University program helps elderly adults improve their mood and memory

By Scott Sleek
Monitor staff

Julie Nicholson sits amid a group of four senior citizens, reading them a brief story about a girl named Charlene McKune, who grew up on a farm and used her toy building blocks to make tiny homes for her pets. Then, Nicholson asks each person in the room to remember the girl?s name. Three of the participants couldn?t remember, even though they?d heard it just seconds before.

So Nicholson suggests a strategy for the forgetters: transform the story into visual images. 'McKune' sounds like 'raccoon,' so she suggests the participants picture a raccoon jumping over the building blocks.

'The goal is to remember all the important information in the story visually,' she says. 'And the strategy works best if the images are really bizarre or strange.'

The exercise is one of many memory-enhancing techniques that graduate students are teaching elderly adults through a landmark program at Michigan State University (MSU). For the past 10 years, Norm Abeles, PhD, APA past president and director of MSU?s psychology clinic, has been pioneering a service that helps elderly adults understand their normal age-related memory decline, but also helps them improve their power of recall.

Abeles and his graduate students invite area seniors who are worried about memory decline to come into the clinic. They then give each individual a battery of tests designed to identify those that may have symptoms of dementia or depression. (Memory impairment is often a sign of depression.) Those who show no serious cognitive problems are then invited to participate in the workshops, which provide them with tips and mental exercises they can use to enhance their recollection of names, appointments or the newspaper article they just read.

The program is all part of Abeles? vision of a new standard for elder care. He believes older adults should undergo regular mood and memory checkups, the same way they see their physicians for routine physicals. And, just as they?re encouraged to exercise their bodies well into their golden years, seniors should also learn to exercise their memory muscles, he says. The students who help Abeles operate the program say they enjoy calming participants who fear their memory lapses signal the beginning stages of dementia?a common trepidation amid the expanding public knowledge about Alzheimer?s disease (see related story on page 1). 'We see a lot of people who are relieved to find out that their memory problems are normal,' says Adam Alban, one of Abeles? graduate students.

Financial support

A variety of sources have provided funding for the program, including MSU, the Michigan state government and the American Association of Retired Persons? Andrus Foundation. Abeles and his students have tested 400 to 500 elderly adults. Participants must be at least 60, but most average about 70 years old. They are recruited through mailings, newspaper advertisements and presentations in residential facilities for seniors.

Elderly participants who respond to the invitation will, on their first visit to the clinic, undergo about two-and-a-half hours of testing. The graduate students will measure the participants? ability to remember such simple items as names and objects, and ask them to perform tasks that will measure their attention span, their concentration, their verbal intelligence and their reading skills. To measure verbal-learning ability, for example, a student will give a participant a 16-item list five times. The word list comprises four items, each from four different categories?fruits, tools, clothing, and spices and herbs. The participant is then asked, after a delay, to remember items on the list.

The examiners also administer such mood assessment instruments as the Beck Depression Inventory and the Geriatric Depression Scale.

When they identify people who show signs of dementia or a mood disorder, they immediately refer them to an appropriate health professional for the proper care. But they invite the participants whose test scores are normal to attend the workshops.

In each 90-minute workshop session, a graduate student serves as the leader, guides the participants through several memory-building exercises, and gives them activities to work on at home.

The participants also learn that a somber mood can hinder their memory and share some of the pleasant activities they engage in to keep themselves feeling chipper. Jeanne Galgier, 75, recalls the uplifting feeling of delivering flowers to some shut-ins. And Bob Higdon, 71, talks about the pride he feels when he mows his lawn.

During the session, the participants also practice relaxation exercises, such as a guided imagery technique in which they envision themselves in a pleasant, tranquil place.

The MSU students retest the workshop participants immediately after they?ve completed the curriculum and again six months later. A control group is also selected to take the tests twice before entering the group workshop.

Abeles and his students have documented some favorable outcomes from the workshops. In one study, for example, they found that 150 older adults reported improvements in their memory immediately after completing the workshop curriculum. And they were still reporting those improvements when they came in for follow-up testing six months later.

And results from the testing are also giving the MSU psychology students some rich data to use for their research, Abeles says. He and the students have found, for example, that seniors with 'even a smidgen of depression have more memory complaints, even though their memory may be fine.' One of Abeles? research assistants, Jodi Levy-Cushman, has found that elderly people appear to have an accurate perception of their memory decline. (Most studies have shown that memory complaints are not directly related to memory performance.) Levy-Cushman recently won an award from the American Society on Aging for her research. Abeles next hopes to test study participants for anxiety. While the public has come to recognize depression as a significant disorder among the elderly, anxiety is also prevalent, particularly among older women , he says. And anxious people have a hard time concentrating, which may contribute to their complaints about memory problems, he says.

Many seniors may still be ashamed or reluctant to admit memory problems, Abeles notes. But he expects that to change. The next generation of elderly adults?baby boomers who have been more receptive to mental health care than previous generations?may actually demand the type of services MSU is modeling, he says.