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Intergenerational Program Benefits for People Living with Dementia
Worldwide, Approximately 50 million people are living with dementia (World Health Organization, 2018) and currently, 5.7 million in the United States are living with dementia (Alzheimer's Association, 2018). Due to life expectancy increasing, the number of individuals diagnosed with dementia is on the rise and questions of how to appropriately and successfully meet the needs of people living with dementia is of concern. Intergenerational programs have been researched on the effectiveness of such programs, that allow older adults to engage in meaningful activities with both younger adults and children.
Characteristics of dementia make it challenging to discover successful and appropriate activities for people living with dementia. Review of literature highlights emerging benefits of intergenerational programs for PLWD. These include a): relationships and engagement, b) sense of self, and c) mood and behavior.
Alzheimer's disease is the sixth leading cause of death and is the most common type of dementia (National Institutes of Health, 2016). According to the World Health Organization, approximately 50 million people are living with dementia in the world (World Health Organization, 2018).
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Currently, in the United States, 5.7 million people are living with Alzheimer's or other related dementias (Alzheimer's Association, 2018). By 2050, this number is predicted to escalate to nearly 14 million (Alzheimer's Association, 2018). Dementia, not a normal part of aging. It affects cognitive abilities and eventually makes everyday activities hard to perform. With the projected growth rate of PLWD, it is important to meet their changing needs. PLWD experience negative impacts in memory, communication, judgement, and behavior that ultimately affect the emotional, physical, and social aspects of their lives (Galbraith, Larkin, & Moorhouse, 2015).
Due to these changes, assistance with activities of daily living and instrumental activities of daily living are needed (Galbraith et al., 2015). Also, PLWD often face challenges in their "sense of self, perceived capabilities, and self-determination" (Galbraith et al., 2015, pg. 358). A need for relationships and familiarity, when it comes to the constant changes of PLWD, is imperative. To compensate for these losses and build meaningful interactions, intergenerational programs in health care facilities are a growing topic. Weintraub and Killian (2007) suggested that intergenerational programming offers potential benefits for PLWD (Weintraub & Killian, 2007). Providing intergenerational programs allows older adults to be included in an environment where both children and young adults can interact with PLWD (Galbraith et al., 2015). These factors have led to a review in the positive outcomes that intergenerational activities and programs offer for PLWD. A review of the literature finds that, intergenerational programs for PLWD enhance three important aspects of well-being: relationships and engagement, sense of self, and mood and behavior.
PLWD are less likely to socially interact (Sterns, A., Sterns, H., Sterns, R., & Lax, 2011), potentially causing relationship barriers and inactivity. There is a greater need for socially engaging opportunities for PLWD due to behaviors stemming from loneliness and boredom (Sterns et al., 2011). PLWD may experience such emotions for reasons like outliving family and friends, cognitive declines causing communication barriers, not being at home, and confusion. Relationships are critical in forming meaningful and engaged opportunities for PLWD (Galbraith et al., 2015). Meaningful interactions and activities include stimulation in many areas like attention, memory, communication, autonomy, movement, and decision making that all decrease aggressive behaviors (Sterns et al., 2011), thus, potentially opening relationship barriers for PLWD.
Intergenerational interactions have shown both positive relationships and engagement due to the implementation of programs (Gigliotti, Morris, Smock, Jarrot, & Graham, 2005; Galbraith, et al., 2015; Brooker, Woolley, & Lee, 2007; Sterns et al., 2011; & Weintraub and Killian, 2007). Brooker et al. (2007), mentioned a significant increase in well-being due to being engaged in activities, especially those in lower cognitive abilities (Brooker et al., 2007). Four programs reported an increase in interaction and group participation (Gigliotti et al., 2005; Galbraith et al., 2015; Brooker et al., 2007; & Sterns et al., 2011). Sterns et al (2011), attained participant responses that were categorized into three common responses: promoted interaction and group involvement, stimulated memories, and was enjoyable and fun. Participants showed more engagement compared to regular activities and participants that normally would not engage in regular activities, joined in. Relationships between staff and residents were also much more positive, due to training from the program (Sterns et al., 2011) As a result of another program, the relationships between PLWD and children, were described as strong and special relationships and they would look for each other at the program (Galbraith et al., 2005). A scoping review on intergenerational activities and PLWD reported many articles citing behaviors that reflected social engagement such as smiling, laughing, physical contact, and eye contact. Also, nine articles that were reported in the review, found social engagement was stronger between PLWD and children. PLWD were much more attentive and wanting to support them. (Galbraith et al., 2015) These results of positive interactions and engagement from intergenerational programs, including reduced amounts of stress amongst PLWD and staff, can potentially bridge relationship barriers.
PLWD that do not engage in meaningful activities may feel they are not valued or even feel a lack of purpose. Galbraith et al. (2015), mentions that a person's sense of self is directly associated with relationships and engagement (Galbraith et al, 2015), meaning that if social isolation occurs, one's personal identity can feel lost. Declines that impact their self-confidence and self-esteem may cause PLWD to feel disconnected in themselves and the world around them (Galbraith et al., 2015). It is important when engaging in activities that person-centered care is involved. Person-centered care creates an important connection for PLWD so that they may feel accepted, a sense of purpose, and joy. When psychological needs are met using person-centered care, well-being improves (Nyman & Szymczynska, 2016).
Nyman & Szymczynska (2016) assessed the connection between meaningful activities and the psychological need being addressed, and the well-being of PLWD. Meaningful activities that consisted of life review therapy or life story work results in the development of wisdom, sense of meaning and order, opposed to a sense of despair or disgust (Nyman & Szymczynska, 2016). PLWD need time to reflect on life so they can make meaning out of it instead of developing a sense of despair. Through activities, it allows them to engage in the process and share. Spiritual or religious activities results in the development of purpose or place in the world and acceptance of death (Nyman & Szymczynska, 2016). Intergenerational activities result in the development of caring for others, opposed to focusing on oneself and losing a sense of purpose. These activities serve the purpose of altruism. Engaging in leisure activities like dancing, singing, and reading results in control and deep value in one's life. Lastly, engaging in new activities results in creativity (Nyman & Szymczynska, 2016). By understanding and addressing these needs through intergenerational programs, a greater sense of self and purpose in one's life can be met.
Galbraith et al. (2005) mentioned six articles that reported that PLWD, participating in intergenerational programs, had an increase in sense of self, self-confidence, and self-esteem. They also found that PLWD enjoyed teaching children. A participant responded that they felt needed when the children were around. Due to the relationships formed from this program, sense of self and quality of life increased for both groups (Galbraith et al, 2005). Another intergenerational program reported acceptance from everyone that participated (Gigliotti et al., 2005). These interactions provide opportunities for generativity. By contributing to the programs and feeling accepted meets these needs rather than feeling a lack of purpose in one's life. Appropriate innovation and development of activities in intergenerational programs, that are person centered, successfully increases sense of self among PLWD.
Due to declines in functioning, emotional wellbeing is important to address when discussing PLWD's quality of life. Creating a meaningful and purposeful environment requires the understanding and knowledge about what specific factors need addressed for PLWD. PLWD experience changes in mood, personality, and behaviors that all disrupt their emotional wellbeing, causing them to be more vulnerable to depression (Sterns et al., 2011). Sterns et al. also notes that PLWD are less likely to socially interact (Sterns et al., 2011), making relationships, engagement, mood, and behaviors a challenge. Becoming aware of these changes that a PLWD experiences can better help the emotional well-being of PLWD. It can a be struggle for PLWD to maintain a good sense of self along with the emotional challenges that occur. Therefore, it is imperative that we meet the changing needs of PLWD. Intergenerational programs combat these negative changes to increase the emotional well-being for PLWD.
Intergenerational programs were mentioned in multiple articles that increased mood and decreased negative behaviors in PLWD (Galbraith et al., 2015; Brooker et al., 2007; ) Galbraith et al. (2015) reported on studies that found, increases in joy, mood, pleasure, and decreases in anxiety among PLWD that participated in intergenerational activities. Also, behavior was cited in the articles, found by Galbraith et al., as positive behavioral outcomes due to intergenerational programs and even more so when children were present. One article reported more positive behaviors occurred in moderate to severe PLWD compared mild to moderate dementia. Decreases in agitation and aggressive behaviors were also reported (Galbraith et al., 2015). One program reported levels of depression remarkably dropping due to the program implementation, but no changes in anxiety levels (Brooker et al., 2007). Much like the scoping review mentioned in relationships and engagement about many articles citing behaviors that reflected social engagement such as smiling, laughing, physical contact, and eye contact, can also reflect on the mood they were in and the use of positive behaviors (Galbraith et al., 2015). Weintraub and Killian (2007) obtained participant's perceptions of the emotional impact of intergenerational programming that resulted in positive responses. Important aspects of emotional well-being that the participants felt were most impactful were emotional support from peers and staff, able to choose their own level of involvement, and given respect from the children. Responses also included enjoyment from being around children, feelings of being needed, and felt calm and relaxed (Weintraub & Killian, 2007). One participant responded that she really got enjoyment out of seeing the children, their expressions, and the children were a true joy to older adults. Another participant mentioned how their presence felt valued and helpful towards the children (Weintraub and Killian, 2007). It is important to note that while Weintraub and Killian's (2007) participants were not living with dementia. However, the emotional well-being that is enhanced due to intergenerational programs, can meet the same effect for PLWD when certain characteristics of PLWD are met. By reinforcing emotional well-being, opportunities for negative moods and behaviors to occur, decrease. A study on an intergenerational program's effect on behaviors in PLWD found that positive behaviors occurred more during implementation of intergenerational programs compared to when no intergenerational program was implemented (Jarrott& Bruno, 2003). This study also included the negative behaviors stemmed more from the exclusion of person-centered care found when non- intergenerational program observations occurred (Jarrott & Bruno, 2003), thus stressing the importance of person-centered care in intergenerational programs for PLWD. When the emotional needs are met for PLWD, overall well-being appears to increase while negative behaviors decrease.
Intergenerational programs, often a successful activity for PLWD, especially (Low, Russel, McDonald, & Kauffman, 2015; Jarrott & Bruno, 2003; Brooker et al., 2007; Galbraith et al., 2015; Gigliotti et al., 2005; Nyman & Szymczynska, 2016; Sterns et al., 2011; & Weintraub & Killian, 2007) It was noted in one study that PLWD are more likely to experience such benefits if they have opportunities to participate frequently and regularly (Jarrott & Bruno, 2003) Programs that are not implemented well, may cause problems for these opportunities to occur. The majority of the articles cited, identified different problems within the program despite the benefits recorded. A few downfalls in the programs included: methodological challenges, recruitment, design, and training (Brooker et al., 2007; Galbraith et al., 2015; Gigliotti et al., 2005; Jarrott & Bruno, 2003; Nyman & Szymczynska, 2016; Sterns et al., 2011; & Weintraub & Killian, 2007) While these challenges were addressed, it suggests further research in intergenerational programs for PLWD. First and foremost, it is important to understand dementia and the continuous changes PLWD may experience. Becoming aware will not only increase relationships with PLWD but will contribute to the knowledge gap in the dementia community. Also, by addressing what it is missing will create better programs for PLWD. Through review, successful intergenerational programs have an overall impact on one or more areas of wellbeing and quality of life (Brooker et al., 2007; Galbraith et al., 2015; Gigliotti et al., 2005; Jarrott & Bruno, 2003; Nyman & Szymczynska, 2016; Sterns et al., 2011; & Weintraub & Killian, 2007). By bringing together successful programs and meeting the needs of PLWD, intergenerational programs can be beneficial for PLWD. Relationships and engagement, sense of self, and mood and behavior, all important aspects of well-being, were found to increase among PLWD, that participate in intergenerational programs (Brooker et al., 2007; Galbraith et al., 2015; Gigliotti et al., 2005; Jarrott & Bruno, 2003; Nyman & Szymczynska, 2016; Sterns et al., 2011; & Weintraub & Killian, 2007).
People Living with Dementia. (2019, Dec 03). Retrieved from https://studymoose.com/people-living-with-dementia-essay
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