Practicum Projects

The Best Practices of the Recreational Therapy Profession in the Long-Term Care Setting

Marli Sather

Student #: 10121881

CORE 594

Best Practices in Recreational Therapy

            Today’s world sees an increasingly matured population, as the baby boomer population has begun to age and/or move into retirement age (Luu, 2013). Seeing as how this is the case more and more of this generation is moving into retirement homes or long-term care facilities, settings which often utilize Recreation Therapy Services. Recreation Therapy is often set up in these facilities in order to help residents to find different ways they can enjoy their leisure time and to improve their cognitive, physical, emotional and social skills (Luu, 2013). This is done through the production of various recreation programs, including Exercise Programs, Trivia/News Activities and Music Therapy (Hickman, Newton, Halcomb, Chang & Davidson, 2007).  In addition to building these above skills, it is also hypothesized that Recreational Therapy programs help to reduce mental aliments ( i.e. anxiety, stress, depression ) as well as physical ailments (i.e. less flexibility, increased pain, etc.) in clients who partake in them. (Luu, 2013). The follow five literature reviews attempt to demonstrate and support this hypothesis.

Exercise Therapy

            Research from Lavie , Milani, O'Keefe, & Lavie (2011) and  Cho, An and Yoo (2014)  have found that exercise programs can reduce mental and physical aliments respectively. Lavie et al ( 2011) discovered that nearly of the 500 patients they analyzed before using exercise therapy reported a much higher level of anxiety (27%) than they did after using it, seeing a decrease of 56%. In a more recent study of 104 patients, the 14% who were 70 years old or older who had anxiety saw a 32% overall decrease in their symptoms( Lavie et al 2011). Regarding depression, 552 individuals were assessed before and after participating in exercise therapy programs(Lavie et al, 2011). They saw a reduction in depression rates, starting at 26% before the programs, to only 9% over all ( Lavie et al, 2011). In both cases of depression and anxiety, rates of mental aliments saw a decrease between 30-60%, a notable decline for those individuals involved (Lavie et al, 2011).

On the physical side, Cho, An & Yoo (2014) looked to see how areas such as flexibility, balance and strength were affected in older adults who participated in exercise programs. In their study , 43 individuals over the age of 75 years of age participated twice a week in exercise programs for eight weeks (Cho et al, 2014). Each week, the level of activity would increase gradually , such  additional  two minutes of total duration time or more repetitions of stretches were preformed (Cho et al, 2014) . Their muscle strength, flexibility and balance were tested before starting the programs and there was once again, a notable increase in all areas tested (Cho et al, 2014).  Flexibility saw an increase from 12% to 17%, balance saw increase of 14% to 18% and strength saw an increase from11% to 16% (Cho et al, 2014). Though these gains may seem small, the time frame in which they occurred was only a small fraction of the individual’s lives and if they were to continue these programs, their growth would continue to swell (Cho et al, 2014).

Both of these above findings help to support the idea that Exercise therapy can help to reduce both mental and physical ailments in elderly individuals. Exercise is well known to help one physically, but it is not well known about its mental benefits as well ( Lavie et al 2014). Since exercise programs are done in group settings, it allows for one to socialize, learn new information,  and feel supported and to take care of their body (Cho et al, 2014; Hickman et al, 2007; Lavie et al, 2011).

Cognitive Stimulation Activities

As discussed by Aguirre, Woods, Spector and Orell (2013), cognitive stimulation is a psychological intervention widely used in both long term and dementia care units. It offers a range of activities (including trivia and current events) and provides general stimulation of cognitive abilities( Aguirre et al, 2013). In this study, 94 studies with  a total of 718 participants performing various activities within them were used ( Aguirre et al 2013). Among the most popular were trivia based questions that focused on individuals factual knowledge and News discussions, which help individuals to reflect and keep current (Aguirre et al, 2013). The results on the cognitive functions of individuals saw benefits following these activities. (Aguirre et al, 2013). Cognitively, the improvement for the individuals was small, with only a 5% increase seen; however, mood and anxiety saw a major decrease, almost reaching the level of zero ( 0.5) in the participants ( Aguirre et al, 2013). With continued use, some participants reported having a improved quality of life as well ( Aguirre et al, 2014).

Though there were not  noteworthy gains in the improvement of physical ailments concerning this type of recreation therapy, there is still great support of mental ailment improvements. As well, these types of activities allow for socialization because members can discuss their opinions or confer on answers ( Aguirre et al, 2013; Luu, 2013). As well, they can experience many different emotions during these types of activities, such as excitement, nostalgia and so on ( Luu, 2013).  .

Arts and Crafts

Another popular recreation activity is that of arts and crafts.  Im and Lee ( 2014)  studied 94 elderly individuals from January to March of 2013, to see how art therapy (  more commonly dubbed “arts and crafts”) affected  their mood levels. Activities such as holiday themed crafts ( i.e. Valentine’s Day cards), painting, sketching and DIY projects were what were used as therapy tools ( Im & Lee, 2014). What was found through the two month process was that, depression levels saw a 10% decrease overall in the individuals ( Im. & Lee, 2014). The most successful—the activity that showed the biggest increase—or most enjoyed activities were ones that involved painting (Im & Lee, 2014). Though the effects of art therapy were shown to be great on depression levels, there was no information about the level of anxiety in the individuals in this particular study. However, participants did report how after art therapy, they felt that their lives were made healthier by it ( Im & Lee, 2014). They also reported higher levels of happiness and quality of life ( Im & Lee, 2014).

            There were no explicit effects reported on physical ailments were helped during this study, other than some reported that their fine motor skills ( i.e. grasping) contributed to their overall increase of better quality of life ( Im& Lee, 2014). They also reported better social skills, because of group projects or having to share art supplies ( Im& Lee, 2014; Luu, 2013). Art therapy, as shown can have major mental health benefits and minor physical health benefits, where the latter can also affect the former (Im& Lee, 2014).

Music Therapy

            Music Therapy, its own separate form of therapy, is often used by within the  recreational therapy fields and has proved to be another popular activity for clients ( Luu, 2013). Since it is so popular, Chu, Yang, Lin, Ou, Lee, O'Brien, & Chou (2013) studied how music therapy truly affects the mental health of those who participate in it. Participants would attend two 30 minute sessions per week for 6 weeks (12 sessions in total); their mood levels would were tested prior to starting the sessions and then again after the sessions were done ( Chu et al, 2013). What was found was that there as noteworthy affects on both depression levels and cognitive functioning in the participants ( Chu et al, 2013). Regarding depression, reports decreased immediately after the first trial and continued to do so throughout the rest of the program (Chu et al, 2013). Regarding cognitive functioning, especially short term recall, improved slightly after the 6^th session ( 2%) and then slightly more after the 12^th session ( 4% , for an overall increase of 6%) (Chu et al, 2013). Participants also reported that they felt happier after a session and that happiness lasted much longer after each consecutive music session ( Chu et al, 2013). Though music sessions can include some movement, such as marching to the beat, there were no explicit reports of how it affected their overall physical health (Chu et al, 2013).

Aromatherapy

            Aromatherapy, a well known therapy tool, is now making an appearance in recreational therapy practices. It is known for its calming affects and creation of a soothing environment for people who partake in it ( Luu, 2013). Nguyen and Paton ( 2008) discussed how it can affect the behavior of clients who used it. Looking at eleven studies, noting what types of oils they used, how they were administered  and the overall outcome ( Nguyen & Paton, 2008). What was found was that  nine of the studies used lavender oil and administered them through either touch or massage( Nguyen & Paton, 2008). There was  no distinct relation between these two factors and the final outcome of the study ( Nguyen & Paton 2008). A variety of measures to assess changes in behavior were used, including validated quantitative scales for symptoms of agitation (Nguyen & Paton, 2008). Overall, it was found that there were no direct effects of aromatherapy on behavior, other than participants reporting it did relax them, but affected neither their mental health, nor their physical health (Nguyen& Paton, 2008).

Conclusion

            As this literature review has shown, these types of activities (though there are many more) used by Recreational Therapy, have notable benefits not only for building skills in clients, but also to their mental and physical well being. It would be hard to say which is the most effective, as variety of activities would probably be the most helpful and interesting for the clients. Doing too much of one thing does not allow one to truly experience everything life has to offer. As well, not everyone holds the same interests, so having different options will therefore attract and help more individuals. Variety is the spice of life, and the best practices put forth by Recreational Therapy certainly support that notion.

           

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References

Aguirre, E., Woods, R. T., Spector, A., & Orrell, M. (2013). Cognitive stimulation for dementia: a systematic review of the evidence of effectiveness from randomised controlled trials. Ageing research reviews, 12(1), 253-262.

 Cho, S. I., An, D. H., & Yoo, W. G. (2014). Effects of Recreational Exercises on the Strength, Flexibility, and Balance of Old-old Elderly Individuals. Journal of physical therapy science, 26(10), 1583.

Chu, H., Yang, C. Y., Lin, Y., Ou, K. L., Lee, T. Y., O'Brien, A. P., & Chou, K. R. (2013). The Impact of Group Music Therapy on Depression and Cognition in Elderly Persons With Dementia: A Randomized Controlled Study. Biological research for nursing, 1099800413485410.

Hickman, L., Newton, P., Halcomb, E. J., Chang, E., & Davidson, P. (2007). Best practice interventions to improve the management of older people in acute care settings: a literature review. Journal of Advanced Nursing, 60(2), 113-126.

Im, M. L., & Lee, J. I. (2014). Effects of the art and music therapy on the depression and cognitive function of elderly. Technology and Health Care.

Lavie, C. J., Milani, R. V., O'Keefe, J. H., & Lavie, T. J. (2011). Impact of exercise training on psychological risk factors. Progress in cardiovascular diseases, 53(6), 464-470.

Nguyen, Q. A., & Paton, C. (2008). The use of aromatherapy to treat behavioral problems in dementia. International Journal of geriatric psychiatry, 23(4), 337-346.

 Logic Model