JAMDA 15 (2014) 79e81
JAMDA journal homepage: www.jamda.com
Editorial
Meaningful Activities in the Nursing Home John E. Morley MB, BCh a, b, *, Carolyn D. Philpot RN, MSN(R), GNP a, David Gilla, Marla Berg-Weger PhD, LCSW a, c a
Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO Division of Endocrinology, Saint Louis University School of Medicine, St. Louis, MO c School of Social Work, Saint Louis University, St. Louis, MO b
Meaningful activities can be defined as enjoyable activities that engage the nursing home resident to an extent that they improve either their emotional wellbeing, cognitive status, physical function, or reduce problematic behaviors. The classical example of a nonmeaningful activity is a group of nursing home residents watching television or a movie and falling asleep while watching. This could be turned into a low grade meaningful activity if an aide or nurse paused the program every 5 to 10 minutes, and engaged the residents in a discussion of what they had been watching. Most of us who have worked in nursing homes realize that meaningful activities are a rarity. A study in England suggested that residents in nursing homes spent less than 13% of their time engaged in meaningful activities.1 A second study in 12 care homes found that most residents spent less than 2 minutes a day taking part in meaningful social interaction.2 In this issue of the Journal, we publish 2 structured approaches to providing meaningful activities in the nursing home. In one, a nursing home developed a cognitive stimulus therapy (CST) program coupled with exercise.3 This program showed an increase in resident activity and improvement in the Saint Louis University Mental Status Examination,4 the Brief Interview for Mental Status Examination,5 and the Patient Health Questionnaire-9.6 Previous large scale controlled programs using CST have demonstrated its effectiveness.7e9 This study shows it can be easily affected in a nursing home and that there may be advantages of coupling it with an exercise program. The same nursing home has demonstrated the utility of an exercise program to reduce difficult behaviors.10 Physical exercise can be enjoyable and improve outcomes in nursing home residents. It can enhance gait speed, decrease falls, decrease fear of falling, decrease dysphonia, improve cognition, decrease health service utilization, and slow the deterioration of functional decline.11e23 Exercise is particularly useful in preventing disability in persons with frailty and sarcopenia.24e37 Singh et al38 have shown remarkable effects of exercise on outcomes during rehabilitation for hip fracture. Both Mahjong and Tai Chi have been shown to maintain function in Hong Kong nursing homes.39 Restorative care, when the persons doing it are appropriately trained, can delay both functional and cognitive deterioration.40e42 Mental practice sessions The authors declare no conflicts of interest. * Address correspondence to John E. Morley, MB, BCh, Division of Geriatric Medicine, St. Louis University School of Medicine, 1402 S. Grand Blvd, M238, St. Louis, MO 63104. E-mail address: [email protected] (J.E. Morley).
between rehabilitation improves outcome in persons with stroke.43 Pedometers can be used to stimulate persons to increase their walking.44 Wii games are also useful.45 One nursing home has residents walking from unit to unit where they obtain signatures in a log book. After sufficient signatures are obtained, they are eligible for a prize. Virtual reality exercises with robot-assisted intervention can also improve outcomes.46,47 This not only increases physical activity but forces social interaction with the nurses on each unit. The second study examines the use of a reminiscence program focusing on a professional baseball team as a possible approach to engaging persons with dementia.48 Utilizing the ability of patients with Alzheimer’s disease to remember events from the past and then coupling them with the events affecting the current team during the season allows a logical stimulation of new memories. A similar program exists in Scotland, focusing on soccer.49 The Scottish program was particularly developed for males with dementia because of the shortage of meaningful activities for men. Reminiscence therapy has been well established as a meaningful activity, though with varying results as far as cognitive enhancement.50e53 Cohen-Mansfield et al54e56 have been leaders in focusing on the values of brief quality interactions in the nursing home. Interventions focus on known interests of residents, their previous occupation, and current events using a standardized framework. Building on this, Ballard et al57 have developed a brief (10-minute) psychosocial therapy program that creates a structured social intervention program that can be taught to nursing home staff. This leads to more positive communication. Using this in the Cholinesterase Inhibitor and Atypical Neuroleptic in the Management of Agitation in Alzheimer Disease (CALM-AD) Trial, they found that it could be easily delivered and that in the individuals receiving the intervention, there was a significant reduction in agitation.57 Improving care staff engagement is a key to these activities.58 Individualizing the engagement process is also important.59,60 The Videant Program provided individual activity sessions for 45 minutes, twice weekly by occupational therapists.61 This program reduced agitation and disruptive behavior. Animal-assisted therapy decreases symptoms of agitation and aggression.62,63 There is also evidence suggesting that robotic animals may be equally effective.64e66 As previously stressed, the activities need to be individualized. Minimum Data Set 3.0 now provides some insight into resident activity interests.67,68 Residents tend to find meaning in activities that
1525-8610/$ - see front matter Ó 2014 - American Medical Directors Association, Inc. All rights reserved. http://dx.doi.org/10.1016/j.jamda.2013.11.022
80
Editorial / JAMDA 15 (2014) 79e81
Table 1 Classification of Meaningful Activities 1. Brief Social Stimulus Meaningful social interactions with staff Brief psychosocial therapy (
JAMDA journal homepage: www.jamda.com
Editorial
Meaningful Activities in the Nursing Home John E. Morley MB, BCh a, b, *, Carolyn D. Philpot RN, MSN(R), GNP a, David Gilla, Marla Berg-Weger PhD, LCSW a, c a
Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO Division of Endocrinology, Saint Louis University School of Medicine, St. Louis, MO c School of Social Work, Saint Louis University, St. Louis, MO b
Meaningful activities can be defined as enjoyable activities that engage the nursing home resident to an extent that they improve either their emotional wellbeing, cognitive status, physical function, or reduce problematic behaviors. The classical example of a nonmeaningful activity is a group of nursing home residents watching television or a movie and falling asleep while watching. This could be turned into a low grade meaningful activity if an aide or nurse paused the program every 5 to 10 minutes, and engaged the residents in a discussion of what they had been watching. Most of us who have worked in nursing homes realize that meaningful activities are a rarity. A study in England suggested that residents in nursing homes spent less than 13% of their time engaged in meaningful activities.1 A second study in 12 care homes found that most residents spent less than 2 minutes a day taking part in meaningful social interaction.2 In this issue of the Journal, we publish 2 structured approaches to providing meaningful activities in the nursing home. In one, a nursing home developed a cognitive stimulus therapy (CST) program coupled with exercise.3 This program showed an increase in resident activity and improvement in the Saint Louis University Mental Status Examination,4 the Brief Interview for Mental Status Examination,5 and the Patient Health Questionnaire-9.6 Previous large scale controlled programs using CST have demonstrated its effectiveness.7e9 This study shows it can be easily affected in a nursing home and that there may be advantages of coupling it with an exercise program. The same nursing home has demonstrated the utility of an exercise program to reduce difficult behaviors.10 Physical exercise can be enjoyable and improve outcomes in nursing home residents. It can enhance gait speed, decrease falls, decrease fear of falling, decrease dysphonia, improve cognition, decrease health service utilization, and slow the deterioration of functional decline.11e23 Exercise is particularly useful in preventing disability in persons with frailty and sarcopenia.24e37 Singh et al38 have shown remarkable effects of exercise on outcomes during rehabilitation for hip fracture. Both Mahjong and Tai Chi have been shown to maintain function in Hong Kong nursing homes.39 Restorative care, when the persons doing it are appropriately trained, can delay both functional and cognitive deterioration.40e42 Mental practice sessions The authors declare no conflicts of interest. * Address correspondence to John E. Morley, MB, BCh, Division of Geriatric Medicine, St. Louis University School of Medicine, 1402 S. Grand Blvd, M238, St. Louis, MO 63104. E-mail address: [email protected] (J.E. Morley).
between rehabilitation improves outcome in persons with stroke.43 Pedometers can be used to stimulate persons to increase their walking.44 Wii games are also useful.45 One nursing home has residents walking from unit to unit where they obtain signatures in a log book. After sufficient signatures are obtained, they are eligible for a prize. Virtual reality exercises with robot-assisted intervention can also improve outcomes.46,47 This not only increases physical activity but forces social interaction with the nurses on each unit. The second study examines the use of a reminiscence program focusing on a professional baseball team as a possible approach to engaging persons with dementia.48 Utilizing the ability of patients with Alzheimer’s disease to remember events from the past and then coupling them with the events affecting the current team during the season allows a logical stimulation of new memories. A similar program exists in Scotland, focusing on soccer.49 The Scottish program was particularly developed for males with dementia because of the shortage of meaningful activities for men. Reminiscence therapy has been well established as a meaningful activity, though with varying results as far as cognitive enhancement.50e53 Cohen-Mansfield et al54e56 have been leaders in focusing on the values of brief quality interactions in the nursing home. Interventions focus on known interests of residents, their previous occupation, and current events using a standardized framework. Building on this, Ballard et al57 have developed a brief (10-minute) psychosocial therapy program that creates a structured social intervention program that can be taught to nursing home staff. This leads to more positive communication. Using this in the Cholinesterase Inhibitor and Atypical Neuroleptic in the Management of Agitation in Alzheimer Disease (CALM-AD) Trial, they found that it could be easily delivered and that in the individuals receiving the intervention, there was a significant reduction in agitation.57 Improving care staff engagement is a key to these activities.58 Individualizing the engagement process is also important.59,60 The Videant Program provided individual activity sessions for 45 minutes, twice weekly by occupational therapists.61 This program reduced agitation and disruptive behavior. Animal-assisted therapy decreases symptoms of agitation and aggression.62,63 There is also evidence suggesting that robotic animals may be equally effective.64e66 As previously stressed, the activities need to be individualized. Minimum Data Set 3.0 now provides some insight into resident activity interests.67,68 Residents tend to find meaning in activities that
1525-8610/$ - see front matter Ó 2014 - American Medical Directors Association, Inc. All rights reserved. http://dx.doi.org/10.1016/j.jamda.2013.11.022
80
Editorial / JAMDA 15 (2014) 79e81
Table 1 Classification of Meaningful Activities 1. Brief Social Stimulus Meaningful social interactions with staff Brief psychosocial therapy (
