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This study evaluated whether a mentally stimulating activities (MSA) program reduced neuropsychiatric symptoms and improved cognitive status and quality of life, as compared to a support group for persons in the early stage of Alzheimer’s disease (AD). This randomized controlled trial included 81 adults (aged 55+), who were randomly assigned to the MSA group (treatment) or a social support group (control). A repeated measures multivariate analysis of variance (MANOVA) identified that MSA participants significantly reduced apathy (p 0.001) and depressive symptoms (p 0.001), as well as improved cognitive status (p 0.001) and quality of life (p 0.001) as compared to the control group. A structured classroom-style MSA program may be a viable and therapeutic intervention to alleviate neuropsychiatric symptoms, and improve cognitive status and quality of life in early-stage AD.

Objective The objective of this study is to compare three different interventions for persons who report memory difficulties: health promotion, cognitive training, and a participation-centered course, using a single-blind, randomized controlled design. Methods Participants were 44 Israeli adults with memory complaints, aged 65 years or older. The main outcome variable was the Global Cognitive Score assessed using the MindStreams® mild cognitive impairment assessment, a computerized cognitive assessment. The Mini-Mental State Examination and the self-report of memory difficulties were also utilized. To assess well-being, the UCLA Loneliness Scale-8 was used. Health was evaluated by self-report instruments. Results All three interventions resulted in significant improvement in cognitive function as measured by the computerized cognitive assessment. All approaches seemed to decrease loneliness. The only variable which showed a significant difference among the groups is the self-report of memory difficulties, in which the cognitive training group participants reported greater improvement than the other groups. Conclusion Multiple approaches should be offered to older persons with memory complaints. The availability of diverse options would help fit the needs of a heterogeneous population. An educational media effort to promote the public's understanding of the efficacy of these multiple approaches is needed. Copyright © 2014 John Wiley & Sons, Ltd.

This article provides a secondary analysis of data collected from a recreation therapy intervention trial for older adults with dementia and neuropsychiatric symptoms. In a subsample of 54 individuals who received wheelchair (WC) biking on some days and other recreation therapy interventions on other days, a comparison of engagement levels, time engaged, and encouragement needed was completed. The analysis showed that WC biking provided significantly more time on task and significantly higher levels of engagement, and less encouragement was needed. Collecting recreation therapy session engagement data was found to be a simple and useful method of comparing effectiveness of recreation therapy interventions.

Introduction: To meet the needs of persons with dementia, adequate psychosocial interventions such as individualized music (IM) therapy is needed through resident involvement and person-centered care.Aim: The aim of this study was to explore the experience of care staff working with IM in nursing home residents with dementia.Method: A qualitative, explorative, and descriptive design was used. Semistructured interviews of seven care staff from four nursing homes were carried out.Result: The main findings included improved person-centered care and resident involvement, categorized in the three main themes: (1) IM in care staff-resident relation, (2) IM as a psychosocial intervention for agitation and restlessness, and (3) IM and job satisfaction in care staff.Conclusion: These findings suggest that IM can improve facilitation of person-centered care, thus providing an increased focus on resident involvement.

This pilot project was established to refine and test the Community of Care continuum for older adults with memory loss. The treatment group (n = 40) received the opportunity to select classes and was compared to the control group (n = 40), members of which simply maintained their normal lifestyles in the community after assessment. A total of 80 participants were tested at baseline, six months, and 12 months. Data were analyzed using repeated-measure analysis of variance to assess the effectiveness of the intervention over time. This allowed for analysis regarding intervention, time, and the interactive effects of time and intervention. The treatment group showed significant positive intervention effects (p 0.05) for Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), instrumental activities of daily living (IADL), and quality of life. These preliminary findings show great promise for recreation therapists and others using community-based programs for older adults concerned about memory loss.

The purpose of this article is to grade research evidence supporting exercise-based interventions for persons with early-stage dementias and to report the recommendations of a consensus panel. The search produced 11 databased articles testing the effects of exercise interventions on a variety of outcomes. The body of evidence to support exercise interventions in the prevention and treatment of Alzheimer’s disease is growing and has potential as a treatment modality following translational studies in recreation therapy and other fields.

This study describes a clinical trial of at-home recreational therapy for community dwelling older adults with dementia and disturbing behaviors. After two weeks of daily, individualized therapeutic recreation interventions (TRIs), results indicated a significant decrease in levels of both passivity and agitation. Biograph data collection was useful in identifying the physiological changes that occurred with each intervention technique. Specific information is included on the time of day each behavior occurred and the most effective interventions, as well as implications for service delivery.

This study identified perceived benefits of animal-assisted therapy (AAT) on anxiety, pain, communication, and cognition among patients waiting for treatment in a large urban cancer center. A convenience sample of 75 patients and five family members (n = 80) waiting for treatment completed a survey about AAT. After giving informed consent, participants were asked to complete questions related to attitudes about offering a complementary therapy dog program in the hospital. Findings indicated that most respondents were very accepting of AAT in the cancer center, with 78 percent indicating that they would like to take part in this complementary therapy. The perceived benefits of AAT included that it would provide a method for positive communication (93 percent), cognitive stimulation (92.3 percent), it would help to pass time more quickly (88.8 percent), it would help people to feel more comfortable at the cancer center (84.8 percent), and it would reduce participants’ pain (71.3 percent) and anxiety (68.4 percent). The association between gender and anxiety produced a statistically meaningful result in this study about predicting subjects’ participation in the program. Ultimately, offering recreational therapy facilitated AAT in cancer center waiting areas may provide benefits for patients and provide a competitive edge to hospitals.

This three-phase project evaluated the content validity and test-retest reliability of an assessment tool aligned with the specific content areas of the Minimum Data Set 3.0. In phase I, 54 experts examined the content and made several suggestions for improvement of the tool. In phase II, recreational therapy (RT) students and experienced practitioners pilot tested the “Leisure History and Interest” checklist and interview section of the assessment. A total of 10 categories were found pertinent to interviewing residents about their recreational interests. In the final phase, 15 certified therapeutic recreation specialists tested and retested 45 residents and provided time-limited treatment. The test-retest reliability coefficient for the overall assessment was found to be very high at 0.93. Positive outcomes of RT treatment were found across all domains for the majority of residents.

The purpose of this article is to increase nurses’ awareness of animal-assisted therapy as a treatment option for older adults with dementia. We describe the differences between animal visitation programs and goal-directed therapy. We also address credentials of human-animal teams and provide an overview of possible therapeutic outcomes for older adults with dementia. Step-by-step methods are outlined for nurses to advocate for clients with dementia to receive these services.

We studied changes in apathy among 77 community-dwelling older persons with mild memory loss in a randomized clinical trial comparing two nonpharmacological interventions over four weeks. The study used a pre-post design with randomization by site to avoid contamination and diffusion of effect. Interventions were offered twice weekly after baseline evaluations were completed. The treatment group received classroom style mentally stimulating activities (MSAs) while the control group received a structured early-stage social support (SS) group. The results showed that the MSA group had significantly lower levels of apathy (P<.001) and significantly lower symptoms of depression (P<.001). While both groups improved on quality of life, the MSA group was significantly better (P=.02) than the SS group. Executive function was not significantly different for the two groups at four weeks, but general cognition improved for the MSA group and declined slightly for the SS group which produced a significant posttest difference (P<.001). Recruitment and retention of SS group members was difficult in this project, especially in senior center locations, while this was not the case for the MSA group. The examination of the data at this four-week time point shows promising results that the MSA intervention may provide a much needed method of reducing apathy and depressive symptoms, while motivating participation and increasing quality of life.

Innovative uses of technology offer many exciting possibilities for better care and improved quality of life for people with Alzheimer’s disease and their families. This article provides empirical evidence through a systematic review of 10 studies involving technological advances. Although the studies reported have a small number of participants, the early results are positive. We believe the use of technology has the potential to save health care costs, ease caregiver stress, and help people with dementia live better, safer, and more fulfilling lives.

This article examines the moderating effect of depression on interdisciplinary treatment approaches for behaviors in dementia. A secondary analysis of data collected on tailored treatment of 105 long-term care residents with dementia found a significant relationship between treatment and passivity ( p < 0.001), treatment and agitation ( p = 0.001), and the mediating effect of change in passivity on change in agitation ( p < 0.001). The moderating effect of depression was found as a significant factor. For participants with depression and agitation, a significant change in passive behavior was related to significant change in agitated behavior. Thus, by focusing treatment on passivity, both types of neuropsychiatric behaviors improved. The implications of thoroughly assessing not only a behavior problem such as agitation but also other neuropsychiatric symptoms that complicate the delivery of the intervention are discussed.

This pilot project evaluated change in staff knowledge, stress, and skills in engaging long term care residents in meaningful individualized activity. A recreational therapist provided 10 short training sessions to 29 staff members with the goal of increasing staff skills in providing activities. Data indicates significant improvements in knowledge, stress, and engagement skills occurred in this training project indicating the role of staff trainer provides significant impact.

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.

Delirium is a common syndrome in older adults especially for those in hospital and acute settings. Delirium is sometimes reversible; however, it is associated with increased mortality, increased hospital costs, and long-term cognitive and functional impairment. Fortunately if recognized early, it can be treated successfully without complications and declines in health and function. Delirium can also be prevented with identification of highrisk patients and the implementation of interventions. Because delirium may be underrecognized by physicians and nurses, routine screening for delirium should be part of comprehensive nursing care of older adults. Recognition of delirium is complicated as it may be difficult to differentiate delirium from dementia and depression. This article will review the risks, signs and symptoms, consequences, and assessment techniques for the detection of delirium in this population.

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.

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.

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.

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, selfefficacy, 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. How do you feel when you are given a diagnosis by your physician for a disease that has no treatment to stop its progression? What do you do? Many people search for information on the Internet, ask friends, healthcare providers or others with the same diagnosis for advice, read articles, and attend workshops and conferences. When the diagnosis is Alzheimer's disease (AD) or another type of dementia, what does that person do? Where do they get information—especially since most services and education are aimed at the caregiver?

This study describes a clinical trial of at-home recreational therapy for community dwelling older adults with dementia and disturbing behaviors. After two weeks of daily, individualized recreational therapy interventions (TRIs), results indicated a significant decrease in levels of both passivity and agitation. Biograph data collection was useful in identifying the physiological changes that occurred with each intervention technique. Specific information is included on the time of day each behavior occurred and the most effective interventions, as well as implications for service delivery.

A survey of 76 caregivers of individuals with probable Alzheimer's disease was completed over a 2 1/2 year period through the Alzheimer's Disease Assistance Center at Binghamton University. The survey was used to assess educational and support needs for the families in rural and urban settings. The analysis of the data showed that rural caregivers and care receivers were significantly older, and used fewer services than urban families. Caregivers in both settings were very interested in learning about how to provide activities and recreation for their family member with Alzheimer's disease. Over 90% of rural families expressed an interest in learning new ways to keep their family member busy with meaningful activities in and out of the home.

The purpose of this article is to share the findings from the Alternative and Complementary Therapies for Healthy Aging panel that recently disseminated their research at the annual Gerontological Society of American Conference, November 18-22, 2009, in Atlanta, GA. The interdisciplinary panel examined the influence of alternative and complementary therapies for healthy aging. The National Center for Complementary and Alternative Medicine1 (NCCAM) reports that 38 percent of adults in the United States utilize complementary and alternative medicine (CAM). CAMs offer an alternative or adjunct therapy that has lower risk of adverse side effects and offer a new perspective: healing the patient rather than simply treating them. Quality of life must be considered; more medications and medical interventions do not always equally increase the quality of life. The interventions presented promote a holistic approach (mind, body, and spirit) to wellness.

The Simple Pleasures research team investigated the effects of 30 handmade recreational items on the behavior of nursing home residents with dementia. The impact on family visits, staff knowledge, and volunteer involvement also was examined during the course of this study. Twenty-three items were found therapeutically valuable and acceptable for nursing home use. Family visits, use of recreational items, and satisfaction with visits significantly improved during the intervention. Residents were significantly less agitated at one nursing home and slightly less agitated at the other nursing home. More than 540 volunteers of all ages were trained and made Simple Pleasures recreational items during this project.

The link between boredom, agitation, and therapeutic programming for individuals with dementia is a strong one. Research indicates that carefully planned activities can have a powerful impact on behavior, functioning, and mood of residents. Interdisciplinary staff involvement, careful assessment of residents' needs and interests, and the use of both diversional and therapeutic activities programs are examined in this article.

Thirty-six long term care residents with dementia and agitation were selected for participation in this eight week study. During the eight week J 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, over all 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.

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.

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.

Revised surveyor guidelines for ac- activities requirements in long-term care facilities became effective in June 2006. These guidelines have important programmatic, clinical, staff, and cost implications for gerontological nurses, administrators, and other facility staff. The investigative protocol used by surveyors is designed to determine whether a facility has provided a sufficient ongoing activities program that accommodates individual residents’ interests and enhances their physical, mental, and psychosocial well-being, according to each individual’s comprehensive assessment. The protocol details procedures that should be used for each resident in the sample to determine the facility’s compliance with the regulation.

What treatment approaches are best to treat a combination of apathetic and agitated behaviors? The answer may be the key to preserving quality of life in older adults with dementia. ABSTRACT 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.

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 efficacy 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 participation) were taken from these videotapes. Univariate logistic regression analyses indicated that cognitive status 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.

ization time of flight MS, and conclusive protein identifications accomplished by liquid chromatography-tandem MS. Conclusions: Several proteins were reproducibly quantitatively affected by GSE in rat brain, either in abundance, or in isoform complexity. The majority were “old” proteins, i.e. those that had been shown to be differentially expressed in AD or transgenic mouse models of dementia (i.e. creatine kinase brain beta chain, glial fibrillary acidic protein). Because the direction of change for most proteins affected by GSE in the normal healthy rats was opposite to that in AD or transgenic demented mouse brain, administration of GSE to healthy adults to protect critical proteins may be a strategy for prevention of AD.

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 project tested an innovative intervention in a controlled clinical investigation of a nonpharmacological treatment of depression in long-term care residents with dementia. This treatment utilized a wheelchair bicycle in a recreation therapy protocol, which combined small group activity therapy and one-to-one bike rides with a staff member. Depression levels were significantly reduced in the two-week portion of the study with levels maintained in the 10-week maintenance period. Improvements were also found in sleep and levels of activity engagement.

Edited by Mona M. Shattell, PhD, RNUniversity of North Carolina at Greensboro, School of Nursing, Greensboro, North Carolina, USAIn a work-centered environment, society, and life, leisure experienc...

The purpose of this article is to increase awareness of therapeutic recreation as a treatment option for nursing home residents. It addresses recent regulations and documentation changes that have occurred under the prospective payment system, and summarizes efficacy research documenting the possible health outcomes of recreation therapy.