Caring for the caregiver Caring for individuals with AD creates a physical and emotional toll on families, caregivers, and friends. The changes in a loved one’s personality and mental abilities; the need to provide constant, loving attention for years on end; and the physical and emotional demands of bathing, dressing, and other caregiving duties can be overwhelming. Caregivers juggle many responsibilities and must adjust to new and changing roles. When joining the patient care team, it is important to assess the roles and needs of caregivers because they are key to the successful long-term management of individuals with AD (Sadowsky & Galvin, 2012). The ability to keep an older adult at home (versus in a long-term care facility) is significantly influenced by caregiver burden. Although the majority of people with AD are cared for at home early in their illness, research suggests that increasing perceptions of caregiver stress – physical and emotional – are associated with nursing home placement (Gaugler, Mittelman, Hepburn, & Newcomer, 2010). In working with caregivers, sensitive consideration must be given to cultural beliefs, family roles and expectations, communication Conclusion Evidence continues to mount regarding the physical, functional, cognitive, and behavioral benefits of exercise and activity interventions for individuals with AD and other dementias. By supporting and facilitating mobility, fitness, and safety, physical therapists can impact the quality of life of clients and caregivers. Individuals with dementia have unique interpersonal and therapeutic needs and rehabilitation professionals who are aware of these needs and have a repertoire of strategies to address them will have the best chance of therapeutic success. This course has provided a review of the pathophysiology and typical progression of AD, as well as a brief review of related dementias and reversible causes of cognitive changes. Movement disorders, albeit subtle, are present early in the Resources ● Alzheimer’s Association http://www.alz.org ● Alzheimer’s Disease and Related Dementias of the National Institute on Aging http://www.nia.nih.gov/alzheimers ● Alzheimer’s Foundation of America http://www.alzfdn.org ● American Occupational Therapy Association http://www.aota.org ● American Physical Therapy Association http://www.apta.org ● Association for Frontotemporal Degeneration (AFTD) http://www.theaftd.org ● Caregiver Action Network http://www.caregiveraction.org ● Creutzfeldt-Jakob Disease Foundation, Inc. http://www.cjdfoundation.org ● Family Caregiver Alliance https://caregiver.org References Allali, G., & Verghese, J. (2017). Management of gait changes and fall risk in MCI and dementia. Current Treatment Options in Neurology , 19 (9), 29. https://doi.org/10.1007/s11940-017-0466-1. Alzheimer’s Association. (2018a). 2018 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association , 14 (3), 367-429. Alzheimer’s Association. (2018b). Alzheimer’s Association. Retrieved from https://alz.org/. Aman, E., & Thomas, D. R. (2009). Supervised exercise to reduce agitation in severely cognitively impaired persons. Journal of the American Medical Directors Association , 10 (4), 271-276. https://doi.org/10.1016/j. jamda.2008.12.053. American Geriatrics Society. (2015). 2015 Updated Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society , 63 (11), 2227-2246. https://doi.org/10.1111/ jgs.13702. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, DC: American Psychiatric Publishing. Archer, T. (2011). Physical exercise alleviates debilities of normal aging and Alzheimer’s disease. Acta Neurologica Scandinavica , 123 (4), 221-238. https://doi.org/10.1111/j.1600-0404.2010.01412.x. Barreto, P. de S., Demougeot, L., Pillard, F., Lapeyre-Mestre, M., & Rolland, Y. (2015). Exercise training for managing behavioral and psychological symptoms in people with dementia: A systematic review and meta- analysis. Ageing Research Reviews , 24 (Pt B), 274-285. https://doi.org/10.1016/j.arr.2015.09.001. Beauchet, O., Allali, G., Sekhon, H., Verghese, J., Guilain, S., Steinmetz, J.-P., . . . Helbostad, J. L. (2017). Guidelines for assessment of gait and reference values for spatiotemporal gait parameters in older adults: The biomathics and Canadian Gait Consortiums initiative. Frontiers in Human Neuroscience , 11 (Article 353). https://doi.org/10.3389/fnhum.2017.00353. Beauchet, O., Annweiler, C., Callisaya, M. L., De Cock, A.-M., Helbostad, J. L., Kressig, R. W., . . . Allali, G. (2016). Poor gait performance and prediction of dementia: Results from a meta-analysis. Journal of the American Medical Directors Association , 17 (6), 482-490. https://doi.org/10.1016/j.jamda.2015.12.092. Beck, C., Heacock, P., Rapp, C. G., & Mercer, S. O. (1993). Assisting cognitively impaired elders with activities of daily living. American Journal of Alzheimer’s Care and Related Disorders & Research , 8 (6), 11-20. https:// doi.org/10.1177/153331759300800602. Birks, J. S., & Grimley Evans, J. (2015). Rivastigmine for Alzheimer’s disease. The Cochrane Database of Systematic Reviews , (4), CD001191. https://doi.org/10.1002/14651858.CD001191.pub3. Birks, J. S., & Harvey, R. J. (2018). Donepezil for dementia due to Alzheimer’s disease. The Cochrane Database of Systematic Reviews , 6 , CD001190. https://doi.org/10.1002/14651858.CD001190.pub3.
patterns, and beliefs about caring for others. As the disease progresses and caring at home becomes increasingly difficult, family members face difficult decisions about long-term care. Interestingly, when individuals with AD participate in exercise programs, caregiver perception of burden may diminish. This is true whether the caregiver is exercising with the person who has AD (the dyad model of both individuals exercising together) or not (Lowery et al., 2013; Stella et al., 2011). Exercise programs designed for dyads of individuals with AD and their caregivers can be an effective mode of intervention and provide structured time that is beneficial for both members of the pair. Caregivers will more successfully keep individuals with AD compliant with their home exercise program if they understand the benefits of exercise and if the program is promoted or supported by the healthcare team (Suttanon, Hill, Said, Byrne, & Dodd, 2012). Therefore, education of the caregiver relative to these issues and awareness of the caregiver’s perceived level of burden should be a priority. course of AD and progress with the severity of dementia; the most common movement disorders were reviewed. Much of this course focused on optimal interactions with individuals who have AD and characteristics of effective interventions. These principles can be integrated into any rehabilitation or exercise environment. The scientific and clinical evidence in support of exercise interventions with individuals who have AD and specific recommendations related to the use of outcome measures were provided. After completing this course, return to the case vignettes at the end of the course Introduction and identify how to proceed in each situation. ● Lewy Body Dementia Association, Inc. http://www.lbda.org National Institute of Neurological Disorders and Stroke Information Pages: ● Alzheimer’s Disease Information Page https://www.ninds.nih.gov/Disorders/All-Disorders/ Alzheimers-Disease-Information-Page ● Dementia With Lewy Bodies Information Page https://www.ninds.nih.gov/Disorders/All-Disorders/Dementia- Lewy-Bodies-Information-Page ● Frontotemporal Dementia Information Page https://www.ninds.nih.gov/Disorders/All-Disorders/ Frontotemporal-Dementia-Information-Page ● Multi-Infarct Dementia Information Page https://www.ninds.nih.gov/Disorders/All-Disorders/Multi- Infarct-Dementia-Information-Page Shirley Ryan AbilityLab: Rehabilitation Measures Database ● http://www.rehabmeasures.org Blankevoort, C. G., van Heuvelen, M. J. G., Boersma, F., Luning, H., De Jong, J., & Scherder, E. J. A. (2010). Review of effects of physical activity on strength, balance, mobility and ADL performance in elderly subjects with dementia. Dementia and Geriatric Cognitive Disorders , 30 (5), 392-402. https://doi. org/10.1159/000321357. Blankevoort, C. G., van Heuvelen, M. J. G., & Scherder, E. J. A. (2013). Reliability of six physical performance tests in older people with dementia. Physical Therapy , 93 (1), 69-78. https://doi.org/10.2522/ptj.20110164. Booth, V., Hood, V., & Kearney, F. (2016). Interventions incorporating physical and cognitive elements to reduce falls risk in cognitively impaired older adults: a systematic review. JBI Database of Systematic Reviews and Implementation Reports , 14 (5), 110-135. https://doi.org/10.11124/JBISRIR-2016-002499. Borson, S., Scanlan, J., Brush, M., Vitaliano, P., & Dokmak, A. (2000). The mini-cog: a cognitive “vital signs” measure for dementia screening in multi-lingual elderly. International Journal of Geriatric Psychiatry , 15 (11), 1021-1027. Boyer, K. A., Johnson, R. T., Banks, J. J., Jewell, C., & Hafer, J. F. (2017). Systematic review and meta-analysis of gait mechanics in young and older adults. Experimental Gerontology , 95 , 63-70. https://doi.org/10.1016/j. exger.2017.05.005. Bridenbaugh, S. A., & Kressig, R. W. (2014). Quantitative gait disturbances in older adults with cognitive impairments. Current Pharmaceutical Design , 20 (19), 3165-3172. Britt, W. G., Hansen, A. M., Bhaskerrao, S., Larsen, J. P., Petersen, F., Dickson, A., . . . Kirsch, W. M. (2011). Mild cognitive impairment: Prodromal Alzheimer’s disease or something else? Journal of Alzheimer’s Disease , 27 (3), 543-551. https://doi.org/10.3233/JAD-2011-110740. Brody, E. M., Kleban, M. H., Lawton, M. P., & Silverman, H. A. (1971). Excess disabilities of mentally impaired aged: Impact of individualized treatment. The Gerontologist , 11 (2), 124-133. Buddingh, S., Liang, J., Allen, J., Koziak, A., Buckingham, J., & Beaupre, L. A. (2013). Rehabilitation for long-term care residents following hip fracture: A survey of reported rehabilitation practices and perceived barriers to delivery of care. Journal of Geriatric Physical Therapy , 36 (1), 39-46. https://doi.org/10.1519/ JPT.0b013e3182569b4f. Burns, J. M., Johnson, D. K., Watts, A., Swerdlow, R. H., & Brooks, W. M. (2010). Reduced lean mass in early Alzheimer disease and its association with brain atrophy. Archives of Neurology , 67 (4), 428-433. https://doi. org/10.1001/archneurol.2010.38. Burton, E., Cavalheri, V., Adams, R., Browne, C. O., Bovery-Spencer, P., Fenton, A. M., . . . Hill, K. D. (2015). Effectiveness of exercise programs to reduce falls in older people with dementia living in the community: A
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