Dance Therapy for People Suffering from Alzheimer's & Dementia

What is dance therapy?

Music therapy was established in 1950. It is designed to improve physical and emotional health through the use of music, through listening, song writing, performing, exploring lyrics or other activities related to music. Music therapy is most often used as part of stress management programs.

NICE guidelines specify that “people with mild to moderate dementia of all types should be given the opportunity to participate in a structured group cognitive stimulation program.” However, because of uncertainty about cost effectiveness, it remains for the voluntary sector to provide these services.

Dance therapy is the use of movement to improve physical and psychological wellbeing. Sessions deliver either structured dancing technique, such as social dancing with a partner, or a more contemporary approach that uses improvisation to link thoughts with movement. Sessions should be tailored to the severity of the dementia. For example, people with more severe dementia benefit from simpler movements and more caregivers to help. Small class sizes with similarly affected participants facilitate participation. Classes should last about an hour to reduce the risk of the symptoms of Alzheimer’s disease hindering further progress.

Social dancing with a partner is a familiar and enjoyable activity for elderly people and provides quality time for the patient and their partner. It develops procedural learning (long term memory initiated by past experience) and concentration because dancing is a dynamic rather than repetitive physical activity and can “link past memories to the present.” A man who attended Scottish country dancing lessons once a month with his wife, who had Alzheimer’s disease, noted that his wife remembered lots of the steps despite her limited cognitive ability. In one project, participants who danced in a circle felt they had been accepted into, and belonged to, a group. So social dancing offers participants an opportunity to succeed and boost their self esteem.

Projects that focused on free and creative expression have had similar benefits. A weekly project in which 8-10 participants used props and various musical genres encouraged people to move however they wanted, rather than follow a routine. Observations included participants engaging and improvement in mood and relationships among participants and between participants and their caregivers. Building relationships led to an increased sense of self and self esteem. One participant in this study remembered things from her childhood and her personal qualities and thought that she had been “got together again.” This type of dance also allowed emotions such as grief, anger, and loss to be tackled and reflected upon, allowing people to celebrate life again.

Dance awakens memories outside the dance session and helps patients “find themselves” again. A multisensory approach with different sounds, colors, and tangible objects further stimulates engagement and stimulation of participants.

Benefits of dance therapy

Various aspects of a dance session, such as the music, exercise, and social components of dancing, may achieve positive effects. However, vastly varying methods between most studies mean that they fail to agree the most important component. Although a Cochrane review shows that music therapy offers no definite benefits, subsequent research indicates that music can improve autobiographical memory and reduce agitation, anxiety, delusions, and other behavioral symptoms in dementia of any severity.

Exercise slows the progression of cognitive symptoms and is neuro-protective through increasing concentrations of insulin-like growth factor and reducing serum homocysteine. An active mid-life can reduce the risk of Alzheimer’s disease by up to 60% in people with the apolipoprotein E ε4 allele. The positive self esteem and social experience of exercise also improves cognition. However, exercise can be repetitive and there is a degree of “doing it right or wrong,” whereas dance is spontaneous and “always right”; indeed, some propose dance to be the only preventive physical activity. Overall, dance combines all these benefits into an attainable and enjoyable activity for all levels of disability.

According to researchers M. Brotons and S.M. Kroger of the Willamette University Psychology Department in Oregon, in their study on "The Impact of Music Therapy on Language Functioning in Dementia," patients showed statistically significant improvements in speech content and fluency after eight sessions of music therapy combined with conversations.

Other researchers have reported on proven benefits to Alzheimer’s patients derived from music therapy on aspects such as cognitive functions, social skills, and behavior (including reduced agitation and behavioral problems). Music and music therapy are not curative of Alzheimer’s and dementia, but the use of music therapy results in the beneficial effects on dementia and Alzheimer’s symptoms. These benefits lead to an enhanced quality of life for both the patient and his or her caregiver.

Sound of Music

Typically, “stimulating music” activates, while “sedative music” quiets. Stimulating music, with percussive sounds and fairly quick tempos, tends to naturally promote movement, such as toe taps. Look to dance tunes of any era for examples. Slightly stimulating music can assist with activities of daily living: for example, at mealtime to rouse individuals who tend to fall asleep at the table or during bathing to facilitate movement from one room to another.

On the other hand, the characteristics of sedative music—ballads and lullabies—include unaccented beats, no syncopation, slow tempos, and little percussive sound. This is the best choice when preparing for bed or any change in routine that might cause agitation.

Responses that are opposite of those expected can occur and are likely due to a person’s specific associations with the piece or style of music.

Agitation Management

Non-verbal individuals in late dementia often become agitated out of frustration and sensory overload from the inability to process environmental stimuli. Engaging them in singing, rhythm playing, dancing, physical exercise, and other structured music activities can diffuse this behavior and redirect their attention.

For best outcomes, carefully observe an individual’s patterns in order to use music therapies just prior to the time of day when disruptive behaviors usually occur.

 Emotional Closeness

 As dementia progresses, individuals typically lose the ability to share thoughts and gestures of affection with their loved ones. However, they retain their ability to move with the beat until very late in the disease process.

Ambulatory individuals can be easily directed to couple dance, which may evoke hugs, kisses or caresses; those who are no longer walking can follow cues to rhythmically swing their arms. They often allow gentle rocking or patting in beat to the music and may reciprocate with affection.

An alternative to moving or touching is singing, which is associated with safety and security from early life. Any reciprocal engagement provides an opportunity for caregivers and care receivers to connect with one another, even when the disease has deprived them of traditional forms of closeness.

 How-to of music therapy

 Early stages

• ·         Go out dancing or dance in the house. 
• ·         Listen to music that the person liked in the past—whether swing or Sinatra or salsa. Recognize that perceptual changes can alter the way individuals with dementia hear music. If they say it sounds horrible, turn it off; it may to them. 
• ·         Experiment with various types of concerts and venues, giving consideration to endurance and temperament. 
• ·         Encourage an individual who played an instrument to try it again. 
• ·         Compile a musical history of favorite recordings, which can be used to help in reminiscence and memory recall.

Early and middle stages

Use song sheets or a karaoke player so the individual can sing along with old-time favorites.

Middle stages

• ·         Play music or sing as the individual is walking to improve balance or gait. 
• ·         Use background music to enhance mood. 
• ·         Opt for relaxing music—a familiar, non-rhythmic song—to reduce sundowning, or behavior problems at nighttime.

Late stages

• ·         Utilize the music collection of old favorites that you made earlier. 
• ·         Do sing-alongs, with “When the Saints Go Marching In” or other tunes sung by rote in that person’s generation. 
• ·         Play soothing music to provide a sense of comfort. 
• ·         Exercise to music. 
• ·         Do drumming or other rhythm-based activities.
• ·         Use facial expressions to communicate feelings when involved in these activities.

Negative aspects of dance therapy

Dance therapy may be effective only during a period of regular sessions. Patients and their families awaiting drug treatment or a “wonder cure” may be disappointed when dance therapy is offered. Patients who find dancing and movement difficult might be saddened by this reality. Concerns exist that physical activities in people with dementia in particular may raise the risk of falls and exacerbate various existing health conditions, such as high blood pressure, heart problems, chronic obstructive pulmonary disease, and so on. However, exercise could reduce falls by improving stability and improve the long term progress of other chronic conditions.

Prevention is better than no cure

The main risk factors for dementia include increasing life expectancy, obesity, diabetes, excessive alcohol consumption, and hypertension. Although these are largely vascular dementia risk factors, age is a key cause of Alzheimer’s disease, so prevalence is also set to rise.

Dance therapy could be a preventive measure. Combining physical and mental activities can increase the cognitive reserve, reduce the rate of brain atrophy, stimulate neuroplasticity and neurogenesis, and increase brain perfusion as well as combating many of the risk factors. Early prevention is key, given that clinical presentation of symptoms occurs 10-20 years after the biological changes start.

The resources exist to allow any willing caregivers to run dance therapy classes, regardless of dance experience, and there is a lot of information available. The Expressive Arts with Elders resource also promotes easy, money saving dance techniques, such as using a dustpan as a drum or beans as shakers. Alternatively, professional dance teachers charge about £30 an hour. Additional considerations, such as facilities, facilitators, organizing transport, and coordinating and organizing potential participants and their caregivers require further research, to see whether these factors allow dance therapy to be a cost effective option.

Dance “challenges the stereotypes of ageing and disease.” It also provides a good mix of cognitive and physical stimulation. It is also refreshing for patients and caregivers to experience a treatment that is not a drug regimen.

Sources and Additional Information:

http://archive.student.bmj.com/issues/09/03/education/112.php

http://www.caring.com/articles/music-therapy-stroke-diagnosis

http://www.alzfdn.org/EducationandCare/musictherapy.html

http://www.parentgiving.com/elder-care/music-as-a-tool-to-improve-communications-skills-in-alzheimers-patients/

 

Posted by Michael Pekker (AKA Nesher) 

 

Courtesy  : http://alzheimers-review.blogspot.com/2010/03/dance-therapy-for-alzheimers-patients.html

‘Quality Dementia Care Framework’ : Dementia Care Giver Training workshop, May 2011

1^st time in Mumbai unique Dementia Care Giver Training Programme

Silver Inning Foundation in association with ARDSI Greater Mumbai Chapter  & Supported by  Harmony for Silvers Foundation Presents

‘Quality Dementia Care Framework’

Dementia Care Giver Training workshop

By Mrs. Nilanjana Maulik : Expert Trainer & Director of Dementia Services, ARDSI Calcutta Chapter

Background:

Dementia is a progressive brain dysfunction (in Latin 'dementia' means irrationality), which results in a restriction of daily activities and in most cases leads in the long term to the need for care. Dementia is one of the major causes of disability in late-life.  Many diseases can result in dementia, the most common one being Alzheimer's disease. It mainly affects older people; about 2% of cases start before the age of 60 years. After this, the prevalence doubles every five years. Dementia affects each person and family differently. As dementias progress, there are notable changes in memory, thinking, language, behavior and function — all of which require different skills and strategies. Very few of us have a natural born knack for care giving. Most caregivers have to learn and practice these new skills. It is estimated that over 3.7 million people are affected by dementia in our country. This is expected to double by 2030. The challenge posed by dementia as a health and social issue is of a scale we can no longer ignore. Despite the magnitude, there is gross ignorance, neglect and scarce services for people with dementia and their families.

Need:

The importance of taking care of elderly has become more relevant in India due to the increased lifespan and consequent increase in the population of the aged.  As a result of the demographic transition and changing family structure, care of aged is emerging as concern of modern times. The support system and care giving that had been earlier available in the traditional family set up for the elderly has withered away. One of the most important components of developing dementia services in the Country is training health human resources.  We at Silver Inning Foundation like other NGO’s have realize the implications of the increasing aging population in the country, and responded by creating care programmes and delivery services aimed at meeting the needs of older persons.

The Training of Care Giver for people with Dementia has evolved with parting of knowledge and innovative ways of empowering the family members and professionals to gain skill sets that could help them in Management of Dementia. By undertaking such Geriatric care trainings we at Silver Inning Foundation will achieve our vision of creating an Elder Friendly World where Ageing becomes a Positive and Rewarding Experience.

Objectives:

• To create awareness about dementia and its various types.
• To educate volunteers and caregivers to identify early warning signs of dementia and early prevention of dementia.
• To train volunteers and caregivers to disseminate knowledge about dementia to local population and Senior Citizens.
• To enhance the capacity & skills of Care givers in managing elderly with dementia.

Date: Friday 6^th May to Sunday 8^th May (3 Full Days)

 Timing: 10am to 5.30pm

Venue : Harmony Interactive Centre ,Harmony for Silvers Foundation,5th, Floor Zaobawadi Lane, Next to Ram Mandir , Thakurdwar,Girgaum , Mumbai .Maharashtra 400002.

Who can participate: Social Workers, Medical Professionals, Nursing Students, Family Members, Care Givers, Psychologist, Gerontologist, Geriatricians, Legal Professional, Police Professionals, Senior Citizens and Staff of NGO/Old Age Homes

Eligibility:

• Minimum Age - 18 years and above
• Minimum education- 10^th  +
• Must have Passion to serve.

Language of Training: English

Methodology:

The methodology of training would include lecture cum discussions, case presentations, group exercises, role play and efforts would be made to make the training participatory in approach. Pre and post assessment evaluation of the participants on knowledge base would be conducted at the beginning and end of the course respectively.

Highlights of Basic Curriculum:

Definition, nature and type of Dementia, Myth and Fact, Symptoms/Identification of Dementia Patients, Role-Play, Group Work, Brain Boosters/other exercises, Documentary,  Care Giver Experience etc

What you will get:

• Knowledge & skill for Dementia management
• Certificate of Participation
• Free Leaflets/notes 
• Books on dementia/care giving will be available at Rs.275/175/-
• Free Volunteer Membership to Silver Inning Foundation & ARDSI Greater Mumbai Chapter

Number of Participant: minimum 15 to maximum 30 (first come first basis)

How to register:  Rs. 700/- p.p. non residential (inclusive of lunches, refreshments and materials).

Special rates of Rs.500/- p.p. for Senior Citizens who are age 50yrs and above .

Rs.  500/- p.p. early bird discount until 15^th April 2011.

Please note there will be no refund of registration fees in event of cancellation by the participant.

Note: Last date for registration is 30^th April 2011.  

Please send the filled-in form along with the Chq payment to:

Silver Innings, C/o Sailesh Mishra, ARENA III, Flat - 801/802, Poonam Garden, Mira Road -East, Mumbai. India – 401107.

Contact person:

Ms. Mona - 09987104233

Ms. Laxmi Rao – 09029000091

Email: silverinnings@gmail.com

Organized by Silver Innings, a social Enterprise for Age Care. Silver Innings is working towards creating an Elder Friendly World where Ageing becomes a Positive and Rewarding Experience.

www.silverinnings.com

High Cholesterol, Hypertension May Harm Memory in Middle Age

Hypertension and high cholesterol may be linked to losses in memory and mental abilities in middle age, a new study finds.


Researchers in France assessed data on about 3,500 British men and 1,300 British women with an average age of 55 who participated in Whitehall II, a long-term study that tracked British civil servants.

Three times over the course of a decade, participants took tests that measured their reasoning skills, memory, fluency and vocabulary. The reasoning test was composed of 65 verbal and mathematical questions of increasing difficulty, and the memory test asked people to recall a list of 20 words. The fluency test asked participants to do such things as name as many words as they can, in one minute, that start with the letter "s" or name as many animals as they can.

Participants were also given a what's called a Framingham risk score, which takes into account a person's age, gender, cholesterol levels, blood pressure, smoking history and diabetes status to predict the chances of having a heart attack, stroke or other cardiovascular problem sometime in the next 10 years.

Those who had poorer cardiovascular health were more likely to do worse on tests of memory and mental ability than were those who had better cardiovascular health, according to the study.

For example, a 10 percent higher cardiovascular risk score was associated with a 2.8 percent lower score on the memory test for men and a 7.1 percent lower score for women.

Over time, those who had worse cardiovascular health also saw steeper declines in mental tasks, with the exception of reasoning for men and fluency for women.

"We found that cardiovascular risk in middle age is related to lower overall cognitive function," said study co-author Sara Kaffashian, a doctoral student at INSERM, the French National Institute of Health & Medical Research in Paris. "We also observed a relationship between poor cardiovascular scores and overall cognitive decline over 10 years."

The study is to be presented in April at the American Academy of Neurology's annual meeting in Honolulu. Experts note that research presented at meetings has not been subjected to the same rigorous scrutiny given to research published in medical journals.

Dr. Ralph Sacco, president of the American Heart Association, said an increasing body of research is showing the importance of cardiovascular health in maintaining brain function over a person's life span.

"The link between cardiovascular health and brain health is becoming increasingly important and recognized," said Sacco, a professor of neurology, epidemiology and human genetics at the University of Miami Miller School of Medicine.

High blood pressure, diabetes, smoking, high cholesterol and inactivity can contribute to a narrowing of the large blood vessels throughout the body, but also the small blood vessels of the brain, Sacco explained.

Those changes can reduce blood flow, which can "starve the brain of oxygen and lead to changes in thinking, cognition and our mental abilities," he said.

Though the people in the study did not have Alzheimer's, other research suggests that hypertension, diabetes and poor cardiovascular health are a risk factor for both Alzheimer's and vascular dementia, he added.

"In the old days, we thought vascular risk factors only led to vascular dementia, but now we know vascular risk factors may also have an impact on Alzheimer's," Sacco said.

But the good news, he said, is that middle-aged adults can take steps to improve cardiovascular health, including eating a proper diet, exercising, controlling diabetes if they have it and, if applicable, taking the correct medications for hypertension, Sacco said.

"There is a hopeful note, which is that by controlling your vascular risk factors, you may be able to reduce or forestall cognitive decline," he said.

Source:  http://consumer.healthday.com/Article.asp?AID=650108

Alzheimer's Foundation of America (AFA) Unveils Interactive 'Community of Care' Web Site to Educate and Connect Family Caregivers

With the nation facing a huge swell in the number of individuals with Alzheimer's disease and related illnesses, the Alzheimer's Foundation of America (AFA) yesterday unveiled an innovative, interactive "community of care" Web site that will help family caregivers meet other caregivers, learn about the brain disorder and connect "live" with experts.

     Called Care Crossroads, the robust site addresses a major issue raised by caregivers of loved ones with Alzheimer's disease: a feeling of isolation and stigma. It also fills a growing need for alternate types of support services, especially for caregivers whose round-the-clock responsibilities prevent them from interacting in person at organized programs.

     "Caregiving, especially for loved ones with Alzheimer's disease, can be a very lonely as well as heartbreaking journey," said Eric J. Hall, AFA's president and CEO. "Care Crossroads is the ultimate Internet coffee shop for caregivers. Family members can gather here to obtain guidance from experts and gain insight, support and inspiration from each other."

     Among the site's highly-versatile and unique features, AFA's social workers are standing by to respond to questions and concerns on caregivers' own communication terms: online via live Skype and chat, as well as e-mail and phone calls to the organization's toll-free hot line at 866-232-8484.

     Caregivers are introduced to other caregivers via "I Care" video stories, creative contributions, and an active discussion board in partnership with Inspire, an online multi-disease health and wellness support community.

     Then, featured in the site's "learn" section, the "House of Care" is the go-to place where visitors can click on specific rooms to learn more about strategies for behavioral challenges, recreational activities and safety issues appropriate for the specific stages of the disease.

     Care Crossroads was made possible by funding from Eisai Inc. and Pfizer Inc. To learn more, visit www.carecrossroads.org. 

Giving Alzheimer’s Patients Their Way, Even Chocolate

Margaret Nance was, to put it mildly, a difficult case. Agitated, combative, often reluctant to eat, she would hit staff members and fellow residents at nursing homes, several of which kicked her out. But when Beatitudes nursing home agreed to an urgent plea to accept her, all that changed.


Disregarding typical nursing-home rules, Beatitudes allowed Ms. Nance, 96 and afflicted with Alzheimer’s, to sleep, be bathed and dine whenever she wanted, even at 2 a.m. She could eat anything, too, no matter how unhealthy, including unlimited chocolate.

And she was given a baby doll, a move that seemed so jarring that a supervisor initially objected until she saw how calm Ms. Nance became when she rocked, caressed and fed her “baby,” often agreeing to eat herself after the doll “ate” several spoonfuls.

Dementia patients at Beatitudes are allowed practically anything that brings comfort, even an alcoholic “nip at night,” said Tena Alonzo, director of research. “Whatever your vice is, we’re your folks,” she said.
Once, Ms. Alonzo said: “The state tried to cite us for having chocolate on the nursing chart. They were like, ‘It’s not a medication.’ Yes, it is. It’s better than Xanax.”

It is an unusual posture for a nursing home, but Beatitudes is actually following some of the latest science. Research suggests that creating positive emotional experiences for Alzheimer’s patients diminishes distress and behavior problems.

In fact, science is weighing in on many aspects of taking care of dementia patients, applying evidence-based research to what used to be considered subjective and ad hoc.

With virtually no effective medical treatment for Alzheimer’s yet, most dementia therapy is the caregiving performed by families and nursing homes. Some 11 million people care for Alzheimer’s-afflicted relatives at home. In nursing homes, two-thirds of residents have some dementia.

Caregiving is considered so crucial that several federal and state agencies, including the Department of Veterans Affairs, are adopting research-tested programs to support and train caregivers. This month, the Senate Special Committee on Aging held a forum about Alzheimer’s caregiving.

“There’s actually better evidence and more significant results in caregiver interventions than there is in anything to treat this disease so far,” said Lisa P. Gwyther, education director for the Bryan Alzheimer’s Disease Research Center at Duke University.

The National Institute on Aging and the Administration on Aging are now financing caregiving studies on “things that just kind of make the life of an Alzheimer’s patient and his or her caregiver less burdensome,” said Sidney M. Stahl, chief of the Individual Behavioral Processes branch of the Institute on Aging. “At least initially, these seem to be good nonpharmacological techniques.”

Techniques include using food, scheduling, art, music and exercise to generate positive emotions; engaging patients in activities that salvage fragments of their skills; and helping caregivers be more accepting and competent.


Changing the Mood
Some efforts involve stopping anti-anxiety or antipsychotic drugs, used to quell hallucinations or aggression, but potentially harmful to dementia patients, who can be especially sensitive to side effects. Instead, some experts recommend primarily giving drugs for pain or depression, addressing what might be making patients unhappy.

Others recommend making cosmetic changes to rooms and buildings to affect behavior or mood.
A study in The Journal of the American Medical Association found that brightening lights in dementia facilities decreased depression, cognitive deterioration and loss of functional abilities. Increased light bolsters circadian rhythms and helps patients see better so they can be more active, said Elizabeth C. Brawley, a dementia care design expert not involved in the study, adding, “If I could change one thing in these places it would be the lighting.”

Several German nursing homes have fake bus stops outside to keep patients from wandering; they wait for nonexistent buses until they forget where they wanted to go, or agree to come inside.

And Beatitudes installed a rectangle of black carpet in front of the dementia unit’s fourth-floor elevators because residents appear to interpret it as a cliff or hole, no longer darting into elevators and wandering away.

“They’ll walk right along the edge but don’t want to step in the black,” said Ms. Alonzo, who finds it less unsettling than methods some facilities use, bracelets that trigger alarms when residents exit. “People with dementia have visual-spatial problems. We’ve actually had some people so wary of it that when we have to get them on the elevator to take them somewhere, we put down a white towel or something to cover it up.”


When elevator doors open, Beatitudes staff members stand casually in front, distracting residents with “over-the-top” hellos, she said: “We look like Cheshire cats,” but “who’s going to want to get on the elevator when here’s this lovely smiling person greeting you? It gets through to the emotional brain.”

New research suggests emotion persists after cognition deteriorates. In a University of Iowa study, people with brain damage producing Alzheimer’s-like amnesia viewed film clips evoking tears and sadness (“Sophie’s Choice,” “Steel Magnolias”), or laughter and happiness (Bill Cosby, “America’s Funniest Home Videos”).

Six minutes later, participants had trouble recalling the clips. But 30 minutes later, emotion evaluations showed they still felt sad or happy, often more than participants with normal memories. The more memory-impaired patients retained stronger emotions.

Justin Feinstein, the lead author, an advanced neuropsychology doctoral student, said the results, being studied with Alzheimer’s patients at Iowa and Harvard, suggest behavioral problems could stem from sadness or anxiety that patients cannot explain.

“Because you don’t have a memory, there’s this general free-floating state of distress and you can’t really figure out why,” Mr. Feinstein said. Similarly, happy emotions, even from socializing with patients, “could linger well beyond the memories that actually caused them.”

One program for dementia patients cared for by relatives at home creates specific activities related to something they once enjoyed: arranging flowers, filling photo albums, snapping beans.

“A gentleman who loved fishing could still set up a tackle box, so we gave him a plastic tackle box” to set up every day, said the program’s developer, Laura N. Gitlin, a sociologist at Thomas Jefferson University in Philadelphia and newly appointed director of a new center on aging at Johns Hopkins University.

After four months, patients seemed happier and more active, and showed fewer behavior problems, especially repetitive questioning and shadowing, following caregivers around. And that gave caregivers breaks, important because studies suggest that “what’s good for the caregiver is good for the patient,” Professor Gwyther said.


Aiding the Caregiver
In fact, reducing caregiver stress is considered significant enough in dementia care that federal and state health agencies are adopting programs giving caregivers education and emotional support.

One, led by Mary S. Mittelman, a New York University dementia expert, found that when people who cared for demented spouses were given six counseling sessions as well as counselors whom they could call in a crisis, it helped them handle caregiving better and delayed by 18 months placing patients in nursing homes.

“The patient did not have fewer symptoms,” Dr. Mittelman said. “It was the caregiver’s reaction that changed.”

The Veterans Affairs Department is adopting another program, Resources for Enhancing Alzheimer’s Caregiver Health, providing 12 counseling sessions and 5 telephone support group sessions. Studies showed that these measures reduced hospital visits and helped family caregivers manage dementia behaviors.
“Investing in caregiver services and support is very worthwhile,” saving money and letting patients remain home, said Deborah Amdur, chief consultant for care management and social work at the Veterans Affairs Department.

Beatitudes, which takes about 30 moderate to severe dementia sufferers, introduced its program 12 years ago, focusing on individualized care.

“In the old days,” Ms. Alonzo said, “we would find out more about somebody from their obituary than we did when they were alive.”

The dementia floor was named Vermillion Cliffs, after colorfully layered rock formations formed by centuries of erosion, implying that, “although weathered, although tested by dementia, people are beautiful” and “have certain strengths,” said Peggy Mullan, the president of Beatitudes.

The facility itself is institutional-looking, dowdy and “extremely outdated,” Ms. Mullan said.

“It’s ugly,” said Jan Dougherty, director of family and community services at Banner Alzheimer’s Institute in Phoenix. But “they’re probably doing some of the best work” and “virtually have no sundowning,” she said, referring to agitated, delusional behavior common with Alzheimer’s, especially during afternoon and evening.
Beatitudes eliminated anything potentially considered restraining, from deep-seated wheelchairs that hinder standing up to bedrails (some beds are lowered and protected by mats). It drastically reduced antipsychotics and medications considered primarily for “staff convenience,” focusing on relieving pain, Ms. Alonzo said.
It encouraged keeping residents out of diapers if possible, taking them to the toilet to preserve feelings of independence. Some staff members resisted, Ms. Alonzo said, but now “like it because it saves time” and difficult diaper changes.

Family members like Nancy Mendelsohn, whose mother, Rose Taran, was kicked out of facilities for screaming and calling 911, appreciate it. “The last place just put her in diapers, and she was not incontinent at all,” Ms. Mendelsohn said.

Ms. Alonzo declined to pay workers more to adopt the additional skills or night work, saying, “We want people to work here because it’s your bag.”


Finding Favorite Things
For behavior management, Beatitudes plumbs residents’ biographies, soothing one woman, Ruth Ann Clapper, by dabbing on White Shoulders perfume, which her biographical survey indicated she had worn before becoming ill. Food became available constantly, a canny move, Ms. Dougherty said, because people with dementia might be “too distracted” to eat during group mealtimes, and later “be acting out when what they actually need is food.”

Realizing that nutritious, low-salt, low-fat, doctor-recommended foods might actually discourage people from eating, Ms. Alonzo began carrying chocolate in her pocket. “For God’s sake,” Ms. Mullan said, “if you like bacon, you can have bacon here.”

Comforting food improves behavior and mood because it “sends messages they can still understand: ‘it feels good, therefore I must be in a place where I’m loved,’ ” Ms. Dougherty said.

Now, when Maribeth Gallagher, dementia program director for Hospice of the Valley, which collaborates in running Beatitudes's program, learns someone’s favorite foods, “I’m going to pop that on your tongue, and you’re going to go ‘yum,’ ” she said. “Isn’t that better than an injection?”

Beatitudes also changed activity programming. Instead of group events like bingo, in which few residents could actually participate, staff members, including housekeepers, conduct one-on-one activities: block-building, coloring, simply conversing. State regulators initially objected, saying, “Where’s your big group, and what you’re doing isn’t right and doesn’t follow regulations,” Ms. Alonzo said.

Ms. Mullan said, “I don’t think we ever got cited, but it was a huge fight to make sure we didn’t.”
These days, hundreds of Arizona physicians, medical students, and staff members at other nursing homes have received Beatitudes’ training, and several Illinois nursing homes are adopting it. The program, which received an award from an industry association, the American Association of Homes and Services for the Aging, also appears to save money.

Arlene Washington’s family moved her to Beatitudes recently, pulling her from another nursing home because of what they considered inattentive and “improper care,” said her husband, William. Mrs. Washington, 86, was heavily medicated, tube fed and unable to communicate, “like she had no life in her,” said Sharon Hibbert, a friend.

At Beatitudes, Dr. Gillian Hamilton, administrative medical director, said she found Mrs. Washington “very sedated,” took her off antipsychotics, then gradually stopped using the feeding tube. Now Mrs. Washington eats so well she no longer needs the insulin she was receiving. During a recent visit, she was alert, even singing a hymn.

That afternoon, Ms. Nance, in her wheelchair, happily held her baby doll, which she named Benjamin, and commented about raising her sons decades ago.

Ms. Alonzo had at first considered the doll an “undignified” and demeaning security blanket. But Ms. Gallagher explained that “for a lot of people who are parents, what gives them joy is caring for children.”
“I was able,” Ms. Gallagher said, “to find Margaret’s strength.”

Ms. Gallagher said she learned when approaching Ms. Nance to “look at her baby doll, and once I connect with the doll, I can look at her.”

She squatted down, complimented Benjamin’s shoes, and said, “You’re the best mom I know.”
Ms. Nance nodded earnestly.

“It’s good to know,” Ms. Nance said, “that somebody knows that you care.”

By PAM BELLUCK

Courtesy :  http://www.nytimes.com/2011/01/01/health/01care.html?_r=2&emc=eta1&pagewanted=all