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P14. New psychosocial interventions

Detailed programme, abstracts and presentations

P14.1. A lot of things work better with music – Music therapy and dementia

Willig Simone

During recent years, music therapy has become  an important part of the psycho-social services provided for people with dementia connecting to the encounters. Often serving as a different kind of language, music assists both in establishing contact with other people, and with one’s own emotions and body. Music has the ability to build a bridge to a person’s past and cultural origin and to promote a sense of belonging and a lasting feeling of security. Frequently, previously undiscovered resources can be promoted through the use of music. For example, many people with dementia can easily reproduce lyrics of songs they used to be familiar with from beginning to end.  Memories connected to these songs are recalled and can thus be communicated. Through this process of reminiscence, a new kind of communication is elicited, which is both verbal and nonverbal and shaped through the use of musical instruments. Music mirrors personal identity, which in turn finds a counterpart in musical expression. Therefore, music is one of the strongest tools in preserving a sense of identity in people with dementia.

Simone Willig is holding a diploma in music therapy (University of Applied Sciences) and has musically accompanied people with dementia for 13 years. She has authored the book  „Mit Musik geht vieles besser – der Königsweg in der Pflege von Menschen mit Demenz“. In her paper music’s effects on body and soul are explained and  music therapy is introduced in the encounter of people with dementia. A large number of practical examples are provided, and listeners are invited to participate and to discover music for themselves.

P14.2. Feasibility of a newly developed tailor-made social fitness program for community-dwelling older people with dementia and caregivers

Donkers Hanneke, Graff Maud, Veen Dinja, Vernooij-Dassen Myrra, Nijhuis-van der Sanden Ria

Background: Social participation is one of the four central themes for good quality of person centered care in dementia in Europe.

Aim: to evaluate feasibility and effectiveness of a newly developed tailor-made social fitness program on participation in meaningful social activities of community-dwelling older people with dementia and caregivers.

Intervention: this tailor-made innovative social fitness program starts with a volunteer of a welfare organisation for the elderly, who cycles through the region with all kind of social information (digital & written information on social activities & communities), and who attends all kind of places where older people come. This person informs and motivates people with dementia and their family members to cooperate in meaningful social activities in the community of the region Nijmegen and Deventer in the Netherlands. If activities need to be adapted and people need to be trained to be able to participate, accordingly a multidisciplinary program of occupational therapy (the COTiD program), physiotherapy (the Coach 2 Move program), home care and voluntary assistance with also coaching on a distance, is offered.

Methods: the research project follows the steps of the MRC framework for evaluation of complex interventions. Using mixed methods: qualitative research methods defining successful program components and testing of the feasibility of the program, a research protocol for a main randomised controlled trial is defined. Finally, a RCT evaluates the effectiveness of the social fitness program on older people with dementia and caregivers. Alongside this RCT we’ll perform a process analysis.

Implication of results: successful components, results on feasibility of the social fitness program and barriers and facilitators for implementation will be presented. Important components of this program are improvement of participation in social activities, of autonomy, of sense of competence and self-esteem, decrease of loneliness and increase of quality of life of older people with dementia and their caregivers. Feasibility of the social fitness program related to the target group of older people with dementia and caregivers, related to the cooperation of the different professional disciplines and related to organisational and health system aspects will be presented. Also barriers and facilitators for implementation and the design of the consecutive randomised controlled trial will be presented at the conference.

P14.3. Admiral nursing in an acute hospital – creating a dementia friendly hospital

Bell Jeni, Dening Karen

This presentation / poster will present the innovative work undertaken within the University Hospital Southampton who are the first hospital in the UK to employ an Admiral Nurse (Specialists in Dementia Care) as a clinical lead in a dementia specific role. Following the SPACE principles, published by the RCN (2011), the acute trust is working towards creating a dementia friendly hospital. The National Dementia Strategy (2009) stated clear objectives with regard to improving quality of care for people with dementia in acute hospitals as well as supporting family carers. This has not always been the case as the Report of the National Audit of Dementia Care in General Hospitals (Royal College of Psychiatrists 2011) has shown.

Admiral Nurses have traditionally worked in community settings supporting family carers at home but this new innovation is aimed at developing the role further to support generalist hospital staff to develop skills in caring for people with dementia within the acute care setting; be able to develop and deliver person centered care within a potentially bewildering and busy large general hospital environment that is adapted to assist the person with dementia in feeling safe and secure. The Admiral Nurse has been pivotal in creating dementia friendly physical environments for people with dementia and the launch of a patient passport scheme “This is me” (Alzheimer’s Society). The Admiral Nurse maintains the traditional role by supporting family carers through the intervention of Memory cafes based within the hospital.

P14.4. Dementia in the elderly: Interventions diversified by competences. Educating to recognise Emotions and Psycho-Physical Potentials

Bruno Patrizia , Pirozzi Mariacarmina, de Rosa Giuliana, Francone Caterina

Introduction: Progression and irreversibility of brain damage, typical of primary  senile dementia, forces us to detect early symptoms and to learn which the psycho-physical changes related to the disease might be. Continuous and prolonged support is needed, not only limited to medical care and pharmaceutical drugs, but which instead takes into consideration all the other relational aspects such as the implementation of interventions diversified by competences.

Purpose: To provide the elderly affected by dementia the right tools to stimulate their remaining physical, mental, emotional and communicative abilities. To support and educate their families so that the latter can stimulate them in the home. In that case an Empowerment process was promoted, both as a tool and the purpose to reach a better psycho-physical condition. It was considered appropriate to herewith mention the pedagogical objectives and the business plan from the educational point of view, which integrated with the cognitive and motor ones, have allowed to fully confirm the achieved results.

Material and Method: Activities of Pedagogical Competence: The meetings have been 7 and all based on the set objectives. The group of 10 elderly was heterogeneous in the degree of pathology.

The first meeting was to get acquainted and create dialogue. It showed good motivation and a lot of curiosity. A box full of antique and modern objects - which would recall their memories to a past and present daily life - was emptied on the table. In that way, it was possible to individually evaluate the degree of awareness about present and past, the degree of memory and the degree of space-time perception. The second meeting focused its attention on mind-hand coordination and awareness of potential hand mobility, through working with plasticine and simple woodworking. For the third and fourth meetings, some art-therapy and music-therapy sessions were organised, mainly relying on the fact that sounds, music and art are intense, multi-sensorial and motor experiences which integrate with the person, regardless the anatomical-functional condition of the brain. For the fifth, sixth and seventh meetings, the activities were focused on mind-body coordination through spontaneous dances and group games and on sensorial and memory stimulus through listening to live music by two voluntary violinists.

Results and Conclusions: Great motivation in carrying out the proposed activities. Enhancement of self-esteem. Greater ability to relate to the group. Improved motor ability, especially fine motor skills. Recognition and expression of emotions.

P14.5. Determinants for success and failure in the implementation of an evidence based occupational therapy intervention in the Netherlands

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

Background: A multifaceted implementation strategy was developed and tested to implement an evidence-based occupational therapy program for people with dementia and their caregivers. The strategy was effective in increasing the number of referrals to the program, but not in improving adherence of occupational therapists (OTs). To identify factors that influenced the success and failure of this strategy we conducted a process evaluation.

Methods: A mixed method approach was used to evaluate the implementation process. Data on attitudes of OTs and barriers to implementation at baseline were collected from all 94 participating OTs  using a 19-item questionnaire. Data on experiences with the implementation strategy were collected using focus groups with OTs and telephone interviews with physicians and managers. Data were  analysed using inductive content analysis.

Results: Our strategy mainly focused on increasing OTs promotional skills due to an initial lack of referrals. Related to this OTs reported a lack of experience with the program and a low feeling of competence. In addition, interpersonal contact was experienced as important however exposure of physician and managers to this type of contact was limited. Managers greatly relied on OTs knowledge and skills and provided limited support in the implementation process. A barrier related to physicians was the negative attitude of several physicians regarding psychosocial interventions. Organisational factors that influenced the implementation were available number of trained OTs, the size of the region a department needed to cover, the demand for OT, the focus of the organisation, and the balance between cost and benefits of the innovation. Last, the position of OTs within the network, the degree of collaboration between professionals, and the lack of physicians within the network with sufficient eligible clients were perceived important determinants for implementation.

Conclusion: The implementation of complex interventions is not an easy task, even if they are highly effective. In spite of targeting our implementation strategy to pre-identified barriers we only found effects regarding the number of referrals which could be explained by the main focus on promotional skills. Our data suggests that a first step to implementation is to make sure individual  and organisational prerequisites for implementation are in place and that partners for collaboration are carefully selected based on ambition, motivation, and personal commitment. In addition, the implementation strategy should be network-based and include aspects that directly stimulate inter-personal and inter-professional contact and collaboration.

P14.6. Developing a creative and theatre based intervention for young people with dementia and their carers

Ward Alison, Parkes Jacqueline, Prior Ross

This presentation will describe the early stages of an ongoing project exploring the  development of a creative and theatre based intervention for younger people with dementia (under the age of 65 years) and their carers. Research with this group has found they are often a marginalised group, who experience significant social isolation (Green and Kleissen, 2013, Harris and Keady, 2009 and Clemersonet al., 2013).

The field of artistic engagement and dementia is growing, currently much of the work is aimed at those aged over 65 years and reside within a care home, as evidenced through the work of Ladder to the Moon (UK) and TimeSlips (USA). Interventions often focus on the carer as a staff member and tailor the work towards developing improved staff carer and person with dementia relationships.  This project aims to learn from this work, adopting positive aspects, for example its focus on a person centered approach, use of music, creative storytelling and movement, and explore how these can be adapted to create an intervention which focuses on the needs of those within a younger age group (under 65 years of age) and their informal carers, living within the community.

The presentation will outline the proposed method, which will include participant observations during the workshops, semi-structured pre and post intervention interviews conducted with the people with dementia and their carers.  Each participant pair will also be asked to record their journey through the intervention with a diary/photo diary which will be used to aid the post intervention interviews.

This abstract will also present learnings from best practice in the field of creative engagement with older people with dementia, which will be reviewed in relation to its fit with a younger age group.  The project will aim to investigate the way in which creativity can aid communication pathways between the carer and person with dementia, consider the role of identity developed through the creative process and aims to better understand the value of engaging with a creative intervention from the perspective of the person with dementia and their carer. A celebratory event is planned to display the work undertaken to a wider community audience, via an exhibition or open workshop, providing a vehicle to challenge, often, negative perceptions towards dementia and inviting the wider community to consider their awareness and understanding of dementia and share in the experiences of those participating in the intervention.

 

 
 

Last Updated: Monday 04 November 2013

 

 
  • Acknowledgements

    The 23rd Alzheimer Europe Conference in St. Julian's, Malta received funding from the European Union, in the framework of the Health Programme. Alzheimer Europe and the Malta Dementia Society gratefully acknowledge the additional support provided by foundations and companies.
  • European Union
 
 

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