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P2. Psychosocial interventions I

Detailed Programme, abstracts and presentations

P2. Psychosocial interventions I (Friday, 5 October, 14.00-15.30, Europa 2)

P2.1. Implementation in clinical practice of an intervention effective in the research setting: a randomised controlled trail

Carola Döpp, Maud Graff, Marcel OldeRikkert, Ria Nijhuis - van der Sanden, Myrra Vernooij-Dassen

Introduction:The effectiveness of a Community Occupational Therapy in Dementia (COTiD) program was proven in a Dutch study. However, implementation of effective interventions in clinical practice has been proven to be challenging. Therefore effective implementation strategies need to be developed in order to make sure people with dementia and their caregivers can actually benefit from interventions proven effective in the research setting.

Aim: Discuss the results of a cluster randomized controlled trail to the effectiveness and cost-effectiveness of two strategies to implement the COTiD program in clinical practice.

Methods: A cluster randomized controlled trial was conducted. Clusters were recruited from nursing homes, hospitals, and mental health services. Each cluster consisted of two occupational therapists (OTs), one manager, and one physician. A total of 45 clusters were recruited including 94 OTs, 80 physicians and 48 managers. Clusters were stratified by type of setting and randomly assigned to the intervention or control group.

In the control group OTs received the usual 3-day post-graduate course on the COTiD program. Physicians and managers in this group did not receive any intervention. Participants in the experimental group received support using a newly developed implementation strategy. OTs, managers, and physicians were the target group of this strategy. OTs received two training days, 5 to 7 coaching sessions, and attended regional meetings in addition to the 3-day post-graduate course. Managers and physicians received telephone calls, four newsletters and access to an educational website to motivate them to facilitate and / or refer to OT according to the COTiD program.

The main outcomes measures were OT adherence to the COTiD program, intended community OT use, and cost-effectiveness of the interventions expressed as cost per extra percent adherence. Secondary, it was evaluated if the implementation strategies were effective regarding client and caregiver treatment outcomes (e.g. quality of life). Therefore, clusters were asked to refer at least 8 client-caregiver couples for participation. Measures were conducted at baseline, 6 months, and 12 months after baseline. Assessors were blinded for group allocation.

Results & Conclusion: The number of clusters in which the OT department did not receive any referrals for community OT for people with dementia was significantly higher in the control group for 6 months after baseline (χ2 (1, 45) = 9,265 p =.002) and 12 months after baseline (χ2 (1, 45) = 9,935 p =.002). In addition multilevel analysis showed that the total number of referrals to the COTiD program was significantly higher in the intervention group after 12 months (p = .031). However, OT adherence to the COTiD program was not significantly different between the control and intervention group at 6 months (p = .103) or 12 months (p = .065). Results on client and caregiver outcomes will be presented at the conference.

P2.2. Improving Meal Times for People with Dementia

Delphine J. Herrmann

There are several factors involved in ensuring oral intake to be successful. They include: ability to swallow safely and effectively, recognizing food preferences, adequate persistence of action necessary to eat (involving memory and attention), and environmental support (Brush & Casper, 2008). When working with people living with dementia, it becomes challenging for caregivers to meet their nutritional needs since the disease affects the factors critical for efficient intake. Caregivers and therapists need to consider the following during mealtimes: swallowing problems (otherwise known as oropharyngeal dysphagia), negative reaction to food textures and consistencies, challenging behaviors which negatively impact food intake, poor sensory awareness and integration, forgetfulness and disorientation, impaired judgment and safety awareness, and impaired communication (Curfman, 2005). These challenges have a negative impact on the mealtime as a pleasurable and social experience for both the person with dementia and their loved ones. Consequently, eating can quickly turn into a negative experience for both the person with dementia and their loved ones, resulting in feelings of isolation and decreased self-esteem. In addition, the physical nursing home environment may not always support the needs of people with dementia, which further complicates the negative experiences around mealtimes (Calkins, 2001). As a result, current research is now highlighting the importance of environmental influences in improving and supporting oral intake for people with dementia. In this presentation, the author will briefly review eating alternatives and green house movements developed as psycho social approaches in improving quality of life and maintaining adequate hydration/nutrition.

Furthermore, the author will discuss a pilot group developed in a nursing home based on 2 different models (Brush and Casper, 2008; Nagy, 2002). One of the primary goals of the group is to facilitate the transition between daily activities and mealtimes, by preparing the person with dementia in mind, body and their own personal connection to food/eating. The group was made up of 6 residents who presented with swallowing difficulties, increased difficulties with self-feeding and benefited from environmental manipulations to improve oral intake. In association with an occupational therapist and nurse, a speech therapist led the group into a pre-meal activity, facilitated social dining and a post meal task. During each group, the participants were more engaged during mealtimes, preventing learned helplessness and promoting independence, in the context of an enjoyable eating experience. In doing so, they preserved their ability to self-feed, maintained safe swallowing and retained a positive swallowing-feedback loop in order to maintain nutrition/hydration. Additionally, the group fostered social interactions among residents through conversation before, during, and after the meal.

During the presentation, the author will focus on the following points:

  • Describe rationale of group based on 2 different models
  • Provide concrete examples of pre-meal activities, each participant’s role during mealtimes, and post meal wrap up tasks
  • Explain how dysphagia management was incorporated during the group activities/meal times
  • Outline the positive functional outcomes of participants in the group.

P2.3. Cognitive stimulation by caregivers for people with dementia

Maarten Milders, Stephen Bell, Angus Lorimer, Tom MacEwan, Alison McBain

Background. Cognitive stimulation (CS) is a psychological intervention for people with dementia aimed at slowing down the rate of cognitive deterioration through stimulating activities. CS is typically delivered by health care professionals, but CS by caregivers would allow long-term intervention without greatly increasing demands on health services. However, CS by caregivers raises questions concerning well-being and treatment integrity.

Method. The current study investigated the effect of CS by caregivers on well-being in caregivers and people with dementia, and whether caregivers were able to present the exercises as intended. Caregivers of home-living people with dementia were trained to engage their relative with dementia in stimulating activities, which were described in a workbook for caregivers.

Results. Twenty-one dyads completed the study. Caregiver and patient well-being showed no deterioration across three assessments: baseline (before the intervention), 8 weeks and 16 weeks after the start of the intervention. Recordings of intervention sessions and analysis of workbooks completed during the intervention indicated adequate treatment integrity. The large majority of caregivers indicated that their relative with dementia had enjoyed the CS activities (20/21) and that they themselves had benefitted from the training (19/21). Eight dyads dropped out after the baseline assessment. In the dyads that dropped out, the person with dementia tended to be more cognitively and functionally impaired than in completing dyads.

Conclusion. CS by caregivers appeared to be acceptable to both caregivers and people with dementia, although poorer functioning in the person with dementia was a potential risk factor for drop-out. Caregivers were able to continue with the activities after supervision had stopped and to follow the training instructions.

P2.4. Effectiveness of reminiscence on the quality of life of residents with dementia in long-stay units: a cluster randomised trial

Eamon O’Shea, Declan Devane, Kathy Murphy, Adeline Cooney, Dympna Casey, Fionnuala Jordan, Andrew Hunter, Edel Murphy, John Newell

There is increasing recognition of the potential use of psychosocial interventions in maintaining or improving the quality of life of people with dementia. One such psychosocial intervention is reminiscence, which involves the discussion of past activities, events and experiences with at least one other person, often with the aid of tangible prompts such as photographs or other familiar items. However, despite being widely used in dementia care, evidence on the effectiveness of reminiscence remains uncertain.

The aim of the current study was to evaluate the effectiveness of a reminiscence programme - the DementiA education programme incorporating Reminiscence for Staff (DARES) - for people with dementia residing in a long-stay setting. DARES is a two group, single-blind, cluster randomised controlled trial conducted in public and private long-stay residential settings in Ireland. Randomisation to the control or intervention group was at the level of the long-stay residential unit. Care staff within the long-stay residential units randomised to the intervention group received a structured education reminiscence based programme, after which they engaged in individual reminiscence sessions with eligible consenting residents within their long-stay setting. Residents in long-stay settings allocated to the control group received usual care. Blinded outcome assessment was completed at baseline and at 18-22 weeks post-randomisation. The primary outcome was the quality of life of residents as measured by the Quality of Life-Alzheimer’s Disease (QOL-AD) instrument. Secondary outcomes included agitation, depression and carer burden.

Nine long-stay residential units (including 153 residents) were randomised to the intervention group and nine to the control group (including 151 residents). The two groups were comparable at baseline. For the primary outcome, 25 patients were lost to follow up in the intervention group and 27 in the control group.

Using an intention to treat analysis, the estimated effect of the intervention on quality of life of residents was 3.27 (95% Confidence Interval (CI) -0.49, 7.03), expressed as the difference in mean improvement between intervention and control group. Three long-stay units did not follow protocol in implementing the intervention. The per-protocol analysis, excluding these units, found a significant effect of the intervention on the quality of life of residents (4.55; 95% CI 0.05, 9.06). These effects were insensitive to the inclusion of missing data using multivariate imputation by chained equations.

There was no evidence of a statistically significant intervention effect in relation to agitation or carer burden. For depression, as measured by the Cornell Scale for Depression in Dementia (CSSD), there was an absence of significant depressive symptoms in the intervention and the control group at both baseline and follow-up, although there was a significant reduction in scores in the control group compared to the intervention group.

The study shows that reminiscence may  be an effective care option for people with dementia in long-stay settings in terms of its potential to impact positively on the quality of life of residents.

P2.5. Cognitive stimulation and maintenance: availability in dementia care.

R.Chattat,  P. Bevilacqua, A.Bonora, A. Fabbo

The cognitive stimulation intervention is widely used as a valid intervention in order to help person of dementia in maintaining cognitive abilities and quality of life. Many studies outline the intervention effects but few research is done on long term effect of cognitive stimulation associated with a maintenance intervention in person with dementia at a mild stage of the disease. The aim of this study is to assess the impact on cognitive abilities, quality of life and depression of person with dementia and on anxiety and depression of their caregivers of cognitive stimulation and also to present the result of collaboration between caregivers associations and health services in developing interventions.

30 Person with diagnosis of dementia, mean age 82,1 years, at the initial stage of the disease (Mean MMSE score: 24,29) are allowed to participate in a program of cognitive stimulation sessions followed by maintenance sessions for a period of 5 months and are assessed before intervention, at the end of stimulation sessions and at the end of maintenance sessions using the following instruments: the MMSE, The Alzheimer Disease Assessment Scale (ADAS), the Geriatric depression scale (GDS), the Short Form 12 and the QoL-AD for the assessment of quality of life, and the Hospital Anxiety and Depression Scale (HADS) for the assessment of caregivers affective state. The selection of partecipant is done by memory clinics while intervention is supported by Caregivers association

The results shown that no change is observed on measures of cognitive state (MMSE , ADAS-Cog); stability also is shown on measures of quality of life while on measures of depression a significant reduction is shown both after interventions and after maintenance.

On measures of caregiver distress no differences are shown between pre, post interventions and maintenance.

The results reported outline that cognitive stimulation had an effect on maintaining cognitive abilities and quality of life of person with dementia and their caregivers over time. In this study “no effect” over time (5 month) can be considered a good effect since the intervention and the maintenance reduce the curve of decline in person with dementia and help caregivers in maintaining their affective state balanced. A control group is needed to verify effects of the interventions even if some ethics questions can be posed since the study is a field study developed by health agencies, in accordance with caregivers association. Finally an important issues of this work is the collaborations between formal services and caregivers associations in promoting, supporting and sharing cognitive intervention for person with dementia in order to get it timely available for a large number of persons interested.

P2.6. Movement from the heart

Silje Høgaas, Julie Skjønberg, Anita Ellefsen

Movement from the heart is a new method in dementia care in nursing homes, combining milieu therapy and activation. The method includes physical exercises, singing, music, rhythms and physical touch. Movement from the heart is an individualized methodology which easily can be integrated as a part of the everyday life in a nursing home. The implementation has no need for high expertise and specialized employees, and do not require a high level of physical or mental functioning of the patients. Movement from the heart is developed by the Church City Mission (SKBO) and is based on dance therapy and movement guidance. This method has been applied alternately in interaction with patients and employees at SKBO’s nursing homes. It has been accompanied by systematic documentation, which gives the opportunity for learning and further development. An important focus has been to make the method accessible and usable in various situations, instructed both by employees and relatives. Based on Movement from the heart, a new tool for use in the dementia care was launched April 2012. In evaluation of Movement from the heart a form developed by and music therapist Audun Myskja was used. In this form, signs of wellness are being recorded systematically by observation of clinically prepared indications on positive and negative feelings, wakefulness etc. Preliminary results suggest that participation has given positive effects on several key areas. In 2010 a Master’s degree study was conducted on Movement from the heart and it was assessed how the employees experienced the method. It was concluded that the employees in SKBOs nursing homes experienced Movement from the heart as a positive addition to the repertoire of therapeutic methods. Furthermore, a research collaboration between SKBO and Oslo and Akershus University College (HiOA) will start in August 2012, where the goals are to examines health and psycosocial effects and integration methods. In conclusion, we believe Movement from the heart could be interesting also for audiences outside Norway.



Last Updated: Friday 08 November 2013