Table of Contents

1.0 CHAPTER ONE 3

1.1 Introduction / Background 3

1.2 Problem Statement 5

1.3 Research Objective 6

1.4 Research Questions 6

1.5 Theoritical Framework 7

1.6 Significance of the Study 8

1.7 Scope of Research and Limitation 9

1.8 Definition of Terms 9

CHAPTER II: LITERATURE REVIEW 10

2.1 The effects of physical exercise and diet 10

2.2 Mental Stimulation 11

2.3 Importance of Socialization 12

2.4 Nursing Care and relevance 13

2.5 Benefits of physical activities for older persons with dementia 16

References 19

1.0 CHAPTER ONE

1.1 Introduction / Background

Physical activity has been important in determining many outcomes of health. This includes cardiorespiratory health like heart disease, stroke, hypertension; metabolic health like diabetes and obesity; musculoskeletal health like osteoporosis and bone health, cancer, depression and functional health and prevention of falls. This means that physical activity is the fourth leading global risk when it comes to human mortality and is estimated to lead to 5.5% of deaths; this is even higher when it comes to developed countries. According to Kayes & Hatfield (2019), physical activity is any bodily movement that is produced by the skeletal muscles which result in the expenditure of energy and can be categorized to sports, occupation, household, conditioning, and other activities.  This should also be differentiated from the physical exercise hat is planned, structured, and repetitive to maintain or improve physical health (Christie et al., 2017). 

When it comes to Dementia, physical activity is significant and can help people living with the condition in many ways from the evidence that is currently scattered and sparse. There are various proposed theories and hypothesis that are used to explain ways that physical activity can impact people living with dementia. Some of these include the vascular hypothesis, the neurochemical hypothesis, stress hypothesis, cognitive reserve hypothesis, and the functional hypothesis (Chen & Pei, 2018).  With the exception of the functional hypothesis, all the others are derived from the animal models. Several studies related to the physical activity programs for people living with dementia have suggested that various benefits include an improvement in cognitive skills, independence, and increased activities throughout their daily lives, there will also be increased mental health and functional ability (Miendlarzewska & Trost, 2014,).  There are also going to be significant social benefits, and this is especially important when the physical activity is done in groups, this can be able to increase the social networks of the individual and reduce the feelings of isolation and loneliness which is a common aspect of people living with dementia (Van der Steen et al., 2018).  It is also essential to take note of the type of physical activity like walking outdoors, which can help in re-establishing a connection with Mother Nature and their families or communities (Leon, 2019).  Others including dancing and musicals which can help promote wellbeing. This means that physical activity can have a tangible health benefit and ensure that the individual has maintained a healthy lifestyle by also reducing the risk of other diseases.

According to Klimova, Valis, & Kuca, (2017), dementia is a form of disorder of which Alzheimer's disease is the most likely. The condition will affect the individual's thinking, memory, behavior, including the ability to engage in normal daily activities (Slattery et al., 2019). It is still a challenge to establish the number of people living with dementia with certainty since the estimates are often affected by the difference in disease definition, study design, criteria for diagnosis and methods of calculation. It is, however, estimated that there would be 115.4 million people living with dementia by 2050 (Sleimen-Malkoun, Temprado, & Hong, 2014).  

There are a lot of benefit that people with dementia can get from physical activity, which has been realized through various evidence that is scattered and currently sparse. There are various proposed hypothesis that have been used to explain how the use of physical activity is going to impact on  a person living with dementia and this includes the cognitive reserve hypothesis, vascular hypothesis, a neurochemical hypothesis, stress hypothesis and the functional hypothesis.  Apart from the functional hypothesis, others hypothesis were inspired by an animal model (Chen & Pei, 2018).    Also several studies regarding physical activity for persons living with dementia have shown that there are multiple benefits which include improve cognitive abilities of daily life and personal independents, mental health and functional ability. Also it is possible that this will also be accompanied by social benefits like when the physical activity is done within a group, this can increase the range of the social networks than the individual has. In the end physical activities can help reduce the patient’s lonely feelings and isolation which is often seen as an issue for people living with dementia (Christie et al., 2017). It is however important to note that the type of physical activity will also be considered; for example if the activity entails the patient walking outdoors  it will be helpful in making them re-establish with nature and the local community,  also activity such as dancing will provide the patient with social and physical wellbeing (Slattery et al., 2019). There are also a lot of physical benefits that come with physical activity, this helps the patient to maintain a healthy lifestyle and reduce the risk of contracting other poor conditions like heart disease. 

1.2 Problem Statement

The Dementia disease is a rapidly growing public health problem that is affecting about 50 million people all around the world. Research from world health organisation indicate that there are 10 million new cases of dementia each year and the figure is set to triple by 2050 (Slattery et al., 2019). Among the known causes of the disability and dependency associated with elder people has seen them living a frustrating and devastating lifestyles which affect them as individuals, their carers and the families.  The disease has also hit hard on the world economies and the society in particular as the cost of caring for people with dementia continues to rise to about USD 2 trillion annually by 2030 at a global scale (Chen & Pei, 2018).   Also there is currently no curative treatment for dementia disease and various review still express a lot of concern about the effectiveness of physical activity programs in the management of dementia among elder people. There are still May questions regarding the resulting effects on their behavioral, functional, cognitive, depression and mortality for these age groups, calling for further research.

1.3 Research Objective

The Main objective of this paper is to provide a literature review study looking at the factors affecting the physical and emotional activities for elderly adults between aging groups 40-80 with dementia. 

This literature review study will work towards the following objectives:

1. To find out the physical activities that can be done by elder person with dementia.
2. To find out the current interventions providing the benefits of physical exercise for elder persons with dementia.
3. To research on the current support systems for people living with dementia to ensure they perform physical activity.

1.4 Research Questions

The following are the research questions:

1. How do physical activity do is going to benefit persons with dementia?
2. What are the current interventions providing the benefits of physical exercise for elder persons with dementia?
3. What are the support systems necessary for people living with dementia to ensure they perform physical activity?

1.5 Theoritical Framework
This research explores the theory of planned behavior as shown in the above framework. According to the above framework, regular practice of physical exercise is a very important fact that will result to the maintenance of personal balance in regard to suppression or prevention of developing chronic disease, improve various body functions, psychological and social functional outcomes (Slattery et al., 2019). The expected increased independence in various basic and instrumental activities of the daily life for a patient with dementia may lead to a better life and reduction of cost for treatment and burden related to caregiving (Chen & Pei, 2018).  This is because with this theory, the planned behavior will see the body improve its cerebral blood flow and the induction of neurogenesis in the hippocampus. 

1.6 Significance of the Study

This study is very important as it investigates the factors affecting the practice of physical activity among the vulnerable group of people living with dementia, specifically the elderly group.  It is important to note that the in most case the practice of physical activity has been associated with a lower incident and prevalence of dementia and reduced cognition.  Various studies have shown that elderly groups that practice physical exercise on a daily basis were 32% less likely to develop dementia than a control group of sedentary subjects (Slattery et al., 2019). Those who recorded low levels of functionalism were actually associated with the risk dementia, however when they are put in a weekly three day regimen it led to a protective effect (Chen & Pei, 2018).  There is also a lot of evidence which clearly indicate that there is actually improved function of these groups when they are admitted to aerobic training independent of any type of aerobic, intensity or duration of the physical activity mainly during the process of execution.  

 The decline of activities of daily living (ADL) and cognition in dementia will be determined by a parallel and temporal hierarchy. In addition, the impairment on the daily living activities could also be linked to motor changes and manifestations in the neurological function that will also occur in the place of AD progression, like the myoclonus, extrapyramidal signs and the frontal gait. The dementia manifestations and the increased risks of falls, stress and more caregiver burden in addition to increased rates of death and institutionalization (Christie et al., 2017). This study is thus important as it is going to assess the relationship between the planned physical exercise and emotional exercises and the improvement of the patient daily activities in dementia patients why attend an environment that cognitive stimulation and physical exercise is done frequently (Slattery et al., 2019). 

1.7 Scope of Research and Limitation

This study will basically consist of a literature review exercise with a great focus being on the United States.  However international statistic regarding the practice of physical and emotional exercises for elder people living with dementia will be incorporated. The main source of the literature review study will be derived from the university online library and other medical online journal libraries like CINHAL, PubMed, Medline and more.  One of the limitations for this literature review study is that most of the information regarding the effectiveness of physical and emotional exercise may not provide most of the details clearly. In this regard, this study will also entail the use of interview among various healthcare practitioners and patients on the resultant effects of physical exercise and dementia patients (Chen & Pei, 2018).  This is important in determining whether there is a coherent theoritical or underlying basis that determines the effectiveness of physical exercise components or the undertaking assets. There is also need to find out about the current services being provided and the use of technology in providing these interventions; this is why combining the literature review and research findings with data can provide a broader understanding of future interventions. 

1.8 Definition of Terms

ADL- Activity of Daily Living

CHAPTER II: LITERATURE REVIEW

2.1 The effects of physical exercise and diet

When it comes to dementia, the physical exercise is important since it helps in the improvement of the patient’s muscles and joints.  It will also provide the individual with a sense of independence.  This also provides the individual with a sense of independence as physical exercise will prevent the onset of more disease progression it will also prevent other effects like cardiovascular disease and hypertension. It also helps the patient improve in regard to their cognitive abilities and having a social life.   Physical exercise is also good when it comes to reducing the sense of loneliness within the affected individual. It is thus important to see that the nursing intervention provides a key role in the conduct and continuation of exercises, as it will also prevent the progression and onset of dementia. 

Also when it comes to the nutritional diet, this is going to be very promising when it comes to progression and prevention of dementia. A lot of evidence actually indicate that the dementia among older groups can be prevented through proper food intake.  Currently there is no cure for this condition, but the nutritional diet can be taken as a strategy as it halts or slows down the progression of dementia.  Also a lot of evidence suggests that the metabolic derangements will be realized because of the adequate nutrition of an individual with dementia.  In addition having the right nutritional supplements should be incorporated in the diet as this will also affect the person’s pathological state. In most cases the Mediterranean diet will be recommended which includes fruits, cereals, fish and vegetables as this will reduced the patient’s risk of deterioration. Some for the dementia forms can also have a negative impact on the patient’s appetite. It can lead to unintended weight loos and other related health issues. In this regard, malnutrition is always a big issue for patients with dementia. So it is important to look at the patient’s food intake as it should be regulated to prevent the cognitive and behavioral issues.  The diet may not be able to reduce the progress of dementia, however it is going to have a lot of therapeutic advantages. For example when the patient takes food with a lot of vitamin E, it will be able to see to it a reduction of progress. Various studies indicates that Vitamin B12 also provides for increased mechanistic plausibility of the condition.  The micronutrient supplementation will also reduce the course of dementia meaning the nutritional supplements and diet will see a reduction of conditions associated with dementia. 

2.2 Mental Stimulation

It is the role of the practising nurse to encourage mental stimulation among patients with dementia since they will work with an inter-professional team to take good care of their patients within 24 hours. In most cases, the nurse is going to deliver holistic car with the support of the care team. This means that they are going to be engaged fully in ensuring the patient’s performance of daily activities that provides the person within their mental situation.  This is very relevant as it ensures the development of thoughts in the patient’s mind and ensure that their health is well coordinated.

This is very important in ensuring that the patient develops positive thoughts as this will also promote the patient’s wellbeing. In most cases, older patients with dementia will look on themselves as the obstruction because of the reduction of their physical activities and socialization.  In most cases they will be aware of their limitations and independence capabilities when it comes to the management of their lives. In this manner, the nurses are going to provide the required tender care so as to increase their initial capacities of the individual.  The patient is also going to be highly involved in the decision making process with is very important is it improves the stimulation of the individual’s mind. For the elder patient the formative phase of dementia will entail a lot of confusion and loss of memory, fall in the attention span and confusion.   It is important that that the mental activity of the brain is constantly stimulated calling for the efforts to remain alert. Also this type of alertness is important as it will help in the reduction and the onset of mental collapse and dementia.  It is important that the nurses take a holistic assessment to the individual as this will make the take the right dimension towards their lifestyle.  The nurse is also going to provide a constant evaluation on the patient’s mental limitations and capabilities, including his functional abilities.  There are also cases where the physician and the families of the patient would want to look at the minor impairments as part of aging.  This is not good since medical interventions may be ignored in the process.  It is therefore important to ensure that the nursing assessment comes as one of the major elements in the strategy for prevention especially among the affected patients. 

2.3 Importance of Socialization

Patients suffering from dementia are most likely to be isolated because of their limited social interaction. This usually is because of the loss of memory which reduces the patient’s cognitive ability. In any case the daily socialization will be required in the prevention of the feeling of isolation which shows that it is required to help prevent the experience of the old age individuals.  The nurse should ensure that the patient’s liveliness is maintained. When the patient has a feeling of being caught by others in the course of the social interaction, it will look at them not being equipped cognitively.  They mostly avoid social activities and consider this to be a distasteful experience.  This also leads to the loss of the patient’s self-esteem. The elderly patient will also consider the issue of social inclusion as part of the heighten rental abilities, so most of them will be insecure and become secluded in a social environment. 

2.4 Nursing Care and relevance

The issue of nursing is very important when it comes to management of people with dementia, this is because nursing care ensures the adoption of special attention provided in different dimensions of the patient health; the social, physical, emotional and mental.  The nurse is a very important person in providing care since they will provide the patient with a much more dignified and long duration care during the periods of intensive care.  They are also going to be instrumental when it comes to developing the right therapeutic relationship achieved under intimate care for the patients. In most case the nurse should be trained in evidence base care, as this is relevant in providing the patient with optimal outcomes. The nurse is also important in providing the patient with quality care due to the fact that the affected person is going to ensure they have the cognitive ability which will help them maintain the quality of life for a longer period. 

Also when looking at the role of nurses in care for people with dementia is a lot. In most cases related to individuals with dementia, the main challenge comes to  being taken care of by the family members at home, this is difficult, thus nurses often come in handy and play the role of family based care and coordination.  The nurse will be given the obligation to ensure that care for the patient in a home based setting in regard to the affordable medical service. Among the things that will be required by the nurses will be to participate in the supply of proper treatment and medication in regard to the orders given by the physician. The other areas of concern for the nurses will be to come up with a positive environment in which   the patients are going to be understood in the right way based on the impaired cognitive abilities or disabilities.  The nurses will also be responsible in ensure that there is an effective communication with the patient and other physicians so that there will be an appropriate type of care for the patient. 

Apart from this, nurses are also responsible when it comes to providing the patient with the required form of education to the patient and the caregivers. This is because the nurse is able to identify the needs and come up with the right plan that can provide the patient with the right form of assistance with other medical experts like the physiotherapists, occupational therapists and the social workers.  In this regard, it is important to note that most nurses have a very important role when it comes to the prevention and care of patients with dementia. 

It is important to appreciate that dementia is an incurable condition, meaning that the patient’s lifestyle factors are also a major aspect to the progression of the condition. However with the right interventions by the nurse, the development of such risk factors is going to delay. Other lifestyle habits like smoking, increase in the patient’s cholesterol levels and hypertension are also some of the things that the nurse can intervene by educating the patient and the family to ensure that there is adoption of the right lifestyle. This should be assured in patient through a proper care plan that leads to the right solutions. The nurse ensures that the patient is provided with the right diet and nutritional guidance, recommendations and weight control in regard to daily activities, including assurance of a daily check-up. There are also other major aspects of dementia care like the early diagnosis which is very important when it comes to the prolonged and deterioration of the condition to ensure that there is an optimized form of prognosis.

Also when it comes to the coordination of different medical professionals, this should be done in an adequate manner to assure the care in different circumstances. The identified pre-requisites will also provide the care giver with the chance to implement a much more advanced care plan for a patient suffering from dementia.  The plan for care is often suboptimal when compared to other chronic conditions like cancer. The situation in caring for a person with dementia especially when there is the aspect of hospitalization, uncontrolled pain and the reduced interference of palliative care is also an issue to look in to.  The patient suffering from dementia will always look at the comorbidities, and the obvious co-mobidity which will affect the patient that has significantly undergone the aspect of dementia. 

BUY CUSTOM NURSING DISSERTATION PAPER FROM EXPERTS NURSING WRITERS

Also when looking at the quality of life for dementia patients, they are usually very unsatisfied due to the challenge of communication between the staff and the families. This is because dementia will not only affect their quality of life, but it will also affect the relatives that take care of these patients. In any case there are three main areas to cater for patients suffering from dementia, this is within their own dwellings, care homes and the hospital care.  The hospital care is the one that provides the patients with both the private and public health systems. During the early stages of dementia, it is common to see the family members always being the initial caregivers. The process is often very sensitive to ensure that the condition does not progress. As the disease continues to progress in the patient, the body will also experience other organic changes that should be care for in special care places like the hospital.  It is also very important that one utilizes medicine as an option for relieving some controlled symptoms.  In most cases, there healthcare systems will try their best to ensure the patient is well cared for and improve the overall ability that will ensure there is maximum care standards, this is because this is a long term condition that cannot be cured currently. However this should be controlled when the right medication and different forms of therapy are applied. The condition of the patient’s health will definitely affect their lives. The major aspect of nursing care will also depend on the patient status. There are many ways that the patient can be catered for as the disease develops of which recommendations are established as a manner of treating dementia patients. Even though the medical interventions may not cure the condition permanently, it is very important during the treatment and care. It also help in fighting longer hospitalization that can lead to a lot of treatment costs with is a very huge challenge for the patients  in the care situation and medical treatment can ensure hospital stay is reduced. 

2.5 Benefits of physical activities for older persons with dementia

As discussed above, there is currently no permanent cure for dementia, however several studies are still being conducted to ensure that current drugs are developed, vaccines and other forms of medical treatment are available at an affordable amount.  However, medical treatments are not the only way available for the treatment and the management of dementia symptoms or help in the slowing down of the process especially for older patients.  In this regard, there are a number of non-drug treatment methods available which help people living with dementia to live a normal life and ensure an improved quality of life.  Such methods include support, recreational activities and therapies. This will be important in keeping the mind of these patients active and allow them to cope better with the effects of dementia.  The care and support for dementia patients’ needs to also be focussed on the individual and the need and preference as is required to be, ‘person centered’.  The activities of the patient with dementia is going to be very useful  when they are able to feel pleasure and involved, a matter  of belonging and connection  and a sense of identity or autonomy. 

These activities related to the patient’s social, physical and mental are the most important aspects of the human being.  In most cases the activities might also contain more than one element which will eventually be beneficial than being engaged in only one type of activity.  When the patients are engaged in activities, it can provide them with the positive impacts on the patient with dementia.  When they are engaged in activities will see an increase in the interests, measured happiness and alertness and a reduction in regard to boredom. 

According to various studies on dementia, recreation activities are defined as the voluntary use of free time for the activities in regard the daily routine. Patients with dementia also show a low rate of participation of activities due to the lack of physical activities and cognitive activities to ensure more engagement.  The recreational activities are also going to help with boosting the quality of life by providing the right amount of stimulation through various meaningful activities. 

The participation and engagement of patients living with dementia in a group or single activity is a very important technique in supporting the patients independent, bring a sense of accomplishment for the individual. The physical activities program is usually a challenge for patients with dementia, since their ability to sustain the activity is often limited because of their pathological changes that entail cognitive impairments. Physical activities do not only met the patient’s interests but will also meet their mental, physical and psycho-social needs.  The physical activities are very important in ensuring that the patient with dementia is able to live well and have an improve quality of life.  It also helps in the improvement of the patient’s mood, mental abilities and wellness.  One example is when looking at the progress of the condition, through physical activities the patient is able to reminisce over some issues. Among the meaningful activities will look at singing, music and art. This is very important especially among individuals with dementia, since it helps the individual to remain active, mentally, physically and socially.  It is also a researched area that exercise, diet and participation in various activities provide positive impacts to the patient memory and processing of information functions.  This means that recreational activities thus need to be more focussed on the patient interest and other specific needs for the stimulation, movement, relaxation and social experiences. Also for the patient to come with different meaningful physical activities, they will be required to access the physical limitation of each client including the cognitive function that ensures the skills level of the client is highly utilized. In respect to the patient assesment by the nurse, the physical activities will be modified so as to meet the interests of the patient and will be adapted in a manner that is going to provide the right outcomes for the patient.  Because dementia is a disorder that progresses with time it eventually limits the individual ability to participate in different activities, however this will not mean that the said activities are not going to be modified in regard to those activities.  In most cases, the steps taken in this process is based on adaptation abilities of the individual. 

The most important thing is to have meaningful activities that produce a positive impact on the cognitive abilities for the patient suffering from dementia. It is important to ensure that such physical activities are designed in a manner that provide the patient with an opportunity to be happy, stay in control and lead a meaningful life.  It also has a very important aspect in ensuring that the individual is supported in other physical abilities.  It is also very important to ensure that the person living with dementia continues to be proud of who they are through participating in activities that provide meaning to them and not the caregiver or the doctors.  This means that there needs to be a sense for which activities will have to be tailored to the individual interests and preferences, instead of people having to be offered to conduct activities at no extra effort to the participant.  In most cases, physical exercise will eventually provide the individual with a more frequent, and intense wellbeing during the different activities. Some of the most common include, creative activities, non-creative activities and music therapies.  This thesis is going to focus on music therapies and look at the impact.
References

Chen, Y., & Pei, Y. (2018). Musical dual-task training in patients with mild-to-moderate dementia: a randomized controlled trial. Neuropsychiatric Disease and Treatment, Volume 14, 1381-1393. doi:10.2147/ndt.s159174

Christie, G. J., Hamilton, T., Manor, B. D., Farb, N. A., Farzan, F., Sixsmith, A., Moreno, S. (2017). Do Lifestyle Activities Protect Against Cognitive Decline in Aging? A Review. Frontiers in Aging Neuroscience, 9. doi:10.3389/fnagi.2017.00381

Kayes, M. K., & Hatfield, B. D. (2019). The Influence of Physical Activity on Brain Aging and Cognition: The Role of Cognitive Reserve, Thresholds for Decline, Genetic Influence, and the Investment Hypothesis. Lifestyle Medicine, 1251-1269. Doi: 10.1201/9781315201108-112

Klimova, B., Valis, M., & Kuca, K. (2017). Cognitive decline in normal aging and its prevention: a review on non-pharmacological lifestyle strategies. Clinical Interventions in Aging, Volume 12, 903-910. doi:10.2147/cia.s132963

Leon, A. S. (2019). Aging-Associated Cognitive Decline and its Attenuation by Lifestyle. Lifestyle Medicine, 1141-1146. Doi: 10.1201/9781315201108-99

Miendlarzewska, E. A., & Trost, W. J. (2014). How musical training affects cognitive development: rhythm, reward, and other modulating variables. Frontiers in Neuroscience, 7. doi:10.3389/fnins.2013.00279

Slattery, C. F., Agustus, J. L., Paterson, R. W., McCallion, O., Foulkes, A. J., Macpherson, K., … Warren, J. D. (2019). The functional neuroanatomy of musical memory in Alzheimer's disease. Cortex, 115, 357-370. doi:10.1016/j.cortex.2019.02.003

Sleimen-Malkoun, R., Temprado, J., & Hong, S. L. (2014). Aging induced loss of complexity and dedifferentiation: consequences for coordination dynamics within and between the brain, muscular, and behavioral levels. Frontiers in Aging Neuroscience, 6. doi:10.3389/fnagi.2014.00140

Särkämö, T., Laitinen, S., Numminen, A., Kurki, M., Johnson, J., & Rantanen, P. (2017). COGNITIVE, EMOTIONAL, AND SOCIAL BENEFITS OF REGULAR MUSICAL ACTIVITIES IN EARLY DEMENTIA. Alzheimer's & Dementia, 13(7), P1209-P1210. doi:10.1016/j.jalz.2017.07.373

Van der Steen, J. T., Smaling, H. J., Van der Wouden, J. C., Bruinsma, M. S., Scholten, R. J., & Vink, A. C. (2018). Music-based therapeutic interventions for people with dementia. Cochrane Database of Systematic Reviews.