On a global scale, 35.6 million people are living with Alzheimer's disease (AD) (Alzheimer's disease International, 2010). By 2050, it has been projected that 16 million Americans (Alzheimer's Association, 2011) and 115.4 million persons worldwide (Alzheimer's disease International, 2010) will have AD. Alzheimer's disease, which is the most common type of dementia, makes up 60 to 80 percent of all cases of dementia (Alzheimer's Association, 2011). Because significant resources are required to address problematic behaviors associated with dementia, new approaches, interventions and treatments are needed to prevent or reduce the occurrence of these behaviors (Camp, Cohen-Mansfield, and Capezuti, 2002). In recent years, important discoveries have been made regarding learning and social interaction in dementia. For example, we have seen that persons with dementia are able to learn new information and express knowledge and life experiences in conducive settings. Individuals with dementia often still have the desire for productive, challenging activit, and it is important that this basic human need continues to be met as long as possible following a dementia diagnosis. This 6-month feasibility study will involve the creation of Asparagus to Zucchini (A2Z), an agricultural sciences-based curriculum designed to utilize remaining strengths and provide productive and purposeful activity for persons in all stages of dementia. This curriculum will incorporate principles of Montessori-based programming for dementia, Horticultural Therapy, and nutrition. Throughout the course of the study, we will develop a prototype A2Z kit, which will include adapted classroom materials and indoor growing supplies, we will train activities staff to present the curriculum to guide participants and encourage active engagement, and we will randomly assign participants to either a treatment group involving participation in A2Z and Current Events (A2Z/CE) or a control group involving participation in Current Events alone (CE). Following baseline measurement, two observations will be conducted each week, at the same time of day, for a period of eight weeks. After the initial eight-week period, Group 1 will take part in CE alone, and Group 2 will have A2Z/CE (a cross-over design). Observations will continue for a second eight-week period. Measured outcomes will include engagement and affect observed during group activities, memory for programming content and perceived purposefulness, descriptive observations of group dynamics and individual expressions of satisfaction/dissatisfaction with programming content. Distal outcome measures will focus on quality of life and will be assessed at baseline and following each 8-week observation period. It is hypothesized that A2Z programming will result in more engagement, positive effect, perceived purposefulness, satisfaction with programming, and better quality of life outcomes compared with standard (CE) programming.
Public Health Relevance: Our aim is to develop an agriculture-based educational program (Asparagus to Zucchini - A2Z) for use in long-term care facilities and other care sites for persons with dementia. Specifically, we wish to assess the effects of this program on engagement, affect and quality of life. Long term goals include refining and extending a curriculum that will train caregivers of individuals with early to moderate stage dementia to educate and provide opportunities for these individuals to engage in meaningful and productive horticultural activities.
