Interventions: Elderly

1. Interventions: Elderly KNR 253

2. Interventions • Reminiscence • Austin, 2009 • Dattilo & McKenney, 2011 • Reality Orientation • Validation Therapy • Sensory Stimulation • Remotivation • Austin, 2009

3. Interventions • Montessori Technique

4. Theoretic Foundations • Role theory • How well one adjusts to aging depends on how well the role changes of later life are accepted • Rosow, 1976 • Disengagement theory • Older adults have a natural tendency to withdraw from society and become more introspective • Cumming & Henry, 1961

5. Theoretic Foundations • Activity theory • People who are active will be more satisfied and better adjusted than those who are less active • Havinghurst, 1968 • Continuity theory • As we age we become more of what we already were in our youth. We deliberately continue familiar patterns • Could be positive or less positive patterns • Atchley, 1993

6. Reminiscence Dattilo & McKenney (2011) calls it Therapeutic Reminiscence

7. Population • Dementia/Alzheimer’s • Depression • Older adults • People in transition or life crisis • People who • Have mild to moderate cognitive functioning • And have at least a 5 minute attention span

8. Definitions of Memory • Memory • Recording of feelings and emotions • Knowledge about self, world, & experiences • Many are involuntary • Sensory • Comes through sense of smell, touch, taste, hearing and seeing • Imprints quickly • Smell word burning & think of campfire • Smell lavender perfume & think of Grandma

9. Definitions of Memory • Short term memory (immediate) • Working memory • Lasts for a few seconds or minutes • Can only keep 6-7 items at once in STM • If retain longer, must be rehearsed & connected to other memories • Look up phone number • Follow directions to a room

10. Definitions of Memory • Long term memory • Information that has been rehearsed & connected • Could be recent (what had for lunch) • Could be distant (first dog’s name) • 4 parts to transfer from STM to LTM • Registration: Information perceived • Encoding: Attach new memory to previously stored memories • Storage: Collection of what retained • Retrieval: Recall information previously registered, encoded, and stored

11. Reminiscence • Excursion into one’s memory of the past • Weiss, 1989 • Act of relating personally significant past experiences • Koffman, 2000 • Activity in which the leader assists and guides a person to recall previous life experiences and facilitates the affirmation of the value of these experiences • Could be individual or group • Could be written or recorded

12. Reminiscence 2 types of life experience recollection: • Simple/informative/story-telling • Recollection of previous life experiences • Remembered for pure pleasure of experiencing occasions and to pass information on to others • Life review • Focused on analyzing, evaluating and coming to terms with unpleasant or unhappy previous life experiences

13. Reminiscence Process: • Quiet, comfortable room free of distractions, table • Same times and day of week, 2x week is best, 30-60 min • Enough time for all to share • For groups, s/b under 10-12 members. With some groups may be 5-6.

14. Vacations Favorite games First playmate First pet School days Olympics Floods Engagements Seasons Holidays Seasons Childhood Adolescence Music Dance Others Reminiscence Topics

15. Reminiscence TopicsCurrent Events: Now & Then • Engagements • Here is a picture of a man who rented a billboard to ask his girl friend to marry him • How did you (your husband) propose? • Did you give (get) a ring? • What did your parents say? • How long had you known each other? • How long were you engaged? • Dattilo, 2000, p. 320

16. Reminiscence Guidelines(See sample) • Intro – welcome, introduce topic • Mr., Mrs., Dr., unless permission for first name • Initial cue – present an item associated withtheme(make cues multi-sensory, present one at a time, use verbal and nonverbal cues) • Prop/artifact #1 – focus on past experiences • Prop/artifact #2 – focus on current experiences • Related activity (time permitting) – slides, movies, cooking, etc. • Closure – thank yous, time for socialinteractions between participants

17. Outcomes • Increase self esteem as review history of competence • Increase life satisfaction • Reaffirm sense of identity • Bring pleasure from sharing the past with others • Increase socialization • Stimulate cognitive processes • Provide feelings of competence as person relates LT memories • Allow for expressing of feelings • Come to terms with old disappointments • Discover similarities with others • Decrease loneliness • Increase self awareness about leisure • Others

18. Decrease depression & confusion Decrease boredom Increase self-esteem Increase well-being Enjoyable Develop friendships Engage in conversation Maintain family contacts Teach & inform Identify & solve problems Prepare for end of life Increase socialization Maintain cognitive functioning Outcomes

19. Activities • Grab Bag • Therapeutic Recreation Directory • Leisure Lifeline • Scrapbook

20. Reality Orientation (RO)

21. Population & Settings • Population • Older adults • Moderate to severe disorientation & confusion • Settings • Nursing homes • Geriatric units in psychiatric hospitals

22. Purpose • Prevent cognitive decline • Reverse cognitive decline • Maintain cognitive functioning

23. Definition • Involves a technique of regular repetition of basic facts • Time, place, names, events of day, things in environment, etc. • The technique is used to help overcome symptoms of confusion and disorientation

24. Types of RO • 24 hour a day RO • Everyone who comes in contact with the person • Asks questions like: • What is your name? • What is the name of this facility? • What city are we in? • What is your hometown? • How is the weather today? • Clues in environment • Signs • Clocks • Calendars, activity calendar

25. Types of RO • Daily RO Classes • 4-6 residents • 15-30 minutes • Same time each day • Quiet well-lighted area • Uses RO board • Location • Date • Time • Weather

26. Types of RO • Daily RO Classes Routine • Greet residents • Would you like to tell the group your name? • What is your name? • If correct answer “good,” if incorrect probe or tell • Introduce ourselves • Tell leader’s name. May ask to repeat • Read the reality orientation board • Ask each patient to read • Perhaps another activity • Write menu & have residents help spell words • Have pictures of food & ask residents to identify • Flash cards • Remind about time of next meeting

27. Types of RO • Incorporate in TR programs • Repeat your name at beginning of groups • Tell what you do • Review programs did in past • Work time in introductions • Talk about seasonal events • Highlight upcoming activities • Review monthly activity calendar • Austin, 2004

28. Validation Therapy Naomi Feil

29. Population • Same as RO • Alzheimer’s • Old-old clients who need help resolving pasts • Not for people who have: • Chronic mental illness • Intellectual disabilities • Alcoholism

30. Rationale • Developed because some folks reacted negatively to RO • Agitation • Withdrawal • Basic premise is that reality underlies the behavior of even very disoriented clients • Resolve past relationships • Resolve unfinished life tasks • Express suppressed feelings

31. Process • Accept people as they are and be empathetic toward them • Maintain eye contact • Rephrase • Speak with caring tone of voice • Use appropriate touch • Avoid “why” questions • Communicate that what they said was heard and respected • Agree but steer without them knowing they are being redirected • Austin also describes phases for groups

32. Chuck: "I have to find my car keys."Me: "Your car keys..." ( I don't tell him he doesn't have a car and he hasn't driven for years)Chuck: "Yes, I need to get home - lot's of work to do, you know!"Me: "You are busy today?" (I don't tell him he is at adult day care and isn't going home for hours)Chuck: "Hell, yes. I'm busy every day, girlee."Me: "You like being busy?" (I'm trying to find a topic of conversation that he might accept discussing)Chuck: "What planet do you live on? I didn't say I LIKED it. I just have to work - like most of the rest of the world, ya know?" (He's getting a little frustrated, but seems to have forgotten the keys.)Me: "I know about work, Chuck. I do some of that myself. In fact, I'm getting ready to fix some lunch for us. Care to join me?"Chuck: "Lunch, huh? What are you having?" • http://www.ec-online.net/community/Activists/difficultbehaviors.htm

33. Sensory Training Sensory Stimulation

34. Sensory Training • Originally developed for work with children with perceptual motor problems (sensory integration) • Autism • Frequently used with regressed & disoriented older persons • Psychiatric facilities • Nursing homes • Long term care facilities

35. Sensory Training • Goal is to improve perception & alertness in responding to the environment • Attempt to maintain or improve functioning of regressed patients • Stimulate all senses each session

36. Sensory Training • Kinesthetic awareness exercises • Flex & extend parts of body while sitting • Tactile stimulation activities • Feel objects (e.g., balls, sponges, wood, etc.) • Answer questions about sensations, preferences, and feelings • Smelling activities • Smell sharp or distinct substance • Answer questions about feelings & uses of substances

37. Sensory Training • Listening activities • Sounds through media like records, clapping, songs, etc. • Tasting activities • Taste contrasting foods like candy & pickles • Visual activities • Mirrors, colorful objects

38. Sensory Stimulation • Used as treatment for patients with TBI who are in prolonged comas • 2 types • Multimodal • All senses every session • Unimodal • Treating single sense in a session • Observe to determine what stimulates consistent responses like hand or head movement or eye gaze

39. I have more frequently heard sensory stimulation for both clients who are disoriented or are in comas • Backrubs • Facials • Brush hair • Lotion • Music • Aromatherapy • Pets

40. Remotivation

41. Population • Moderately confused elderly residents • Often used with folks who have successfully completed RO • Purpose: to promote discussions of topics that may bring participants closer in touch with the world outside the institution

42. Remotivation Process: • Group (8-15) interaction for 45-60 min • Conducted by a trained staff – sometimes an aid (remotivator) • Attempt to renew interest in environment by:

43. Remotivation • Planning conversations that stress simple, objective features of everyday life not related to their emotional difficulties (e.g. gardening, baseball—avoid controversial subjects such as sex, politics) • Establish warm, accepting atmosphere • Deal with well parts of client • Encourage rediscovery of interests • Begin to establish control over leisure selection

44. Remotivation • 5 phase process (each 10 min) • Climate of acceptance • Bridge to reality • Sharing the world we live in • Appreciation of the work of the world • Climate of appreciation

45. Climate of Acceptance • Greet each participant by name • Shake hands • Made some comment about participant’s appearance • Purpose is to create a warm, supportive environment

46. Bridge to Reality • Develop group discussion around a theme • Start by reading a poem, story or article related to theme • Ask questions to encourage participants to recall and share ideas related to topic • When you were little did you have a train set? • What were the cars like? • Read poem “Freight Cars”

47. Sharing the World We Live In • Visual aids and questions used to encourage clients to share personal stories • Attempt to move focus to world as it currently is • What are some uses of freight cars? • What other cars are in a train? • Show a picture of a train

48. Appreciation of the Work of the World • Get participants to think about pros and cons of the topic • Help relate the topic to other things in the world • Encourage to rediscover past hobbies or occupations • Projections to the future are encouraged • Who is the boss of the train? • What are the other jobs on the train? • What jobs are in the freight yard? • Which of these jobs would you like?

49. Climate of Appreciation • Review what has been said • Comment about how each person participated • Than the people for attending • Tell about plans for next session

50. Therapeutic Recreation Directory • Has some activities for • Reminiscence • Remotivation • Sensory stimulation