Faculty Work Across Schools to Improve Outcomes for Alzheimer’s Patients

When dementia and Alzheimer's patients find themselves in care facilities, their daily prescription list can swiftly become overwhelming. These prescriptions are meant to treat a patient’s aberrant, or abnormal, behaviors as they progress through the stages of Alzheimer's or dementia; however, as George Sillup, Ph.D., will tell you, overmedication can exacerbate these side effects, increasing the frequency of sudden bouts of crying, anxiety spells, social withdrawal, sleep issues and more.

“When we treat all these aberrant behaviors pharmacologically, it becomes difficult for the residents to respond and interact,” says Sillup, associate professor of pharmaceutical and healthcare marketing. “So Ron [Klimberg] and I wanted to find ways to treat these behaviors non-pharmacologically.”

Sillup has been working on research with Ron Klimberg, Ph.D., professor of decision and system sciences, since 2005 when Sillup joined the Haub School of Business. This particular study has been in the works for over a decade now. In order to prove residents were thriving through non-pharmacological intervention, they would need help conceiving of and implementing just what those interventions would be from someone with healthcare experience.

The research began when Eileen Sullivan, Pharm.D., assistant professor of health studies in Saint Joseph’s School of Health Studies and Education, brought the concept of non-pharmacological intervention to the attention of Sillup.

Sullivan’s father spent time in a VA facility and as his condition progressed, she became fascinated by the idea of treating the disease’s side effects without adding to a patient’s prescription list.

“The medications a person with Alzheimer’s is on can have so many side effects,” says Sullivan. “As a pharmacist, I was always interested in finding a non-prescription way to treat symptoms such as anxiety, the loss of cognition, respiratory suppression, etc.”

Sillup connected the group with residents experiencing early onset dementia and Alzheimer’s at St. Ignatius Nursing and Rehabilitation Center in Philadelphia and Parker House Rehabilitation and Nursing Center in New Brunswick. Then, they got to work.

STIMULATING THE MIND

The first intervention Sullivan recommended was a technique called TimeSlips: a storytelling tool wherein residents are shown images or given narrative descriptions and then asked to create a story using those points of reference.

“The interesting thing about TimeSlips is that we could show a resident with Alzheimer's a photograph of their grandfather and they might get irritated trying to figure out who that person is,” explains Klimberg. “But if I’m asking, ‘what does this mean to you? What’s happening here?’ They can create a story however they want and it takes the pressure off — this decreases their apprehension about recall, which can promote negative feelings.”

Ultimately, TimeSlips stimulate the creative mind, which is one of the most effective inducers of joy in a person affected by Alzheimer's or dementia.

“It really helps them rekindle the thought process,” adds Sillup. “Those aberrant behaviors — the lip smacking, the finger tapping, all that anxiety — it just kind of melts away as they relax into the thought process.”

Using the Overt Agitation Severity Scale (OASS), Klimberg measured the residents’ aberrant behaviors at the start of each intervention and again at the end. TimeSlip interventions proved to be highly effective for the group of residents — no medication was administered during the sessions and most residents experienced up to 45 minutes of residual joy after treatment.

So Klimberg and Sillup decided to go further — what else could they use to stimulate residents’ minds in this way?

“After observing a professional ballerina, Susan Cade, and concert pianist, Tatyana Shargorodsky, perform a musical intervention in a nursing home, I talked to them about adding research structure and assessment to their intervention and the ‘chair ballet’ was born,” says Sillup.

Piano music accompanied the residents’ movements, which was always thematic or seasonal. Cade would guide the residents in their dance, asking them to make circles with their arms or reach up to the ceiling; other times, they would wander through the experience independently.

“We all make sentimental connections to different songs and there is such a rich history of how music stimulates thinking,” notes Sillup. “Residents were making stories to go with the feelings the music was evoking — they were moving physically along with those stories, too, which added so much value.”

Again, Klimberg’s OASS statistical analysis showed residents responding highly favorably to this musical intervention, the aberrant behaviors were easing, medications weren’t being distributed during treatment sessions and feelings of residual joy were enduring.

Then COVID-19 happened.

FINDING A NEW AUDIENCE

The whole world, and particularly elder care facilities, locked down tight.

“We couldn’t get into any care facilities anymore,” says Klimberg. “No one could. And these interventions can’t really be effectively implemented over Zoom.”

So the research team pivoted — now, Klimberg and Sillup are embarking upon what they refer to as the project’s “third generation.”

The pair approached Stephen J. Forzato, the director of Saint Joseph’s Center for Addiction and Recovery Education, who could help them engage another group that commonly falls victim to over-prescription: those experiencing substance use disorder.

Sillup and Klimberg are looking to begin this new iteration of their research with the Caron Treatment Center. Joseph Garbely ’85, DFASAM, D.O., Caron’s program director, plans to work with Sillup and Klimberg’s Summer Scholars ahead of time to gather necessary data and information before starting.

“In our research with Caron, we’ll be using their physicians and music therapists to implement interventions,” explains Klimberg, “which isn’t a resource that was available to us at the retirement facilities. This way, we’ll have a much more controlled methodology for implementing the treatments before we collect data and analyze each cohort’s outcomes.”

In this third generation of their research, Klimberg will be using the The State-Trait Anxiety Inventory for Adults (STAIA) and working with Caron staff to implement the study, collect data and analyze outcomes to determine the music intervention's success.

Klimberg and Sillup are reviewing the final draft of the protocol and look forward to submitting this research for assessment and approval by Saint Joseph’s Institutional Review Board this coming spring.