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A New Approach to Dementia: Intervening Without Drugs

It’s been called “The Long Goodbye.” Alzheimer’s disease and related dementias (ADRD) cause memory decline, cognitive impairment, and eventual loss of daily functioning. Today, 5.7 million Americans are living with the disease – with numbers projected to more than double by 2050.

Of those living with ADRD, 90 percent struggle with behavioral and psychological symptoms, from agitation and aggression to psychosis. These symptoms can be devastating for the person with ADRD and challenging for those who provide care – family members and health care staff alike.

To address behavioral issues, psychotropic medications have traditionally been the first line of intervention. “These medications have been overused and are linked to serious side effects,” says Susan McKinney, vice president of operations at Lifetime Wellness and certified dementia practitioner and trainer. “They should be used only when clinically necessary – when behaviors are causing harm.

“We have found nonpharmacological, person-centered approaches can often address behavioral responses more effectively than medications. The person living with dementia who may be having difficulty with negative behaviors is often trying to tell us something.  ‘Behaviors’ in dementia care are a form of communication.”

Stimulating the Mind

“When you work with someone with dementia, you need to enter their reality, understanding where they are in their journey,” McKinney says. “You need to find the best path to connection and communication and develop a custom care plan tailored to each person’s needs, interests, and life stories.”

One technique that has worked well is cognitive stimulation. Residents are provided tools designed to reawaken their memories. Activities range from simple trivia questions to “life engagement kits” based on individual interests and experiences.

McKinney cites the example of a retired elementary school teacher. “We created a kit for her filled with objects from her era of teaching, such as a ruler, a protractor, and a composition book. Engaging with these symbols of her past brought back some sense of awareness, belonging, and purpose.”

Cognitive approaches also include activities that may reawaken “executive functioning” skills – the ability to plan and carry out tasks efficiently. Skill development is aided by “life skill stations” designed to trigger memories and create activities that encourage interest and interaction. For example, an office station may feature a vintage desk, telephone, and typewriter to help residents remember their working experience. A nursery station may come equipped with dolls, bassinets, and changing tables to reawaken memories of parenting.

“Although the dolls aren’t real, they give the resident a sense of attachment – that they’re caring for something,” McKinney says. ‘The feeling is, “I have love to give and I’m giving it to this baby.’”

Visiting or resident animals provide a similar link. “An animal’s unconditional love, as well as the healing, physical touch from pet contact, can improve mood, decrease anxiety and sadness, and spur more social interaction,” she notes.

Shaping up With Exercise

Exercise is important at any age and at any stage of mental function. Lifetime Wellness offers a variety of programs to help people living with Alzheimer’s disease and related dementia stay fit. Exercise classes are provided in groups as well as one-on-one sessions.

Activities focus on building strength, endurance, and range of motion. Programs range from chair yoga and tai chi, focused on breathing and bringing awareness of the body, to dancing, gardening, and modified sports fitness classes with such games as “balloon volleyball.”

“The benefits are many,” McKinney says. “Some rhythmic exercises have helped reduce such behaviors as wandering and aggressiveness. Participants experience better sleep, improved mood, and an increased ability to participate in activities of daily living.”

Sparking Memories Through Music

An innovative program called Music & Memory has brought new hope for those struggling with ADRD. The program reawakens memories – and feelings – through the gift of personalized music.

Lifetime Wellness works with several facilities that are Music & Memory certified and offer this personalized music to memory care residents. Staff consult with each resident and the resident’s family to create a personalized playlist, delivered on iPods and other digital devices. Favorite tunes typically span all chapters of a resident’s life – sparking renewed memories and meaning.

Many who are living with ADRD have realized dramatic results. “In a visit to one of the facilities where we work, I heard a woman calling out loudly, over and over,” McKinney remembers. “And then I didn’t hear her anymore. I walked out to see why she was quiet and noticed a member of our staff had put a headset on her. Our resident was listening to her personal playlist. Her eyes were closed, and she was relaxed and content.”

Sharpening the Senses With Aromatherapy

Studies have found that the use of essential oils, also called “aromatherapy,” can be effective in relieving many symptoms of ADRD. For example, cedarwood has been found to enhance memory and ease anxiety; lavender, to help with depression and irritability; and peppermint and rosemary, to stimulate the mind and body.

“Oils can be used in a variety of ways, depending on the type of oil and its level of concentration,” McKinney says. “They can be inhaled directly, used in body massage, diffused in a room, or applied directly to the skin.”

Lifetime Wellness offers an Aroma Works program, which combines aromatherapy with relaxing music or nature sounds, flameless candles, and hand massages for those who want them. “We’ve noticed that residents living with ADRD who participate in the Aroma Works offerings are more likely to make eye contact, experience relief from discomfort, and have less symptoms of anxiety,” McKinney says. “They also tend to sleep more soundly and experience increased appetite.”

In September, Lifetime Wellness will launch an online store to purchase essential oils. “These products are safe and effective for anyone to use but were created with a resident with ADRD in mind,” McKinney says.  “Plant-based and 100 percent natural, they are a wonderful example of a promising, nonpharmacological approach to ADRD.”

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