- Communicating Therapeutic Risks Recent Research In Psychology Haynes sentra 2010 manual
- Chapter 2: Communicating with Older Patients
- Communicating Therapeutic Risks | Louis A. Morris | Springer
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It has been suggested that excessive noise from various sources staff members, other residents, and technology can cause overstimulation in people living with dementia, which can lead to agitation and negative social interactions .
Communicating Therapeutic Risks Recent Research In Psychology Haynes sentra 2010 manual
Physiotherapists should keep this in mind when planning appropriate treatment locations, and suitable places to leave patients when the session is over. Interaction with nature and the outdoors has proven to be beneficial to people living with dementia. Having a garden to wander, participate in gardening, or even just to view have a variety of positive outcomes on people living with dementia, including fewer falls, improved cognition, reduced agitation, and improved sleep-related outcomes .
Innes et al. This is useful information to physiotherapists if there is a garden accessible to use, as patients can experience both physiological and psychological benefits  , and these resources can be incorporated in treatment and education to take advantage of available facilities when possible.
For example, Innes et al. Multi-sensory environments MSE can be used to engage people with dementia in activity and interventions by stimulating the senses or providing sensory calming effects . Various lights, textures, and sounds can be found in an MSE. Refer to the picture below for an example of one being used for a person living with dementia .
MSEs have been found to be equally as effective as other nature-related activities for example, gardening in terms of improving functional performance in people living with moderate to severe dementia . Baker et al. Another study found that using an MSE improved apathetic behavior in people with severe dementia, and the improvements increased when this treatment was used three times per week compared to once per week .
Chapter 2: Communicating with Older Patients
Although physiotherapists may not be involved in constructing a multi-sensory environment, with some creativity, it could be a useful tool to interact with the patient and provide functional exercises and activities in conjunction with physical and psychological comfort. Make a note of some simple adaptations that can be used to convert an environment to being dementia friendly. Download the Environmental Auditing Tool from this website and audit the environment you designed or even the one you work in.
You may want to revisit your design to make it more dementia friendly. Campo and Chaudhury recommend congruence between physical and social environments by ensuring staff have flexibility within their schedules to socialise with residents and facilitate interactions between residents as opportunities arise . This requires all members of the team to be on board in providing a culture that enables these interactions and support from higher levels of management. As a physiotherapist, physical wellbeing is often the first thing that comes to mind, however it is important to consider the person as a whole, and remember the emotional and mental wellbeing as well.
Music has been reported to be valued by people with dementia . Whether it is background music or music-related activities, older people with dementia appreciate that music can help them take part in meaningful activities, such as ADLs, and enjoy themselves as they do .
Communicating Therapeutic Risks | Louis A. Morris | Springer
Background music and singing by the caregiver appears to provide opportunities for people living with dementia to interact with others, including care takers and other residents, and leads to improved ADLs . Music can be included in physiotherapy treatment and many other aspects of everyday life to improve therapeutic interaction for people living with dementia. People with dementia appreciate involving aspects of the community that are normal parts of everyday life, specifically, having children and animals in the building .
Social interaction with family, society and maintaining an ordinary lifestyle can have a positive impact on quality of life for people living with dementia  , an example of which can be seen in the image below . Jing et al. Involving family may be a useful strategy for physiotherapists to use to help the individual remember and be emotionally supported in their treatment and care, making interaction with the physiotherapist as well as the family member more therapeutic. It is important to remember that individuals with dementia vary and therefore, there is not one single environment that will meet the needs of everyone .
This means that an environment that accommodates people living with dementia must be adaptable so that each person can remain at the centre of care. Alzheimer Scotland has provided a simple and efficient way for anyone to contribute, by becoming a Dementia Friend . Dementia friendly environments are an integral part of caring for a person living with dementia. Located in the Netherlands, there is a dementia village and it is the only one of its kind at this point in time.
This gated village is called De Hogeweyk.
Hogeweyk is a two-storey facility with seven different lifestyle themes including homey, urban, Christian, artisan, Indonesian, cultural, and goois upper class. In a study done by Zeisel et al.
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The facility is government funded and the cost per resident living there is euros per month, which is not much higher than the cost of a regular care home facility. The focus is to increase the quality of life for those living with dementia by allowing them to do the same things they loved before their illness took its course . Hogeweyk encompasses all the elements of living that an individual would have had prior to the onset of this disease.
The key is to offer maximum mobility and the opportunity to lead as normal a life as possible. The vision of Hogeweyk is to offer a more humane, engaging dementia care community where residents can experience life as they once had — making their own choices, performing everyday routine tasks, as well as socialising with people who share similar interests, despite their disease .
The built environment plays a major role in promoting or hindering the health and well-being for people living with dementia, therefore as a physiotherapist it is important to understand dementia from the perspective of someone living with dementia in order to enhance and facilitate a positive interaction. There are a multitude of interventions, activities and therapies available to people living with dementia to improve interactions with any individual that the may come across in their daily lives. With regards to improving therapeutic interactions between people living with dementia and Physiotherapists, we will look at physical activity and exercise mainly while also looking briefly at other novel interventions like music therapy.
We will try to understand if these interventions help to enhance interactions for people living with dementia while conversely trying to understand do good therapeutic interactions enhance any of the above interventions. Numerous exercise programs have been developed for relieving symptoms of dementia  - . Muscle strengthening exercises, aerobic exercise, exercise with music, Taichi and hydrotherapy are some of the exercise programs recommended for people living with dementia .
These programs are effective for attention and executive functions but their effectiveness on memory is less clear . Walking is the physical activity recommended most often due to its ease and association with a low falls risk. Improvement in cognitive function is associated with one to two hours of walking . It is reported that there is a need to avoid confusion about the diversity of exercise programs in the general-public by suggesting the most effective types and creating guidelines for designing beneficial exercise programs .
Aerobic exercise and integrated exercise programs involving both aerobic and muscle strengthening exercises are recommended by the world health organisation to prevent reduction in cognitive function in elderly people who are not suffering from cognitive impairment . People with mild cognitive impairment were found to benefit from integrated aerobic and muscle strengthening exercises in terms of cognitive and muscle function .
Physical activity is a significant moderator of age-related decline in cognition, and there are many studies that support this. Less cognitive decline was shown in older adults who participate in some sort of exercise in longitudinal studies carried out over 2 to 10 year follow-up periods.
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Aicheberger et al. More vigorous activity more than once a week resulted in even less cognitive decline . Barnes et al. With regards to cross-sectional studies, many conclude that cardiorespiratory function is associated with more efficient cognitive functions . This information provides us with an overview of the current best practice with regards to exercise prescription for people living with dementia. Physiotherapists should be aware of this as to help enhance their own therapeutic interactions with people living with dementia. Depression has the potential to have a serious effect on therapeutic interactions for people living with dementia and their care givers.
Barreto et al. However, the effect of this physical activity was small and it was reported that its clinical relevance was unclear. Factors that appeared to be the most positively effected in people living with dementia were aberrant motor behavior and, to a lesser extent, eating disorders, apathy and agitation. It must be noted that the last three factors did not reach statistical significance .
Interestingly, Forbes et al. However, it is important to note that this agreed viewpoint on the benefits of exercise appears to be as a result of clinical experience rather than scientific evidence, as the results obtained from the above studies appear to be mixed .
In a large-scale systematic review, it was concluded that there is enough evidence now to suggest that physical activity could have a significant effect on the ability of people living with dementia to perform activities of daily living ADLs and improve their cognitive function. This is due to the increased number of trials available to us . Interestingly, none of the afore-mentioned trials reported and adverse effects related to exercise programs. The following statement from the same review sent a very strong message about the benefits of exercise:.
One of the concluding points this same review makes is that there are additional well designed trials that need to be carried out in a community setting. This is where most people living with dementia live and these trials need to examine outcomes that have relevance to people living with dementia and their caregivers. Some of these outcome measures might include; ADLS, depression, challenging behaviours, cognition, caregiver quality of life and mortality.
Economic research also needs to be carried out in relation to the cost of residential care, acute care settings and visits to emergency departments . After researching the potential effects of physical activity for people living with dementia, there seems to be an obvious gap in the scientific understanding of physical activity, as well as a clear lack of evidence base for many interventions which have been used, especially with regards to the effects of exercise on promoting positive therapeutic reactions. However, the general consensus appears to be that physical activity is beneficial for people living with dementia.
A wide range of benefits are reported from clinical practice and at times are backed up in the available literature. There appears to be a widespread lack of clarity with regard to how exercise interventions work, the outcomes that can be expected and indeed what outcomes are sought . Bowes et al. There is a wide array of benefits that are indicated throughout general practice and literature including improved balance preventing falls , grip strength supports independence in ADLS , well-being and quality of life .
Physical activity should be appropriate to each specific individual living with dementia to ensure safety. Interestingly, there is strong practical evidence of the importance of delivering services that improved quality of life. Sociability appears to maintain people at a higher functioning for longer, this allows people to live better with dementia .
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Many current approaches place an importance on the quality of relationships between caregivers and people living with dementia as the key to the well-being of people living with dementia . Perhaps the increased importance placed on these relationships can enhance therapeutic reactions. Using music as an intervention for people living with dementia has grown in popularity in the past two decades.