JAMDA
Volume 9, Issue 3 , Pages 139-146 , March 2008

Managing Persons with Dementia in the Nursing Home: High Touch Trumps High Tech

  • John E. Morley, MB, BCh

      Affiliations

    • Corresponding Author InformationAddress correspondence to John E. Morley, MB, BCh, Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Boulevard, M238, St. Louis, MO 63104.

References 

  1. Ibach B, Haen E. Acetylcholinesterase inhibition in Alzheimer’s disease. Curr Pharm Des. 2004;10:231–251
  2. Samanta MK, Wilson B, Santhi K, et al. Alzheimer disease and its management: A review. Am J Ther. 2006;13:516–526
  3. Birks J. Cholinesterase inhibitors for Alzheimer’s Disease. Cochrane Database Syst Rev. 2006;25:CD005593
  4. Bright-Long L. Alzheimer’s treatment in nursing homes: room for improvement. J Am Med Dir Assoc. 2006;7:90–95
  5. Joshi S, Morley JE. Cognitive impairment. Med Clin North Am. 2006;90:769–787
  6. Banks WA, Morley JE. Memories are made of this: Recent advances in understanding cognitive impairments and dementia. J Gerontol A Biol Sci Med Sci. 2003;58:314–321
  7. Christensen MD, White HK. Dementia assessment and management. J Am Med Dir Assoc. 2007;8(3 Suppl 2):E89–E98
  8. Rozzini L, Cornall C, Chilovi BV, et al. Predictors of institutionalization in demented patients discharged from a rehabilitation unit. J Am Med Dir Assoc. 2006;7:345–349
  9. McCallum J, Simons LA, Simons J, Friedlander Y. Delaying dementia and nursing home placement: The Dubbo Study of Elderly Australians over a 14-year follow-up. Ann N Y Acad Sci. 2007;1114:121–129
  10. Espinoza RT. Improving the recognition and management of dementia in long-term care: Obstacles and opportunities. J Am Med Dir Assoc. 2006;7:128–130
  11. Tariq SH, Tumosa N, Chibnall JT, et al. Comparison of the Saint Louis University mental status examination and state examination for detecting dementia and mild neurocognitive disorders. Am J Geriatr Psychiatry. 2006;14:900–910
  12. Engel SE, Kiely DK, Mitchell SL. Satisfaction with end-of-life care for nursing home residents with advanced dementia. J Am Geriatr Soc. 2006;54:1567–1572
  13. Finucane TE, Christmas C, Leff BA. Tube feeding in dementia: How incentives undermine health care quality and patient safety. J Am Med Dir Assoc. 2007;8:205–208
  14. Ettema TP, Droes RM, de Lange J, Mellenbergh GJ, Ribbe MW. QUALIDEM: Development and evaluation of a dementia specific quality of life instrument (Scalability, reliability and internal structure). Int J Geriatr Psychiatry. 2007;22:549–556
  15. Blass DM, Black BS, Phillips H, et al. Medication use in nursing home residents with advanced dementia. Int J Geriatr Psychiatry. 2007;18:[Epub ahead of print]
  16. Levenson SA, Morley JE. Evidence rocks in long-term care, but does it roll?. J Am Med Dir Assoc. 2007;8:493–501
  17. Lee J, Monette J, Sourial N, et al. The use of a cholinersterase inhibitor review committee in long-term care. J Am Med Dir Assoc. 2007;8:243–247
  18. Zarowitz BJ, Stefanacci R, Hollenack K, et al. The application of evidence-based principles of care in older persons (Issue 5): Alzheimer’s disease. J Am Med Dir Assoc. 2007;8:183–193
  19. Standridge JB. Current status and future promise of pharmacotherapeutic strategies for Alzheimer’s disease. J Am Med Dir Assoc. 2006;7(3 Suppl):S46–S51
  20. Hansen RA, Gartiehner G, Lohr KN, Kaufer DI. Functional outcomes of drug treatment in Alzheimer’s Disease: A systematic review and meta-analysis. Drugs Aging. 2007;24:155–167
  21. Belgeri M, Morley JE. A step back in time: Is there a place for older drugs in the treatment of dementia?. J Gerontol A Biol Sci Med Sci. 2004;59:1025–1028
  22. Iraqi A, Hughes TL. Antipsychotic drug use among nursing home residents taking rivastigmine. J Am Med Dir Assoc. 2006;7:337–338
  23. Buhr GT, White HK. Difficult behaviors in long-term care patients with dementia. J Am Med Dir Assoc. 2006;7:180–192
  24. Messinger-Rapport BJ, Morley JE, Thomas DR, Gammack JK. Intensive session: New approaches to medical issues in long-term care. J Am Med Dir Assoc. 2007;8:421–433
  25. Rochon PA, Stukel TA, Bronskill SE, et al. Variation in nursing home antipsychotic prescribing rates. Arch Intern Med. 2007;167:676–683
  26. Schneider LS, Tariot PN, Dagerman KS, et al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer’s disease. N Engl J Med. 2006;355:1525–1538
  27. Kales HC, Valenstein M, Kim HM, et al. Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medicines. Am J Psychiatry. 2007;164:1568–1576
  28. Pollock BG, Mulsant BH, Rosen J, et al. A double-blind comparison of Citalopram and Risperidone for the treatment of behavioral and psychotic symptoms associated with dementia. Am J Geratr Psychiatry. 2007;15:942–952
  29. Forester B, Vanelli M, Hyde J, et al. Report on an open-label prospective study of divalproex sodium for the behavioral and psychological symptoms of dementia as monotherapy and in combination with second-generation antipsychotic medication. Am J Geriatr Pharmacother. 2007;5:209–217
  30. Yu F, Kolanowski AM, Strumpf NE, Eslinger PJ. Improving cognition and function through exercise intervention in Alzheimer’s disease. J Nurs Scholarship. 2006;38:358–365
  31. Colcombe SJ, Erickson KI, Scalf PE, et al. Aerobic exercise training increases brain volume in aging humans. J Gerontol A Biol Sci Med Sci. 2006;61:1166–1170
  32. Williams CL, Tappen RM. Effect of exercise on mood in nursing home residents with Alzheimer’s disease. Am J Alzheimers Dis Other Demen. 2007;22:389–397
  33. Rolland Y, Pillard F, Klapouszczak A, et al. Exercise program for nursing home residents with Alzheimer’s disease: A 1-year randomized, controlled trial. J Am Geriatr Soc. 2007;55:158–165
  34. Lazowski DA, Ecclestone NA, Myers AM, et al. A randomized outcome evaluation of group exercise programs in long-term care institutions. J Gerontol A Biol Sci Med Sci. 1999;54:M621–M628
  35. Flaherty JH, Morley JE. Delirium: A call to improve current standards of care. J Gerontol A Biol Sci Med Sci. 2004;59:341–343
  36. Baum EE, Jarjoura D, Polen AE, Faur D, Rutecki G. Effectiveness of a group exercise program in a long-term care facility: A randomized pilot trial. J Am Med Dir Assoc. 2003;4:74–80
  37. Dowd SB, Davidhizar R. Can mental and physical activities such as chess and gardening help in the prevention and treatment of Alzheimer’s? (Healthy aging through stimulation of the mind). J Pract Nurs. 2003;53:11–13
  38. Wilson RS, McCann JJ, Li Y, et al. Nursing home placement, day care use, and cognitive decline in Alzheimer’s disease. Am J Psyschiatry. 2007;164:910–915
  39. Piechniczek-Buczek J, Riordan ME, Volicer L. Family member perception of quality of their visits with relatives with dementia: A pilot study. J Am Med Dir Assoc. 2007;8:166–172
  40. Lee MM, Camp CJ, Malone ML. Effects of intergenerational Montessori-based activities programming on engagement of nursing home residents with dementia. Clin Interv Aging. 2007;2:477–483
  41. Cline J. Montessori-based dementia care. Kans Nurse. 2006;81:14
  42. Skrajner MJ, Camp CJ. Resident-assisted Montessori Programming (RAMP): Use of a small group reading activity run by persons with dementia in adult day health care and long-term care settings. Am J Alzheimers Dis Other Demen. 2007;22:27–36
  43. Volicer L. Goals of care in advanced dementia: Quality of life, dignity and comfort. J Nutr Health Aging. 2007;11:481
  44. Zuidema SU, de Jonghe JF, Verhey FR, Koopmans RT. Neuropsychiatric symptoms in nursing home patients: Factor structure invariance of the Dutch nursing home version of the neuropsychiatric inventory in different stages of dementia. Dement Geriatr Cogn Disord. 2007;24:169–176
  45. McCabe MP, Davison TE, George K. Effectiveness of staff training programs for behavioral problems among older people with dementia. Aging Ment Health. 2007;11:505–519
  46. Bharucha AJ, Dew MA, Miller MD, et al. Psychotherapy in long-term care: A review. J Am Med Dir Assoc. 2006;7:568–580
  47. Soto ME, Nourhashemi F, Arbus C, et al. Special acute care unit for older adults with Alzheimer’s disease. Int J Geriatr Psychiatry. 2007;[Epub ahead of print]
  48. Albert SM. The special care unit as a quality-of-life intervention for people with dementia. J Am Geriatr Soc. 2004;52:1214–1215
  49. Brooker DJ, Woolley RJ, Lee D. Enriching opportunities for people living with dementia in nursing homes: An evaluation of a multi-level activity-based model of care. Aging Ment Health. 2007;11:361–370
  50. Cohen-Mansfield J, Libin A, Marx MS. Nonpharmacological treatment of agitation: A controlled trial of systematic individualized intervention. J Gerontol A Biol Sci Med Sci. 2007;62:908–916
  51. Volicer L, Simard J, Pupa JH, Medrek R, Riordan ME. Effects of continuous activity programming on behavioral symptoms of dementia. J Am Med Dir Assoc. 2006;7:426–431
  52. Camberg L, Woods P, Ooi WL, et al. Evaluation of simulated presence: A personalized approach to enhance well-being in persons with Alzheimer’s disease. J Am Geriatr Soc. 1999;47:446–452
  53. Gerdner LA. Effects of individualized versus classical “relaxation” music on the frequency of agitation in elderly persons with Alzheimer’s disease and related disorders. Int Psychogeriatr. 2000;12:49–65
  54. Ledger AJ, Baker FA. An investigation of long-term effects of group music therapy on agitation levels of people with Alzheimer’s Disease. Aging Ment Health. 2007;11:330–338
  55. de Lepeleire J, Bouwen A, DeConinck L, Buntinx F. Insufficient lighting in nursing homes. J Am Med Dir Assoc. 2007;8:314–317
  56. Sloane PD, Williams CS, Mitchell CM, et al. High-intensity environmental light in dementia: Effect on sleep and activity. J Am Geriatr Soc. 2007;55:1524–1533
  57. Campbell SS, Kripke DF, Gillin JC, Hrubovcak JC. Exposure to light in healthy elderly subjects and Alzheimer’s patients. Physiol Behav. 1988;42:141–144
  58. Volicer L, Bass EA, Luther SL. Agitation and resistiveness to care are two separate behavioral syndromes of dementia. J Am Med Dir Assoc. 2007;8:527–532
  59. Morley JE. Anorexia in older persons—epidemiology and optimal treatment. Drugs & Aging. 1996;8:134–155
  60. MacIntosh C, Morley JE, Chapman IM. The anorexia of aging. Nutrition. 2000;16:983–995
  61. Morley JE. Weight loss in the nursing home. J Am Med Dir Assoc. 2007;8:201–204
  62. Morley JE. Is weight loss harmful to older men?. Aging Male. 2006;9:135–137
  63. Aoyama L, Weintraub N, Reuben DB. Is weight loss in the nursing home a reversible problem?. J Am Med Dir Assoc. 2006;7(3 Suppl):S66–S72
  64. Morley JE, Kim MJ, Haren MT, et al. Frailty and the aging male. Aging Male. 2005;8:135–140
  65. Morley JE, Flood JF, Perry HM, Kumar VB. Peptides, memory, food intake and aging. Aging (Milano). 1997;9(4 Suppl):17–18
  66. Rolland Y, Andrieu S, Cantet C, et al. Wandering behavior and Alzheimer disease (The REAL. FR prospective). Alzheimer Dis Assoc Disord. 2007;21:31–38
  67. Franco KN, Messinger-Rapport B. Pharmacological treatment of neuropsychiatric symptoms of dementia: A review of the evidence. J Am Med Dir Assoc. 2006;7:201–202
  68. Morley JE, Kraenzle D. Causes of weight loss in a community nursing home. J Am Geriatr Soc. 1994;42:583–585
  69. Morley JE, Flaherty JH, Thomas DR. Geriatricians, continuous quality improvement, and improved care for older persons. J Gerontol A Biol Sci Med Sci. 2003;58:M809–M812
  70. Schnelle JF. Continuous quality improvement in nursing homes: Public relations or a reality?. J Am Med Dir Assoc. 2007;8(3 Suppl):S2–S5
  71. Volicer L, Simard J, Pupa JH, Medrek R, Riordan ME. Effects of continuous activity programming on behavioral symptoms of dementia. J Am Med Dir Assoc. 2006;7:426–431
  72. Carrier N, West GE, Ouellet D. Cognitively impaired residents’ risk of malnutrition is influenced by foodservice factors in long-term care. J Nutr Elder. 2006;25:73–87
  73. Mamhidir AG, Karlsson I, Norberg A, Mona K. Weight increase in patients with dementia, and alteration in meal routines and meal environment after integrity promoting care. J Clin Nurs. 2007;16:987–996
  74. Relkin NR. Beyond symptomatic therapy: a re-examination of acetylcholinesterase inhibitors in Alzheimer’s disease. Expert Rev Neurother. 2007;7:735–748
  75. Parrott MD, Young KW, Greenwood CE. Energy-containing nutritional supplements can affect usual energy intake postsupplementation in institutionalized seniors with probable Alzheimer’s disease. J Am Geriatr Soc. 2006;54:1382–1387
  76. Simmons SF, Schnelle JF. Feeding assistance needs of a long-stay nursing home residents and staff time to provide care. Simmons SF, Schnelle JF J Am Geriatr Soc. 2006;54:919–924
  77. Morley JE. Weight loss in the nursing home. J Am Med Dir Assoc. 2007;8:201–204
  78. Keller HH, Gibbs-Ward A, Randall-Simpson J, et al. Meal rounds: An essential aspect of quality nutrition services in long-term care. J Am Med Dir Assoc. 2006;7:40–45
  79. Flood JF, Merbaum MO, Morley JE. The memory enhancing effects of cholecystokinin octapeptide are dependent on an intact stria terminalis. Neurobiol Learn Mem. 1995;64:139–145
  80. Flood JF, Farr SA, Kaiser FE, La Regina M, Morley JE. Age-related decrease of plasma testosterone in SAMP8 mice: Replacement improves age-related impairment of learning and memory. Physiol Behav. 1995;57:669–673
  81. Flood JF, Garland JS, Morley JE. Evidence that cholecystokinin-enhanced retention is mediated by changes in opioid activity in the amygdala. Brain Res. 1992;585:94–104
  82. Flood JF, Smith GE, Morley JE. Modulation of memory processing by cholecystokinin: Dependence on the vagus nerve. Science. 1987;236:832–834
  83. Diano S, Farr SA, Benoit SC, et al. Ghrelin controls hippocampal spine synapse density and memory performance. Nat Neurosci. 2006;9:381–388
  84. Flaherty JH, Rudolph J, Shay K, et al. Delirium is a serious and under-recognized problem: Why assessment of delirium should be the sixth vital sign. J Am Med Dir Assoc. 2007;8:273–275
  85. Flaherty JH, Morley JE. Delirium: A call to improve current standards of care. J Gerontol A Biol Sci Med Sci. 2004;59:341–343
  86. Morley JE. Falls and fractures. J Am Med Dir Assoc. 2007;8:276–278
  87. Culp KR, Wakefield B, Dyck MJ, et al. Bioelectrical impedance analysis and other hydration parameters as risk factors for delirium in rural nursing home residents. J Gerontol A Biol Sci Med Sci. 2004;59:813–817
  88. Tariq SH. Constipation in long-term care. J Am Med Dir Assoc. 2007;8:209–218
  89. Marcantonio ER, Simon SE, Bergmann MA, et al. Delirium symptoms in post-acute care: Prevalent, persistent, and associated with poor functional recovery. J Am Geriatr Soc. 2003;51:4–9
  90. Collins NS, Shapiro RA, Ramsay RE. Elders with epilepsy. Med Clin North Am. 2006;90:945–966
  91. Sawyer P, Lillis JP, Bodner EV, Allman RM. Substantial daily pain among nursing home residents. J Am Med Dir Assoc. 2007;8:158–165
  92. Cipher DJ, Clifford PA, Roper KD. Behavioral manifestations of pain in the demented elderly. J Am Med Dir Assoc. 2006;7:355–365
  93. Zwakhalen SM, Hamers JP, Peijnenburg RH, Berger MP. Nursing staff knowledge and beliefs about pain in elderly nursing home residents with dementia. Pain Res Manag. 2007;12:177–184
  94. Chizh BA. Low dose ketamine: A therapeutic and research tool to explore N-methyl-D-aspartate (NMDA) receptor-mediated plasticity in pain pathways. J Psychopharmacol. 2007;21:259–271
  95. Schuler MS, Becker S, Kaspar R, et al. Psychometric properties of the German “Pain Assessment in Advanced Dementia Scale” (PAINAD-G) in nursing home residents. J Am Med Dir Assoc. 2007;8:388–395
  96. Cervo FA, Raggi RP, Bright-Long LE, et al. Use of the certified nursing assistant pain assessment tool (CPAT) in nursing home residents with dementia. Am J Alzheimers Dis Other Demen. 2007;22:112–119
  97. Flood JF, Morley JE. Dose-response differences in the ability of ramipril to improve retention in diabetic mice. Eur J Pharmacol. 1993;240:311–314
  98. Flood JF, Morley JE, La Reginna M. Age-related changes in the pharmacological improvement of retention in senescence accelerated mouse (SAM). Neurobiol Aging. 1993;14:159–166
  99. Farr SA, Flood JF, Morley JE. The effect of cholinergic, GABAergic, serotonergic, and glutamatergic receptor modulation on posttrial memory processing in the hippocampus. Neurobiol Learn Mem. 2000;73:150–167
  100. Banks WA, Farr SA, La Scola ME, et al. Intravenous human interleukin-1 alpha impairs memory processing in mice: Dependence on blood-brain barrier transport into posterior division of the septum. J Pharmacol Exper Ther. 2001;299:536–541
  101. Martin DM, Wittert G, Burns NR. Gonadal steroids and visuo-spatial abilities in adult males: Implications for generalized age-related cognitive decline. Aging Male. 2007;10:17–29
  102. Zitzmann M. Testosterone and the brain. Aging Male. 2006;9:195–199
  103. Poon HF, Farr SA, Thongboonkerd V, et al. Proteomic analysis of specific brain proteins in aged SAMP8 mice treated with alpha-lipoic acid: Implications for aging and age-related neurodegenerative disorders. Neurochem Int. 2005;46:159–168
  104. Farr SA, Poon HF, Dogrukol-Ak D, Drake J, et al. The antioxidants alpha-lipoic acid and N-acetylcysteine reverse memory impairment and brain oxidative stress in aged SAMP8 mice. J Neurochem. 2003;84:1173–1183
  105. Petersen RC, Thomas RG, Grundman M, et al. Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med. 2005;352:2379–2388
  106. Blacker D. Mild cognitive impairment—no benefit from vitamin E, little from donepezil. N Engl J Med. 2005;352:2439–2441
  107. Morley JE, Kumar VB, Bernardo AE, et al. Beta-amyloid precursor polypeptide in SAMP8 mice affects learning and memory. Peptides. 2000;21:1761–1767
  108. Banks WA, Farr SA, Morley JE, Wolf KM, Geylis V, Steinitz M. Anti-amyloid beta protein antibody passage across the blood-brain barrier in the SAMP8 mouse model of Alzheimer’s disease: An age-related selective uptake with reversal of learning impairment. Exp Neurol. 2007;206:248–256
  109. Farr SA, Banks WA, Uezu K, et al. Antibody to beta-amyloid protein increases acetylcholine in the hippocampus of 12 month SAMP8 male mice. Life Sci. 2003;73:555–562
  110. Morley JE, Farr SA, Flood JF. Antibody to amyloid beta protein alleviates impaired acquisition, retention, and memory processing in SAMP8 mice. Neurobiol Learn Mem. 2002;78:125–138
  111. Woodhouse A, Dickson TC, Vickers JC. Vaccination strategies for Alzheimer’s disease: A new hope?. Drugs Aging. 2007;24:107–119
  112. Morley JE, Farr SA, Kumar VB, Banks WA. Alzheimer’s disease through the eye of a mouse (Acceptance lecture for the 2001 Gayle A. Olson and Richard D. Olson prize). Peptides. 2002;23:589–599
  113. Banks WA, Farr SA, Butt W, et al. Delivery across the blood-brain barrier of antisense directed against amyloid beta: reversal of learning and memory deficits in mice overexpressing amyloid precursor protein. J Pharmacol Exp Ther. 2001;297:1113–1121
  114. Kumar VB, Farr SA, Flood JF, et al. Site-directed antisense oligonucleotide decreases the expression of amyloid precursor protein and reverses deficits in learning and memory in aged SAMP8 mice. Peptides. 2000;21:1769–1775
  115. Poon HF, Farr SA, Banks WA, et al. Proteomic identification of less oxidized brain proteins in aged senescence-accelerated mice following administration of antisense oligonucleotide directed at the Abeta region of amyloid precursor protein. Brain Res Mol Brain Res. 2005;138:8–16
  116. Hull M, Berger M, Heneka M. Disease-modifying therapies in Alzheimer’s disease: How far have we come?. Drugs. 2006;66:2075–2093
  117. Tuszynski MH. Nerve growth factor gene therapy in Alzheimer disease. Alzheimer Dis Assoc Disord. 2007;21:179–189
  118. Yamasaki TR, Blurton-Jones M, Morrissette DA, Kitazawa M, Oddo S, LaFerla FM. Neural stem cells improve memory in an inducible mouse model of neuronal loss. J Neurosci. 2007;27:11925–11933
  119. Morley JE, Flaherty JH. Putting the “home” back in nursing home. J Gerontol A Biol Sci Med Sci. 2002;57:M419–M421
  120. Banks MR, Willoughby LM, Banks WA. Animal assisted therapy and loneliness in nursing homes: Use of robotic vs living dogs. JAMDA. 2008;9:173–177

PII: S1525-8610(07)00546-4

doi: 10.1016/j.jamda.2007.12.008

JAMDA
Volume 9, Issue 3 , Pages 139-146 , March 2008