Strategies for Memory Improvement in Older Adults

Jane S. Saczynski, PhD; George W. Rebok, PhD

Disclosures

Topics in Advanced Practice Nursing eJournal. 2004;4(1) 

In This Article

Case Vignettes

Two case vignettes, with typical memory concerns often raised by middle-aged and older adults, are offered for example of diagnostic and treatment plans.

Case 1: A 56-Year-Old Woman Juggling a Busy Life

A woman, aged 56 years, who is caring for her elderly father and 2 teenaged children comes in complaining that she is having trouble sleeping. She reports that she also works a full-time job as a paralegal and is often embarrassed at work because she cannot remember the names of clients to whom she has been recently introduced.

Because of the age of the patient and the complex tasks of daily living she performs for herself, her family, and her father, it is unlikely that she is demented, so the APN decides not to screen with the MMSE. Following a thorough assessment, the APN tells the patient she is more likely suffering from memory impairment associated with stress. The APN first discusses issues related to anxiety with this patient as she is clearly under an enormous amount of caretaker stress. Additional resources specific to caretaking (ie, support groups in the area, adult day care service, etc.) are discussed at the beginning of the session before addressing memory strategies.

Following a discussion of external factors related to memory performance, visualization and association are explained and practiced with the patient. Two follow-up sessions are scheduled. During the second session, visualization and association are reviewed and the task-specific strategy, name/face associations, is presented and practiced. The patient practices visualization and association by visualizing a connection between 3 practice words presented by the APN, "fish, car, and globe," and describing the visualization: a car driving on the outside of a globe with an antenna flag in the shape of a fish blowing in the wind. Practice between sessions is emphasized, but the patient returns for the following session with several problems. The patient is experiencing difficulty with remembering faces that lack prominent features. The patient is taught to embellish what is already there (eg, no hair on a partially balding client, large eyes on another woman).

The third session is a review of the first 2 sessions and all 3 strategies, including a discussion of how visualization and association are components of the name/face strategy. Additional practice with the name/face association strategy is provided during the third session. The 3 strategies are incorporated in session 3 by visualizing associations between names and faces. The patient practices during the session with people in magazine pictures. She embellishes the eyebrows on a woman named Lydia, picturing them as very bushy and thick, to remind her of a lion. This association combines the 3 strategies.

Case 2: A Man Aged 72 Years With Memory Complaints

A 72-year-old man who lives at home with his wife comes in for a hearing examination but mentions that he's been experiencing trouble with his memory. Specifically, when he goes to the grocery store, he cannot remember half of the items he came in to buy.

Although there are no signs of dementia, the MMSE is performed by the APN to assess this man's cognitive function. He scores within the normal range, with a score of 26/30 on the MMSE. This score indicates that he does not have dementia but that he may be experiencing normal, age-related memory loss. Following a brief discussion about the difference between normal aging and pathologic decline, as would be experienced with AD or other types of dementia, memory strategies are offered.

Visualization and association are explained and practiced during the first session. The patient has some difficulty with visualization, even when prompted with counting the number of windows in his home. It takes some time to find a visualization that resonates with the patient, but he is able to describe the organization of his toolbox and understands how to visualize the toolbox and contents in order to describe the organization of the toolbox. He is reminded to practice visualizing and associating items and is scheduled for 2 additional sessions.

The second session includes a review of visualization and association and also the presentation of the task-specific list learning strategy. The Method of Loci is presented and a route created. The route the patient chooses is his daily walk to the store to buy lottery tickets with a number of houses and a park for locations to place objects. He starts with 5 locations and is not able to remember all of the items by the end of the session. At the end of the second session, he is reminded to practice the Method of Loci at home with his grocery list before coming in for his final session.

The third session is a review of the 3 strategies learned: visualization, association, and the Method of Loci, in addition to practice with the Method of Loci. The patient is able to recall all 5 items using the Method of Loci and additional locations are added to the route for longer lists. By the end of the third session, the patient is able to associate 9 items with locations on his route to and around the store.

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