Annotated Results: 6 Other

Please add comments. Tell us about work we've missed. Add work published after we closed our review.

In your annotated additions please tell what was studied, what benefits were found, what quality of life benefits were found, and how well benefits were sustained.

Thanks. Don

6. Other

Alessi, C.A.; Yoon, E.J.; Schnelle, J.F.; Al-Samarrai, N.R.; Cruise, P.A. (1999). A randomized trial of a combined physical activity and environmental intervention in nursing home residents: do sleep and agitation improve? Journal of the American Geriatric Society, 47, 784-791.
The study tested whether an intervention combining increased daytime physical activity with improvement in the nighttime environment improves sleep and decreases agitation in nursing home residents using a randomized trial in one community nursing home in the Los Angeles, California area. It included twenty-nine incontinent residents (mean age 88.3 years, 90% female) randomized to receive either (1) an intervention combining increased daytime physical activity (14 weeks in duration) plus a nighttime program (5 nights in duration) to decrease noise and sleep-disruptive nursing care practices (intervention group), or (2) the nighttime program alone (control group). Measurements included daytime physical activity monitors and structured physical function assessments; nighttime wrist activity monitors to estimate nighttime sleep; and timed daytime behavioral observations of sleep versus wakefulness, either in or out of bed, and agitation. Physical function measures did not change significantly. Wrist actigraphy estimation of nighttime percent sleep increased in intervention subjects from 51.7% at baseline to 62.5% at follow-up compared with 67.0% at baseline to 66.3% at follow-up in controls. At follow-up, intervention subjects averaged a 32% decrease in the percent of daytime observations in bed compared with baseline, with essentially no change in controls. Seven of 15 intervention subjects had a decrease in observed agitation at follow-up, compared with baseline, versus only 1 of 14 controls with a decrease in observed agitation. The authors contend that this study provides preliminary evidence that an intervention combining increased physical activity with improvement in the nighttime nursing home environment improves sleep and decreases agitation in nursing home residents.

Bober, S.J.; McLellan, E.; McBee, L.; & Westreich, L. (2002). The Feelings Art Group a vehicle for personal expression in skilled nursing home residents with dementia. Journal-of-Social-Work-in-Long-Term-Care, 1(4), 73-87.
Based on the assumption that dementia sufferers continue to experience emotions even in the severe stages of the disease and despite profound declines in cognitive functioning, the authors argue that many struggle to communicate these emotions verbally. This article looks at the Feelings Art Group, a social work led group on a dementia Special Care Unit within a 514-bed academic nursing home offered an ongoing group therapy program for skilled nursing residents with Alzheimer's type and other dementias. This group therapy program employed art-based activities as a stimulus to facilitate uncommunicated emotions in severely demented nursing home residents. The intervention was designed to tap into resident's feelings on a series of universal topics including family, work, holidays and seasons, using art as a vehicle for the expression of emotions. Employing visual, tactile, olfactory and audio stimulation, dementia sufferers were helped to find "voice" for their feelings. Before and after the group, residents with limited verbal abilities were able to identify feelings using a visual recognition scale and verbal cues. Outcomes included a heightened ability to identify emotions and increased socialization among group members.

Brooker, D.J. & Duce, L. (2000). Well-being and activity in dementia: a comparison of group reminiscence therapy, structured goal-directed activity, and unstructured time. Aging and Mental Health, 4 (4), 354-358.
A comparison of well-being levels of 25 individuals with mild to moderate dementia during three types of activity was made. The first was group reminiscence therapy (RT), the second was group activities (GA), and the third was unstructured time (UT). These activities were all part of the usual program of activities within three day hospitals where the study took place. Dementia Care Mapping results indicated that individuals experienced a greater level of relative wellbeing during RT than GA. The level of wellbeing in both RT and GA was significantly higher than in UT.

Brooker, D.J. (2001). Enriching Lives: evaluation of the ExtraCare activity challenge. Journal of Dementia Care, May/June, 33-37.
This article evaluates the ExtraCare activity, which took 19 PWD out of their normal environment for an “exciting 5-day outdoor activity holiday,” including canoeing, hot air ballooningm pony trap riding, abseiling, the zip wire, swimming in the heated pool and the Jacuzzi. The author argues that the intervention of “going on holiday” has not been systematically evaluated as an experience for PWD. Through the use of dementia care mapping (DCM), the well-being of residents was systematically evaluated before, during and one month after the ExraCare challenge to understand the experiences of participants and benefits for both residents and staff. Blinded staff reports suggest that residents with dementia gain enormous increases in self esteem from their achievements on these holidays, in addition to significant improvements in sleep, continence and mobility. In particular, as a group well-being was significantly higher while participants were on holiday and a month later well-being was similar to what it had been prior to the holiday. The control group, who did not go on the holiday, experienced only slight changes in well-being over the same time period.

Brooker, D.J. & Woolley, R.J. (2007). Enriching opportunities for people living with dementia: the development of a blueprint for a sustainable activity-based model. Aging and Mental Health, 11(4), 371-383.
This study includes a lit review (of medline, CINAHL, Cocharne using key words such as AD, activity/occupation, therapy, long term care/homes) but focuses on an expert working group featuring the special expertise of the locksmith, “whose raison d’etre was to ensure residents and tenants reach their potential for well-being” (373). The locksmith’s title is chosen to reflect responsibility in discovering and developing keys that “would unlock the potential for well-being in individuals with dementia” (373). Their role was described as pivotal as resource and leader, with a firm commitment that PWD are entitled to and able to enjoy life. Focus group data was gathered and analyzed to determine how people felt about the project, what life was like for residents/tenants, what were identified as barriers to an enriched life, and what helped facilitate an enriched life.

Brooker, D.J.; Woolley, R.J. & Lee, D. (2007). Enriching opportunities for people living with dementia in nursing homes: an evaluation of a multi-level activity-based model of care. Aging and Mental Health, 11(4), 361-370.
The main facets of this program and its approach have already been summarized in Brooker & Woolley (2007), based on 127 subjects diagnosed with dementia or enduring mental health problems in 3 specialist nursing homes in the UK. However, an interesting distinction was noted in this report between the success of the program in nursing homes and the challenges it faced in extra care housing schemes: “The nursing homes had an established person-centered pattern of working with PWD and specialized in this area” whereas the extra care housing staff had little training and a population more diverse in their problems. Again, the level of long term in-depth commitment from locksmiths was emphasized as a factor explaining why the program was successful. Core components of the program involved general good quality person-centered care, individualized simple and fun activity that occurred everyday, communal space and equipment, and opportunities to get out of the facility (19).

Camp, C. J. & Skrajner, M.J. (2004). Resident-assisted Montessori programming (RAMP): training persons with dementia to serve as group activity leaders. The Gerontologist, 44(3), 426-431.
Four women with ESD were trained to serve as leaders for a small group activity (memory bingo) played by nine persons with more advanced dementia. They demonstrated the potential to fill the role effectively, were described as exhibiting “assisted leadership,” (430) and needing “external cueing” (426), expressed satisfaction with role, and the players showed higher levels of positive engagement and pleasure (measured by the MPES, which looks at four kinds of engagement: constructive, passive, non, and other (428)). The authors contend “that persons with dementia can be trained to produce effects similar to those produced by activity staff.” They state, “We believe that it will one day be possible for dementia residents to lead Montessori-based activities virtually unassisted,” and that satisfaction and self worth are heightened through this work which creates a meaningful social role for leaders as well as engagement for participants. They also state they would like to see it applied to other settings. Activities are defined as rehabilitative “if they can increase or prevent further decline in adaptation and functional levels” (426).

Cartwright, J.C.; Archbold, P.G.; Stewart, B.J.; & Limandri, B. (1994). Enrichment Processes in Family Caregiving to Frail Elders. Advances in Nursing Science, 17(1), 31-43.
This article looks at the role of enrichment and the associated AT activities for family caregivers of frail seniors. It is one of the few studies that examines “enrichment.”

Cheston, (1998). Psychotherapeutic work with people with dementia: A review of the literature. British Journal of Medical Psychology, 71, 211-231.
This article reviews the literature on the utility and outcomes of psychotherapy with people who have dementia.

Chung, J. (2004). Activity Participation and Well-being of People with dementia in long term care settings. Occupation, Participation, and Health, 24(1), 22-31.
43 subjects in Hong Kong long term residential services were evaluated during a 6 hour period. Those with severe dementia “engaged in significantly more passive activities” than those with mild/moderate dementia, and “had fewer social interactions and displayed more negative behavior” (22). The overall research question of the study was: “What were the states of well-being of long term care residents with dementia when participating in their usual activity patterns?” (23). The results described were that participants spent 1/3 time in a passive state, 21% time in passive watching, and 12% of time asleep (29). The greatest amount of time observed was spent engaging in passive activities (43%), double that of those engaged in daily living activities (21%). 15% of respondents spent time in mobility and action activities and the least amount of time was spent engaged in therapeutic/leisure activities. A significant association was found between activity participation and well being. Eating and drinking was listed as the second most important activity. This study did not examine the physical and social environments of the two participating nursing homes, which the authors state “may have had an impact on performance” (30).

Cohen-Mansfield, J. (2005). Nonpharmacological Interventions for Persons with Dementia. Alzheimer, 6(2), 129-145.
Nonpharmacological approaches to the care of persons with dementia differ from pharmacological treatment in that they consider the interaction between the person, caregiver, environment, and system of care in the treatment design. Such interventions generally provide more personalized care for these individuals, addressing their needs, and considering their preferences. Nonpharmacological interventions have been used to enhance cognition, affect, and performance of activities of daily living; to reinforce a positive sense of self; and to reduce agitation/behavior problems and psychotic symptoms. This article presents a framework for implementing such interventions, provides examples from the literature of existing interventions, and argues for increased advocacy to support their research and use.

Devlin, B. (2006). The art of healing and knowing in cancer and palliative care. International Journal of Palliative Nursing, 12(1), 16-19.
This article looks at the role of AT in healing and living with cancer and end-of-life care. It discusses the meaning and therapeutic processes of AT for participants.

Dowd S.B, & Davidhizar, R. (2004). Chess and gardening: the Rx for Alzheimer's?
Caring : National Association for Home Care Magazine, 23(6), 34-38
This article looks at the benefits of activities such as playing chess and gardening as an intervention in the behavioral symptoms associated with dementia.

Dowd S.B, & Davidhizar, R. (2003). Can mental and physical activities such as chess and gardening help in the prevention and treatment of Alzheimer's? Healthy aging through stimulation of the mind. Journal of Practical Nursing, 53(3), 11-13.
This article looks at the role of physical and mental activities (AT), including chess and gardening, in preventing and reducing the behavioral symptoms of AD. It touts a “use it or lose it” approach to brain health and aging generally.

Ehrenfeld, M. (2003). Using therapeutic dolls with psychogeriatric patients. In Schaefer C.E. (Ed.), Play therapy with adults. New York: John Wiley & Sons.
This article reports on the potential usefulness of doll therapy approaches to reduce challenging behaviors, including “acting out” and “non-active” presentations, in seniors with PWD who are agitated, distressed, have communication difficulties, or are withdrawn.

Gigliotti, C.M.; Jarrott S.E.; & Yorgason, J. (2004). Harvesting Health: effects of three types of horticultural therapy activities for persons with dementia. Dementia 3(2), 161-180.
HT uses plant materials to achieve measurable treatment goals with special populations. All 3 types of HT, cooking, crafts, and planting, were used 3 times a week at an adult day service program (averaging 5-19 participants) over nine weeks. DCM and observation were used to map response. Individual codes used were Social, HT (horticulture behavior), productive, nothing. High levels of positive affect, pride, and constructive engagement were observed during all activities. No measurable difference was noted between each of the three. HT utilized Montessori-based activity modifications known as “extensions” to minimize risk of failure, maximize success, and accommodate all individuals within a group setting.

Heath, Y. (2004). Evaluating the effect of therapeutic gardens. American Journal of Alzheimer’s Disease and Other Dementias, 19, 239-242.
This article explores how the visitors to therapeutic gardens do not necessarily always experience the garden the way the designers intended. A postoccupancy evaluation (POE) can reveal discrepancies between the designer’s intentions and use of the environment by the actual visitors. A POE is a user-oriented assessment that elicits the opinions of the visitors to a building, facility, or environment. This paper describes a POE of therapeutic gardens at a multilevel care facility for the aged. The population included patients at various stages of Alzheimer’s disease progression.

Hellestrom, I.; Nolan, M.; & Lundh, U. (2007). Sustaining ‘Couplehood’: Spouses strategies for living positively with dementia. Dementia, 6(3), 383-409.
This study involved 152 interviews with twenty couples over five years. Using constructivist grounded theory methodology, three main phases were identified as “sustaining couplehood,” “maintaining involvement,” and “moving on.” Interviews were structured around the themes of the home, memory disturbance, quality of relationship, everyday life, and dignity and autonomy. In all cases there was an awareness of the diagnosis of dementia but in the majority of cases, a conscious decision was reached not to dwell upon the implications of this, but to focus on the present, and make life as meaningful and enjoyable as possible (enriching). While affirming that the caring role required “work” by the spouse, this work was not seen as burdensome, and carers expressed that they gained as much from their relationships as did PWD. Both parties, especially in the early stages of illness, were found to strive to maintain quality and closeness in their relationship by creating a “nurturative relational context.” The authors describe the gradual way a PWD “hands over” or “let’s go” of responsibilities to their partner.

Kolanowski, A. & Richards, K. (2002). Introverts and extroverts: leisure activity behavior in persons with dementia. Activities, Adaptation, and Aging, 26(4),1-16.
This article looks at the role of AT in reducing the behavioral symptoms of persons with dementia, namely encouraging social interaction and discouraging social withdrawal.

Kovach, C. & Henschel, H. (1996). Planning activities for patients with dementia. Journal of Gerontological Nursing, 22(9), 33-38.
This article examines the effect of various MT interventions on the attention span of persons with dementia. It suggests that MT can increase the attention span of participants.

Larner, A.J. (2005). Gardening and dementia. International Journal of Geriatric Psychiatry, 20(8), 796.
This letter to the editor discusses the positive role that gardening can have in the lives of stimulating persons with dementia. The author suggests that if gardening is contemplated as a component of occupational therapy for dementia patients, an individual approach tailored to cognitive abilities and deficits may be required.

Lee, Y. & Kim, S. (2008). Effects of indoor gardening on sleep, agitation, and cognition in dementia patients-a pilot study. International Journal of Geriatric Psychiatry, 23(5), 485-489.
This pilot study examined the efficacy of indoor gardening on sleep, agitation and cognition of dementia patients. Twenty-three institutionalized dementia patients who had sleep disturbance and/or agitation participated in a 5-week study protocol of 1 week of baseline and 4 weeks of treatment. The study design was a one group repeated measures study. For the first and fifth week of the study period, sleep patterns, agitation, and cognition were evaluated using a sleep diary, Modified Cohen-Mansfield Agitation Inventory and revised Hasegawa Dementia Scale respectively. Significant improvement in wake after sleep onset, nap, nocturnal sleep time, and nocturnal sleep efficiency was identified. On the contrary sleep onset time, wake-up time, total sleep time did not change after indoor gardening. Agitation and cognition score was significantly improved. The authors conclude that indoor gardening was found to be effective for sleep, agitation, and cognition of dementia patients but note that randomized controlled studies of larger sample size are needed to confirm treatment effect.

Libin, A. & Cohen-Mansfield, J. (2004). Therapeutic robocat for nursing home residents with dementia: preliminary inquiry. American Journal of Alzheimer’s Disease and Other Dementias, 19, 111-116.
This article looks at the use of a therapeutic robocat doll for play with PWD living in nursing homes. It reports positive effects of dolls on the lives of seniors with dementia.

Marshall, M. & Hutchingson, S. (2001). A critique of research on the use of activities with persons with Alzheimer’s Disease: a systematic literature review. Journal of Advanced Nursing, 35(4), 488-496.
This critique of research on the use of therapeutic activities found many articles did emphasize QOL and enrichment as goals and stated the benefits of such activities, but concluded the knowledge is still “minimal and fragmented” (489). Theoretical and methodological weaknesses were outlined, research was described as mostly anecdotal, and gaps in research were identified such as a “lack of emphasis on gender, ethnic, racial, or cultural differences” (488). It was also noted that music was used in 16 studies making it by far the intervention activity of choice. The authors found that the nursing literature in particular emphasized pleasure, dignity, friendship, meaning-making, and self-esteem, supporting the use of therapeutic activities, over insufficient long-term results.

Orsulic-Jeras, S.; Judge, K.; & Camp, C. (2000).Use of Montessori-based activities for clients with dementia in adult day care: effects on engagement. American Journal of Alzheimer’s Disease and Other Dementias, 15(1), 42-46.
The results of this study are not clear as to why both greater pleasure and lower anxiety/fear were found in Montessori-based activities for 16 residents in a dementia unit of a Jewish facility. A key issue discussed is whether long-term care staff and volunteers can conduct Montessori-based activities within existing schedules and organizational constraints. The authors state it is their hope that their programs can be implemented across settings.

Phinney, A.; Chaudhury, H.; & O’Connor, D. (2007). Doing as much as I can do: The meaning of activity for people with dementia. Aging and Mental Health, 11(4), 384-393.
Eight subjects with mild to moderate dementia were interviewed 2-6 months, with the goal of ascertaining what type of activities people with mild/moderate dementia identify as important in their everyday lives, and what their involvement in these types of activities means to them. The results emphasize the benefits of meaningful activity to retain autonomy and identity through leisure and recreation, chores, work, and social relationships. These activities were described as meaningful by virtue of their bringing pleasure and enjoyment, a sense of connection and belonging. The authors suggest that changes that accompany dementia may be less traumatic when the person is in a familiar place, surrounded by familiar objects, and engaging in activities that have long been part of their life, so as to establish continuity. The article emphasizes that pleasure can be derived from activities that rely on an “embodied geography” or a “physical insideness.”

Robinson, L.; Hutchings D.; & Corner, L. et al. (2006). A systematic literature review of the effectiveness of non-pharmacological interventions to prevent wandering in dementia and evaluation of the ethical implications and acceptability of their use. Health Technology Assessment, 10, 26.
This article reviews the literature on the efficacy of non-pharmacological interventions to reduce behavioral symptoms thought to be associated with dementia, namely wandering. It also evaluates the ethics of various techniques.

Scholzel-Dorenbox, C.J.M.; Ettema, T.P.; Bos, J.;Boelens-van der Knoop, E.; Gerritsen, D.L.; Hoogeveen, F.; de Lange, J.; Meihuizen, L. & Droes, R-M. (2007). Evaluating the outcome of interventions on quality of life in dementia: selection of the appropriate scale. International Journal of Geriatric Psychiatry, 22, 511-519.
This study shows how the severity of dementia, care type, setting and the specific QOL domains an intervention focuses on can determine which QOL instrument is appropriate. It cites evidence for difference in views on QOL between patients, caregivers, and theoretical models. The authors argue that while caregivers focus on most of the domains that patients consider important, domains that PWD consider important such as financial situation, self-determination/freedom, and being useful/giving meaning to life are focused on least (Rabins 2000) (512). They determine that “…patients can rate their own QOL until late stages of dementia and that caregiver ratings do not substitute for patient ratings…” (517), and that patient’s subjective ratings should be the gold standard, while acknowledging that independent observational ratings are of benefit for patients with (very) severe dementia.

Thelander, V.B.; Wahlin, T-B.R.; Olofsson, L.; Heikkilä, K.; & Sonde, L. (2008). Gardening activities for nursing home residents with dementia. Advances in Physiotherapy,10(1), 53-56.
This article looks at the benefits of gardening, as a type of activity therapy, for persons with dementia in nursing homes. The focus is on the reduction of behavioral problems believed to be association with the condition.

Threadgold, M. (1995). Touching the soul through the senses. Journal of Dementia Care, 3(4), 18-19.
This article reports on an approach called Sonas aPc, which utilizes a series of preplanned and ordered activities including listening to music, singing, touch, exercise, relaxation and reminiscence with groups of up to 8 people with significant communication difficulties. The authors report that participants become more physically responsive and socially aware. Allegedly, they relax and demonstrate evidence of enjoyment, and show signs of heightened cognitive functioning (e.g., talking more spontaneously and recalling memories). In terms of promoting communication, Sonas aPc can be seen as a tool rather than simply an activity.

Truscott, M. (2004). Adapting leisure and creative activities for people with early stage dementia (ESD). Alzheimer’s Care Quarterly, 5, 92-102.
The author, who has ESD, describes her adaptations, and family support, in finding creative outlets despite her loss of cognitive abilities. She focuses on process and pleasure rather than content and suggests hobbies and activities for other PWD.

Vernooij-dassen, M. (2007). Meaningful Activities for People with Dementia. Aging Mental Health,11(4), 359-360.
This editorial reviews the Brooker & Woolley (2007) Enriching Opportunities model of activities with dementia care. It praises the role/style of the locksmith and the programs’ practical approach. Accordingly, “the activities of PWD become meaningful through feelings of pleasure and involvement, a sense of connection and belonging, and a sense of autonomy and self-identity….activities show a striking resemblance to those meaningful for other adults…the question is how can these activities be stimulated…” (359)

Volicer L.; Simard, J.; Pupa J.H. et al. (2006). Effects of continuous activity programming on behavioral symptoms of dementia. Journal of the American Medical Directors Association, 7(7), 426-731.
This article looks at the impact of AT on reducing the behavioral symptoms of dementia. The focus is on behavior modification/management from the perspective of staff in residential settings.

Zeisel, J. & Raia, P. (2000). Nonpharmacological treatment for Alzheimer's disease: A mind-brain approach. American Journal of Alzheimer’s Disease and Other Dementias, 15(6), 331-340.
This article looks at the use of non-pharmacological treatments of AD, such as various art therapies, that can produce behavioral improvements. The authors argue that a new paradigm is needed that focuses on minimizing the symptoms of AD rather than focusing only on a search for a cure. To include AD in the same class of diseases as cancer, multiple sclerosis, diabetes, congestive heart failure, and degenerative arthritis places AD in the realm of the medically and psychosocially understandable and manageable. A critical first step toward making this shift is to examine carefully the way in which we define the disease. An approach to care for people with AD results in treatment when it systematically compensates for functional losses of dementia by linking caregiving actions and environments to specific brain dysfunctions; namely, the neuropathology of the disease. The ultimate measures of success of such a treatment approach are improved quality of life, delayed institutionalization, slowed rate of progression of the disease, people who achieve their potential, and reduced need for medication.