WELLNESS PROGRAMS FOR
ALZHEIMER’S RESIDENTS
DR CHANDINI SHARMA
GERIATRICIAN
GERIATRIC CENTER OF TULSA
OXYMORON???
• Not really
• We are going to see more of both
• There is a role of wellness in residents with dementia…. The boat of wellness
has not left the dock.
WELLNESS PROGRAM?
WELLNESS AND DEMENTIA
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Emotional resilience
Intellectual inquiry
Physical wellness
Social intelligence
Spiritual awareness
Career planning
Financial planning
Environmental health
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Provide positivity
Intellectual engagement
Physical wellness
Social engagement
Spiritual wellness
Fun career
Financial wellbeing
Home/environmental safety
DEMENTIA
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Slow progressive loss of memory and at least one other domain of cognitive function.
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5.2 million people in US
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200,000 are younger than 65
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70% live out in the community.
SILVER TSUNAMI
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MORTALITY
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Change in Number of Deaths
Between 2000 and 2010
Alzheimer's disease is the 6th leading
HIGH PREVALENCE
• 2/3rd residents in NH have some degree of memory loss
• 60% in AL have Dementia
• Another 20% have Mild Cognitive impairment - undiagnosed
BEWARE OF MCI
• Mild Cognitive Impairment
• Preclinical
• Affects cognitive ability but has not yet affected function
• Person knows they have a problem – MOSTLY
• Variable conversion rate 5 – 25 % annually to dementia
A STITCH IN TIME…
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The fastest growing age segment in the United States will soon
be adults aged 65 years and older,1 a group at high risk for
developing dementia. Efforts to reduce dementia may be most
successful at the earliest stages of disease development; subtle
decrements in cognitive function predict dementia many years
later and may be considered a marker of preclinical
disease.2- 5 Thus, research on risk factors for diminished
cognitive function in aging adults is of critical public health
importance.
JAMA. 2004;292(12):1454-1461.
PARALLEL
Av length of stay in IL – 5.5 yrs
Av length of stay in LTC – 2.5 yrs
Median length of stay in AL – 2 yrs
PARALLEL
IL
Mild
AL
Mod
LTC
Severe
IMPORTANCE OF SCREENING FOR COGNITIVE
HEALTH
• Welcome to Medicare
• Even before 65 if indicated
• There are >200,000 adults under 65 with Alzheimer’s
• Several thousands in Oklahoma
DISCLAIMER
No specific wellness program has been studied over a 20-30 year period to
determine the effectiveness of a successful aging intervention. These studies will
almost certainly never be funded or completed. The practicing clinician must
assemble specific recommendations based on available scientific observations
ACTIVE STUDY
Behavior-Based Interventions to Enhance Cognitive Functioning and
Independence in Older Adults
Sally A. Shumaker, PhD; Claudine Legault, PhD; Laura H. Coker, PhD
JAMA. 2006;296(23):2852-2854.
COGNITIVE INTERVENTIONAL TRAINING
• A growing body of research supports the protective effects of late-life
intellectual stimulation on dementia
• ACTIVE trail tested the effectiveness and durability of 3 distinct cognitive
interventions in improving the performance of the elderly on cognitive
measures and measures of cognitively demanding daily activities
JAMA, 2002
STUDY RESULTS
• Improvements in cognitive abilities caused improvement in independence of
participants
• 35.6% reduction in risk of serious health-related quality of life decline
• Effects that last 10+ years without further training
PHYSICAL ACTIVITY AND COGNITIVE HEALTH
• Plethora of evidence to back this up
• Regular exercise reduces the risk factors that are linked to development of
dementia – Alzheimer’s and others
JAMA 2008; 300(9):1027
ACUTE AEROBIC EXERCISE INCREASES BDNF LEVELS
IN ELDERLY WITH ALZHIEMER’S
• Brain derived neurotropic factor
• Small controlled study
• Significant increase
J Alz dis 2014 Jan1
HEART HEAD CONNECTION
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HEALTHY ACTION TO BENEFIT INDEPENDENCE AND
THINKING
Research supports that people with early cognitive impairment
benefit by developing new ‘habits’ that can compensate for
certain memory deficits over a period of time. Incorporating these
new habits can play a role in optimizing independence, improving
overall health, and maintaining normal daily activities.
HABIT
• 10 day, 50 hour
• Outpatient program for MCI and early diagnosis
• 5 components including Memory Compensation Training- with the help of a
cognitive therapist they incorporate a memory tracking and organization tool.
• Brain fitness, Group therapy , Mind-body movement, wellness education
WELLNESS EDUCATION
• Understanding MCI/ mild dementia
• Brain healthy diet and supplements
• Exercise – primary prevention
• Sleep hygiene
• Depression
• New technology for brain fitness
COMMUNITY PROGRAMS FOR PEOPLE WITH ALZ
DIS
• Memory clubs
• Meet up
• Mentor
• Museum program
• Living well with creative arts
MEDITATION
• Neurogenesis
• Neuroplasticity
• Practice of calmness- reduces stress and thus increases BDNF
THEORIES ON THE CAUSE OF AGING
The human genome does not undergo apoptosis, i.e., programmed
self-destruction, until age 120 or 130 and approximately 2/3 of
human aging may be determined by life choices and
environment rather than genetics. With the present human life
expectancy at 79 and future life expectancies exceeding 100,
our best prescription for aging is a wellness program
MACARTHUR FOUNDATION OF AGING STUDIES
• Far more positive aspects to aging than negative ones, in their landmark 1998
study
• Their findings punctured the widespread belief that aging inevitably brings
disability, disease and decreased mental function
SUCCESSFUL AGING
Low risk of
disease
Successful
aging
Active engagement
with life
High mental and
physical function
SUCCESSFUL AGING
Not smoking
Moderate drinking
Low risk of
disease
Low fat diet
Regular aerobic excercise
MENTAL EXERCISE – 4 HRS A DAY
Creative
arts
Problem
solving
Independe
nt
judgement
ACTIVE ENGAGEMENT WITH LIFE
Substantial friendships
Family
Talking
things out
SUCCESSFUL AGING
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DEMENTIA FRIENDLY COMMUNITY
• Deliberate, coordinated and ongoing effort of the entire community, to enable
pts with dementia feel safe in a community. This means everything from easy
access to local facilities such as banks and shops to ensuring social networks
can be maintained
• Watertown Madison WI
• Started in UK
SLEEP
• A critical but overlooked aspect of dementia wellness
• Upto 70% residents with dementia are affected
• Sleep disorder interferes with memory, cognition, problem solving and overall
daily function
SLEEP PROBLEM
• Sleep problems increase risk of falls and fractures
• Contribute to depression, irritability and aggression
• Caregiver exhaustion
• One of the most common reason of transition to higher level of care.
EXPLORE NON PHARM INTERVENTIONS
• Bright light therapy
• Indoor gardening
• “Night camp” – Bronx NY
• TENS
• Passive body heating
• Think of Sleep apnea
NEW MANDATE
• 2/12/2014 in MA a new mandate requires 8 hours of dementia related initial
education for staff in a dementia care unit, followed by 4 hours yearly.
• Also it mandates an ‘activities director’ in each of these units to provide
meaningful activities for this population
QUESTIONS