cognitive functioning using the Mini-Mental State Examination (MMSE), and language ability via the Western Aphasia Battery (WAB). A within-subjects design was used, with order of condition (music or group conversation first) counter-balanced between participants. Subjects participated in groups of 2 to 4, twice per week for 20-30 minutes for a total of 8 sessions (4 music therapy and 4 conversation sessions or vice-versa), and were re-tested on the WAB at the end of each 2 week (4 session) interval. Results from 20 participants revealed that music therapy significantly improved performance on both speech content and fluency dimensions of the spontaneous speech subscale of the WAB (p =.01). While the difference in overall Aphasia Quotient (AQ) for music and conversation sessions (mean AQ = 76 vs. 70, respectively) did not reach statistical significance, data were only available for 10 participants (5 per condition). Hopefully, these findings will stimulate additional research on the use of music therapy interventions with demented patients, as it may offer a noninvasive mechanism to enhance communication between victims and their caregivers.
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This study describes a clinical trial of at-home recreational therapy for community dwelling older adults with dementia and disturbing behaviors. After two weeks of daily, individualized recreational therapy interventions (TRIs), results indicated a significant decrease in levels of both passivity and agitation. Biograph data collection was useful in identifying the physiological changes that occurred with each intervention technique. Specific information is included on the time of day each behavior occurred and the most effective interventions, as well as implications for service delivery.
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An overview will be presented of music therapy, art therapy, movement therapy and reminiscence therapy, memory training, reality orientation, validation therapy, self-maintenance therapy, behaviour therapy, milieu therapy and staff training. The overview will examine the aims of each, the principles on which procedures are based and the proof of their effectiveness. The principal aim of non-drug therapies is to influence symptomatic dementia beneficially and to improve the abilities remaining to the patient. The potential benefits are usually deduced from studies made without control groups. At the present time, proof of the effectiveness of these therapies is still lacking as controlled, randomized studies have yet to be conducted, and so a fundamental evaluation of the therapeutic benefits of non-drug therapies in the treatment of dementia cannot yet be made.
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This systematic review seeks to establish the extent of scientific evidence for the effectiveness of 13 psychosocial methods for reducing depressed, aggressive or apathetic behaviors in people with dementia. The guidelines of the Cochrane Collaboration were followed. Using a predefined protocol, ten electronic databases were searched, studies selected, relevant data extracted and the methodological quality of the studies assessed. With a Best Evidence Synthesis the results of the included studies were synthesized and conclusions about the level of evidence for the effectiveness of each psychosocial method were drawn. There is some evidence that Multi Sensory Stimulation/Snoezelen in a Multi Sensory Room reduces apathy in people in the latter phases of dementia. Furthermore, there is scientific evidence, although limited, that Behavior Therapy-Pleasant Events and Behavior Therapy-Problem Solving reduce depression in people with probable Alzheimer's disease who are living at home with their primary caregiver. There is also limited evidence that Psychomotor Therapy Groups reduce aggression in a specific group of nursing home residents diagnosed with probable Alzheimer's disease. For the other ten psychosocial methods there are no or insufficient indications that they reduce depressive, aggressive or apathetic behaviors in people with dementia. Although the evidence for the effectiveness of some psychosocial methods is stronger than for others, overall the evidence remains quite modest and further research needs to be carried out.
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This exploratory study compared three methods of assessing dementia specific quality of life, corresponding to the perspectives of residents, staff members, and trained observers. We collected data on 172 residents with dementia in four special care nursing facilities and three assisted living facilities. Analyses assessed the relationship of each quality-of-life method or perspective to the others and to resident characteristics such as cognitive and functional status. The relationship of staff quality-of-life measures to resident characteristics varied by care setting while no significant relationships were found for resident quality-of-life measures. Staff and observational measures were moderately correlated in both settings. Moderate correlations of resident measures with staff and observational measures were found in the assisted living sample. Each perspective is relatively independent and somewhat unique. Measures that focus on specific aspects of quality of life may be more appropriate to use with assisted living residents than with residents of special care facilities.
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The authors systematically reviewed the literature on psychological approaches to treating the neuropsychiatric symptoms of dementia. Reports of studies that examined effects of any therapy derived from a psychological approach that satisfied prespecified criteria were reviewed. Data were extracted, the quality of each study was rated, and an overall rating was given to each study by using the Oxford Centre for Evidence-Based Medicine criteria. A total of 1,632 studies were identified, and 162 satisfied the inclusion criteria for the review. Specific types of psychoeducation for caregivers about managing neuropsychiatric symptoms were effective treatments whose benefits lasted for months, but other caregiver interventions were not. Behavioral management techniques that are centered on individual patients' behavior or on caregiver behavior had similar benefits, as did cognitive stimulation. Music therapy and Snoezelen, and possibly sensory stimulation, were useful during the treatment session but had no longer-term effects; interventions that changed the visual environment looked promising, but more research is needed. Only behavior management therapies, specific types of caregiver and residential care staff education, and possibly cognitive stimulation appear to have lasting effectiveness for the management of dementia-associated neuropsychiatric symptoms. Lack of evidence regarding other therapies is not evidence of lack of efficacy. Conclusions are limited because of the paucity of high-quality research (only nine level-1 studies were identified). More high-quality investigation is needed.
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Agitated behaviours are identified by caregivers as the most challenging in dementia care. Alternative approaches reducing occurrence of agitated behaviours and the need for chemical or physical restraints become valuable for institutionalized elders with dementia. This study was to evaluate the effects of group music with movement intervention on occurrence of agitated behaviours of institutionalized elders with dementia in Taiwan. A randomized controlled trial was used. Thirty-six institutionalized elders with dementia completed the study, with 18 in the experimental group receiving group music with movement intervention twice a week for 4 weeks and 18 in the control group receiving usual care without intervention. Modified Cohen-Mansfield Agitation Inventory was used to assess agitated behaviours at baseline, weeks 2 and 4. Agitated behaviours were significantly reduced in the experimental group following 4 weeks of group music with movement intervention compared to that of the control group (p<0.001). Group music with movement intervention can be beneficial in managing agitated behaviours of those with dementia and should be incorporated into care routines in residential facilities.
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The effectiveness of the 5 U.S. Food and Drug Administration-approved pharmacologic therapies for dementias in achieving clinically relevant improvements is unclear. To review the evidence for the effectiveness of cholinesterase inhibitors (donepezil, galantamine, rivastigmine, and tacrine) and the neuropeptide-modifying agent memantine in achieving clinically relevant improvements, primarily in cognition, global function, behavior, and quality of life, for patients with dementia. Cochrane Central Register of Controlled Trials, MEDLINE, PREMEDLINE, EMBASE, Allied and Complementary Medicine Database, CINAHL, AgeLine, and PsycINFO from January 1986 through November 2006. English-language randomized, controlled trials were included in the review if they evaluated pharmacologic agents for adults with a diagnosis of dementia, did not use a crossover design, and had a quality score of at least 3 on the Jadad scale. Data were extracted on study characteristics and outcomes, including adverse events. Effect sizes were calculated and data were combined when appropriate. 96 publications representing 59 unique studies were eligible for this review. Both cholinesterase inhibitors and memantine had consistent effects in the domains of cognition and global assessment, but summary estimates showed small effect sizes. Outcomes in the domains of behavior and quality of life were evaluated less frequently and showed less consistent effects. Most studies were of short duration (6 months), which limited their ability to detect delay in onset or progression of dementia. Three studies directly compared different cholinesterase inhibitors and found no differences in cognition and behavior. Limitations of available studies included short duration, inclusion of only patients with mild to moderate Alzheimer disease, poor reporting of adverse events, lack of clear definitions for statistical significance, limited evaluation of behavior and quality-of-life outcomes, and limited direct comparison of different treatments. Treatment of dementia with cholinesterase inhibitors and memantine can result in statistically significant but clinically marginal improvement in measures of cognition and global assessment of dementia.
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The American Geriatrics Society and American Association for Geriatric Psychiatry Expert Panel on Quality Mental Health Care in Nursing Homes developed this consensus statement. The following organizations were represented on the expert panel and have reviewed and endorsed* the consensus statement: Alzheimer's Association, American Association for Geriatric Psychiatry, American Association of Homes and Services for the Aging, American College of Health Care Administrators, American Geriatrics Society, American Health Care Association, American Medical Directors Association, American Society on Aging, American Society of Consultant Pharmacists, Gerontological Society of America, National Association of Directors of Nursing Administration in Long-Term Care, National Citizen's Coalition for Nursing Home Reform, National Conference of Gerontological Nurse Practitioners. The following organizations were also represented on the expert panel and reviewed and commented on the consensus statement: American Psychiatric Association: Council on Aging, American Psychological Association.
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Cognitive impairments and depression are relatively common in the older population. They result from many causes and negatively impact functional rehabilitation. Rehabilitation professionals should be able to identify and quantify the presence of cognitive impairment and depression in older adults and understand their impact on function. This article discusses the variety of objective scales available to the rehabilitation practitioner and details the use of three scales: the Clock Drawing Test, the Mini-Mental State Examination, and the Geriatric Depression Scale.
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Historically, the arts and humanities were seldom recognized for their capacity to advance health care and promote quality of life within the fields traditionally reserved for the “hard sciences.” There has been little vision of the powerful analytic and therapeutic applications offered by the myriad of art forms (Rugh & Buckwalter, 1989, unpublished manuscript). However, in recent years, we have seen an increased awareness of the potential value of music, art, and other recreational therapies in persons with dementia. A comprehensive literature review was conducted to identify the most current research in this area. Studies on the use of music and other recreational therapies in patients with dementia are summarized in Table 1.
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Dementia care mapping: an approach to quality audit of services for people with dementia in two health districts The audit reported in this paper and submitted to the Psychiatry of Old Age Management group, assessed six units within each of two health districts in the UK. Using a nonparticipatory observation method in the units selected, the aim was to measure quality and the environment of care. Dependency levels of the clients/residents were also estimated to give a clearer picture of the setting and the care requirements. This was intended to establish a baseline for the units mapped and to enable care developments to be focussed upon intended outcomes. Results led to a number of observations related to the levels of interaction between staff and clients/residents, the need for a wider range of activities to promote person–centred care, and a suggested route to the improvement in quality of life for this vulnerable group of people. Assessment of dependency levels linked to the results of the mapping showed that high dependency does not lead automatically to a lower quality of person centred care.
Article
The topic of this paper concerns the use of therapeutic activities with persons with Alzheimer's disease (AD). The purpose is to present a critique of the research on these activities, with an emphasis on methodology. ORGANIZING CONSTRUCT AND SCOPE: Nursing literature identifies a number of purposes for activities for persons with AD. Activities should be therapeutic, enhance quality of life, arrest mental decline, and generate and maintain self-esteem. Other purposes of activities for this population are to create immediate pleasure, re-establish dignity, provide meaningful tasks, restore roles, and enable friendships. Activities may be more important to the psychological state of well-being of persons with dementia than the general physical and social environments in which they live. The literature reviewed was identified with the use of computer data bases (Medline - 1991-March 2001; Cumulative Index of Nursing and Allied Health Literature (CINAHL) - 1991-March 2001; and PsychLit - 1988-March 1999). In addition, data bases of Science Citation Index and Social Science Citation Indexes as they appear in the computer base, Web of Science, were searched for 1992-2001. The time period for each search was determined by the manner in which the literature was grouped for inclusion in the particular database. Hand searches of 11 selected journals included the years 1993-2001. The search dates were selected to reflect the time period when the largest number of studies on activities and AD have appeared in the professional literature. We critique a total of 33 studies. While researchers have demonstrated interest in the use of activities with persons with AD, theoretical and methodological difficulties, unclear findings and gaps exist, including a lack of emphasis on gender, ethnic, racial or cultural differences. Sampling issues involving diagnosis and staging complicate the research on individuals with AD. Case studies, single subject experimental designs, and tightly controlled quasi-experimental and experimental designs are needed to advance knowledge in this important area.
Article
Music therapy (MT) has been proposed as valid approach for behavioral and psychologic symptoms (BPSD) of dementia. However, studies demonstrating the effectiveness of this approach are lacking. To assess MT effectiveness in reducing BPSD in subjects with dementia. Fifty-nine persons with dementia were enrolled in this study. All of them underwent a multidimensional assessment including Mini Mental State Examination, Barthel Index and Neuropsychiatry Inventory at enrollment and after 8, 16, and 20 weeks. Subjects were randomly assigned to experimental (n=30) or control (n=29) group. The MT sessions were evaluated with standardized criteria. The experimental group received 30 MT sessions (16 wk of treatment), whereas the control group received educational support or entertainment activities. NPI total score significantly decreased in the experimental group at 8th, 16th, and 20th weeks (interaction time x group: F3,165=5.06, P=0.002). Specific BPSD (ie, delusions, agitation, anxiety, apathy, irritability, aberrant motor activity, and night-time disturbances) significantly improved. The empathetic relationship and the patients' active participation in the MT approach, also improved in the experimental group. The study shows that MT is effective to reduce BPSD in patients with moderate-severe dementia.
Article
Obtaining assent and respecting dissent are widely adopted safeguards when conducting dementia research involving individuals who lack consent capacity, but there is no consensus on how assent and dissent should be defined or what procedures should be used regarding them. Our objective was to provide recommendations on these issues based on the opinions of knowledgeable key informants. Cross-sectional qualitative research. University research institutions. Forty informants, including 1) nationally known experts on dementia and research ethics, 2) dementia researchers, and 3) dementia caregivers and advocates. Semistructured individual and focus group interviews, audio recorded, and transcribed for content analysis. Assent and dissent should be defined broadly and based on an assessment of how adults who lack consent capacity can express or indicate their preferences verbally, behaviorally, or emotionally. Assent requires the ability to indicate a meaningful choice and at least a minimal level of understanding. Assent should be required whenever an individual has the ability to assent, and dissent should be binding if it is unequivocal or sustained after an effort to relieve concerns and/or distress. Standards for seeking assent and respecting dissent should not be linked to the risks or potential benefits of a study. Lacking the ability to assent and/or dissent should not automatically preclude research participation. Obtaining assent and respecting dissent from individuals who lack consent capacity for dementia research allows them to participate, to the extent possible, in the consent process. Assent and dissent are important independent ethical constructs.
Article
In response to the need to develop evidence-based best practices interventions and services for individuals in the early stages of Alzheimer's disease (AD), the authors conducted an interdisciplinary literature review of exemplar programs, defined as those including multimodal or unimodal interventions; shown to be appropriate for individuals in the early stages of AD; demonstrating promise to support, maintain, and improve independent functioning; and shown to have positive effects for a variety of outcomes, including quality of life. This article examines evidence from five kinds of programs: (a) multimodal interventions, (b) programs developed by the Southwest Florida Interdisciplinary Center for Positive Aging, (c) sleep enhancement interventions, (d) managed care programs, and (e) technology-based interventions. Evidence from the review suggests that a number of programs can support functioning and improve quality of life for adults living with the early stages of memory loss. The article concludes with recommendations to advance a national research agenda in this area.
Article
The Cornell Scale for Depression in Dementia is introduced. This is a 19-item clinician-administered instrument that uses information from interviews with both the patient and a nursing staff member, a method suitable for demented patients. The scale has high interrater reliability (kw = 0.67), internal consistency (coefficient alpha: 0.84), and sensitivity. Total Cornell Scale scores correlate (0.83) with depressive subtypes of various intensity classified according to Research Diagnostic Criteria.
Article
The authors assessed the validity of the nursing home version of the Neuropsychiatric Inventory-Nursing Home Version (NPI-NH), comparing the responses of certified nurses' aides (CNAs) and licensed vocational nurses (LVNs) with research observations. Correlations were significant but moderate for all of the domains of the NPI-NH (delusions, hallucinations, agitation/aggression, depression, apathy, disinhibition, euphoria, irritability/lability, and aberrant motor disturbances) except anxiety and appetite disturbance. The LVNs' ratings showed consistently higher correlations with the researchers' behavioral observations than did the CNAs', but were moderate and generally better for residents with high levels of neuropsychiatric symptoms, thus, caution should be used with any untrained rater in the nursing home setting. The NPI-NH used by non-research staff can be useful in identifying residents with significant neuropsychiatric disturbances, but may be limited as an instrument for tracking behavioral changes.
Article
To investigate the nature of deficits in social cognition and real-life decision making in a group of patients with Alzheimer's disease (AD). A comprehensive neuropsychological and psychiatric assessment, including the Moral Judgment Interview and the Bechara's Card Test, was carried out in 25 patients with AD and 20 age-comparable normal controls. Outpatient clinic. AD patients had significantly lower scores in the Moral Judgment Interview and obtained significantly less earnings in the card test when compared to the normal control group. The Moral Judgment Interview score correlated significantly with Raven's Progressive Matrices and Block Design, whereas the card test correlated significantly with both the Benton Visual Retention Test and the Buschke Selective Reminding Test. No significant correlations were observed between the experimental tasks and the psychiatric variables. AD patients demonstrated significant deficits on tasks assessing social cognition and real-life decision making. These impairments correlated with deficits on specific neuropsychological tasks, but not with behavioral problems frequently found in AD patients.
Article
Assisted living is a rapidly-growing sector of long-term care, but little research has been done on depression in this setting. Using data from a large sample of assisted-living residents, the authors sought to 1) describe the prevalence of depression and depressive symptoms; 2) identify resident characteristics associated with depression; and 3) examine the relationship between depression and the rate of nursing home placement and mortality. A group of 2,078 residents age 65 and older were enrolled from 193 assisted-living facilities across four states (Florida, Maryland, New Jersey, and North Carolina). Residents were classified as depressed if their score on the Cornell Scale for Depression in Dementia (CSDD) exceeded 7. Using this criterion, 13% were depressed, and only 18% of those were on antidepressants. Over one-third of residents had symptoms of depression, such as anxious expression, rumination, or worrying, and 25% displayed sad voice, sad expression, or tearfulness. Depression was significantly associated with medical comorbidity, social withdrawal, psychosis, agitation, and length of residence in the facility. Depressed residents were discharged to nursing homes at 1.5 times the rate of nondepressed residents. Rates of mortality were also higher for depressed residents, but only those with severe depression (CSDD >12) had a statistically significant increased rate of death. The mission of assisted living is to help older adults retain autonomy, privacy, and quality of life in a personalized environment. Greater effort should be made to detect and treat depression in this setting, both to reduce suffering and prolong the resident's ability to remain in their preferred environment.
Article
Neuropsychiatric symptoms of dementia are common and associated with poor outcomes for patients and caregivers. Although nonpharmacological interventions should be the first line of treatment, a wide variety of pharmacological agents are used in the management of neuropsychiatric symptoms; therefore, concise, current, evidence-based recommendations are needed. To evaluate the efficacy of pharmacological agents used in the treatment of neuropsychiatric symptoms of dementia. A systematic review of English-language articles published from 1966 to July 2004 using MEDLINE, the Cochrane Database of Systematic Reviews, and a manual search of bibliographies was conducted. Inclusion criteria were double-blind, placebo-controlled, randomized controlled trials (RCTs) or meta-analyses of any drug therapy for patients with dementia that included neuropsychiatric outcomes. Trials reporting only depression outcomes were excluded. Data on the inclusion criteria, patients, methods, results, and quality of each study were independently abstracted. Twenty-nine articles met inclusion criteria. For typical antipsychotics, 2 meta-analyses and 2 RCTs were included. Generally, no difference among specific agents was found, efficacy was small at best, and adverse effects were common. Six RCTs with atypical antipsychotics were included; results showed modest, statistically significant efficacy of olanzapine and risperidone, with minimal adverse effects at lower doses. Atypical antipsychotics are associated with an increased risk of stroke. There have been no RCTs designed to directly compare the efficacy of typical and atypical antipsychotics. Five trials of antidepressants were included; results showed no efficacy for treating neuropsychiatric symptoms other than depression, with the exception of 1 study of citalopram. For mood stabilizers, 3 RCTs investigating valproate showed no efficacy. Two small RCTs of carbamazepine had conflicting results. Two meta-analyses and 6 RCTs of cholinesterase inhibitors generally showed small, although statistically significant, efficacy. Two RCTs of memantine also had conflicting results for treatment of neuropsychiatric symptoms. Pharmacological therapies are not particularly effective for management of neuropsychiatric symptoms of dementia. Of the agents reviewed, the atypical antipsychotics risperidone and olanzapine currently have the best evidence for efficacy. However, the effects are modest and further complicated by an increased risk of stroke. Additional trials of cholinesterase inhibitors enrolling patients with high levels of neuropsychiatric symptoms may be warranted.
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Percentage totals may not add to 100% due to rounding. a Education Level was missing on four participants. b See Table 2 for baseline group means. * (1, 93) (1, 93) QOL Staff-Rated b Control 41
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Note. Percentage totals may not add to 100% due to rounding. a Education Level was missing on four participants. b See Table 2 for baseline group means. * (1, 93) (1, 93) QOL Staff-Rated b Control 41.37 (1.01) 41.79 (1.10) .29 1.65
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