Feature

Myer Erlich is a bright, loquacious man, a retired radio show host and World War II vet who speaks proudly of a son who lives in China and a daughter who lives nearby.

He also has Alzheimer's disease. But looking at the life he is leading, you'd never know it. At Hearthstone at New Horizons, in Marlborough, Mass., the assisted-living residence where he lives, Erlich hosts book clubs and shares his knowledge of history during a weekly news program that residents watch through an interactive DVD. "It's fun, let me tell you," the 84-year-old says.

Erlich is the rule, not the exception, in facilities touched by the work of psychologist Cameron Camp, PhD, an applied gerontologist and former University of New Orleans professor who develops creative, empirically based approaches to helping people with dementia engage in meaningful activities and learn new memory strategies. Camp is director of research and product development at Hearthstone Alzheimer's Care, a company headed by sociologist John Zeisel, PhD, that oversees several Alzheimer's assisted-living residences in New York and Massachusetts.

Camp's philosophy is to see a client with Alzheimer's as a person, not a diagnosis.

"We want to flip the system on its ear—to change people's expectations about what people with dementia are capable of," he says. "Our job is to allow this person to be present—to help them, wherever they are in the journey of dementia, to be connected with a community, to contribute to the best of their ability."

Tapping strengths

The team takes a "translational research" approach to its work, where researchers bring lab findings into real-world settings. The trend began in the late 1990s when researchers and the National Institutes of Health began to emphasize the need to look beyond statistically significant effects in lab-based research, and ensure that research findings are applied in real-world settings and produce clinically relevant results, says Camp.

In the case of Alzheimer's patients, the team does this using a glass-half-full philosophy, Camp says.

"It starts with saying, 'What are the abilities that remain? How can we connect with the person who is still here?'" he says.

One way is through a method called Montessori-Based Dementia Programming, which Camp began developing about 15 years ago. He thought that the Montessori method—which guides children to direct their own learning via tasks, tools and projects that engage all of their senses—might work for people with dementia, in part because it is based on rehabilitation principles.

One Montessori-based skill-building game, for instance, helps people with Alzheimer's build the muscles and skills they need to continue to feed themselves. The task has residents use a slotted spoon to search for objects buried in a tub of rice. When they find one, the rice falls through the slots and the treasure remains. Each time they find an object, they put it aside until all of them are collected.

Just as important, the task helps them achieve a concrete goal in the present moment, without having to count or remember, Camp explains.

"By creating these cognitive prostheses, we can circumvent deficits in memory and executive function and bolster people's sense of accomplishment and self-esteem as a result," he says.

Another intervention he helped to develop, called spaced retrieval, lets people with dementia practice recalling information over progressively longer periods of time, using supportive props to help them remember. One common example is a resident who keeps forgetting that her daughter has just visited her, grows anxious, and repeatedly asks staff when her daughter will come back. To help the resident remember, Camp has her daughter write about their visits in a book and date each entry. He then helps staff members train the mother's memory so she eventually remembers to look at the book any time she gets anxious about not seeing her daughter.

The team regularly draws on people's backgrounds and strengths as well—an approach that squares with Montessori programming by helping to create environments that challenge people but also let them succeed, Camp explains. Michelle Boiardi, program director at Hearthstone at New Horizons, says she recently enlisted the aid of a Chinese-American resident to help her and other residents develop a Chinese New Year's celebration.

"He felt very empowered and important because he had something to offer that others didn't have," she says. "That's just a human need for any of us."

Overall, the methods demonstrate that psychological interventions can effectively treat people with Alzheimer's and boost caregiver morale, says George Niederehe, PhD, branch chief of the Geriatrics Research Branch at the National Institute of Mental Health, which has funded Camp's work.

"Cameron's work has made people aware that there are psychological methods that can be useful in treating cognitive disability in older people," Niederehe says. "As a result, it's created a sense of therapeutic optimism, giving caregivers a method of working with people that they can see has benefit."

Nurturing community

The team infuses its techniques with relevant research on memory, social connections and other pertinent topics. Zeisel, for example, has developed and implemented what he calls a "naturally mapped" environment, where all of the information a person needs to navigate is self-evident. For instance, Hearthstone facilities all have pleasant destinations at the end of every corridor—a reading room, a peaceful garden, a kitchen—rather than closed doors.

"So, if someone gets up and walks, no one says, 'You can't do that,'" Zeisel says. "They will always be going somewhere where something is going on."

They also work to ensure patients have meaningful social roles, Camp adds. For example, residents create welcoming committees for new residents and put on their own comedy revues and musicals.

The approach has a powerful effect on families as well as residents. Following the lead of Camp and Zeisel, families continue to see their ailing members as whole people. Center staff further encourage family members to engage their loved ones in meaningful conversations, and to collaborate with Alzheimer's patients on projects, such as food and toy drives.

"These are very different visits from, 'How ya doin', how are they treating ya?'" Camp says.

Likewise, using these techniques helps staff see residents with new eyes, Boiardi notes.

"Instead of getting burned out and seeing someone as a problem to solve, you're able to see the humanity, you're able to connect on a really meaningful level," she says.

Spreading the word

The methods Camp and Hearthstone use are catching on internationally. Camp has conducted training across the United States and in Australia, Greece, Taiwan, Canada and France. Manuals on his Montessori method and spaced retrieval are available in Japanese, Mandarin, Spanish and Greek, and will soon be printed in French.

In the research realm, Camp—who has been funded by NIMH, the National Institute on Aging and the National Alzheimer's Association, among others—has published a number of small-scale studies showing that his interventions help people with dementia feel they lead fuller lives.

A 2004 study in The Gerontologist (Vol. 44, No. 3), for instance, found that people with early-stage Alzheimer's who were trained to lead group activities with peers with advanced dementia—such as Erlich leading the book group—were more satisfied than when they engaged in standard activities. The findings suggest that such interventions can provide people with Alzheimer's with meaningful social roles, a tack Camp is pursuing on a broader scale with NIMH funding. Camp also is hoping to conduct a larger randomized controlled trial comparing his interventions with standard nursing home care.

Given the increasing prevalence of Alzheimer's disease due to America's aging population, Camp's research is more important than ever, says Peter Lichtenberg, PhD, president of APA's Div. 20 (Adult Development and Aging) and director of Wayne State University's Institute of Gerontology.

"Cameron's work is viewed nationally by different chains, homes and projects as the cutting-edge way of engaging people with dementia intellectually, as well as assessing them," Lichtenberg says. "As much as anyone in the country, he has taken developmental theory and applied it in meaningful ways to people with moderate to severe Alzheimer's disease."


Tori DeAngelis is a writer in Syracuse, N.Y.

Further reading, resources

• Joltin, A., Camp, C., Noble, B., & Antonucci, V.M. (2005). A different visit: Activities for caregivers and their loved ones with memory impairments. Cleveland: Minorah Park Center for Senior Living.

• Zeisel, J. (2009). I'm still here: A breakthrough approach to understanding someone living with Alzheimer's. New York: Avery.

• Camp, C.J. (2006). Montessori-Based Dementia Programming in long-term care: A case study of disseminating an intervention for persons with dementia. In R.C. Intrieri & L. Hyer (Eds.), Clinical applied gerontological interventions in long-term care (pp. 295–314). New York: Springer.

• Camp, C.J. (2006). Spaced retrieval: A case study in dissemination of a cognitive intervention for persons with dementia. In D.K. Attix & K.A. Welch-Bohmer (Eds.), Geriatric neuropsychological assessment and intervention (pp. 275–292). New York: Guilford Press.