the art of mindfulness: cultivating wellbeing · the art of mindfulness: cultivating wellbeing...

The Art of Mindfulness: Cultivating Wellbeing

Lucia McBee, Laura Peters, Kimberly Coder

Leading Age Conference 2016 Indianapolis, IN

Session 145-C

Laura Peters, MA, PHR

Human Resources Development and Learning Manager,

Kendal at Ithaca, NY

Lucia McBee, LCSW, MPH, CYI

Author of Mindfulness-Based Elder Care, Consultant, New York City

Kimberly Coder, LSW

Social Services Director, Barclay Friends,

A Kendal Affiliate in West Chester, PA

The Art of Mindfulness: Cultivating Wellbeing

What is mindfulness? How does it work? What are the research outcomes? How can we bring it home? Practice Q & A

Agenda

60 Minutes

2015

Dr. Richie Davidson Center for Healthy Minds

U-WI Madison 2001

2014

Bill Moyers Healing and the Mind

1993

2012

2008

Dr. Jon Kabat-Zinn Mindfulness-Based

Stress Reduction 1979

Lucia McBee 2008

Paying attention on purpose

in the present moment

nonjudgmentally

--Dr. Jon Kabat-Zinn,

Founder of Mindfulness-Based Stress Reduction

What is Mindfulness?

Mindfulness Practice: 3 deep breaths

How mindfulness works:

Fight or Flight Sympathetic Nervous System

“Gas”

Rest and Digest Parasympathetic Nervous System

“Brake”

Physical:

Decrease chronic pain

Lower blood pressure

Improve sleep

Improve digestion

Strengthen resilience to stress

Boost immune system

What can mindfulness do?

Emotional:

Decrease anxiety, depression, ease grief

Strengthen impulse control:

anger management

weight loss, addictions

Enhance communication:

self-awareness, empathy, teamwork

What can mindfulness do?

Intellectual:

Improve cognitive function

Strengthen focus

Improve decision-making

What can mindfulness do?

MINDFULNESS: THE EVIDENCE

PERSONAL HISTORICAL EMPIRICAL

PERSONAL EVIDENCE: THE MIND BODY CONNECTION

THREE MINUTE BREATHING SPACE

1. Awareness: what is my experience right now?

2. Gathering: focus on the breath.

3. Expanding: including the entire body in awareness.

Segal, Williams, and Teasdale Mindfulness-Based Cognitive Therapy for Depression (2002)

MECHANISMS OF MINDFULNESS

Attention regulation

Sustaining attention, and returning

Body awareness

Physical sensations

Emotion regulation

Reappraisal (non-judging awareness)

Exposure, extinction, reconsolidation

Sense of self

Dis-identification with static sense of self

Compassion (Holzel et al. 2011)

HISTORICAL EVIDENCE

Based on Buddhist and yogic practices

Origins pre AD, approximately 2500 years

Continuously practiced and refined since origins

All major spiritual traditions include contemplative practice

MINDFULNESS: EMPIRICAL EVIDENCE

The growth in mindfulness research from1980–2015. Results from a search on the term "mindfulness" at the ISI Web of Science database.

MINDFULNESS: KEY STUDIES

Improvements in immune system and brain post MBSR group (Davidson et al, 2003)

Increase in brain’s “grey matter” (governs sensory perception such as seeing and hearing, memory, emotions,

speech, decision making, and self-control) following 8 week MBSR class (Holzel et al, 2011)

Decrease in cellular aging and disease protection: Increase in telomeres (Epel et al, 2009)

For all studies on mindfulness, visit: www.goamra.org

STOP

S- Stop what you are doing

T- Take a breath

O- Observe how you are feeling

P- Proceed with what you were doing

o Get off auto-pilot

o Bring attention to the present moment

o Build capacity to focus in an environment of information overload

o Accept ourselves and others with compassion

Mindfulness skills

1979

Jon Kabat-Zinn founds Stress Reduction Clinic

University of Massachusetts Medical Center

Mindfulness-Based Stress Reduction

1. Teaching from one’s own practice

2. Mindfulness practices:

sitting, body scan, yoga, walking

3. Education on research outcomes

4. Support Group

Mindfulness-Based Stress Reduction Class: 4 main components

Mindfulness-Based Stress Reduction

Kendal at Ithaca Mindfulness for Stress Reduction

8 weeks of 2.5 hour classes

6 weeks of 1 hour classes

45 minutes daily practice 10 minutes daily practice (gradually increasing)

Homework Handouts-voluntary

General population Tailored to older adults and their caregivers

Day-long retreat Weekly 30-minute drop-in sitting meditation

Customizing the Class

20% of community completed since 2012 (25 classes)

2/3 residents, 1/3 staff

Age range: 20s to 90s

4-12 people per class

Unassisted/cane/walker/wheelchair

Kendal at Ithaca class demographics

Gender

Men

Women

Kendal at Ithaca Stories

Mindfulness Practice: Yoga

MINDFULNESS BASED INTERVENTIONS FOR ELDERS AND CAREGIVERS: THE RESEARCH

NEED FOR NEW MODELS OF MEDICINE

Improvements in acute care decrease in death from acute illness = population living longer with 1+ chronic conditions

Treatment of chronic conditions is symptom management not cure

New models of care: palliative and CAM/integrative

PHYSICAL AND EMOTIONAL BENEFITS

Review of 15 peer-reviewed, quantitative studies support feasibility and acceptability of MBSR for older adults (Geiger et al, 2015)

Mindfulness interventions decrease:

Psychological distress (Young & Baime, 2010).

Sense of loneliness and pro-inflammatory gene expression in elders (Creswell, et al, 2012)

Lower back pain (Morone, Greco & Weiner, 2008)

Depression (Helmes & Ward, 2015)

Blood pressure (Palta et al, 2012)

COGNITIVE BENEFITS

Meta analysis of 7 studies suggest a positive effect of meditation techniques on cognitive functions in the context of aging and neurodegenerative diseases (Marciniak, et al. 2014)

Meta-analysis of 12 studies indicates meditation for older adults feasible and may prevent cognitive decline (Gard, Holzel & Lazar, 2014)

MBIs have been shown to increase telomere activity, and hold potential to thus impact cognitive decline (Sapozhnikov, 2015)

MBSR FOR ELDERS WITH MCI

MBSR and other Mindfulness Based interventions with modifications are teachable to elders with MCI (Mild Cognitive Impairment) and demonstrate:

Improved cognition, memory and wellbeing (Wells et al, 2013; Hyer, et al, 2013;

Sapozhnikov, 2015; Larouche, Hudon & Goulet, 2015)

MINDFULNESS BASED INTERVENTIONS for ELDERS WITH ALZHEIMER’S DISEASE

Large control group 2 year study compared cognitive stimulation, progressive relaxation and mindfulness interventions for elders with probable AD (Canary Islands)

Participants in groups with mindfulness remained stable in cognition, functionality and behavioral problems

Participants in 2 control groups declined in these areas (Hernández et al, 2014; Hernández & Barrachina, 2015).

MINDFULNESS GROUPS FOR

INSTITUTIONALIZED ELDERS

Elders who completed MBSR showed improvements in mood and health related quality of life (60% drop out, homework not feasible) (Ernst et al, 2008)

MBEC participants show improved quality of life and trends towards improved pain CDs and homework not feasible

Attendance irregular

Ongoing group more successful than time limited group (McBee et al, 2004)

QUOTES

“Makes me feel at peace with the world. It helps my whole body and spirit. I forgot all my troubles.”

“I’ve always liked this [group] since I started.. being quiet, relaxed.. a special feeling.”

“I feel more alive in spite of the pain”

“I feel uplifted. I realize we all have pain. We talk about how we are getting along. It is important to be with other people.”

(McBee, 2008)

STOP

S- Stop what you are doing

T- Take a breath

O- Observe how you are feeling

P- Proceed with what you were doing

Mindfulness Based Elder Care: OVERVIEW

Connect- with each person, regardless of disability or impairment

Communicate- create novel, non verbal ways of communication

Care for the caregivers- bringing stress reduction skills to all persons engaged with elders

MBEC APPLICATIONS FOR ELDERS

• Groups for nursing home residents with physical and cognitive disabilities

• Groups for elders with moderate-severe dementia and behavioral problems

• 1:1 with isolated elders • MBEC by telephone

TEACHING ADAPTATIONS

Shorter groups

Simplified language

Increased repetition

Imagery simplified with use of key words

Stretches, meditations and other exercises modified for elders

Verbal, visual and physical cuing

ENVIRONMENTAL ADAPTATIONS

Creating a calming milieu

Aromatherapy

Music

The most important factor is the teacher

A calm demeanor

Flexibility

Acceptance

TEACHING MEDITATION TO FRAIL ELDERS

Shorter practice time

More directive, less quiet time

Repetition

Concrete language

Consider tone of voice

Use visual cues

YOGA

Meditation in movement

Learning to listen to our body

Breathwork is also yoga

Working with abilities not disabilities

Exploring our limits (edges)

Becoming stronger, more flexible and more balanced

ADAPTING YOGA FOR

FRAIL ELDERS

Postures can be adapted for wheel chair or bedbound Demonstrate visually Give hands on guidance Remind elders to breath Focus on what elders can do!

ADAPTING YOGA

For caregivers Postures can be integrated into daily life Standing and seated mountain pose Diaphragmatic breathing

For both elders and caregivers Teach a reconnection with the body Be positive and have fun

DIAPRAGMATIC BREATHING

STOP

S- Stop what you are doing

T- Take a breath

O- Observe how you are feeling

P- Proceed with what you were doing

CARING FOR THE CAREGIVERS

• Emphasize importance of stress reduction

• For physical and mental health

• For communications with care receiver

• Consider short meditations and those that can be integrated into a busy life

• Integrate meditation that can be used while caregiving

MBEC FOR CAREGIVERS

Staff stress reduction offerings One, one hour in-service for entire staff Seven session class for interdisciplinary

staff on two units Wellness coordinator offering stress reduction

Family and friend caregivers

Nursing home residents and caregivers together

QUOTES FROM STAFF

“The deep breathing was so soul searching and relaxing. It makes me more aware of myself.”

“I appreciate taking the time during the day when it’s stressful, to learn ways to come back to a state of equilibrium.”

“I know how to control myself when I feel nervous and angry.”

“I am pretty flexible for my age. I like myself.”

TREVISO (Italy) ELDER CARE MODEL (ISRAA) AN INTEGRATIVE APPROACH TO ELDER CARE

850 residents, 4 facilities, 27 care units, 2 day care centers, 1 Specialized Dementia Centre, 32 independent living flats 690 staff, Budget 30 million € MODELED ON: Person Centered Care (Kitwood)

Alzheimer Cafè (B. Miesen)

Ambiguous Loss (P. Boss)

Mindfulness-based elder care (McBee)

Mindful Ageing, Family Systemic Model, Age friendly community (World Health Organization)

The most important intervention we can bring to our elders is our selves-

who we are in each moment. - McBee

How to Bring Mindfulness to Your Communities:

A Beginner’s Perspective

The Start of Mindfulness at Barclay Friends, Kendal Affiliate

• Wellness Committee for Staff - Weight Loss Group and Guided imagery - Roving Meditation In-services

(5-10 minutes) • Compassion Fatigue and Self-

Care In-Services - Education: Symptoms and

Prevention - Self-reflection of current and

desired lifestyles - Mindfulness Practices

Modified Mindfulness Practices and Tools for Direct Care Staff

5-10 minute guided meditation

Deep breathing exercises

Mindful eating exercises

Use of reflection to set intentions

Creating a Maintenance Self-Care Plan: Assessing mind, body, emotions, and spirit

Informal visualization of “happy place” for stressful times

From Informal Practice to Formal Mindfulness Meditation Groups

• Support from your Executive Director and Wellness Program

• Determine who will facilitate the groups

• Facilitator training and daily practice

• Determine who will be included: staff, residents, and/or family members

Qualifications and Training

Mindfulness-Based Stress Reduction (MBSR): 8 Week courses which were originated by Jon Kabat-Zinn at the University of Massachusetts

Certification Programs: Durations vary although many are one year training programs

MBSR and certification programs are typically offered at universities and hospital systems

Local meditation and yoga centers

Barriers and Feedback

“Too much noise:” Choose your setting wisely.

“Too busy:” Consider the duration of your group.

“You’re going there?” Expect some judgment from others.

Let’s Pause for a short

guided meditation

1) Notice the sensation of breath

2) When your mind wanders, bring your attention back to your breath

Resident-Centered Groups: Structure and Plan

Consider varying degrees of cognitive ability

Consider location of group(s) offered and accessibility for your residents

Will you offer different

groups for different levels of care or offer inclusive groups?

Resident Groups at Barclay Friends

Monthly groups are offered in both our skilled nursing and personal care communities

Residents from either community may decide to attend both groups

Group times/locations are announced on both recreation calendars

Guided Imagery with Sensory Components

Benefits to Residents

Fosters a sense of community and belonging

Cultivates a feeling of security and safety

Greater acceptance of aging

Stress management Pain management Connection to higher

power and spirituality Reminiscing and

reflection

Put on your own oxygen mask first!

While stress is contagious, a relaxed attitude is also

contagious.

You can be a powerful source of change just by

taking steps to reduce your stress!

Lucia McBee, Consultant, Author of Mindfulness-Based Elder Care

lucia@luciamcbee.com Laura Peters, Human Resources Development and Learning Manager, Kendal at Ithaca Lpeters@kai.kendal.org 607.266.5360 Kimberly Coder, Social Services Director, Barclay Friends, A Kendal Affiliate Kcoder@bf.kendal.org 610.918.3437

Contact information

Appendix

Improve assessment skills Reduce errors when administering complex procedures Improve listening skills Enhance communication through higher level of empathy,

self-awareness, and non-reactivity Increase resilience to stress Source: American Nurse Today, Sept. 2015 https://americannursetoday.com/mindful-nurse/

Benefits for Nursing Staff

13,000 employees (25%) 2011 to date completed free meditation/yoga classes at Aetna

Stress level: 28% reduction

Sleep quality and pain: 20% improvement

Reduced rates of heart rate variability and cortisol (markers of stress) validated self-reports

Efficiency gain: 62 min./week

$3,000/employee/year

2012: health care costs dropped 7% (11:1 ROI)

Aetna Mindfulness Class Outcomes

Mark McLellan, Director of the Robert J. Margolis Center for Health Policy and Margolis Professor of Business, Medicine and Health Policy Duke University 2015 Leading Age Conference Presentation Health care financial reform to “align payments with value at the person level” Innovation toward “personalized, prevention-oriented” care

Health care funding implications

Steve Jobs Bill Ford Google “Search Inside Yourself,” Leadership Institute (SILYI) General Mills Institute for Mindful Leadership: Janice Marturano clients include Centers for Disease Control, Mayo Clinic BlackRock Financial Services Aetna

U.S. Marines “M-Fit” (Mindfulness-Based Mind Fitness Training) U.S. Olympic Rowing Team, Seattle Seahawks, Boston Celtics UCSF Law students-Prof. Rhonda Magee

Meditators

When you’re mindful, you’re aware of your presence and the ways you impact other people….And that prevents you from slipping into a life that pulls you away from your values. Bill George, Harvard Business School professor