Exercise and Volunteer Work: Contexts for AD Language and Memory Interventions

Nidhi Mahendra; Sharon M. Arkin

doi:10.1055/s-2004-825652

Seminars in Speech and Language, Table of Contents

Semin Speech Lang 2004; 25(2): 151-167
DOI: 10.1055/s-2004-825652

Exercise and Volunteer Work: Contexts for AD Language and Memory Interventions

Nidhi Mahendra¹ ^, ³ , Sharon M. Arkin² ^, ³

¹Postdoctoral Fellow, University of Arizona, Tucson, Arizona
²Visiting Assistant Research Scientist, University of Arizona, Tucson, Arizona
³Department of Speech & Hearing Sciences, University of Arizona, Tucson, Arizona

Abstract

This article describes two novel contexts for language and memory stimulation in individuals with Alzheimer's disease (AD): student-supervised physical exercise and partnered volunteering at community agencies. Information presented is based on 5 years of the authors' experiences at the University of Arizona supervising student-administered interventions with mildly to moderately affected home-dwelling AD patients in the Volunteers in Partnership and Elder Rehab programs. The authors report significant mood and fitness improvements by program participants, as measured on direct testing as well as by caregiver perceptions regarding the relative benefits of the four program components. Finally, they advocate for greater use of nontraditional approaches and utilizing students and volunteers when working with persons who have AD.

KEYWORDS

Alzheimer's disease - dementia - interventions - physical exercise - volunteer work

Full Text

References

REFERENCES

1 Arkin S M. Volunteers in partnership: an Alzheimer's rehabilitation program delivered by students. Am J Alzheimers Dis. 1996; 11 12-22
2 Arkin S M. Volunteers in Partnership: A Rehabilitation Program for Alzheimer's Patients [videotape]. University of Arizona Center for Neurogenic Communication Disorders 1995 Telerounds #T-26. Available from sherryj@u.arizona.edu
3 Arkin S M. Alzheimer rehabilitation by students: interventions and outcomes. Neuropsychol Rehabil. 2001; 11 273-317
4 National Institute of Aging/National Institutes of Health .Progress Report on Alzheimer's Disease: Taking the Next Steps. Washington, DC; NIA/NIH 2002 Available at www.alzheimers.org/pubs/prog00.htm
5 Khachaturian Z S, Radebaugh T S. Alzheimer disease: where are we now? Where are we going?. Alzheimer Dis Assoc Disord. 1998; 12(suppl 3) S24-S28
6 Bookmeyer R, Gray S, Kawas C. Projections of Alzheimer's disease in the United States and the public health impact of delaying disease onset. Am J Public Health. 1998; 88 1337-1342
7 National Alzheimer's Association Web site .http://www.alz.org/AboutAD/Statistics.htm
8 World Health Organization Web site .http://www.who.int
9 Schneider L S. Treatment of Alzheimer's disease with cholinesterase inhibitors. Clin Geriatr Med. 2001; 17 337-358
10 Grundman M. Alternative treatments for Alzheimer's disease. Paper presented at: UCSD ADRC Conference 2003 San Diego, CA;
11 Thal L. Treatment update: major clinical trials. Paper presented at: UCSD ADRC Conference 2002 San Diego, CA;
12 Mahendra N. Direct interventions for improving the performance of individuals with Alzheimer's disease. Semin Speech Lang. 2001; 22 291-304
13 Clare L, Wilson B A, Carter G et al.. Intervening with everyday memory problems in dementia of the Alzheimer type: an errorless learning approach. J Clin Exp Neuropsychol. 2000; 22 132-146
14 De Vreese L P, Neri M, Fioravanti M, Belloi L, Zanetti O. Memory rehabilitation in Alzheimer's disease: a review of progress. Int J Geriatr Psychiatry. 2001; 16 794-809
15 Camp C J, Foss J W, O'Hanlon A M, Stevens A B. Memory interventions for persons with dementia. Appl Cogn Psychol. 1995; 9 374.1-374.18
16 Judge K S, Camp C J, Orsulic-Jeras S. Use of Montessori-based activities for clients with dementia in adult day care: effects on engagement. Am J Alzheimers Dis. 2000; 15 42-46
17 Moss S, Polignano E, White C L, Minichiello M, Sunderland T. Reminiscene group activities and discourse interaction in Alzheimer' disease. J Gerontol Nurs. 2002; 28 36-44
18 Hopper T L, Bayles K A, Tomoeda C K. Using toys to stimulate communicative function in individuals with Alzheimer's disease. J Med Speech-Lang Pathol. 1998; 6 73-80
19 Bourgeois M S. Enhancing conversational skills in patients with Alzheimer's disease using a prosthetic memory aid. J Appl Behav Anal. 1990; 23 29-42
20 Casby J A, Holm M B. The effects of music on repetitive disruptive vocalizations of persons with dementia. Am J Occup Ther. 1994; 48 883-889
21 Denney A. Quiet music: an intervention for mealtime agitation?. J Gerontol Nurs. 1997; 23 16-23
22 Zanetti O, Binetti G, Magni E, Rozzini L, Bianchetti A, Trabucchi M. Procedural memory stimulation in Alzheimer's disease: impact of a training programme. Acta Neurol Scand. 1997; 95 152-157
23 Knight B G, Lutzky S M, Macofsky-Urban F. A meta-analytic review of interventions for caregiver distress: recommendations for future research. Gerontologist. 1993; 33 240-248
24 Chapman S B, Rackley A, Weiner M, Hynan L, Cullen M. A randomized study: does cognitive linguistic intervention boost the effects of donepezil (Aricept) in Alzheimer's disease?. Paper presented at: Clinical Aphasiology Conference Ridgedale, HN; 2002
25 Ronch J L. Specialized Alzheimer's units in nursing homes: pros and cons. Am J Alzheimer's Care. 1987; 2 10-19
26 Ansbacher HL, Ansbacher RR Alfred Adler: Superiority and Social Interest. New York; WW Norton & Co 1979: 14-15
27 Manaster G J, Corsini R J. Individual Psychology: Theory and Practice. Itasca, IL; Peacock Publishers 1982: 44-62
28 Logsdon R G, Gibbons L E, McCurry S M, Teri L. Quality of life in Alzheimer's disease: patient and caregiver reports. J Ment Health Aging. 1999; 5 21-32
29 Camp C J, Cohen-Mansfield J, Capezuti E A. Mental health services in nursing homes: use of nonpharmacological interventions among nursing home residents with dementia. Psychiatr Serv. 2002; 53 1397-1404
30 Hopper T L, Kim E S, Bayles K A. Retained neuropsychological abilities of individuals with Alzheimer's disease. Semin Speech Lang. 2001; 22 261-274
31 Beatty W W, Winn P, Adams R L et al.. Preserved cognitive skills in dementia of the Alzheimer type. Arch Neurol. 1994; 51 1040-1046
32 Eslinger P J, Damasio A R. Preserved motor learning in Alzheimer's disease: implications for anatomy and behavior. J Neurosci. 1986; 6 3006-3009
33 Nebes R D, Martin D C, Horn L C. Sparing of semantic memory in Alzheimer's disease. J Abnorm Psychol. 1984; 93 321-330
34 Evans W, Rosenberg I H. Biomarkers: the ten determinants of aging you can control. New York; Simon & Schuster 1991
35 Lamb DR, Gisolfi CV, Nadel E Exercise in older adults. Carmel, IN; Cooper Publishing Group 1995
36 Vertinsky P. Old age, gender and physical activity: the biomedicalization of aging. J Sport Hist. 1991; 18 64-80
37 Whaley D E, Ebbeck V. Older adults' constraints to participation in structured exercise classes. J Aging Phys Activity. 1997; 5 190-213
38 Teri L, McCurry S M, Buchner D M et al.. Exercise and activity level in Alzheimer's disease: a potential treatment focus. J Rehabil Res Dev. 1998; 35 411-419
39 Goldman L, Cook E F. The decline in ischemic heart disease mortality rates: an analysis of the comparative effects of medical interventions and changes in lifestyle. Ann Intern Med. 1984; 101 825-836
40 Etnier J, Lalazar W, Sanders D, Petruzzello S, Han M, Nowell P. The influence of physical fitness and exercise upon cognitive functioning: a meta-analysis. J Sport Exerc Psych. 1997; 19 249-277
41 Clarkson-Smith L, Hartley A A. Relationships between physical exercise and cognitive abilities in older adults. Psychol Aging. 1989; 4 183-189
42 Fiatarone M A. Physical activity and functional independence in aging. Res Q Exerc Sport. 1996; 67(suppl 3) S70
43 Lindenmuth G F, Lindenmuth E B. Effects of a three-year exercise therapy program on cognitive functioning of elderly personal care home residents. Am J Alzheimer's Care. 1994; 9 20-24
44 Pitetti K H. Introduction to exercise capacities, and adaptation of people with chronic disabilities: current research, future direction, and widespread applicability. Med Sci Sports Exerc. 1993; 25 421-422
45 Rimmer J. Alzheimer's disease. In: American College of Sports Medicine. Exercise Management for Persons with Chronic Diseases and Disabilities Champaign, IL; Human Kinetics 1997: 227-229
46 Bonner A P, Cousins S O. Exercise and Alzheimer's disease: benefits and barriers. Activities Adaptation Aging. 1996; 20 21-32
47 McGrowder-Lin R, Bhatt A. A Wanderer's Lounge Program for nursing home residents with Alzheimer's disease. Gerontologist. 1988; 28 607-609
48 Mace N L. Principles of activities for persons with dementia. Phys Occup Ther Ger. 1987; 5 13-27
49 Beck C, Modlin T, Heithoff K, Shue V. Exercise as an intervention for behavior problems. Geriatr Nurs. 1992; 13 273-275
50 Friedman R, Tappen R M. The effect of planned walking on communication in Alzheimer's disease. J Am Geri Society. 1991; 39 650-654
51 Palleschi L, Vetta F, deGennaro E et al.. Effects of aerobic training on the cognitive performance of elderly patients with senile dementia of the Alzheimer type. Arch Gerontol Ger. 1996; (suppl 5) 47-50
52 Folstein M F, Folstein S E, McHugh P R. “Mini-mental state”: a practical method for grading the mental state of patients for the clinician. J Psychiatr Res. 1975; 12 189-198
53 Arkin S M. Elder Rehab: a student-supervised exercise program for Alzheimer's patients. Gerontologist. 1999; 39 729-735
54 Arkin S M. Student-led exercise sessions yield significant fitness gains for Alzheimer's patients. Am J Alzheimers Dis Other Demen. 2003; 18 159-170
55 NIA/NIH .Exercise: A Guide from the National Institute on Aging (with video). Publication No. NIH 99-4258 (free); 2001, 82 pages Available at http://www.nih.gov/nia
56 Arkin S M. Monograph on Alzheimer's Disease and Exercise. National Center for Physical Activity and Disability. 2002 Available at http://www.ncpad.org/whtpprs/alzheimer's
57 Hunter K I, Linn M W. Psychosocial differences between elderly volunteers and non-volunteers. Int J Aging Hum Dev. 1981; 12 205-213
58 Crist-Houran M. Efficacy of volunteerism for role-loss depression: a complement to Weinstein et al. Psychol Rep. 1996; 79 736-738
59 Van Willigen M. Differential benefits of volunteering across the life course. J Gerontol. 2000; 55B S308-S318
60 Thoits P A, Hewitt L N. Volunteer work and well-being. J Health Soc Behav. 2001; 42 115-131
61 Keys L M. Former patients as volunteers in community agencies: a model work rehabilitation program. Hosp Community Psychiatry. 1982; 33 1017-1018
62 Hughes M. Enhancing the self-esteem of the nursing home resident. La Grange, TX; M & H Publishing 1987
63 Stansell J. Volunteerism: contributions by persons with Alzheimer's disease. In: Harris PB The Person with Alzheimer's Disease: Pathways to Understanding the Experience. Baltimore, MD; Johns Hopkins University Press 2002: 211-227
64 Morris J C. Clinical Dementia Rating (CDR): current version and scoring rules. Neurology. 1993; 43 2412-2414
65 Morris J C, Heyman A, Mohs R C et al.. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology. 1989; 39 1159-1165
66 McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlen E M. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology. 1984; 34 939-944
67 Wechsler D. Wechsler Adult Intelligence Scale-Revised (WAIS-R). San Antonio, TX; Psychological Corporation 1981
68 Bayles K A, Tomoeda C K. Arizona Battery for Communication Disorders of Dementia (ABCD). Tucson, AZ; Canyonlands Publishing 1991
69 Arkin S, Mahendra N. Discourse analysis of Alzheimer's patients before and after intervention: methodology and outcomes. Aphasiology. 2001; 14 533-569
70 Yesavage J, Brink T, Rose T et al.. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982-1983; 17 37-49
71 Elder Rehab Program Web site .www.u.arizona.edu/~sarkin/elderrehab.html
72 Mahendra N, Arkin S M. Effects of four years of exercise, language, and social interventions on Alzheimer discourse. J Commun Disord. 2003; 36 395-422
73 Arkin S M. Alzheimer memory training: students replicate learning successes. Am J Alzheimers Dis. 2000; 15 152-162
74 Arkin S M. Alzheimer memory training: addendum on long-term retention. Am J Alzheimers Dis. 2000; 15 314-315
75 Rikli R E, Jones J. Senior Fitness Test Manual. Champaign, IL; Human Kinetics 2001
76 Arkin S M. Effects of Exercise and Cognitive Stimulation on the Progression of Alzheimer's Disease [videotape]. University of Arizona National Center for Neurogenic Communication Disorders 2002 Telerounds #T-64. Available from sherryj@u.arizone.edu

APPENDIX: ELDER REHAB PROGRAM: CAREGIVER EVALUATION

Date____Name____Relationship to program participant____

Do you live with program participant?____If not, how often do you see him or her?____
Please rate the exercise component of the program in terms of its benefit to participant.

Harmful____No benefit____Some benefit____Much benefit____Very much benefit____

Please rate the volunteer work/community activity component of the program in terms of its benefit to your care recipient.

Harmful____No benefit____Some benefit____Much benefit____Very much benefit____

Please rate the conversation stimulation component of the program in terms of its benefit to your care recipient.

Harmful____No benefit____Some benefit____Much benefit____Very much benefit____
If you believe the program was beneficial, what aspect(s) of your care recipient's life do you feel was/were enhanced by the program? Check all that apply. (2 checks if benefit substantial)

Mood or morale?____Self-esteem?____Feelings of usefulness?____Energy level?____Feelings of connectedness to others?____Conversation quantity?____
Conversation quality?____Taking of initiative in conversation (introducing topics, etc)____
Memory?____Sense of humor?____Attitudes toward own health or pain?____
Attitudes toward other people in general?____General quality of life?____
Awareness of events?____Opportunities to socialize?____
Other (Please specify)____
Please rate the usefulness of your care recipient's student partner as a source of stimulation and companionship to your care recipient.

____Detrimental
____Not at all useful
____More useful than not useful
____Definitely useful
____Unable to judge

Please rate the value of the student as a source of support to you the caregiver.

____Source of stress, not support
____Not supportive to me
____More supportive than not supportive
____Definitely supportive
____Very supportive
____Unable to judge or not applicable

Please rate Dr. Arkin with reference to her supervision of the program.

Poor____Fair____Good____Excellent____Outstanding____
Open-ended Question 1

Please tell us in your own words what impact the program had on the life of your care recipient and on your job as a care provider. You may write on the back of this paper. Feel free to make suggestions for changes or improvements. (Continue on the back of this paper.)

Open Ended Question 2

Please give us your opinion generally on the students as potential sources of companionship, stimulation, and respite care to persons with Alzheimer's disease or other memory or language disorders. (Continue on the back of this paper.)

Signature of person completing this form Return to: Dr. Audrey Holland Dept. of Speech and Hearing Sciences University of Arizona Tucson, AZ 85721

Nidhi MahendraPh.D.

Room 517, Building No. 71

Department of Speech & Hearing Sciences

The University of Arizona

Tucson, AZ 85721

Email: nidhi@email.arizona.edu

[1] Do you live with program participant?____If not, how often do you see him or her?____

[2] Please rate the exercise component of the program in terms of its benefit to participant.