Mind-Body Therapies in Individuals With Dementia: An Integrative Review

Measurement of Five Emotions Defined by Traditional Chinese Medicine With a Focus on Preventing Mild Cognitive Impairment

Objectives: This study aimed to develop a novel Measurement of the Five Emotions (MFE) based on traditional Chinese medicine for assessing cognitive impairment in elderly individuals. Methods: Surveys were collected from 184 participants, over 65 years of age, who were residents of Kyoto City, Japan. The surveys included the Measurement of the Five Emotions (MFE) and the Dementia Assessment Sheet for the Community-based Integrated Care System (DASC-21). Item-total reliability and internal consistency reliability were assessed using Spearman's correlation test and Cronbach's alpha coefficient analysis. Factor analysis was conducted to identify the main factors related to the theoretically constructed emotional reaction patterns. Criterion-related validity was examined by investigating the correlation between the scores of the 2 surveys (MFE and DASC-21). Results: The factor analysis revealed that the final version of MFE consisted of 5 factors, which accounted for a cumulative contribution rate of 57.71%. The Cronbach's alpha coefficient reached .71, indicating satisfactory internal consistency. There was a negative correlation between the MFE and DASC-21 scores with a correlation coefficient of -.3149. Furthermore, when comparing participants with lower cognitive function (DASC-21 score >26) to those with higher cognitive function, MFE subscale scores in the emotions of "Sorrow" and "Thought" were significantly lower, suggesting that these particular emotions are related to cognitive impairment. These findings confirmed the reliability and the construct validity of the MFE. Conclusion: The criterion reliability and validity tests provided evidence for the construct validity of the MFE. The negative correlation (coefficient = -.3149) between MFE scores and DASC-21 scores suggested that MFE can serve as a scale for detecting cognitive impairment.

Mind-body therapies for older adults with dementia: a systematic review and meta-analysis

PURPOSE

This systematic review of randomised controlled trials (RCTs) aimed to determine the effects of mind-body therapies (MBTs) among older adults with dementia.

METHODS

We searched five electronic databases (PubMed, PsycINFO, Web of Science, EMBASE, and the Cochrane Library) for publications investigating the effect of MBTs until July 14th, 2020. We included published peer-reviewed RCTs among participants with a mean age of 60 and above and a diagnosis of any dementia. Eligible studies included measurements for all types of health outcomes, including cognitive function, neuropsychiatric inventory, depressive syndromes, agitation, psychosocial status, and other health outcomes. Two investigators extracted data, the risk of bias for each study was evaluated through Review Manager, and statistical meta-analysis was performed using Stata.

RESULTS

A total of nine studies met the eligibility criteria, with full-text available for systematic review. Five of them, with 338 participants, were included in the meta-analysis. For most included RCTs of the review, the methodological quality was moderate. The meta-analysis showed that Tai Chi had a mild effect on global cognitive function (Mini-Mental State Examination, SMD = 0.40, 95% CI 0.10-0.70). Yoga and aromatherapy may also be beneficial for depression, and these three MBTs improved quality of life.

CONCLUSION

The current review suggested that MBTs may act as potential non-pharmaceutical approaches to improve certain health outcomes among older populations with dementia. Systematic review and meta-analysis registration: PROSPERO CRD42021198514.

Predictors of Mind-Body Therapy Use Among Sexual Minority Older Adults

Introduction: Sexual minority (SM; lesbian, gay, bisexual) older adults age 50+ experience a higher prevalence of chronic disease and disability, as well as a poorer physical and mental health status, compared with their heterosexual peers. Many adults use complementary and integrative therapies, particularly mind-body therapies, as health-enhancing approaches and to support well-being. However, no study to date has examined the use of mind-body therapies among SM older adults. Materials and Methods: Data were from the 2017 National Health Interview Survey. Descriptive and summary statistics were calculated to describe use of mind-body therapies by SM older adults (aged 50+). The authors also tested associations between use of mind-body therapies and health and well-being among SM older adults and compared associations with their non-SM counterparts. Results: SM older adults reported higher usage (36%) of mind-body therapies compared with heterosexual adults (22%), with lesbian women reporting the highest use (39.4%). Having a SM identity was associated with mind-body therapy use; SM older adults were 57% more likely to use a mind-body therapy. Conclusion: Mind-body therapies may be a useful tool for SM older adults to enhance their health and well-being. Future qualitative research is needed to investigate more deeply the reasons SM older adults use mind-body therapies. To advance the health and well-being of SM older adults, the authors also need intervention studies that explore the effectiveness of mind-body interventions and the possible need for tailoring these to the unique needs of this population.

Knowledge and clinical dialogues about complementary health approaches among nurse practitioners specialized in geriatrics

BACKGROUND

In the United States, people over the age of 65 years will account for 20% of the population by 2030, and these elders are more likely to have chronic comorbid complex health problems. Sixty-three percent use complementary health approaches (CHAs) but less than half disclose their use to their health care providers. Nurse practitioners (NPs) are the fastest growing population of primary care health providers.

PURPOSE

This study identifies to what degree NPs with specialized training in geriatrics understand CHAs, use them themselves, encourage their patients to access them, and engage in CHA clinical dialogue.

METHODS

Cross-sectional online survey collecting quantitative and narrative data; US NPs with specialized training in geriatrics (n = 170, mean age 52 years, SD: 9.0, range: 29-73).

RESULTS

Although NPs are knowledgeable about some CHA and believe they are beneficial for older adults to use, they want more education to help understand the effects of a variety of CHA, be more aware of possible treatment interactions, and to integrate CHA into the current health care system. Patient factors (impaired cognitive function, acute health problems, and not open to CHA), provider factors (inadequate CHA knowledge, limited referral paths and resources), and system factors (limited accessibility and availability of CHA in in-patient setting, CHA not covered by insurance, and limited clinical time) disrupt NPs from assessing and discussing CHA with their patients.

IMPLICATIONS FOR PRACTICE

There is a need to develop and implement NP practice guidelines for CHA clinical management for older adults and provide educational opportunities to incorporate CHA into clinical practice.

Nonpharmacological Strategies Used By Family Caregivers of Persons With Alzheimer's Disease and Related Dementias as Presented in Blogs

Individuals with Alzheimer's disease and related dementias (ADRD) may exhibit behavioral and psychological symptoms of dementia that can increase the strain experienced by their family caregivers. This strain correlates with increased stress and reduced quality of life for the family caregiver and individual with ADRD. More information is needed regarding the ways in which caregivers manage the caregiving experience in their efforts to reduce strain and maintain or improve quality of life. Many individuals, including dementia caregivers, use web blogs as online journals to share their lived experiences. The current study used blogs written by family caregivers of persons with ADRD to explore strategies used to support their care recipients. Using a qualitative thematic analysis, six themes related to the strategies used by caregivers were identified: Modifying the Physical and Personal Environment; Engaging the Person With ADRD; Seeking Outside Assistance; Using Complementary Therapies; Planning and Organization; and Reminiscing and Traditions. The current findings extend our understanding of strategies for caregiving that are used by and acceptable to family caregivers of persons with ADRD. This information can be used to develop or modify nursing-related interventions and services aimed at improving caregiver strain and quality of life. [Journal of Gerontological Nursing, 45(7), 25-35.].

Meditation-Based Interventions for Adults With Dementia: A Scoping Review

IMPORTANCE

With the high prevalence and cost of dementia care worldwide, a need exists to develop cost-effective and evidence-based treatment for people with dementia. Meditation, which has been demonstrated to have positive effects on brain health, may be a viable intervention option.

OBJECTIVE

To investigate how meditation-based interventions affect health and quality-of-life (QOL) outcomes for adults with dementia.

DATA SOURCES

Articles were located by using the keywords meditation, mindfulness, mind-body, dementia, and Alzheimer's to search the following electronic databases: PubMed, CINAHL, Embase, Cochrane, and JumboSearch at Tufts University.

STUDY SELECTION AND DATA COLLECTION

Using Arksey and O'Malley's methodology, a scoping review was conducted to examine scientific and gray literature published between 1997 and 2018. Data were abstracted and assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Only articles that included a meditation-based intervention and at least 1 participant with dementia were included.

FINDINGS

Nineteen articles met inclusion criteria. The four main outcomes that emerged from the literature were improvement in QOL, mental health, cognition, and functional abilities after participation in a meditation-based intervention. The outcome with the strongest support was the effectiveness of meditation-based interventions in maintaining cognitive function in people living with dementia. Significant gaps in the research were identified, including weak research design, inconsistency in measurement of outcomes, small sample sizes, and a lack of standardized meditation protocols for people with dementia.

CONCLUSIONS AND RELEVANCE

Our findings suggest that incorporating meditation into interventions for clients with dementia can have beneficial results. Opportunities exist for occupational therapy practitioners to advocate for the continuation of research in this field. Notable gaps in the literature highlight the need for randomized controlled trials and the development of standardized meditation protocols for people with dementia.

WHAT THIS ARTICLE ADDS

Meditation-based interventions for people with dementia are associated with improved quality of life and cognition and may be viable treatment options for occupational therapists to implement in their practice.

Efficacy of different types of exercises on global cognition in adults with mild cognitive impairment: a network meta-analysis

OBJECTIVE

To compare the efficacy of different types of exercises on global cognition in adults with mild cognitive impairment.

METHODS

We systematically searched six databases from their inception to December 14, 2018, for randomized controlled trials evaluating the efficacy of exercise on global cognition in adults with mild cognitive impairment. For the included studies, the mean changes in global cognition from baseline to endpoint were analyzed. A random-effects model was used to conduct pairwise meta-analyses to directly examine the efficacy of different types of exercises. The consistency model was used to conduct a network meta-analysis to evaluate the relative efficacy and rank probability of different types of exercises.

RESULTS

Pairwise meta-analyses suggested that there was no significant heterogeneity in the exercises. Aerobic exercises (n = 5), resistance exercises (n = 4), and mind-body exercises (n = 7) all had significant benefits compared to the control. Exergame showed a positive trend for higher efficacy than control (n = 1) and mind-body exercise (n = 1). The results of the network meta-analysis indicated that the four exercise types all had significant benefits compared to the control, and resistance exercises outperformed mind-body exercises. Resistance exercises were most likely to be ranked 1, followed by exergames, aerobic exercises, and mind-body exercises.

CONCLUSIONS

High-intensity and frequent resistance exercises may be the most effective exercise type to improve global cognition in adults with mild cognitive impairment. More multi-arm designs and randomized controlled trials examining the efficacy of exergames are needed.

Nutritional Interventions for Persons With Early-Stage Dementia or Alzheimer's Disease: An Integrative Review

Persons with Alzheimer's disease and related dementias (ADRD) are at particular risk of malnutrition and weight loss. Clinical research concerning the role and impact of nutritional intervention in early-stage ADRD, specifically on cognition and key symptoms such as behavior, is less straightforward. Thus, an integrative review was conducted to examine the literature pertaining to nutritional interventions for persons with ADRD and to make recommendations for priority areas for future research and practice. Findings from the studies reviewed highlight multiple potential opportunities for improving nutritional status and support for persons with ADRD living in the community. Despite the small amount of evidence, the six studies identified in the current review suggest a broad benefit may be conferred through educational approaches and nutritional supplementation. [Res Gerontol Nurs. 2019; 12(5):259-268.].

"A Fine Line That We Walk Every Day": Self-Care Approaches Used by Family Caregivers of Persons with Dementia

Individuals living with Alzheimer's disease and related dementias (ADRD) often exhibit behavioral and psychological symptoms of distress that can contribute to the strain experienced by their family caregivers. This strain can increase levels of stress for family caregivers and reduce quality of life, which can have a negative impact on physical health and wellbeing for both the caregiver and the person with ADRD. This study used blogs written by family caregivers of persons with ADRD to explore self-care strategies practiced by these caregivers. Using a qualitative thematic analysis, seven themes related to self-care approaches used by caregivers of persons with ADRD were identified: (1) health and wellness; (2) altruism and activism; (3) reminiscing and legacy building; (4) social support; (5) information exchange; (6) organization and planning; and (7) spirituality. By understanding the ways in which caregivers for someone with ADRD practice self-care, interventions and services can be developed in an effort to improve caregiver quality of life.

Safety of Qigong: Protocol for an overview of systematic reviews

BACKGROUND

Qigong, as one of the essential elements of Traditional Chinese exercises, has been used to improve physical and psychological health and combat diseases in China for thousands of years. In recent years, the beneficial effects of Qigong on different medical conditions are becoming more accepted by both patients and health care providers. Although it is a common impression that Qigong and related therapies are generally safe procedures, but the current understanding of its adverse events is fragmented. Thus, we conducted this overview to synthesize comprehensively existing systematic reviews on adverse events associated with Qigong and related therapies, and our findings can be used to informing clinicians, Qigong practitioner, and patients alike on applying such treatments or interventions in clinical treatment and daily life training mindful manner, and provide a guideline for researchers in future.

METHODS

A systematic review of reviews will be performed. A literature search strategy designed by a number of specialists in the fields of Traditional Chinese Medicine (TCM), sports medicine, health information, and Qigong training will be carried out in relevant English and Chinese electronic database. The date range of search will start from inception to the search date. Two reviewers will identify relevant studies, extract data information, and then assess the methodical quality by Assessment of Multiple Systematic Reviews (AMSTAR) tool. Any types of systematic review that summarized adverse effects related to Qigong and related therapies in human will be included. Any safety-related outcomes will be considered as the primary outcomes of this overview. Where objectives from 2 or more reviews overlap, we will assess the causes of any noted discrepancies between reviews. An overall summary of results will be performed using tabular and graphical approaches and will be supplemented by narrative description.

RESULTS

This overview will identify any adverse events associated with nonstandardized Qigong and related therapies procedures based on current relevant literature evidence of safety for Qigong.

CONCLUSION

Our overview will provide evidence to help synthesize the broad degree of information available on furthering the knowledge, safety, and application of Qigong.

ETHICS AND DISSEMINATION

Formal ethical approval is not required, as this study is an overview based on the published systematic reviews. The result of this overview of systematic reviews will be published in a peer-reviewed journal or disseminated at national and international conferences.

PROSPERO REGISTRATION NUMBER

PROSPERO CRD42018109409.