Improving Cognitive Function of Residents in Nursing Homes
- Julia Doo
- May 7, 2020
- 7 min read
(RAND Corporations)
The second most prevalent diagnosis in nursing homes in the United States after circulatory diseases is mental illness (Bercovitz, Dwyer, Jones, & Strahan, 2009). In the most recent National Nursing Home Survey (2004) performed by the Centers for Disease Control and Prevention, 16.4% of residents upon admission and 21.9% of residents at the time of data collection had diagnoses of mental disorders. The 1999 National Nursing Home Survey reported mental illness diagnoses in 18.2% of residents at the time of data collection (Bercovitz, Dwyer, Jones, & Strahan, 2009), showing an increase in mental illness in nursing homes. The high prevalence and upward trend of mental illness in nursing homes prove the importance of the availability and quality of mental health services, evaluation, and intervention in nursing homes.
Upon admission to a nursing home, the elderly experience greater cognitive decline and a lower score on the Mini-Mental State Examination (MMSE) compared to elderly that do not live in nursing homes (Harmand, Meillon, Rullier, Avila-Funes, Bergua, Dartigues, & Amieva, 2014). Rates of depression are high in nursing homes, and studies suggest that living in a nursing home may contribute to the onset of depression. In a 2007 study involving 76,735 nursing home residents from 921 nursing homes in Ohio, 48% of residents were diagnosed with depression, 23% of which were not receiving treatment. Only 0.5% of residents diagnosed with depression were receiving psychotherapy (Levin, Wei, Akincigil, Lucas, Bilder, & Crystal, 2007). Functional mobility, independence level, and quality of life were reported to be lower in nursing home residents compared to those living outside of nursing homes (Karakaya, Bilgin, Ekici, Köse, & Otman, 2009).
As one ages, declines in cognitive function may become one’s biggest concern, which may lead to distress, loss of autonomy, and lower quality of life in some. Part of the natural aging process includes declines in the hippocampus, temporal lobe, and prefrontal cortex (Rabbitt & Lowe, 2000), areas important to episodic and long term memory consolidation and executive functioning. In nursing homes, dementia and neurodegenerative diseases are common. Estimates of prevalence of dementia in nursing homes in the United States range from 9.9% (Bercovitz, Dwyer, Jones, & Strahan, 2009, p.28) to 72% (Andersson & Gottfries, 1992). Performing cognitive tasks and challenges can help improve cognitive functioning, emotional health, and quality of life. Tasks that focus on learning, memory, creativity, and executive function have been shown to be effective in improving cognition and quality of life.
Learning
Older adults who participated in regular social dancing classes as opposed to an equal amount of walking showed significant improvement in spatial memory (Merom, Grunseit, Eramudugolla, Jefferis, Mcneill, & Anstey, 2016). Older adults who were taught to use the online social networking website, Facebook, showed improvement in a composite measure of executive functioning and working memory (Myhre, Mehl, & Glisky, 2017). In a study involving 1,839 older men, learning later in life was shown to cause improvement in cognitive function, particularly in those with lower levels of prior education (Wight, Aneshensel, & Seeman, 2002). Learning a second language was found to be correlated with an increase in density of grey matter and integrity of white matter in subjects of all ages, as well as elderly (Li, Legault, & Litcofsky, 2014).
(Harvard Health Publishing: Back to school: Learning a new skill can slow cognitive aging)
Memory
Memory training and tasks with regular rehearsal can help improve or preserve memory function in older adults. Elderly have been shown to maintain the ability to learn novel information and strategies, maintain the improvement in memory for 6 months after memory training (Neely & Bäckman, 1995), and benefit from memory training just as much as younger study participants do (Cavallini, Pagnin, & Vecchi, 2003). People with severe memory loss and symptoms of dementia have shown improved recall performance when instructed on visual imagery techniques (Zarit, Zarit, & Reever, 1982).
Effective memory training may involve instruction of memory encoding strategies, including imagery, using mental images to cue recall; organization, ordering or putting ideas into categories to cue recall; verbal elaboration, including detail with the idea to cue recall; and method of loci; associating the idea with a location to cue recall (Neely & Bäckman, 1995, p.134). Basic mental imagery, when learned in multiple sessions, has shown to be effective in memory rehabilitation (Hussey, Smolinsky, Piryatinsky, Budson, & Ally, 2012). Evidence shows that computer games can help with short-term and long-term memory (Farris, Bates, Resnick, & Stabler, 1995).
A Memory and Facial Recognition Game for Seniors (Memozor.com)
Creativity
Creative activity is beneficial for both emotional and cognitive health, providing the experience of fulfillment, competence, growth, purpose, and individuality while exercising problem-solving and perception and providing an outlet for expression (Fisher & Specht, 1999). Creativity does not wane with age, nor its benefits. Elderly participants of creative activity have reported improved “well-being and life satisfaction” (Hickson & Housley, 1997).
Creative classes lead to improvement in artistic ability, encourage social interaction (Weiss, Schafer, & Berghorn, 1989), and can improve depression and anxiety symptoms (Ciasca, Ferreira, Santana, Forlenza, dos Santos, Brum, & Nunes, 2018). The versatile nature of making art allows for elderly of different levels of cognitive and physical status to be able to express themselves (Kahn-Denis, 1997) and dementia patients who experienced progressive loss of cognitive functions still produced enough motivation to create art and express themselves (Stewart, 2004).
Drama therapy utilizes a multitude of activities and improvisation to provide a creative, sensory, social, and emotional experience that also aids in memory, attention, motivation, relaxation, and physical exercise. These may include acting out spontaneous scenes, role play, guessing an acted out idea, challenges of communicating without a spoken word, and many other games and activities (Huddleston, R., 1989).
(pixfeeds)
Executive Function
Older bridge players performed better in working memory and reasoning tasks than those who did not play bridge (Williams & Kemper, 2010). Computer games and tablet games can provide mental stimulation and enjoyment and help to increase or preserve attentional capacity, processing time, working memory, and self-esteem. Computer games were accessible to the elderly that had moderate physical and mental impairments (Weisman, 1983).
(Sierra Wave Media: Free computer and internet classes for seniors return)
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