M Parker Senior Occupational Therapist Helen Plesner Occupational Therapy Assistant Kingsley Mortimer Unit North Shore Hospital Waitemata DHB Aim Explain the rationale for adapting CST in an acute p ID: 557110
Download Presentation The PPT/PDF document "Cognitive Stimulation Therapy on an Acut..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Cognitive Stimulation Therapy on an Acute Psychogeriatric Ward
M Parker Senior Occupational Therapist
Helen Plesner Occupational Therapy Assistant
Kingsley Mortimer Unit , North Shore Hospital,
Waitemata
DHB Slide2
Aim
Explain
the rationale for adapting CST in an acute p
sychogeriatric setting.
Report on observations of patient enjoyment, communication, interest and mood over 14 weeks from June- October 2015.
Report on patient feedback that was collected.
Comment on issues and adaptability of CST approach to a mixed inpatient unit.Slide3
Cognitive Stimulation Therapy (
CST
)
CST is an evidence based approach for persons with mild to moderate dementia (Woods et al 2012).
It improves outcomes in cognition, communication and quality of life (QOL) for the person with dementia.
A pilot study in New Zealand (Cheung and
Peri
, 2014) replicated the results found in the literature.Slide4
Cognitive Stimulation Therapy (
CST)
CST is a structured group treatment of 14 sessions over 7 weeks.
Uses an orientation and reminiscence approach with activities and social interactions.
Twice weekly groups for seven weeks.
Closed group of 6 to 8 people with dementia in a community setting or residential facility
. Slide5
Clinical Context
Waitemata
DHB serves 600,000 people with 75,000 over 65 years of age.
Estimated number with Mental Health conditions over 65 years of age ~14,000.
Highest
Life expectancy
(86 years) yet
l
owest
institutionalisation
rate.
The DHB has an estimated 7,700 persons with dementia. Slide6
Kingsley
Mortimer
Unit
Kingsley Mortimer
Unit (Ward 12)
is a 19 bed Older
Adults Mental Health Unit.
Mental Health Services for Older Adults -ward and four community
teams.
Allied Health staff OT, OTA, PT, SW and psychologists.
It
has
a through-put
of 160 patients with an average LOS of ~
37 days.Slide7
Ward 12 Clinical Conditions
Major Depressive Episode +/-psychosis, +/-suicidal ideation or
attempt.
Anxiety - severe +/-
cognitive
impairment.
Bipolar Affective Disorder (BPAD
).
Dementia
with behavioural
and psychological symptoms of
dementia (BPSD).
Mental Health issues
overlaid on Parkinson’s Disease +
Stroke.
60-70% usually having some
cognitive impairments.Slide8
Rationale for using CST
L
arge
number of persons with cognitive
impairment.
Initially
present with severe depression or anxiety
but,
once
treated,
cognitive impairments become apparent.Wanting evidence based approaches used for group therapy inputs.Part of OT role development in 2015.Slide9
Issues using CST
Open
group
required due to admissions and discharges.
Number of sessions
provided would vary so variable CST dosage
Higher and lower functioning patient cohorts mixed on ward.Slide10
What we did
Ran an open group using CST approach four
times weekly on Kingsley Mortimer
unit from June 2015.
Reviewed by CST trainer, September 2015.
Patient observations kept for 42 sessions (June- October).
Collected patient feedback (46
patient comments from 12
groups).Slide11
Patient Cohort
51 patients attended CST groups
Attendance 1-14 groups
Dementia 43%
Depression 25%
Depression + psychosis 11%
Anxiety 11%
BPAD 10%
Schizophrenia and Schizoaffective Disorder 7%
Psychotic disorder 13%
Slide12
Results
Patient observations
by staff attending
group (42 sessions).
Rated enjoyment, communication, interest and mood (1-5
).
Despite large cohort of depressed patients most scored ‘3’ or above in, interest (84%),
communication(86%), mood(77%)
and enjoyment(76%).
Low mood (20%) correlated with Low enjoyment (19%)
Surprising result as often acutely unwell.Slide13
ResultsSlide14
ResultsSlide15
ResultsSlide16
ResultsSlide17
Patient Feedback Themes
46 patient comments from 12 groups.
Themes
Interesting variety
Active minds
Learning things
FunSlide18
Theme-Fun
Group Names
.
Song-
changed every three weeks at patient request.
Mystery objects- to prompt reminiscence theme.
News items -
numerous topical items (e.g.) Gangs in NZ, flag changes, children's health Slide19
Cultural Adaptations
CST has
adapted well to several cultures
-Tanzania
Nigeria India and
Japan.
Japanese
CST-J pilot
with
similar results
on
original studies in Great Britain (Yamanaka et al 2013
).
Guideline
for adaptation to different cultures completed. Steps include
programme
trial, manual translation and revision by cultural stakeholders (Aguirre et al 2014
).Slide20
Maori Language Week
OTA designed module completed in Maori language week.
a) Maori Greetings /
mihi
b)Maori proverbs/
whakatauki
, meaning
c) Simple nouns (
e.g
)
maunga
(hill)
nui
(big)
d) Maori place names beginning with “ T”
e) Location of Iwi on map
f)Maori word to English word matching quizSlide21
Theme 1:Adaptability of CST approach
Not a ‘precious’ approach.
Due to increased frequency of group, staff had to introduce more activities not in manual.
Followed use
of structure and
principles.
“Improvise - the programme is not meant to be rigid but to stimulate your own creativity, ideas and thinking” p47 (Spector et al 2006).Slide22
Activities Adapted
Art- artists they knew, famous paintings and galleries they had visited.
Activity on Toys from their youth, and a classic toy display was provided by occupational therapy assistant.
Chickens- reminiscence about rearing chickens, chicken types, chicken care.
Travel stories with large wall map.
Spring poem, making a group poem.Slide23
Staff Themes/ Programme strengths
Unexpected reminiscence.
Helpful maintaining mood.
Higher
functioning usually very
supportive
Confidence to staff using evidence based principles to run groups.
Ability to adapt to level of impairments of group.
CST overdose- no negative effects.Slide24
Weaknesses
Never designed as a robust study with before and after outcome measures.
Kept observations as a way to validate approach for ward as a quality improvement.
A NZ first and may be first anywhere to use CST on mixed clinical cohort of Mental Health diagnoses as well as persons with dementia.
Ideally could be trialled in different settings using robust outcome measures in QOL and cognition.Slide25
Going Forward
CST approach used DHB wide.
CST as a front end approach to maintain cognition and function for persons with mild-moderate dementia.
As CST improves QOL, may eventually reduce the incidence of BPSD in some patients dosed regularly with CST.Slide26
Going Forward
Adaptability of approach,
both culturally,
with
new activities and to level of person with dementia.
Trial CST Maori language modules with stakeholder inputs for revision.
World Alzheimer Report stated that cognitive stimulation had the “strongest evidence by far” for cognitive benefits in dementia.
Thank YouSlide27
References
Aguirre E.,
Spector
A.,
Orrell
M., (2014)
Guidelines for adapting cognitive stimulation therapy to other cultures
.
Clinical Interventions in Aging 9 1003–1007
Cheung, G. and Peri, K., (2014) Cognitive stimulation therapy: A New Zealand pilot. Auckland:
Te
Pou
o
Te
Whakaaro
Nui.
Spector A,
Thorgrimsen
L, Woods B,
Royan
L, Davies S, Butterworth M, (2003). Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial.
British Journal of Psychiatry
2003;183:248–54.
Spector A,
Thorgrimsen
L, Woods RT,
Orrell
M.
Making a Difference: An Evidence-Based Group Programme to Offer Cognitive Stimulation Therapy (CST) to People With Dementia
. London: Hawker Publications; 2006.
Woods B, Aguirre E, Spector A.E,
Orrell
M. (2012) Cognitive stimulation to improve cognitive functioning in people with dementia.
Cochrane Database of Systematic Reviews
Issue 2. Art. No.: CD005562. DOI: 10.1002/14651858.CD005562.pub2.
Yamanaka
K., Kawano Y., Noguchi D. ,
Nakaaki
S., Watanabe N. , Amano T
.,&
Spector A. (2013): Effects of cognitive stimulation therapy Japanese version (CST-J) for people with dementia: a
single blind, controlled
clinical trial,
Aging & Mental Health, D
OI:10.1080/13607863.2013.777395Slide28