Iain K. B. Twaddle’s research while affiliated with University of Guam and other places

The island of Guam is a U.S. territory in the Western Pacific with a population of approximately 174,000. Most persons with Alzheimer’s disease and related dementias (ADRD) in Guam live at home with their family. This is due, in part, to Guam’s indigenous Chamorro culture, which emphasizes the importance of caring for the manåmko’ (elderly), but also to the limited availability of residential care facilities for older adults. In fact, Guam currently has no nursing homes or assisted living facilities that specialize in care for persons living with ADRD. This places a heavy burden on Guam’s families. Fortunately, Guam has an impressive array of community‐based resources to support persons living with dementia and their family caregivers. However, many members of the community are not aware of these services or do not know how to access them. To improve access to Guam’s dementia care support services, a series of education outreach presentations were provided to the community through an online support group for family caregivers of persons with dementia held weekly on Wednesday evenings and Saturday mornings. The presentations were conducted by elder care specialists from local government agencies and private healthcare organizations. A wide range of services were covered including: (1) adult day care services; (2) transportation services; (3) congregate and home‐delivered meals; (4) adult protective services; (5) case management services; (6) in‐home services; (7) home health services; (8) long‐term residential care for non‐ambulatory older adults; (9) government health insurance programs for older adults including Medicaid and Guam’s Medically Indigent Program; and (10) legal services for older adults, including guardianship, powers of attorney, wills, living wills, and advance healthcare directives. Each presentation provided guidance on eligibility criteria and application procedures, as well as contact information for key personnel. Program outcomes indicate the following: (1) all sessions were well attended; (2) participant feedback was overwhelmingly positive; and (3) a significant number of participants followed through with applying for dementia care services. In sum, education outreach presentations conducted online can serve as an effective means to improve access to community resources for persons living with ADRD and their family caregivers.

Background Persons living with dementia often find it easier to remember experiences from long ago—including memories from their youth and early adulthood—than to recall recent events, such as what they did that week or even earlier that day. As a result, trying to navigate the present can be stressful and overwhelming, while reminiscing about the past can be a comforting experience. Connecting with valued memories from the past often helps persons living with dementia maintain their identity, preserve their sense of self, and enhance their overall quality of life. Reminiscence therapy was developed as a way to achieve these benefits by engaging older adults in the exploration of cherished memories to improve cognitive functioning and psychological well‐being. In recent years, reminiscence therapy has become an effective and popular approach to providing therapeutic support for persons living with dementia. Method Training in reminiscence therapy was provided to family and professional caregivers in the Pacific island of Guam through a weekly online support group. Training sessions were designed to help caregivers learn to use reminiscence therapy with persons with dementia in culturally sensitive ways reflecting the oral storytelling traditions of Pacific island cultures. Session topics addressed: (1) the benefits of reminiscence for persons with dementia, from maintaining memory health to building confidence and self‐esteem; (2) guidance from local writers and historians on how to talk with older adults about their life histories, including questions to ask and ways to evoke favorite memories; (3) the use of historical photos from Guam as conversation starters for older adults with memory loss; and (4) sharing stories about growing up in Guam in the 1930s, '40s, ‘50s, and ‘60s, along with readings from memoirs based on this period. Result Participants reported highly positive experiences with implementing reminiscence therapy with persons with dementia in their care. The techniques helped persons with dementia to relive beautiful memories and to share these memories with their families. Conclusion Program outcomes indicate that online training in reminiscence therapy is an effective way to teach caregivers skills to promote memory health and psychological well‐being for persons living with dementia.

Background Alzheimer’s Disease and Related Dementias (ADRD) are not only characterized by a decline in memory and cognition, but also by marked difficulties in language, communication, and social functioning. As ADRD progresses, it becomes increasingly challenging for persons living with dementia to participate in social interactions with family, friends, and caregivers, adversely impacting their well‐being and quality of life. Despite impairment in social functioning, persons with dementia still enjoy interaction with others and respond positively to social contact even in advanced stages. Thus, there is a need to develop effective strategies for interacting with persons living with dementia in a meaningful way. Method A telehealth dementia care training initiative was developed in the Pacific island of Guam focused on teaching family and professional caregivers to make meaningful connections with persons with ADRD through a wide range of stimulating, culturally responsive activities adapted to meet their unique needs, interests, and abilities. Activities were designed to provide opportunities for social engagement and simultaneously to help persons with dementia remain mentally and physically active. Examples include: (1) making meaningful connections with persons with dementia during activities of daily living; (2) rediscovering Guam’s history and culture through family‐based virtual museum tours; (3) embracing the oral storytelling traditions of Pacific island cultures by sharing family memories; (4) employing culturally responsive bibliotherapy by reading indigenous stories and picture books together; (5) stimulating the mind through collaborative readings of poetry; (6) soothing the aches and pains that come with aging by providing therapeutic massage; and (7) integrating music, dance, and movement into each day. All trainings were conducted in virtual family caregiver support group sessions as part of a comprehensive telehealth outreach program designed to provide improved access to dementia care support services for persons with dementia and their caregivers in Guam. Result Approximately 60‐100 family and professional caregivers participate in the program each month. Conclusion Program outcomes indicate that telehealth training in activity‐based dementia care can be an effective way to help caregivers learn to make meaningful connections with persons living with dementia.

This chapter provides an overview of psychology in the western Pacific region of Micronesia, which includes five US-affiliated Pacific Island (USAPI) jurisdictions: the US Territory of Guam, the Commonwealth of the Northern Mariana Islands (CNMI), and the three independent nations of Palau, the Federated States of Micronesia (FSM), and the Republic of the Marshall Islands (RMI). This chapter begins with a review of the region’s geography and cultural heritage, as well as the impact of colonization and social change on Micronesian societies. The authors then examine behavioral health problems in Micronesia, with a particular focus on suicide and mental illness. Recent decades have seen alarming rates of suicide throughout the region, especially among adolescent and young adult males. Males are also at higher risk of serious mental illness in Micronesia, although prevalence rates range considerably across the region. This chapter concludes with an overview of behavioral health services in each of Micronesia’s five USAPI communities, including a variety of culturally specific prevention, intervention, and outreach strategies designed to meet the unique needs of each island community. These formal behavioral health services supplement Indigenous cultural practices, such as traditional healers and informal familial and community support networks, which continue to play a vital role in the communities’ responses to suicide, mental illness, and other behavioral health concerns.

Background: The COVID-19 pandemic has led to heightened levels of isolation and loneliness for millions of individuals and families worldwide, resulting in adverse health and mental health outcomes. Persons with dementia and their family caregivers are particularly vulnerable due to the deleterious impact of social isolation on both dementia symptoms and caregiver burden. One of the greatest challenges for dementia patients has been accessing dementia care services during COVID-19 lockdowns. In the Pacific island of Guam, the pandemic quickly led to the closure of senior centers, adult day care centers, family caregiver support programs, and other social services for older adults and their families in March 2020. As a result, persons with dementia suddenly found themselves isolated at home and dependent upon family members to provide round-the-clock care. This presentation will describe the development of an innovative telehealth outreach program that was launched in Guam in the summer of 2020, three months after the first COVID-19 case had appeared on the island. The program was designed to provide improved access to social support and specialized community services for persons with dementia and their family caregivers. There are four components: (1) virtual family caregiver support groups where participants can share the stresses and challenges of caring for a loved one with dementia with others who are going through similar experiences; (2) virtual presentation and consultation sessions led by dementia care specialists from the community providing easy access to dementia care information and services; (3) 24/7 family caregiver support networks through mobile messaging apps to mitigate social isolation and ensure the availability of support in times of crisis; and (4) telehealth family counseling for persons with dementia and their family members employing narrative approaches that embrace the oral storytelling traditions of Pacific island cultures. The community response has been strong with approximately 50-60 family caregivers and persons with dementia participating in the program monthly. Project outcomes suggest that telehealth outreach services represent an effective and sustainable approach to connecting persons living with dementia and their family caregivers to community resources during times of isolation.