Md3011 Clinical Healthcare:Reduction Of Dementia Assessment Answers

As the aim of the research was to explore the impact of physical exercise on reducing risk of dementia in ageing population of Australia, the key words that were included for the literature search include ‘elderly people and dementia’, ‘relation between physical exercise and dementia’, ‘Impact of lack of physical exercise on dementia’ and ‘link between ageing and dementia’.

Analysis:

Research article published between 2006 and 2017 and focusing of ageing population of Australia was included for the systematic review. About 312 research article, books and grey literature were initially considered. Out of them 142 were excluded after reading the abstract and 38 after reading full extract of the article. Finally, a total of 20 journal and articles were reviewed.   Thematic content analysis was done to classify the findings into different themes. 

Findings:

The following themes emerged from systematic review of literature:

Improved physical capacity and mental health due to exercise

Treatment for dementia has mainly focused on antihypertensive therapy, hormone replacement therapy and non-steroidal anti-inflammatory drug treatment. However, little is known about the impact of preventive measures of dementia such as lifestyle changes and physical fitness. Physical activity helps in management of many chronic disorders and evidence have shown that it has helped in delaying cognitive loss and impairment in elderly people. It improves brain function by improving cerebral blood flow and oxygen delivery (Larson et al. 2006). The research study (Öhman et al. 2014) showed that physical activity initiated in middle age protects against cognitive impairment in old age. The review of different intervention studies showed the positive effect of physical exercise in improving executive function in older healthy adults. Secondly, the evaluation of physical exercise on reducing risk in older adults with dementia or mild dementia showed that interventions consisting of aerobic exercise, balance and dual tasking helped in improvement in mini-mental state examination. Participants achieved verbal fluency and task switching skill after physical exercise programs. The study also revealed that outcome was better for people with mild dementia compared with those with dementia.

The above findings has implication for public health development activities as the study presents the need to address the risk of dementia at an early stage of progression of disease or in middle age so that people are protected from the risk of dementia and its adverse impact. This will delay the onset of dementia. As inconsistent and poor results has been found for people with dementia, public health programs should focus separately on older patients with mild, moderate and severe dementia. This will help to focus on challenges faced by individual group. Public health intervention should encourage people to engage in physical activity at middle age to minimize the risk. Effective health promotion program will help to promote physical activity among people and prevent dementia (Sofi et al. 2011).

Physical activity has the benefit of reducing social problems and reconnecting to environment

Social integration is an important part of physical and mental well being of person. However, older adults are at increased risk of social isolation due to chronic illness or disability. Due to the cognitive impairment in dementia patient, they are at increased risk of social isolation and attending to unique care needs of important in such patients. With the rise in number of people living with dementia, residential care burden is likely to increase (Abbott et al. 2015). Review of literature gave the idea of addressing social problem in people with dementia by means of physical activity. This is possible because participation in physical activities increased the likelihood of meeting other individual with similar cognitive problems. This eliminates feeling of loneliness and prevents the risk of creating harm to themselves by engaging in social activities. This will have positive benefits of reducing suicidal thoughts in patient and improving their quality of living (Ervin et al. 2015). Wallace et al. (2014) also gives evidence regarding the positive benefits of exercise program on reducing social isolation in elderly people and improving their quality of life. A 12 week exercise programme given to elderly people showed that physical exercise had a psychological effect on them. They enjoyed activities and connecting with people. Hence, social participation by means of physical activity program will encourage positive health behavior in elderly people.

The review of the above articles related to positive impact of physical exercise gives many useful implications for public health action. Firstly, they can use the evidence to promote cognitive stimulation in elderly people by participation in physical activity programs. This is an innovative means not only reconnect them to their social environment, but also address their feelings of apathy and depression. Hence, modifying the risk factor of social isolation in elderly people will minimize the burden on the health care system and delay complications in affected people. More and more community wide initiative should be implemented in community such as mass media campaign and physical activity club to make people aware about the importance of physical activity and make these clubs easily accessible to them (King and King 2017).

Exercise preserves quality of life

Cabrera et al (2015) presented different challenges in lives of people with dementia that has an impact on their quality of living. People with dementia are dependent on formal or informal carer to perform ADLS such as bathing, dressing, toileting and transfer. Hence, considering the decline in quality of life of people with dementia, it is necessary that that health promotion intervention focuses on promoting independence in these people by means of non-pharmacological intervention. Physical activity is one of the non-pharmacological intervention and many studies revealed the positive impact of physical exercise on clinical symptoms , quality of life and cognition. Physical activity in ageing population results in improvement in cognitive functions, depressive symptoms and age related cognitive decline. This eventually results in enhancement of quality of life (Dauwan et al. 2016). Many article gave insight into the contribution of yoga and exercise on improving quality of life (Young et al. 2015). With this finding, the information can be encourage public health agencies to priorities physical activity as a health promotion intervention for elderly population of Australia. Implementation of supervised group exercise program for consistent period of time has the potential to enhance livelihood of elderly people at risk of dementia.

Physical activity leads to improvement in cognitive functions

Ahlskog et al. (2011) showed the exercise has the potential to attenuate cognitive impairment and reduce risk of dementia. Regular exercise act as a neuroprotective therapy as it favours brain health and develops resilience to neurodegenerative mechanism in people. Aerobic exercise has been shown to provide cognitive benefits, however the intensity and duration of exercise should be considered for individual age group. Glynn et al. (2016) also supported the fact that elderly people who are physically active are less likely to experience cognitive decline compared to inactive individual. Hence, international health community must focus on providing environment where moderate-intensity physical exercise is possible for people and dependence on medications should be minimized to across elderly people.

Discussion

Dementia is a major public health concern as the global health burden on the ageing population is increasing with each passing year. Recent research points out that dementia is multi-factorial, encompassing both environmental and genetic factors. Several lifestyle and vascular factors are known to be associated with dementia. The results, however, remain contradictory, especially those research that are on the impact of physical activity on dementia (Atherton et al. 2016). The present research undertaken had the objective of understanding the relation between physical activity and reduction of the impacts of dementia.

A rapidly growing body of literature has indicated that exercise had a strong connection with improvement of physical capacity and mental health for dementia patients. In addition, cognitive impairment might be attenuated and risk of dementia might be prevented (Öhman et al. 2014). Ahlskog et al. (2011) had put forward a similar concept previously through their study on the exact by which physical exercise are beneficial for the disease-modifying treatment or preventive treatment of dementia. As per the authors, though medication has no distinct neuro-protective impact on dementia patients, literature suggests that regular, long-term exercises have a deep impact on dementia risk, cognition and to some extent dementia progression. The studies conducted so far have focused on an attenuating impact on resilience to neurodegenerative mechanisms of dementia. Bowes et al. (2013) highlighted that there is a gap in scientific understanding of physical activity for dementia patients. There is also a paucity of notable evidence linked with theories with many interventions of dementia. There is a general notion that physical activity has some beneficial impacts on dementia patients, the degree and form of which are still to be explored. Though suggestions have come up that physical activity can be included as a major intervention for dementia, there is still a lack of literature on proper guidance in this direction. There is an absence of clarity regarding the steps through which physical activity works as an intervention. The outcomes that are to be expected and the outcomes that are required are still not clear. This is to say that physical activity interventions need further study for establishing the benefits in terms of quality of life and well-being of the patients. Physical activity has no harmful impact per se; however, it needs to be applied as per the needs of the individual (Lee et al. 2016).

Service providers would play an important role in how physical activity can be included as a part of intervention for dementia. There might be a need for ongoing resource-based support. One vital issue that can be faced by health care consumers at the time of receiving assistance for physical activity might be a lack of adequate staffing. The reason for this is that a high client: staff ratio is needed for some form of physical activity. Providers of services based on community needs might face the issue of growing demand for services that can outstrip the ability to provide them. There needs to be increased funding for activity programs if physical activity is to be included in treatment regime for dementia patients. In the lack of adequate funding, the range of physical activity offered might become limed (Inskip et al. 2016). Staff training needs to be enhanced at the earliest for future service development. Information-based support needs of the service providers must also be met, including the inter-provider exchange of knowledge for disseminating evidence-based practice and suggestions. Through shared lessons, it is expected that care providers would come up with innovative approaches physical activity of dementia patients. Overall, physical activity can be made a part of intervention strategies for dementia with the identification of suitable partners within the community (Telenius at al. 2015).

Ervin et al. (2015) had highlighted that physical activity could be beneficial for patients in that patients can meet other patients with same issues and engage in social interactions. Social exclusion and isolation can be potentially reduced so that dementia patients can be enabled to bring improvement in their quality of life. The direct benefits are a reduction in self-harm and reduced social problems. According to Louise and Mestre (2017) individuals with dementia can improve the quality of life by bringing improvements in issues faced such as pain, sleep disorders and risk of falling. Against these findings, it is also necessary to mention that a broader range of exercises is to be researched on for determining the best and most effective exercise program for patients with dementia. Quality of life of dementia patients can be made better by minimising the stress, isolation, loneliness and other associated factors that have a contribution towards cognitive decline. The sense of self-worth of patients can also be increased through physical activities. Moreover, intellectual stimulation can bring in some benefits by improving the performance of daily activities of living. Physical exercises must only be implemented after determining the social component of the exercises and their potential impact on patients (Ruthirakuhan et al. 2012).

Almeida et al. (2014) stated that physical activity plays a role if enhancing vascular changes in the brain, thereby reducing adverse impacts of cognitive impairment. Glynn et al., (2016) had supported that active elderly patient shows less decline in cognitive functions in comparison to those who are less active. Grande et al. (2014) in their research paper had stated that the trajectory of cognitive decline could possibly be modulated in healthy elderly patients as well as those with mild cognitive impairment though compliance with regular physical activity program. The researchers had highlighted that from the public health viewpoint, it is the duty and the responsibility of the clinicians to encourage dementia patients with mild cognitive impairment to carry out physical activities. Guure et al. (2017) in this regard had stated that a number of explanations could be put forward regarding the impact physical activity has on the personal health of individuals suffering from dementia. Findings from the study imply that individuals having active lifestyle can reduce cortisol level, helping in preventing stress. This has a direct positive impact on cognitive function.

The benefits of the undertaking an intervention plan based on physical activity and exercise for dementia patients have been time and again highlighted through a rich pool of literature. Much of the evidence has been anecdotal; hence comes the need for extensive further research to form a strong foundation upon which the interventions can rest. Such research needs the inclusion of randomised control trials for evaluating interventions and programs for augmenting knowledge on best practice. The capacity of dementia patients to take part in structured and planned exercise has been questioned often though a certain section of a large pool of studied indicate that patients in early stages of dementia can initiate exercises. It is absolutely pivotal that before starting with the regime of physical exercise, the symptoms, rate of progression, type of dementia and personality of the patients is assessed with corresponding tools (Anderiesen et al. 2014). Lee et al. (2015) had opposed that it is vital to communicate the exact benefits of physical activities to the patients who can then consider referring to an appropriate activity program.

A growing body of research, from randomised control trial to retrospective cross-sectional studies, suggests that elderly dementia patients can gain positive effects from physical activity. Physical activity acts by influencing many physiologic tissues and systems, such as the endocrine system, immune system and cardiovascular system. This form of intervention is relevant to treatment of dementia at all the three levels of health care- primary, secondary and tertiary. Brett et al. (2016) argue that some components of physical exercise programs have not been addressed in the studies that have been so far conducted. As per the authors, a population-based public health perspective can aid in investigating the health relationship between dementia and physical exercise.

Physical activity might be an economical, practical and accessible intervention for management and prevention of dementia. Engagement in physical activity on a routine basis can possibly reduce the risk of developing the disease. For individuals with dementia, physical and mental symptoms can be mitigated easily. Evidence-based guidelines would serve the purpose of supporting the promotion of physical activity. These required guidelines would stipulate the intensities, amounts and type of physical activities from which one can draw benefits. However, at present, there is a lack of proper guidelines that can be followed blindly. Dose-response data needs to be consulted for formulating guidelines (Tan et al. 2017).  

A wide range of physical activity programs has come into practice for relieving the major symptoms of dementia. They have been known to be effective for executive and attention functions of individuals. Nevertheless, the impact of physical activities on memory has been under controversy. Therefore, one needs to confirm the extent to which physical activity programs are successful for relieving the dementia symptoms. The physical activities mainly recommended include Tai-Chi, muscle-strengthening exercises, aerobic exercises, hydrotherapy. It is to be mentioned that the general population might be facing challenges and confusion regarding the diverse options available regarding the forms of exercises. Therefore, a guideline is to be present for suggesting the most suitable method for designing patient-centred programs (Kishimoto et al. 2016).

The above discussion has a strong implication for bringing research into practice. Against the background of increasing knowledge of benefits of physical activity in dementia, health care systems must focus on designing the programs as per the individual needs of the patients. Programs must address any arising barriers to participation for certain communities. Local councils must come forward to help healthcare settings by providing support for community-based activities. This can be in the form of volunteer support for activities such as Tai Chi, yoga and walking groups (Taylor et al. 2017). Implementation of physical activity programs for dementia patients must take into consideration objective measure of the activities, bring adjustments for full range of confounders and must have sufficient follow up tools. Implementation of physical activity programs for dementia patients might prove to be difficult in the long run. Meanwhile, since benefits of physical activities have been established across numerous health domains, it is to be encouraged regardless of the direct relationship with dementia. Public health professionals have been time and again criticized for lagging behind in incorporating research evidence into practice. Initiatives have therefore been less taken up for bringing changes in practice (Stephen et al. 2017). Organizations wanting to promote physical activity might be limited to do so. In response to the growing need of incorporating physical exercise in treatment and management of dementia, research evidence must formulate knowledge products and messages for disseminating to the public. Clinicians, researchers and caregivers are to be encouraged by the health care organisations for adopting the messaging statement along with information sources. Challenges might be faced in providing a physical activity formula optimum for lowering risks for dementia. It is necessary that care settings consider frequencies and duration of the exercise sessions before commencing on those. Different patients have different needs, preferences and abilities for carrying out physical exercises. All evidence put together it can be concluded that different forms of physical exercise are suitable for different individuals with varied needs. Health authorities are to provide recommendations for the proper utilization of physical activity so that the society can benefit (Richards, Gale and Ding 2017).

The findings of all studies pooled together can give way to the conclusion that whole interventions based on physical activity can have a positive impact on dementia. The health care professionals who can help in providing physical activity programs need special attention in this regard. General practitioners can help by assessing the physical activity needs of providing guidance about safe activity practices. They can refer the clients to exercise physiologist, physiotherapist or other allied healthcare professionals (Gallaway et al. 2017). Exercise physiologists are qualified professionals who have the knowledge about the link of physical activities with dementia and can prescribe the exercise course for rehabilitation, fitness or both. Developing healthy habits in patients is the best possible method for bringing about best patient outcomes. Physiotherapists can assist with personalised physical activity programs by developing such programs and monitoring them on a regular basis. Patients can benefit by reducing pain, recovering from injury and increasing level of mobility.

Conclusion

The review and critical discussion of key themes from literature review established the positive link between physical exercise and preventing risk of dementia in elderly population of Australia. The exploratory research by means of thematic analysis of literature revealed the four important positive effect of physical exercise  such as- improvement in physical capacity, cognitive decline, quality of life and social connectedness among people. The discussion also revealed several consistencies in literature regarding the intensity of physical activity in elderly. Hence, service providers will play an important role in analyzing physical activity needs for different age group of people and shared lessons would help them to come up with innovative support for this group of people.  However, there is a need to increase funding for physical activity programs at community level to achieve true benefits of physical activity (Inskip et al. 2016). These findings will have useful implications and application for public health development as they can plan innovative health promotion strategies to encourage people to become physically active and actively participate in physical activity programs. Aged care provider can enter into partnership with private gyms and physical activity trainers so that people with dementia or at risk of dementia can easily access exercise programs and activities. It will also encourage local councils to implement dementia friendly community activities to enhance their emotional and social well-being.

References

Abbott, K.M., Bettger, J.P., Hampton, K.N. and Kohler, H.P., 2015. The feasibility of measuring social networks among older adults in assisted living and dementia special care units. Dementia, 14(2), pp.199-219.

Ahlskog, J. E., Geda, Y. E., Graff-Radford, N. R., and Petersen, R. C. 2011. Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging. In Mayo Clinic Proceedings (Vol. 86, No. 9, pp. 876-884). Elsevier.

Ahlskog, J.E., Geda, Y.E., Graff-Radford, N.R. and Petersen, R.C., 2011, September. Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging. In Mayo Clinic Proceedings (Vol. 86, No. 9, pp. 876-884). Elsevier.

Anderiesen, H., Scherder, E. J., Goossens, R. H., and  Sonneveld, M. H. 2014. A systematic review–physical activity in dementia: the influence of the nursing home environment. Applied ergonomics, 45(6), pp.1678-1686.

Atherton, N., Bridle, C., Brown, D., Collins, H., Dosanjh, S., Griffiths, F., Hennings, S., Khan, K., Lall, R., Lyle, S. and McShane, R., 2016. Dementia and Physical Activity (DAPA)-an exercise intervention to improve cognition in people with mild to moderate dementia: study protocol for a randomized controlled trial. Trials, 17(1), p.165.

Blondell, S. J., Hammersley-Mather, R., and Veerman, J. L. 2014. Does physical activity prevent cognitive decline and dementia?: A systematic review and meta-analysis of longitudinal studies. BMC public health, 14(1), p.510.

Bowes, A., Dawson, A., Jepson, R., and McCabe, L. 2013. Physical activity for people with dementia: a scoping study. BMC geriatrics, 13(1), p.129.

Bowling, A., 2014. Research methods in health: investigating health and health services. McGraw-Hill Education (UK).

Brett, L., Traynor, V., Stapley, P.J. and Meedya, S., 2016. An evidence-based physical activity protocol for people living with dementia in nursing homes.

Cabrera, E., Sutcliffe, C., Verbeek, H., Saks, K., Soto-Martin, M., Meyer, G., Leino-Kilpi, H., Karlsson, S., Zabalegui, A. and RightTimePlaceCare Consortium, 2015. Non-pharmacological interventions as a best practice strategy in people with dementia living in nursing homes. A systematic review. European Geriatric Medicine, 6(2), pp.134-150.

Dauwan, M., Begemann, M.J., Heringa, S.M. and Sommer, I.E., 2016. Exercise improves clinical symptoms, quality of life, global functioning, and depression in schizophrenia: a systematic review and meta-analysis. Schizophrenia bulletin, 42(3), pp.588-599.

Ervin, K., Pallant, J., Terry, D.R., Bourke, L., Pierce, D. and Glenister, K., 2015. A Descriptive Study of Health, Lifestyle and Sociodemographic Characteristics and their Relationship to Known Dementia Risk Factors in Rural Victorian Communities. AIMS Med Sci, 2, pp.246-260.

Gallaway, P.J., Miyake, H., Buchowski, M.S., Shimada, M., Yoshitake, Y., Kim, A.S. and Hongu, N., 2017. Physical Activity: A Viable Way to Reduce the Risks of Mild Cognitive Impairment, Alzheimer’s Disease, and Vascular Dementia in Older Adults. Brain sciences, 7(2), p.22.

Giebel, C.M., Sutcliffe, C., Stolt, M., Karlsson, S., Renom-Guiteras, A., Soto, M., Verbeek, H., Zabalegui, A. and Challis, D., 2014. Deterioration of basic activities of daily living and their impact on quality of life across different cognitive stages of dementia: a European study. International psychogeriatrics, 26(08), pp.1283-1293.

Ginis, K. A. M., Heisz, J., Spence, J. C., Clark, I. B., Antflick, J., Ardern, C. I., ... and  Middleton, L. 2017. Formulation of evidence-based messages to promote the use of physical activity to prevent and manage Alzheimer’s disease. BMC public health, 17(1), 209.

Glynn, R.W., Dolan, C., Shelley, E. and Lawlor, B., 2016. Evidence-based prevention and treatment of dementia. The Lancet Neurology, 15(10), p.1006.

Grande, G., Vanacore, N., Maggiore, L., Cucumo, V., Ghiretti, R., Galimberti, D., ... and Clerici, F. 2014. Physical activity reduces the risk of dementia in mild cognitive impairment subjects: a cohort study. Journal of Alzheimer's Disease, 39(4), pp.833-839.

Guure, C. B., Ibrahim, N. A., Adam, M. B., and Said, S. M. 2017. Impact of Physical Activity on Cognitive Decline, Dementia, and Its Subtypes: Meta-Analysis of Prospective Studies. BioMed Research International, 2017.

Inskip, M., Mavros, Y., Sachdev, P. S., and Singh, M. A. F. 2016. Exercise for individuals with Lewy body dementia: a systematic review. PloS one, 11(6), e0156520.

King, A.C. and King, D.K., 2017. Physical activity for an aging population. Public Health Reviews, 32(2), p.401.

Kishimoto, H., Ohara, T., Hata, J., Ninomiya, T., Yoshida, D., Mukai, N., ... and Kanba, S. (2016). The long-term association between physical activity and risk of dementia in the community: the Hisayama Study. European journal of epidemiology, 31(3), 267-274.

Larson, E.B., Wang, L., Bowen, J.D., McCormick, W.C., Teri, L., Crane, P. and Kukull, W., 2006. Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Annals of internal medicine, 144(2), pp.73-81.

Lee, A.T., Richards, M., Chan, W.C., Chiu, H.F., Lee, R.S. and Lam, L.C., 2015. Intensity and types of physical exercise in relation to dementia risk reduction in community-living older adults. Journal of the American Medical Directors Association, 16(10), pp.899-e1.

Lee, H. S., Park, S. W., and Park, Y. J. 2016. Effects of Physical Activity Programs on the Improvement of Dementia Symptom: A Meta-Analysis. BioMed Research International, 2016.

Louise, C., and Mestre, L. 2017. Off-Label Prescribing of Antipsychotics in Adults, Children and E...: Ingenta Connect. Ingentaconnect.com. Retrieved 31 March 2017, from https://www.ingentaconnect.com/content/ben/cpd/2015/00000021/00000023/art00004

Öhman, H., Savikko, N., Strandberg, T.E. and Pitkälä, K.H., 2014. Effect of physical exercise on cognitive performance in older adults with mild cognitive impairment or dementia: a systematic review. Dementia and geriatric cognitive disorders, 38(5-6), pp.347-365.

Richards, J., Gale, J. and Ding, M., 2017. Active body, active brain: Quantifying the role of physical activity in preventing dementia. Journal of Science and Medicine in Sport, 20, p.e122.

Ruthirakuhan, M., Luedke, A.C., Tam, A., Goel, A., Kurji, A. and Garcia, A., 2012. Use of physical and intellectual activities and socialization in the management of cognitive decline of aging and in dementia: a review. Journal of aging research, 2012.

Sofi, F., Valecchi, D., Bacci, D., Abbate, R., Gensini, G.F., Casini, A. and Macchi, C., 2011. Physical activity and risk of cognitive decline: a meta?analysis of prospective studies. Journal of internal medicine, 269(1), pp.107-117.

Stephen, R., Hongisto, K., Solomon, A. and Lönnroos, E., 2017. Physical Activity and Alzheimer’s Disease: A Systematic Review. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, p.glw251.

Tan, Z.S., Spartano, N.L., Beiser, A.S., DeCarli, C., Auerbach, S.H., Vasan, R.S. and Seshadri, S., 2017. Physical activity, brain volume, and dementia risk: the Framingham study. The Journals of Gerontology: Series A, 72(6), pp.789-795.

Taylor, M.E., Lord, S.R., Brodaty, H., Kurrle, S.E., Hamilton, S., Ramsay, E., Webster, L., Payne, N.L. and Close, J.C., 2017. A home-based, carer-enhanced exercise program improves balance and falls efficacy in community-dwelling older people with dementia. International Psychogeriatrics, 29(1), pp.81-91.

Telenius, E. W., Engedal, K., & Bergland, A. 2015. Effect of a high-intensity exercise program on physical function and mental health in nursing home residents with dementia: an assessor blinded randomized controlled trial. PloS one, 10(5), p.e0126102.

Wallace, R., Lees, C., Minou, M., Singleton, D. and Stratton, G., 2014. Effects of a 12-week community exercise programme on older people: Nurses should promote exercise to reduce patients’ social isolation and increase their independence, say Ricky Wallace and colleagues. Nursing older people, 26(1), pp.20-26.

Young, J., Angevaren, M., Rusted, J. and Tabet, N., 2015. Aerobic exercise to improve cognitive function in older people without known cognitive impairment. The Cochrane Library.