Coupled with normal age-related regression in muscle mass, adults with cognitive impairment are at high risk for exacerbated declines in muscle strength, associated psychological well-being, and overall independence. Working from the environmental press model, a 12-week strength training intervention was designed to both support participants' continuing abilities and meet varied needs. Tailoring the environment helps optimize participation, which is essential if participants are to experience the greatest possible gains from a group-based exercise program. The intervention was a group-based, progressive strength training program designed specifically for adults with dementia at two dementia care centers. The exercises were performed three times each week and the sessions were led by the centers' activities leaders. Participants used hand-held barbells when performing the upper-body exercises. Findings indicated that individuals retain the capability to enhance their own quality of life through active participation in a therapeutic intervention. This is illustrated by the consistent effort of exercising participants to perform appropriately during the exercise intervention. Not only were adults able to demonstrate effort to appropriately participate, but the intervention supported high levels of correct performance of the exercise repetitions which is important for achieving physical gains. Exercisers did not experience improvement in physical abilities nor did they significantly differ at posttest from non-exercising participants in measures of physical ability and function or quality of life. The program was deemed to be a feasible intervention for adults with dementia as indicated by both regular participant attendance at the program sessions and high levels of effort to engage appropriately in the exercises. Due to the lack of opportunities for adults with dementia to participate in stimulating or meaningful activities, and the individuals' susceptibility to excess disability, the strength training program is a viable intervention to incorporate into the regular activities programming at dementia care centers. Future research should utilize the progress made by this study to continue exploring the environmental variables that most greatly affect the participation of adults with dementia, as well as outcome measurements that best capture important effects of participation in exercise for these individuals. / Ph. D.

Engaging persons with dementia in meaningful activities supports well-being; however care staff are challenged to identify activities that are developmentally and generationally appropriate in a group setting. In this study, I compared a randomly assigned treatment group (HT) to a comparison group (traditional activities) on outcome variables, including engagement, affect, and problem behaviors. HT programming was implemented twice weekly at four treatment sites for six weeks, while traditional activities were observed at four comparison sites during that time period. A mixed method assessment was undertaken to examine the processes and outcomes that influenced the observed outcomes and the interrelationships between these dependent variables. Data was gathered from a variety of sources using a range of methods, including structured observational assessments, semi-structured interviews, and a focus group session. Informants included persons with dementia, traditional activity facilitators from the comparison sites, and observational research team members. Nonparametric Mann Whitney-U analyses were used to compare the treatment and comparison groups on behavioral and affective domains, while multiple correspondence analysis (MCA) was used to examine the interrelationships between these outcome variables. Analytic induction and constant comparison enabled the researchers to identify factors that affected the implementation of the intervention and its subsequent impact on the participants. Mann Whitney-U results revealed no statistical differences between the HT and traditional groups on the three affective domains; however, levels of adaptive behavior did differ between the two groups, with the treatment group demonstrating significantly higher levels of active, passive, and other engagement, and the comparison group demonstrating significantly higher levels of self-engagement. MCA analyses indicated that individuals who exhibited high level of active engagement were also likely to display high levels of pleasure and low levels of non-engagement, further supporting the value of active engagement in activities to optimize well-being. Qualitative findings highlighted the importance of simultaneously capturing the participants' responses as well as indicators of the social and physical environment to gain a holistic understanding of the intervention and associated outcomes. Results demonstrated that while HT programming results in positive outcomes for participants, facilitation of therapeutic activities for persons with dementia is a critical element influencing the targeted outcomes. / Ph. D.

The purpose of this paper is to integrate and synthesize the literature from the fields of Horticulture Therapy (HT) and therapeutic activities for persons with dementia using the theory of environmental press Utilizing horticulture as a treatment modality, the therapist can either modify the environment or the person's competence level or both to assist persons to reach the desired Adaptation Level (AL). The AL represents an appropriate person-environment fit, and attainment of this zone is demonstrated by positive affect and adaptive behavior. At this time, research about HT for persons with dementia is limited. Applying theory to research is essential in order to clarify the appropriate outcome measures, independent variables, and research designs to the study. Therefore, research that fails to utilize theory often does little to contribute to the advancement of the field. This paper offers an environmental press perspective about HT for persons with cognitive impairment. / Master of Science

There is an evident gap in the research regarding the environmental needs of older adults with Alzheimer's disease and related dementias (ADRD) and the design of therapeutic outdoor spaces for these persons. With the rapid growth of the aging population, appropriate outdoor spaces will become essential to improved quality of life for older adults with ADRD. This study explores nonpharmacological treatment approaches for persons with ADRD that can be facilitated in the outdoor environment. The study presents an examination of the literature, including theoretical frameworks and treatment approaches, interviews with professionals in the fields of landscape architecture and gerontology, and an assessment of case studies. Design guidelines identify the necessary landscape elements that can be incorporated in outdoor environments to reduce maladaptive behaviors and improve positive affect and the overall quality of life for persons with dementia. This study concludes with an example of a prototypical wander garden design that responds to the design guidelines and addresses the physical and mental capabilities of persons with ADRD. / Master of Landscape Architecture