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P9. Psychosocial interventions

Detailed programme and abstracts

P9.1. Can the Meeting Centre Support Programme reduce the burden of stigma among people with cognitive deficits?

LION Katarzyna1, SZCZEŚNIAK Dorota2, EVANS Shirley3, EVANS Simon3, SAIBENE Francesca Lea4, D'ARMA Alessia4, SCOROLLI Claudia5, FARINA Elisabetta4, BROOKER Dawn3, CHATTAT Rabih5, MEILAND Franka6, DRÖES Rose-Marie6, RYMASZEWSKA Joanna2

1Menzies Health Institute Queensland, Griffith University, Brisbane, Australia, 2Department of Psychiatry, Wrocław Medical University, Wrocław, Poland, 3Association for Dementia Studies, University of Worcester, Worcester, United Kingdom, 4IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy, 5Department of Philosophy and Communication Studies, University of Bologna, Bologna, Italy, 6Department of Psychiatry and Department of Research and Innovation, Amsterdam University Medical Centers, VU University Medical Center, GGZ inGeest, Amsterdam, Netherlands

Introduction: Although the issue of stigmatisation in dementia is widely discussed around the world, studies investigating the individual experience of people with dementia are lacking.

Aim: This project aimed to a) evaluate the level of stigmatisation across Poland, Italy and the United Kingdom, b) identify corresponding factors and c) assess the role of the Meeting Centre Support Programme (MCSP) in decreasing stigmatisation among people with dementia and mild cognitive impairment (MCI).

Materials and methods: A pre/post-test control group study design compared outcomes for 114 people with dementia and MCI in Italy, Poland and the UK who attended the MCSP or usual care (UC). The stigmatisation level was assessed with theStigma Impact Scale: neurological impairment(SIS) at two points in time, 6 months apart.

Results: The level of stigmatisation (SIS) among participants varied from 2 to 65 (median = 33.5; Q1 = 27; Q3 = 41). People from the UK experienced a higher level of stigmatisation than people in Italy and Poland. Stigmatisation level negatively correlated with social support (rho = -0.42, p = 0.000) and life quality (rho = -0.39, p = 0.000). In Italy, stigmatisation was significantly lower (p=0.02) in the MCSP group following the intervention. Social Isolation level increased significantly (p=0.05) in the UC group after 6 months in Poland. Social Rejection level significantly raised (p=0.03) over time in the MCSP in the UK. Statistical analysis did not show any significant differences for 3 countries combined.

Conclusions: The experience of stigma by people with dementia and MCI is complex. There are country specific contexts and mechanisms. There is still a need for more detailed investigation into stigmatisation experience in different cultures/countries with a more sensitive measuring tool dedicated for people with cognitive impairment. The role of psychosocial interventions in reducing the burden of stigma requires further investigation.

P9.2. Development of a theory of change for an intervention aimed to improve sleep of people with dementia in nursing homes

HALEK Margareta1-2, HYLLA Jonas1-2, BERG Almut3, EGGERS Daniela4, MÖHLER Ralf5, MEYER Gabriele3, KÖPKE Sascha6, DICHTER Martin1-2

1German Center for Neurodegenerative Diseases (DZNE), Witten, Germany, 2School of Nursing Science, Witten/Herdecke University, Witten, Germany,3Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany, 4Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany, 5School of Public health, Bielefeld University, Bielefeld, Germany, 6Institute of Nursing Science, University Hospital of Cologne, Köln, Germany

Background: The literature suggests low to moderate effectiveness of complex psychosocial interventions to reduce sleep disturbances in people with dementia (PwD) living in nursing homes. There is a lack of theory-driven multicomponent interventions and it is still unclear which components are most effective. More information about causal assumptions to create a better theoretical understanding of the intervention is needed.

Objectives: To develop a Theory of Change (ToC) that describes the causal assumptions for reducing sleep disturbances in people with dementia living in nursing homes.

Design and Methods: The ToC approach is a participatory method in intervention development to generate knowledge about how, why, and under which circumstances interventions can be effective. We conducted two expert workshops (n=16), a subsequent expert survey (n=12), a systematic literature review, and expert interviews (day and night nurses).

Results: Our systematic review indicates a low to moderate effectiveness of physical activities, staff training and bedtime routines. The conducted workshops within the ToC pointing out that a complex intervention needs to address staff, management and culture of nursing homes. Intermediate goals like “individual knowledge on people with dementia is available”, “a specific institutional concept to promote sleep is implemented”, “person-centred care is implemented” and “sleep preferences of person with dementia are fulfilled” were defined. All intermediate goals were rated as relevant or highly relevant in the expert survey. Based on the ToC, the new multicomponent sleep intervention includes theory-driven components and will be now tested in a clinical trial.

Conclusions: The ToC model displays how a complex psychosocial intervention is likely to be effective in reducing sleep disturbances and meeting sleep preferences of PwD in nursing homes. It defines the intervention elements and the requirements for a successful implementation. The ToC also provides a theoretical framework for planning a process evaluation along our evaluation study.

P9.3. Implementing two evidence-based eHealth interventions for caregivers of people with dementia: an evaluation of myinlife and partner in balance a municipality context

CHRISTIE Hannah1, BOOTS Lizzy2, TANGE Huibert3, VERHEY Frans2, DE VUGT Marjolein2

1Alzheimer Center Limburg, Maastricht, Netherlands, 2Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, Netherlands, 3Department of Family Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands

Background: Evidence-based eHealth interventions for caregivers of people with dementia are rarely implemented into practice. Due to policy and innovation incentives regarding (dementia) caregiving and prevention, municipalities are being considered as a promising context to implement these interventions. This study examines the implementation of Myinlife and Partner in Balance, two evidence-based eHealth interventions for caregivers of people with dementia, in eight municipalities in the Euregion Meuse-Rhine. The aims were to evaluate the implementation and investigate determinants of successful implementation.

Methods: This study took place in the context of the euPrevent Senior Friendly Communities project. This study collected the interventions’ usage data, administered Partner in Balance coach evaluation questionnaires, and interviewed municipality officials.  The interviews were conducted with an interview guide based on the Measurement Instrument for Determinants of Implementation (MIDI). The different types of data were integrated and mapped to analyze which implementation determinants were linked to successful implementation.

Findings: Implementation was considered successful in five of the eight municipalities. However, only three municipalities planned to continue the implementation of Partner in Balance, while none planned to continue the implementation of Myinlife. Successful implementations were linked to implementer self-efficacy and ownership, which were not as present in unsuccessful implementations. For Myinlife, there was insufficient in-person interaction to foster a sense of ownership in the implementing municipality. For Partner in Balance, implementers experienced uncertainties about their implementation capabilities.

Conclusions: The implementation of eHealth interventions to support caregivers of people with dementia in municipalities was promising. These findings on sense of ownership and self-efficacy as important implementation determinants will give direction to future implementation packages for Myinlife and Partner in Balance. These intervention-specific implementation packages will facilitate sustainable implementation of these interventions and contain concrete guidelines for the municipal implementation team and the implementing health care organizations. 

P9.4. What are we measuring when we test non-drug interventions in MCI and mild dementia? A scoping review

COUCH Elyse, CO Melissa, LAWRENCE Vanessa, PRINA Matthew

King's College London, London, United Kingdom

Background: Non-drug treatments are an important aspect of dementia care, they are often a safe alternative to drug treatments. When testing non-drug treatments there are a wide variety of outcome measures for researchers to choose from. However, this diverse use of outcome measures makes it difficult to make meaningful comparisons between treatments.

Aim: This study aimed to systematically map which outcome measures are being used in studies testing non-drug treatments in mild cognitive impairment and dementia.

Methods: This study was a scoping review of randomised controlled trials of non-drug treatments for mild dementia and mild cognitive impairment. EMBASE, Psych Info, Medline and the Cochrane Register of Controlled Trials were searched to identify relevant papers. We extracted which outcome measures were used by the included studies and explored the trends in the use of outcome measures by type of intervention, country and year of publication.

Results: We identified 91 eligible studies. We extracted 358 different outcome measures, 22% (78) were used more than once. Cognition was the most measured domain with the MMSE being the most common outcome measure. Cognition remained the most consistent domain measured over time, over all types of intervention and country. Despite people living with dementia and their caregivers rating quality of life being the most important outcome, quality of life was only measured by 14 studies, and the use of quality of life measures had decreased over time.

Discussion: Our findings show an inconsistency in the use of outcome measures, with cognition being used over other important measures. To be able to make meaningful comparisons between non-drug treatments researchers should be clear on what benefits they can expect their treatments to produce, and choose high quality outcome measures which can capture these benefits.

P9.5. A feasibility study of a randomised control trial to investigate the individual Cognitive Stimulation Therapy (iCST) application for people with dementia

RAI Harleen

Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom

Introduction: There is a lack of resources for the mental stimulation and engagement of people with dementia. Cognitive Stimulation Therapy (CST) is a non-pharmacological, group treatment for people with dementia and has shown to improve cognition and quality of life (QoL). Recently, an individual version of CST (iCST) has been developed which is delivered by a carer at home, and benefits the relationship quality of the dyad, and the QoL of carers. Technology-based interventions have also demonstrated some promising effects on the cognition and well-being of people with dementia and therefore, a touch-screen version of iCST (the iCST app) has been developed.

Aims: to evaluate the feasibility of conducting a full-scale Randomised Controlled Trial (RCT) with the iCST app compared to a treatment as usual (TAU) control group.

Methods: a multi-centre, pragmatic, single blind feasibility trial was undertaken in the United Kingdom (n = 43). Dyads were randomised to the iCST app intervention or TAU group for 11 weeks. Feasibility outcomes included recruitment, and retention rates, intervention fidelity and usability, and acceptability of the outcome measures. A total of three semi-structured, post-trial interviews were conducted.

Results: Twenty-one dyads were randomised to the iCST app intervention and 22 to the TAU group with high retention rates. Slow recruitment was due to the specific, technology-related inclusion criteria. Intervention fidelity was lower than expected and was likely due to a lack of sufficient, tailored content. Findings also indicated improvements in the QoL of carers after using the iCST app. No other effects were detected.

Conclusions: Considering the positive attitudes of people with dementia and carers towards the iCST app and the promising results from the feasibility trial, it is recommended to conduct a large-scale RCT with a refined version of the iCST app and minor modifications to the study design and process.



Last Updated: Tuesday 30 June 2020


  • Acknowledgements

    The 30th AE Conference received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe gratefully acknowledges the support of all conference sponsors.
  • European Union
  • Roche