Can Extension Programs Help Communities Educate Older Adults About Age-Associated Memory Loss?

Introduction

It may happen as early as age 30, but it usually begins a decade or two later. Age-associated memory difficulties are a reality for older adults. Some amount of forgetting is present in at least 50% of people over age 50 (Harvard Health Publications, 2000).

Memory loss is demonstrated when an older adult has difficulty recalling a familiar name or remembering the location of a personal item. Problems range from short delays in retrieving information to a complete inability to recall facts. These memory difficulties are unsettling and even frightening for aging adults. They have an impact on activities of daily living and cause individual and familial distress (Rabins & Margolis, 2004).

Oregon State University Extension faculty has developed educational materials that can assist in making the distinction between simple forgetting and substantive memory difficulties. A 90-minute workshop, Memory Difficulties: Should I Be Worried?, has been offered to over 1,000 people in southern Oregon. In 2005, it was awarded the MetLife Foundation MindAlert Award, one of five such awards given in the nation.

Identifying the Problem

Acquiring information about age-associated memory loss is not always easy. Much of the existing material on memory impairment focuses on dementia, rather than age-related forgetting. Health literacy plays a role. Low health literacy, the limited ability to read and/or understand health-related materials, is present in almost half the population. Older adults are twice as likely to have these difficulties (Sanders, 2005).

Problems are further exacerbated because aging adults may be reluctant to talk about memory problems other than a quick joke about "senior moments." Aging individuals sometimes hesitate to reveal memory difficulties because it's seen as a threat to personal well-being or an admission that opens the door to discussion of a possible diagnosis of dementia (Schmall & Bowman, 2000).

Posing a Solution

In southern Oregon, community interest in understanding and managing age-associated memory loss is strong. A local hospital's community education administrators requested that Extension faculty design educational materials focused on age-related memory challenges. The result was the development of a workshop, Memory Difficulties: Should I be Worried?, a 26-slide PowerPoint presentation with easy-reference fact sheets and a memory road map. Participants in the workshops are given materials identifying the seven most common memory problems, with specific ideas about how to manage them (Schacter, 2001). A brief memory recall test, used mid-workshop, allows the participants to self-assess their own memory ability (Sizer & Whitney, 2000).

Understanding the Role of Lifestyle

Memory Difficulties: Should I Be Worried? focuses on the practical aspects of simple forgetting. It challenges participants to look closely at their activities of daily living and overall lifestyle as a possible explanation for memory loss (Rabins & Margolis, 2003). Figure 1 shows the lifestyle factors that may affect memory.

The workshop materials introduce alternatives or accommodations to assist individuals in modifying specific memory-related problems. For example, in response to stress-related memory issues, deep breathing and relaxation exercises are explained and briefly practiced. In response to nutrition-related memory problems, information is provided about the role of fruits like blueberries and vegetables like spinach and kale. (Snow, 2002)

Recognizing the Use of Social Supports and Memory Aids

Factors such as social engagement and mental aerobics also play a role in the ability to recall information (Snow, 2001; Margolis & Rabins, 2002). Individuals who participate in these workshops are introduced to memory aids that range from talking to your keys, "Car keys, I am hanging you on the hook by the back door," to the use of pneumonic devices, "I will remember the name Mary Decker by envisioning her in a wedding dress on the deck of a boat" (Harvard Health Publications, 2000).

Recognizing When Memory Loss Is a Significant Problem

The workshops draw from current research on age-associated memory loss. The educational messages encourage older adults and their family members to think about memory-related difficulties from a practical and solution-oriented perspective.

The workshops acknowledge some memory problems can be precursors to dementia. The question is posed, "When is memory loss a significant problem?" Four possible responses are put forward for discussion (Harvard Health Report, 2000; Rabins & Margolis, 2004)/ Figure 2 shows four memory problems that indicate that memory loss may be a problem.

The workshop instructor prompts the participants to think about the above-identified situations in terms of a "rule of three." If three people, from different areas of the individual's life identify a memory problem, there is a need for further intervention. For example, if concerns about your spouse's memory difficulties are expressed by your neighbor, a daughter who lives at a distance, and the pastor of your church, there are multiple indications of the need for clinical referral.

Evaluating the Impact of Memory Workshops

The Memory Difficulties: Should I Be Worried? workshops have been evaluated in terms of quality of content, relevance of content, and quality of presentation/format on a 1-5 scale, with 5 being excellent. The workshop evaluations were consistently rated in the 4.8-5.0 range in each category.

In 30% of the workshops, a retrospective self-evaluation tool was used to assess knowledge gains. Evaluation responses were sought in four areas: 1) understanding of age-related memory loss, 2) factors that affect memory, 3) how to relate to a person with memory loss, and 4) how to recognize when memory loss is significant. Completed evaluations identified statistically significant knowledge gains in all four areas.

Continued use of the same evaluation tool with a larger sample of workshop attendees is in process. It is to be coupled with postcard follow-up 2 months after the date of the workshop to determine continued application of the knowledge gained.

Conclusion

Educating older adults and their family members regarding age-associated memory difficulties will become increasingly important as the percentage of aging adults in the population continues to increase. Oregon State University's experience with Memory Difficulties: Should I Be Worried? demonstrates that clearly presented, easy-to-understand information on age-associated memory loss can be beneficial to individuals and families.

The PowerPoint version of this nationally award-winning workshop is available by contacting the author <s.johnson@oregonstate.edu>. It is designed for easy replication. The goal is to assist Extension educators in responding to older adults in their communities who want practical, research-based information about age-related memory difficulties.

References

Gordon, B. (2004). Improving memory: Remembering and forgetting in everyday life. MasterMedia Limited, New York.

Harvard Health Publications. (2000). Improving memory: Understanding and preventing age-related memory loss. Harvard University, Boston MA

Rabins, P. V., & Margolis, S. (2002, 2003, 2004). Memory. The Johns Hopkins White Papers, Baltimore, MD

Sanders, J., (2005). The effects of literacy on health care. Florida Health Care Journal Policy Brief. Available at: http://floridahealthstat.com/publications/fhcj/article5.html

Schacter, D. L. (2001). The seven sins of memory: How the mind forgets and remembers. Houghton-Mifflin, Boston, NY

Schmall, V., & Bowman, S. (2000). Helping memory impaired elders: A guide for caregivers. Pacific Northwest (PNW) Extension Publication. Oregon, Washington and Idaho

Sizer, F., & Whitney, E. (2000) Nutrition concepts & controversies. Wadsworth /Thomson Learning, Belmont, CA

Small, G., (2000) The memory bible: An innovative strategy for keeping your brain young Hyperion, New York