Alzheimer’s patients find purpose

Experts: Meaningful work helps prevent depression in people with dementia

By Mac McLean / The Bulletin / @agingbeat

Depression and Alzheimer’s disease

A 1997 study conducted by Johns Hopkins University’s School of Medicine found 27 percent of the people who have Alzheimer’s disease routinely suffer from minor depressive symptoms and 22 percent routinely suffer from major depressive symptoms.

It also found people who have major depressive symptoms are more likely to experience certain problems associated with having Alzheimer’s disease than anyone else, including:

Aggression and disruptive behaviors: 8.8 percent of the people who had major depressive symptoms exhibited anger or another depressive behavior compared with 2.9 percent of the people who had no depressive symptoms and 5.7 percent who had minor ones.

Falls and accidents: 17 percent of the people who had major depression fell or experienced an accident compared with 14 percent of the people who had no depressive symptoms and 10 percent who had minor ones.

Physical dependency: 13.3 percent of the people who had major depressive symptoms had problems performing their activities of daily living compared with 6.5 percent of the people who experienced no depressive symptoms and 5.9 percent of the people with minor ones.

Wandering: 26 percent of the people who had major depressive symptoms wandered off from their homes or rooms compared with 4 percent of the people who had no depressive symptoms and 21 percent of the people who experienced minor ones.

Source: “Major and Minor Depression in Alzheimer’s Disease: Prevalence and Impact” published in The Journal of Neuropsychiatry and Clinical Neurosciences

Berney Cunningham found a large black trash bag full of cans and plastic bottles sitting just outside his front door when he walked out of his room at the Mt. Bachelor Memory Care Center late Tuesday morning.

“It’s been good,” the 72-year-old said as he loaded the bag of cans into a cardboard box that was covered with wrapping paper the southwest Bend facility had left over from its Christmas party. “(I tell people) just bring the cans here and we’ll add them to the piles.”

Cunningham has spent five months collecting soft drink cans and other recyclable materials from the memory care center’s residents, staff members, friends and family members as part of an effort to raise money for the Equine Outreach horse rescue group.

So far, he’s raised more than $135 by turning these items in for their 5-cent deposit. Mt. Bachelor administrators said they expect that amount to keep growing until Cunningham presents Equine Outreach with the money on Help a Horse Day on April 26.

But what’s more important than the amount of money raised — or the fact it came in one nickel at a time — is the fact that, according to some Alzheimer’s experts, the project has given Cunningham an opportunity to do “meaningful work” and stay connected to his community.

Mt. Bachelor’s administrators say these two activities, which they try to incorporate in the lives of each of the facility’s 51 residents, have kept Cunningham from developing depression and helped him fight back a condition he has had for more than two years.

“It’s very encouraging,” said Erica Psaltis, the memory care center’s activities director.

The disease

More than 5.2 million Americans have Alzheimer’s disease, according to the Alzheimer’s Association’s 2014 Facts and Figures Report.

The association expects this number will more than triple over the coming decades — it’s expected that 16 million people will have Alzheimer’s disease by 2050 — as the country’s 79.6 million baby boomers age.

During the disease’s early stages, people start to suffer memory lapses where they may forget familiar words or the location of certain objects. The disease gets progressively worse and eventually the person can no longer carry on a conversation, perform certain activities most people take for granted, or control their movements. A recent study published by the American Academy of Neurology linked Alzheimer’s disease to 503,400 deaths in 2010, making it the country’s third-leading cause of death after heart disease and cancer.

Without going too much into his medical history, Psaltis said Cunningham’s disease reached a point where it made him nonverbal — unable to speak with coherent sentences — when Mt. Bachelor’s assessment team met with him before he moved into the facility this summer.

Cunningham’s cognitive abilities started improving almost immediately after that, she said, and while he may not be the best of conversationalists now, it’s safe to say that Cunningham can speak a few coherent sentences and follows what other people are saying.

Psaltis said these improvements have a lot to do with the time Cunningham spent working with Equine Outreach’s horses.

Every now and then, Mt. Bachelor sends its residents to the horse rescue group’s facility in Northeast Bend so they can feed the animals, clean their pens and brush their manes. Psaltis said Cunningham took to the horses almost immediately and quickly gained a reputation for being one of the facility’s biggest horse lovers and one of its hardest working volunteers.

Psaltis said Mt. Bachelor tries to make sure each of the memory care center’s residents has some type of job or work to do. She said most people are conditioned to working at least eight hours a day, and losing this work can be devastating for a person, regardless of his or her cognitive abilities, if they don’t have something to take its place and keep their minds active.

“People have to have a reason to get out of bed every day,” said Shelly Edwards, outreach and program director for the Alzheimer’s Association’s Oregon Chapter. “If they don’t and things stay that way for a long time, then depression can set in.”

Edwards said recent studies have shown that about half of the people who have Alzheimer’s disease also suffer from depression, which can make the condition worse and interfere with a patient’s ability to deal with its progression (see “Depression and Alzheimer’s disease”).

That’s why it’s important to make sure patients have something they can do to keep busy.

“Giving somebody a purpose is really important,” Edwards said. “It helps them feel worthy and worthwhile.”

The cans

Psaltis remembers one afternoon in October when Cunningham walked into her office with an empty drink can and placed it on her desk.

“He said, ‘I wanted to give this money to Equine Outreach,’” she recalls as she talked about how Cunningham started his can-collecting project.

Psaltis said Cunningham was working at Equine Outreach the previous afternoon and overheard some volunteers talking about how they were able to make money by collecting cans. She said Cunningham was probably thinking about this conversation when he finished his drink and wanted to make sure Equine Outreach got the can’s deposit fee. He asked one of Mt. Bachelor’s staff members to escort him through a locked door to Psaltis’ office so he could personally bring her the can.

But rather than simply take the can from him, Psaltis decided to turn Cunningham’s initial inspiration into a long-term project.

She helped him make boxes where people could put their cans, hang signs up in the facility’s hallways and next to its vending machines reminding people to put their cans away, and even helped him write a letter to run in the facility’s newsletter explaining his project and why he wanted to help Equine Outreach.

“Berney (Cunningham) is like the can police around here,” said Psaltis, who has seen Cunningham reminding people to turn in their empty container before they’ve even had a chance to open it.

As word of the project spread through the facility, Psaltis said a lot of Mt. Bachelor’s staff members started bringing their own cans from home to help Cunningham raise money for Equine Outreach. She said a few private businesses — including the Beer Dawgs growler fill station in Redmond — have also joined in the effort.

“This sounds like a pretty good thing for (Cunningham) right now,” said Edwards with the Alzheimer’s Association.

Though she hasn’t heard any stories involving people who collect cans for charity, Edwards said she’s heard several stories about memory care centers that give their residents jobs as part of a plan to keep them active and avoid depression.

She said some places will match people who used to have pets with groups that work with animals. She also knows of one facility that left dust rags sitting around its common areas so that women who used to be housewives could dust and do light cleaning work. In addition to keeping the residents occupied, Edwards said these activities helped them maintain a connection to the person they were before their symptoms set in. The work also gave them a chance to socialize and kept them connected to their community as a whole.

“That’s a big part of what we do here,” Psaltis said, explaining that Mt. Bachelor has tried to incorporate these two characteristics into every activity the facility has offered since it opened its doors this past spring.

Psaltis said Mt. Bachelor’s residents have had a chance to foster kittens for the BrightSide Animal Shelter and routinely get visited by a deaf dog that can understand only commands that are given through hand signals.

They are building incubators to help members of a local 4-H Club raise baby chicks and will spend this weekend delivering hand-made Easter baskets to children who are staying at St. Charles Bend.

The residents also make soap, she said, that they’ve given to their friends and family members during the holidays and will be giving to Equine Outreach’s volunteers as a thank-you gift on Help a Horse Day.

“I have 400 pieces of that in my office,” Psaltis said, hinting that this was her favorite resident activity. “It smells really nice.”

— Reporter: 541-617-7816, mmclean@bendbulletin.com