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Experiences Matter: The Science Of Using Therapeutic Activities As Interventions For Neuropsychiatric Symptoms Linda L.

Experiences Matter: The Science Of Using Therapeutic Activities As Interventions For Neuropsychiatric Symptoms Linda L. Buettner, PhD, LRT, CTRS. Physician ordered Individualized Time limited treatment with goals

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Experiences Matter: The Science Of Using Therapeutic Activities As Interventions For Neuropsychiatric Symptoms Linda L.

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  1. Experiences Matter: The Science Of Using Therapeutic Activities As Interventions For Neuropsychiatric Symptoms Linda L. Buettner, PhD, LRT, CTRS

  2. Physician ordered • Individualized • Time limited treatment with goals • Provided by a licensed or certified therapeutic recreation specialist (CTRS). Treatment is designed to improve function or behavior. NOT the same as DIVERSIONAL ACTIVITIES What is recreational therapy?

  3. Typical daily experience for People with Dementia (PwD) • Mixed behavior issue: complicates our approaches • Tailored RT makes a difference in symptoms and QOL 4. Provide examples of individualized interventions that worked. Four Major Points Today

  4. Recreation Therapy Intervention (RTI) Study (n=107) funded by the Alzheimer’s Association. At-home RTI Study (n=30) funded by the Retirement Research Foundation. Total N=137 individuals with severe dementia and neuropsychiatric behaviors. Studies I Will Draw On

  5. Comprehensive Model of Engagement By Dr. Cohen-Mansfield

  6. Enrolled 6 participants at a time. • Baseline evaluation included 5 days of observation of current lifestyles, mood, behavior, functioning, interests. • Three randomly assigned to recreation therapy treatment – three to usual care. • Pre-Post evaluations by blind evaluators and RT session documentation Research Design

  7. 21 Hours Buettner, Fitzsimmons, & Atav, 2006

  8. 6% Had One Engaging Experience In 5 Days

  9. 11% agitation 30% apathy and isolation 59% mixed behaviors Not relaxed or enjoying free time Buettner, Fitzsimmons,& Atav, 2006

  10. More than 5 medications for either mood or behavior

  11. More medications: • Less activities • Poorer mobility • More behavior problems • More cognitive impairment Setting (special care in nursing home and assisted living significantly worse behavior problems and significantly less activity) Interesting Correlations: less activity

  12. Existing Activity Offerings* *Buettner, L. & Fitzsimmons, S. (2003) Activities calendars: want you see is not what you get, American Journal of Alzheimer’s Disease, 18(4), 215-226.

  13. Recreational interests listed by participants

  14. Prescribing RTIs • Determined target behaviors by gathering data on • the type of behavior the participant exhibited • throughout the day and current routine • Coded for eight time periods in two-hour blocks • Started at 6AM and ended at 10PM • Assessed level of function, unmet needs for • stimulation, and recreational interests • Used information to prescribe the tailored • recreational therapy – daily for 2 weeks.

  15. Timing of non-pharmacological intervention

  16. Tailored Recreational Therapy Interventions (RTIs) A. To calm individuals with agitation B. To alert individuals with apathy Ultimate goal: active engagement in meaningful recreational activities to change a behavior at the right time. Could we predict the outcome physiologically?

  17. Physical ***.000 • Cognitive ***.001 • Feelings ***.001 • Life roles ***.000 • Relaxation ***.001 • Aroma n.s. Categories of Interventions

  18. What we measured • Used Biofeedback to measure the physiology of engagement • N=137 participants over 3 years • Baseline: Demographics, Function, Depression, Current Experiences • Pre and Post Apathy, and Agitation Alzheimer’s Association & Retirement Research Foundation, 2001-2003

  19. Typical Biograph™ Reading

  20. From arts to athletics…

  21. Parachutes to party decorations…

  22. Animal Assisted Therapy

  23. Games and Volunteer work

  24. Piano Lessons and Dance Lessons

  25. Wheelchair Biking

  26. Body and brain fitness…

  27. Baking and Peeling

  28. Artwork and Woodwork

  29. Rain barrels and relaxation

  30. Agitation

  31. Apathy/Passivity

  32. Summary and Key Points Highly significant decrease agitated and apathetic behaviors with person-centered recreational therapy interventions. 2. Delivery of treatment just before problem rountinely occurs is important concept. 3. Intervention chosen had the desired effect 97% of the time. Average activity engagement 27 minutes, with WC biking found as the most engaging treatment. Once we know what works a care plan can be provided for others (Time limited and cost effective)

  33. http://www.uncg.edu/rth/faculty/lindabuettner.html • Buettner, L., Fitzsimmons, S., Labban, J., Barba, B, & Durgin, G. (In review). ACTIVE LIFESTYLE FOR OLDER ADULTS WITH DEMENTIA: WHEELCHAIR BIKING VS. OTHER RECREATIONAL THERAPY INTERVENTIONS • Buettner, L., Fitzsimmons, S., Dudley, WN, (2010) MODERATING EFFECT OF DEPRESSION ON TREATMENT OF NEUROPSYCHIATRIC SYMPTOMS IN OLDER ADULTS WITH DEMENTIA: TREATMENT IMPLICATIONS, Accepted for special issue on depression summer 2010, Research in Gerontological Nursing. Guest Editor for this issue.   • Buettner, L. & Fitzsimmons, S. (January, 2010) RECREATIONAL THERAPY INTERVENTIONS: A FRESH APPROACH TO TREATING APATHY AND MIXED BEHAVIORS IN DEMENTIA. Volume 1,( 1) ,Journal of Non-pharmacological Therapies in Dementia. •  Buettner, L. & Fitzsimmons, S., PROMOTING HEALTH IN ALZHEIMER’S DISEASE: EVALUATION OF A 12-WEEK COLLEGE COURSE FOR INDIVIDUALS WITH A NEW DIAGNOSIS (2009) Journal of Gerontological Nursing. This paper won the Edna Stillwell Award for Gerontological Nursing. Presented at the Gerontological Society of America, November, 2009. •  Buettner, L. & Fitzsimmons, S., N.E.S.T. (NEEDS, ENVIRONMENT, STIMULATION, TECHNIQUES): INTERDISCIPLINARY DEMENTIA PRACTICE GUIDELINES. (2009) Venture Publishing, State College, PA.[Book] • Buettner, L. (2006), PEACE OF MIND: A PILOT COMMUNITY BASED PROGRAM FOR PEOPLE WITH MEMORY LOSS, American Journal of Recreation Therapy, (3), 33-41. •  Buettner, L. & Fitzsimmons, S., Atav, S. (2006) PREDICTING OUTCOMES: THERAPEUTIC RECREATION FOR BEHAVIORS IN DEMENTIA, Therapeutic Recreation Journal. Arlington: First Quarter 2006. Vol. 40, Iss. 1; p. 33 •  Buettner, L. & Fitzsimmons, S. (2006) RECREATION CLUBS: AN OUTCOME BASED ALTERNATIVE TO DAY CARE FOR OLDER ADULTS WITH DEMENTIA, Activities Directors Quarterly, (3) 12-14. • Buettner, L. & Fitzsimmons, S. (2006) MIXED BEHAVIORS IN DEMENTIA: A NEW PARADIGM FOR TREATMENT, Journal of Gerontological Nursing. Thorofare: Jul 2006. Vol. 32, Iss. 7; 15-22. • Buettner, L. & Fitzsimmons, S. (2003) Activities calendars: what you see is not what you get, American Journal of Alzheimer’s Disease, 18(4), 215-226. References/Resources

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