Can reality orientation be rehabilitated? Development and piloting of an evidence-based programme of cognition-based therapies for people with dementia

Spector, Aimee; Orrell, Martin; Davies, Stephen; Woods, Bob

doi:10.1080/09602010143000068

Cited by 156 publications

(126 citation statements)

References 36 publications

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“…Departemen Kesehatan di Inggris menetapkan prioritas nasional untuk meningkatkan akses bagi lansia dengan demensia di negara yaitu terlibat dalam terapi psikososial . Salah satu terapi psikososial yang dapat dipertimbangkan adalah Terapi Stimulasi Kognitif (TSK) karena manfaatnya terbukti setara dengan obat-obatan anti demensia dalam meningkatkan fungsi kognitif dan kualitas hidup (Spector, et al, 2001;2006;& Streater, 2012).…”

Section: Pendahuluanunclassified

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Domain Fungsi Kognitif setelah Terapi Stimulasi Kognitif

Komalasari¹

2014

JKI

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AbstrakTerapi Stimulasi Kelompok (TSK) merupakan terapi kelompok yang terbukti efektif meningkatkan fungsi kognitif lanjut usia dengan demensia ringan-sedang. Penelitian ini bertujuan membuktikan efektifitas TSK dengan 14 sesi terhadap peningkatan fungsi kognitif di Kelurahan Binong, Tangerang, Indonesia. Sebanyak 43 orang mengikuti skrining demensia dengan Mental State Examination (MMSE) rentang. Jumlah responden yang mengukti pretes 24 orang. Attrition rate responden mencapai 79,1%. Hanya lima responden mengikuti TSK hingga pos-tes. Kendati ada kenaikan skor MMSE 2,4 poin antara pre-dan pos-test, namun berdasarkan paired t test, tidak ada perbedaan signifikan antara skor MMSE pre-dan pos-tes secara keseluruhan (p=0,080; α=0,05)dan tidak ada perbedaan pre dan pos-tes untuk tiap domain fungsi kognitif. Kecilnya jumlah sampel dapat memengaruhi hasil penelitian ini. Penelitian lebih lanjut dengan ukuran sampel lebih besar dibutuhkan guna memvalidasi temuan penelitian ini. Kata kunci: fungsi kognitif, lanjut usia (lansia), Mini Mental State Examination (MMSE), terapi stimulasi kognitif Abstract Cognitive Function Domain after Cognitive Stimulation Therapy (CST). CST is a group therapy proved effective at

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Section: Pendahuluanunclassified

“…Hasil penelitian ini sejalan dengan kebanyakan bukti literatur tentang keefektifan terapi stimulasi kognitif (Spector,et al, 2001;2006;. Terapi kelompok ini telah mendapatkan pengakuan sebagai terapi alternatif selain terapi farmakologis untuk orang dengan demensia ringan sampai sedang (Spector, et al, 2003;.…”

Section: Hasilunclassified

Domain Fungsi Kognitif setelah Terapi Stimulasi Kognitif

Komalasari¹

2014

JKI

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“…47 Two reviewers independently assessed eligibility. Of the 94 references, nine studies met the inclusion criteria [48][49][50][51][52][53][54][55] and were included in the analysis. Three recent studies were left awaiting classification.…”

Section: Studies Included In the Reviewmentioning

confidence: 99%

“…6,55,62,64 Most studies took steps to ensure that at least part of the assessment of outcomes was carried out by assessors blinded to treatment allocation. Only three studies 48,60,62 did not report the blinding of assessors.…”

Section: Quality Of Included Studiesmentioning

confidence: 99%

“…Data were identified, included and pooled from the 15 included RCTs, 6,[48][49][50][51][52][53][54][55][59][60][61][62][63][64] with a total of 718 participants (407 in experimental groups and 311 in control groups). Analyses were adjusted to the random-effects model, owing to the heterogeneity of trials, and SMDs, because trials used different measures to assess the same outcomes.…”

Section: Meta-analysismentioning

confidence: 99%

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Support at Home: Interventions to Enhance Life in Dementia (SHIELD) – evidence, development and evaluation of complex interventions

Orrell

Hoe

Charlesworth

et al. 2017

Programme Grants Appl Res

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BackgroundDementia is a national priority and this research addresses the Prime Minister’s commitment to dementia research as demonstrated by his 2020 challenge and the new UK Dementia Research Institute. In the UK > 800,000 older people have dementia. It has a major impact on the lives of people with dementia themselves, on the lives of their family carers and on services, and costs the nation £26B per year. Pharmacological cures for dementias such as Alzheimer’s disease are not expected before 2025. If no cure can be found, the ageing demographic will result in 2 million people living with dementia by 2050. People with dementia lose much more than just their memory and their daily living skills; they can also lose their independence, their dignity and status, their confidence and morale, and their roles both within the family and beyond. They can be seen as a burden by society, by their families and even by themselves, and may feel unable to contribute to society. This programme of research aims to find useful interventions to improve the quality of life of people with dementia and their carers, and to better understand how people with dementia can be supported at home and avoid being admitted to hospital.Objectives(1) To develop and evaluate the maintenance cognitive stimulation therapy (MCST) for people with dementia; (2) to develop the Carer Supporter Programme (CSP), and to evaluate the CSP and Remembering Yesterday, Caring Today (RYCT) for people with dementia both separately and together in comparison with usual care; and (3) to develop a home treatment package (HTP) for dementia, to field test the HTP in practice and to conduct an exploratory trial.Methods(1) The MCST programme was developed for people with dementia based on evidence and qualitative work. A randomised controlled trial (RCT) [with a pilot study of MCST plus acetylcholinesterase inhibitors (AChEIs)] compared MCST with cognitive stimulation therapy (CST) only. The MCST implementation study conducted a trial of outreach compared with usual care, and assessed implementation in practice. (2) The CSP was developed based on existing evidence and the engagement of carers of people with dementia. The RCT (with internal pilot) compared the CSP and reminiscence (RYCT), both separately and in combination, with usual care. (3) A HTP for dementia, including the most promising interventions and components, was developed by systematically reviewing the literature and qualitative studies including consensus approaches. The HTP for dementia was evaluated in practice by conducting in-depth field testing.Results(1) Continuing MCST improved quality of life and improved cognition for those taking AChEIs. It was also cost-effective. The CST implementation studies indicated that many staff will run CST groups following a 1-day training course, but that outreach support helps staff go on to run maintenance groups and may also improve staff sense of competence in dementia care. The study of CST in practice found no change in cognition or quality of life at 8-month follow-up. (2) The CSP/RYCT study found no benefits for family carers but improved quality of life for people with dementia. RYCT appeared beneficial for the quality of life of people with dementia but at an excessively high cost. (3) Case management for people with dementia reduces admissions to long-term care and reduces behavioural problems. In terms of managing crises, staff suggested more costly interventions, carers liked education and support, and people with dementia wanted family support, home adaptations and technology. The easy-to-use home treatment manual was feasible in practice to help staff working in crisis teams to prevent hospital admissions for people with dementia.LimitationsGiven constraints on time and funding, we were unable to compete the exploratory trial of the HTP package or to conduct an economic evaluation.Future researchTo improve the care of people with dementia experiencing crises, a large-scale clinical trial of the home treatment manual is needed.ConclusionThere is an urgent need for effective psychosocial interventions for dementia. MCST improved quality of life and was cost-effective, with benefits to cognition for those on AChEIs. MCST was feasible in practice. Both CSP and RYCT improved the quality of life of people with dementia, but the overall costs may be too high. The HTP was useful in practice but requires evaluation in a full trial. Dementia care research may improve the lives of millions of people across the world.Trial registrationsCurrent Controlled Trials ISRCTN26286067 (MCST), ISRCTN28793457 (MCST implementation) and ISRCTN37956201 (CSP/RYCT).FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 5. See the NIHR Journals Library website for further project information.

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