In recent years the treatment of dementia in nursing homes has gone from a medication-intensive regimen ruled almost completely by intense psychiatric medications such as Thorazine to a flurry of low-cost ideas that staff members can implement in a harried environment to lessen the pain residents feel as they slowly lose touch with reality. To help nursing home employees keep up, the John A. Hartford Foundation and the University of Rochester School of Nursing are working with area nursing homes to explore new ways to ease dementia among residents.
"There's a lot that can be done to improve the quality of life for people in nursing homes who have dementia. There are a lot of simple measures, a lot of low-tech, inexpensive tools that nursing assistants in nursing homes can do to improve the lives of residents," says Nancy Watson, Ph.D., director of the Center for Clinical Research on Aging at the nursing school.
A good example is a simple water bottle. Linda Buettner, Ph.D., author of Simple Pleasures and the featured speaker at last week's gathering, has found that giving an agitated resident a warm fleece-covered water bottle often reduces screaming and keeps the person calm for an average of 40 minutes. She's also found that fleece muffs on the hands also help sooth a person.
At one Rochester nursing home, staff members encourage residents to create memory boxes of items that focus on past events, weddings, jewelry, or gardening, as a way to stave off the effects of dementia, remember happy times in their lives, and even provoke conversations among residents.
Other ideas developed or implemented in Rochester nursing homes recently include exercise programs, pet therapy, the telling of one's life story, sing-a-longs, art therapy, guided imagery, and even bowling within the nursing home as a way to keep people connected and calm.
Another recommendation is a specially designed "wandering cart." Instead of struggling with agitated residents who want to commandeer medication or food carts in nursing homes, Buettner encourages workers to make available to residents their own carts they can push around, maybe equipped with snacks for residents, booklets, or other harmless items.
"There are some therapies out there, like music or massage therapy, but they're not utilized to the fullest," says Watson. "Other than medications, there aren't a lot of well established approaches to helping people with behavioral problems in nursing homes. But there are a great many little things we can do. There are resources available – but for very busy and understaffed nursing homes, it can be really difficult for workers to find the time to use them. We're trying to link workers with simple, inexpensive methods to improve the lives of residents."
It was more than 25 years ago that Watson began working with older people, and she quickly realized that nursing homes weren't simply a place where older people live; she saw that many had significant dementia. More than half of nursing home residents –some estimates top 80 percent – have dementia, and she was an author on the first study, in 1984, to point out that nursing homes were caring primarily for people who are cognitively impaired.
"Back when I started, Alzheimer's disease wasn't well recognized, and most people with dementia were treated with heavy-duty medications, reality therapy, and restraints. Now there are newer medications that have fewer side effects, and there is greater medical understanding of Alzheimer's and other causes of dementia. But mainly, people are generally medicated less, and worked with more intensively."
Any nursing home worker is familiar with a resident searching for the front porch of a house long since gone, or for a family member who died decades ago. Sheer terror of ordinary items, pacing back and forth, sobbing in a corner, throwing things at other residents or employees – these events happen every day in nearly every nursing home as people age and their brains simply fail to guide them.
While Alzheimer's is the most common cause of dementia in residents of nursing homes, there are many other causes, including alcohol abuse, Parkinson's disease, cardiovascular problems, and infectious disease. It was Watson who, six years ago, led a study that showed that simply rocking in rocking chairs helps ease anxiety and depression among nursing home residents with dementia. Since then rocking therapy has been implemented in nursing homes around the country. The group has also explored the use of humor as a way to help people with dementia who are upset. And her group has identified those residents with dementia who are most likely to have dramatic emotional breakdowns – people who are still aware enough to realize they are losing their ability to function.
"This is a population where there are a lot of little things that can be done that mean a lot to them. Simple pleasures. For a woman, that might include combing her hair and putting on some makeup and letting her look at herself in a mirror, or helping her put on hand lotion and having her smell it. For a man, it could be taking him outdoors for a walk if that's something he has loved doing all his life. You can do so many little things that make so much difference in their quality of life. Unfortunately, we don't provide enough support to nursing homes to allow the staffing that would be needed for everyone to receive such treatment."
For more information about the Hartford Community Initiative and to check out some of the techniques now being used in nursing homes to work with people who have dementia, visit www.dementianursing.org.