In our last post we delved into the current models for treating dementia patients. As we discussed before, the Salutogenic model emphasizes how to help patients adjust as their abilities change, instead of just treating the symptoms medically. The term “salutogenesis” was coined by Anton Antonovsky, a professor of medical sociology. The term refers to an approach that focuses on factors that support health and well-being, in contrast to factors that cause disease (pathogenesis). In today’s post, we will continue to explore the Salutogenic model, and discuss ways to engage patients through social interactions, meaningful activities, singing and humor.
Environment for Patients
Many environments for dementia patients lack stimulation. An evaluation of 17 care homes found that people spent less than 13% of waking hours engaged in meaningful activity. Another study found that residents on average spent only two minutes a day in meaningful social interaction. Unmet needs can precipitate increased irritability or aggression, and often result in the prescribing of antipsychotic medication. Although nursing homes take care of a patient’s physical needs, dementia patients also need to interact with others and engage in meaningful activities. Research has shown that the most engaging activities are interactions with another person, a baby, or a pet, such as a dog or a cat. However, researchers have also found that tasks that simulate work, such as folding towels, stamping letters, or sorting jewelry are a good second choice in keeping dementia patients occupied. This is important because it is not always possible to provide live interactions and is preferable to patients feeling isolated, bored, distressed or agitated. Providing stimulation has been shown to reduce boredom and agitation by 25%, the same effect as that produced by administering antipsychotic drugs, without any of the harmful side effects. In addition to adding stimulation to their environments, another way to engage patients with dementia is through music and singing.
Singing and Dementia
One of the most engaging activities for all people is singing, even for those in comas. Many people have observed the preservation of musicality in people with dementia. Listening to music and singing have been shown to reduce depression, agitation, aggression, impaired social interactions and sleep disturbances. The film, “Alive Inside”, chronicles the Music and Memory project, which is dedicated to providing personalized music for residents of nursing care facilities. It is truly remarkable to witness the transformation as residents, many of whom are nonverbal and appear completely shut down, “wake up” and become revitalized in response to the music of their past. (Alive Inside Henry clip).
In the brain, the dorsal medial prefrontal cortex (DMPFC) is associated with autobiographical memories and emotions, and is highly stimulated during musical activities. In some cases of dementia, this portion of the brain is relatively preserved and can be one of the last regions of the brain to shrink. According to Alicia Clair, Ph.D., a music therapist known for her work with dementia patients, “Singing is integral to life quality for those who are in progressive dementia and their caregivers. It functions to provide islands of arousal, awareness, familiarity, comfort, community and success like nothing else can. It is particularly valuable as an intervention because it is accessible to a wide array of individuals and can include persons across cultures and socioeconomic strata. It is also effective in severe, late stage dementia where responses to other stimuli are nonexistent.”
Humor and Dementia
The use of humor is another method to connect with dementia patients. The SMILE study in Australia studied the impact of humor therapy on mood, agitation, behavioral disturbances and social engagement. They found that weekly visits by “clown doctors” along with training staff to provide humor therapy, reduced agitation by 20% among 180 residents in 17 nursing homes compared with a control group. This video shows how dementia patients were activated and engaged by clowns. The authors of the study noted that the effect was equilvalent to what would be expected with the use of antipsychotic medication. Results from the study also showed that improvements in levels of depression among residents correlated with the enthusiasm and dedication of nursing home staff trained in humor therapy.
My next post in this series will explore research on Reminiscence Therapy and Life Story Work as additional methods to engage patients with dementia. I will also provide examples of how my mother used imagination and playfulness in her interactions with my father to transcend the confines of the nursing home where he resided as a dementia patient.