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Attaining a higher level of education is considered to be important in order to keep up good cognitive functioning in old age. Moreover, higher education also seems to decrease the risk to develop dementia. This is of high relevance in so far that dementia is a terminal disease characterized by a long degenerative progression with severe impairments in daily functioning. Despite a great amount of research emphasizing the relevance of education, it is not entirely clear how education protects cognitive functioning in old age and how much education is possibly ‘enough’.

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It was midnight and I had just slumped into bed, exhausted after one of my first days on-call as a new intern, and still adjusting to life in a new apartment. As my nagging reflections on the day were just beginning to subside, insistent knocking at my door jolted me back to alertness. Dragging myself out of bed to open the door, I was surprised to see a diminutive elderly lady who appeared quite perturbed.

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Who decides with whom we are allowed to have sex? Generally, consenting adults are considered to have the ability to make decisions regarding sexual activity and are allowed to pursue a sexual relationship with whomever they choose, assuming appropriate criteria for consent are met.

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Along with a staunch group of Australian literary professionals, Ellie Royce is a strong advocate for promoting encouragement for families to connect with older generations, share love and facilitate the power of memory. Her latest picture book is one in a line up, not only involved in initiatives to create awareness of ageing people and […]

Imagine the unimaginable. Suffering from Alzheimer’s Disease (AD), the person with whom you shared most of your life has forgotten who you are, and even worse, can no longer remember their own experiences, their relationships, and how to behave appropriately in everyday situations. But although most of their long-term memory is heavily impaired, they may continue to relate astonishingly well to autobiographically relevant pieces of music.

The post What stays when everything goes appeared first on OUPblog.

Our brain lives in a symbiotic relationship with the bugs in our gut. Whatever we eat, they eat. In return, they help our brain function optimally in a variety of ways. During the past few years, it has become increasingly apparent that in the absence of bacteria humans would never have evolved to our current level of cognitive performance. Our brains are profoundly dependent upon a wide range of chemicals produced by these gut bugs.

The post How do gut bugs affect brain health? appeared first on OUPblog.

One of the many things I like about Facebook? You get to learn things about your family that you otherwise probably wouldn’t have known.

The man laying on the ground in the picture above is my grandfather – my dad’s dad. He fought in World War II.

I’m just going to post what my Aunt posted on Facebook …

Dan said his dad never talked about the war much (who could blame him) but he would tell us this story often.

One day there was an order to head out, so some of his buddies got into the jeep. Right before Leroy got in, his commanding officer said “Hutton you stay”. That jeep was hit and Leroy lost good friends. He would say to us, “If I would have gotten in, you all would have never been here, that saved my life”. Glad he didn’t get in!”

Isn’t it amazing to think that one moment in time, that one split second decision my grandfather’s commanding officer made, led us to this moment: Four children, ten grandchildren, nineteen (?) great grandchildren later.

It sort of boggles the mind when you stop to think about it.

My grandfather is in his early nineties now. We lost my grandmother, my dad’s mom, about … three years ago (?). She developed dementia toward the end of her life and it was a terribly sad way to say goodbye. It was very hard on my parents, I know. And now my grandfather is being moved to a nursing home today because we have reached the point where he can’t take care of himself and it’s physically too hard on my family to help. (He’s wheelchair bound and he requires physical assistance to get into bed, go to the bathroom, etc).

This is INCREDIBLY hard on my grandfather. He’s FIERCELY independent, has been his whole life, so now that he is being forced into this situation, well, it’s been difficult, to say the least.

My parents came over yesterday and they filled in the details. It was heartbreaking to listen to the anguish in their voices and watch tears gather in their eyes.

My grandfather begs them to take him home. He doesn’t want to go to the home. Who can blame him?? But though my family tried to take care of him in his home for one week, the situation is simply more than any of them can handle. They’re trying to make deals with my grandfather, work hard, participate in physical therapy, work on his strength so that he can at least walk on his own again and then they can take him home and work on a schedule to have someone with him at all times. But my grandfather is being stubborn. I’m sure the whole situation is embarrassing and humiliating for him. I see this in patients every day at work. It’s SO HARD to succumb to physical restrictions and have to rely on other people to help you when you’ve been so used to being on your own, taking care of yourself, your whole life.

This situation makes me think of my own parents a lot. They’re getting up there in age, too. Though they are still both relatively young and stay physically active (they go to a gym to walk and socialize every day), I can see early signs of dependency. It brings a lump to my throat to think me and my siblings may be in a similar boat one of these years. And though you can promise you’ll never, ever, put your loved ones in a home, you can’t TRULY promise that. I think this situation with my grandfather has taught me that. All you can do is the best you can do for the situation you find yourself in.

I also wonder how our boys will react when Kevin and I reach that age. Getting older has never really bothered me before, but honestly, seeing my grandfather’s situation has opened up doors I never really knew existed before.

I learned that being in a home, a DECENT home, is terribly expensive. This will likely put a huge dent in my grandfather’s money. I have no idea how much he has, it’s really none of my business how much money he has, but knowing my family, he likely has a nest egg somewhere he can rely on to help him through this stage. I feel terribly sorry for people that DON’T have that money to fall back on.

Kevin and I have talked about making sure we have a will. But I’m not sure we have ever really discussed our plan if one of us ends up in a nursing home. I have made Kevin promise me he will never put me in a home, and vice versa, but my grandfather’s situation has taught me, it’s never quite that black and white.

I worry that dementia runs in our family. I mentioned my grandmother had it and there are signs my grandfather might have it, too. I’ve always worried about my own memory – I have trouble remembering things NOW. What will I be like when I reach my twilight years?

I think that’s one big reason I refuse to retire. Which, I realize is unrealistic, my body will deteriorate … I realize this. But I hereby pledge to work on keeping my mind active. I’m not saying my grandparents did not do that, dementia is not something you can likely prevent, but I will do everything in my power to keep it at arm’s length.

In the meantime, life trudges on. All we can do is try and keep pace with it.

The human brain might be perceived as an organ with two main strategic tasks: goal-directed motor behavior, and mental functioning in order to work out that goal. These two main functions have two prototypical diseases: Alzheimer disease, in case of mental function, and Parkinson’s disease, with motor function. Following its inception as an entity, Parkinson’s disease (PD) was long perceived to be a purely motor disorder with unimpaired mental functions.

The post Parkinson’s disease: the flip side of the coin appeared first on OUPblog.

“Griffin came into the Silk family after Scarlet, Indigo, Violet, Amber and Saffron. He came early in the morning on that uncommon day, the twenty-ninth of February. His father’s prediction, considering the date of Griffin’s birth, was that he would be an uncommon sort of boy.

Perhaps he was, thought Griffin ruefully. For the first time in his life, he wished he’d been born on the twenty-eighth day of February or even the first of March. Maybe then he would have been an ordinary boy instead. If he were an ordinary boy, maybe Mama wouldn’t have gone away. Maybe his secret thoughts wouldn’t have changed everything.

With these words The Naming of Tishkin Silk by Glenda Millard starts weaving gentle magic around your unsuspecting heart.

Griffin is a member of the somewhat unusual and perhaps slightly bohemian Silk family, who live on the outskirts of a small Australian town. Griffin carries a secret deep inside him, a huge worry that he finds hard to share until he meets Layla, instantly recognisable to him as a princess because she is wearing a daisy-chain crown. Thanks to the thoughtfulness shown by his new friend, Griffin’s courage grows and together they do something that heals the sorrow which all the family has felt after a terrible event no-one has been able to talk about for months.

Just like Griffin, this is a truly “uncommon” short novel, the first in a seven part series. From unexpected characters to profoundly moving themes threaded together with sometimes astonishingly lyrical writing, this book is something utterly different and incredibly beautiful. I have never before come across such delicate and yet powerful writing in a novel for children. Unique, breathtaking and full of fierce love and deep sorrow, The Naming of Tishkin Silk is the sort of book that changes you forever, the sort of book you are just so glad to have inside you, to enrich even the happiest of days and to sustain you on dark nights.

The dual aspect of this novel – intense sadness and intense happiness – reminded me of a passage in The Prophet by Khalil Gibran about joy and sorrow; “the deeper that sorrow carves into your being, the more joy you can contain.“. Whilst this book deals with some of the most difficult themes you’re likely to come across in books for its target age range (approximately 8-12), Millard does it with such quiet tenderness that it doesn’t overwhelm. Indeed, like the adult characters inside the book, Millard enters the world children inhabit without patronising them, but rather with immense respect, sincerity and creativity.

The stories we tell ourselves in an attempt to make sense of the world around us, adjusting to different family setups when new babies are born, sibling jealousy, and the value of having space and taking time to think form some of the varied threads woven throughout this precious book. Never once soppy or sentimental, Millard writes with honesty and integrity about deep and loving emotions. This is a tremendous book for exploring kindness and empathy.

It’s Australian setting is lightly but evocatively worn, grounding the somewhat enchanted story in a very real time and place. Yes, my praise for this book goes on and on! And yet, when this book first arrived in my home, I shelved it in a dusty corner. I judged the book by its cover, and the cover did not work for me at all (Caroline Magerl illustrated this first book in the series, but subsequent volumes have been illustrated by Stephen Michael King). It looked airy-fairy, hippy-dippy, saccharine and syrupy and not like something I would enjoy. Someone whose judgement I trust, however, kept telling me I should read the book. Pig-headedly, I kept ignoring this advice. But what a fool I was! Tishkin could have been part of me for two whole extra years if I had listened and not let my prejudices sway me.

For once I had read the book, I was utterly smitten. I could not get hold of the rest of the series quickly enough.

If, however, I still had a niggling doubt, it was about how children would respond to these books. Subtle and yet emotionally complex, featuring an unusual family, and dealing with issues as varied as death, illness, fostering, immigration and dementia over the course of the books now available in the UK (the 6th title in the series, The Tender Moments of Saffron Silk, is published next week on World Book Day, and the final will be available in September this year), I was very curious as to how young people, rather than adults would respond to these books.

I only have one child’s response to call upon, but M, my ten year old, has taken these stories to her heart as much as I have. She’s read each one in a single sitting, and whilst she agrees they are indeed full of sadness, they are also “really funny and playful”, “just the sort of family I want ours to be like”. She has SO many plans for implementing aspects of these stories into our lives, from making the recipes which feature throughout the series, to adopting the special breakfast rituals the Silk Family has into our own home, from making our own paper to consecrating an apple tree for tea parties, from collecting shiny foil to painting special poems on walls and doors. I think I shall be posting our activities, our Kingdom of silk playing by the book for a long time to come on the blog!

As it is, we’ve already got our own green rubber gloves with red nail polish…

…we’ve painted our toes like Layla…

… and we’ve started having hummingbird nectar and fairy bread when we come in from school.

Layla and Griffin and all the Kingdom of Silk clan are now part of our lives: We are all the richer for them. These books are alive with wonder and warmth and they’re some of the best I think my family has ever shared.

In the closing pages of The Naming of Tishkin Silk , this gently heart wrenching, heart-soaring short novel, Millard writes, “There are some days when heaven seems much closer to earth than others, and Friday the twenty-seventh of February was one of them.” By introducing you to this book today, also a Friday the twenty-seventh of February, I’ve tried to offer you a slice of such beauty, kindness and wonder as will indeed make today (or at least the day you start reading your own copy of The Naming of Tishkin Silk ) one of those days where heaven really does seem a little nearer by.

Photo: Tonya Staab

About 500,000 Canadians are living with Alzheimer’s disease or a related dementia. This number is expected to soar to 1.1 million within 25 years. To date, there is no definitive way for health care professionals to forecast the onset of dementia in a patient with memory complaints. However, new research provides a glimmer of hope.

As a geriatrician, I have been looking at walking speed and variability as a predictor of dementia’s progression and whether it is associated with physical changes in the brain.

The “Gait and Brain Study” is a longitudinal cohort study funded by the Canadian Institutes of Health Research (CIHR). It assessed up to 150 seniors with mild cognitive impairment (MCI) — a pre-dementia syndrome — in order to detect an early predictor of cognitive and mobility decline, and progression to dementia.

While walking has long been considered an automatic motor task, emerging evidence suggests cognitive function plays a key role in the control of walking, avoidance of obstacles, and maintenance of navigation.

In our recent research, my team asked people with mild cognitive impairment to walk on a specially-designed mat linked to a computer. The computer recorded the individual’s walking gait variability and speed. This information was then compared to their walking gait while simultaneously performing a demanding cognitive task, such as counting backwards or doing calculations while walking (“walking-while-talking”).

It was subsequently determined that some specific gait characteristics are associated with high variability, particularly during walking-while-talking. These gait abnormalities were more marked in MCI individuals with the worst episodic memory and with executive dysfunction revealing a motor signature of cognitive impairment.

If confirmed in subsequent studies, these gait changes can be an effective predictor of cognitive decline and may eventually help with earlier diagnoses of dementia.

Finding early dementia detection methods is vital. In the future, it is conceivable that we will be able to make diagnoses of Alzheimer’s disease and other dementias before people even have significant memory loss. We believe that gait, as a complex brain-motor task, provides a golden window of opportunity for researchers to see brain function. The high variability observed in people with mild cognitive impairment can be seen as a “gait arrhythmia,” predicting mobility decline, falls, and now, cognitive impairment. Our hope is to combine these methods with promising new medications to slow or halt the progression of mild cognitive impairment to dementia.

Image Credit: Elderly person walking CC0 via Pixabay

The post Gait disturbances can help to predict dementia in older adults appeared first on OUPblog.

        

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Victoria Lane has made a successful career from writing; as an award-winning financial journalist for many years, editor and correspondent for many leading media publications, and of course, as a picture and chapter book writer for children. Today, we delve into Victoria’s writerly mind as she shares her inspirations behind her touching picture book, Celia […]

I love the way award-winning author Debra Tidball describes her view on valuing connectedness across the generations. I also love the sentiment in celebrating people’s personal histories and appreciating who they are now, and then. Having had a grandmother with whom I had a strong bond, ‘When I see Grandma’ really resonated in my heart. […]

By Lawla Law

Cognitive impairment is a common problem in older adults, and one which increases in prevalence with age with or without the presence of pathology. Persons with mild cognitive impairment (MCI) have difficulties in daily functioning, especially in complex everyday tasks that rely heavily on memory and reasoning. This imposes a potential impact on the safety and quality of life of the person with MCI as well as increasing the burden on the care-giver and overall society. Individuals with MCI are at high risk of progressing to Alzheimer’s diseases (AD) and other dementias, with a reported conversion rate of up to 60-100% in 5-10 years. These signify the need to identify effective interventions to delay or even revert the disease progression in populations with MCI.

At present, there is no proven or established treatment for MCI although the beneficial effects of physical activity/exercise in improving the cognitive functions of older adults with cognitive impairment or dementia have long been recognized. Exercise regulates different growth factors which facilitate neuroprotection and anti-inflammatory effects on the brain. Studies also found that exercise promotes cerebral blood flow and improves learning. However, recent reviews reported that evidence from the effects of physical activity/exercise on cognition in older adults is still insufficient.

Surprisingly, studies have found that although numerous new neurons can be generated in the adult brain, about half of the newly generated cells in the brain die during the first 1-4 weeks. Nevertheless, research also found that spatial learning or exposure to an enriched environment can rescue the newly generated immature cells and promote their long-term survival and functional connection with other neurons in the adult brain

It has been proposed that exercise in the context of a cognitively challenge environment induces more new neurons and benefits the brain rather than the exercise alone. A combination of mental and physical training may have additive effects on the adult brain, which may further promote cognitive functions.

Daily functional tasks are innately cognitive-demanding and involve components of stretching, strengthening, balance, and endurance as seen in traditional exercise programs. Particularly, visual spatial functional tasks, such as locating a key or finding the way through a familiar or new environment, demand complex cognitive processes and play an important part in everyday living.

In our recent study, a structured functional tasks exercise program, using placing/collection tasks as a means of intervention, was developed to compare its effects on cognitions with a cognitive training program in a population with mild cognitive impairment.

Patients with subjective memory complaint or suspected cognitive impairment were referred by the Department of Medicine and Geriatrics of a public hospital in Hong Kong. Older adults (age 60+) with mild cognitive decline living in the community were eligible for the study if they met the inclusion criteria for MCI. A total of 83 participants were randomized to either a functional task exercise (FcTSim) group (n = 43) or an active cognitive training (AC) group (n = 40) for 10 weeks.

We found that the FcTSim group had significantly higher improvements in general cognitive functions, memory, executive function, functional status, and everyday problem solving ability, compared with the AC group, at post-intervention. In addition, the improvements were sustained during the 6-month follow-up.

Although the functional tasks involved in the FcTSim program are simple placing/collection tasks that most people may do in their everyday life, complex cognitive interplays are required to enable us to see, reach and place the objects to the target positions. Indeed, these goal-directed actions require integration of information (e.g. object identity and spatial orientation) and simultaneous manipulation of the integrated information that demands intensive loads on the attentional and executive resources to achieve the ongoing tasks. It is a matter of fact that misplacing objects are commonly reported in MCI and AD.

Importantly, we need to appreciate that simple daily tasks can be cognitively challenging to persons with cognitive impairment. It is important to firstly educate the participant as well as the carer about the rationale and the goals of practicing the exercise in order to initiate and motivate their participation. Significant family members or caregivers play a vital role in the lives of persons with cognitive impairment, influencing their level of activities and functional interaction in their everyday environment. Once the participants start and experience the challenges in performing the functional tasks exercise, both the participants and the carer can better understand and accept the difficulties a person with cognitive impairment can possibly encounter in his/her everyday life.

Furthermore, we need to aware that the task demands will decrease once the task becomes more automatic through practice. The novelty of the practicing task has to be maintained in order ensure a task demand that allows successful performance and maintain an advantage for the intervention. Novelty can be maintained in an existing task by adding unfamiliar features, and therefore performance of the task will remain challenging and not become subject to automation.

Dr. Lawla Law is a practicing Occupational Therapist for more than 24 years, with extensive experience in acute and community settings in Hong Kong and Tasmania, Australia. She is currently the Head of Occupational Therapy at the Jurong Community Hospital of Jurong Health Services in Singapore and will take up a position as Lecturer in Occupational Therapy at the University of Sunshine Coast, Queensland, Australia in August 2014. Her research interests are in Geriatric Rehabilitations with a special emphasis on assessments and innovative interventions for cognitive impairment. Dr. Law is an author of the paper ‘Effects of functional tasks exercise on older adults with cognitive impairment at risk of Alzheimer’s disease: a randomised controlled trial’, published in the journal Age and Ageing.

Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.

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Image credit: Brain aging. By wildpixel, via iStockphoto.

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By Cretien van Campen

Frail older people are more oftentimes considered a burden for society, than not. They are perceived to require intensive care that can be expensive while producing nothing contributory to society. The collective image is that frail older people are ‘useless’. In my opinion, we do not endeavor to ‘use’ them or know how to release productivity in them.

Around the age of 70, the extremely frail wheelchair bound musician Johnny Cash made the music video ‘Hurt’ with the help of film director Mark Romanek and producer Rick Rubin. The video was a tremendous success, receiving abundant critical acclaim and becoming a favorite with many for all time. The song was taken from a series of albums, the ‘American Recordings’, Cash created in his frailest period, selling millions of copies. The albums have been regarded as outstanding contributions to American culture and many people have found strength, joy and solace in his recordings.

Click here to view the embedded video.

Cash was no exception. He was not the only frail older person who flourished in his last years. The painter Henri Matisse, the music conductor Herbert von Karajan, and others reached creative summits in the last seasons of their lives. Also non-artists like sawmill worker Lester Potts became a creative painter in his later years when he was suffering from Alzheimer’s disease. In other types of dementia, such as frontotemporal dementia, creativity can be released as well.

The case of Cash also is an example of what is needed to release creative productivity in a frail older person — and what has to be avoided. In his last years Cash suffered from several complex diseases and physical limitations, a long and sad process which biographer Robert Hilburn has described with compassion and in detail. Cash was successively diagnosed among others with Parkinson’s disease, Shy-Drager syndrome, and double pneumonia. These contributed to hospital admissions several times a year and receiving prescriptions in quantities that greatly impacted the long time Dexedrine (speed) addict. (Cash had been addicted during his career as a touring artist.)

By the end of the twentieth century Cash was in forlorn condition, exhausting himself in a mixture of drugs and over-extended tours. Of deeper emotional consequence, his records did not sell the numbers they once had. His musical career was considered by many to be over by the time he was approached by producer Rick Rubin. In retrospect Rubin gave Cash two ingredients that supported his creative productivity: mental reminiscences and physical exercises.

In elongated sessions at home Rubin and Cash played old and new music, evoking reminiscences with musical roots and connecting them with the music of younger generations, which created new flourish and renewed hunger for music in Cash. He transformed from an older musician playing golden oldies into an interpreter of contemporary songs with vision, re-honing his craft. Mentally, he returned from living in the past to living in the present and creating new interpretations, which revived a sense of direction to his life. He connected to younger generations and inspired them with his interpretations as he mutually was inspired by their music.

Not only in the mental and spiritual domains did he regain strength, but also in the physical domain. Rubin engaged a befriended physiotherapist. Physical exercises got Cash out of his wheelchair and walking independently again, while simultaneously bringing back feeling in his fingers to play the guitar with agility. By exercising his body, energy returned and he was able to sustain longer recording sessions, his most valued passion.

Rubin is an artist, not a doctor. He did not cure Cash. Instead he gave a man whose health was rapidly declining renewed opportunities and stimuli to thrive and find meaning in his life. Cash often said that all he wanted was to make music. The music gave him the will to survive, and to fight the diseases.

Although the medical records of Cash are confidential, reports from his family share indications that he was overmedicated. According to his son, his father would have lived longer and produced more songs and recordings if the medication had been decreased – something his physiotherapist pleaded for several times after another hospital admission.

Returning home after this hospital stay, every inch of his body appeared unduly medicated. As well meaning of his professional caregivers were in prescribing such pill-induced treatments, he actually lived in a medical cage, and his brilliant mind suffered. Fortunately some of his family members and friends understood he needed physical, mental, and spiritual space to flourish. They helped in opening that cage with recovered mental and physical strength and he eloquently delivered to us some of the most heart-provoking songs in the history of music.

Cretien van Campen is a Dutch author, scientific researcher and lecturer in social science and fine arts. He is the founder of Synesthetics Netherlands and is affiliated with the Netherlands Institute for Social Research and Windesheim University of Applied Sciences. He is best known for his work on synesthesia in art, including historical reviews of how artists have used synesthetic perceptions to produce art, and studies of perceived quality of life, in particular of how older people with health problems perceive their living conditions in the context of health and social care services. He is the author of The Proust Effect: The Senses as Doorways to Lost Memories.

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Image credit: Johnny Cash 1969, Photograph by Joe Baldwin. Public Domain via Wikimedia Commons.

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By Cretien van Campen

Would you take a person with dementia to the beach?

This might not really be an idea you would think of. There are several possible constraints: difficulty with travel, for example, being one. And what if, having succeeded in getting the dementia sufferer there and back, the next day you asked if they enjoyed their day out and he or she just stared at you with a confused gaze as if to ask, ‘what are you talking about?’

If you think it makes little sense to take persons with dementia to the beach, it will surprise you that a nursing home in Amsterdam has built a Beach room. In this room, residents can enjoy the feeling of sitting in the sun with their bare feet in the sand. The room is designed to improve the well-being of these residents. The garden room at the centre of the home has recently been converted into a true ‘beach room’, complete with sand and a ‘sun’ which can be adjusted in intensity and heat output. A summer breeze blows occasionally and the sounds of waves and seagulls can be heard. The décor on the walls is several metres high, giving those in the room the impression that they are looking out over the sea. There are five or six chairs in the room where the older residents can sit. There are also areas of wooden decking on which wheelchairs can be parked. The designers have even managed to replicate the impression of sea air.

Multisensory ‘Beach room’ in the Vreugdehof care centre, Amsterdam.

Visits to the beach room appear to have calming and inspiring effects on residents of the nursing home. One male resident used to go to the beach often in the past and now, after initially protesting when his daughter collected him from his bedroom, feels calm and content in the beach room. His dementia hinders us from asking him whether he remembers anything from the past, but there does appear to be a moment of recognition of a familiar setting when he is in there.

Evidence is building through studies into the sensorial aspects of memorizing and reminiscing by frail older persons in nursing and residential homes. Several experimental studies have noted the positive effects of sense memories on the subjective well-being of frail older persons. For instance, one study showed that participants of a life review course including sensory materials had significantly fewer depressive complaints and felt more in control of their lives than the control group who had watched a film.

The Beach Room is an example of a multisensory room that emanates from a specific sensorial approach to dementia. The ‘Snoezelen’ approach was initiated in the Netherlands in the late 1970s. The word ‘Snoezelen’ is a combination of two Dutch words: ‘doezelen’ (to doze) and ‘snuffelen’ (to sniff ). Snoezelen takes place in a specially equipped room where the nature, quantity, arrangement, and intensity of stimulation by touch, smells, sounds and light are controlled. The aim of these multisensory interventions is to find a balance between relaxation and activity in a safe environment. Snoezelen has become very popular in nursing homes: around 75% of homes in the Netherlands, for example, have a room set aside for snoezelen activities.

On request by health care institutions, artists have taken up the challenge to design multisensory rooms or redesign the multisensory space of wards (e.g. distinguished by smells) and procedures (cooking and eating together instead of individual microwave dinners). Besides a few scientific evaluations, most evidence is actually acquired from collaborations of artists and health professionals at the moment. The senses are often a better way of communicating with people affected by deep dementia. Like the way that novelist Marcel Proust opened the joys of his childhood memories with the flavour of a Madeleine cake dipped in linden-blossom tea, these artistic health projects open windows to a variety of ways of using sensorial materials to reach unreachable people.

So, would you take a person with dementia to the beach? Yes, take them to the beach! It can evoke Proust effects and enhance their joy and well-being. Although, we still do not know what the Proust effect does inside the minds of people with dementia, we can oftentimes observe the result as an enhanced state of calmness with perhaps a little smile on their face. People with dementia who have lost so much of their quality of life can still experience moments of joy and serenity through their sense memories.

Cretien van Campen is a Dutch author, scientific researcher and lecturer in social science and fine arts. He is the founder of Synesthetics Netherlands and is affiliated with the Netherlands Institute for Social Research and Windesheim University of Applied Sciences. He is best known for his work on synesthesia in art, including historical reviews of how artists have used synesthetic perceptions to produce art, and studies of perceived quality of life, in particular of how older people with health problems perceive their living conditions in the context of health and social care services. He is the author of The Proust Effect: The Senses as Doorways to Lost Memories.

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Image credits: Multisensory ‘Beach room’ in the Vreugdehof care centre, Amsterdam. Photo: Cor Mantel, with permission from Vreugdehof.

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By Siegfried Weyerer

Depression in old age occurs frequently, places a severe burden on patients and relatives, and increases the utilization of medical services and health care costs. Although the association between age and depression has received considerable attention, very little is known about the incidence of depression among those 75 years of age and older. Studies that treat the group 65+ as one entity are often heavily weighted towards the age group 65-75. Therefore, the prediction of depression in the very old is uncertain, since many community-based studies lack adequate samples over the age of 75.

With the demographic change in the forthcoming decades, more emphasis should be put on epidemiological studies of the older old, since in many countries the increase in this age group will be particularly high. To study the older old is also important, since some crucial risk factors such as bereavement, social isolation, somatic diseases, and functional impairment become more common with increasing age. These factors may exert different effects in the younger old compared to the older old. Knowledge of risk factors is a prerequisite to designing tailored interventions, either to tackle the factors themselves or to define high-risk groups, since depression is treatable in most cases.

In our recent study, over 3,000 patients recruited by GPs in Germany were assessed by means of structured clinical interviews conducted by trained physicians and psychologists during visits to the participants’ homes. Inclusion criteria for GP patients were an age of 75 years and over, the absence of dementia in the GP’s view, and at least one contact with the GP within the last 12 months. The two follow-up examinations were done, on average, one and a half and then three years after the initial interview.

Depressive symptoms were ascertained using the 15-item version of the Geriatric Depression Scale (GDS). We found that the risk for incident depression was significantly higher for subjects

• 85 years and older
• with mobility impairment and vision impairment
• with mild cognitive impairment and subjective memory impairment
• who were current smokers.

It revealed that the incidence of late-life depression in Germany and other industrialized countries is substantial, and neither educational level, marital status, living situation nor presence of chronic diseases contributed to the incidence of depression. Impairments of mobility and vision are much more likely to cause incidents of depression than individual somatic illnesses such as diabetes mellitus and coronary heart disease. As such, it is vital that more attention is paid to the oldest old, functional impairment, cognitive impairment, and smoking, when designing depression prevention programs.

GP practices offers ample opportunity to treat mental health problems such as depression occurring in relation to physical disability. If functional impairment causes greater likelihood of depression, GPs should focus on encouraging older patients to maintain physical health, whether by changing in personal health habits, advocating exercise, correcting or compensating functional deficits by means of medical and surgical treatments, or encouraging use of walking aids. Additionally, cognitive and memory training could prevent the onset of depressive symptoms, as could smoking cessation. If these steps are taken, the burden of old age depression could be significantly reduced.

Siegfried Weyerer is professor of epidemiology at the Central Institute of Mental Health in Mannheim, Germany. He has conducted several national and international studies on the epidemiology of dementia, depression and substance use disorders at different care levels. He is also an expert in health/nursing services research. He is one of the authors of the paper ‘Incidence and predictors of depression in non-demented primary care attenders aged 75 years and older: results from a 3-year follow-up study’, which appears in the journal Age and Ageing. You can read the paper in full here.

Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.

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The post Depression in old age appeared first on OUPblog.

By Anayo Akunne

Delirium is a common but serious condition that affects many older people admitted to hospital. It is characterised by disturbed consciousness and changes in cognitive function or perception that develop over a short period of time. This condition is sometimes called “acute confusional state.”

It is associated with poor outcomes. People with delirium have higher chances of developing new dementia, new admission to institutions, extended stays in the hospital, as well as higher risk of death. Delirium also increases the chances of hospital-acquired complications such as falls and pressure ulcers. Poor outcomes resulting from delirium will reduce the patient’s health-related quality of life but also increase the cost of health care.

Delirium can be prevented if dealt with urgently. Enhanced care systems based on multi-component prevention interventions are associated with the potential to prevent new cases of delirium in hospitals. Prevention in a hospital or long-term care setting will lead to the avoidance of costs resulting from patients’ care. For example, the cost of caring for a patient with severe long-term cognitive impairment is high, and prevention of delirium could reduce the number of patients with such impairment. It will therefore reduce the cost of caring for such patients. Prevention could reduce lost life years and loss in health-related quality of life due to other adverse health outcomes associated with delirium.

The multi-component prevention interventions involve making an assessment of people at risk in order to identify and then modify risk factors associated with delirium. Delirium risk factors targeted in such interventions normally include cognitive impairment, sleep deprivation, immobility, visual and hearing impairments, and dehydration. The people at risk of delirium have their risk of delirium reduced through such interventions. The implementation of these interventions is usually done by a trained multi-disciplinary team of health-care staff. This means additional implementation cost. It would therefore be useful to know if this set of prevention interventions would be cost-effective. It was indeed found to be convincingly cost-effective by the UK National Institute for Health and Clinical Excellence (NICE) and was recommended for use in medically ill people admitted to hospital.

It is cost-effective to target multi-component prevention interventions at elderly people at both intermediate and high risk for delirium. It is an attractive intervention to health-care systems. In the United Kingdom the savings for the intervention would spread unevenly between the National Health Service (NHS) and social care providers. The savings to the NHS may be modest and largely accrue through lower costs resulting from reduced hospital stay, whereas the savings to social care are likely to be more considerable resulting from an enduring and diminished burden of dependency and dementia, particularly reduced need for expensive care in long-term care settings. The NHS acute providers may need to invest to implement the intervention and to accrue savings to the wider public sector. The current NHS hospital funding system does not incentivise this type of investment, and this could be a major structural barrier to a widespread uptake of delirium prevention systems of care in the UK.

In the work undertaken as part of the NICE guideline on delirium, the additional cost of implementing the intervention was based on the description of the intervention that required additional staff for delivery. It is possible that the guideline provides an important under-estimate of cost-effectiveness. This is because it might be possible to implement the intervention within existing resources. The intervention is designed to address risk factors for delirium by delivering the sort of person-centred routine c

Terry Pratchett received a knighthood recently. (That's why he's dressed all fancy in this video.)

Here's a snippet of his comments on Alzheimer's disease, which he was diagnosed with last year. My favorite line: "An awful lot of snowflakes are piling up at the top of the mountain."

I heart Terry Pratchett. (Oh, and Nation is an awesome book!!)



Bonus: Both links above have more video of TP talking about his books and his writing process. Good stuff.