Linda L. Buettner, PhD, LRT, CTRS

1. Experiences matter: Emerging science of recreational therapy in treatment of dementia Linda L. Buettner, PhD, LRT, CTRS

2. What is recreational therapy? • Recreation therapy is a physician ordered, individualized and time limited intervention provided by a licensed or certified therapeutic recreation specialist (CTRS) to improve function or behavior.

3. 4 Major Points Today • Typical experience for PwD • 2. Mixed behavior issue: complicates our approaches • Tailored RT makes a difference • in behavior and QOL • Critical components for moving • this information into the real world

4. Studies I will draw on: • TRI Study (n=107) and at • home TRI Study (n=30) • Health Promotion Study • (n=10 and n=89) • Peace of Mind (n=212) • Acknowledgement: Sue Fitzsimmons was co-PI on all these projects.

5. 21 Hours Buettner, Fitzsimmons, & Atav, 2006

6. 6% Had one engaging experience in 5 days

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

8. Spending much more timewaiting for …..

9. More than 5 medications for either mood or behavior 26.9%

10. Interesting Correlations: less activity • More medications • 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)

11. 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.

12. Recreational interests listed by participants

13. Prescribing TRIs • 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.

14. Timing of non-pharmacological intervention

15. Stimulating plasticity and improved function through new meaningful experiences

16. Tailored Recreational Therapy Interventions (TRIs) 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.

17. TRI: What we measured • Used Biofeedback to • measure the physiology of • engagement (n=142) • Baseline: Demographics, • Function, Depression, • Current Experiences • Pre and Post Apathy, • Passivity, and Agitation by • blind nurse evaluator Alzheimer’s Association & Retirement Research Foundation, 2001-2003

18. Typical Biograph™ reading

19. Pottery class: a former teacher and magazine editor

20. Former postal worker with severe aggression and AAT

21. Wheelchair bike

22. Tailored Intervention Results Highly significant decrease agitated and passive (apathy) behaviors with recreational therapy intervention. 2. Intervention chosen had the desired effect 97%of the time. 3. Average activity engagement 27 minutes.

23. Agitation

24. Apathy/Passivity

25. Depression is important • For those with depression and mixed behaviors: provide interventions during passive times. Buettner, Fitzsimmons, & Dudley (in press).

26. Critical components to move this knowledge into the real world State of Florida Elder Affairs Demonstration Project, 2001-2006

27. University Based Center for Positive Aging in the Community • Memory loss: keep them home • Behavior problems • Fall prevention • Depression • Loss of mobility • Loss of social opportunities • Loss of community living skills • Worked with 100 families in Charlotte County, FL

28. Com·mu·ni·ty (kə-myū'nĭ-tē) • n., pl. -ties. • A group of people living in the same locality and • under the same government. • b. A group of people having common interests or caring for each other: the scientific community; the international business community, the campus community.

29. Weekly Screenings and Enrollment • Cognitive Health • MMSE and memory battery • CANS-MCI • Local physician partners

30. Immediate enrollment in programs to help • Recommend programs and services within 24 hrs. • Dignity • Integrated and normalized • Rewarding and engaging classes • People without memory loss included

31. 10-12 week course Manage memory loss Special notebook Pre and Post Quiz Graduation to other programs Health Promotion Class Funded by Retirement Research Foundation

32. Brain Fitness ClassesFitzsimmons, 2009

33. Memory aides Living with memory loss Self-esteem Relationships Grief/Losses Friendship Empowerment Creativity Life 101: Coping Skills Class

34. Physical function Cognitive function Social function Communication skills Emotional function Relaxation skills Maintaining life skills Individualized goals Recreation Clubs:Three unique sessions

35. Staying Fit

36. Clients leading small groups Cooking Connect 4 Triminoes Dominoes

37. Clients as Community Volunteers Signage Decorations Mailings

38. Saving the environment: Rain Barrels

39. Pet Encounters

40. Pet Encounters AAT Research • Goals: • Practice ADLs • Mobility • Social skills • Communication • Provide social-emotional • outlet • Significant improvements • in all areas Delta Society & Robert Wood Johnson Funding

41. Providing for families

42. Use Biofeedback technology to measure calming techniques Tested: Guided Imagery, Progressive Muscle, and Modified Chair Tai Chi All were effective forms of relaxation Relaxation Classes FGCU Foundation Grant #1023

43. Promote understanding in young people • Education in public • schools • Simple Pleasures and • Chair Volleyball projects • Intergenerational Pet • Partners programs • Community service • learning experiences

44. Peace River Kayakers

45. Findings • N=212 families (July 2001-June 2006) • Data from 2003 • Mean MMSE 17.5 (0-27 range) • Mean age PwD 78.6 (59-99) • Average MMSE improvement: 1.8 points • Improvements were seen at all stages • Only one client placed this year Buettner, L. (2006), Peace of mind: a pilot community based program for people with memory loss, American Journal of Recreation Therapy, (3), 33-41

46. Instrumental Activities of Daily Living (Lawton, 1969)