Abstracts - Alzheimers New Zealand Confernce 2010

Conference Secretariat
Conferences & Events Ltd
PO Box 24078, Manners St,
Wellington

Email:alzheimers10@confer.co.nz
Tel: +64 4 384 1511
Fax: +64 4 384 4667

Concurrent Sessions Abstracts

Concurrent sessions Thursday

A Change Process, People with Dementia and Residential Care
Presenting Author: Grace O’Sullivan *

Affiliations:
Academic PhD candidate AUT University

Practice: Consultant occupational therapist, St Andrew’s Village, Auckland, New Zealand

Abstract
New knowledge and understanding has paved the way for improvements in the ‘care’ of people with Alzheimer’s or similar type diseases. Person centred care is now considered essential at all stages of the disease process and the environment is known to have a positive and/or negative effect on behaviour. Research findings have highlighted the inappropriate use of anti psychotic drugs and currently there is debate about their value in ‘managing’ symptoms.

A change process which took place over three years in two secure dementia units, will be summarized in this presentation. The strategies used to enable residents to live life within their ability and without antipsychotics will be outlined. Barriers to and enablers of change will be discussed.

The units, each with 15 beds are part of St Andrew’s Village, a ‘non profit’ residential care facility for older people. Previously, the use of antipsychotic medications was taken for granted. In light of new understandings, the use of these drugs has been eliminated.

A combination of approaches was essential to the success of the changes. Statistics showing a decline in the number of resident falls, letters from grateful family members, and resident’s obvious well being validate the positive difference the changes have made.

Back

YOD in Oz (Younger Onset Dementia in Australia)
Deanne Ballard
Alzheimer’s Australia ACT

While all people with dementia and their family carers want timely, quality and accessible services that meet their individual needs, there are unique and complex issues faced by people with younger onset dementia and their family carers which are currently not being met.

I would like to present the objectives, goals, outcomes and ongoing implementation of the YOD summit held at Parliament House Canberra by Alzheimer’s Australia in February 2009.
The Summit involved more than [40] people – both people with younger onset dementia and their family carers from all States and Territories.

The 7 priority areas that were identified by the participants at the summit were:

Increased awareness to reduce stigma and social isolation

Timely and accurate diagnosis

Access to age appropriate services.

Employment and financial needs

Improved quality of life

Legal and bureaucratic issues

Increased investment in research

These were presented in a communiqué to the Minister for Ageing, by the participants of the summit.

Back

SHIELD (your brain)
Presenting Author, Vivienne Boyd*
Education Co-ordinator Alzheimers Canterbury

Much has been discussed and written about activities, food, medications, and general lifestyle factors that could contribute to reducing the risk of people developing a dementia. Some of the evidence is ‘contradictory’ and may at times be promoted by groups with vested interests. Internationally programmes have been developed by dementia organisations encouraging adults young and old to maintain a healthy lifestyle and in doing so build their cognitive reserve and take a proactive approach to adding to their quality of life. Examples are in Australia ‘Mind your mind’ and in USA ‘Maintain your brain’.

I have developed a presentation for adults in New Zealand interested in doing what they can to protect their brain and their general health which I am calling SHIELD. To date feedback from local community groups about my SHIELD approach has been positive. Information about dementia can be woven into it.

At the workshop I will outline the components of SHIELD and together we will further develop this presentation so that participants can take it away afterwards to use in their communities. Perhaps thereafter we could also lobby for funding to run this initiative nationally throughout New Zealand possibly in partnerships with other community based organizations

Back

Actualizing our Vision with the "Best Friends" Approach to Dementis care
Donya Nee, Admatha Dementia Care
Donna Jemmett, Admatha Dementia Care
Simon Hamley, Admatha Dementia Care

The Best Friends approach to dementia care was initially developed by V. Bell and D. Troxal in 1997. This approach has helped us to actualize our vision and values.
In our group of homes we seek to create a loving, warm and homely atmosphere where each is person is supported to experience each moment richly. We strive to do this by promoting the uniqueness and immense value of each person, using openness, honesty and integrity.

A set of four workshops for staff have been developed from the book, Best Friends Approach to Dementia Care.

The first three workshops include:
Knowledge of dementia.
Delirium.
Empathy - by encouraging staff to consider what it is like to ‘walk in the shoes’ of someone with dementia.
Celebrating the characteristics of a best friend and how to create ‘magic moments’ using communication and knack.

Homely activities.
The final workshop brings together learning from the previous three sessions and assists participants to use their new learning to actualize our vision and values as they work with people affected by dementia. An increased sense of well being for residents, families and staff is achieved.
This level of ‘connectedness’ is highly fulfilling for staff and creates an atmosphere of acceptance.

Back

The Consumer Dementia Reasearch Network, Australia
Michele Hawkins, Alzheimer’s Australia

A Consumer Dementia Research Network (Network) is being established in Australia under the auspices of Alzheimer’s Australia and in partnership with the three Dementia Collaborative Research Centres. The key objectives of the Network are to improve the way research is prioritised, commissioned, undertaken, communicated, and used, and to improve the quality of dementia care through the rapid dissemination and uptake of research evidence.

Specifically, the Network could develop and promote alliances between consumers and researchers; promote greater public involvement in guiding the direction of research; encourage the evaluation of the effects of research on consumers; take a consultative role in the development of research projects; help disseminate research findings, and advocate for their inclusion in clinical practice, nursing care, and social services through knowledge translation; and respond to requests for help from researchers and others.

This presentation will address why consumer involvement is important in dementia research; the nature of the partnership between consumers and researchers; and lessons from the U.K. Alzheimer’s Society.

Back

Concurrent Sessions Friday

Addressing Dementia and Whakama (Embarrassment/Shame in Māori Communities)
Leef-Smith, R.* ¹, Rameka, E. ², Paki, P. ³
^₁ Community Advisor, Alzheimers Society Northland
² Care Assistant, Alzheimers Society Northland
³ Social Worker, Alzheimers Society Northland

This presentation will focus on whakama, and our aim to remove barriers for Maori seeking help with dementia issues.

Maori are proud, and some will try to ignore the issue or decline offers of help, placing whanau (family) in a position of weakness and despair, and making it hard to offer our services.

In the words of Northland kaumatua (elder) Tupari Tito:
Ka tae te whakapehapeha, ka tae ano te whakama. Kei te hunga whakaiti ia te whakaronui.
(When pride comes, then comes shame. But with the humble comes wisdom).

We will outline the different approaches used as support workers in dealing sensitively with whakama issues in Te Tai Tokerau (Northland). Understanding whakama, developing mutual links and whanau/community trust are a few essential beginnings.

Whakama must be seen as only one of many issues that require an integrated approach in working with Maori affected by dementia.

Back

The Community Psychogeriatric Programme – Improving Dementia Care in Singapore
Dr Li-Ling Ng
Senior Consultant
Department of Psychological Medicine
Changi General Hospital
Singapore

Singapore’s population is ageing rapidly. With an estimated 18% of Singaporeans aged 65 and above by the year 2030, the number of people with dementia is projected to increase from 18,000 in 2009 to 48,000 in 2030. As part of a multi-pronged, multi-agency approach, the Community Psychogeriatric Programme was set up in 2007 to improve community capabilities in dementia care by training GPs, staff and volunteers of eldercare agencies in recognising and managing dementia. The challenge is to develop dynamic networks of community-based dementia services that are integrated with primary care and hospital services and, in doing so meet the needs of people with dementia and their families.

Back

“DEALS ON WHEELS” - DEMENTIA & DRIVING
Gary Cheung¹, Wendy Wright², Kath Henderson³

¹ Specialist Psychogeriatrician, Auckland City Memory Service, Auckland District Health Board
² Senioir Occupational Therapist, Mental Health Services for Older People, Auckland District Health Board
³ Senior Advisor, AA Driver Education Foundation

Workshop – 45 minutes

* Presenters not available on 6th May

It is recognized that driving is important in maintaining the independence, freedom and mobility of older people. Stopping driving can limit access to family, friends, and services. While there is a general consensus that people with moderately severe dementia should not drive, there is also evidence to suggest that not all people with dementia are incompetent drivers, particularly in the earliest stages of disease. However, Previous research found that the decision to stop driving in people with dementia was usually unplanned and abrupt made in response to a physician recommendation.

In clinical practice we often negotiate (i.e. doing a deal) with people with dementia to cease driving. For example, suggesting alternative means of transportation; asking to agree to undergo a driving assessment in return for to continue driving, reinforcing that they can continue to drive with restrictions and under certain conditions.

This workshop will use a case study to illustrate the process of driving assessment and the difficulties encountered in reinforcing driving cessation for a person with dementia. Participants in this workshop will be involved in exploring their experience in dementia and driving. This workshop welcomes participation from people with dementia, their carers/families, health and social workers. Information obtained from this workshop can be used in lobbying policy makers and guiding partners involved in driving & dementia (e.g. people with dementia, their carers/families, clinicians, New Zealand Transport Agency, Pog

Back

Looking at Life Through Their Lens (Helping the Carer Understand Changes in a Person with Dementia)
Presenting Author : Jane Kay
Presenting author’s affiliation: Manager/Educator of Alzheimers New Zealand Waikato.
Previously Primary Carer for two family members with dementia.

It is difficult to know who is most confused – the person with dementia who has no idea why they are struggling with the changes in their ability to remember, focus, comprehend, carry out daily tasks etc; or their carers who are suddenly confronted with unexplainable reactions and behaviours from someone they thought they knew so well.

This presentation focuses on the radical changes in the way that a person with dementia perceives the world and attempts to help the carer understand the reasons for the changes

We cannot hope to know exactly what a person with dementia is perceiving in each situation, but an awareness of the possible differences goes a long way towards reducing the confusion and resultant frustration and distress.

Back

Then and Now - Residential Care for those with Dementia
Jan Hide
Consultant and Trainer in Dementia Care

The face of dementia and its management, particularly within residential care facilities has undergone significant change over the last twenty years. Having been involved in this progression, it seems timely to look back (to consider where we have come from), to review the current and to look to the future. What has improved, what could be improved and where are we headed?

Key areas to be considered will include:
- suitable care environments for dementia residents
- staff education and training programmes and their contents
- staff selection, ratios and supports
- possible threats/risks

With correct staff selection, training and support and an appropriate environment, we should expect that those with dementia who require residential care can be provided with a meaningful lifestyle.

Back

Effects of Regular Aerobic Exercise on Neural Function in Persons with Alzheimer’s Disease
Don J. Milham PhD., Senior Academic Staff – School of Science & Primary Industries, Waikato Institute of Technology, Hamilton, NZ; Roberta Newton PhD, Professor – Temple University, Pennsylvania, USA; Zeb Kendrick PhD, Professor – Temple University, Pennsylvania, USA;

ABSTRACT

Objective: This study examined the AD/exercise hypothesis which posits exercise enhances neural function and attenuates AD symptoms/delays onset through enhanced expression of Brain-derived neurotrophic factor; a peptide that plays a major role in neural function and the mediation/attenuation of the primary AD pathogen, ß-amyloid. Methods: Participants (N = 19; mean 85.5 yrs, SD = + 5.20) diagnosed with probable AD completed a single treatment, regular walking over time (30-min, 3 days per week for 12 weeks); pre/post-test evaluations measured cognitive function and motor capabilities. Statistics - T-test with repeated measures ANOVA with various categorical variables as between-group factors. Results: Along with significant reduction in falls (z = 2.392, p < .017), change in Cognitive function [t(18) = 5.74, p < .001], Balance [t(18) = 7.43, p < .001], and Mobility [t(18) = 3.82, p < .001] were significant. No main effect was associated with AD stage, Activities of daily living, Gender, or Education level. Conclusion: Along with illustrating the positive effects exercise can have in the elderly, results of this study support the exercise hypothesis positing regular aerobic exercise enhances neural function in persons with probable AD, thus possibly attenuating AD symptoms and delaying AD onset.

Back

Occupational Therapy Input for Persons with Mild-Moderate Dementia
Michael Parker –Occupational Therapist
Waitemata District Health Board

This presentation will examine recent evidence for community occupational therapy input and cognitive stimulation programmes. Positive outcomes have been obtained in daily function, cognition, quality of life and reducing caregiver burden. These results have been comparable or exceeded improvements in studies of Acetylcholine inhibitors. Facets of these programmes will be examined and some models of dementia rehab teams from UK settings.

This presentation will also advocate for increased Occupational Therapy input to be included in existing structures and services for persons with mild-moderate dementia as this clinical population is often underserved by therapy professionals.

Back

Wandering prevention and Detection
Ross Gordon
Development Manager
Search and Rescue Institute New Zealand (SARINZ)

“How do we stop them wandering” and “where do we find them?”. These are two critical questions which researchers, Police officers and search and rescue personnel can now answer with confidence based on research and the experience of thousands of incidents.

This presentation will explore the developments in lost person behaviour and also wandering prevention strategies. Case studies will be used to make it practical and applicable for people with Alzheimer’s living at home, care givers and rest home staff.

The development of a New Zealand wide national strategy is currently underway and the key progress from that will be shared.

Back

Who Are We Missing? The First Year of our Memory Service
Dryden Badenoch*1, Verity Brown ²
¹ Consultant Clinical Psychologist, Waikato DHB Memory Service
² Occupational Therapist, Waikato DHB Memory Service

The Waikato DHB Memory Service expands on the conventional Memory Clinic model of "diagnosis & medication".

We provide a range of psychosocial supports & interventions (e.g. Activity Management, Cognitive Remediation, Couple Counselling, etc.) to individuals & families dealing with possible or confirmed progressive memory problems.

As we complete our first full year of operation, who are we supporting? How successful are we in reaching the full range of people who would benefit from our service?

We present an analysis of our work thus far:

(i) we report the range of conditions with which we are working;

(ii) we identify health services & partner agencies with which we may need to work more closely in the coming year;

(iii) we identify geographical areas & population groups which may require different approaches to service delivery.

Back

Who will be caring for you? (Investigating Care Amongst an Ageing Population with Long Term Conditions Such as Dementia)
Tony Lawson
RN MN (Hons1^st) BHSc (Applied Gerontology).
Clinical Nurse Specialist Health in Ageing, Bay of Plenty District Health Board.
Committee Member, Alzheimers Tauranga, & Board Member, Alzheimers New Zealand.

Demographic projections of population ageing indicate increasing actual numbers of older people with long term conditions, inclusive of dementia, so who will be caring for this increasing dependent population in the near future? Moreover, will there be an adequate number of paid carers to provide the care? What will be the impact on informal carers and volunteers supporting people with dementia?

This presentation will outline the recent report from Dept of Labour: Workforce 2020: Demographic Shift: The future demand for paid caregivers in a rapidly ageing society published August, 2009.

Back

Concurrent Sessions Saturday

DriveABLE™ Cognitive Assessement Tool – Identifying the Medically at Risk Driver
*Anne Molloy
Anne Molloy Occupational Therapist – Driver Risk Management Solutions

Medical Practitioners are faced with a difficult task in assessing whether a patient diagnosed with cognitive impairment, is capable of driving their motor vehicle. The doctor’s assessment may include an assessment by a qualified Occupational Therapist.

The assessments are a difficult task and until recently have been undertaken using systems that have not enjoyed extensive research and development. The purpose of this seminar is to introduce the Driveable assessment system which has been developed by Professor Emeritus Dr Allen Dobbs of the University of Alberta, Canada.

The Driveable assessment system allows the Therapist to generate a quantified test score to measure the ability of the patient to continue driving. The Driveable system relies on a two part system. The first element of the assessment is the in- office (DCAT™), a push button/touch screen technology with advanced software which is highly predictive of actual on-road driving performance.
The On-road test (DORE) only taken if deemed necessary by the assessor. The Driveable system reduces both the risk and cost to the patient, and assists the Doctor to make objective, informed decisions on their patient’s fitness-to-drive.

Back

Oral Health and Māori with Dementia
Jean Gilmour¹, Bridget Robson² Annette Huntington³
¹ Massey University
² Te Rōpū Rangahau Hauora a Eru Pōmare, University of Otago
³ Massey University

This paper reports the results of a qualitative study identifying oral health issues affecting Māori with dementia and a survey of Alzheimers New Zealand member groups employees about oral health issues.

Thirteen interviews were held with 17 Māori whānau members. Findings included the prohibitive costs of dental care, strategies for managing dentures, and the stress involved in dental visits. While oral health was seen as important, it was difficult to prioritise when caring demands were complex. Participants suggested dental provider education about dementia, subsidised dental care, improved strategies for services to accommodate people with dementia, and further information for caregivers.

There were 34 responses to the survey of Alzheimer Society member groups. Problems with chewing, dentures, swallowing and pain were the most frequent oral health issues identified. Comments about the oral health priorities included attention to pain because of the communication issues with dementia, the accessibility, affordability and availability of fluoride, access to services in relation to cost and travel and oral health education. The survey identified a gap in oral health information provision for people with dementia and their whānau and an oral health information sheet has been developed as part of the research project.

Back

THE C.I.T.S.: A SIMPLE TOOL FOR MEASURING & REDUCING STRESS
Dryden Badenoch*
Consultant Clinical Psychologist, Waikato DHB Memory Service

There are many tools to measure stress and there is much advice on reducing stress. But the measurements don't offer guidance on how to cope and it's difficult to know which advice to follow.

Stress affects the physical health & mental functioning of people with Alzheimer's Disease, their families, their carers and health & social workers. Stress can result in physical illness, transforming a carer into someone requiring care themselves.

The CITS (Chart for the Identification & Treatment of Stress) is a simple paper & pencil tool. It can be used by anyone — health & social workers, paid carers, family members — to both measure and reduce stress in their own lives or in the lives of the people for whom they are caring.

Use of the CITS requires minimal training and is free of charge. The CITS is based upon fundamental psychological principles and has been used successfully by people of all ages.

Back

Quality of Life of Persons with Dementia and their Caregivers in Canterbury - New Zealand
Franziska Gallrach*¹, Ray Kirk¹, Andrew Hornblow¹, Matthew Croucher²
¹University of Canterbury, Christchurch, New Zealand; ²Psychiatry of Old Age Academic Unit,
Psychiatry Service for the Elderly - Canterbury District Health Board, Christchurch School of Medicine
and Health Sciences - University of Otago, Christchurch, New Zealand.

This study was the first aiming to measure quality of life (QoL) of persons with dementia and their informal caregivers in New Zealand. To date, it is also the only one examining what interventions from primary and secondary care in New Zealand are helpful for enhancing QoL and what these interventions cost.

In this prospective cohort study, questionnaires investigating various QoL-domains were administered to 53 outpatients and their caregivers at baseline and 12 months follow-up. Time and resource utilisation were assessed for identifying direct and indirect costs using questionnaires and diaries. Most patient measurements confirmed the predicted correlations. Caregivers’ QoL differed from the
predicted outcomes. Joint income/pension and financial burden were factors that also influenced QoL in dementia. Most correlations remained stable over 12 months. Combined information and support interventions achieved significantly better QoL than single interventions. Direct costs increased with an increase in dementia severity, neuropsychiatric and behavioural symptoms and functional limitations.

A mix of different clinical and non-clinical factors can predict QoL in dementia. QoL can be sustained over 1 year in a cohort of mainly early dementia patients and their caregivers. Developing psychosocial and financial incentives could be a key factor to support persons with dementia and their caregivers.

Back

ON YER BIKE - strategies for supporting a fulsome life at home
Jude Dore, Director, Elder Family Matters Limited
Lawrie Stewart, General Manager, Elder Family Matters Limited

Join us to hear one company’s frame-work for working in tandem with people living with dementia. We’ll cycle you through the thinking behind what we find works, and tell you some stories along the path.

You’ll ride away with some ideas for your own practice, a paradigm to reflect on, and hopefully feel invigorated to get into the saddle.

Back

Lessons in Communication from Animals
Michele Hawkins
Alzheimer’s Australia

We know that 70% or more of human communication is nonverbal and we know that nonverbal communication is potent. As with words, we use nonverbal messages to reveal or to hide our true feelings and intentions. But what happens to our capacity to understand nonverbal language when its forms are significantly changed, such as when dementia is present? Can we learn to be equally effective in how we communicate with those whose verbal and nonverbal communication has become foreign to us?

Nonverbal communication in non-human primates and other species, though powerful, is often incomprehensible to the uninitiated. This means that we can observe it and try to understand its intent without the emotional difficulties that often obscure communication between those who are cognitively intact and those who are not.

Participants at this session will have the opportunity to see the world from the point of view of a select number of non-human animal species ranging from chimpanzees; mandrill and gelada monkeys; and Hamadryas baboons, to blind subterranean naked mole rats. Trying to see the world from perfectly valid, yet unfamiliar, perspectives might help us to find fresh and imaginative ways to approach communication with people with dementia.

Back

Epigenetics and Alzheimer’s disease
Pritika Narayan*^1,2, Richard Faull1, Michael Dragunow^1,2
¹ Centre for Brain Research, University of Auckland
² National Research Centre for Growth and Development

Epigenetics is an exciting new field of gene regulation. It encompasses chemical modifications and interactions which influence the expression of genes. Growing evidence suggests that the effects of environment, inheritance and susceptibility to disease may manifest through epigenetic mechanisms.

Method: This study investigated epigenetic changes in Alzheimer’s disease (AD; n=13) and neurologically normal control (n=17) human brain tissue obtained from the NZ Neurological Foundation Human Brain Bank. Immuno-labelling and protein analysis using Western blot techniques revealed that there are significant alterations to epigenetic patterns observed in AD brain compared to control brain. These changes involved specific histone modifications which regulate the expression of DNA, and were shown to be significantly elevated in AD tissue.

Results and clinical implications: These novel findings suggest that people with AD have altered epigenetic modifications that may be involved in disease progression and these epigenetic changes may provide targets to develop treatments for AD which currently has no cure. Furthermore, if these epigenetic changes are also manifest in peripheral tissues such as blood cells, then they may also serve as biomarkers to aid in earlier diagnosis of this disorder.

Back

Back to top of page