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Depression in older people is an important clinical and public health problem that is commonly overlooked by health care providers. As people age, social support systems may be lost due to the death of significant others, retirement, cognitive and physical health problems, and residence relocation. With these changing circumstanc-es, health care professionals expect older clients to show changing activity levels and reduced resilience and may miss the symptoms of depression. As a result, many older people find themselves having to manage a set of problems that could otherwise be easily treated.

This project tested a 12-week health promotion course for older adults with early- stage dementia. In a quasi-experimental design, participants were assigned by site to intervention group or control group and evaluated at two time points. Mini- Mental State Examination scores, Geriatric Depression Scale scores, health behaviors, plus several measures of psychological well-being were used in this study. In the independent samples t-test analysis, significant positive change was found from pretest to posttest for the treatment group on cognition and depression. A chi square analysis found several significant positive differences in health behaviors for the treatment group.

The purpose of this article is to critically review and synthesize the literature on the effects of nonpharmacological cognitive training on dementia symptoms in early-stage Alzheimer’s disease (AD) and related dementia. Electronic databases MEDLINE (PubMed), CINAHL, PsycInfo, and the Cochrane Library were searched using the keywords cognition, reality orientation, Alzheimer’s disease, psychosocial factors, cognitive therapy, brain plasticity, enriched environments, and memory training. The findings support that cognitive training improves cognition, activities of daily living, and decision making. Interventions are more effective if they are structured and focus on specific known losses related to the AD pathological process and a person’s residual ability, or are combined with cognitive- enhancing medications. Nursing implications are also discussed.

Cultures, by their very nature, can either embrace or resist change. Culture change can arise from an improved environment, due to inventions and other influences like regulations, or as a result of contact with other cultures. In its attempt to break away from traditional long-term care models culture change movement has created its own lingo.

The medical literature defines frailty as older persons experiencing low physical activity levels, muscle weakness, slowed physical and cognitive performance, fatigue, and unlntentional weight loss.1 A person with three or more of these characteristics is considered frail. Older persons who have dementia are more likely to become disabled, to be admitted to the hospital, and to have health problems that lead to frailty. These individuals are often resistant to exercise classes and need motivation.

In 2007, a comprehensive review of the extant research on nonpharmacological interventions for persons with early-stage dementia was conducted. More than 150 research reports, centered on six major domains, were included: early-stage support groups, cognitive training and enhancement programs, exercise programs, exemplar programs, health promotion programs, and “other” programs not fitting into previous categories. Theories of neural regeneration and plasticity were most often used to support the tested interventions. Recommendations for practice, research, and health policy are outlined, including evidence-based, nonpharmacological treatment protocols for persons with mild cognitive impairment and early-stage dementia. A tested, community-based, multimodal treatment program is also described. Overall, findings identify well-supported nonpharmacological treatments for persons with early-stage dementia and implications for a national health care agenda to optimize outcomes for this growing population of older adults.

The purpose of this paper is to grade research evidence supporting nutritional interventions for persons with early stage dementias and to report the recommendations of a consensus panel. Thirty four studies were reviewed in the areas of dietary restriction, antioxidants, and Mediterranean diet with strong support from epidemiological studies found in all three areas. The body of evidence to support nutritional interventions in the prevention and treatment of AD is growing and has potential as a treatment modality following translational studies.

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.

Individuals with dementia are often passive, which places them at risk for further cognitive and functional decline. Recreational activities have been used in research to reduce passive behaviors, but systematic reviews of these studies have found modest effect sizes for many activities. In this article, we describe the further theoretical development of an innovative method for prescribing activities that have a high likelihood of engaging nursing home residents who are passive and present examples for research application and clinical practice. This method may increase the effect size of activity interventions and encourage more widespread adoption of nonpharmacological interventions in practice.

Many nursing home residents are unoccupied and at risk for poor health outcomes because of inactivity. The purpose of this study was to identify characteristics of residents with dementia that predict engagement in activities when activities are implemented under ideal conditions. Data from a clinical trial that tested the effi-cacy of individually prescribed activities were used to address the study aim. Thirty subjects were videotaped daily for 12 days during 20-minute activity sessions. Measures of engagement (time on task and level of par-ticipation) were taken from these videotapes. Univariate logistic regression analyses indicated that cognitive sta-tus and physical function explained a significant amount of variance in engagement. Efforts to promote function may facilitate even greater benefits from prescribed activities by improving capacity for engagement.

This research was an examination of two specific types of behaviors, apathy and agitation, that commonly occur in older adults with dementia. In a retrospective analysis of existing data from two intervention projects, the authors explored the times and the types of behaviors occurring in 141 older adults living in the community, assisted living, and nursing home settings. The occurrence of apathetic and agitated behaviors was monitored throughout the day for a 2-week period. The result of the analysis suggests that in all stages and settings, a combination of apathy and agitation is the most common phenomenon, and that the predominant behavior actually fluctuates during the course of the day. The use of individualized interventions based on carefully monitored behavior patterns may provide a more sensitive approach to the overall treatment needs of individuals with dementia in the future.

The testing of psychosocial interventions in a clinical trial poses many challenges to maintaining a rigorous experimental protocol and to delivering the interventions uniformly throughout the project. These challenges directly affect the reported effectiveness of psychosocial interventions. In this article, the authors describe the treatment fidelity plan developed by an interdisciplinary research team from recreational therapy and nursing for implementing recreational activities during a clinical trial funded by the National Institute of Nursing Research. The trial tests the efficacy of activities for responding to the behavioral symptoms of dementia. The authors report treatment fidelity strategies to allow comparison of their intervention with that of other studies, to improve effect size in similar studies, and to facilitate replication and translation of this work into clinical practice.

The purpose of this study was to examine the ability to predict outcomes of prescribed therapeutic recreation interventions (TRIs) for the treatment of the two major categories of disturbing behaviors in institutionalized older adults with dementia. Interventions were selected based on the participant's current level of functioning, past leisure interests, and the target behavior problem identified during baseline assessment. TRIs were then prescribed to calm individuals with agitated behaviors and (or) to alert individuals with passive behaviors. Each participant received two weeks of individually prescribed therapeutic recreation and biofeedback readings were randomly taken three times during the two-week intervention period to measure physiological change. The predicted outcome was found between 79-91% of the time when treating passivity, and between 92-100% of the time for agitation. Therapeutic recreation interventions were found to be predictable and efficacious for disturbing behaviors of dementia.

Background: Agitation and passivity are behavioral symptoms exhibited by 90% of nursing home residents with dementia. They account for many poor health outcomes, caregiver burden, and increased costs of long-term care. Objectives: This study tested the efficacy of recreational activities derived from the Need-driven Dementia-compromised Behavior (NDB) model: activities matched to skill level only; activities matched to style of interest only; and a combination of both (NDB-derived) for responding to the behavioral symptoms of dementia. Methods: Thirty participants were randomly assigned to 1 of 6 possible order-of-condition presentations in this crossover experimental design with repeated measures of dependent variables. Trained research assistants, blind to condition match, implemented each condition for 12 consecutive days. Measures of engagement (time on task and participation), affect, and behavioral symptoms (agitation and passivity) were taken from videotape recordings of each session. Mood was measured with the Dementia Mood Picture Test. The primary analysis method was mixed-model analysis of variance. Results: Significantly more time on task, greater participation, more positive affect, and less passivity were found under NDB-derived and matched to interest only treatments compared with the matched to skill level only treatment or baseline. Agitation and negative affect improved under all treatments compared with baseline. There was no significant change in mood. Discussion: The NDB-derived activities are tailored to meet individual needs and improve behavioral symptoms associated with dementia. These findings help to explain factors that produce behavioral symptoms and the mechanisms that underlie their successful treatment.

This article describes a pilot study of an experimental college course for individuals with newly diagnosed dementia, with a focus on teaching methods for promoting and maintaining optimal health. Community involvement included recruitment by the local Alzheimer?s Association chapter and an off-campus site at a local assisted living center with easy access for the students. Course topics covered over the 10-week period, included modules on: physical and cognitive fitness, nutrition, recreation, communication, understanding the disease process, depression, coping, relationships, and driving issues. Stress, depression, self- efficacy, and self-esteem were evaluated both prior to and after the 10-week course. Providing education early in the course of the disease, empowers the older adult student and provides an element of personal control and dignity. The course also attempts to prevent future problems by teaching new habits and lifestyles early in the disease process. Attempts to change habits and behavior later in the course of the disease often fail due to the difficulty of learning new behaviors.

This paper reports on a two-part study of nursing home recreation. In part one, a retrospective activity calendar and chart review was used in this comparative study of 107 long-term care residents with dementia. Data were collected and documented regarding demographics, cognitive and physical functioning, medications, activities listed on facility activity calendars, leisure preferences, and actual involvement in recreation over a two-week consecutive period during baseline. In part two, this information was compared to opportunities offered during a two-week clinical trial of recreational therapy. The results showed that, during baseline, almost 45 percent of the subjects in the sample received little or no facility activities, 20 percent received occasional activities, and 12 percent received daily activities but they were deemed inappropriate based on the functioning levels or interests of the residents. The clinical trial period demonstrated that small group recreational therapy was successful in engaging residents 84 percent of the time.

Activity is a basic human need expressed in work and leisure pursuits. Unfortunately, people with dementia have a low rate of activity participation because of associated physical and cognitive constraints. Recently, the American Therapeutic Recreation Association (ATRA) held a consensus meeting to address this issue and formulate practice guidelines for recreation therapy in the care of people with dementia. The consensus document presents an evidence-based intervention theory that draws on the science of two disciplines: nursing and recreation therapy. This article reports on the ATRA guidelines and illustrates their applicability in a case study of a resident with severe aggression associated with dementia.

This study describes a clinical trial of a recreational therapy cooking program for older adults with dementia and disturbing behaviors living in an assisted living center. After two weeks of daily participation, results indicated a significant improvement in levels of both passivity and agitation. Biographical data collection was useful in identifying the physiological changes that occurred during each session. Implications for service delivery are included.

Thirty-six long term care residents with dementia and agitation were selected for participation in this eight week study. During the eight week period, the participants received two different four week therapeutic recreation interventions in a clinical crossover design. These interventions included a sensorimotor program and a traditional activity program. The effects of these two programs were evaluated in terms of the effect on strength, flexibility, overall functioning, and agitation. The analysis showed that there was a significant improvement of grip strength, flexibility, and a reduction in agitation during the sensorimotor segment of the treatment. The results of this study indicate a new direction for therapeutic recreation specialists working with older adults with dementia and agitation.