Methods MINDFULNESS BASED

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					MINDFULNESS-BASED ELDER CARE
Lucia McBee, LCSW, MPH www.luciamcbee.com

PROMOTING WELLNESS & STRESS REDUCTION IN GERIATRIC CARE:

OVERVIEW OF COMPLEMENTARY AND ALTERNATIVE MEDICINE
•
–

Use of complementary and alternative medicine (CAM) has increased
74% of US health care consumers use CAM already
(National Center for Complementary and Alternative MedicineNCCAM, 2002)

•

•

CAM is currently offered in most health care settings, studied and published in major peer reviewed journals, taught in medical settings and is responsible for an increasing amount of health care dollars spent There are over 100 CAM interventions listed by the National Institute of Medicine

COMPLEMENTARY AND ALTERNATIVE MEDICINE
• Is generally low risk and low cost • Engages the patient in the healing
process • Reflects a diverse cultural model • Can offer relief from the pain and distress associated with chronic conditions

COMPLEMENTARY AND ALTERNATIVE MEDICINE
• Complementary and Alternative Medicine
• A group of diverse medical and health care systems,

(NCCAM) of the National Institutes of Health as:
practices, and products that are not presently considered to be part of conventional medicine.

• Can be used with (complementary) or in the place
of (alternative) conventional medical treatment • Five major domains are: alternative medical systems, mind-body interventions, biologically based therapies, manipulative and body-based methods and energy therapies
(http://nccam.nih.gov/health/whatiscam/)

WHY USE CAM FOR ELDERS AND THEIR CAREGIVERS?
• Loss, disability and chronic pain disproportionately affect •
• •
older adults Pharmacological treatment alone often does resolve pain and distress Stress and chronic pain negatively impact quality of life 71% of older adults already use CAM (http://researchnews.osu.edu/archive/olaltmed.htm) Complementary and Alternative (CAM) techniques offer another avenue for communication and healing for persons with communication or cognitive difficulties CAM can offer relief at the end of life Families can learn skills to help loved ones Staff and caregivers also suffer from stress and physical symptoms Addresses mind, body and spirit

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• • • •

MINDFULNESS
Is paying attention to our lives, moment by moment, without judgment

• Utilizing model of Mindfulness Based Stress
Reduction (MBSR)
– – – – – –
– Formal and informal practices

MINDFULNESS BASED ELDER CARE (MBEC)
Meditation Breath awareness Awareness of the senses Gentle mindful, body movement Body scan Metta/lovingkindness

• MBEC interventions
– – – – – Guided imagery Gentle yoga Breathing exercises Aromatherapy Hand massage

GUIDED IMAGERY
• Participants sit or lie down, instruction verbally •
•
guides Images can be specific, focusing on a desired outcome, or general, for overall well being Images can be visual, auditory, olfactory, tactile, taste Participants learn that images can elicit powerful experiences in the body Use of guided imagery empowers participant and can eventually be self directed Use of guided imagery with elders
– For relaxation – For pain management – Empowerment

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•

•

GENTLE YOGA
• Learning to listen to our body • Working with abilities not disabilities • Exploring our limits • Becoming stronger, more flexible and more
balanced • Postures can be adapted for wheel chair or bedbound residents

YOGA BREATHING EXERCISES
• Diaphragmatic breathing is most effective • Positive effects on systems:
– – – – – respiratory cardiovascular neurological gastrointestinal psychic

• Can improve concentration, mood,
memory and energy level

AROMATHERAPY
• Used for over 3000 years for healing physical and
emotional ailments • Essential oils have unique complex chemical compositions with distinctive effects on the mind and body • Pathways of essential oils:

• Use of 4-5 oils:
– – – –

– Smell: directly connects with limbic portion of brain, affecting memory and emotions – Skin: simple molecular structure enables essential oils to easily pass through the skin into the blood stream Lemongrass: Calmative, for pain, indigestion and headaches Peppermint: Uplifting, energizing Cinnamon: Appetite stimulant Ylang ylang: A sedative for agitation, depression, lowers blood pressure – Lavender: All purpose, calming, for sleep

HAND MASSAGE
• Soothing, non-invasive, gentle touch • “M” technique:
– Gentle stroking – Structured in order, number and pressure – Developed in England for ICU patients by Dr. Jane Buckle

• May combine with essential oils diluted with
almond oil (a carrier oil) • Personal touch is soothing, relaxing, caring • Requires training and time

MBEC FOR FRAIL ELDERS AND THEIR CAREGIVERS
• Nursing home residents with physical and cognitive
• • • • • • • •
disabilities Elders with moderate-severe dementia and behavioral problems Stress reduction with isolated elders 1:1 work Wellness by telephone Use of tapes and cds Staff stress reduction Family and friend caregivers Nursing home residents and caregivers together

ADAPTATIONS FOR ELDERS
• Stretches, meditations and other exercises • • • • •
• •
modified for elders Shorter groups Simplified language Increased repetition Chair yoga For elders with dementia, the best approach is structured yet flexible Individual work can be tailored to specific needs Use of aromatherapy and music to create a calming milieu The most important factor is the teacher
– A calm demeanor – Flexibility – Acceptance

•

ADAPTATIONS FOR PROFESSIONAL CAREGIVERS
• • • • • • • • • •
Classes offered to interdisciplinary staff Psychoeducational and experiential Overview of causes of stress and stress related illness Deep breathing, simple stretches and meditation techniques Discussion of stressful situations at work Focus on techniques to be utilized in stressful moments or “down” time Consider timing and location Class series Brief classes, from 15 minutes to 1 hour 1:1 stress reduction Handouts, resources and referrals made available

GROUPS FOR STAFF AND CAREGIVERS TOGETHER

• Teaches practical and simple stress

reduction skills • Reduces environmental stress • Offers ways of reducing stress while providing/receiving care • Can provide an opportunity for staff and residents to view share an experience and view each other in new ways

FLORENCE V. BURDEN STUDY OF CAM ON A DEMENTIA UNIT
• Aromatherapy • Breathing exercises • Hand massage • Guided imagery • Used on a nursing home unit for those with
moderate to severe dementia • Statistically significant improvements in mood and behavior in a one year study using interventions

Change in Agitation Over Time
(Cohen-Mansfield Agitation Inventory: p<0.01)
100 90 80 70 60 50 40 30 20 10 0

CAM CONTROL

Baseline

Interim

Endpoint

Change in Depression Over Time
(Cornell Scale for Depression in Dementia, p<0.05)
16 14 12 10 8 6 4 2 0

CAM Control

Baseline

Interim

Endpoint

WHY IS STRESS REDUCTION FOR CAREGIVERS IMPORTANT?
• Stress can lead to
– – – – Physical and emotional problems Caregiver burnout Anger, frustration and resentment Isolation

• Stress is contagious • Persons with dementia are still able to connect with
how their caregivers are feeling • When we are not stressed we may enjoy the caregiving experience more

WHAT IS STRESS?
• What is stressful to me is not necessarily
stressful to you • Stress can feel overwhelming • Stress is also associated with that which we aspire to and value • Stress is experienced mentally, emotionally and physically • Caregivers experience unique stress

STRESS BUSTING
• The mind-body connection • The role of perception and stress
you

– Caregiving rewards – What helps my stress does not necessarily help

• Learning skills to reduce stress and make
choices • Incremental lifestyle changes • A relaxed attitude is also contagious

CONSIDERATIONS
• Modify interventions for elders with cognitive and
physical limitations and disruptive behaviors • Consider shorter and on-unit programs Convincing administrators – Increasing research on benefits of CAM Low cost – Acceptance and use by general public – 7.6% use meditation – 5.1% use yoga (NCCAM, 2002) – Marketability • Finding your comfort level in teaching Making time for stress reduction

CONSIDERATIONS
• Working with caregivers may have the greatest

• • • •

impact on elders Encourage participation for staff and caregivers Consider how you describe this- “stress and pain reduction” or “wellness” appeal to almost everyone Staff are busy, be flexible Consider timing and location Informal caregivers may have difficulty caring for themselves

STRESS REDUCTION SKILLS
• There are many options- see what works for you • Learning to listen to our body’s signals and take

time out • Mini breaks and classes – Many of the exercises can be practiced in stressful moments or “down” time – Classes are universally available now • Try stress reduction practices with your care receiver – Can provide an opportunity for caregivers and care receivers to view share an experience and view each other in new ways

OVERVIEW
• Mindfulness based stress reduction skills
can help everyone • Resources easily available
– Tapes and trainings – Essential oils – Yoga and meditation classes – Practice what you know and enjoy – And have fun!

• Start with yourself


				
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