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P23. Psycho-social interventions

Detailed programme and abstracts

P23. Psycho-social interventions (Wednesday 2 Nov., 10.30 - 12.00)

P23.1. The effectiveness of music therapy to reduce behavioral and psychological symptoms in patients with dementia or delirium in the acute general hospital: a systematic literature review and review of current evidence.

MATHEWS Jillian, SHERRIFF Carol Anne, REYNISH Emma, SHENKIN Susan

Background: Non-pharmacological measures, such as music therapy, are recommended for management of behavioral and psychological symptoms of dementia (BPSD). Dementia and delirium are common in acute hospitals. We performed a systematic literature review to establish whether music therapy improves BPSD in dementia or delirium (D/D) in older people in the acute general hospital.

Methods: We systematically searched CINAHL, Medline, and PsycInfo (inception to November 2015) according to a published protocol PROSPERO: CRD42015024691. We hand searched key journals, and consulted experts in the field. Search terms included music therapy, dementia and delirium. Only published, primary studies in the acute hospital setting, with a registered music therapist, involving patients with D/D, n≥10, were eligible for inclusion. All study designs, and published languages were eligible. Two authors independently reviewed titles and abstracts, and read full text articles for eligibility. 

Results: Of 5527 titles reviewed, we read 142 in full text, and none met inclusion criteria. We therefore qualitatively reviewed articles which can inform future research for music therapy in the acute hospital for people with D/D.  Music has had a positive effect on behavioral and psychological symptoms in a range of settings, but the studies are generally small, and do not use recognized frameworks for evaluating complex interventions.

Strengths and Limitations: The study used a robust search strategy, involving two reviewers from different disciplines, psychiatry and music therapy. Un-published studies were not included and we were restricted to three databases so some eligible foreign language studies may have been missed.

Conclusion: We found no published evidence for the use of music therapy for the treatment of BPSD in D/D in acute settings. Well-designed, multidisciplinary studies of this complex intervention are now needed.

P23.2. ReACT - Rehabilitation in Alzheimer’s disease using cognitive support technology

ØKSNEBJERG Laila, WALDEMAR Gunhild, HANSEN Mette Tandrup, WARA Vibeke

Cognitive rehabilitation and easy-to-use advanced technology has great potential to address the disabling cognitive symptoms of dementia. However, there is of lack well-suited software tools to meet the special and individualized needs of people with dementia, and well-suited methods to implement the technology into everyday life are also needed.

The objectives of this study are:

  • To innovative tablet-based software designed to meet the needs of persons with early Alzheimer’s disease and to optimize the implementation of the technology through a programme of cognitive rehabilitation.
  • To conduct a proof-of-concept study, exploring the feasibility and applicability of both the cognitive rehabilitation programme and the specific designed software. 
  • To identify and implement relevant outcome measures for this type of intervention.

A basic part of the research project is to design and develop software, which meets the needs of the people with dementia. The software has been designed and developed through an iterative user-driven innovation process, and this has resulted in the innovation of an adaptive application, which is designed to support memory, structuring and communication. In addition a software management tool has also been developed, which will relieve the users of the often troublesome request for setting up and updating the software. The software also includes an online tool for monitoring the wellbeing of the person with dementia and data on the persons’ use of the software will be logged continuously and analyzed for research purposes.

The project is ongoing, and results from the user-driven innovation process and the initial results from the proof-of-concept study will be presented.

P23.3. Psychosocial interventions for people living with dementia, and their supporters, after diagnosis in the community: identifying influences on take up

FIELD Becky, COATES Elizabeth, MOUNTAIN Gail

Background: Living well with dementia is now promoted and UK health policy recommends psychosocial interventions to support people post-diagnosis. Yet delivery of such interventions is still developing. There appears little understanding of influences which affect the take up of offers of such post-diagnostic support.

This study aimed to explore influences on why people accepted the offer of a psychosocial intervention (‘Community Occupational Therapy in Dementia’, COTiD). This intervention formed part of the ‘Valuing Active Life in Dementia’ (VALID) research programme during its development phase (National Institute of Health Research Programme Grant for Applied Research RP-PG 0610-10108.)  

Methods: Semi-structured interviews, with people living with dementia and their supporters (‘dyads’), after intervention were conducted to explore acceptability and aid intervention development. A secondary, qualitative, thematic analysis was then completed, to explore if reasons why people accepted this post diagnostic psychosocial intervention could be identified within this rich existing data set.

Results: 17 dyads were interviewed. Four main themes were identified: ‘Grabbing at straws and keen to take part’; ‘We’re trying to put a routine in’ ‘We didn’t know what to expect’ and ‘Give it a go’. Intervention being offered at the ‘right’ time, as perceived by at least one member of the dyad, regarding the intervention as potentially meeting a need for support, valuing activity or services were all key influences. Struggling to adjust to the diagnosis, or cope with symptoms also may have acted as facilitators to take up.

Conclusions: A willingness to accept the offer of this intervention, despite uncertainty, limited expectations or apprehension was demonstrated. Identifying reasons why people take up or reject offers of psychosocial interventions post-diagnosis could help services develop the way interventions are offered, to facilitate take up. Primary research to identify influences on take up or rejection is needed.

P23.4. Computer-based cognitive training for dementia. Results from a randomized controlled trial on MCI, mild AD and healthy ageing.

ZACCARELLI Chiara, MATTARELLI Paolo, PASSUTI Simone CIRILLO Giulio, ANNICCHIARICO Roberta

The progressive aging of population is related to an increased incidence of age-related diseases, included dementia. The Mild Cognitive Impairment (MCI) is defined as a condition with objectively identifiable cognitive impairment in absence of criteria for the diagnosis of dementia, and is considered a transitional stage between normal aging and Alzheimer's disease.

Objectives: The present study examined the efficacy of novel computer-based cognitive training program (pb-CT) combined with reminiscence therapy (RT) on patients with mild Alzheimer disease (mAD), mild cognitive impairment (MCI) and healthy elderly (HE) subjects.

Material and Methods: The training was administered using a software specifically created and operating on a touch-screen computer. A multicenter, randomized, controlled trial involved 348 participants with mAD, MCI and HE from four European countries. Participants were randomized in two arms of a crossover design: arm A consisted in 3 months of computerized cognitive training focused on memory and executive functions combined with RT and 3 months of rest; those in arm B underwent the reverse. All participants were followed up for 6 months, with assessments at baseline, at 3 months and at 6 months. The training consisted in 24 one-hour treatment sessions (individual or group) twice weekly for 12 weeks.

Results:  We found a significant effect of the training for memory in all three groups on delayed recall and for executive functions in HE. MCI and HE participants maintained these effects at follow-up. MCI and mAD participants also showed a significant effect on the Mini Mental State Examination scale. Participants with mAD showed more stable effect on functional ability (IADL) during the training versus the rest period. Our results corroborate the positive effect of pb-CT and its maintenance primarily on memory in HE and MCI participants that did not seem to be potentiated by RT. Moreover, our results are very promising for the mAD participants.

P23.5. Growing together: Designing a participatory horticultural therapy study for people with dementia and their care supporters

NOONE Sarah

This presentation will discuss the participatory design and preliminary findings of a study exploring whether participation in a horticultural therapy initiative can improve well-being for community-dwelling people with dementia and their care supporters.

Enjoyment of, and access to, outdoor spaces has been identified as a crucial factor in creating dementia-friendly communities, and the provision of outdoor activities for people with dementia can help to encourage social interaction, improve well-being, and enable people living with the condition to cultivate a sense of purpose and make a meaningful contribution to their community. However, few opportunities for people with dementia to interact with nature are currently available, and factors such as embarrassment and risk aversion prevent community-dwelling people with dementia from enjoying the benefits of the outdoors.

A small number of studies have demonstrated the benefits of gardening for people with dementia; however, these studies have focused on formal care settings, with no identified research involving community-dwelling people with dementia. Furthermore, the outcomes of such studies have been assessed using researcher observations, rather than the perspectives of participants, and may therefore not accurately reflect the lived experiences of people with dementia.

This study places the voices of people with dementia at the core of the research process, utilising participant feedback as a key method of data collection to determine the impact of the research upon people with dementia from their own perspectives, and encouraging participant collaboration within an action research methodology. The study’s participants will inform the design of each horticultural therapy session, further encouraging their involvement and ownership in the process. This presentation will reveal the successes and limitations of the study’s design, reflecting upon the researcher’s experiences to offer a series of recommendations for the involvement of people with dementia in community-based dementia research.

P23.6. Analysis of a logopedic intervention program aiming to enhance communication between people with dementia and their caregivers: a qualitative study

OLTHOF-NEFKENS Mariëlle, DERKSEN Els, KRUSE Hannes, SWART de Bert, NIJHUIS-VAN DER SANDEN Ria, KALF Hanneke

Background: Cognitive communication disorders are common in people with dementia, however well-designed logopedic intervention programs are scarce. The goal of this study was to identify the relevant components and the underlying mechanisms of a newly developed logopedic intervention, intended to enhance communication between people with dementia (PwD) and their caregivers. The final aim is to standardize the approach for future trials.

Methods: Eighteen therapy sessions of four PwD-caregiver couples were video-recorded. Semi-structured interviews with all couples and an interview with the SLT were audio-recorded. Triangulation and framework analysis were used to analyze the data.

Results: The SLT created two communication tools (individualized communication advices (ICAs) and thematic texts (TTs)) in close collaboration with the PwD-caregiver couples, basing the contents on the narrative stories and the own words of the PwDs and caregivers. This way of tailoring these communication aids for each couple seems highly important for a successful implementation in daily life. Throughout the intervention, the SLT systematically applied a combination of person-centered communication strategies (like facilitation of conversation, validation of feelings, recognition of life history) and language-based communication strategies (like affirmations, repetition, yes/no questions and rephrasing). This approach matches with the philosophy of person-centered (dementia) care, which has not been described for logopedic interventions up until now.

Conclusion: We managed to analyze and describe a short, newly constructed, logopedic intervention program for communication problems caused by dementia, which proved to be highly appreciated by people with dementia (PwDs) and their caregivers.

 

 
 

Last Updated: Tuesday 10 January 2017

 

 
  • Acknowledgements

    The 26th AE Conference in Copenhagen received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe and Alzheimerforeningen gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche
 
 

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