The management of behavioural and psychological symptoms of dementia in residential homes: Does Tai Chi have any role for people with dementia?

Abstract

Dementia is a common illness that is increasing in frequency and set to challenge the resources and expertise of health and social care services over the coming years. Increasingly, there has been interest in the management of behavioural and psychological symptoms of dementia (BPSD), as they are both common and associated with a range of negative outcomes. BPSD are associated with the admission of people with dementia to care homes. Limited resources and lack of knowledge in permanent care settings often lead to BPSD being managed with antipsychotic medications, which are associated with significant morbidity and mortality. There is evidence for the benefits of exercise within care home settings, although only a few studies include those with cognitive impairment. Tai Chi is a mind-body exercise combining relaxed physical movement and meditation, and has been suggested to have many health benefits. This article discusses the rationale and available options for treating BPSD and the current practice and reviews theliterature regarding the benefits of exercise and, in particular, Tai Chi in the management ofBPSD.

Keywords

dementia behavioural and psychological symptoms of dementia BPSD Tai Chi exercise

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References

Alessi

C. A.

Schnelle

J. F.

MacRae

P. G.

Ouslander

J. G.

al-Samarrai

Simmons

S. F.

Traub

(1995) Does physical activity improve sleep in impaired nursing home residents? Journal of the American Geriatrics Society, 43, 1098–102.

All-Party Parliamentary Group on Dementia. (2008). Always a last resort. Inquiry into the prescription of antipsychotic drugs to people with dementia living in care homes. Retrieved October 5, 2011 from http://www.alzheimers.org.uk/site/scripts/download_info.php?fileID=322.

Best-Martini

Botengagen-Digenova

(2004) Physical activity upper body range-of-motion exercises. Seated arm swing. Geriatrics, 59, 37–37.

British National Formulary No.62 (September 2011) Retrieved October 7, 2011 from http://bnf.org/bnf/bnf/current/3248.htm?q=risperidone&t=search&ss=text&p=1#_hit.

Brittle

Patel

Wright

Baral

Versfeld

Sackley

(2009) An exploratory cluster randomized controlled trial of group exercise on mobility and depression in care home residents. Clinical Rehabilitation, 23, 146–154.

Brody

J. A.

(1982) An epidemiologist views senile dementia – Facts and figures. American Journal of Epidemiology, 113, 155–162.

Burgio

(1996) Interventions for the behavioral complications of Alzheimer's disease: Behavioral approaches. International Psychogeriatrics, 8(Suppl 1): 45–52.

Chan

A. S.

Yim-chi, Ho

Cheung

Albert

M. S.

Chiu

H. F. K.

Lam

L. C. W.

(2005) Association between mind-body and cardiovascular exercises and memory in older adults. Journal of the American Geriatrics Society, 53, 1754–1760.

Charman, R. (2000). Complementary Therapies for Physical Therapists. Qigong and tai chi in physical therapy – Makone, S. 217–230. Butterworth-Heinemann.

10.

Chen, K. M., Lin, J. N., Lin, H. S., Wu, H. C., Chen, W. T., Li, C. H., & Kai Lo, S. (2008). The effects of Simplified Tai Chi Exercise Program (STEP) on physical health of older adults living in long term care facilities: A single group design with multiple time points. International Journal of Nursing Studies, 45, 501–507.

11.

Choi

J. H.

Moon

J. S.

Song

(2005) Effects of Sun-Style Tai Chi exercise on physical fitness and fall prevention in fall-prone older adults. Journal of Advanced Nursing, 51, 150–157.

12.

Chu

L.-W.

Alice

Y. Y.

Chiu

A. Y. Y.

Chi

(2007) Falls and subsequent health service utilizationin community-dwelling Chinese older adults. Archives of Gerontology and Geriatrics, 46, 125–135.

13.

Cohen-Mansfield

(1995) Assessment of disruptive behavior/agitation in the elderly: Function, methods and difficulties. Journal of Geriatric Psychiatry and Neurology, 8(Suppl 1): 52–60.

14.

Cohen-Mansfield

Marx

M. S.

Werner

(1992) Agitation in elderly persons: An integrative report of findings in a nursing home. International Psychogeriatrics, 4(Suppl 2): 221–240.

15.

Committee on Safety of Medicines. (2004). Atypical antipsychotic drugs and stroke. Retrieved November 23, 2009, from http://www.mhra.gov.uk/home/groups/pl-p/documents/websiteresources/con019488.pdf.

16.

Deimling

G. T.

Bass

D. M.

(1986) Symptoms of mental impairment among elderly adults and their effects on family caregivers. Journal of Gerontology, 41, 778–784.

17.

Donnelly, L. (2008). Dementia time bomb ‘will hit 1.2m’. Retrieved November 23, 2009, from http://www.telegraph.co.uk/news/uknews/1582524/Dementia-timebomb-will-hit-1.2m.html.

18.

Draper

Snowdon

Meares

Turner

Gonski

McMinn

McIntosh

Latham

Draper

Luscombe

(2000) Case-controlled study of nursing home residents referred for treatment of vocally disruptive behavior. International Psychogeriatrics, 12, 333–334.

19.

Everett

Dennis

Ricketts

(1995) Physiotherapy in Mental Health, 12, 383–399.

20.

Finkel

S. I.

Costae Silva

Cohen

Miler

Sartorius

(1997) Behavioural and psychological signs and symptoms of dementia: A consensus statement on current knowledge and implications for research and treatment. International Psychogeriatrics, 8(Suppl 3): 497–500.

21.

Finkle

S. I.

Burns

(1999) Behavioral and psychological symptoms of dementia (BPSD): A Clinical and research update, International Psychogeriatric Association, Consensus group.

22.

Forbes, D., Forbes, S., Morgan, D. G., Markle-Reid, J., & Culum, I. (2008). Physical activity programs for persons with dementia. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD006489. DOI: 10.1002/14651858.CD006489.pub2.

23.

Galante

(1981) Tai Chi: The supreme ultimate, Boston, MA: Weiser.

24.

Galik

E. M.

Resnick

Pretzer-Aboff

(2009) ‘Knowing what makes them tick’: Motivating cognitively impaired older adults to participate in restorative care. International Journal of Nursing Practice, 15, 48–55.

25.

Gibb

Morris

C. T.

Gleisberg

(1997) A therapeutic programme for people with dementia. International Journal of Nursing Practice, 3, 191–199.

26.

Great Britain, Department of Health. (2009). Living well with dementia: A national dementia strategy. Retrieved November 23, 2009, from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_094058.

27.

Health Education Authority (2000) Avoiding slips, trips and broken hipsFact sheet 5 (p. 3).

28.

Jahnke, R. (2007). Introductory Articles. Feel the Qi. Retrieved June 29, 2009, from http://www.feeltheqi.com/intro_articles.htm.

29.

Lan, C., Lai, J.S., & Chen, S.Y. (2002). Tai Chi Chuan: An Ancient Wisdom on Exercise and Health Promotion. Sports Medicine, 32(4), 217–224.

30.

Margallo-Lana

Swann

O'Brien

Fairbairn

Reichelt

Mynt

Ballard

(2001) Prevalence and pharmacological management of behavioural and psychiatric symptoms amongst dementia sufferers living in care environment. International Journal of Geriatric Psychiatry, 16, 39–44.

31.

Morriss

R. K.

Rovner

B. W.

Folstein

M. F.

German

P. S.

(1990) Delusions in newly admitted residents of nursing homes. American Journal of Psychiatry, 147, 299–302.

32.

National Center for Complementary and Alternative Medicine. (2009). Tai Chi: An introduction. Retrieved June 21, 2009, from http://nccam.nih.gov/health/taichi/.

33.

National Institute for Health and Clinical Excellence – Social Care Institute for Excellence. (2006). Dementia: The NICE-SCIE guidelines on supporting people with dementia and their carers in health and social care. Quick reference guide. Retrieved November 23, 2009, from http://www.nice.org.uk/nicemedia/pdf/CG042quickrefguide.pdf.

34.

National Institute for Health and Clinical Excellence – Social Care Institute for Excellence. (2007). Dementia: The NICE-SCIE guidelines on supporting people with dementia and their carers in health and social care. Retrieved November 23, 2009, from http://www.nice.org.uk/nicemedia/pdf/CG042NICEGuideline.pdf.

35.

O'Dea

Kerrison

Pollock

(2000) Access to health care in nursing homes: A survey in one English Health Authority. Health Social Care Community, 8, 180–185.

36.

O'Donnell

B. F.

Drachman

D. A.

Barnes

H. J.

Peterson

K. E.

Swearer

J. M.

Lew

R. A.

(1992) Incontinence and troublesome behaviors predict institutionalization in dementia. Journal of Geriatric Psychiatry and Neurology, 5, 45–52.

37.

Oschman

J. L.

(2003) Energy medicine in therapeutics and human performance. The Journal of Alternative and Complementary Medicine, 10, 418–418.

38.

Rabins

P. V.

Mace

N. L.

Lucas

M. J.

(1982) The impact of dementia on the family. Journal of the American Medical Association, 248, 333–335.

39.

Roberts, L. (2007). Dementia time bomb will cost the NHS millions. Mail Online. Retrieved November 23, 2009, from http://www.dailymail.co.uk/news/article-438450/Dementia-timebomb-cost-NHS-millions.html.

40.

Rodney

(2000) Nurse stress associated with aggression in people with dementia: Its relationship to hardiness, cognitive appraisal and coping. Journal of Advanced Nursing, 3, 172–180.

41.

Royal College of Psychiatrists Faculty for the Psychiatry of Old Age. (n.d.) Atypical antipsychotics and behavioural and psychiatric symptoms of dementia prescribing update for old age psychiatrists. Retrieved November 23, 2009, from http://www.rcpsych.ac.uk/PDF/BPSD.pdf.

42.

Sackley

C. M.

Gatt

Walker

(2001) The use of rehabilitation services by private nursing homes in Nottingham. Ageing, 30, 532–533.

43.

Spector

Orrell

Davies

Woods

(2000) Reality orientation for dementia. Cochrane Database of Systematic Reviews, 4, CD001119–CD001119.

44.

Steele

Rovner

Chase

G. A.

Folstein

(1990) Psychiatric symptoms and nursing home placement of patients with Alzheimer’s disease. American Journal of Psychiatry, 147, 8–8.

45.

Stokes

(2009) Caring for people living with dementia – Behaviour in dementia that challenges us. Presentation held at Moseley. Birminghamon July 9, 2009.

46.

Sung

H. C.

Chang

S. M.

Lee

W. L.

Lee

M. S.

(2006) The effects of group music with movement intervention on agitated behaviors of institutionalized elders with dementia in Taiwan. Complementary Therapies in Medicine, 14, 113–119.

47.

Teri

Logsdon

Uomoto

McCurry

(1997) Behavioral treatment of depression in dementia patients: A controlled clinical trial. Journals of Gerontology: Psychological Sciences, 52B, 159–166.

48.

Teri

Logsdon

R. G.

McCurry

S. M.

(2008) Exercise interventions for dementia and cognitive impairment: The Seattle Protocols. Journal of Nutrition, Health and Aging, 12, 391–394.

49.

Teri

Logsdon

R. G.

Peskind

Raskind

Weiner

M. F.

Foster

N. L.

Schneider

L. S.

Sano

Whitehouse

Tariot

Mellow

A. M.

Auchus

A. P.

Grundman

Thomas

R. G.

Schafer

Thal

L. J.

(2000) Treatment of agitation in AD. A randomized, placebo-controlled clinical trial. Neurology, 55, 1271–1278.

50.

The Qigong Institute. (2004–2009). Tai Chi for health. Retrieved June 19, 2009, from http://www.qigonginstitute.org/html/taichihealth.php.

51.

Tsang

H. W.

Fung

K. M.

Chan

A. S.

Lee

Chan

(2006) Effect of a Qigong exercise programme on elderly with depression. International Journal of Geriatric Psychiatry, 21, 890–897.

52.

Verhagen

A. P.

Immink

van der Meulen

Bierma-Zeinstra

S. M. A.

(2004) The efficacy of Tai Chi Chuan in older adults. Family Practice, 21, 107–107.

53.

Wainapel, S. F., & Fast, A. (Eds.). (2002). Alternative medicine and rehabilitation: A guide for practitioners. New York: Demos Medical Publishing. Retrieved March 10, 2009, from http://site.ebrary.com/lib/staffordshire/Doc?id=10118505&ppg=5.

54.

Wall

Duffy

(2010) The effects of music therapy for older people with dementia. British Journal of Nursing, 19, 108–113.

55.

Westcott

(2007) 9 secrets to a healthier heart. Living prevention. Health74–75.

56.

Williams

C. L.

Tappen

R. M.

(2008) Exercise training for depressed older adults with Alzheimer's disease. Aging and Mental Health, 12, 72–80.

57.

Wolf

S. L.

Coogler

(1997) Exploring the basis for Tai Chi Chuan as a therapeutic exercise approach. Archives of Physical Medicine and Rehabilitation, 78, 886–892.

58.

Woods

(2002) Non-pharmacological techniques. In: Qizilbash

Schneider

Chui

Tariot

Brodaty

Kaye

Erkinjuntti

(eds) Evidence-based dementia practice, Oxford: Blackwell Publishing, pp. 428–442.

59.

Yao

Giordani

Alexander

N. B.

(2008) Developing a positive emotion-motivated tai chi (PEM-TC) exercise program for older adults with dementia. Research and Theory for Nursing Practice, 22, 241–255.