Clinical Handbook of Mindfulness (120 page)

experience some restoration and skill building during the group, it may help

them when they are not in the group. Staff groups, also, are often held in the

dining area. I use aromatherapy and music for some groups to create a milieu

that may support the mindfulness practice.

Exclusionary Criteria

Given the broad adaptations of mindfulness skills, there is no reason to

exclude anyone who can safely participate from MBEC. MBSR classes often

screen out persons with a history of trauma or abuse. Psychosocial history

442

Lucia Mc Bee

of frail elders may be limited, and they may not be able to supply infor-

mation themselves. Therefore, teachers should be aware of participant’s

verbal and non-verbal response to the interventions and make adjustments

accordingly.

Nursing home residents may have cognitive or physical impairments, or

both. Unless a resident is unable to get to the group, physical impairments

should not prevent participation in appropriate exercises. Residents with

cognitive impairments can also be included in groups unless their behavior

is too unsafe or disruptive to other participants. I usually allow for some inter-

ruptions, encouraging the participant to settle in. If the disruptive behavior

continues, I will ask staff to take the resident to the other end of, or out of,

the room. Encouraging acceptance of others in the group can be part of the

group’s practice.

When I first thought about offering such groups to our population, I won-

dered if the elders would be open to new experiences. What I found is that

most residents are surprisingly open and receptive. There are also some resi-

dents who are clearly not interested. One resident, discussing her pain, said,

“Just give me a pill.”

I also consider the language I use to describe the group and the practices:

Meditation can be sitting quietly, yoga can be gentle stretches, and the groups

can be stress-reduction groups or relaxation groups. During the course of

the group, I integrate language that might be less familiar to them, including

meditation and mindfulness.

Communicating

One of the most difficult losses for elders is the loss of ease in communica-

tion. Some elders are vision impaired. Others may be hard of hearing. Oth-

ers may speak very softly due physical problems. The group is a wonderful

opportunity to focus on strengths! For example, I will sit next to a resident

who is hard of hearing so that I can speak directly into his or her good ear.

I move around a lot in groups so that I can make sure that I am communi-

cating with each resident. I often repeat what one resident said so that the

entire group will hear. I find hands-on and touch are also helpful in guiding

residents.

Ongoing Groups or Time Limited

A key component of traditional MBSR groups is that they are time-limited.

For nursing home residents, however, I found that ongoing groups are more

beneficial. Residents face many daily challenges in the nursing home and

carryover, the ability to maintain the practices and learning, is difficult. As

previously discussed, residents did utilize some of the practices, like deep

breathing, but were not able to practice other skills outside of class. Con-

crete reminders like handouts can help participants recall the mindfulness

practices. Long-term effectiveness for caregivers may reflect the results docu-

mented in multiple studies on MBSR. Given the stress of caregiving, however,

refresher groups may be helpful.

Chapter 23 Mindfulness-Based Elder Care

443

Conclusion

The explosive growth of the older adult population with the concurring pro-

jected growth in chronic conditions cries out for modalities that address

these conditions. Complementary and alternative medicine (CAM) use is

increasingly accepted and utilized. In 2000, approximately 1000 United

States citizens over 52 were interviewed about their use of CAM and 31%

of those over 65 utilized meditation
(Ness, Cirillo, Weir, Nisly, & Wallace,

2005).
Tilden et al. (2004)
interviewed 423 caregivers about the use of CAM

during end of life care. Decedents median age was 57 and 50% of the care-

givers reported the decendent’s use of relaxation techniques. Another US

study reported that of 2055 adults interviewed in 1997–1998, one in five

used at least one mind-body therapy in the last year. Meditation, imagery

and yoga were the most commonly reported (Wolsko, Eisenberg, Davis, &

Phillips,
2004).

Mindfulness training adaptations benefit frail elders holistically offering

skills to address physical, spiritual and emotional needs. In addition, train-

ing caregivers in mindfulness practices impacts both those who give care

and those who receive it. Future research will dictate and refine the differen-

tial use of mindfulness interventions for cognitively and physically impaired

populations and their caregivers. The difficulty in quantifying results in a

population often unable to communicate, and with results related to quality

of life and difficult to quantify, should not deter further investigation into the

benefits of their profound practice for this compellingly needy population.

Acknowledgements:
The author wishes to thank Victoria Weill-Hagai for her

editorial assistance, and Sue Young and Dr. Gary Epstein Lubow for their

comments.

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