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P8. Pychosocial interventions II

Detailed Programme, abstracts and presentations

P8. Pychosocial interventions II (Friday, 5 October, 16.00-17.30, Europa 2)

P8.1. SOCIABLE pilot study

P. Sakka, O. Lymperopoulou, S. Pantelopoulos

SOCIABLE is a multi-national, multicenter ICT project. The aim of the pilot study is to investigate the effects of computerized cognitive training on cognition, affection and functional abilities of cognitively intact elderly, elderly suffering from Mild Cognitive Impairment (MCI) and patients with mild Alzheimer’s disease (AD). The project pilots a radically new ICT-based approach for support of mental activity, which builds upon novel perceptive mixed reality interfaces based on surface computing devices. SOCIABLE will be piloted with the participation of a minimum of 350 senior citizens in 7 different pilot sites from 4 European countries (Greece, Italy, Norway and Spain).

We present the preliminary results from 185 users (102 healthy, 57 MCI and 55 mild AD) aged >65 years old. Subjects were randomly assigned to either an immediate intervention condition or 3-month delayed intervention control group. Subjects assigned to the delayed intervention condition served as controls for those assigned to receive immediate treatment. The users participated in 24 hourly twice-weekly computerized cognitive training 3-month sessions. In order to assess the efficacy of the program, cognitive, affective and functional assessment was performed pre- and post-intervention and 3 months after the end of the program (follow up).  The data collected were analyzed through a repeated measure analysis of variance 3 x 2 ΑΝΟVA with as within factor the assessment (0, 3, 6 months) and between factor the group (experimental vs control).

Significant improvements were observed for all the three user groups in most of the cognitive functions assessed, while depression scores remained unchanged. The follow up assessment revealed that most of the acquired gains were maintained for healthy elderly and MCI patients, but not for mild AD patients.

We acknowledge the support of all the partners of the project.

P8.2. The Spiritual Care of the Deeply Forgetful: Redefining Chaplaincy for the New Culture of Memory Care

Rev. John T. McFadden

Chaplaincy in health care settings, including skilled-care facilities, has traditionally been centered in carrying out specific religious offices (worship, sacrament, etc.) and being present to individual patients/residents in a pastoral manner which includes prayer and reading sacred texts.  Such practices can certainly remain meaningful to the deeply forgetful who have been strongly shaped by their faith.  But in an emerging culture of memory care that emphasizes relationships within community, chaplains are called to define “spiritual care” more broadly, affirming that all relationships (with other persons, the natural world, and the arts, as well as with the transcendent) are inherently spiritual and contribute to well-being. 

In this new context, chaplains are called to be agents of building joyous community in which all participants (including residents, staff, family members and friends) may flourish.  The chaplain can encourage and facilitate mutual care in a manner that “softens the categories” that traditionally divide caregivers from care receivers, the cognitively able from the cognitively diminished.  The chaplain can contribute to weaving a community of mutual affirmation, one in which the self-identity of the deeply forgetful is not negated by “consensus reality” that too often denies or denigrates the reality they are experiencing.  The exciting new possibility for chaplains serving in memory care settings is to “enchant the community” in a manner that enables all its members to experience joy, laughter, meaning and affirmation.

P8.3. Mirror neurons and physical rehabilitation in dementia

Erik Scherder, Gerdine Douma, Marco Blom

There are at least two major problems in the care of older persons with dementia. In the first place, the number of nurses that will take care of patients with dementia will decline in the next decade. In the second place, unintended physical inactivity of patients with dementia who are still ambulatory is a too frequent observation of those who live in a nursing home. A shortage of staff and a physical inactive life on the psychogeriatric ward are closely related as there is simply no time for the nurses to take the patients out for a walk. This situation is the more alarming as literature has shown that an increase in physical activity may have a beneficial influence on cognition, behavior, and the sleep-wake rhythm, at least in those who are at risk for dementia or in a very early stage. The question therefore arises how to solve this issue. One possibility is to develop an intervention that appeals to mirror neurons in the brain. Mirror neurons start to fire when a person is looking at another person who is, for example, walking. These mirror neurons are part of a neuronal circuit that is involved in walking itself. In other words, looking at other people who walk, may stimulate the patient who is watching to start walking again. In an European project, together with Italy and Spain, we develop an intervention in which patients in a relatively early stage of dementia, ambulatory but generally physical inactive, are invited to walk on a treadmill, in a virtual street, while watching themselves walking in that virtual street. We hypothesize that this intervention will stimulate these patients to start walking again, by activating mirror neurons that are still present in this stage of dementia. If this appears to be the case, a new field of rehabilitation for patients with dementia will become available.

P8.4. Admiral Nursing DIRECT Plus: Developing a telephone based psychosocial intervention casework model for family carers

Ian Weatherhead, Zara Ferreira

This paper will present the Admiral Nursing DIRECT national dementia helpline in the United Kingdom. It provides a telephone based intervention of information, advice and support to carers, people with dementia, and health and social care professionals on any related aspect of dementia with the overall aim of improving quality of life for people with dementia. The service is delivered by experienced Admiral Nurses, a specialist nurse model in dementia care. (1) Internal data indicates the helpline receives an increasing number of repeat calls from carers seeking on-going help and advice in supporting a person with dementia. This has led to developing a telephone casework model to augment the existing helpline and provide a clinical framework to support such callers. The model will provide a number of telephone sessions underpinned by the bespoke Admiral Nurse assessment model (1). It will also record reasons why people contact the helpline and why such an approach is preferable to them.

Stress, burden and depression amongst carers will be measured at points throughout the intervention period and will be used as outcome measures to assess effectiveness of the service

Key advantages in providing this model are in convenience and extension of choice for carers. Benefits of this approach will be collated throughout the pilots course, e.g. reduced cost in terms of time; travel etc. A clear and structured method of delivering psychosocial/educational programme and information solely over the telephone will be utilized.

Subject to its efficacy a similar approach will be considered via email, and online access to individuals own care plan via a secure website and database.

Carers will be recruited to the study through a triage system to identify a greater level of need than an otherwise general enquiry to the helpline.

Carers will be contacted at agreed and regular intervals for up to 6 months. 

Inclusion criteria:

  • The participant will be the identified principle carer of someone with dementia.
  • A formal diagnosis of dementia has been made.
  • Evidence through initial screening of carer burden and stress or depression.
  • The carer has no formal mental health diagnosis of their own

Assessment tools may include

  • The Admiral Nursing 17 point assessment schedule
  • The Zarit Burden Interview  
  • The CES-D Scale self-reporting depression measurement tool (2)
  • A Cost Benefit Analysis tool will be utilized to assess cost effectiveness of the programme.

Anticipated outcomes include reduced stress, burden, and increased caring skills. This two year pilot study will commence May 2012.

P8.5. Adherence to a psychosocial intervention protocol: the hassles of ever-changing practice in community mental health services

Anouk Spijker, Emmelyne Vasse, Eddy Adang, Frans Verhey, Hub Wollersheim, Myrra Vernooij-Dassen

Background: Analysis of health professionals’ use of the Systematic Care Program for Dementia (SCPD) showed no effect on patient and caregiver outcomes, partially because of the health professionals’ limited adherence to the SCPD.

Aims: To explore barriers and facilitators affecting adherence to the SPCD intervention protocol in community mental healthcare.

Method: Qualitative thematic framework analysis at six levels of healthcare. Semi structured interviews were held with 11 health professionals in six community mental health services across the Netherlands.

Results: Barriers and facilitators appeared at nearly all healthcare levels. The key themes that facilitated the use of SCPD when present and hindered its use when absent were appreciation of the intervention and training, involvement in deciding to participate in the study, leadership and secretarial assistance.

Conclusion: Although barriers and facilitators are usually studied in the implementation phase of effective interventions, they appear in the introduction phase of intervention studies. They should therefore be studied in that phase.

 

 
 

Last Updated: Thursday 15 November 2012

 

 
 

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