Sarah Duff Research Proposal

This research proposal is subject to change as the project progresses.

Research Question: Can Yoga Help Bring Calm in People with Dementia?
Background/Rationale:
I have worked for Alzheimer Scotland as Service Manager for the South Aberdeenshire Service for 20 years. In that time, as a practitioner working in dementia care I have become interested in the positive impact that physical exercise can have on people with dementia.
The benefits of physical activity for the health of the body and heart are well known, however there is increasing evidence that physical activity also has a significant positive impact on brain health. People who do regular physical exercise on average have healthier brains, better memory, more efficient planning and other thinking skills. (Brown BM, Peiffer JJ, Martins RN)
The South Aberdeenshire Service has introduced various physical activity groups for our service users with dementia over the last ten years. We have walking groups, Nordic Walking groups, exercise classes and yoga groups. Groups such as these, sit comfortably within the 8 pillars model of Community Support (Alzheimer Scotland 2012) which is very much the driving force of how we shape dementia care. The 8 pillars model is a comprehensive and evidence based approach to supporting people with dementia living at home. The model highlights the importance for therapeutic interventions (pillar 2) and Community Connections (pillar 9).

All the groups that the South Aberdeenshire service offer are popular and I have become increasingly aware that after participating in physical exercise our service users appear relaxed and at ease and this was particularly apparent after our yoga sessions. Hence the reason I have undertaken this research project. I want to find out if yoga can help bring about calm in people with dementia.

There seems to be growing evidence that physical fitness and function benefits are engendered through yoga practice in older adults “the scientific evidence supporting yoga for improved fitness in older adults shows promise, there are meaningful trends towards improvement in gait, balance, strength, flexibility and anthropometric measures as a result of practicing yoga” (Roland,Jakobi and Jones, Journal of Aging and Physical Activity 2011).
However research on the effect of yoga practice on people with dementia appears to be thin on the ground – “despite the widespread advocacy of using yoga for neurological disorders (multiple sclerosis, Alzheimer’s, Parkinson’s) there is a dearth of randomized controlled evidence in this area (Wahbeh, Elsas &Oken, 2008).

The research articles I have read conclude that yoga does have positive effects for people with dementia, “improvements in all measured areas in the group that practiced yoga” (Jue-ting Fan and Kuei-MinChen, Using silver haired yoga to promote physical and mental health of elders with dementia in long term care facilities). For example, one study concluded that “the study group had less overall atrophy in the hippocampus and better connectivity in other parts of the brain responsible for memory that the other group” (Yagana Shah Can meditation and yoga slow the progression of dementia).

I have read eight different papers researching the effect of yoga on people with dementia and findings of existing studies focus on physical function and data examined seems to be medically based; blood pressure, gait speed tests, muscles strength and endurance and cardiopulmonary functions. I have not yet found research papers describing how people with dementia feel about the yoga practice and whether they feel it enhances their mood and feeling of wellbeing. This is the rational for the approach to my project, I am hoping that my research will add to existing literature creating interest in whether yoga can help bring about calm in people with dementia.
Aims

• To find out if a simple short yoga practice can bring about calm in people with dementia.

• If it does bring about calm – how long does the feeling last for?

• To find out if the participants are able to practice the yoga routine in their own homes.

Objectives

• Small scale qualitative study with 6 to 8 people with dementia and some carers.

• To run an 8 week yoga course, each yoga session to be 30 minutes long, starting and finishing with the same piece of music and doing the same exercises with the same practitioner.

• To make a CD with the music and verbal instructions for the participants to use at home.

• Explore how the participants find the experience by discussion groups and interviews.

Theoretical Framework/Methodology

This research will be a qualitative study using a Participative Action Research (PAR) approach. I feel this approach is best suited to my research as I want to include the participants (people with dementia) actively in the research. I looked up definitions of various different types of research and PAR seems the most suited to this project.

Participatory Action Research (PAR) can be defined as:
“…research with people rather than research on people. It is about inquiry as a means by which people engage together to explore some significant aspect of their lives, to understand it better and to transform their action so as to meet their purposes more fully” (Reason 1994: 1).
McIntrye describes the three characteristics of PAR as;
“the active participation of researchers and participants in the co-construction of knowledge, collective, and /or social change; and the building alliances between the researcher and participants in the planning, implementation and dissemination of the research process . ( McIntrye in Qualitive Research Methods)
I feel by participating with the group I will be better equipped to see how the experience is for them and it will allow the participants to interact with me with ease and will enable them be involved in the planning of the project and help with the sharing of the experience and learning at the end of the project.

Methods

This research will be a small-scale qualitative study involving 6 to 8 people with dementia. I plan to involve participants actively in the research to find out how they feel about the yoga practice, how they find the experience and if they feel that practicing yoga has helped to bring about a feeling of calm. At the outset of the research I considered using medical assessments such as taking participants blood pressure and pulse, however on reflection I decided against this as it would bring a formality into the group and could cause the participants unnecessary stress, something we are trying to reduce. The chosen methods are all geared towards measuring the participants mood, letting them tell their own story, in their own words describing how the experience of yoga practice was for them.

The methods will be used to gather this information:

1. Discussion groups

There will be a short discussion before and after three of the yoga classes. Due to the nature of dementia it will be important to try to capture participants’ mood and feelings at the time of the yoga class as their memory of how they feel could quickly fade.

In my role as Service Manager, I find when I am trying to explore how service users feel about the service we offer that discussion groups with people with dementia often work better than one to one interviews. People with dementia often find it easier to communicate in a group rather than on a one to one basis as other people’s ideas can spark conversation and new ideas for others.

The discussion groups will be taped and transcribed. It will be interesting to see if different themes emerge, developing a sense of what I am looking for, to answer the question, does yoga help bring about calm in people with dementia?

Suggested prompts for the discussion group prior to the class:

• How would you describe how you feel today?
• Are you looking forward to the class?
• Why are you looking forward to it?
• Do you feel well today and do you feel able to do yoga?
• How do you hope to feel after the class?

Prompts for discussion after the class:

• Did you enjoy the class?
• What did you enjoy about it?
• How do you feel right now?
• Are you looking forward to coming back next week to do yoga….why are you looking forward to it?

2. Semi Structured Interviews
Information will also be gathered by having semi structured interviews. I feel having one to one interviews could give greater depth making findings more robust. The interviews will be held after the class on the weeks when there is not a group discussion. The plan is to do semi-structured interviews with 2 service users at a time which will be taped. Open-ended questions will be asked similar to the discussion groups encouraging participants to talk about their feelings and about how the practice felt for them. The questions need to be open so that the words used by the people with dementia are their own. For example, I do not want to ask if the yoga class has made them feel calm as this could influence their response. To help service users express their feelings the option of using emotional touch points will be offered.

“The benefits of using this approach include its ability to help practitioners to see in a more balanced way both the positive and negative aspects on an experience and to her service users to take part in a meaningful and realistic way” (Belinda Dewar Journal of Research in nursing November 26, 2009)

Suggested questions:

• Do you feel different now to how you felt before the yoga class? Can you describe that difference?
• How do you feel now? (emotional touch points to be used)
• How did you feel before the yoga class? (emotional touch points to be used)
• Do you feel it was the yoga class that has made you feel like this?
• Do you look forward to the class….why do you/do you not look forward to it
• Would you like to do more yoga? …why? … would you like to do it at home?
• Is yoga something that you feel is good for you? Why?

Time will be allowed at the interviews to encourage service users to feel comfortable and relaxed, to explore responses, to reflect back on what has been said and to check that they have understood the question and that I have understood their response. These questions will be used as a guide, in reality interviews could take a different course; they will be shaped by the individual. Interviews will be taped and later transcribed.

3. Practitioner Diary
I will keep a diary recording my findings from observing the participants, giving an overview of how the yoga class is going, commenting on how I feel the participants find the class, noting any changes over time, using my professional gaze and knowledge of the participants to see if I feel there is a change in the participants’ mood and wellbeing.

4. Yoga Practitioner Diary
The yoga teacher will keep a diary recording her feelings about the class, what she is learning from the experience, any changes she makes to the routine and why she has made the changes and noting whether she feels a sense of calm in the group and if she feels this changes over time.
5. Staff and carer feedback
Some people with dementia attending the yoga class will be living with family carers, others will have close contact with Alzheimer Scotland support staff and their thoughts on how the person with dementia has responded to the yoga class will be sought by a questionnaire.
Summary of methods
This is a small-scale study as findings will be from a small sample of people. However using the combination of the five different methods as highlighted above should give good evidence based on a variety of different people’s perspectives (participants, practitioner, staff), using their perceptions and experiences to explore whether yoga can help bring about calm for people with dementia.
Ethics
A research application was made to Lindsay Kinnaird, Research Officer for Alzheimer Scotland (appendix 1) and consent to do the research was granted. Service users invited to participate in the research are in the early to middle stages of dementia and are considered to have capacity and therefore are able to consent to take part in the research
Prior to embarking on the research programme prospective participants are to be given a research information sheet, which I will discuss with them. (appendix 2). This sheet fully explains the objectives, expectations, methodology, confidentially, anonymity and the required commitment of the individual. Receiving this information and discussing it with me should help prospective participants feel more informed and able to decide whether to consent to participate in the research .

Knowledge Exchange
Once the research is complete the next step will be to share the findings to as wider audience as possible. The findings will be written up in a formal report and also in an abbreviated easy to read summary. My target groups will include: the participants, service users, carers, practitioners, funders and colleagues. I will share the findings through: the media, for example, Dementia In Scotland magazine, local papers, Alzheimer Scotland intranet (ALIS) and face book. I hope to present the findings at conferences, information sharing events (the first one being the PROP knowledge exchange event, July 2015), team meetings and at Alzheimer Scotland AGM. If the findings show that yoga can engender calm in people with dementia I will want to spread the word as people with dementia deserve every chance they can get to feel more relaxed and peaceful and to do something they enjoy.

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