This year, Ovation Communities in Milwaukee celebrates the 25th anniversary of its dementia care facility, the Helen Bader Center.
When it opened, the center was the first of its kind to implement a home-centered care concept rather than one that was institutional and clinical. This model since has become a nationally recognized standard for care.
Our anniversary has prompted a look back on how far research has advanced practices in dementia care and where the studies we’re working on today will take us in the future.
Twenty-five years ago, there was much less written or even talked about with regard to dementia care, and hospital-like long-term care facilities focused on addressing the basic physical needs of their residents. Certain behaviors associated with dementia, such as agitation, were viewed as problems that often were treated with psychotropic drugs.
Gerald Weisman, Ph.D., and Uriel Cohen, ArchD, pioneered the newly emerging field of architectural design and dementia with their seminal book, “Holding On to Home: Designing Environments for People with Dementia.” Published in 1991, their work changed the long-followed institutional way of developing nursing homes to look like “junior hospitals” to creating a space that really felt like a home— with a living room, dining room, activity room and kitchen, and common areas that could include a restaurant, movie theatre, art studio, exercise room and pool.
Additional changes in the field came from research that determined that most behaviors associated with dementia, which had previously been seen as psychological problems, really were caused by factors such as pain or boredom. Fortunately, we have moved toward focusing on strengths and enabling quality of life — behaviors are no longer viewed as problems but as potential symptoms of unmet needs.
Today, it is standard to meet people where they are and, based on their individualized preferences, help them fill their days with activities that meet their goals. Each day, caregivers provide meaningful human interaction, work to decrease excessive environmental stressors and pace activity schedules to create a balance between sensory-stimulating and calming activities. It is our job now, as caregivers, to anticipate needs so that behaviors such as agitation do not occur, and to be vigilant in identifying when behaviors do change, which may indicate a specific unmet need.
As we move forward and look to the next 25 years in the dementia care field, there is a need to develop activities that help prevent co-morbid problems. It is critically important that caregivers provide opportunities for physical movement and exercises to maintain strength as well as exercise for balance and endurance. Too many exercise programs for older adults are primarily range-of-motion exercises. Research has shown that participating in more robust physical fitness programs is associated with decreased falls, less decline in cognition and better overall health.
Although we do not yet have a way to reverse or cure dementia, we are beginning to learn more about neuroplasticity, and there is some evidence that people with mild cognitive impairment and early dementia can delay its progression through some drugs as well as social, cognitive and physical activities.
The dementia care field has taken enormous strides over the past 25 years with new research findings, technologies and perspectives. It is important that we continue to innovate and continue using research to further inform and improve dementia care.