ONLINE MEDIA PARTNER for World Alzheimer's Awareness Day / Month 2013 Mumbai Events

Thursday, April 28, 2011

How to Reduce Wandering in People with Alzheimer’s

Wandering is a common but dangerous symptom of Alzheimer’s disease — a degenerative disease of the brain that affects memory and cognition.

Alzheimer’s patients may suddenly walk off and become lost, frightened and confused about where they are, and many do not even know where they are trying to go. Since many of these people can’t identify themselves or where they live, wandering in unconfined and unsecured areas can be very dangerous.

Disorientation, medication, stress, fear or anxiety, and restlessness may all cause an Alzheimer’s patient to wander.

To keep patients safe and minimize wandering, the Alzheimer’s Association of Los Angeles offers these suggestions:
  • Make sure the patient is always comfortable and doesn’t need to use the restroom and isn’t hungry or thirsty.
  • Try to make sure he receives regular exercise and activity to reduce restlessness and boredom. If he is still capable, let the patient help with daily chores like laundry or light cooking or housekeeping.
  • Tell the person often that you are there to help him, and make sure he understands he doesn’t need to be anywhere but right where he is.
  • Keep the environment quiet and relaxing — avoid noise and confusion that may frighten the patient into trying to scamper away.
  • If possible, keep doors locked and secured to prevent wandering into the street and getting lost.
  • Devise a plan of action in the event the patient does become lost — keep current information on hand, like height and weight, and a recent photograph. Also, keep a list of places where the person has wandered previously, or places he used to frequent that he may be trying to find. 
By Diana Kohnle

Source : 

Friday, April 22, 2011

‘Alzheimer's will be on the rise in India'

With the number of elderly people in the country expected to be 9 crore in the Census 2011 report, the government has to recognise that diseases of the elderly is going to be a very important public health problem in India, said Dr. K. Jacob Roy, who was recently elected chairman of Alzheimer's Disease International (ADI).

In an exclusive interview with Shyama Rajagopal, Dr. Roy, who founded the Alzheimer's and Related Disorders Society of India (ARDSI), spoke about conditions of the elderly in the country and specifically about Alzheimer's disease, a complex and frightening disease that is affecting a lot of elderly. He will take on the mantle of ADI chairman for three years in 2012 at the organisation's London meeting.

What is this public health problem?
In 20 years, the number of elderly is going to double which would make India the country with the largest number of elderly in the world.

In that context, the medical problems of a large group would create a public health problem in the country. Since age is the single most risk factor of the disease, and when we have segment of people over 80 growing because of better health care and nutrition, conditions like Alzheimer's will also be on the rise.

What is the extent of the disease?
The prevalence of the disease [in India] is said to be one in 20 for people over 60 years, and one in 5 for people over 80 years. There are about 3.7 crore people affected by the disease, and the cost of treating the disease is pegged at Rs. 14,700 crore.
This is going to treble in the next 20 years as the number of affected is going to double and become 7.6 crore.

So unless we plan now there is going to be a catastrophe. Families are becoming nuclear… and if someone in our family gets dementia, who's going to take care of the person?

How is ARDSI tackling this problem?
ARDSI has come out with a Dementia India report last year — an effort of two years by experts.
When we have to convince the medical community, you need to have scientific data. The developed countries were using their country-specific report to make the Government device policies for supporting the elderly.

It is a scientific authoritative report on dementia and it contains all the statistics you need, like what the disease is all about, the number of people affected, types of dementia, cost of care per person and many more.

This report will be used to influence the Governments, both the Centre and State to recognize dementia as a health priority and include it in the national agenda. If any significant change has to happen, the Government has to accept it and make it a health priority. As the national chairman of ARDSI, the campaign is for the support.

What are the measures adopted in creating facilities for Alzheimer's disease patients?
The facilities that ARDSI is providing in taking care of patients with dementia are on par with what is happening elsewhere in the developed world.

Because we are a developing country, we should not dilute standards. Ideas were taken from the West, but are implemented taking care of our cultural ethos. So far 14 chapters of ARDSI have been started across India. Ten new places have also been identified. We have already started one in Pune. Nagpur, Varanasi, Lucknow, Manipur and Srinagar are among those we will be starting soon. We are going to raise this issue in Parliament and to get Ministry of Health and Social Welfare to fund the programmes.

We need to provide more services for which Governmental support and recognition is necessary. Help to set up memory clinics in all districts, to improve diagnosis, more services like day care, home care, 24-hour residential care, information centre, training programme for doctors and more research programmes are the kind of things for which we want support from the Government.

What kind of work does ADI do?
ADI is not a medical organization, but it has individuals from medical fraternity as well as social organisations. It is an umbrella organisation for societies formed by care givers of patients. I have been part of the ADI for a long time as it was a personal experience of my father being affected by it that led me to search for what could be done.

As the chairman, the agenda will be to extend the reach of ADI where there is hardly anything happening like in Asian and African countries. The first step will be to engage world governments to recognise dementia and to encourage societies to bring out country-specific reports.

What kind of work has ARDSI done?
We started the first ARDSI chapter in Kerala as a result of the Kochi conference in 1998, the first such meeting of ADI that was held outside a developed country. It resulted in forming a group dedicated to research — primarily to developing research and epidemiological studies where hardly any work was done. ADI helped improve the scenario in research in the country from where very little data was coming in.

It also led to the formation of the Asia-specific regional group of ADI and India was the first to join in. I had been associated with ADI as the vice chairman and was also working in the elected board of ADI. The headquarters of ARDSI was shifted from Kunnamkulam (where I'm working in a hospital) in Kerala to New Delhi for better interaction with the governments.

Though awareness programmes on dementia were on for a long time, don't you think films based on the issue helped in reaching out to more people?
The impact of a commercially successful film can never be matched. Obviously it had a profound impact. One Thanmatra (in Malayalam) and one Black (Hindi) is not sufficient.

One needs to continue the efforts. More films and more activities are required to reach out to the people. [Movies should convey] information about what needs to be done for the people affected with dementia, guidelines for caregivers, what should be done and what should not be done.

There should be a change in attitude towards handling the patient.


Silver Inning Foundation Congratulate Dr.Jacob Roy on being appointed as Chairman ADI & is committed to support the cause of Dementia / Alzheimer's . 

Wednesday, April 20, 2011

Dance Therapy for People Suffering from Alzheimer's & Dementia

What is dance therapy?
Music therapy was established in 1950. It is designed to improve physical and emotional health through the use of music, through listening, song writing, performing, exploring lyrics or other activities related to music. Music therapy is most often used as part of stress management programs.

NICE guidelines specify that “people with mild to moderate dementia of all types should be given the opportunity to participate in a structured group cognitive stimulation program.” However, because of uncertainty about cost effectiveness, it remains for the voluntary sector to provide these services.

Dance therapy is the use of movement to improve physical and psychological wellbeing. Sessions deliver either structured dancing technique, such as social dancing with a partner, or a more contemporary approach that uses improvisation to link thoughts with movement. Sessions should be tailored to the severity of the dementia. For example, people with more severe dementia benefit from simpler movements and more caregivers to help. Small class sizes with similarly affected participants facilitate participation. Classes should last about an hour to reduce the risk of the symptoms of Alzheimer’s disease hindering further progress.

Social dancing with a partner is a familiar and enjoyable activity for elderly people and provides quality time for the patient and their partner. It develops procedural learning (long term memory initiated by past experience) and concentration because dancing is a dynamic rather than repetitive physical activity and can “link past memories to the present.” A man who attended Scottish country dancing lessons once a month with his wife, who had Alzheimer’s disease, noted that his wife remembered lots of the steps despite her limited cognitive ability. In one project, participants who danced in a circle felt they had been accepted into, and belonged to, a group. So social dancing offers participants an opportunity to succeed and boost their self esteem.

Projects that focused on free and creative expression have had similar benefits. A weekly project in which 8-10 participants used props and various musical genres encouraged people to move however they wanted, rather than follow a routine. Observations included participants engaging and improvement in mood and relationships among participants and between participants and their caregivers. Building relationships led to an increased sense of self and self esteem. One participant in this study remembered things from her childhood and her personal qualities and thought that she had been “got together again.” This type of dance also allowed emotions such as grief, anger, and loss to be tackled and reflected upon, allowing people to celebrate life again.

Dance awakens memories outside the dance session and helps patients “find themselves” again. A multisensory approach with different sounds, colors, and tangible objects further stimulates engagement and stimulation of participants.

Benefits of dance therapy

Various aspects of a dance session, such as the music, exercise, and social components of dancing, may achieve positive effects. However, vastly varying methods between most studies mean that they fail to agree the most important component. Although a Cochrane review shows that music therapy offers no definite benefits, subsequent research indicates that music can improve autobiographical memory and reduce agitation, anxiety, delusions, and other behavioral symptoms in dementia of any severity.

Exercise slows the progression of cognitive symptoms and is neuro-protective through increasing concentrations of insulin-like growth factor and reducing serum homocysteine. An active mid-life can reduce the risk of Alzheimer’s disease by up to 60% in people with the apolipoprotein E ε4 allele. The positive self esteem and social experience of exercise also improves cognition. However, exercise can be repetitive and there is a degree of “doing it right or wrong,” whereas dance is spontaneous and “always right”; indeed, some propose dance to be the only preventive physical activity. Overall, dance combines all these benefits into an attainable and enjoyable activity for all levels of disability.

According to researchers M. Brotons and S.M. Kroger of the Willamette University Psychology Department in Oregon, in their study on "The Impact of Music Therapy on Language Functioning in Dementia," patients showed statistically significant improvements in speech content and fluency after eight sessions of music therapy combined with conversations.

Other researchers have reported on proven benefits to Alzheimer’s patients derived from music therapy on aspects such as cognitive functions, social skills, and behavior (including reduced agitation and behavioral problems). Music and music therapy are not curative of Alzheimer’s and dementia, but the use of music therapy results in the beneficial effects on dementia and Alzheimer’s symptoms. These benefits lead to an enhanced quality of life for both the patient and his or her caregiver.

Sound of Music

Typically, “stimulating music” activates, while “sedative music” quiets. Stimulating music, with percussive sounds and fairly quick tempos, tends to naturally promote movement, such as toe taps. Look to dance tunes of any era for examples. Slightly stimulating music can assist with activities of daily living: for example, at mealtime to rouse individuals who tend to fall asleep at the table or during bathing to facilitate movement from one room to another.

On the other hand, the characteristics of sedative music—ballads and lullabies—include unaccented beats, no syncopation, slow tempos, and little percussive sound. This is the best choice when preparing for bed or any change in routine that might cause agitation.

Responses that are opposite of those expected can occur and are likely due to a person’s specific associations with the piece or style of music.

Agitation Management

Non-verbal individuals in late dementia often become agitated out of frustration and sensory overload from the inability to process environmental stimuli. Engaging them in singing, rhythm playing, dancing, physical exercise, and other structured music activities can diffuse this behavior and redirect their attention.
For best outcomes, carefully observe an individual’s patterns in order to use music therapies just prior to the time of day when disruptive behaviors usually occur.

 Emotional Closeness

 As dementia progresses, individuals typically lose the ability to share thoughts and gestures of affection with their loved ones. However, they retain their ability to move with the beat until very late in the disease process.
Ambulatory individuals can be easily directed to couple dance, which may evoke hugs, kisses or caresses; those who are no longer walking can follow cues to rhythmically swing their arms. They often allow gentle rocking or patting in beat to the music and may reciprocate with affection.

An alternative to moving or touching is singing, which is associated with safety and security from early life. Any reciprocal engagement provides an opportunity for caregivers and care receivers to connect with one another, even when the disease has deprived them of traditional forms of closeness.

 How-to of music therapy

 Early stages

  • ·         Go out dancing or dance in the house. 
  • ·         Listen to music that the person liked in the past—whether swing or Sinatra or salsa. Recognize that perceptual changes can alter the way individuals with dementia hear music. If they say it sounds horrible, turn it off; it may to them. 
  • ·         Experiment with various types of concerts and venues, giving consideration to endurance and temperament. 
  • ·         Encourage an individual who played an instrument to try it again. 
  • ·         Compile a musical history of favorite recordings, which can be used to help in reminiscence and memory recall.
Early and middle stages

Use song sheets or a karaoke player so the individual can sing along with old-time favorites.

Middle stages

  • ·         Play music or sing as the individual is walking to improve balance or gait. 
  • ·         Use background music to enhance mood. 
  • ·         Opt for relaxing music—a familiar, non-rhythmic song—to reduce sundowning, or behavior problems at nighttime.
Late stages

  • ·         Utilize the music collection of old favorites that you made earlier. 
  • ·         Do sing-alongs, with “When the Saints Go Marching In” or other tunes sung by rote in that person’s generation. 
  • ·         Play soothing music to provide a sense of comfort. 
  • ·         Exercise to music. 
  • ·         Do drumming or other rhythm-based activities.
  • ·         Use facial expressions to communicate feelings when involved in these activities.

Negative aspects of dance therapy

Dance therapy may be effective only during a period of regular sessions. Patients and their families awaiting drug treatment or a “wonder cure” may be disappointed when dance therapy is offered. Patients who find dancing and movement difficult might be saddened by this reality. Concerns exist that physical activities in people with dementia in particular may raise the risk of falls and exacerbate various existing health conditions, such as high blood pressure, heart problems, chronic obstructive pulmonary disease, and so on. However, exercise could reduce falls by improving stability and improve the long term progress of other chronic conditions.

Prevention is better than no cure

The main risk factors for dementia include increasing life expectancy, obesity, diabetes, excessive alcohol consumption, and hypertension. Although these are largely vascular dementia risk factors, age is a key cause of Alzheimer’s disease, so prevalence is also set to rise.

Dance therapy could be a preventive measure. Combining physical and mental activities can increase the cognitive reserve, reduce the rate of brain atrophy, stimulate neuroplasticity and neurogenesis, and increase brain perfusion as well as combating many of the risk factors. Early prevention is key, given that clinical presentation of symptoms occurs 10-20 years after the biological changes start.

The resources exist to allow any willing caregivers to run dance therapy classes, regardless of dance experience, and there is a lot of information available. The Expressive Arts with Elders resource also promotes easy, money saving dance techniques, such as using a dustpan as a drum or beans as shakers. Alternatively, professional dance teachers charge about £30 an hour. Additional considerations, such as facilities, facilitators, organizing transport, and coordinating and organizing potential participants and their caregivers require further research, to see whether these factors allow dance therapy to be a cost effective option.

Dance “challenges the stereotypes of ageing and disease.” It also provides a good mix of cognitive and physical stimulation. It is also refreshing for patients and caregivers to experience a treatment that is not a drug regimen.

Sources and Additional Information:

Tuesday, April 5, 2011

‘Quality Dementia Care Framework’ : Dementia Care Giver Training workshop, May 2011

1st time in Mumbai unique Dementia Care Giver Training Programme

Silver Inning Foundation in association with ARDSI Greater Mumbai Chapter  & Supported by  Harmony for Silvers Foundation Presents

‘Quality Dementia Care Framework’
Dementia Care Giver Training workshop
By Mrs. Nilanjana Maulik : Expert Trainer & Director of Dementia Services, ARDSI Calcutta Chapter

Dementia is a progressive brain dysfunction (in Latin 'dementia' means irrationality), which results in a restriction of daily activities and in most cases leads in the long term to the need for care. Dementia is one of the major causes of disability in late-life.  Many diseases can result in dementia, the most common one being Alzheimer's disease. It mainly affects older people; about 2% of cases start before the age of 60 years. After this, the prevalence doubles every five years. Dementia affects each person and family differently. As dementias progress, there are notable changes in memory, thinking, language, behavior and function — all of which require different skills and strategies. Very few of us have a natural born knack for care giving. Most caregivers have to learn and practice these new skills. It is estimated that over 3.7 million people are affected by dementia in our country. This is expected to double by 2030. The challenge posed by dementia as a health and social issue is of a scale we can no longer ignore. Despite the magnitude, there is gross ignorance, neglect and scarce services for people with dementia and their families.

The importance of taking care of elderly has become more relevant in India due to the increased lifespan and consequent increase in the population of the aged.  As a result of the demographic transition and changing family structure, care of aged is emerging as concern of modern times. The support system and care giving that had been earlier available in the traditional family set up for the elderly has withered away. One of the most important components of developing dementia services in the Country is training health human resources.  We at Silver Inning Foundation like other NGO’s have realize the implications of the increasing aging population in the country, and responded by creating care programmes and delivery services aimed at meeting the needs of older persons.
The Training of Care Giver for people with Dementia has evolved with parting of knowledge and innovative ways of empowering the family members and professionals to gain skill sets that could help them in Management of Dementia. By undertaking such Geriatric care trainings we at Silver Inning Foundation will achieve our vision of creating an Elder Friendly World where Ageing becomes a Positive and Rewarding Experience.


  • To create awareness about dementia and its various types.
  • To educate volunteers and caregivers to identify early warning signs of dementia and early prevention of dementia.
  • To train volunteers and caregivers to disseminate knowledge about dementia to local population and Senior Citizens.
  • To enhance the capacity & skills of Care givers in managing elderly with dementia.

Date: Friday 6th May to Sunday 8th May (3 Full Days)
 Timing: 10am to 5.30pm

Venue : Harmony Interactive Centre ,Harmony for Silvers Foundation,5th, Floor Zaobawadi Lane, Next to Ram Mandir , Thakurdwar,Girgaum , Mumbai .Maharashtra 400002.

Who can participate: Social Workers, Medical Professionals, Nursing Students, Family Members, Care Givers, Psychologist, Gerontologist, Geriatricians, Legal Professional, Police Professionals, Senior Citizens and Staff of NGO/Old Age Homes

  • Minimum Age - 18 years and above
  • Minimum education- 10th  +
  • Must have Passion to serve.

Language of Training: English

The methodology of training would include lecture cum discussions, case presentations, group exercises, role play and efforts would be made to make the training participatory in approach. Pre and post assessment evaluation of the participants on knowledge base would be conducted at the beginning and end of the course respectively.

Highlights of Basic Curriculum:
Definition, nature and type of Dementia, Myth and Fact, Symptoms/Identification of Dementia Patients, Role-Play, Group Work, Brain Boosters/other exercises, Documentary,  Care Giver Experience etc

What you will get:
  • Knowledge & skill for Dementia management
  • Certificate of Participation
  • Free Leaflets/notes 
  • Books on dementia/care giving will be available at Rs.275/175/-
  • Free Volunteer Membership to Silver Inning Foundation & ARDSI Greater Mumbai Chapter

Number of Participant: minimum 15 to maximum 30 (first come first basis)

How to register:  Rs. 700/- p.p. non residential (inclusive of lunches, refreshments and materials).

Special rates of Rs.500/- p.p. for Senior Citizens who are age 50yrs and above .

Rs.  500/- p.p. early bird discount until 15th April 2011.

Please note there will be no refund of registration fees in event of cancellation by the participant.

Note: Last date for registration is 30th April 2011.  

Please send the filled-in form along with the Chq payment to:
Silver Innings, C/o Sailesh Mishra, ARENA III, Flat - 801/802, Poonam Garden, Mira Road -East, Mumbai. India – 401107.

Contact person:
Ms. Mona - 09987104233
Ms. Laxmi Rao – 09029000091

Organized by Silver Innings, a social Enterprise for Age Care. Silver Innings is working towards creating an Elder Friendly World where Ageing becomes a Positive and Rewarding Experience.