ATRA Webinar: Older Adults Brain Fitness Laura Kelly, MS, CTRS Learning Objectives 1. Identify current aging trends and potential implications on the Recreational Therapy profession 2. Articulate evidence based literature supporting Brain Fitness interventions as an effective modality to treat older adults with varying cognitive abilities. 3. Understand the APIED process for providing Brain Fitness programming across older adult settings. 1
2
RT Implications The Aging Brain Marin s Model of Apathy Apathy occurs in 70% of Alzheimer s disease patients within five years of diagnosis (Boyle & Malloy, 2004) (Buettner et al., 2011) 3
Brain Fitness RCT (Buettner et al., 2011) Brain Fitness 2x/week x 60 minutes x 4 week MMSE 18-28 scores Significantly lower apathy scores (MSA 3.9-, Control 5+) QOL improved for both groups (MSA 8.62+, Control 1.9+) MMSE scores (MSA 1+, Control 1-) PHQ 9 (MSA 1.39-, 1.82+) Cognitive Training for Early-Stage Alzheimer s Disease Literature Review- 30+ Articles RCT-cognitive stimulation- 86 patients with mild AD improved MMSE (from 22.95 to 24.45) RCT- cognitive training- 37 patients with early stage AD 5 weeks, home 30 minutes, 6x/week, improved MMSE (23.50 to 24.33) RCT- Cognitive Stimulation/Life Story, 54 adults mild to mod AD, 1-1.5 hours 1x/week x 8 weeks, slower decline in MMSE, less irritability, less apathy, and improved QOL (Fang et al., 2009) Brain Fitness Computer Games 42 healthy older adults 6 days a week for one hour ( 3 days at home) BF training did transfer to fluid ability remodeled brain connectivity impacting everyday functioning Auditory perception training Brain Fitness (Strenziok, M. et al., 2014) 4
Settings Nursing Homes Independent Living, Assisted Livings Rehabilitation Home Senior Centers / Day Programs Client Selection NOT ABOUT IMPROVING MEMORY 5
Mini Mental State Exam HIGH up to 20 participants MMSE 20-30 MODERATE up to 14 participants MMSE < 20 LOW up to 4 participants per staff member MMSE < 10 http://www4.parinc.com/products/product.aspx?producti D=MMSE#Items SLUMS Scoring High School Education < High School Education 27-30 21-26 1-20 Normal Mild Neurocognitive Disorder Dementia 25-30 20-24 1-19 SH Tariq, N Tumosa, JT Chibnall, HM Perry III, and JE Morley. The Saint Louis University Mental Status (SLUMS) Examination for detecting mild cognitive impairment and dementia is more sensitive than the MiniMental Status Examination (MMSE) - A pilot study. Am J Geriatr Psych 14:900-10, 2006. 6
Assessment Considerations PHQ-9 Geriatric Depression Scale Apathy Evaluation Scale Cornell Brown Quality of Life UCLA Loneliness Scale Supplies Program Planning 7
Program Planning Steps 1. Greeting 2. Education/ Information/ Announcements 3. Getting the Body Ready 4. Easy Mental Warm-ups 5. Brain Exercise Categories Implementation Adaptations Determine weekly dates and times Environmental considerations Physician Order 2-20 minutes per exercise Homework for moderate level Evaluation Was the level appropriate for client? Was the patient successful? Visual/ Hearing/ Communication / Behaviors Consider client: staff ratio 4 weeks administer assessments Discharge process if appropriate 8
Documentation Coming to the Brain Fitness Club is the highlight of my week. I feel I can focus better since I ve been coming to the Brain Fitness club. This is the only place I feel I can really talk about what this Alzheimer s is like. I have new friends who understand what I m going through. No one here says, I already told you that. (ICAA Innovators, 2014) Marketing Word of Mouth Clients/ Families Receptionist Physician Nursing IDT Speech Therapy Referrals Hospital Liaison Administration Community Connections References http://www4.parinc.com/products/product.aspx?productid=mmse#items SH Tariq, N Tumosa, JT Chibnall, HM Perry III, and JE Morley. The Saint Louis University Mental Status (SLUMS) Examination for detecting mild cognitive impairment and dementia is more sensitive than the MiniMental Status Examination (MMSE) - A pilot study. Am J Geriatr Psych 14:900-10, 2006. https://agingstats.gov/docs/latestreport/older-americans-2016-key-indicators-of- WellBeing.pdf Fitzsimmons, S. (2008). Brain Fitness: An Instructor s Manual of 150 Exercises for People with Low to High Cognitive Function. Venture Publishing, Inc. State College, PA. Buettner, L., Fitzsimmons, S., Atav, S., Sink, K. (2011). Cognitive Stimulation for Apathy in Probable Early Stage Alzheimer s. Journal of Aging Research. 1-6. P. A. Boyle and P. F. Malloy, Treating apathy in Alzheimer s disease, Dementia and Geriatric Cognitive Disorders, vol. 17, no. 1-2, pp. 91 99, 2004. 9
References Fang, Y., Rose, K., Burgener,S., Cunningham, C., Buettner, L., Beattie, E., Bossen, A., Buckwalter, K., Fick, D., Fitzsimmons, S., Kolankowski, A., Pringle Specht, J., Richeson, N., Testad, I., & Mckenzie, S. (2009). Cognitive Training for Early Stage Alzheimer s Disease and Dementia. Journal of Gerontolocial Nursing. 35 (3), 23-29. ICAA Innovators. (2014). The Brain Fitness Club: A Strengths Based Program Supports Individuals with Early Memory Loss. The Journal of Active Aging. 42-45. Yu, F, Rose, K, Burgener, S, Cunningham, C, Buettner, L, Beattie, E, Bossen, A, Buckwalter, K, Fick, D, Fitzsimmons, S, Kolanowski, A, Specht, J, Richeson, N, Testad, I, & McKenzie, S. (2009). Cognitive training for early-stage Alzheimer's disease and dementia. Journal of Gerontological Nursing, 35 (3), 23-29. QUESTIONS 10