The Gerontological Society of America (GSA) held its 60th Annual Scientific Meeting Nov. 16-20 in San Francisco. The theme was “The Era of Global Aging: Challenges and Opportunities.” A highlight of this year’s conference was the Lawton Award Lecture, delivered by University of Washington Alzheimer’s Disease Research Center faculty member Dr. Linda Teri.
Dr. Teri provided an overview of 20 years of research on identifying and treating behavioral problems in Alzheimer’s disease (AD). She described the development of psychosocial treatments to treat these problems, meaning treatments that look at the interaction between social and psychological factors.
In her lecture, Dr. Teri noted that research has come a long way in the past two decades. Just 20 years ago, it was believed nothing could be done to help people with AD – that they would simply have to suffer and worsen as the illness progressed. Now, clinicians have a variety of research-based interventions shown to improve care and quality of life for those living with AD, as well as their caregivers.
|(from left) Drs. Linda Teri and Nancy Fugate Woods, Dean of the University of Washington School of Nursing|
In particular, Dr. Teri noted that co-existing emotional and behavioral disturbances cause “excess disability” over and above the cognitive decline that occurs in dementia. In the 1980s, Dr. Teri and colleagues conducted a series of clinical investigations applying behavioral and social learning theory to the treatment of depression in AD. These studies showed that training caregivers to use behavioral skills to increase pleasant events and decrease negative behaviors was as effective as antidepressant medicine in treating depression in the person with AD.
The use of behavioral skills also improved the caregiver’s mood. The effects of the treatment were long-lasting: They persisted even after the nine-week treatment program was completed.
Dr. Teri also talked about the role of exercise in reducing excess disability in AD. A 2003 study involving exercise along with behavioral management that lasted 12 weeks and had an exercise and problem-solving focus showed significant decreases in depression at three-month and two-year follow-up. Also, those in the study were far less likely to be institutionalized because of behavioral problems.
A 2005 study trained direct care staff in assisted living residences to use compassionate and clear communication with residents who had cognitive impairment. This study also reinforced the values of dignity and respect. In addition, this intervention trained staff to identify and treat common care problems, such as depression and anxiety. Residents in the treatment groups had decreases in both depression and anxiety, compared with increases among the control group.
A similar study focused on family caregivers of individuals with dementia. This program trained community consultants to help family members improve care. Compared with the control group, caregivers in the treatment group had decreased depression and burden. During the treatment program, care recipients (individuals with moderate to severe dementia) also had significantly less decline in overall quality of life than the control group.
What does the past 20 years of research mean in terms of treatment for AD? Dr. Teri explained that for those with AD, it means depression, anxiety and general behavior problems can be reduced. Physical activity can be increased, and disability can be decreased. Also, institutionalization can be delayed. For family caregivers, it means both burden and depression can be reduced. And for staff caregivers, it means skill and job satisfaction can be improved.
At the end of her presentation, Dr. Teri touched on what might be achieved in the next two decades of AD research and treatment. Continued improvement in emotional, physical and cognitive well-being in those with dementia, as well as decreased burden, depression and health problems in their caregivers, are within our grasp. Providing those with dementia, their families and health care workers with easy access to a wide range of research-tested information, education, support programs and interventions is an important “next step” to improving the quality of their lives and maximizing their continued involvement in chosen activities.
Getting there, Dr. Teri said, will require several things: Continued funding for nonpharmacological approaches to patient care, a focus on training those with the most influence in patient care (e.g., families, universal workers, nurses), and identifying untreated sources of disability in people with AD.
|Dr. Rebecca Logsdon participated in a discussion on recruiting for diversity in NIH Alzheimer’s Disease Centers. She also gave two presentations. The first was on an ongoing investigation which is finding that participants with early-stage AD were able to reliably report on their physical health and their mood. In her second presentation, she discussed research that translates what was learned from two programs, Reducing Disability in Alzheimer’s Disease (RDAD) and EnhanceFitness© (EF) to dementia-specific programs within community-based adult day activity programs.||David La Fazia gave a poster presentation on a study that examined the resilience of caregivers and whether that resilience helps protect against depression, stress and burden. The findings indicate that the more resilient a caregiver was, the more protected they were against these adverse outcomes listed, and that it may be important to develop interventions to strengthen resilience among caregivers to improve their lives.||Dr. Susan McCurry gave a poster presentation on a study that examined the factors associated with daytime inactivity and sleepiness in people with AD and their family caregivers. The study indicates that objectively measured daytime inactivity appears to be a product of age and amount of nighttime sleep, whereas self-reports about daytime sleepiness are more influenced by physical health, patient behavioral disturbance and caregiver need for support.|