International Journal of Geriatric Psychiatry, early cite 1 April 2021,
Publisher:
Wiley
Objective: Dementia, a global epidemic, currently affects 50 million individuals worldwide. There are currently limited effective treatments for moderate to severe dementia, and most treatments focus on reducing symptoms rather than improving positive factors. It is unclear if improvements are not possible due to disease severity. This review examines the efficacy of the current psychosocial...
(Edited publisher abstract)
Objective: Dementia, a global epidemic, currently affects 50 million individuals worldwide. There are currently limited effective treatments for moderate to severe dementia, and most treatments focus on reducing symptoms rather than improving positive factors. It is unclear if improvements are not possible due to disease severity. This review examines the efficacy of the current psychosocial interventions for people with moderate to severe dementia, focusing on improving cognition and quality of life (QoL) to evaluate what treatments are working and whether improvements are possible. Methods: A systematic search was conducted using six key databases to identify psychosocial interventions for people with moderate to severe dementia, measuring cognition or QoL in randomized controlled trials (RCTs), published between 2000 and 2020. Results: The search identified 4193 studies, and 74 articles were assessed for full‐text review. Fourteen RCTs were included and appraised with the Physiotherapy Evidence Database Scale. The included RCTs were moderate in quality. Conclusions: Aromatherapy and reminiscence therapy showed the strongest evidence in improving QoL. There was some evidence that aerobic exercise enhanced cognition, and a multicomponent study improved QoL. However, a quality assessment, using pre‐specified criteria, indicated many methodological weaknesses. While this study found improvements in cognition and QoL for moderate to severe dementia, results must be interpreted with caution. Future interventions with rigorous study designs are a pressing need and required before we can recommend specific interventions.
(Edited publisher abstract)
Subject terms:
dementia, psychosocial intervention, psychosocial approach, quality of life, reminiscence therapy, therapy and treatment, systematic reviews;
Objective: This research study aims to evaluate the effectiveness of an expanded cognitive stimulation therapy (CST) model that combines a CST group and tai chi on improving the cognitive ability of community-dwelling Chinese elderly with mild stage dementia (EwMD). Method: A randomized waitlist controlled trial design was adopted in this study. The treatment group participated in a structured...
Objective: This research study aims to evaluate the effectiveness of an expanded cognitive stimulation therapy (CST) model that combines a CST group and tai chi on improving the cognitive ability of community-dwelling Chinese elderly with mild stage dementia (EwMD). Method: A randomized waitlist controlled trial design was adopted in this study. The treatment group participated in a structured CST group followed by tai chi twice a week, with a total of 14 sessions throughout the study period. The waitlist control group received treatment as usual at the initial stage and expanded CST model at a later stage. The Chinese Mattis Dementia Rating Scale (DRS) and the Chinese Mini Mental State Examination (MMSE) were used to assess the cognitive ability of EwMD in the pre- and post- treatment periods. Results: At baseline, the treatment group (n = 51) and control group (n = 50) did not differ significantly in any demographic or clinical variables. Overall, the participants had a mean baseline MMSE score of 20.67 (SD = 2.30). The 2 × 2 repeated measures ANCOVA demonstrated that the treatment group was significantly more effective than the control group in improving the MMSE score (F = 12.31, p< .01) with a moderate effect size (partial eta square = .11) after controlling for group difference in age, gender, education, and having a diagnosis of dementia. Conclusion: The present study demonstrates the effectiveness of the expanded CST model on the improvement of cognitive ability of community-dwelling EwMD. More research is needed to further investigate this intervention model across cultures and societies.
Dementia: the International Journal of Social Research and Practice, 18(4), 2019, pp.1373-1392.
Publisher:
Sage
Objectives: Literature regarding Montessori-based activities with older adults with dementia is fairly common with early stages of dementia. Conversely, research on said activities with individuals experiencing late-stage dementia is limited because of logistical difficulties in sampling and data collection. Given the need to understand risks and benefits of treatments for individuals with late...
(Edited publisher abstract)
Objectives: Literature regarding Montessori-based activities with older adults with dementia is fairly common with early stages of dementia. Conversely, research on said activities with individuals experiencing late-stage dementia is limited because of logistical difficulties in sampling and data collection. Given the need to understand risks and benefits of treatments for individuals with late-stage dementia, specifically regarding their mental and behavioural health, this study sought to evaluate the effects of a Montessori-based activity program implemented in a long-term care facility. Method: Utilizing an interrupted time series design, trained staff completed observation-based measures for 43 residents with late-stage dementia at three intervals over six months. Empirical measures assessed mental health (anxiety, psychological well-being, quality of life) and behavioural health (problem behaviours, social engagement, capacity for activities of daily living). Results: Group differences were observed via repeated measures ANOVA and paired-samples t-tests. The aggregate, longitudinal results—from baseline to final data interval—for the psychological and behavioural health measures were as follows: problem behaviours diminished though not significantly; social engagement decreased significantly; capacities for activities of daily living decreased significantly; quality of life increased slightly but not significantly; anxiety decreased slightly but not significantly; and psychological well-being significantly decreased. Conclusion: Improvements observed for quality of life and problem behaviours may yield promise for Montessori-based activities and related health care practices. The rapid physiological and cognitive deterioration from late-stage dementia should be considered when interpreting these results.
(Edited publisher abstract)
Subject terms:
health, outcomes, dementia, long term care, mental health, behaviour, behaviour problems, therapy and treatment;
International Journal of Geriatric Psychiatry, 34(3), 2019, pp.439-446.
Publisher:
Wiley
...they not attended MAS, the cost‐effectiveness ratio would be £25 056. The largest MAS (N = 32; 46%) with over 50 new patients a month were more likely to be cost‐effective than smaller ones (P < 0.01). Conclusions: MAS are effective and can be cost‐effective for diagnosing and treating people with suspected dementia. Large variations in costs between clinics suggest that many MAS could improve their cost
(Edited publisher abstract)
Objectives: This paper aims to compare changes over 2 years in patients' health‐related quality of life (HRQL) with the health and social care costs of diagnosis and treatment of people newly referred to memory assessment services (MAS).
Methods: This study analysed observational data from 1318 patients referred to 69 MAS who completed resource use and HRQL questionnaires at baseline 3, 6, 12, and 24 months. This study reported mean differences in HRQL (disease‐specific DEMQOL and generic EQ‐5D‐3 L), quality‐adjusted life years (QALYs), costs and cost‐effectiveness between baseline, and 2‐year follow‐up. Results: Two years after referral to MAS, patients reported a higher DEMQOL score (mean gain 4.47, 95% confidence interval, 3.08‐5.90) and EQ‐5D‐3 L (0.014, −0.011 to 0.039). Mean total costs and QALYs over 24 months was £2411 (£1721‐£2873) and 0.027 (0.003‐0.051), respectively. Assuming that patients' HRQL would not have altered over the 2 years had they not attended MAS, these outcomes suggest an incremental cost‐effectiveness ratio of £89 546 (£38 123‐£145 864) based on changes in EQ‐5D‐3 L. If we assumed that patients' HRQL would have declined by about 10% over this period had they not attended MAS, the cost‐effectiveness ratio would be £25 056. The largest MAS (N = 32; 46%) with over 50 new patients a month were more likely to be cost‐effective than smaller ones (P < 0.01). Conclusions: MAS are effective and can be cost‐effective for diagnosing and treating people with suspected dementia. Large variations in costs between clinics suggest that many MAS could improve their cost‐effectiveness.
(Edited publisher abstract)
Subject terms:
economic evaluation, cost effectiveness, dementia, intervention, memory, quality of life, outcomes, evaluation, therapy and treatment, diagnosis;
International Journal of Geriatric Psychiatry, 34(5), 2019, pp.709-721.
Publisher:
Wiley
Objectives: To determine whether individual goal‐oriented cognitive rehabilitation (CR) improves everyday functioning for people with mild‐to‐moderate dementia. Design and methods: Parallel group multicentre single‐blind randomised controlled trial (RCT) comparing CR added to usual treatment (CR) with usual treatment alone (TAU) for people with an ICD‐10 diagnosis of Alzheimer, vascular or mixed...
(Edited publisher abstract)
Objectives: To determine whether individual goal‐oriented cognitive rehabilitation (CR) improves everyday functioning for people with mild‐to‐moderate dementia. Design and methods: Parallel group multicentre single‐blind randomised controlled trial (RCT) comparing CR added to usual treatment (CR) with usual treatment alone (TAU) for people with an ICD‐10 diagnosis of Alzheimer, vascular or mixed dementia, and mild‐to‐moderate cognitive impairment (Mini‐Mental State Examination [MMSE] score ≥ 18), and with a family member willing to contribute. Participants allocated to CR received 10 weekly sessions over 3 months and four maintenance sessions over 6 months. Participants were followed up 3 and 9 months post randomisation by blinded researchers. The primary outcome was self‐reported goal attainment at 3 months. Secondary outcomes at 3 and 9 months included informant‐reported goal attainment, quality of life, mood, self‐efficacy, and cognition and study partner stress and quality of life. Results: We randomised (1:1) 475 people with dementia; 445 (CR = 281) were included in the intention to treat analysis at 3 months and 426 (CR = 208) at 9 months. At 3 months, there were statistically significant large positive effects for participant‐rated goal attainment (d = 0.97; 95% CI, 0.75‐1.19), corroborated by informant ratings (d = 1.11; 95% CI, 0.89‐1.34). These effects were maintained at 9 months for both participant (d = 0.94; 95% CI, 0.71‐1.17) and informant (d = 0.96; 95% CI, 0.73‐1.2) ratings. The observed gains related to goals directly targeted in the therapy. There were no significant differences in secondary outcomes. Conclusions: CR enables people with early‐stage dementia to improve their everyday functioning in relation to individual goals targeted in the therapy.
(Edited publisher abstract)
Subject terms:
randomised controlled trials, cognitive behavioural therapy, dementia, Alzheimers disease, activities of daily living, objectives setting, disabilities, person-centred care, reablement, evaluation, intervention, outcomes, therapy and treatment;
Dementia: the International Journal of Social Research and Practice, 17(2), 2018, pp.227-233.
Publisher:
Sage
Psychosocial approaches to the management of behavioural and psychological symptoms of dementia have received much support in the scientific literature. The following paper focuses on cognitive behaviour therapy as a valid framework in assessing and treating people with behavioural and psychological symptoms of dementia. The importance of identifying symptoms of depression and anxiety...
(Edited publisher abstract)
Psychosocial approaches to the management of behavioural and psychological symptoms of dementia have received much support in the scientific literature. The following paper focuses on cognitive behaviour therapy as a valid framework in assessing and treating people with behavioural and psychological symptoms of dementia. The importance of identifying symptoms of depression and anxiety is emphasised, as cognitive behaviour therapy has been shown to be an effective intervention for these conditions in older adults. Modifications of cognitive behaviour therapy for those with dementia are discussed based on available evidence, with emphasis on incorporating nursing home staff in treatment programs and focusing on behavioural elements of cognitive behaviour therapy such as activity scheduling. The paper concludes with suggestions regarding how to incorporate and promote the use of cognitive behaviour therapy in dementia care settings.
(Edited publisher abstract)
Subject terms:
cognitive behavioural therapy, challenging behaviour, dementia, behaviour problems, nursing homes, psychosocial approach, therapy and treatment, care homes;
Background: Seventy percent of people with advanced dementia live and die in care homes. Multisensory approaches, such as Namaste Care, have been developed to improve the quality of life and dying for people with advanced dementia but little is known about effectiveness or optimum delivery. The aim of this review was to develop an explanatory account of how the Namaste Care intervention might...
(Edited publisher abstract)
Background: Seventy percent of people with advanced dementia live and die in care homes. Multisensory approaches, such as Namaste Care, have been developed to improve the quality of life and dying for people with advanced dementia but little is known about effectiveness or optimum delivery. The aim of this review was to develop an explanatory account of how the Namaste Care intervention might work, on what outcomes, and in what circumstances. Methods: This is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories, and their validation with a purposive sample of stakeholders. Twenty stakeholders - user/patient representatives, dementia care providers, care home staff, researchers -took part in interviews and/or workshops. Results: The study included 85 papers. Eight focused on Namaste Care and the remainder on other types of sensory interventions such as music therapy or massage. The study identified three context-mechanism-outcome configurations which together provide an explanatory account of what needs to be in place for Namaste Care to work for people living with advanced dementia. This includes: providing structured access to social and physical stimulation, equipping care home staff to cope effectively with complex behaviours and variable responses, and providing a framework for person-centred care. A key overarching theme concerned the importance of activities that enabled the development of moments of connection for people with advanced dementia. Conclusions: This realist review provides a coherent account of how Namaste Care, and other multisensory interventions might work. It provides practitioners and researchers with a framework to judge the feasibility and likely success of Namaste Care in long term settings. Key for staff and residents is that the intervention triggers feelings of familiarity, reassurance, engagement and connection.
(Edited publisher abstract)
Subject terms:
dementia, palliative care, end of life care, terminal illness, dying, therapies, therapy and treatment, intervention, care homes, residential care, quality of life, literature reviews;
The second edition of a guide providing advice for people with dementia, and their carers, to help them come to terms with their diagnosis, and to plan ahead and enable them to live well with the condition. It includes sections focusing on the emotional impact of a diagnosis; drug treatments that are available; signposting to services available through the NHS; social services, charities
(Edited publisher abstract)
The second edition of a guide providing advice for people with dementia, and their carers, to help them come to terms with their diagnosis, and to plan ahead and enable them to live well with the condition. It includes sections focusing on the emotional impact of a diagnosis; drug treatments that are available; signposting to services available through the NHS; social services, charities and private organisations; and support for carers. The guide has been endorsed by the Royal College of Psychiatrists (RCP), the Royal College of General Practitioners (RCGP) and the Association of Directors of Adult Social Services (ADASS).
(Edited publisher abstract)
Subject terms:
carers, dementia, diagnosis, health professionals, social care provision, quality of life, therapy and treatment;
British Journal of Occupational Therapy, 79(12), 2016, pp.762-767.
Publisher:
Sage
Introduction: The delivery of cognitive stimulation as a cognitive based psychosocial intervention for people with mild to moderate dementia is supported in the National Institute for Health and Care Excellence guidelines. There is a strong evidence base for its effectiveness in providing improvements in cognition and quality of life for people with dementia. However, less is known about its...
(Publisher abstract)
Introduction: The delivery of cognitive stimulation as a cognitive based psychosocial intervention for people with mild to moderate dementia is supported in the National Institute for Health and Care Excellence guidelines. There is a strong evidence base for its effectiveness in providing improvements in cognition and quality of life for people with dementia. However, less is known about its delivery and its impact using outcome measures when used in practice.
Methods: A 1-year observational study was conducted, which measured the cognition and quality of life of 89 people with dementia living in care homes and the community and were in receipt of cognitive stimulation therapy and a maintenance programme as part of their usual care in practice.
Results: A paired sample T-test demonstrated a significant improvement in cognition. Quality of life remained unchanged for people with mild to moderate dementia.
Conclusions: This study reports promising findings with demonstrated benefits for people with dementia and strengthens the evidence base supporting its use in routine care. However, attention should be given to the level of cognitive impairment of attendees. This research is relevant to the field of occupational therapy as the profession has knowledge of using psychosocial interventions and a commitment to evidence-based practice.
(Publisher abstract)
Subject terms:
dementia, therapy and treatment, evaluation, psychosocial intervention, quality of life, outcomes;
This report sets out an integrated and comprehensive approach to supporting people with advanced dementia through to end of life, whether they are living in their own home, in a care home or spending time in a health care setting. The report looks at the experience of advanced dementia and outlines the issues that need to be addressed. Issues discussed include equality of access to services...
(Edited publisher abstract)
This report sets out an integrated and comprehensive approach to supporting people with advanced dementia through to end of life, whether they are living in their own home, in a care home or spending time in a health care setting. The report looks at the experience of advanced dementia and outlines the issues that need to be addressed. Issues discussed include equality of access to services; advanced planning and decision making, nutrition and hydration, and psychological issues. It also looks at the support needs of carers providing day-to-day care for people with dementia. The report then outlines the Advanced Dementia Practice Model, which focuses the Advanced Dementia Specialist Team and the 8 Pillars that make up the model. These are: the Dementia Practice Coordinator; General health care and treatment; Mental Health care and treatment; personalised support; therapeutic approach; Support for carers; Environmental responses; and Community Connections. The report then makes recommendations and calls for the Scottish Government to test the Advanced Dementia Practice Model as part of the objectives of the National Dementia Strategy 2016 in Scotland.
(Edited publisher abstract)
Subject terms:
dementia, end of life care, models, quality of life, care planning, integrated care, multidisciplinary services, person-centred care, therapy and treatment, good practice;