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By Richard Powers: Richard has been teaching historic and contemporary social dance for 40 years. He leads workshops around the world and is currently a full-time instructor at Stanford University’s Dance Division.
For centuries, dance manuals and other writings have lauded the health benefits of dancing, usually as physical exercise. More recently we’ve seen research on further health benefits of dancing, such as stress reduction and increased serotonin level, with its sense of well-being. More recently we’ve heard of another benefit: Frequent dancing apparently makes us smarter.
A major study added to the growing evidence that stimulating one’s mind by dancing can ward off Alzheimer’s disease and other dementia, much as physical exercise can keep the body fit. Dancing also increases cognitive acuity at all ages.
You may have heard about the New England Journal of Medicine report on the effects of recreational activities on mental acuity in aging. Here it is in a nutshell:
The 21-year study of senior citizens, 75 and older, was led by the Albert Einstein College of Medicine in New York City, funded by the National Institute on Aging, and published in the New England Journal of Medicine. Their method for objectively measuring mental acuity in aging was to monitor rates of dementia, including Alzheimer’s disease.
The study wanted to see if any physical or cognitive recreational activities influenced mental acuity and discovered that some activities had a significant beneficial effect while others had none.
Cognitive activities such as reading books, writing for pleasure, doing crossword puzzles, playing cards and playing musical instruments were studied; as were physical activities like playing tennis or golf, swimming, bicycling, dancing, walking for exercise and doing housework.
One of the surprises of the study was that almost none of the physical activities appeared to offer any protection against dementia. There can be cardiovascular benefits of course, but the focus of this study was the mind. There was one important exception: the only physical activity to offer protection against dementia was frequent dancing:
Reading – 35% reduced risk of dementia
Bicycling and swimming – 0%
Doing crossword puzzles at least four days a week – 47%
Playing golf – 0%
Dancing frequently – 76%, the greatest risk reduction of any activity studied, cognitive or physical.
What could cause these significant cognitive benefits? Neurologist Dr. Robert Katzman proposed these persons are more resistant to the effects of dementia as a result of having greater cognitive reserve and increased complexity of neuronal synapses. Like education, participation in mentally engaging activities lowers the risk of dementia by improving these neural qualities.
As Harvard Medical School psychiatrist Dr. Joseph Coyle explains in an accompanying commentary: “The cerebral cortex and hippocampus, which are critical to these activities, are remarkably plastic, and they rewire themselves based upon their use.”
Our brain constantly rewires its neural pathways, as needed. If it doesn’t need to, then it won’t.
AGING AND MEMORY
When brain cells die and synapses weaken with aging, our nouns go first, like names of people, because there’s only one neural pathway connecting to that stored information. If the single neural connection to that name fades, we lose access to it. As people age, some of them learn to parallel process, to come up with synonyms to go around these roadblocks.
The key here is Dr. Katzman’s emphasis on the complexity of our neuronal synapses. More is better. Do whatever you can to create new neural paths. The opposite of this is taking the same old well-worn path over and over again, with habitual patterns of thinking and living. . . We need to keep as many of those paths active as we can, while also generating new paths, to maintain the complexity of our neuronal connections. In other words: Intelligence — use it or lose it.
We immediately ask two questions: 1) Why is dancing better than other activities for improving mental capabilities? 2) Does this mean all kinds of dancing, or is one kind of dancing better than another?
. . .The essence of intelligence is making decisions. The best advice, when it comes to improving your mental acuity, is to involve yourself in activities that require split-second rapid-fire decision-making, as opposed to rote memory (retracing the same well-worn paths), or just working on your physical style.
One way to do that is to learn something new. Not just dancing, but anything new. Don’t worry about the probability that you’ll never use it in the future. Take a class to challenge your mind. It will stimulate the connectivity of your brain by generating the need for new pathways. Difficult classes are better for you, as they will create a greater need for new neural pathways.
Then take a dance class, which can be even more effective. Dancing integrates several brain functions at once — kinesthetic, rational, musical, and emotional — further increasing your neural connectivity.
WHO BENEFITS MORE, WOMEN OR MEN?
In social dancing, the Follow role automatically gains a benefit, by making hundreds of split-second decisions as to what to do next, sometimes unconsciously so. As I mentioned on this page, women don’t “follow”, they interpret the signals their partners are giving them, and this requires intelligence and decision-making, which is active, not passive.
This benefit is greatly enhanced by dancing with different partners, not always with the same fellow. With different dance partners, you have to adjust much more and be aware of more variables. This is great for staying smarter longer.
The study made another important suggestion: do it often. Seniors who did crossword puzzles four days a week had a measurably lower risk of dementia than those who did the puzzles once a week. If you can’t take classes or go out dancing four times a week, then dance as much as you can. More is better. And do it now, the sooner the better. It’s essential to start building your cognitive reserve now. Some day you’ll need as many of those stepping-stones across the creek as possible. Don’t wait — start building them now.
By Lewy Body Dementia Association:
ATLANTA (November 10, 2014) — The recent release of the autopsy and coroner reports on Robin Williams has raised questions about his state of health at the time of his tragic suicide earlier this year. Some news reports indicate that Mr. Williams had dementia at the time of his death.
The Lewy Body Dementia Association (LBDA) provides information about what can – and cannot – be concluded from these reports. The autopsy indicated the presence of ‘diffuse Lewy body dementia’ in the brain of Mr. Williams. This is more commonly called ‘diffuse Lewy body disease’ which reflects the biological disease process in the brain.
“The use of the term dementia in the neuropathology report should not be inferred to mean that dementia was observed during life,” warns Dennis Dickson, M.D., Mayo Clinic in Jacksonville, Fla. and member of the LBDA Scientific Advisory Council.
Lewy bodies are mis-folded protein deposits found in the brains of individuals with several different disorders including Parkinson’s disease (PD) and dementia with Lewy bodies (DLB).
According to his wife, Robin Williams was battling “the early stages of Parkinson’s disease” before his death. In early PD, Lewy bodies are generally limited in distribution, but in DLB, the Lewy bodies are spread widely throughout the brain, as was the case with Robin Williams.
Dr. Dickson, who has reviewed the autopsy and coroner’s report, further states, “Mr. Williams was given a clinical diagnosis of PD and treated for motor symptoms. The report confirms he experienced depression, anxiety and paranoia, which may occur in either Parkinson’s disease or dementia with Lewy bodies.”
Both Parkinson’s disease with dementia and DLB are considered Lewy body dementias because of the presence of Lewy bodies in the brain. Collectively, Lewy body dementias are the second most common form of dementia and affect an estimated 1.4 million Americans.
To receive a diagnosis of dementia with Lewy bodies, a person must have significant problems with thinking and memory that interfere with everyday life. There is no mention in the media or in the autopsy report that Robin Williams exhibited these symptoms. It is not uncommon, however, for early signs of dementia to go undetected. The Mini Mental Status Exam – a common screening test for cognitive impairment and dementia used by many physicians – is not able to detect cognitive impairment in early DLB.
“Further research is needed to better understand why some individuals with diffuse Lewy body disease do not show symptoms of dementia,” according to Dr. Dickson. “In particular, we need to learn how dementia with Lewy bodies differs clinically from Parkinson’s disease when they both share the same underlying disease process.”
DLB and PD share many symptoms, but have different patterns of onset, progression and symptom severity. The most prominent and problematic clinical symptoms in early PD are related to movement, while in DLB they are more likely to be cognitive and psychiatric. However, over the course of both disorders, the symptoms become more and more alike.
by Ken Clasper, individual living with Lewy Body Dementia
Stigma is a terrible thing, but it’s not something which is new,it has been around for many years.
We have seen stigma in many illnesses,like cancer in the 1950-60s. It has also been attached to Aids, and recently Ebola, yet much of it is caused by old stories and myths, which do not seem to go away; possibly because many people simply believe they are true.
I have been asked on many occasions whether dementia us contagious, something which has left me staggered. Some think you can catch it if someone who has dementia sneezes.
But I believe much of this stems from the fact that it sometimes seems to run in families; but most of it seems to come from the fact that some forms are called disease, like Lewy Body Dementia, which in some cases is called Lewy Body Disease; just one case in many.
Some charities sometimes call themselves “Alzheimer’s Disease” or “Dementia Disease”, and this also helps keep the stigma going. I suppose this is because professionals cannot decide what to call illnesses; or people call things by different terms and names.But I feel that much of this could be stopped if everyone was educated properly about this illness, rather than picking up odd pieces and trying to find the truth their own way
To educate everyone we should be starting with school children, who are already learning about someone in their families who has the illness. Many of these children want to learn more about what is happening to granny or grand dad, and it’s now time to start helping them understand just what is going on. These are the people who will shape the future in stopping this stigma, and therefore we must help them to help us.
Years ago parents kept their children out of the way, when someone had dementia, but now things have changed for the best, and it would be much better without the stigma. I have also heard stories of people crossing the road, so they did not come into contact with someone who had dementia in their families. This usually happened in very close communities like small villages.
So it’s time to find a way of getting into all schools, to teach all children that stigma, is not a nice thing, no matter which illness it’s attached to. Teachers should allow people with illnesses into schools to help educate those who are our future support.
The Government says that they are dementia friendly, so it’s time they factored this into education. It does not need to be an examination study, just allow us in during free time to speak to children and explain our problems and the stigma which is attached to it.
Let us hope that sometime soon things will change and change for the best. Let us all work to remove all stigma once and for all
The first day of school our professor introduced himself and challenged us to get to know someone we didn’t already know. I stood up to look around when a gentle hand touched my shoulder. I turned around to find a wrinkled, little old lady beaming up at me with a smile that lit up her entire being.
She said, ‘Hi handsome. My name is Rose. I’m eighty-seven years old. Can I give you a hug?’
I laughed and enthusiastically responded, ‘Of course you may!’ and she gave me a giant squeeze.
‘Why are you in college at such a young, innocent age?’ I asked.
She jokingly replied, ‘I’m here to meet a rich husband, get married, and have a couple of kids…’
‘No seriously,’ I asked. I was curious what may have motivated her to be taking on this challenge at her age.
‘I always dreamed of having a college education and now I’m getting one!’ she told me.
After class we walked to the student union building and shared a chocolate milkshake. We became instant friends. Every day for the next three months we would leave class together and talk nonstop. I was always mesmerized listening to this ‘time machine’ as she shared her wisdom and experience with me…
Over the course of the year, Rose became a campus icon and she easily made friends wherever she went. She loved to dress up and she reveled in the attention bestowed upon her from the other students. She was living it up.
At the end of the semester we invited Rose to speak at our football banquet. I’ll never forget what she taught us. She was introduced and stepped up to the podium. As she began to deliver her prepared speech, she dropped her three by five cards on the floor. Frustrated and a little embarrassed she leaned into the microphone and simply said, ‘I’m sorry I’m so jittery. I gave up beer for Lent and this whiskey is killing me! I’ll never get my speech back in order so let me just tell you what I know.’
As we laughed she cleared her throat and began, ‘ we do not stop playing because we are old; we grow old because we stop playing. There are only four secrets to staying young, being happy, and achieving success. You have to laugh and find humor every day. You’ve got to have a dream. When you lose your dreams, you die. We have so many people walking around who are dead and don’t even know it! There is a huge difference between growing older and growing up.
If you are nineteen years old and lie in bed for one full year and don’t do one productive thing, you will turn twenty years old. If I am eighty-seven years old and stay in bed for a year and never do anything I will turn eighty-eight. Anybody! Can grow older. That doesn’t take any talent or ability. The idea is to grow up by always finding opportunity in change. Have no regrets. The elderly usually don’t have regrets for what we did, but rather for things we did not do. The only people who fear death are those with regrets.’
She concluded her speech by courageously singing ‘The Rose..’ She challenged each of us to study the lyrics and live them out in our daily lives. At the year’s end Rose finished the college degree she had begun all those years ago.
One week after graduation Rose died peacefully in her sleep. Over two thousand college students attended her funeral in tribute to the wonderful woman who taught by example that it’s never too late to be all you can possibly be.
REMEMBER, GROWING OLDER IS MANDATORY. GROWING UP IS OPTIONAL. We make a Living by what we get. We make a Life by what we give.
by: Laura Beck – developer of Eden at Home. Today, as Learning and Development Guide, she coordinates management of the Eden Alternative brand and packaging of the organization’s message in promotional and educational content. Laura also supports design of new and existing Eden Alternative curricula and educational products, coordinates and facilitates the Eden Alternative’s webinar-based education, and serves as a public speaker and an educator of designated educational offerings.
I’m always struck by ageist remarks that bundle aging and living with dementia as sort of a package deal. It came up again recently in a discussion with a friend who argued that people living with dementia were victims of ageism. Hmmmm… perhaps… if the individual in question is indeed being marginalized due to his or her age alone.
Here’s the rub. Living with dementia is about changing abilities, not necessarily growing older. You can be a younger adult and still live with dementia. It’s true that, statistically speaking, a large number of people living with dementia are older people. But to compartmentalize the experience of dementia as an aging issue alone is a very bad habit on the part of society.
To really shift this paradigm, the world of aging services must clasp hands tightly with those who support the well-being of people who live with differing abilities. This meeting of the minds is crucial when it comes to creating well-informed, respectful, and supportive communities that integrate the needs and contributions of those living with dementia.
At a recent national summit hosted by the Dementia Action Alliance, Val Halamandaris, head of the National Association of Home Care and Hospice, described living with dementia as a civil rights issue. I could not agree more. The American Disabilities Act helped wake us up to the need for universal design, accommodation, and a serious shift in public awareness. We still have a ways to go there, folks, and even further, regarding the ability of those who live with dementia to be active, contributing members of their communities.
I am inspired by the efforts of some towns and cities to become dementia-friendly communities. These initiatives include comprehensive plans to create easy-to-navigate environments and accessible travel options; respectful and responsive businesses; opportunities for community engagement; and education designed to deconstruct stigma, build awareness, and highlight contribution potential. Through their actions, communities like these are saying, “Yes, we welcome the unique gifts that individuals living with dementia have to offer us. Yes, we believe that every person is vital to creating a rich and diverse community. Yes, we see you.”
Here’s to the power of possibility. Just say, “Yes.”
by: Dr. Heather Hill, facilitator/trainer in dementia care. She has worked for twenty-five years in dance therapy
As dance therapist – or “the lady with scarves” as I think the nursing caregivers regarded me – I was expected to bring in sweetness and light – and I did! But not by myself. Despite the awful environment, despite the dementia – entering a ward filled with people in various states of withdrawal and confusion was daunting– I found PEOPLE. Together we created moments that were, creative, exciting, emotional, loud, joyous, touching and sometimes fabulously funny! This was the beginning of a passion, which still burns brightly in me to this day.
My experiences in dancing with people with dementia started me on a path of questioning. How could people who had a degenerative disease, which supposedly destroyed the person, come to life in the dance sessions? Surely if I could find people among the grey ghostly inhabitants of this institution, others could too? I refused to believe you had to be a dancer to do this.
My questioning led me to the work of Tom Kitwood, pioneer of person-centered care in dementia – a true visionary, on whose work others have continued to build and build in exciting ways. His mantra: The key psychological task in dementia care is the maintenance of personhood. Kitwood suggested that personhood is constructed and maintained in relationship, and that the relationship with the caregiver is crucial to the maintenance of personhood and the fostering of wellbeing in the person with dementia.
For me this was the lightening strike. Gone was the grim determinism of the medical label; the label of “dementia” did not mean the person had “left the building”. Very importantly, it was clear that I and others working with and caring for people with dementia could indeed make a difference; and that difference was to help the person remain a person. It also reinforced my own experience in the dance sessions where seemingly “lost” people could reappear in all their vitality.
Then came more questions, how can we help people with dementia experience themselves as persons in their everyday lives, not just in the heightened moments of an arts experience? Over the years this has been accompanied by equally important questions: How can we persuade professional caregivers to move beyond the medical label and see the person. How can they be encouraged to cease to regard behavior as a symptom of disease but rather look on it as an expression of a person’s needs and wishes? How can they be persuaded that acknowledging the person as a person is not an optional extra to the real work of physical care, that person-centered care is possible, desirable and ethical? These are the questions, which continue to engage me now in my work as a dementia care trainer and facilitator.
In all these years of being with people with dementia, I have learnt so much about what it is to be a person. This is not because of any idealization of people with special needs. Absolutely not, people with dementia are as varied as everyone else in the community. Some are lovely and some are downright infuriating! The reason that I have learnt so much from people with dementia is that dementia by its very nature – as an assault on personhood – has brought me face to face with the very basics of being a person, stripped bare and uncluttered by all the things which make up our very Western, individualistic, cognitive-obsessed and materialistic lifestyle.
It has very much turned me towards relational concepts of self, that one becomes a person in relationship and continues to be a person in relationship. It has placed less emphasis on us as purely rational human beings, and highlighted the importance of feeling and emotion. It has pointed the way to not just talk of a mind/body connection (core to my work as a dance therapist), but rather of a totality. “One’s persona is in no way ‘localizable in the classical sense…it cannot be equated with any given ‘center’, ‘system’, nexus,’ etc., but only with the intricate totality of the whole organism, in its ever-changing continuously modulated, afferent-efferent relations with the world.” (Sacks,1991, footnote 116, p.239). Again, that word relationship comes up!
In taking a more and more relational perspective, I have come also to take into account the personhood of carers and families. “Person”-centered care is really about all-persons-in-relationship. It has brought to the fore for me the constant striving of human beings to make sense of their lives, to find meaning even in the darkest moments and to be happy. As someone who rejected formalized religion, I have come to experience moments with people with dementia, which I can only describe as spiritual – a sense of heightened experience, connectedness and total immersion in the moment. I have witnessed again and again the need people have for this type of experience and the power of the arts to meet this need.
I’ve learnt a lot about myself and being with another human. Persons are more than the sum of all the facts we might know about them and the person can never be reduced to file notes on the ward, descriptions of past life, interests etc. The nature of dementia requires that we connect with the person as they are in the now. The present, especially for the person with dementia, can be a second by second thing and therefore this requires a heightened attention to who the person is right now in this moment. Taking this intense and challenging journey accompanying the person with dementia has been a huge learning experience, and has challenged me to be fully human myself.
I have also come to understand that human beings are about both continuity and change – difficult as the often-extreme changes of dementia can be for both the person and for their families. How do we cope with such extremes – how can we find the continuities but also be able to work with the changes. Since Kitwood first mooted the possibility of “relative wellbeing” for people with dementia, we have moved on first to “wellbeing” and now to “flourishing” and “creativity” in dementia. People with dementia can experience positive change and growth.
Further, the person with dementia need no longer be viewed as a passive recipient of the efforts of others, but as an active partner in making sense of the changes in their lives. And now many people with dementia themselves are speaking up and asserting their personhood.
By: Amanda Kaestner Having grown up with a mother who was an RN for both in-home and traditional nursing homes, she’s had an appreciation for the well-being of today’s seniors by volunteering at VA hospitals and attending veteran events in her town.
If you’re considering a nursing home or an assisted living agency for a beloved senior, selecting one is an arduous process. Researching, locating, making unannounced visits to, and choosing the absolute best nursing home or reputable at-home service is neither simple nor easy. Although both have benefits that make them viable options, it’s critically important to do your due diligence before deciding.
Traditional Assisted Homes
The reality is – no one wants to move to a nursing home; no one dreams of it, hopes for it, or is happy about it if the time comes. Seniors want to continue growing older with dignity, respect, and an ability to make choices. Nursing homes don’t often provide the opportunity for these seemingly-simple standards of living. It’s not that the facilities don’t mean to take away a resident’s rights, self-esteem, confidence, feeling of safety, or joy – it just often happens as a result of the facilities being understaffed and/or staffed with minimum wage aides who don’t really want to be there either. If you take a moment to peruse Medicare’s long list of a resident’s rights in a nursing home (and what should be done if those rights are violated) you might wonder why it’s necessary to list all these basic-human privileges. You would hope that being talked to kindly, getting warm meals, and not being physically neglected or emotionally hurt would never be commonplace at a facility focused on caring for seniors; but, that is not always the reality. Fortunately, the movement across America has been toward a person-centered care philosophy where nursing home residents can bathe, eat, sleep, and enjoy their life in sync with their own particular life’s rhythm and not by some rigid, inflexible schedule set forth by a facility’s director.
Not every resident is the same, especially for seniors coping with mental health issues like Alzheimer’s or Dementia. Nursing conferences and culture change workshops across America are being held to teach staff how to instill the patient-centered care mission and create an environment where residents direct their own lives and make their own decisions. More specialty assisted living facilities are doing things different than what was done in the past in order to personalize the living experience for each and every resident. According to the Health Care Management Group, more of these types of full-time care facilities offer more than traditional nursing homes and are capable of servicing their residents with rehabilitation after injuries or to control their pain management, they offer speech therapy and stimulating activities to help with memory care. Activities are optional and the area on these properties is bright and spacious allowing residents to wander safely within a beautiful natural setting. More facilities are going the extra mile to ensure maximum comfort for their residents to give them more of living experience rather than feeling cared for
In-Home Living Services
With this choice, your loved one lives in the comfort, privacy, and security of his/her (or your) family home and the professional healthcare workers and caregivers come to the home as often as you schedule the visits. Depending on the medical needs and challenges of your loved one, this option truly provides the absolute best scenario for an individual if you and your other family members are able to physically and emotionally embrace the roles of being caregivers yourselves – even alongside a 24/7 caregiver you may hire. Having the healthcare providers come to your home and making a few physical adjustments to your property may be all you need to enable your loved one to remain at home. In a 2013 Forbes article, making small changes in the living space like adding a ramp or railings, removing throw rugs, or installing shower bars may be all you need to do to “keep them [seniors] out of nursing facilities for months or even years” or ideally – indefinitely so there’s never a goodbye to a dreaded nursing home.
Finding the right facility or caregiver doesn’t have to be something to worry about or be afraid of. Accepting care should never be taken as a reflection of a person’s inner strength and with the options that are out there today, there are many dignified routes to go about assisted living whether in-home or at a facility. Remember, just because someone is living doesn’t really mean they’re alive and every human being has the right to enjoy their life at any age. So explore your options and don’t settle for anything less than what best fits the medical and overall comfort needed.