INTRODUCTION Dementia Green Care What does ‘Therapeutic’ mean? Principles & Benefits Activities & Environmental Design Dementia Prevention Risk Factors Evidence RIPE & Dementia Beat Camp Dr. Garuth Chalfont PhD ASLA Director of RIPE and Chalfont Design Health and Wellbeing in Later Life Chalfont Design Taking care outside Talk given to LWDP, Bamber Bridge December 9th 2014 [email protected]www.chalfontdesign.com on Facebook - Dementia Beat Camp
Transcript
INTRODUCTIONDementia Green Care
What does ‘Therapeutic’ mean? Principles & Benefits Activities & Environmental Design
1. Pleasure, enjoyment, relaxation2. To maintain skills3. Physical activity and exercise4. Meaningful occupation5. Visiting and social interaction6. Caring for something living7. Escape from indoors8. Peace and quiet9. Sensory stimulation 10. To keep the spirit alive
Nature-based therapeutic activity or stimulation (Outcome or benefits) [email protected]
www.chalfontdesign.com
on Facebook - Dementia Beat Camp
Some Evidence for Nature Activities and DementiaInt J Geriatr Psychiatry 2008; 23: 485–489.Y. Lee and S. Kim Effects of indoor gardening on sleep, agitation, and cognition in dementia patients…
…effective for sleep, agitation, and cognition…
Canadian Journal on Aging Vol 24 Iss 04 Winter 2005, pp 367‐377 Gigliotti & Jarrott Effects of Horticulture Therapy on Engagement and Affect
…higher levels of productive engagement and positive affect and lower levels of non‐engagement…
Journal of Therapeutic Horticulture 18 ‐ 2007‐2008D’Andrea, et al. Effect of HT on Preventing the Decline of Mental Abilities of Patients with Alzheimer’s…
overall higher functional level than the control group
Am J AlzDis Other Dementias Dec, 2010 Jarrott & Gigliotti Comparing Responses to Horticultural‐Basedand Traditional Activities in Dementia Care Programs
higher levels of active, passive, and other engagement…
Journal of Psychosocial Nursing and Mental Health Services, 2010, 48(12):42‐50 Kang, H.Y. et al An integrated dementia intervention for Korean older adults.
…cognitive stimulation training, exercise, music, art, and horticultural therapy. Significant differences were found… in…cognitive function, depression levels, and mental‐emotional health.
Psychiatry Investig 2012;9:100‐11 Detweiler et al What Is the Evidence to Support the Use of Therapeutic Gardens for the Elderly?
attention, lessening of stress, modulation reduction of pain, improvement of agitation, lowering of PRN medications and antipsychotics and reduction of falls
ournal of Clinical Nursing, 2014, 23(19‐20):2698‐2715Gonzalez & Kirkevold Benefits of sensory garden and horticultural activities in dementia care: a review
may improve well‐being and affect and reduce the… disruptive behaviour. …use of psychotropic drugs, falls, sleep and sleep pattern also seem to improve.
Prevention, Delaying the Onset and Slowing the Decline
…is the ability of the brain to physically change in response to stimulus and activity, to develop new neuronal/synaptic interconnections and thereby develop and adapt new functions and roles believed to be the physical mechanism of learning.
• Neuroplasticityrefers to structural and functional changes in the brain that are brought about by training and experience.
Prevention, Delaying the Onset and Slowing the Decline
High Intensity Strength Training
• Cardiovascular exercise makes the heart pump oxygen and nutrients to your brain • You produce BDNF (brain-derived neurotrophic factor) which gets it to sprout new cells • The brain produces endorphins (hormones) that act as mood elevators, analgesics and anti-inflammatories
All factors that impact brain health and slash Alzheimer’s risk.
Prevention, Delaying the Onset and Slowing the Decline
Examples of the Evidence for Prevention, Delaying Onset or Slowing Decline
Activity & Physical exercise• Physical activity slowed the normal rate of cognitive decline (40)• The evidence for a protective effect of moderate exercise on cognitive decline in elderly people is growing (138)• Studying 163,797 healthy people, 3,219 went on to develop dementia. Physical activity was inversely associated with risk of dementia – higher activity = lower risk. (160)• A meta-analysis demonstrated a significant association between physical exercise and a reduced risk of developing vascular dementia. (166)
Diet• Increased intake of vegetables is associated with a lower risk of dementia and slower rates of cognitive decline in older age. (194)• Low levels of the two B-vitamins, folate and vitamin B12, cause an excess of homocysteine in the blood. People with the highest levels of blood homocysteine had almost double the risk of AD and other dementias. (95)
Recommendation: 5 to 15 minutes of sunlight 2-3 times a week (10am – 3pm) arms and legs
Vitamin D activates more than 900 genes in human physiology, most of which are important for brain health. Low levels of vitamin D correlate with increased risk for multiple sclerosis, dementia, and Parkinson disease.
Prevention, Delaying the Onset and Slowing the Decline
Prevention, Delaying the Onset and Slowing the Decline
Retirement and Dementia
Adam et al 2013. Occupational activity and cognitive reserve: implications in terms of prevention of cognitive aging and Alzheimer’s disease. Clinical Interventions in Aging. 2013:8 377–390.
• The effect of retirement on cognitive functioning occurs with a delay of about one year post retirement. Cognitive scores in the elderly are better for countries in which the retirement age is higher. In other words, retirement negatively impacts cognitive functioning. • Cognitive aging is delayed by continuing to work and by undertaking regular charity or voluntary work. • All types of occupational activity have a positive effect on cognitive functioning, while mobility limitations and living alone had a negative association with cognition.
• The strongest positive association was observed for attending an educational or training course.
Prevention, Delaying the Onset and Slowing the Decline
Delaying onset of dementia with Brain TrainingA small study (n=8) of community-based individuals with MCI tested a multifaceted memory enhancement training (Rapp, Brenes, and Marsh 2002). It was comprised of six 2-hour meetings held weekly and also involved education, relaxation skills, and homework practice. At the 6-month follow-up the group had superior delayed list recall than the control group, suggestive of durable effects.
Rozzini et al. (2007) conducted a RCT with 59 individuals diagnosed solely with MCI. Cognitive training was based on a computerized software package and targeted multiple cognitive functions with increasing complexity. Participants completed 60 one-hour sessions of training over a period of 9 months. Three months after the end of training, episodic memory and abstract reasoning were significantly increased. This study therefore suggests an enduring effect of training…reduced levels of depressive symptoms and a significant reduction in behavioral disturbance. This trial therefore provides clinically relevant evidence that cognitive training may be useful in MCI.
RIPE Research Initiative for Preventative Education
• Prevention – Education and activities
• Research - Developing medical evidence for dementia prevention
• Potential Collaboration - Occupational Health at Sheffield Hallam University, the Sheffield Institute for Translational Neuroscience, University of Sheffield and the Alzheimer’s Society, Sheffield
• Day courses – Beat Camp for older people with memory concerns
• Respite - People with dementia
Prevention, Delaying the Onset and Slowing the Decline [email protected]
www.chalfontdesign.com
on Facebook - Dementia Beat Camp
Dementia
Preventing, Delaying onset or
Slowing decline
Social Interaction
Singing, Music and Dancing
Reducing stress and
blood pressure
Genetics(something you maybe
can’t change...?)
Walking, Aerobic Exercise, Gardening,Resistance Training
Brain Training(Cognitive
Stimulation)DIET – Brocolli, Spinach, Beetroot, Berries, Green Tea,
