title: Maintaining health and wellness in the face of dementia: an exploratory analysis of individuals attending a rural and remote memory clinic.
abstract: BACKGROUND
  Worldwide, countries are calling for a chronic disease management approach to people with dementia. In response, 'living well' with dementia and 'supported self-care' frameworks are being adopted by advocacy and volunteer organizations, and more attention is being directed towards health and wellness promotion as a critical component for 'living well'. This exploratory study examined the health and wellness self-management behaviors of patients attending a rural and remote memory clinic; and relationships between engaging in health and wellness behaviors and psychological and neuropsychological function, independence in daily activities, and balance.
  
  
  METHODS
  The cross-sectional sample comprised 260 patients referred to the Rural and Remote Memory Clinic (RRMC), Saskatchewan, Canada. Patients were diagnosed with amnestic or non-amnestic mild cognitive impairment, Alzheimer's disease (AD), or non-AD dementia. Via questionnaire, patients were asked how many days a week they exercised for at least 20 minutes, if their diet met theCanada's Food Guide to Healthy Eatingrecommendations, and what they did to maintain their psychological health. Patients completed a depression scale, a neuropsychological battery, and a balance scale. Caregivers completed the Functional Assessment Questionnaire. Questionnaire data were analyzed using descriptive statistics and correlational analyses. Bivariate associations between variables were assessed using point-biserial and Spearman's correlations, where appropriate. Open-ended responses were analyzed thematically.
  
  
  RESULTS
  Participants were aged between 44 and 97 years, and had between 0 and 20 years of formal education. About half of those with Alzhemier's disease and more than half of the other diagnostic groups reported having five or more chronic conditions. Over a third of the total sample reported not exercising at all on a weekly basis. Less than half (42.7%) of the Alzhemier's disease group reported exercising for 20 minutes less than three times per week, while more than half of the other groups reported exercising for 20 minutes less than three times per week. Associations between exercise and tests of neuropsychological function and balance were statistically non-significant for the non-AD dementia group. In contrast, for the group with AD, engagement in exercise for 20 minutes for three or more times a week was moderately associated with better Stroop interference test scores and better balance. Seventy-four percent reported they met most or all of the Canada's Food Guide to Healthy Eating dietary recommendations, and 71% indicated they were engaged in activities to maintain their psychological health. Although many who reported engaging in activities to maintain their psychological health reported more than one activity, only 2.1% reported engaging in a combination of physical activities, social activities, and mentally stimulating activities.
  
  
  CONCLUSIONS
  Patients referred to the RRMC reported good nutrition habits and participating in a variety of activities to maintain psychological health. Engaging in exercise and good nutrition was found to have beneficial effects for the sub-sample of patients with AD. Patients and their caregivers may require additional education and information regarding beneficial health and wellness promoting behaviors related to their diagnosis and concurrent comorbid conditions.
authors.affiliation: School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada. vdalbel@mcmaster.ca.
authors.forename: Vanina P M
authors.initials: VP
authors.lastname: Dal Bello-Haas
authors.affiliation: Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. megan.oconnell@usask.ca.
authors.forename: Megan E
authors.initials: ME
authors.lastname: O'Connell
authors.affiliation: Royal University Hospital, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. debra.morgan@usask.ca.
authors.forename: Debra G
authors.initials: DG
authors.lastname: Morgan
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000523:psychology*; D002908:Chronic Disease; D060825:Cognitive Dysfunction / Q000523:psychology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003704:Dementia / Q000523:psychology; D004032:Diet; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D019035:Rural Health Services; D012525:Saskatchewan; D012648:Self Care; D012737:Sex Factors; D058992:Social Participation; D012959:Socioeconomic Factors
keywords: Aged Care; Allied Health; Evidence-based Care; Geriatrics; Health Promotion; Medical; North America; Nursing; Practice Tips