WELLNESS AND DEMENTIA Emotional resilience Intellectual inquiry Physical wellness Social intelligence Spiritual awareness Career planning Financial planning Environmental health Provide positivity Intellectual engagement Physical wellness Social engagement Spiritual wellness Fun career Financial wellbeing Home/environmental safety
DEMENTIA Slow progressive loss of memory and at least one other domain of cognitive function. 5.2 million people in US 200,000 are younger than 65 70% live out in the community.
HIGH PREVALENCE 2/3 rd 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… 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
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
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 Successful aging Low risk of disease High mental and physical function Active engagement with life
SUCCESSFUL AGING Not smokingModerate drinking Low fat diet Regular aerobic excercise Low risk of disease
MENTAL EXERCISE – 4 HRS A DAY Independe nt judgement Problem solving Creative arts
ACTIVE ENGAGEMENT WITH LIFE Substantial friendships Family Talking things out
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