CONSIDERATIONS WHEN ENGAGING THE COMMUNITY IN BRAIN HEALTH: Lessons Learned from Memory Screening and Memory Training

Transcription

1 CONSIDERATIONS WHEN ENGAGING THE COMMUNITY IN BRAIN HEALTH: Lessons Learned from Memory Screening and Memory Training Jan Dougherty, RN, MS Director, Family & Community Services Banner Alzheimer's Institute Learning Objectives: Describe the purpose of memory screening and memory training in the community Review appropriate materials in memory screening and memory training that consider cultural differences DISCLOSURE OF COMMERCIAL SUPPORT Jan Dougherty, RN, MS does not have a significant financial interest or other relationship with manufacturer(s) of commercial product(s) and /or provider(s) of commercial services discussed in this presentation. 1

2 Engaging the Community in Brain Health: Lessons Learned from Memory Screening and Memory Training Jan Dougherty, MS, RN Director, Family and Community Services Banner Alzheimer's Institute Phoenix, AZ Session Objectives Review the purpose of Memory Screening and Memory Training Programs in the community Discuss findings from both memory screening and memory training programs Outline lessons learned and future directions Why Memory Screening & Memory Training? Memory Screening Health screenings widely accepted for early detection (1,2) Brings low/no cost screening to a variety of community settings (2) Alzheimer s disease is the 2 nd feared illness by adults (3) Memory Training Significant increase in memory complaints with age Growing demand for brain health programming in the community (4) 66% of participants enrolled in BAI Memory Training program expressed concerns about developing Alzheimer's disease (unpublished study). Allows adults to learn more about normal aspects of age-related memory v. symptoms of Alzheimer s disease 2

3 Memory Screening Logistics Community based locations Community/senior centers; faith communities Reservations v. walk-ins 20 minute appointments Plan for walk-ins and give estimate of wait time to complete process Screening tool Montreal Cognitive Assessment (5,6) Process Identify DNP/MD students Train to perform/interpret cognitive testing Check in Screening evaluation Normal review Recipe for Brain Health Abnormal follow algorithm Participant Evaluation Sample of Memory Screening Participants (N=320; 9 sites) Age Range Mean Age Range Gender Consistent with MetLife Survey (2) 70% Females 30% Males Race 70% Caucasian 10% Hispanic 12% Asian 8% African American Years of Education Range 11.6± 3.32 to ± 2.57 Family History of AD Range 9.76** (mean) = **Chinese Senior Center 3

4 MoCA Scores Memory Screening Evaluation Highly rated by participants Comments include: I thought it was very helpful. I was worried at first, but I am glad I did it. Staff really nice. I find BAI very helpful and it is good to have this screening in the neighborhood. Interesting, as I forget words regularly. Good; helpful. Made me more confident that I am aging normally.. Very happy with experience. Very reassuring. Started me on the right path for assistance. Believe I would not do well, as is the case. Helpful; feel better about my memory now. A relief! I'm not as crazy as I thought. Excellent, informative - reinforces self worth Makes one realize how lazy I've gotten in thinking; especially what I did younger. Always wanted to know how my memory was or is or where I'm at. Memory Screening Limitations Participants with lower level of education or English as a 2 nd language are more likely to have lower scores Some authors have recommended adding functional assessment with cognitive assessment for more sensitive screening in these populations (7) Providing direction following the screening is essential Follow up with abnormal scoring participants is ideal 4

5 UCLA Memory Training Program 4-week, 2 hours/week Facilitated by 2 Memory Training Volunteers Community participants without cognitive impairment > age 50 Screened during enrollment (e.g. have you ever been told that you have Alzheimer s disease or Mild Cognitive Impairment?) Focus on improving memory related to: Items on a list Faces and names Numbers and dates New words Memory Training Process Secure location and trainers Advertise and enroll up to 20 participants/site Mail participants Memory Awareness Questionnaire Learning Style Assessment Facilitate 4-week program Weekly Skill Builders Complete program evaluation Brain Health Survey ( ) Program Survey Record Pre/Post Memory Assessment Questionnaire Progress chart for Memory Checks Memory Training Demographics Age range (mean = 77.8) Gender 63% female 37% male Years of education 39% High school 13% Associate s degree 30% Bachelor s degree 18% Master s degree or higher Self-rated health 23% Excellent 35% Very good 36% Good 6% Fair 5

6 Memory Training 2011 Findings: 18 sites N=213 Reason for Taking Class Performance Scores Memory Assessment Questionnaire 10% decrease in memory concerns 2 sites reported an increase in memory concerns both sites had older participants Memory Checks 42.3% improvement overall (even in sites that reported more memory concerns post MT program) 6

7 Participant Comments I found that the most important thing to remember is to focus, concentrate, do one thing at a time, slow down. I loved the class very much. It made me realize there are things I can do to help my memory that I wasn't doing. I thought the instructors were so interesting and comfortable to work with. The people in the group were great! Many new concepts to consider; find that with practice concepts work. New ideas for memory. Want to learn more about how to keep and improve my memory. I have already applied grouping connecting and stories to my memory and leave the course with a better brain than when I started. My husband and I plan on learning Spanish next using the Rosetta Stone. We will continue to keep learning. Took class with my Mom to give her confidence to come. The class definitely boosted my own skills in remembering things and brought a new awareness. It refreshed my mind and gave me hope, though I am 86 years of age. Program Limitations In retirement communities, older participants were more likely to struggle and drop program (likely MCI/early AD) Program geared for largely educated English speaking population and needs adaptation for making more culturally sensitive Piloted in Spanish, Chinese Offered in Native American seniors Added Normal Age-related Memory v. Symptoms of AD to 1 st class to allay fears Works only short-term memory issues Conclusion Both Memory Screening and Memory Training Programs are highly sought out by community dwelling adults Bringing free/affordable programming to the community is necessary Cultural considerations are essential for both programs There will continue to be a demand for both programs 7

8 References 1. Crews, WE, Harrison, DW, et al. (2009). The Memory Screening Outreach Program: Findings from a Large Community-Base Sample of Middle-Aged and Older Adults. Journal of the American Geriatrics Society 57: Memory Screening: Who Attends and Why, MetLife Foundation, October 2006, 3. What America Thinks: MetLife Foundation Alzheimer s Survey, February 2011, 4. Small, G. The Memory Prescription (2004). The Memory Prescription. New York: Hyperion. 5. The Montreal Cognitive Assessment Damian, AM et al. (2011). The Montreal Cognitive Assessment and the Mini-Mental State Examination as Screening Instruments for Cognitive Impairment: Item Analyses and Threshold Scores. Dementia and Geriatric Cognitive Disorders, 31: Tappen, RM et al. (2001). Use of the MC-FAQ and MMSE-FAQ in Cognitive Screening of Older African American, Hispanic Americans, and European Americans. Journal of the American Geriatrics Society 49: