P2. Psychosocial interventions
Detailed Programme, abstracts and presentations
P2.1. Effective cognitive training based on surface computers: a multi-national, multicentre, non-randomised, placebo-controlled efficacy study
Stelios Pantelopoulos, Paraskevi Sakka, A. Miliou, O. Lymperopoulou, E. Danasi
In this paper we describe a multi-national, multicentre, non-randomised, placebo-controlled efficacy study which aims at manifesting the merits of cutting edge ICT technology (notably surface computing) for cognitive training of the elderly. This study is part of the SOCIABLE project which includes creating, piloting, evaluating and promoting a novel ICT based model for cognitive training and social activation of elderly people. The pilot study is taking place in multiple hospitals and care centers across four different countries (Greece, Italy, Norway and Spain) for duration of approximately eighteen (18) months. It involves 350 elderly users with normal cognition, mild cognitive impairment (MCI) or mild form of dementia supervised by health professionals (carers, gerontologists, neurologists, neuropsychologists and other).
The primary objective of this study is to evaluate the effects of a computer-based cognitive training and social activation program on the cognition, the affection and the functional abilities of the participants, in the scope of a disciplined and clinically sound process that involves the following steps:
Cognitive, affective and functional assessment of the elderly users based on a proper neuropsychological battery administered to them prior to their inclusion in the SOCIABLE programme. This assessment serves as a vehicle for classifying them in one of the three SOCIABLE target groups (normal/healthy elderly, elderly with MCI, and elderly with mild dementia). Furthermore, the neuropsychological tests will help the health professionals to identify the deficits and needs of the users.
A number of preparatory activities towards the SOCIABLE sessions are carried out by health care professionals. These activities include briefing/training the elderly in the use of the SOCIABLE surface platform and preparing his/her sessions on the basis of his/hers cognitive record.
Implementation of a SOCIABLE programme comprising several sessions. Each one involves specially designed cognitive training games and the Book-of-Life application for social activation. Furthermore, the elderly is given the opportunity to interact with other elderly via a set of communication applications and services. The duration of a SOCIABLE programme is 3 months, 2 sessions per week, each one of 60 minutes duration.
A Satisfaction Questionnaire follows the completion of a SOCIABLE programme in order to get users’ feedback on the procedure. This Questionnaire is an element of the users’ evaluation of the SOCIABLE approach.
A cognitive, functional and affective assessment will be carried out at the end of the 3 months program in order to evaluate the impact of the SOCIABLE intervention.
P2.2. Cognitive stimulation therapy in a group of patients with dementia
Petra Bevilacqua, Annalisa Bonora, Lucia Bergamini, Rabih Chattat, Andrea Fabbo
Purpose: Non-pharmacological therapies are commonly used for the treatment of people with dementia. Among these, several studies have demonstrated benefits in the cognitive domain (Olazaran J. et al. 2010; Spector A. et al 2010; Aguirre E. et al. 2010). The aim of this study was to evaluate the maintenance benefits of the cognitive stimulation therapy through repeated cycles of weekly sessions.
Methods: The present study was a non-randomised controlled study and included one group of subjects: 18 patients (mean age 75,83 ± 8,54 and education 2,39 ± 0.9) affected by mild dementia (MMSE, corrected score 22,5± 2.25) were treated with a systematic cognitive stimulation therapy (CST protocol, Spector A. et al. 2001, 2008). First, an intensive training was executed twice a week (14 sessions); afterwards, weekly maintenance trainings were activated (overall 10 sessions). In particular, the latter was made at the end of intensive training. Outcome measures evaluated the cognitive performances (MMSE and ADAScog), everyday abilities (ADL and IADL) and the subjective well-being (SF-12 and GDS-15). Neuropsychological evaluations were administered both before and after the intensive training, and also for the maintenance sessions.
Results: At the preliminary analysis, comparisons before and after the maintaining sessions an effect of stabilization of the cognitive performances was evident although there was no significant increasing in cognitive scales (MMSE and ADAS-COG) administered before and after treatment.
Conclusion: Cognitive stimulation is a psychosocial intervention recognised in people affected by dementia that has beneficial effects on cognition both in the short and long term period. Preliminary data obtained from our group of patients, treated through a systematic sessions of CST, seems to suggest an effect of maintaining of the cognitive performances.
Disclosure of Interest: None Declared
P2.3. Meaningful life for people with dementia through logotherapeutic model of dementia care
Sirkkaliisa Heimonen, Minna Laine
Logotherapy emphasises human value and finding a meaning. Applied to dementia care, the ideas of logotherapy underline the human value, uniqueness and resources of the person with dementia. The meaning of maintaining hope and finding possibilities in daily encounters is central. The logotherapeutic model of dementia care is based on the idea that people with dementia have a right to meaningful life and to be encountered as unique and valuable persons with their individual resources.
The daily encounters are very important for both a person with dementia and a nurse, because, at best, they support wellbeing and quality of life for the person with a dementia and, for the nurse, they offer many opportunities for learning. The nurse’s philosophy, attitudes and choices play a central role in the quality of these encounters and how persons with a dementia can lead a meaningful life. According to logotherapeutic thinking, the meaningfulness of life can be fulfilled by adopting an attitude, by acting or by experiencing. In the early stages of a dementia, the significance of attitude is high but, with the advancing illness, the experiences of success and self-realisation through action become more important. To the very end it is possible to fulfill the meaningfulness of life by enjoying experiences.
The Logos project (2008-2010) by the Orivesi Association of Nursing Services combined philosophical thinking of logotherapy with the latest knowledge of good dementia care. This project aimed to improve the quality of life of people with dementia and support the continuance of their life stories. The logotherapeutic model of dementia care was developed in five care units. This development process was supported by joint training days (7) and monthly tutorial meetings for the personnel. In addition to this, in each unit they used diaries with nurses’ evaluations and experiences of the development process. At the end of this development process these diaries contained a summary of the logotherapeutic model developed in each unit. The results of the project showed that the logotherapeutic thinking is highly applicable in dementia care. The nurses reported an increase in the capacity to find alternatives and possibilities, their understanding of the situation of persons with dementia had improved, and their experience of the importance of their work had increased.
On the basis of this project it seems that the logotherapeutic model is applicable in elderly care as well. At the Age Institute a new project is launched in which the main aim is to enhance the mental wellbeing of older persons, and for reaching this aim the logotherapeutic perspective is used for example in arranging peer support groups for vulnerable older persons (e.g. persons with early stage dementia). In this project, the logotherapeutic model in dementia care is further developed and widely disseminated.
P2.4. Still caring. An innovative and responsible approach.
Luisa Bartorelli, Alessia Fiandra, Silvia Ragni, Stephanie Levi
The Alzheimer Centre of the Fondazione Roma has developed two distinct yet interconnected services – a Day Centre and a Home Care Service. The Day Centre not only provides activities to patients to fill a void in their lives, but also serves as a prosthetic space to stimulate their cognitive functions, encouraging meaningful relationships, sustaining their dignity and helping them to continue their roles as long as possible. When a patient’s condition worsens so that he or she can no longer participate in the activities of the Day Centre, the Home Care Service takes over, guaranteeing the continuity of support at home, where the patient’s own personal history and identity can be best preserved.
Care is given to the patients in both the Day Centre and at home by a multi-professional team consisting of geriatricians, psychologists, nurses, physiotherapists, health-care workers and social workers. The team is trained to make a multi-dimensional assessment of patients with complex problems using a global approach. The activities then created take into account the stage of the disease and the individual patient’s lifestyle and personal background.
The Day Centre runs the usual activities such as memory training (ROT), occupational therapy, motor activities and music therapy. However, some innovative therapies are periodically inserted into the schedule, including cognitive empowerment, the use of violins in music therapy, dance-movement therapy, art therapy (such as including creating cartoons), drama therapy, pet therapy with unusual animals such as frogs, and a special memory project involving the projection of films that capture earlier periods in the patient’s own life. A training course called “The Savvy Caregiver” is also offered for the family, instead of the usual support groups.
Some of these same activities are continued within the home as part of the Home Care Service, personalized for the individual patient and adapted to the environment. The innovative aim is to provide stability by using the same professional team and many of the same activities that are used in the Day Centre while constantly attending to the changing needs of the patient and family in the home.
These two services rely heavily on the competence and creativity of the staff. With a total of 315 patients in the Day Centre (since 2003) and 142 patients (since 2008) in the Home Care Service, this project has shown positive results on cognitive and behavioural parameters. These services have contributed to a modification of the natural history of the disease in terms of slowing its progress and creating a better quality of life for the entire nuclear family.
The Day Centre provides for a daily maximum of 15 patients who are still in the mild/ moderate stages of the disease and who do not often present severe behavioral disturbances. The Home Care Service is currently supporting 55 patients in moderate/ severe stages of the disease including some with behavioural disturbances. The connection to a neighbouring hospice allows for some patients to be supported up to the terminal phase of the disease.
All of these activities described above are extensively documented in photographs and video which can be presented.
P2.5. The impact of a short-term multicomponent residential treatment programme on activities of daily living in persons with dementia
Barbara Romero, Christina Jonas, Constanze Lahmeyer, Friedemann Müller, Matthias W. Riepe
Background: To support long-term participation in activities of daily living of people with dementia an intervention programme for patients and family caregivers is needed.
Aims: To test the hypothesis that a short-term residential treatment programme would benefit activities of daily living of people with dementia
Method: A controlled trial with pre-treatment 3 months and 6 months follow up design recruited 202 people with dementia. The outcome measures are changes in cognitive functions, quality of life and activities of daily living. The multicomponent programme was designed to prepare patients with dementia and caregivers for life with a progressive disease. The programme includes: (1) medical treatment and intensive rehabilitation for patients, based on the concept of Self-Maintenance Therapy, and (2) an intervention programme for caregivers.
Results: Results of the study will be presented in October 2011. We predicted that at follow up the intervention group had better outcome relative to the control group on “Activities of Daily living” (Bayer–ADL) and on “Instrumental Activities of Daily living” (iADL) scales.
Discussion: The long-term relative stability of everyday function and social participation can be seen as beneficial for patients.
The study was funded by the Federal Ministry of Health (BMG-LTDemenz_04_61).
Last Updated: mercredi 26 octobre 2011