AN INTEGRATIVE GROUP MOVEMENT PROGRAM FOR PEOPLE WITH DEMENTIA AND CARE PARTNERS TOGETHER (PAIRED PLIÉ): INITIAL QUALITATIVE FEEDBACK

Abstract

There is growing evidence that behavioral interventions can improve physical function, cognitive function, and mood in people with dementia, but most programs (a) target a single domain and (b) only allow the affected individual to participate. Paired PLIÉ (Preventing Loss of Independence through Exercise) integrates physical, mental and social activities into a multi-modal, group movement program for pairs of affected individuals and care partners. It includes 24 in-person classes (1 hour, 2 days/week, 12 weeks) and home practice (weekly handouts with behavioral/attitudinal themes for reflection and practice) followed by access to a weekly community class. This process evaluation aimed to examine care partners’ observations and reactions to the Paired PLIÉ Program as part of a larger randomized controlled trial. The study population was the first three pairs to complete the program. Data included care partners’ daily written logs, weekly responses to questions related to practicing the skills of PLIÉ at home over 12 weeks, and care partners’ emails received after completion of the program. Themes were initially categorized as physical, cognitive and social/emotional based on prior work (Wu et al., 2014), and sub-themes were identified through an iterative, collaborative process with multidisciplinary investigators. Within the domain of physical functioning, care partners observed functional improvement and less symptomatic discomfort in themselves and affected individuals. Related to cognitive functioning, care partners observed heightened engagement and improved focus in affected individuals. Within the domain of social/emotional functioning, care partners observed greater social connection between themselves and the affected individual and lower stress in both partners. However, two care partners noted that the PLIÉ program added burden. All three pairs have chosen to continue to participate in an ongoing Paired PLIÉ program in the community. One participant found the community classes helpful and less burdensome. Care partners observed physical, cognitive and social/emotional benefits of the Paired PLIÉ Program while also experiencing some added burden. Additional research is needed to determine whether weekly community classes are adequate to maintain gains achieved during the program. Functional improvement • Dyad 1, week 11: “I think Mom is benefitting physically. Straighter posture sometimes, easier to go from sit to stand, climb stairs.” • Dyad 2, week 9: “Great class, found movements helped do things couldn't accomplish in the past” • Dyad 3, week 9: “He could get up even without optimal chair and cushion” Less discomfort • Dyad 2, week 1: “[AI] seems to be better in the ache dept. Is easier to understand why necessary to do [the exercises]” Engagement • Dyad 3, week 1: “[AI] seemed more alert. Spoke a bit more. Followed instructions. I enjoyed more when he was more engaged.” • Dyad 1, week 6: “She usually gets very sleepy/fatigued looking when we do this, wants to keep eves closed. Today was eves open, participating, commenting about how it felt when touching body.” More able to focus • Dyad 2, week 4: “He finished two crosswords completely (this was never done prior)” Connection between AI and CP • Dyad 3, week 1: “I notice that when I make effort to engage more in conversation he does too and time spent together [is] more energizing” • Dyad 2, week 8: “Getting along better with each other” Lower stress • Dyad 1, week 2: “Calmed me down, helped me relax and feel less stress” • Dyad 2, week 3: “Felt slimmer - calmer… no stress even when [AI] asked 1 question several times over!” • Dyad 2, week 8: “Both very happy, left completely renewed” • Dyad 3, week 9: “Neither of us was into doing more than [a] short time.” • Dyad 1, post-completion email: “The follow up [community] class on Thursday mornings is very different for me. There is no pressure on me (I put none on myself). It is only once a week, and it is closer to home, a 10 minute drive instead of a 30 minute drive. And now I see what the class is doing for us, how it is helping in a real and important way.”