Moving Towards Wellness in Long-term Care: Considerations for Dementia-Associated Aggression

Abstract

Dementia is a debilitating and progressive neurodegenerative condition expected to affect over 13 million Americans by 2050 (Mitchell et al. in N Engl J Med 361:1529–1538, 2009) and 132 million individuals worldwide (Prince et al. in Alzheimer’s Res Ther 8(1):23, 2016). Characterized by cognitive and physical loss and change, and loss of one’s sense of self, this illness significantly impairs the ability to communicate needs and discomfort successfully; aggressive behaviors are common and may affect overall well-being. Dementia-associated aggression often leads to care facility placement, may contribute to care partner burden, and significantly increases healthcare costs. Dance/movement therapy (DMT) influences physical, psychological, and cognitive behavior, supports productive self-expression, and helps to improve quality of life. This article sheds light on some challenges within the long-term care environment and affirms that DMT, as a complementary approach, is a beneficial, cost-efficient, and non-pharmacologic modality for the treatment of dementia-associated aggression for older adults in these settings.

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References

  1. Beerens, H. C., Zwakhalen, S. M. G., Verbeek, H., Ruwaard, D., & Hamers, J. P. H. (2013). Factors associated with quality of life of people with dementia in long-term care facilities: A systematic review. International Journal of Nursing Studies,50(9), 1259–1270. https://doi.org/10.1016/j.ijnurstu.2013.02.005.

    PubMed  Article  Google Scholar 

  2. Berrol, C. F. (1992). The neurophysiologic basis of the mind-body connection in dance/movement therapy. American Journal of Dance Therapy,14(1), 19–29.

    Article  Google Scholar 

  3. Berrol, C. F., Katz, S. S., & Ooi, W. L. (1997). Dance/movement therapy with older adults who have sustained neurological insult: A demonstration project. American Journal of Dance Therapy,19(2), 135–160.

    Article  Google Scholar 

  4. Bräuninger, I. (2012). The efficacy of dance movement therapy group on improvement of quality of life: A randomized controlled trial. The Arts in Psychotherapy,39(4), 296–303.

    Article  Google Scholar 

  5. Bräuninger, I. (2014). Dance movement therapy with the elderly: An international internet-based survey undertaken with practitioners. Body, Movement and Dance in Psychotherapy,9(3), 138–153.

    Article  Google Scholar 

  6. Bumanis, A., & Yoder, J. W. (1987). Music and dance: Tools for reality orientation. Activities, Adaptation & Aging,10(1–2), 23–35.

    Google Scholar 

  7. Burns, A., Byrne, J., Ballard, C., & Holmes, C. (2002). Sensory stimulation in dementia: An effective option for managing behavioural problems. British Medical Journal,325(7376), 1312–1313.

    PubMed  Article  Google Scholar 

  8. Burns, A., Dening, T., & Baldwin, R. (2001). Mental health problems. British Medical Journal,322(7289), 789–791.

    PubMed  Article  Google Scholar 

  9. Cohen-Mansfield, J., & Werner, P. (1998). The effects of an enhanced environment on nursing home residents who pace. Gerontologist,38(2), 199–208.

    PubMed  Article  Google Scholar 

  10. Dettmore, D., Kolanowski, A., & Boustani, M. (2009). Aggression in persons with dementia: Use of nursing theory to guide clinical practice. Geriatric Nursing,30(1), 8–17.

    PubMed  Article  Google Scholar 

  11. Douglas, S., James, I., & Ballard, C. (2004). Non-pharmacological interventions in dementia. Advances in Psychiatric Treatment,10, 171–179.

    Article  Google Scholar 

  12. Fersh, I. (1980). Dance/movement therapy: A holistic approach to working with the elderly. American Journal of Dance Therapy,3(2), 33–43.

    Article  Google Scholar 

  13. Gill, S. S., Bronskill, S. E., Normand, S., Anderson, G. M., Sykora, K., Lam, K., … Rochon, P. A. (2007). Antipsychotic drug use and mortality in older adults with dementia. Annals of Internal Medicine,146(11), 775–786.

    PubMed  Article  Google Scholar 

  14. Gitlin, L., & Hodgson, N. (2018). Better living with dementia: Implications for individuals, families, communities, and societies. Cambridge, MA: Academic Press.

    Google Scholar 

  15. Gitlin, L., Hodgson, N., Jutkowitz, E., & Pizzi, L. (2010). The cost-effectiveness of a non-pharamacologic intervention for individuals with dementia and family caregivers: The tailored activity program. The American Journal of Geriatric Psychiatry,18(6), 510–519.

    PubMed  PubMed Central  Article  Google Scholar 

  16. Gitlin, L., Winter, L., Earland, T., Herge, E., Chernett, N., Piersol, C., & Burke, J. (2009). The tailored activity program to reduce behavioral symptoms in individuals with dementia: Feasibility, acceptability, and replication potential. Gerontologist,49(3), 428–439.

    PubMed  PubMed Central  Article  Google Scholar 

  17. Goldstein-Levitas, N. J. (2015). Dance/movement therapy with institutionalized older adults: An effective, holistic intervention for loss adaptation. In S. L. Brooke & D. A. Miraglia (Eds.), Using the creative therapies to cope with grief and loss (pp. 263–282). Springfield, IL: Charles C. Thomas Publishers.

    Google Scholar 

  18. Goldstein-Levitas, N. (2016). Dance/movement therapy and sensory stimulation: A holistic approach to dementia care. American Journal of Dance Therapy,38(2), 429–436. https://doi.org/10.1007/s10465-016-9221-5.

    Article  Google Scholar 

  19. Hill, H. (2017). Dance movement therapy and the possibility of wellbeing for people with dementia. In V. Karkou, S. Oliver, & S. Lycouris (Eds.), The Oxford handbook of dance and wellbeing. Cary, NC: Oxford University Press. https://doi.org/10.1093/oxfordhb/9780199949298.013.42.

    Google Scholar 

  20. Hoe, J., Hancock, G., Livingston, G., Woods, B., Challis, D., & Orrell, M. (2009). Changes in the quality of life of people with dementia living in care homes. Alzheimer’s Disease and Associated Disorders,23(3), 285–290.

    Article  Google Scholar 

  21. Hung Ho, R. T., Ki Cheung, J. K., Chan, W. C., Man Cheung, I. K., & Wah Lam, L. C. (2015). A 3-arm randomized controlled trial on the effects of dance movement intervention and exercises on elderly with early dementia. BMC Geriatrics. https://doi.org/10.1186/s12877-015-0123-z.

    Article  Google Scholar 

  22. Jackson, K. (2014). Expressive therapies for people with Alzheimer’s and related dementias. Social Work Today,14(1), 1–10.

    Google Scholar 

  23. Karkou, V., & Meekums, B. (2014). Dance movement therapy for dementia (protocol). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd011022.

    Article  Google Scholar 

  24. Karkou, V. & Meekums, B. (2017). Dance movement therapy for dementia (review). Cochrane Database of Systematic Reviews, 2. Art. No.: CD011022. https://doi.org/10.1002/14651858.cd011022.pub2.

  25. Lee, J. B. (2015). Film review: Alive inside. American Journal of Dance Therapy,37(1), 60–66.

    Article  Google Scholar 

  26. Levy, F. J. (2005). Dance/movement therapy; A healing art (2nd rev ed.). Reston, VA: National Dance Association, an Association of the American Alliance for Health, Physical Education, Recreation, and Dance.

  27. Lewis, P. (1986). Theoretical approaches in dance/movement therapy, volume one (2nd ed.). Iowa: Kendall/Hunt Publishing Company.

    Google Scholar 

  28. Lindner, E. C. (1982). Dance as a therapeutic intervention for the elderly. Educational Gerontology,8(2), 167–174.

    Article  Google Scholar 

  29. Logsdon, R., Gibbons, L., McCurry, S., & Teri, L. (1999). Assessing quality of life in Alzheimer’s disease: Patient and caregiver reports. Journal of Mental Health and Aging,5(1), 21–32.

    Google Scholar 

  30. Matherly, N. (2014). Navigating the dance of touch: An exploration into the use of touch in dance/movement therapy. American Journal of Dance Therapy,36(1), 77–91.

    Article  Google Scholar 

  31. Mitchell, S. L., Teno, J. M., Kiely, D. K., Shaffer, M. L., Jones, R. N., Prigerson, H. G., … Hamel, M. B. (2009). The clinical course of advanced dementia. New England Journal of Medicine,361(16), 1529–1538.

    PubMed  Article  Google Scholar 

  32. Newman-Bluestein, D. (2013). Dancing with dementia: Looking through the lens of LMA. (Unpublished paper). New York: LIMS.

  33. Newman-Bluestein, D., & Chang, M. (2017). The dance of interaction: An embodied approach to nonverbal communication training for caregivers of people with dementia. Self-published: www.danceforconnection.com.

  34. Pelletier, I. C., & Landreville, P. (2007). Discomfort and agitation in older adults with dementia. BMC Geriatrics,7, 27. https://doi.org/10.1186/1471-2318-7-27.

    PubMed  PubMed Central  Article  Google Scholar 

  35. Pinniger, R., Thorsteinsson, E. B., Brown, R. F., & McKinley, P. (2013). Tango dance can reduce distress and insomnia in people with self-referred affective symptoms. American Journal of Dance Therapy,35(1), 60–77.

    Article  Google Scholar 

  36. Prince, M., Ali, G. C., Guerchet, M., Prina, A. M., Albanese, E., & Wu, Y. T. (2016). Recent global trends in the prevalence and incidence of dementia, and survival with dementia. Alzheimer’s Research & Therapy,8(1), 23. https://doi.org/10.1186/s13195-016-0188-8.

    Article  Google Scholar 

  37. Ray, K. D., & Fitzsimmons, S. (2014). Music assisted bathing: Making shower time easier for people with dementia. Journal of Gerontological Nursing,40(2), 9–13.

    PubMed  Google Scholar 

  38. Ray, K. D., & Mittleman, M. S. (2015). Music therapy: A nonpharmacological approach to the care of agitation and depressive symptoms for nursing home residents with dementia. Dementia. https://doi.org/10.1177/1471301215613779.

    PubMed  Article  Google Scholar 

  39. Rayner, A. V., O’Brien, J., & Schoenbachler, B. (2006). Behavior disorders of dementia: Recognition and treatment. American Family Physician,73(4), 647–652.

    PubMed  Google Scholar 

  40. Robinson, L., Tang, E., & Taylor, J. P. (2015). Dementia: Timely diagnosis and early intervention. British Medical Journal,350, h3029.

    PubMed  Article  Google Scholar 

  41. Rushford, N., & Harvey, D. (2016). Dementia as a disability and human rights issue. HealthcarePapers Journal,16(2), 45–51.

    Article  Google Scholar 

  42. Russell-Curry, P. (2018). Book review: The dance of interaction: An embodied approach to nonverbal communication training for caregivers of people with dementia. American Journal of Dance Therapy,40(1), 179–182.

    Article  Google Scholar 

  43. Sade, R. M. (2018). Introduction: Perspectives on Alzheimer’s disease: Ethical, legal, and social issues. The Journal of Law, Medicine, and Ethics,46(3), 691–693.

    PubMed  Article  Google Scholar 

  44. Sandel, S. L. (1978). Reminiscence in movement therapy with the aged. Art Psychotherapy,5(4), 217–221.

    Article  Google Scholar 

  45. Sandel, S. L., Chaiklin, S., & Lohn, A. (Eds.). (1993). Foundations of dance/movement therapy: The life and work of Marian Chace. Columbia, MD: Marian Chace Memorial Fund of the American Dance Therapy Association.

    Google Scholar 

  46. Sandel, S. L., & Johnson, D. R. (1987). Waiting at the gate: Creativity and hope in the nursing home. Activities, Adaptation & Aging,9(3), 1–185.

    Google Scholar 

  47. Schmais, C. (1985). Healing processes in group dance therapy. American Journal of Dance Therapy,8(1), 17–36.

    Article  Google Scholar 

  48. Schneider, J. (2018). The arts as a medium for care and self-care in dementia: Arguments and evidence. International Journal of Environmental Research and Public Health,15(6), 1151. https://doi.org/10.3390/ijerph15061151.

    PubMed Central  Article  Google Scholar 

  49. Sheard, D. (2017). The stuff of life. The Journal of Dementia Care,25(4), 22–25.

    Google Scholar 

  50. Stone, R. (2011). Long-term care for the elderly. Washington, DC: The Urban Institute Press.

    Google Scholar 

  51. Takeda, M., Hashimoto, R., Kudo, T., Okochi, M., Tagami, S., Morihara, T., … Tanaka, T. (2010). Laughter and humor as complementary and alternative medicines for dementia patients. BMC Complementary and Alternative Medicine. https://doi.org/10.1186/1472-6882-10-28.

    PubMed  PubMed Central  Article  Google Scholar 

  52. van der Steen, J. T., Smaling, M. C., van der Wouden, J. C., Bruinsma, M. S., Scholten, R. J. P. M., Vink, A. C. (2018). Music-based therapeutic interventions for people with dementia. Cochrane Database of Systematic Reviews, Issue 5. Art. No.: CD003477. https://doi.org/10.1002/14651858.cd003477.pub3.

  53. Voyer, P., Verreault, R., Azzizah, G. M., Derosiers, J., Champoux, N., & Bedard, A. (2005). Prevalence of physical and verbal aggressive behaviours and associated factors among older adults in long-term care facilities. BMC Geriatrics,5, 13. https://doi.org/10.1186/1471-2318-5-13.

    PubMed  PubMed Central  Article  Google Scholar 

  54. Vozzella, S. (2007). Sensory stimulation in dementia care: Why it is important and how to implement it. Topics in Geriatric Rehabilitation,23(2), 102–111.

    Article  Google Scholar 

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Correspondence to Natasha Goldstein-Levitas.

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Goldstein-Levitas, N. Moving Towards Wellness in Long-term Care: Considerations for Dementia-Associated Aggression. Am J Dance Ther 41, 286–301 (2019). https://doi.org/10.1007/s10465-019-09303-9

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Keywords

  • Aggression
  • Dance/movement therapy
  • Dementia
  • Long-term care