Living well with dementia

Extending the evidence base for Cognitive Stimulation Therapy

(CST)

What is CST ?

A structured group intervention for people with mild / moderate dementia

Recommended in the NICE guidelines for Dementia (2006)

World Alzheimer’s Report 2011: “CST should be routinely offered to people with early stage

dementia”.

Cochrane review 2012Established benefits of CST: Cognitive functioning ( improvements equivalent to the anti

dementia drugs) Quality of Life /wellbeing Mood/confidence

Provided in most KMPT Memory Assessment Services

What is CST ?

It comprises 14 group sessions covering a series of themed activities aimed at stimulating specific cognitive processes e.g. executive functioning, language

Themed activities include: Food, childhood, sounds, categorising objects, current affairs, using money

Orientation and memory are addressed indirectly to avoid experiences of failure

It is delivered in an inclusive and empowering way allowing choice

It aims to provide a pleasurable experience- fun

Specific staff training required is minimal: Brief manual provided and maximum 1 day training course

Local interest

Extending CST groups beyond 14 sessions- seems beneficial

What training is needed for staff to be effective?

SHIELD

Support at Home, Interventions to Enhance Life in Dementia

3 Cognitive Stimulation Therapy studies

University College London Prof Martin Orrell

The research projects

Study 2 : Evaluation and Comparison of the Effectiveness of Staff Training in Maintenance CST- staff are the “ subjects”

Study 3 : What is the effect of providing 24 weeks of maintenance CST over and above standard CST ( 14 sessions) ?

Why get involved ?

Benefits for :me: Service line role to promote research; help

develop the psychosocial evidence base service users: enhance provision and quality of

CST across the trust; provide extra treatment for staff: use their therapeutic skills ,develop

research experience ; extra staff training in CST

for the trust : reputation; FT research requirements ; research targets

Getting started

Summer 2011

Identify the local PI : Negotiations between UCL & KMPT &

CLRN Local Research Approvals Identify “interested” sites and staff

The cast

5 sites – Tunbridge Wells ,Thanet, Maidstone, Canterbury and Sittingbourne

24 staff - OTs , Nurses, support workers, therapy technicians, assistant psychologist

Research nurse- K&M Comprehensive Local Research Network( CLRN)

Summer 2012Lift off ….

Induction to the studies from UCL researcher 24 Staff consent for study 2 22 Staff complete baseline questionnaires

The “ real” study – study 3

Recruitment of participants from those who’ve recently received a diagnosis of dementia in Memory Assessment Services.

46 people screened 38 people consented 38 Baseline assessments completed : QoL-

AD; CDR; MMSE

Forms…

What then?

5 groups started and ran for 14 sessions +24 sessions maintenance

Groups involved about 8- 10 members Assessments completed at baseline, end of 14 sessions and end of 24 maintenance

sessions for research participants.

Autumn 2013 All CST groups have finished 18 follow up assessments are completed so

far (5 dropped out due to ill health/ died) UCL study team doing a focus group with 9

staff to hear their observations 18 Staff have completed their final on line

assessments – study 2 ( 22 staff started)

The outcomes for participants

Formal data not yet analysed, but

Locally, staff observed improvements in confidence social functioning skills mood

i.e. Living better with dementia

The staff experience

How was it?

The voices of some participants

Heidi

Suzanne

What have we learned ?

Research takes time and energy

KMPT staff can really step up to the plate- but exhausting without a research supportive environment

5 sites and 2 studies at once was maybe over ambitious !

What next…..

Plans to engage with new multi site study -IDEAL

Develop our own research study and get research funding to implement it

Thanks for listening