Health and Wellbeing in Later Life

Transcription

1 Health and Wellbeing in Later Life Dr. Garuth Chalfont PhD ASLA Director of RIPE and Chalfont Design INTRODUCTION Dementia Green Care What does Therapeutic mean? Principles & Benefits Activities & Environmental Design Dementia Prevention Risk Factors Evidence RIPE & Dementia Beat Camp Talk given to LWDP, Bamber Bridge December 9th 2014 Chalfont Design Taking care outside

2 Therapeutic means... Reducing needs through an enabling environment Improving quality of life for all levels of need Maintaining and improving skills Agreed set of aims with measurable outcomes

3 Dementia Green Care Making best use of nature and outdoors GARUTH CHALFONT GARUTH CHALFONT GARUTH CHALFONT

4 Dementia Green Care The Principles 1. Nature-based activity and best use of the outdoors 2. Therapeutic benefits for people with dementia - and everyone else involved 3. Evidence-based on research findings 4. Importance of Place and an enabling environment

5 Therapeutic benefits for people of nature and outdoors Therapeutic benefits

6 What people need Pleasure, enjoyment, relaxation 2. To maintain skills 3. Physical activity and exercise 4. Meaningful occupation 5. Visiting and social interaction 6. Caring for something living 7. Escape from indoors 8. Peace and quiet 9. Sensory stimulation 10. To keep the spirit alive Therapeutic benefits

7 Engagement Occupation Purpose Being needed Therapeutic benefits

8 Enabling environment of people and place For supported use Therapeutic benefits

9 Enabling environment of people and place For independent use Therapeutic benefits on Facebook - Dementia Beat Camp

10 Taking people outside or encouraging them to go independently GARUTH CHALFONT GARUTH CHALFONT GARUTH CHALFONT Enabling activity Independent & Supported Therapeutic benefits

11 Having a Sense of Purpose by doing proper jobs and real work Therapeutic benefits

12 Seasonal familiar plantings - useful, edible or beautiful GARUTH CHALFONT GARUTH CHALFONT GARUTH CHALFONT Therapeutic benefits

13 Rhubarb! Fruit-kabobs! Therapeutic benefits

14 GARUTH CHALFONT GARUTH CHALFONT GARUTH CHALFONT Animals as Pets Therapeutic benefits

15 Wildlife habitat Interactions with Wildlife Nature stimulates. Therapeutic benefits

16 Food & parties outside Therapeutic benefits

17 Therapeutic benefits Movement, Sport & Exercise

18 Care Farming UK Care Farms This one is for older people in the Netherlands Therapeutic benefits

19 Grow your own Place as enabling Access Therapeutic benefits Edibles

20 Chores DIY Memories Place as enabling Therapeutic benefits

21 Creativity Art & Nature Therapeutic benefits

22 Nature Indoors Art & Nature Therapeutic benefits

23 Creativity overlaps in the Garden Art & Nature Therapeutic benefits

24 Use of outdoor structures Greenhouse, gazebo, raised beds, window boxes, staging and a poly-tunnel Meaning & Purpose Therapeutic Design

25 Connect inside rooms with outdoor uses Getting People Outside Therapeutic Design

26 Research findings on the benefits of nature and the outdoors for people with dementia Nature and being outdoors provides sensory stimulation and improves orientation, circadian rhythms, blood pressure, attention, talkativeness... and it reduces agitation and aggression.

27 Research findings on the benefits of nature and the outdoors for people with dementia GARUTH CHALFONT GARUTH CHALFONT GARUTH CHALFONT Benefits of exercise and movement include improved sleep patterns, mood, memory, behaviour, appetite, strength, agility, balance and delayed onset of dementia.

28 Spiritual connection to the life force through access to the living world Therapeutic benefits

29 Physical activity Exercise (Strength, balance, agility, cardiovascular health, stress relief) Connection to nature Sensory stimulation (Heart, spirit, memory ) Dementia Green Care Cognitive stimulation Occupation (Re-skilling & neuroplasticity) Fresh air Sunshine (Better sleep & heartier appetite) Nature and Outdoors Grow your own food Healthy Eating (Improved diet, nutrition & awareness) Social interaction (Identity, relationship, personhood) Animals and Art (Creativity, empowerment & emotion) Nature-based therapeutic activity or stimulation (Outcome or benefits)

30 Some Evidence for Nature Activities and Dementia Int J Geriatr Psychiatry 2008; 23: effective for sleep, agitation, and cognition Y. Lee and S. Kim Effects of indoor gardening on sleep, agitation, and cognition in dementia patients Canadian Journal on Aging Vol 24 Iss 04 Winter 2005, higher levels of productive engagement and positive pp Gigliotti & Jarrott Effects of affect and lower levels of non engagement Horticulture Therapy on Engagement and Affect Journal of Therapeutic Horticulture D Andrea, et al. Effect of HT on Preventing the Decline of Mental Abilities of Patients with Alzheimer s Am J AlzDis Other Dementias Dec, 2010 Jarrott & Gigliotti Comparing Responses to Horticultural Based and Traditional Activities in Dementia Care Programs 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. Psychiatry Investig 2012;9: Detweiler et al What Is the Evidence to Support the Use of Therapeutic Gardens for the Elderly? ournal of Clinical Nursing, 2014, 23(19 20): Gonzalez & Kirkevold Benefits of sensory garden and horticultural activities in dementia care: a review overall higher functional level than the control group higher levels of active, passive, and other engagement cognitive stimulation training, exercise, music, art, and horticultural therapy. Significant differences were found in cognitive function, depression levels, and mental emotional health. attention, lessening of stress, modulation reduction of pain, improvement of agitation, lowering of PRN medications and antipsychotics and reduction of falls may improve well being and affect and reduce the disruptive behaviour. use of psychotropic drugs, falls, sleep and sleep pattern also seem to improve.

31 Dementia Prevention GARUTH CHALFONT Dementia Beat Camp GARUTH CHALFONT The s of Prevention GARUTH CHALFONT Delaying the onset and Slowing the decline!

32 Dementia Prevention Retirement Risk Factors Diabetes Obesity CVD Smoking Poor sleep Poor diet Stress Unresolved trauma Depression Head injury Other factors. Prevention, Delaying the Onset and Slowing the Decline

33 Dementia Prevention Evidence Activity & Physical Exercise Diet & Supplements Cognitive Stimulation Reduced Stress Meditation Improved Sleep Social Interaction Connection to Nature Prevention, Delaying the Onset and Slowing the Decline

34 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. Neuroplasticity... Neuroplasticity refers to structural and functional changes in the brain that are brought about by training and experience. Prevention, Delaying the Onset and Slowing the Decline

35 Prosentia Hypothesis A NATURE B PERSON PERSON Brain Training & Sensory stimulation promote Neuroplasticity Prevention, delaying onset, slowing decline Prevention, Delaying the Onset and Slowing the Decline

36 Dr. Jeffry Life 72 years old Sport, Exercise and Socialising 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

37 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) Prevention, Delaying the Onset and Slowing the Decline

38 Diet Prevention, Delaying the Onset and Slowing the Decline

39 Evidence Diet Prevention, Delaying the Onset & Slowing the Decline

40 Why do we need it? Vitamin D The Sunshine Vitamin Calcium & Vit D = strong bones & teeth Cancer prevention, Cardiovascular disease, Diabetes, Hypertension (high blood pressure), Mood disorders, Multiple sclerosis, Psoriasis, Tuberculosis etc. Prescribed specifically for older people for: Improved Cognition Falls prevention Fracture prevention Osteoporosis Muscle weakness or Pain Physical performance Rheumatoid arthritis Senile warts Vitamin D3 and calcium prevent hip fractures in the elderly women Chapuy, 1992 NEJM showed reduction in fractures. 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. Recommendation: 5 to 15 minutes of sunlight 2-3 times a week (10am 3pm) arms and legs Prevention, Delaying the Onset and Slowing the Decline

41 Capetown, South Africa Barefoot Park, Kew Gardens Barefoot walkers on their weekly 7km walk on the Trentham Estate, Stoke-on-Trent they have mud, bark, babbling streams, logs, hay, grass, pebbles and more Grounding National Trust, Cornwall Barefoot walkers

42 Retirement and Dementia 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. Adam et al Occupational activity and cognitive reserve: implications in terms of prevention of cognitive aging and Alzheimer s disease. Clinical Interventions in Aging. 2013: Prevention, Delaying the Onset and Slowing the Decline

43 Delaying onset of dementia with Brain Training A 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 followup 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. Prevention, Delaying the Onset and Slowing the Decline

44 Recovery from Cognitive Disturbance aided by Horticultural Therapy Kenshi Nishino HTR.M.D. Ph.D. Fukuoka, Japan October 2010 Location of Kenshi s five year study in Japan Kenshi and Garuth at the AHTA conference in Philadelphia, USA in October Prevention class for lifestyle related diseases 2. Prevention class for dementia 3. Early to middle stage dementia 4. Care House and 5. Group Home

45 Aerobic exercise Three central pillars Mental Activity Communication

46 Result 70% of MCI and Mild AD reverted to normal after 24months. 90% of MCI and Mild AD reverted to normal after 45months. (3 did not continue participating because of physical problems) Before 4 24mon. 1 45mon Normal MCI & Mild AD Normal MCI & Mild AD Normal MCI & Mild AD

47 RIPE Research Initiative for Preventative Education Sheffield S10 Healthy living through learning Evidence-based Education & Training Personal Empowerment Therapeutic for Mind, Body & Spirit Place-based Charitable Social Enterprise An educational initiative to train older people to stay physically and mentally fit

48 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

49 Dementia Beat Camp TM Singing, Music and Dancing DIET Brocolli, Spinach, Beetroot, Berries, Green Tea, Cocoa, Coffee, Salmon, Red Wine... Social Interaction Preventing, Delaying onset or Slowing decline Reducing stress and blood pressure Brain Training (Cognitive Stimulation) Antioxidants, Vitamins D, B6, B12, Folic Acid, Quit smoking Walking, Aerobic Exercise, Gardening, Resistance Training Genetics (something you maybe can t change...?)

50 Good Luck! 1. Dementia Green Care 2. Dementia Prevention Dementia Green Care Handbook download from Find Dementia Beat Camp on Facebook