Saturday, December 19, 2015

Delighting Persons with Dementia with TimeSlips Storytelling

If there was activity that you could offer your loved one or offer a client with dementia that would bring them delight and potentially improve their mood, would you do it?  

I am glad you said “Yes!” because there is such an activity if you are ready to learn the process, prepare for the activity, and have some fun.  It is called TimeSlips (TS) and was created by Professor of Theatre, Anne Basting at the Peck School of the Arts, University of Wisconsin-Milwaukee in 1998.
In full disclosure, I am a bit biased as the first and now 1 of 2 Certified TimeSlips facilitators in my state of Louisiana (LA). I think we need 25, then 50, then 100 facilitators here even if that means less TS freelance opportunities for me. I will not possibly keep up with the demand when residences and facilities catch on to this. So, I encourage others to join our ranks - family members, volunteers, and professionals alike.

To see the TimeSlips Storytelling activity in your mind, imagine a room (free of distractions) with 6-12 persons with a dementia - varying ages and varying levels of cognition. The “storytellers” are seated in a half circle with a facilitator at the front of them, equipped with a white flipchart pad on easel and some markers.  Everyone has a nametag sticker on.  To start the session I distribute a picture printed on 8.5 x 11 paper (cardstock when possible) to each storyteller.  The Leaping Cowboy in this post is an example of a picture I use. I simply explain that we are going to create a story based on the picture. “I will ask you some questions and write down all of your answers with names of the contributor.  There are no wrong answers :) Let’s have fun.” For the next 20 minutes, the storytellers are engaged. They are laughing. They are joking.  They are happy.  In the end we have the flipchart page filled with a story that they are proud of.   As facilitator, I have put them in charge in creating something special.  After 1 or 2 stories, I shake each storyteller's hand and thank them for their input.  The smiles and reciprocated thank you’s are gold for a facilitator. 

You can enjoy my fun stories from my storytellers here.

Why does TimeSlips have this delightful effect on these groups that are so diverse, but who also have much in common? As the the TimeSlips staff will tell you, the activity does several things:
  • Presents a fun challenge
  • Returns a role back to people who have had so many roles taken away by dementia and then by society
  • Strengthens the relationships of the storytellers
  • Strengthens the relationships between the storytellers and staff, when the staff see the abilty of the storytellers.
  • The Storytellers are engaged with a purpose and have their ideas validated.

Please check out this 2014 research article in the American Journal of Alzheimer's Disease and Related Dementias on TimeSlips Storytelling. 

Stay tuned to a future post describing my experiences as a Certified TimeSlips Facilitator, including some of the feedback from the Storytellers and Staff. In the meantime, please take action with this information. It is not enough to fill your head with interesting stuff!

Action Items:

  • Watch this TEDx event with founder Anne Basting. 
  • Read the stories that I have facilitated.
  • Hear a 5 interview with facilitator Liz Nichols as she explains TimeSlips.
  • Consider becoming a TimeSlips facilitator to make a difference in your family or in your facility.
  • If you are a staff member, read more about TimeSlips and approach your leaders about becoming Certified Facilitator. Share the research article.  If management somehow says "no," be a leader for change and do it anyway on your time and on your dime.  Introduce it to your residents, invite the leaders, and show them it works. It can have a high impact and is not costly.  
  • If you are a Family member with a loved one in a facility, ask management if they will bring TimeSlips to the residence. If not, ask why.  Be persistent. I hope that one day this is a program that residences can use to demonstrate how dementia-friendly they are. 
Matt Estrade, MBA, CAPS is the Founder and Chief Mentor at Care Partner Mentoring, LLC in Covington/New Orleans, LA, USA. A more extensive biography can be found here.

Wednesday, December 9, 2015

Would You Break a Sweat to Save Your Brain?

Tis the season to begin thinking about new year's resolution and for sure, many will hit the gym, the pool, and the neighborhood pavement for a few months.

What if I could offer greater motivation, perhaps enough to start today in December?

As we become older adults, our brains begin to shrink or "atrophy" at a rate of 1-2% per year.  Scary, yes, but there may be something we can do about it.  We will focus on the hippocampus, the part of the brain "critical for establishing new memories, part of the brain most vulnerable in Alzheimer's Disease (AD) and vulnerable to aging."

As discussed in a very informative lecture by Professor Frank Longo, MD, PhD, Chairman of Neurology and Neurological Sciences at Stanford University, it is possible to grow your brain with daily exercise.

Dr. Longo cites a 2011 Prospective Randomized Controlled Trial (RCT) by Erikson et al. entitled 
"Exercise training increases size of hippocampus and improves memory."  RCTs are the gold standard in research trial design, showing cause and effect, not just association (or correlation) of factors.

Dr. Longo then imagined out loud how this good news may play out when speaking with a patient at his Stanford clinic:

"I have this new drug out, it's is going to reverse the shrinkage of your hippocampus- I know that sounds like science fiction- we have this drug that will reverse brain shrinkage... here are the side effects of this 'drug': less hypertension, less diabetes, and less depression... so you'd say write me a prescription, I'm ready. I'd tell you you need to do brisk walking, or some form of exercise, 30 minutes a day 5 days, you'd be really disappointed and probably wouldn't take it."

This, no doubt, will not stop Dr. Longo from offering the findings and encouragement. Of course, we should all still try to spread the news of the potential benefits of exercise. Will you make that difference?

I hope you consider this study and start lacing up your tennis shoes. Please do not see this as an all or nothing proposition.  If you can exercise 3 days a week, that is better than nothing. I'll post more research on prevention. The best way to find Peace with Dementia is to take steps to avoid developing it. Be well!

A special thanks to Dr. Longo for this presentation and Dr. Erikson and team for this important work.

Action Items:

  • Decide if you want to reduce risk of hypertension, depression, diabetes, and dementia.
  • If yes, find a cardiovascular activity that you enjoy doing - swimming, walking, cycling, etc.
  • Add a comment or question. 
  • Share, Like, and +1 this article.
  • Like us on FB and visit our website for a list of support groups and services.
Matt Estrade, MBA, CAPS is the Founder and Chief Mentor at Care Partner Mentoring, LLC in Covington/New Orleans, LA, USA. A more extensive biography can be found here.

PubMed Citation of Study Discussed:
 2011 Feb 15;108(7):3017-22. doi: 10.1073/pnas.1015950108. Epub 2011 Jan 31.  Exercise training increases size of hippocampus and improves memory.
Erickson KI1Voss MWPrakash RSBasak CSzabo AChaddock LKim JSHeo SAlves HWhite SMWojcicki TRMailey EVieira VJMartin SAPence BDWoods JAMcAuley EKramer AF.

Sunday, November 29, 2015

Individualized Music in Preventing and Soothing Agitation in Dementia

They say that music is the soundtrack of our lives. Most probably, this strikes a chord with you. Do you ever hear a song on the radio or television that for a moment transports you back to a distant place and time? Perhaps the memory is pleasant and reminds you of event like courting your spouse or your wedding.  A song may also bring back a painful memory such as a bad relationship or breakup. It could even be bittersweet, reminding you of a loved one who is no longer physically in your life. This blog post will tell you how music can create Peace with Dementia. As always, I offer some action steps if you are committed making Peace.

Music is a powerful thing.  According to Professor Linda A. Gerdner at the Stanford Geriatric Education Center, music can be used to sooth persons with dementia when they are agitated.  Agitation is a term used to describe "inappropriate verbal, vocal, or motor activity that is not explained by needs or confusion per se" (Cohen-Mansfield & Billig, 1986, p.712) as documented in Dr. Gerdner's presentation mentioned in the next paragraph.  When someone has a dementia, their "stress threshold" is lower, meaning that it takes even less distraction and disruption to become agitated (Richards-Hall & Buckwalter, 1987) as documented in Dr. Gerdner's presentation. Where you and I today may have a strong ability to keep our cool,  we will generally be set off more easily if we have dementia.  Using music in the proper way can help prevent agitation and also help calm someone down when agitated.

Dr. Gerdner has been studying the benefits of music for persons with dementia for 25 years. In 1996, she published her original evidence based guidelines which is in its 5th edition. In early 2015, Stanford uploaded this Dr. Gerdner presentation that you will enjoy.  I highly recommend viewing the presentation and focusing on these key points from Dr. Gerdner's research:

  • It is important to know this a "music intervention" that can be used by family members and staff who follow Dr. Gerdner's evidence-based guidelines. This is not "music therapy" that is offered by therapists. 
  • For music to effectively create peace, select songs and artists that you know are special to the person with dementia.
  • Dr. Gerdner has developed two (2) assessments to assist you in exploring song selection.
    • One (1) assessment is for persons in the early stages of dementia - Page 16 of the guidelines
    • One (1) assessment is for a family care partner and/or professional care partner- Page 18 of the guidelines.
  • Prevention of agitation is optimal. Dr. Gerdner recommends playing music 30 minutes prior to the time of day when it appears.  This takes looking for patterns and sources of agitation. 
  • The only way to know if this will work for your loved one or a client is to try the selected songs and takes notes on progress.  When a songs works, write that down. When a song does not work, write that down. Discontinue songs that create more agitation.  The person with dementia is the expert from whom we take our cues.
  • If music from a music player bothers other people, try comfortable headphones with a safe volume. Remember the person will like have different hearing ability as you, and not necessarily worse if they have a hearing device.
  • Dr. Gerdner's research also discuss ethnic music that can be very powerful if they have not heard it in a very long time. Her above presentation includes two powerful examples of this.
  • Naomi Feil, creator of Validation Therapy, is seen on this popular video of utilizing music to communicate with someone in repetitive motion and non-verbal.
  • Here is a popular example of a gentleman coming alive with the help of his favorite music.
Action items for you to create Peace with Dementia:
Matt Estrade, MBA, CAPS is the Founder and Chief Mentor at Care Partner Mentoring, LLC in Covington/New Orleans, LA, USA. A more extensive biography can be found here.

Sunday, November 15, 2015

Holiday Tips for Peace with Dementia

The holidays should be peaceful and happy times. While they are positive for many people, these last months of the year certainly are busier times with holiday parties, shopping, and cooking. When you are a care partner for someone with dementia or have dementia yourself, the extra holiday tasks can make the holidays extra stressful.  Here are 2 links that may provide some appreciated information for you, along with some of my comments on the articles.

The first article is from the Mayo Clinic and discusses how to simplify the holidays this year.  These are good tips, but do remember that ultimately your loved one decides what are good ideas. For example, the article mentions to keep things low-key.  That is sage advice, unless your loved one with dementia love a loud party this year.  As a care partner, take care of yourself and do the best you can.  It is very hard to make everyone happy.

The second article/PDF is from the Alzheimer's Association regarding gift giving. Remember that this is just a good list of ideas and that no list is perfect.  It is divided up into different stages of dementia. You may not know the stage! When in doubt ask the family or professional care partner about what you are considering getting. While it may be well intentioned to get someone a memory aid, post it notes, a pad for writing down tasks, think about how the person with dementia will feel getting it.  It very well could be unintentionally insulting or make them feel like a child.  Instead, think about what hobbies they have always enjoyed, but keep it simple.  When in doubt, music or a music player can be a priceless gift that stimulates the mind and brings joy. Consider things that bring comfort on the list. Something not on the list are essential oils for aromatherapy.  Also, do not forget their care partner!  Offer a coupon book of hours to relieve them while they go to a movie, hair salon, or dinner.  Gift certificates for any of these place are nice as well, just remember they may need help to leave the house.

I hope you find this helpful and I welcome comments and additional holiday and gift ideas.
  • As always, write your favorite ideas, make a plan to follow through and see how it goes! 
  • Be flexible and go with the flow. Write down your successes and lessons learned.
  • Add a comment or question. 
  • Like us on FB and visit our website for a list of support groups and services.
Here's wishing you and your family and happy and peaceful holiday season!

Matt Estrade, MBA, CAPS is the Founder and Chief Mentor at Care Partner Mentoring, LLC in Covington/New Orleans, LA, USA. A more extensive biography can be found here.
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