The Art of Mindfulness: Cultivating Wellbeing

Transcription

1 The Art of Mindfulness: Cultivating Wellbeing Lucia McBee, Laura Peters, Kimberly Coder Leading Age Conference 2016 Session 145-C Indianapolis, IN

2 The Art of Mindfulness: Cultivating Wellbeing Laura Peters, MA, PHR Human Resources Development and Learning Manager, Kendal at Ithaca, NY Lucia McBee, LCSW, MPH, CYI Author of Mindfulness-Based Elder Care, Consultant, New York City Kimberly Coder, LSW Social Services Director, Barclay Friends, A Kendal Affiliate in West Chester, PA

3 Agenda What is mindfulness? How does it work? What are the research outcomes? How can we bring it home? Practice Q & A

4 Dr. Jon Kabat-Zinn Mindfulness-Based Stress Reduction 1979 Bill Moyers Healing and the Mind 1993 Lucia McBee Dr. Richie Davidson Center for Healthy Minds U-WI Madison Minutes 2015

5 What is Mindfulness? Paying attention on purpose in the present moment nonjudgmentally --Dr. Jon Kabat-Zinn, Founder of Mindfulness-Based Stress Reduction

6 Mindfulness Practice: 3 deep breaths

7 How mindfulness works: Fight or Flight Sympathetic Nervous System Gas Rest and Digest Parasympathetic Nervous System Brake

8 What can mindfulness do? Physical: Decrease chronic pain Lower blood pressure Improve sleep Improve digestion Strengthen resilience to stress Boost immune system

9 What can mindfulness do? Emotional: Decrease anxiety, depression, ease grief Strengthen impulse control: anger management weight loss, addictions Enhance communication: self-awareness, empathy, teamwork

10 What can mindfulness do? Intellectual: Improve cognitive function Strengthen focus Improve decision-making

11 MINDFULNESS: THE EVIDENCE PERSONAL HISTORICAL EMPIRICAL

12 PERSONAL EVIDENCE: THE MIND BODY CONNECTION

13 THREE MINUTE BREATHING SPACE 1. Awareness: what is my experience right now? 2. Gathering: focus on the breath. 3. Expanding: including the entire body in awareness. Segal, Williams, and Teasdale Mindfulness-Based Cognitive Therapy for Depression (2002)

14 MECHANISMS OF MINDFULNESS Attention regulation Sustaining attention, and returning Body awareness Physical sensations Emotion regulation Reappraisal (non-judging awareness) Exposure, extinction, reconsolidation Sense of self Dis-identification with static sense of self Compassion (Holzel et al. 2011)

15 HISTORICAL EVIDENCE Based on Buddhist and yogic practices Origins pre AD, approximately 2500 years Continuously practiced and refined since origins All major spiritual traditions include contemplative practice

16 MINDFULNESS: EMPIRICAL EVIDENCE The growth in mindfulness research from Results from a search on the term "mindfulness" at the ISI Web of Science database.

17 MINDFULNESS: KEY STUDIES Improvements in immune system and brain post MBSR group (Davidson et al, 2003) Increase in brain s grey matter (governs sensory perception such as seeing and hearing, memory, emotions, speech, decision making, and self-control) following 8 week MBSR class (Holzel et al, 2011) Decrease in cellular aging and disease protection: Increase in telomeres (Epel et al, 2009) For all studies on mindfulness, visit:

18 STOP S- Stop what you are doing T- Take a breath O- Observe how you are feeling P- Proceed with what you were doing

19 Mindfulness skills o Get off auto-pilot o Bring attention to the present moment o Build capacity to focus in an environment of information overload o Accept ourselves and others with compassion

20 Mindfulness-Based Stress Reduction 1979 Jon Kabat-Zinn founds Stress Reduction Clinic University of Massachusetts Medical Center

21 Mindfulness-Based Stress Reduction Class: 4 main components 1. Teaching from one s own practice 2. Mindfulness practices: sitting, body scan, yoga, walking 3. Education on research outcomes 4. Support Group

22 Customizing the Class Mindfulness-Based Stress Reduction 8 weeks of 2.5 hour classes Kendal at Ithaca Mindfulness for Stress Reduction 6 weeks of 1 hour classes 45 minutes daily practice 10 minutes daily practice (gradually increasing) Homework Handouts-voluntary General population Day-long retreat Tailored to older adults and their caregivers Weekly 30-minute drop-in sitting meditation

23 Kendal at Ithaca class demographics 20% of community completed since 2012 (25 classes) 2/3 residents, 1/3 staff Age range: 20s to 90s 4-12 people per class Unassisted/cane/walker/wheelchair Gender Men Women

24 Kendal at Ithaca Stories

25 Mindfulness Practice: Yoga

26 MINDFULNESS BASED INTERVENTIONS FOR ELDERS AND CAREGIVERS: THE RESEARCH

27 NEED FOR NEW MODELS OF MEDICINE Improvements in acute care decrease in death from acute illness = population living longer with 1+ chronic conditions Treatment of chronic conditions is symptom management not cure New models of care: palliative and CAM/integrative

28 PHYSICAL AND EMOTIONAL BENEFITS Review of 15 peer-reviewed, quantitative studies support feasibility and acceptability of MBSR for older adults (Geiger et al, 2015) Mindfulness interventions decrease: Psychological distress (Young & Baime, 2010). Sense of loneliness and pro-inflammatory gene expression in elders (Creswell, et al, 2012) Lower back pain (Morone, Greco & Weiner, 2008) Depression (Helmes & Ward, 2015) Blood pressure (Palta et al, 2012)

29 COGNITIVE BENEFITS Meta analysis of 7 studies suggest a positive effect of meditation techniques on cognitive functions in the context of aging and neurodegenerative diseases (Marciniak, et al. 2014) Meta-analysis of 12 studies indicates meditation for older adults feasible and may prevent cognitive decline (Gard, Holzel & Lazar, 2014) MBIs have been shown to increase telomere activity, and hold potential to thus impact cognitive decline (Sapozhnikov, 2015)

30 MBSR FOR ELDERS WITH MCI MBSR and other Mindfulness Based interventions with modifications are teachable to elders with MCI (Mild Cognitive Impairment) and demonstrate: Improved cognition, memory and wellbeing (Wells et al, 2013; Hyer, et al, 2013; Sapozhnikov, 2015; Larouche, Hudon & Goulet, 2015)

31 MINDFULNESS BASED INTERVENTIONS for ELDERS WITH ALZHEIMER S DISEASE Large control group 2 year study compared cognitive stimulation, progressive relaxation and mindfulness interventions for elders with probable AD (Canary Islands) Participants in groups with mindfulness remained stable in cognition, functionality and behavioral problems Participants in 2 control groups declined in these areas (Hernández et al, 2014; Hernández & Barrachina, 2015).

32 MBEC participants show improved quality of life and trends towards improved pain CDs and homework not feasible Attendance irregular Ongoing group more successful than time limited group (McBee et al, 2004) MINDFULNESS GROUPS FOR INSTITUTIONALIZED ELDERS Elders who completed MBSR showed improvements in mood and health related quality of life (60% drop out, homework not feasible) (Ernst et al, 2008)

33 QUOTES Makes me feel at peace with the world. It helps my whole body and spirit. I forgot all my troubles. I ve always liked this [group] since I started.. being quiet, relaxed.. a special feeling. I feel more alive in spite of the pain I feel uplifted. I realize we all have pain. We talk about how we are getting along. It is important to be with other people. (McBee, 2008)

34 STOP S- Stop what you are doing T- Take a breath O- Observe how you are feeling P- Proceed with what you were doing

35 Mindfulness Based Elder Care: OVERVIEW Connect- with each person, regardless of disability or impairment Communicate- create novel, non verbal ways of communication Care for the caregivers- bringing stress reduction skills to all persons engaged with elders

36 MBEC APPLICATIONS FOR ELDERS Groups for nursing home residents with physical and cognitive disabilities Groups for elders with moderate-severe dementia and behavioral problems 1:1 with isolated elders MBEC by telephone

37 TEACHING ADAPTATIONS Shorter groups Simplified language Increased repetition Imagery simplified with use of key words Stretches, meditations and other exercises modified for elders Verbal, visual and physical cuing

38 ENVIRONMENTAL ADAPTATIONS Creating a calming milieu Aromatherapy Music

39 The most important factor is the teacher A calm demeanor Flexibility Acceptance

40 TEACHING MEDITATION TO FRAIL ELDERS Shorter practice time More directive, less quiet time Repetition Concrete language Consider tone of voice Use visual cues

41 YOGA Meditation in movement Learning to listen to our body Breathwork is also yoga Working with abilities not disabilities Exploring our limits (edges) Becoming stronger, more flexible and more balanced

42 ADAPTING YOGA FOR FRAIL ELDERS Postures can be adapted for wheel chair or bedbound Demonstrate visually Give hands on guidance Remind elders to breath Focus on what elders can do!

43 ADAPTING YOGA For caregivers Postures can be integrated into daily life Standing and seated mountain pose Diaphragmatic breathing For both elders and caregivers Teach a reconnection with the body Be positive and have fun

44 DIAPRAGMATIC BREATHING

45 STOP S- Stop what you are doing T- Take a breath O- Observe how you are feeling P- Proceed with what you were doing

46 CARING FOR THE CAREGIVERS Emphasize importance of stress reduction For physical and mental health For communications with care receiver Consider short meditations and those that can be integrated into a busy life Integrate meditation that can be used while caregiving

47 MBEC FOR CAREGIVERS Staff stress reduction offerings One, one hour in-service for entire staff Seven session class for interdisciplinary staff on two units Wellness coordinator offering stress reduction Family and friend caregivers Nursing home residents and caregivers together

48 QUOTES FROM STAFF The deep breathing was so soul searching and relaxing. It makes me more aware of myself. I appreciate taking the time during the day when it s stressful, to learn ways to come back to a state of equilibrium. I know how to control myself when I feel nervous and angry. I am pretty flexible for my age. I like myself.

49 TREVISO (Italy) ELDER CARE MODEL (ISRAA) AN INTEGRATIVE APPROACH TO ELDER CARE 850 residents, 4 facilities, 27 care units, 2 day care centers, 1 Specialized Dementia Centre, 32 independent living flats 690 staff, Budget 30 million MODELED ON: Person Centered Care (Kitwood) Alzheimer Cafè (B. Miesen) Ambiguous Loss (P. Boss) Mindfulness-based elder care (McBee) Mindful Ageing, Family Systemic Model, Age friendly community (World Health Organization)

50 The most important intervention we can bring to our elders is our selves- who we are in each moment. - McBee

51 How to Bring Mindfulness to Your Communities: A Beginner s Perspective

52 The Start of Mindfulness at Barclay Friends, Kendal Affiliate Wellness Committee for Staff - Weight Loss Group and Guided imagery - Roving Meditation In-services (5-10 minutes) Compassion Fatigue and Self- Care In-Services - Education: Symptoms and Prevention - Self-reflection of current and desired lifestyles - Mindfulness Practices

53 Modified Mindfulness Practices and Tools for Direct Care Staff 5-10 minute guided meditation Deep breathing exercises Mindful eating exercises Use of reflection to set intentions Creating a Maintenance Self- Care Plan: Assessing mind, body, emotions, and spirit Informal visualization of happy place for stressful times

54 From Informal Practice to Formal Mindfulness Meditation Groups Support from your Executive Director and Wellness Program Determine who will facilitate the groups Facilitator training and daily practice Determine who will be included: staff, residents, and/or family members

55 Qualifications and Training Mindfulness-Based Stress Reduction (MBSR): 8 Week courses which were originated by Jon Kabat- Zinn at the University of Massachusetts Certification Programs: Durations vary although many are one year training programs MBSR and certification programs are typically offered at universities and hospital systems Local meditation and yoga centers

56 Barriers and Feedback Too much noise: Choose your setting wisely. Too busy: Consider the duration of your group. You re going there? Expect some judgment from others.

57 Let s Pause for a short guided meditation 1) Notice the sensation of breath 2) When your mind wanders, bring your attention back to your breath

58 Resident-Centered Groups: Structure and Plan Consider varying degrees of cognitive ability Consider location of group(s) offered and accessibility for your residents Will you offer different groups for different levels of care or offer inclusive groups?

59 Resident Groups at Barclay Friends Monthly groups are offered in both our skilled nursing and personal care communities Residents from either community may decide to attend both groups Group times/locations are announced on both recreation calendars

60 Guided Imagery with Sensory Components

61 Benefits to Residents Fosters a sense of community and belonging Cultivates a feeling of security and safety Greater acceptance of aging Stress management Pain management Connection to higher power and spirituality Reminiscing and reflection

62 Put on your own oxygen mask first!

63 While stress is contagious, a relaxed attitude is also contagious. You can be a powerful source of change just by taking steps to reduce your stress!

64 Contact information Lucia McBee, Consultant, Author of Mindfulness-Based Elder Care Laura Peters, Human Resources Development and Learning Manager, Kendal at Ithaca Kimberly Coder, Social Services Director, Barclay Friends, A Kendal Affiliate Kcoder@bf.kendal.org

65 Appendix

66 Benefits for Nursing Staff Improve assessment skills Reduce errors when administering complex procedures Improve listening skills Enhance communication through higher level of empathy, self-awareness, and non-reactivity Increase resilience to stress Source: American Nurse Today, Sept

67 Aetna Mindfulness Class Outcomes 13,000 employees (25%) 2011 to date completed free meditation/yoga classes at Aetna Stress level: 28% reduction Sleep quality and pain: 20% improvement Reduced rates of heart rate variability and cortisol (markers of stress) validated self-reports Efficiency gain: 62 min./week $3,000/employee/year 2012: health care costs dropped 7% (11:1 ROI)

68 Health care funding implications Mark McLellan, Director of the Robert J. Margolis Center for Health Policy and Margolis Professor of Business, Medicine and Health Policy Duke University 2015 Leading Age Conference Presentation Health care financial reform to align payments with value at the person level Innovation toward personalized, prevention-oriented care

69 Meditators Steve Jobs Bill Ford Google Search Inside Yourself, Leadership Institute (SILYI) General Mills Institute for Mindful Leadership: Janice Marturano clients include Centers for Disease Control, Mayo Clinic BlackRock Financial Services Aetna U.S. Marines M-Fit (Mindfulness-Based Mind Fitness Training) U.S. Olympic Rowing Team, Seattle Seahawks, Boston Celtics UCSF Law students-prof. Rhonda Magee

70 When you re mindful, you re aware of your presence and the ways you impact other people.and that prevents you from slipping into a life that pulls you away from your values. Bill George, Harvard Business School professor