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PO7. Psychosocial interventions

Detailed programme, abstracts and presentations

PO7.1. Tai Chi and body schema, balance and attention of people with dementia: A comparative study

MABIRE Jean-Bernard, CHARRAS Kevin, AQUINO Jean-Pierre

Fondation Médéric Alzheimer, Paris, France

Introduction: Tai Chi is a multimodal activity involving body, cognitive and psychological components. Tai Chi is characterized by gentle and slow movements and is therefore an adapted activity for elderly people and for people with dementia. Empirical benefits of Tai Chi have been observed on several dimensions: muscle strengthening, postural stability, risk of fall, cardiovascular diseases, cognitive functions, anxiety, depression and well-being. The aims of this study were to evaluate the effects of a Tai Chi intervention on body schema, balance and attention of people with dementia.

Methods: The Living Lab of the Fondation Médéric Alzheimer led this study in a day care centre. The study used a comparative experimental design with two groups: one group (n=9) practicing a 12 weeks Tai Chi intervention in addition to their usual care and one group (n=9) with only their usual care. A skilled Tai Chi instructor led the intervention with two care staff. Three assessments were undertaken: before the intervention, after the intervention and two months after the intervention. Assessment were items "knowledge of body parts" of the Geronto-Psychomotor Examination and a task involving drawing a picture of a man for body schema; the Tinetti tool for balance; and the K-T cancellation test for attention.

Results: Mean age was 83.5 years old. Attendance was strong with an average of 11.66 sessions carried out [10-12]. Comparisons between the groups will be presented in terms of body schema, balance and attention. A qualitative analysis of the drawings of the man will also be presented.

Discussion: The Tai Chi intervention was adapted for people with dementia in a day care centre. The intervention will be discussed in terms of benefits, implementation procedures and participants’ feedback.

PO7.2. Can live music performances improve well-being for people living with dementia? Evaluating the music, hospitals and care concert club

SMITH Sarah Kate1, INNES Anthea2, BUSHELL Sophie2

1Salford Institute for Dementia, Salford, United Kingdom, 2University of Salford, Salford, United Kingdom

Evidence is emerging that relates to music-based interventions and positive health outcomes for people living with dementia who can access them. Much of this research-based evidence is focused in care home settings where interventions can be readily applied as part of a weekly schedule of activities. The impact of music on wellbeing of community dwelling people with dementia is less well understood.

This paper describes the findings from an evaluation of a music café – a series of live concert performances hosted at the Dementia Hub at the University of Salford over a twelve-month period. Concert attendees included 9 People living with dementia, 10 Care partners and 4 Former care partners. The genre of musician varied from session to session and included 7 groups of performers from opera, classical, traditional British folk, traditional African, traditional Japanese, comic, musical, and pop music.

Semi-structured interviews with concert attendees took place before the intervention to explore the meaning of music and expectations of the upcoming concerts. Dementia Care Mapping was utilised as an observational tool to capture in the moment experiences of the concerts for those attending the music café throughout each performance. Follow-up semi-structured interviews took place after the conclusion of the concert programme to explore the experiences of the concerts and the impact of music on wellbeing, interviews with the musicians enabled a further, essential perspective. Interviews were transcribed and analysed thematically. Findings indicate the collaborative nature of the concerts and the active participation of audience members was empowering promoting feelings of collective wellbeing.

PO7.3. Object handling for people with dementia: A scoping review

D'ANDREA Federica1, DENING Tom2, TISCHLER Victoria1

1School of Nursing, Midwifery and Healthcare, University of West London, London, United Kingdom, 2Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom

Objectives: Various psychosocial interventions have been implemented to improve behaviour, cognition, quality of life and the wellbeing of people living with dementia. Among such interventions, one that has attracted recent attention has been object handling, for example in relation to museum collections. This study aims to provide an overview of available studies on object handling, their effects and methodological characteristics.

Methods: A scoping review of object handling for people with dementia was undertaken using a pre-selected research strategy. The research was conducted using CINAHL Complete, psycINFO, MEDLINE, psycARTICLES, Academic Search Elite and Art Full Text, plus review of reference lists and hand search. Studies were included where the intervention comprised presenting the object to participants (or allowing them to choose) followed by a period of exploration, reflection and response, before moving to another item. Group or individual sessions were included. No specific restrictions regarding age, subtype and severity of dementia were applied.

Results: Following our inclusion criteria, nine studies were included in the review. Data from the studies selected will be extracted using a PRISMA checklist.  Due to the variety of design used across the studies, the results will be reported in narrative form and presented in terms of different characteristics of interventions: participants, frequency and duration of intervention, settings and materials, outcome measures and outcomes.

Conclusion: The presented review could offer an important contribution to the limited literature on object handling and lay the groundwork for further studies in this area.

PO7.4. The effectiveness of art interventions in emotion recognition and expression among elderly people with MCI (mild cognitive impairment)

TSATALI Marianna1, GAVRA Andromachi2, AVDIKOU Konstantina2, GIALAOUZIDIS Moses2, TSOLAKI Magda3

1Panhellenic Federation of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece, 2Alzheimer Hellas, Thessaloniki, Greece, 3Department of Neurology, Medical school, Aristotle University of Thessaloniki, Thessaloniki, Greece

It is observed that participation in art projects increases cognitive performance in elders with MCI, whereas is also reduces their depressive symptomatology. The aim of this study is to investigate the extent to which emotion functionality, in particular the emotional expressivity and emotional recognition, as well as creativity, can also be improved in this population through participation in art programs. Method: Sixty-two participants with MCI were recruited from the Greek Alzheimer Association. Initially, they were divided in four sub groups: the first group joined those who attended two programs (poetry and painting), the first group joined those who participated only in the painting program, in the third group participants didn’t attend any non-pharmacological interventions, whereas in the fourth group, participants attended other than art programs. The duration of the non-pharmacological programs, both the art programs as well as the other ones, lasted for two-three times per week over a two-years period. The following tools were administered to the sample after the two-year period: a) Reading the Mind in the Eyes Test, b) Guilford's Alternative Uses Task, and c) Toronto Alexithymia Scale. Results: According to the results, participants from the second group scored higher from the third and fourth groups in the Guilford's Alternative Uses Task, which measures creativity, [F(3, 58) = 1.770, p = .049], and also in the Reading the Mind in the Eyes Test [F(3, 62) = 3.373, p = .024], which assesses emotion recognition. However, no significant differences were found for alexithymia. Conclusions: The case of the existing study is that those who attended art programs had higher scores in recognizing one’s emotions, whereas their creativity levels are also improved. However, the levels of alexithymia were not affected by these interventions. Future studies will need to confirm the aforementioned findings.

PO7.5. Process evaluation of a participatory action research-RCT aimed at reducing inappropriate psychotropic drug use in nursing home residents with dementia by tailored intervention-and implementation plans


1University Medical Center Groningen (UMCG), Groningen, Netherlands, 2Groningen, Netherlands, 3Nijmegen, Netherlands, 4Amsterdam, Netherlands

Background: Psychotropic drugs are frequently used and often inappropriate prescribed for nursing home residents with dementia with neuropsychiatric symptoms, despite their side effects and limited effectiveness. Non-pharmacological (psychosocial) interventions are recommended as first-line treatment. Multidisciplinary care programs targeting staff is another way to enhance appropriate psychotropic drug use (PDU). However, effects of the latter, ‘complex interventions’ are regularly small due to suboptimal implementation. Given the complexity of implementation, standardized interventions are less likely to be successful.

We integrated participatory action research (PAR) with a stepped wedge cluster RCT to reduce inappropriate PDU. Using PAR, we adapted to local differences and needs. Two strategies were aimed at increasing effectiveness, being coaching, and tailored information provision which was provided at several time points on PDU. This included a problem analysis prior to start, targeting perceived problems in managing NPS and PDU. Choosen interventions by the nursing homes were required to match the experienced problems, resulting in a tailored intervention- and implementation plan.

Methods: A process evaluation was carried out to gain insight into internal and external validity, using a model proposed by Leontjevas et al. Data about sample quality, intervention quality en implementation knowledge was evaluated. Data were collected from internal projectleaders and coaches, using a digital questionnaire and semi-structured interviews.

Conclusion: Preliminary results show that implementation is likely to be facilitated by collaboration and communication between stakeholders, key-persons taking the lead, involvement of staff, and management support. Organizational changes and staff turnover seem to negatively impact implementation. Implementation within nursing homes showed varying degrees of success, indicating that implementation is complex despite our implementation strategies. Results will be presented at the symposium.

PO7.6. ‘Thank you for listening to me…


Alzheimer Nederland, Amersfoort, Netherlands

A sentence that concludes many calls to the AlzheimerTelefoon. The Dutch helpline started in 1987, and its volunteers have answered more than 83.000 calls since.

Callers have questions about dementia, the diagnosis and the future. When diagnosed with dementia, both their relatives and persons with dementia face all sorts of practical and emotional questions. They also call to tell their story or to share an emotional experience.

But we receive other questions too:

“I have to make a paper about an ethical dilemma; are there medicines for that condition?” Or “Do you also give massages against dementia?” People who ask for the telephone number of the taxi center, the vet, the go-kart track ... Well, if the questioner sounds a bit confused, we look up the number for him on the internet.

In my contribution I will tell how the AlzheimerTelefoon is organised and how we find, train and coach the volunteers. I will give insight in hot topics, and what these require from volunteers. And I will highlight some innovations, like the call-back service by specialised volunteers. Visitors of our platform may choose for this service when they can’t find the answer to their question.

For many relatives of people with dementia the AlzheimerTelefoon is a lifeline; in the words of a caller: “This conversation enabled me to better organize my thoughts. It does not immediately change the situation, but I do feel understood. And that gives me courage to continue.”

PO7.8. Using archive collections: A multi-sensory approach to dementia care.

TISCHLER Victoria1, CLAPP Sophie2

1University of West London, London, United Kingdom, 2Boots UK, Nottingham, United Kingdom

This paper aimed to identify the potential for archival items to be used in or to support therapeutic interventions in dementia care, with a particular focus on olfactory stimulation. Olfaction or smell, is perhaps the most potent of human senses yet the least understood. This may be due to its amorphous nature, and the relative lack of olfactory research that has taken place.  Olfaction is closely linked to emotional processing and autobiographical memory therefore has potential therapeutic use in dementia care. 

Archive collections are resources that have been utilised within research such as oral history studies. More recently, archives have been shown to be powerful agents in recovering forgotten memories. The Boots company was established in Nottinghamshire, England in 1849 and is a well-known feature of the British high street (shopping precinct), offering pharmacy, health and beauty, photographic and optical services. Its extensive archive is housed at the company's Nottinghamshire headquarters and has been made available for scholarly research and public benefit. 

This study used archival research including object handling, analysis of records, documentation and interviews with archivists to identify olfactory-rich items and formulations from Boots UK that may be used therapeutically in dementia care settings.  A range of material and smells for use with people living with dementia were identified and olfactory profiles created for males and females. Strong smells and items featuring well-known brands and distinctive packaging included carbolic soap, shaving sticks and Old English Lavender talcum powder. These and other items elicited positive feedback when introduced to people with dementia by archivists. A dataset of items has been created (Tischler & Clapp, under review). It is anticipated that this will be of use in future research studies. 

Reference: Tischler, V. & Clapp, S. (under review) Multi-sensory potential of archives in dementia care. Archives & Records. 

PO7.9. Experiences, resistances and fears in the use of Doll Therapy

GHILARDI Nicoletta1, CAROBBIO Egle Miriam1, PACENZA Caterina2, CILESI Ivo Giovanni1, LAURIA Isabella2

1Centro Studi e Ricerche "Innovative Elder Research" Onlus, San Paolo d'Argon (BG), Italy, 2Associazione Insieme A Te Onlus, San Paolo d'Argon (BG), Italy

The recent literature (Qin Xiang Ng et al., 2017; Mitchell et al., 2016; Fernandez R. et al., 2014; Turner F. et al., 2014), highlights a huge number of reviews paper about Doll Therapy and existing guidelines. These studies show that Doll Therapy is largely diffused as a non pharmacological therapy in the management of behavioural and psychological symptoms of dementia (BPSD).

In this study, the experience of several years of Doll Therapy use will be reported. In particular, the presence of critical issues that can appear at different times: both in the early stage where the use of Doll Therapy is proposed to the family member and/or to the caregiver, and during the therapy itself.

Therefore, it becomes interesting to analyse the dynamics/ experiences/ resistances that Doll Therapy could generate in the caregiver, whether they are formal caregiver (geriatric operators such as doctor, nurse, psychologist, physiotherapist, animator, educator, healthcare operators, etc…), volunteers, or informal caregiver (family members like spouse, children, etc..).

From the experience gained in years of training and supervision in the field with caregiver, some topic experiences have emerged, such as: the fear that the use of a doll in assisting an elderly person with dementia may be infantilising, the fear that Doll Therapy can cause regressive processes, the unsolved dynamics in the parent/child relationship and the impression that you want to joke with the person in front of you.

In order to delve into this topic issue, different Italian structures where the Doll Therapy is applied have been contacted and an “ad hoc” questionnaire have been submitted.

The presented work describes the results obtained from the data elaborations and possible answers traceable in the current literature.

PO7.10. Facilitation of activities for people with dementia in day care: A qualitative study exploring the experiences of staff

STRANDENÆS Margit Gausdal1, LUND Anne2, ROKSTAD Anne Marie Mork3

1Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust and Oslo University College, Tønsberg/Oslo, Norway, 2Oslo and Akershus University College of applied science, Oslo, Norway, 3Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust and Molde University College, Oslo/Molde, Norway

Background: Day care service (day care) is recommended as an activity service for home-dwelling people with dementia in Norway. However, there is limited knowledge about strategies to promote engagement and participation in activities at day care.  The aim of this study was to gain understanding of the staff’s experiences on how to enhance engagement and participation in activities for attendees.

Methods: The study has a qualitative design, using group interviews with staff and field observations at day care designed for people with dementia. Thematic content analysis was used to analyze interviews, and the findings from the observations were used to illuminate the findings in the interviews. Three group interviews including a total of 10 staff participants were conducted. Additionally, 35 attendees were observed during two days of field observations at each day care.

Results: The main theme that emerged from the analysis was the staff’s primary objective to make meaningful days for the attendees. To achieve this, the importance of having individual knowledge about the attendees to enhance relationships, creating a balanced group composition, personal competence and skills of the staff, and the importance of using activities in different ways, was highlighted. Most findings from the field observations coincide with those in the interviews. However, the observations revealed that the staff seemed to have insufficient knowledge of offering individual tailored and structured meaningful activities to the attendees. There is a potential of including the attendees even more in the ongoing activities.

Conclusion: Staff play an important role in promoting and facilitating activities to increase engagement and participation in activities. There is a potential for greater structured use of activities and cognitive stimulation. To avoid occupational injustice and the risk of decreased health and well-being among home-dwelling people with dementia, more differentiated and individual tailored services are needed.

PO7.12. The impact of virtual memory palaces on well-being with dementia


KULeuven, Leuven, Belgium

Objective: Dementia is the problem of the future in health care. Dementia is hard for the person living with it, but even more burdensome for his/her environment. The conversational dialogue between them seems to decline. Dementia is more than memory-loss, there is also communication-loss.

The primary objective is to examine whether the addition of (augmented) reality to communication strategies can reconnect subjects in the early phase of Alzheimer's disease (AD) with their caregivers and family members. The secondary objective includes a follow-up on recall and recognition of familiar faces. As well as a follow up on quality of life of subjects in the early phase of AD and their significant others.

Method: We have developed a mobile application (MemoryHome) which allows caregivers to construct virtual scale models of the residential settings these individuals with early AD presently are living in. These models function as memory palaces in which photos of significant others are connected to the architectural, spatial environment. It is a visual-audio-guide through a well-known environment and subjects in the early phase of AD can make this walk together with a caregiver or a family member.

Results: Our intervention is non-pharmacological, rather inexpensive, patient-friendly, unconventional and easy to combine with regular treatment of Alzheimer’s disease. Data was collected in two different environments: in homecare and residential settings. Results showed a modest but positive effect of MemoryHome on quality of life, connectedness between caregivers and their family members and the absence of feelings of geriatric depression.

Conclusion: The mobile application MemoryHome is a convenient instrument to reinforce the dialogue that seemed to diminish between patients and their environment. Furthermore, the application will allow participants to independently improve the recall and recognition of familiar faces, as a positive side effect.

PO7.13. The Rosemary diary: A useful tool for people with dementia

FABBO Andrea1, BEVILACQUA Petra2, GUIDI Laura3, BRUNO Patrizia4, BERGAMINI Lucia5, NEVIANI Francesca1

1Health Authority and Services of Modena, Modena, Italy, 2ASDAM Association, Mirandola Modena, Italy, 3Giovani nel Tempo Association Onlus, Bologna, Italy, 4Amnesia Association onlus, Napoli, Italy, 5Health Authority and Services of Modena, Mirandola Modena, Italy

Objective: The Rosemary diary is a useful tool for older person with cognitive impairment to build the track of time and monitor the daily tasks and activities; the diary has been planned to be use without instructions, but simply using intuition with icons and pictures that accompany simple questions. The first part makes references to the traditional ROT (a part of CST actually)- Reality Orientation Therapy, while the second part collects the activities of daily life. The aim of the study is to determine if this tool strengthens cognitive performance and autonomy as compared to traditional model of home care.

Method: the case series consisted of 87 PWD (30 M, 57F9; mean age: 80 ±74 years) divided into a study Group (n°71) submitted to a Rosmarine project (use of agenda lasting one hour/day for 6 days per week for one month) and into a control Group (n° 16) with an usual care. At the start (T0) and the end (T1) of the study time, the 2 groups were screened for cognitive performance with MMSE, activities of daily living with Barthel index and the affective status by GDS- short version. The statistical analysis was conducted by SPPS-21.

Result: for both groups significant improvements was found for depression (SG-GDS: t=5.36, p<0.001; CG-GDS: t=2.25, p<0.05) and functional parameters (SG-ADL: t=7.85; p<0.001; CG-ADL: t=2.37, p<0.05), whereas only the study group had a significant improvement in MMSE scores (t=7.31, p<0.001). These preliminary results confirmed tha a simple tool such as the Rosemary diary had positive effects on cognitive functions as temporal and spatial orientation and enviromental behavior; they are important to explain functioning in ADL. Using this tool, the cognitive stimulaton may not be limited to improve orientation and memory, but also interact to improve skills in ADL to promote and maintain autonomy.

PO7.14. A review of outcome measurement instruments for a dementia core outcome set on community based interventions

HARDING Andrew1, REILLY Siobhan1, MORBEY Hazel1, AHMED Faraz1, WILLIAMSON Paula2, SWARBRICK Caroline1, LEROI Iracema3, KEADY John3

1Lancaster University, Lancaster, United Kingdom, 2University of Liverpool, Liverpool, United Kingdom, 3University of Manchester, Manchester, United Kingdom

Background: Core outcome sets (COS) constitute the minimum outcomes which should be included in trials, and are produced to address the high variability in outcomes and measurement instruments (OMIs) which makes meta-analysis and interpretation of results difficult.

As part of the Neighbourhoods and Dementia Programme, an earlier study phase used a two-round modified Delphi survey and consensus meeting to gain agreement from over 300 key stakeholders on 13 core outcome items for inclusion in a COS for trials focusing on non-pharmacological community based interventions for people with dementia living at home. The scope and focus of these 13 outcome items fit with the emerging concept of social health. This presentation will present a systematic review, which assessed ‘how’ these core outcome items should be measured.

Methods: We conducted a systematic review and used COSMIN guidance to assess the psychometric properties of existing OMIs in relation to the COS. OMI were extracted from:

  • Over 200 existing dementia trials from the ALOIS database
  • Reviews and reports of OMI development from 108 searches in six academic databases
  • Other key reviews/sources.

OMIs that met the inclusion criteria (i.e. self-reported OMIs for people living with dementia at home) were assessed for face validity, content validity and internal consistency.

Results: The scope and focus of existing OMI (as single OMIs or as a configuration of OMIs) have inadequate face validity in the context of the 13 outcome items in the COS.

Conclusions: While we argue that funders and researchers need to shift their focus to measuring social health and the 13 outcome items in the COS, existing OMIs do not support this objective. We call for the creation of new measure(s), the scope and focus of which should be based on the 13 core outcome items and the emerging concept of social health.

PO7.15. Musical emotions in dementia - A psychological perspective


Uppsala Universitet, Uppsala, Sweden

Music is understood to be a great way to break through to dementia patients. Literature suggests that patients are able to identify musical emotions in the middle stage of the disease when familiar music is played. Yet, little is known about how progressive impairment of psychological mechanisms involved on the mediation between music and emotion might affect how listeners suffering from dementia respond emotionally to music. The aim of this study was to answer whether listeners suffering from dementia show different patterns of emotional reactions to music from controls by manipulating four psychological mechanisms involved on the mediation between music and felt emotions. On this study, several listeners (65–90 years old) took part in an experiment which compared elderly individuals diagnosed with dementia (Alzheimer´s and frontotemporal dementia) with healthy elderly controls. The participants listened to music stimuli designed to target specific psychological mechanisms (brain stem reflex, contagion, episodic memory, and musical expectancy), and were asked to rate felt emotions. Because self-report of felt emotions could be biased in individuals suffering from dementia, and underlying mechanisms cannot be observed, psychophysiological measures were obtained (skin conductance level and facial electromyography). Other variables assessed participants’ cognitive abilities (Mini Mental Test) and depression level (Geriatric Depression Scale). Based on previous studies, we made predictions about how dementia could affect each mechanism. Initial results will be presented, including an approach that may help determine future music interventions and rehabilitation with dementia patients.

PO7.16. Addressing the needs of people with dementia and family carers directly after diagnosis dementia

VAN DER VELDEN Claudia, VAN BELZEN Elsemieke, WILLEMSE Bernadette

Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands

When someone is diagnosed with dementia it clarifies the cause of the problems they perceive. At the same time, a variety of questions will rise and it will cause a range of emotions. According to people with dementia, their family carers and professionals, support nowadays is mainly focused on later stage dementia instead on early stage. While studies show that it is a complex process for people with dementia and their family carers to cope with the diagnosis in their daily life directly after diagnosis.

The aim of the present project was 1) to examine the specific needs according to support of people with dementia and family carers in the period right after diagnosis, and 2) to develop a regional model of support for that matches these needs. Focus groups, interviews and a literature review were performed to determine these needs.

In short, it was found that the support provided in this phase should focus more on the social and psychological needs of people with dementia besides the more practical and medical side of living with dementia. Together with professionals we translated the findings into the regional model of support. An important part of the model was to offer all people with dementia diagnosed with dementia a ‘First help to live with dementia’ conversation with a specialised professional. A conversation guide was developed to ensure that the professionals focus on all aspects in this conversation; practical/medical, emotional and psychological needs.

An evaluation of the dialogue is conducted by observations and interviews with people with dementia and family carers and a work session with professionals. The first outcomes were very positive. The final outcomes will be merged and final adaptations will be made to the conversation guide of the dialogues.

PO7.17. How can we reduce refusals of personal care in dementia? A systematic review


University of East Anglia, Norwich, United Kingdom

Background: People with dementia develop high needs for assistance with their personal care and in the later stages can be reluctant to receive support with these daily tasks. When people with dementia refuse assistance with personal care it leaves those caring for them in a difficult position. Little is known about the best way to reduce refusals.

Aim: To identify strategies and interventions that could be used to reduce refusals of care in dementia

Methods: We searched MEDLINE, CINAHL, PsycINFO, EMBASE, AMED and the Cochrane Central Register of Controlled Trials databases. An additional lateral search was conducted. Articles were included if they: focussed on people with dementia, covered refusals of personal care or behaviours arising during care interactions, included knowledge about an intervention or strategy that may reduce refusals of care.

Results: Out of the 5020 records identified, 30 articles relating to 26 studies met the eligibility criteria. Twenty-four of the studies (92%) were set in long-term care facilities, one in a psychogeriatric unit and one with community dwelling people. Ten out of the 26 studies focussed on mixed care activities, 7 bathing, 5 eating or medication administration, 2 mouth care, and 2 dressing. Strategies or interventions identified as ways to reduce refusals included: modifying caregiver communication or approach, music, bathing variants, video-simulated presence of a loved one, and changes to the environment. There was no evidence that slow-stroke massage (mixed care activities) or aromatherapy (mixed care activities and medication administration) reduced refusals of care.

Conclusion: Refusals of care can be reduced by some non-pharmacological interventions. More research evidence is needed to underpin strategies identified as encouraging, and to test these within community settings with family carers. Our results provide detailed information about interventions and strategies which could be used to reduce refusals of care in dementia.

PO7.18. Can music therapy improve quality of life of persons with dementia? A systematic review


Leiden University Medical Center, Leiden, Netherlands

Background: Dementia is a syndrome of progressive cognitive and functional decline that adversely affect quality of life (QoL) of persons with dementia. While music therapy (MT) is demonstrated to be effective to relieve behavioural and psychological symptoms of dementia, data over its effectiveness on overall QoL is conflicting.

Objective: This systematic review was performed to determine whether and to what extent MT affects QoL or wellbeing of persons with dementia living in long- term care (LTC).

Methods: Pubmed, Embase, Web of Science, Cochrane Library, Emcare, PsycINFO, Academic Search Premier databases were searched to identify studies that provided data and risk estimates for the effect of MT on QoL. The search strategy included keywords related to “music therapy”, “Quality of life”, “wellbeing”, “long term care” and “dementia”. These studies were reviewed for eligibility, assessed for methodological quality, and the data extracted.

Results: Of the 331 potential reports, 12 (7 RCTs and 5 observational) studies were included comprising total N=697 participants, with age range 65-100 years. MT was given by a certified music therapist in 8 of the 12 studies. Except for one study where participants received once-off MT session, duration of MT intervention in the other 11 studies range from 2 weeks to 5 months. Several QoL domains were tested in the various studies using different tests.

8 studies comprising N=522 participants (74% of total N) showed significant improvement in one or more QoL domains after receiving active or receptive MT, either individually or in groups. Of the remaining 4 studies, one (n=42persons) demonstrated non-significant improvement of QoL after receiving MT, two (n=63persons) showed inconclusive results and one study (n=70persons) that qualitatively measured wellbeing showed no improvement after 2 weeks of intermittent MT.

Conclusion: This systematic review provides evidence that MT improves QoL of persons with dementia living in long-term care.

PO7.20. Virtual Diogenes: Treatment of hoarding symptoms in older adults with cognitive impairment using virtual reality

PINO Maribel1,2, URBIOLA GALLEGOS Maria-José1, BENVENISTE Samuel1,2, HUGONOT Laurence1,3

1Broca Living Lab, Paris, France, 2CEN STIMCO, Paris, France, 3Hôpital Broca (Assistance Publique- Hôpitaux de Paris), Paris, France

Hoarding disorder is characterized by persistent difficulties with discarding possessions and excessive acquisitions, resulting in significant clutter that obstructs the individual’s living environment and produces considerable functional impairment. It remains largely under-reported, but estimates range from 3 to 6% of the population affected in developed countries, about 20 to 40 million people in Europe. In addition to functional impairment, this behaviour may pose significant environmental and health risks for patients and their neighbours (increased risks of disease, fires, collapse of buildings etc.). Thus, authorities must impose emergency, forced de-cluttering to prevent catastrophes. These operations are extremely traumatic for patients and often lead to relapse, depression and suicide attempts.

Concerned older adults with cognitive impairment show poor treatment response in both pharmacotherapy and cognitive-behavioral therapy (CBT). Lack of compliance with CBT exercises in fact predicts a weak treatment response in hoarding disorder. Virtual Diogenes seeks to treat hoarding disorder using virtual reality (VR), which would be more effective than classical therapy and thus enable therapists to work with patients in their “own” virtual apartments.

We report on the iterative co-design, implementation and testing of our VR tool with patients and a multidisciplinary team of experts (psychiatrists, psychologists, anthropologists and engineers). This tool enables patients to recreate parts of their cluttered homes using an interface akin to that of “The Sims” and then plunge into it in VR to practice discarding objects with the help of a therapist. This posed several challenges in terms of design (i.e. choice of features to maximize therapeutic efficacy without making the tool too complex and costly), usability (for patients and therapists), acceptability, CBT protocol design and implementation, for which we explain our solutions. We then discuss ongoing research, including clinical studies and exploration of other uses for the VR tool such as primary and secondary prevention.

PO7.22. Effects of music therapy on neuropsychiatric symptoms in people with dementia: A randomized controlled trial

PRICK Anna-Eva1, VAN HOOREN Susan2, VAN DOMBURG Peter2, ZUIDEMA Sytse3, SCHOLS Jos4, VINK Annemieke5

1Zuyd University of Applied Sciences, Heerlen, Netherlands, 2Heerlen, Netherlands, 3Groningen, Netherlands, 4Maastricht, Netherlands, 5Enschede, Netherlands

Neuropsychiatric symptoms, such as agitation, depression and aggression, are highly prevalent in people with dementia. It has a negative impact on quality of life of the patients and their caregivers and is difficult to manage in healthcare. Psychosocial interventions, such as individual music therapy, to reduce these symptoms are more preferred than the use of psychiatric medication. An individual music therapy intervention and a receptive music intervention were developed for people with dementia living in care homes. The individual music therapy intervention was characterized by active use of music and constantly adapting to the needs of the person with dementia. The music intervention was characterized by listening to the personal music preference of the person with dementia. A randomized controlled trial (N= 172) with three groups, i.e. individual music therapy, receptive music intervention, and control group, was planned in order to examine effects on neuropsychiatric symptoms, (non-)verbal social behavior, wellbeing and quality of life using regression analysis. The music interventions and the preliminary results will be presented on the congress.

PO7.23. Psychosocial interventions in the care of persons with dementia across Europe – The SIDECARE project

DOSTÁLOVÁ Vladimíra1, POVOLNÁ Pavla1, HOLMEROVÁ Iva1, CHATTAT Rabih2, CHIRICO Ilaria2, OTTOBONI Giovanni2-3, JANSSEN Niels4, DASSEN Fania4, DE VUGT Marjolein4, SANCHEZ Cruz5, GARCÍA-PEÑALVO Francisco5, PEREA Vitoria5, FRANCO Manuel5

1Institut for Postgraduate Medical Education; Charles University, Faculty of Humanities, Prague, Czech Republic, 2Department of psychology, University of Bologna, Bologna, Italy, 3"Giorgio Prodi", Interdepartmental Cancer Research Centre, Bologna, Italy, 4Alzheimer Centrum Limburg / Maastricht University, Maastricht, Netherlands, 5Psychosciences Research Group of IBSAL. Salamanca University, Salamanca, Spain

Introduction: The importance of high quality and appropriate care of people with dementia is mentioned in governmental and political statements across Europe. An increasing number of studies exploring psychosocial interventions in dementia care have shown positive outcomes. Many National Plans on dementia also emphasise the importance of both pharmacological and psychosocial care for people with dementia.

Aims: The aim of the poster is to provide an overview of how psychosocial interventions are mentioned or incorporated into strategic (political, governmental) documents on dementia.

Methods: Available strategic and policy documents and official guidelines across European countries will be reviewed to achieve the objective. Data will be collected using websites and databases and in collaboration with INTERDEM and Alzheimer Europe members.

Results: Preliminary analysis shows that many institutions, NGOs and care providers publish documents for formal and informal carers that directly specify some psychosocial interventions for use in the care of people with dementia. These organizations also organize courses and workshops that include practical training in psychosocial interventions. Government documents, e.g. National Action Plans for the care of people with dementia, usually recommend psychosocial interventions in general, mostly without specifying which interventions.

The poster will present results of the review of available European policy and strategic documents and give an overview of which documents include the topic of psychosocial interventions in the care of people with dementia. The results of the analysis of these documents will facilitate the preparation of a joint international curriculum of educational programs on psychosocial care in Higher Education within the SiDeCar – Skills in Dementia CARe; Building psychosocial knowledge and best practise in dementia care, EU Erasmus + project (KA 2).

PO7.24. Use intervention research method to development oral-language program for people with mild dementia

KUO Li-Lan1, LIN Chih-Yuan2, LIN Chen-Ju3, KUO Jen-Hwa4, HUANG Chien-Jung5, YEH Yuh-Hsiang6, HSU Chung-Hua6

1Department of Nursing, Taipei City Hospital, Taipei, Taiwan, Province Of China, 2Department of Neurology, Taipei City Hospital, Taipei, Taiwan, Province Of China, 3Department of Rehabilitation, Taipei City Hospital, Taipei, Taiwan, Province Of China, 4Department of Long Term Care, Taipei City Hospital, Taipei, Taiwan, Province Of China, 5Department of Metabolism and Endocrinology, Taipei City Hospital, Taipei, Taiwan, Province Of China, 6Department of Chinese Medicine,Taipei City Hospital, Taipei, Taiwan, Province Of China

Importance: The core functional impairment of neurocognitive disorder including memory, language, and autonoetic awareness. Guidelines suggest that behavioral and psychological symptoms of dementia should adapt non-pharmacological management before medication. However, the effectiveness of non-pharmacological interventions still inconclusive. As a traditional Chinese medicine and neurology combine neurocognitive care team, how to use the evidence-based and intervention research methods to design and development a localization care program is an urgent task. This study aims to report our oral-language intervention program and outcome evaluation indicators.

Methods: We conducted four sessions of focus group discussions adapt evidence-based health care and intervention research methods including problems and needs assessment, goal setting, literature systematic review and appraisal, consensus findings, apply (pilot test and main-field test), endpoints and indicators development, and evaluation to development our intervention program. Our panel composed of 32 members from the social worker, speech therapist, nurse, rehabilitation therapist, nutritionist, neurologist, Chinese medicine physician, daycare worker and carer for dementia people. Panel discussion adapted the person-centered approach, neuro-developmental sequencing theory, need-driven dementia-compromised behavior model, play therapy, recreational therapy, and traditional Chinese medicine health preservation components.

Results and conclusions: Our program chose the oral system as central intervention target. We developed eight sessions of traditional Chinese medicine health preservation program including play therapy, singing, traditional Chinese diet therapy and food preparation, oral health care and swallowing exercise to maintain oral cavity hygiene and muscular function. Upwardly, we design games to encourage and assist mild dementia people more language expression to maintain their confidence; and downwardly maintain their swallowing function. Outcome indicators including the amount of daily fluid intake, dental condition, aspiration event, ADL, IADL, MMSE, facial expression scale, health-related quality of life EQ-5D, Frontal Assessment Battery and the Frontal Behavioral Inventory.

PO7.25. Effectiveness of recreational therapy in dementia care. Taiwan daycare center survey

SHIH Hsiu-Chen1, LIN Chih-Yuan2, WEI Chung Jen3, HUANG Po-Yu4, HSIAO Wei-Ling4

1Department of Nursing, Taipei City Hospital, Taipei, Taiwan, Province of China, 2Department of Neurology, Taipei City Hospital, Taipei, Taiwan, Province of China, 3Department of Public Health, Fu Jen Catholic University, Taipei, Taiwan, Province of China, 4Department of Chinese Medicine, Taipei City Hospital, Taipei, Taiwan, Province of China

Importance: According to the dementia care guidelines, the non-pharmacological intervention should be the first priority for the patients with behavioural and psychological symptoms of dementia (BPSD). However, the effectiveness of the non-pharmacological intervention has no concrete results yet. This survey aims to study the cognition regarding the recreational therapy of the dementia daycare center staff and the effectiveness of recreational therapy in BPSD care.

Methods: In 2018, subjects of this study (including the activity designers and the activity leaders) were the frontline staff of the 183 dementia daycare centers in Taiwan. Our study designed as the cross-sectional study of the quantitative study by mailing questionnaire. The content of the questionnaire includes “recreational therapy items scale,” “recreational therapy frequency and effectiveness scale,” “effectiveness of behavioural and psychological symptoms of dementia scale.” The statistic analysis applied the frequency, mean, Pearson correlation, and multiple regression.

Results: Total of 366 questionnaires mailed out, and the response rate is 40.4% (n=148). The interviewees are mainly the middle-age female nursing attendant and have more than 5-year nursing experience. The result shows that the staff believes that recreational therapy to enhance cognitive stimulation, multisensory stimulation, and limbs activities are necessary. The top 3 of the effectiveness items are exercise, singing, and group games. The most frequent recreational therapy activity arrangement is five times per week, and the recreational therapy intervention and BPSD has positive correlation. However, the multivariate regression of the recreational therapy predicted BPSD no statistically significance.

Conclusions: The frontline staff of the dementia daycare center in Taiwan believes that recreational therapy has its necessity and effectiveness. However, multivariate regression that recreational therapy intervention no significant difference in BPSD is worth further study.

PO7.26. The model of neuropsychologically-based cognitive rehabilitation group for people with dementia

CHOU Ting-Yun, LIN Wan-Ling, SHEN Meng-Zhu, LU Yi-Feng, YANG Chi-Cheng, HUANG Sheng-Jean

Taipei City Hospital, Taipei, Taiwan, Province of China

Objectives: In recent years, the rapid increase of the global population of dementia has begun. However, the limitations and side effects of pharmacological treatments for dementia have been found. Therefore, non-pharmacological treatment has been more emphasized. Since it is necessary to develop a coordinated model combining cognitive rehabilitation for persons with dementia and their families under the cooperation between medical system and community, the purpose of this study is to maintain cognitive capabilities, improve life quality and reduce the care burden of caregivers through the above model.

Methods: The program is divided into five cognitive themes: attention, memory, orientation, judgment and comprehensive ability. The group is led by both clinical psychologists and counseling psychologists. There are12 classes, each of which lasts 2 hours. The course includes social interaction training, physical exercise and thematic cognitive training. The group outcome scale (ORS) and the interview scale (SRS) were used to assess the effectiveness after the course, and the panoramic support scale and family load scale were used in the first and last course.

Results and Conclusions: The cognitive rehabilitation group for dementia in this study carried out a total of 6 times and 48 classes. A total of 338 people involved. The results showed that psychologists were guided by the concept of "cognitive rehabilitation combined with ecological environment", and help patients and their families to participate in and engage in group activities. By establishing supportive group environment, psychologists assisted people with dementia to adapt to life, and provided family members with cognitive training exercises to recognize patients' abilities at home. In addition, this model further confirms that the cognitive rehabilitation group of dementia is effective based on the concept of "cognitive integrated environment".

PO7.27. Ask the Expert - Ask your questions on


Alzheimer Nederland, Amersfoort, Netherlands

In 2016, Alzheimer Nederland started the online platform The online platform aims at informal caregivers, and offers a lot of information and tips, news, tests, personal stories and tools like an online training on how to deal with changing (challenging) behaviour, a network support app (Myinlife) and a forum. The platform was visited nearly 1,000,000 times in 2018.

On this (infographic) poster we focus on the Expert functionality. Since the launch of the platform, people are able to ask questions to experts. Since the beginning of this service, a total of 3,000 questions have been asked to 18 experts. The experts all have different roles: a notary, casemanager, general practitioner, care expert, psychologist, occupational therapist, retirement and pension expert, driving expert and a spiritual carer/ethics.

Most questions go to the notary (29%). The retirement and pension expert receives the least questions (1%). In order to measure the quality of answer given by the experts, people who ask questions receive a survey afterwards. The vast majority (90%) of people would recommend the expert function to someone else. On the basis of the questions and answers, new informative articles are written to expand the content of the platform. 

To find suitable experts, co-operation with partners (companies or professional groups) from the platform is often required. The Expert functionality is continuously being developed to meet changing requirements and needs.

PO7.28. The management of neuropsychiatric symptoms in young-onset dementia: A cluster randomised controlled trial

APPELHOF Britt1, BAKKER Christian2, VAN DUIJNEN-VD IJSSEL Jeannette3, SMALBRUGGE Martin4, ZWIJSEN Sandra4, TEERENSTRA Steven5, DE VUGT Marjolein6, VERHEY Frans6, ZUIDEMA Sytse7, KOOPMANS Raymond8

1Radboudumc, Department of Primary and Community Care / Archipel Caregroup, Eindhoven, Nijmegen, Netherlands, 2Radboudumc, Department of Primary and Community Care / Radboudumc Alzheimer Center , Nijmegen, Netherlands, 3Radboudumc, Department of Primary and Community Care / Radboudumc Alzheimer Center, Nijmegen, Netherlands, 4Amsterdam UMC, Department of general Practice & Elderly Care Medicine, Amsterdam, Netherlands, 5Radboudumc / Radboud Institute for Health Sciences, Nijmegen, Netherlands, 6School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University Medical Centre, Maastricht, Netherlands, 7Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands, 8Radboudumc, Department of Primary and Community Care / Radboudumc Alzheimer Center /  De Waalboog, “Joachim en Anna”, Centre for Specialized Geriatric Care, Nijmegen, Netherlands

Background: Neuropsychiatric symptoms (NPS) are common in nursing home residents with young-onset dementia (YOD) and associated with increased psychotropic drug use, diminished quality of life, and nursing staff burden. There are no psychosocial interventions available for the management of NPS in YOD. Therefore, in the Beyond-II study a multicomponent intervention for the management of NPS was developed and evaluated. 

Methods: A cluster randomized controlled trial was performed using a stepped wedge design.  Thirteen YOD special care units with 274people with YOD and305 staff members participated. These care units were divided into three groups, receiving the intervention at different time pointsduring two years. NPS were assessed with the Cohen-Mansfield Agitation Inventory and the Neuropsychiatric Inventory. Psychotropic drug use was retrieved from residents’ medical files. Burnout was assessed with the Utrecht Burnout Scale. Job satisfaction and job demands were assessed with subscales of the Leiden Quality of Work Questionnaire. Data on validity and implementation were collected with questionnaires. Multilevel modeling, accounting for clustering of measurements within clients and staff, within units was used to evaluate the effect. 

Results: The process evaluation showed sufficient internal and external validity, allowing further effect analyses. Although, nursing staff were satisfied with the intervention, some parts of the intervention were perceived as less relevant for their own organization. Factors affecting the implementation covered 3 themes: organizational aspects, culture of the organization, and aspects of the intervention. No significant differences on main study outcomes were found after care units crossed over to the intervention condition. 

Conclusion: Although, this study shows that the intervention was not more effective compared to care as usual, the process evaluation shows that the intervention can be interesting for nursing homes currently lacking a structured approach towards the management of NPS. Also, this study provides important insights regarding the implementation of complex interventions in daily practice.

PO7.29. Three-level prevention framework based community home psychological services for people with dementia

CHI YU-CHUN1, CHI YU-CHUN2, LEE Yi-Jhen2, LIN Wan-Ling2, YANG Chi-Cheng2, HUANG Sheng-Jean2

1Taipei City Hospital, Holistic Social Preventive and Mental Health Center, Taipei, Taiwan, Province of China, 2Taipei City Hospital, Taipei, Taiwan, Province of China

Background: For people with dementia, professional services from psychologists usually include cognitive assessment and neuropsychological counseling at hospitals. Unfortunately, persons who may suffer from dementia in the community could not easily receive proper psychological cares. This study thus aims to establish a holistic model of psychological care that can fully link "community-home-hospital" with the needs of people with dementia and caregivers, and further to provide convenience and individualized services.

Method: This study takes the conceptual framework of 3-level preventions as the implementation policy. The services from psychologists in the care system of dementia include: (1) Primary prevention: knowledge of dementia for the general public promotion. (2) Secondary prevention: conducting home visit consultation, psychological assessment, cognitive environment evaluations for suspected or high-risk dementia in the community, with a view to early detection and early intervention. (3) Tertiary prevention: for people with dementia and caregivers, cognitive rehabilitation groups, emotional support groups for caregivers, and individual psychotherapy for extramural hospital clinics, are provided.

Results and Conclusions: Psychologists directly connect the relevant resources through the case management, and initiate secondary prevention services - arrange for home assessment and consultations. Accordingly, psychologists coordinate and connect different levels of psychological services, which emphasizes the continuity of primary to tertiary prevention services. Regardless of the intervention levels from which the cases enter into the service system, their needs can be assisted in integrated services.

PO7.30. A protocol for a randomised pilot feasibility trial: To explore the feasibility and acceptability of a comprehensive resilience-building psychosocial intervention (CREST)

DOYLE Priscilla, GALLAGHER Niamh, CASEY Dympna, SMYTH Siobhan

National University of Ireland Galway, Galway, Ireland

Resilience theory which focuses on strengthening people’s resources in the face of serious challenges and difficulties may provide the basis upon which an inclusive supportive psychosocial environment can be built. This pilot feasibility study seeks to create such an environment.

The CREST intervention is a multi-level complex psychosocial intervention which simultaneously targets people with memory problems/dementia (mild to moderate) and their informal carers living in the community. Two randomly selected general practices in the west of Ireland, will be allocated on a 1:1 ratio to control and intervention. Each GP practice will recruit 24 participants, comprised of 12 people living with dementia (PWD) and their primary carers x12. Participants in the intervention arm will receive the CREST intervention and those allocated to the control will receive usual care. It will run over 15 weeks and is comprised of various interrelated components targeting different participants which includes:

1) a 7-week cognitive stimulation programme ‘Making a Difference’ delivered to PWD

2) an 8-week physical exercise programme delivered to PWD who will also be supported by 12 older adults from the community

3) The DARES dementia education programme. This consist of three elements (a) a once off community dementia awareness programme delivered to members of the public (b) a 7-week dementia carers educational programme (c) a continuing professional development (CPD) and accredited PREPARED GP workshop.

Each component will be led by a trained health professional.  Quantitative data will be collected at baseline and post intervention.  In addition, an embedded qualitative component will be included. This will involve interviewing participants as they undertake the intervention and following completion.  This poster presents the protocol for the study which will include a detailed description of outcome measures, recruitment, data collection methods, fidelity and planned data analysis techniques.

PO7.32. Support groups for informal caregivers of person with dementia in Estonia: The participatory action research

VARIK Merle1, HEINMETS Hanna Stiina2

1Living with Dementia, Tartu, Estonia, 2Living with Dementia, Tallinn, Estonia

The non-profit organization “Living with Dementia” was founded in 2016. The organization brings together informal caregivers, social and health care specialists and also some residential care organization to support persons with dementia (PwD) and their families. Together, it was recognized that in Estonia there were not enough support services and support groups for informal caregivers of PwD.

Study design: The members of NGO defined the problems in the community, created plans and solutions to change the situation and take action. The study was based on participatory action research (PAR). The aim of the study was to launch support groups in various regions of Estonia for caregivers of PwD to support and empower them. PAR was carried out October 2016 - May 2019 in 3 cycles. The study used various methods for data collection: caregiver interviews, participant observation, field notes, questionnaires, informal conversations, memos of meetings and group facilitator reflections.

Results: Four support group were started. The support group facilitators were mainly members of Living with Dementia. The best format for support groups was to tailor the support group according to needs of caregivers. They include fragments with education, information and peer-support aspects.  End of the PAR was to facilitate 17 support groups in different regions in Estonia. From the support groups increased the need for training seminars and Memory-Cafes.

Conclusions: Informal caregivers will need information about illness and available services, advice and emotional support. Support groups are beneficial interventions to empower caregivers cope with the demands of caring, to get information, knowledge and peer-support.

PO7.33. ‘iSupport’: WHO’s global online training and support program for carers. Part I: Content, implementation and research

POT Anne Margriet, PINTO-BRUNO Angel, KLEIBOER Annet, VAN STRATEN Annemieke

Vrije Universiteit, Amsterdam, Netherlands

Support for family and other unpaid carers is included as one of the seven action areas in the Global Action Plan on dementia of the World Health Organization (WHO). The target for 2025 is that 75% of WHO’s 194 Member States provide support and training programmes for carers of people with dementia tailored to their needs.

To help scale up caregiver support globally, the World Health Organization (WHO) developed iSupport in collaboration with an international development team. It is an extensive training and support program for family and other unpaid carers of people with dementia. iSupport aims to improve unpaid carers’ mental health and coping resources. The program is based on cognitive behavioural principles. It consists of five main themes divided into 23 lessons. Currently, there is an online and a hardcopy version available.

In this presentation, the content of iSupport and the current status of its development, implementation and research around the world will be presented. In addition, more specifically the translation, adaptation, and implementation in the Netherlands will be discussed, with practical information for participants who would like to adapt iSupport for their country. The adaptation took place in accordance with WHO’s adaptation and implementation guide and was carried out by the Vrije Universiteit in Amsterdam in collaboration with Alzheimer Netherlands.






Last Updated: Thursday 07 November 2019


  • Acknowledgements

    The 29th AE Conference in The Hague received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe and Alzheimer Nederlands gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche