Background: Depression in dementia is common and associated with negative health outcomes. Mindfu... more Background: Depression in dementia is common and associated with negative health outcomes. Mindfulness-based cognitive therapy is a recommended treatment of choice for recurrent depression, but its use for depression in dementia is yet to be assessed. Objective: This study aimed to investigate the experiences of people with depression and dementia who participated in the mindfulness-based cognitive therapy intervention and those of their carers and facilitators. Methods: This qualitative study was nested within a randomised controlled feasibility study. Semistructured interviews were conducted with 18 people (eight people with dementia and depression, six carers and four course facilitators). Thematic analysis was used to analyse the data. Findings: Several beneficial effects of mindfulness-based cognitive therapy were described. These were a sense of shared suffering among the group, greater present moment focus and awareness, various positive emotional changes, including greater self-compassion, and benefits for carers, such as the reduction of anxiety. Specific aspects of the programme were identified as particularly useful, including facilitator characteristics and certain mindfulness practices. Carer involvement, cognitive difficulties and barriers to home practice influenced engagement with the course. Facilitators described adaptations made to mindfulness-based cognitive therapy and suggested additional modifications for future groups. Conclusion: Results of this process evaluation suggest that mindfulness-based cognitive therapy is a potentially useful intervention for people with depression in dementia, but that further adaptation of the intervention is required to make the programme suitable for this clinical population. Keywords depression, dementia, mindfulness-based cognitive therapy, qualitative, mindfulness '…when you've got someone with memory problems like she's got, by the time she came home from the class she'd forgotten really, what they did there.' (C05)
Background: Depression and dementia are major public health problems in the UK. Depression in ear... more Background: Depression and dementia are major public health problems in the UK. Depression in early-stage dementia is very common and significantly reduces quality of life, speeds cognitive decline and increases functional impairment. Mindfulness-Based Cognitive Therapy (MBCT) is an effective depression prevention programme, and the National Institute for Clinical Excellence (NICE) has suggested that MBCT is a priority for implementation. Alongside this, there is emerging evidence demonstrating promising results in relation to the benefits of adapted mindfulness interventions for people with dementia, suggesting that it could be beneficial in reducing depressive symptoms and in slowing deterioration in cognitive functions such as sustained attention, distraction inhibition and task switching. Methods: The design is a single-blind randomised controlled feasibility trial. Participants with mild to moderate depression and early stages of dementia will be recruited from the participating memory services. Participants will receive either immediate or delayed access to an 8-week MBCT programme. Participants will be assessed by a blind assessor and complete cognitive and mood-related outcome measures before and after the intervention. This feasibility study will test the trial design and assess recruitment, retention, acceptability and adherence, as well as providing preliminary efficacy data. Discussion: This study will inform the design and sample size for a future full randomised controlled trial (RCT), which will be carried out to determine the effectiveness of the intervention in reducing depressive symptoms in people with early stages of dementia.
Background Cognitive stimulation is an intervention for people with dementia which offers a range... more Background Cognitive stimulation is an intervention for people with dementia which offers a range of enjoyable activities providing general stimulation for thinking, concentration and memory usually in a social setting, such as a small group. Its roots can be traced back to Reality Orientation (RO), which was developed in the late 1950s as a response to confusion and disorientation in older patients in hospital units in the USA. RO emphasised the engagement of nursing assistants in a hopeful, therapeutic process but became associated with a rigid, confrontational approach to people with dementia, leading to its use becoming less and less common. Cognitive stimulation is often discussed in normal ageing as well as in dementia. This reflects a general view that lack of cognitive activity hastens cognitive decline. With people with dementia, cognitive stimulation attempts to make use of the positive aspects of RO whilst ensuring that the stimulation is implemented in a sensitive, respectful and person-centred manner.
IntroductionThe prevalence of dementia is almost five times higher in people with intellectual di... more IntroductionThe prevalence of dementia is almost five times higher in people with intellectual disabilities compared with the general population. However, evidence-based treatments for this population are lacking, as most randomised controlled trials for dementia interventions have not included people with intellectual disabilities. Cognitive stimulation therapy (CST) has a robust evidence base in the general dementia population, consistently showing benefits to cognition, quality of life and being cost-effective. We are conducting a mixed-methods feasibility trial of group CST for people with intellectual disabilities and dementia, to determine if a future definitive randomised controlled trial is feasible.Methods and analysisFifty individuals with intellectual disabilities and dementia will be randomised to either the intervention arm (14 sessions of group CST plus treatment as usual) or the control arm (treatment as usual). Randomisation will occur after informed consent has been...
Aims People with depression are up to 72% more at risk to develop cardiovascular disease (CVD) in... more Aims People with depression are up to 72% more at risk to develop cardiovascular disease (CVD) in their lifetime. Evidence-based psychotherapies are first-line interventions for the treatment of depression and are delivered nationally in England through the National Health Service via the Improving Access to Psychological Therapy (IAPT) primary care programme. It is currently unknown whether positive therapy outcomes may be associated with cardiovascular risk reduction. This study aimed to examine the association between psychotherapy outcomes for depression and incident CVD. Methods and results A cohort of 636 955 individuals who have completed a course of psychotherapy was built from linked electronic healthcare record databases of national coverage in England: the national IAPT database, the Hospital Episode Statistics (HES) database, and the HES–ONS (Office of National Statistics) mortality database. Multivariable Cox models adjusting for clinical and demographic covariates were...
Background and Objectives The Covid-19 pandemic reduced access to social activities and routine h... more Background and Objectives The Covid-19 pandemic reduced access to social activities and routine health care that are central to dementia prevention. We developed a group-based, video-call, cognitive well-being intervention; and investigated its acceptability and feasibility; exploring through participants’ accounts how the intervention was experienced and used in the pandemic context. Research Design and Method We recruited adults aged 60+ years with memory concerns (without dementia). Participants completed baseline assessments and qualitative interviews/focus groups before and after the 10-week intervention. Qualitative interview data and facilitator notes were integrated in a thematic analysis. Results 12/17 participants approached completed baseline assessments, attended 100/120 (83.3%) intervention sessions and met 140/170 (82.4%) of goals set. Most had not used video calling before. In the thematic analysis, our overarching theme was social connectedness. Three sub-themes were...
Background & Objectives: The Covid-19 pandemic has revolutionised how we receive services, with a... more Background & Objectives: The Covid-19 pandemic has revolutionised how we receive services, with a huge shift to online delivery. Online health promotion tools could be a costeffective and safe way to improve population health. We used mixed methods to explore user responses to an online cognitive health tool. Methods: 15-28 months after completing an online tool, comprising a cognitive test, lifestyle questionnaire; and dietary and lifestyle behaviour feedback, 4826 participants completed an online survey about their perceptions of it; and questions about their capability, opportunity and motivation for behavioural change developed using the COMB behaviour change model. We reported how responses to the behaviour change questionnaire predicted decisions to make lifestyle and dietary changes. 24 participants attended focus groups to further explore their responses. Results: Most users reported that the tool was useful (88%), with 37% reporting they made lifestyle or dietary changes after using it. More positive responses to questions regarding capability and motivation predicted making changes. Over a third (36%) felt more fearful after completing the tool. In qualitative findings, we identified barriers to engagement across the three COMB domains: a sense that information was "nothing new" (so did not enhance capability); that "experts don't agree" and that the tool may not be credible (influencing motivation), and a lack of support from peers and lower availability of healthy food (reducing opportunities for change). Conclusions: Future e-health tools will be most effective if they have high credibility, demonstrate advice is evidence-based and provide opportunities for support and follow up.
BackgroundDepression is an important, potentially modifiable dementia risk factor. However, it is... more BackgroundDepression is an important, potentially modifiable dementia risk factor. However, it is not known whether effective treatment of depression through psychological therapies is associated with reduced dementia incidence. The aim of this study was to investigate associations between reduction in depressive symptoms following psychological therapy and the subsequent incidence of dementia.MethodsNational psychological therapy data were linked with hospital records of dementia diagnosis for 119808 people aged 65+. Participants received a course of psychological therapy treatment in Improving Access to Psychological Therapies (IAPT) services between 2012 and 2019. Cox proportional hazards models were run to test associations between improvement in depression following psychological therapy and incidence of dementia diagnosis up to eight years later.ResultsImprovements in depression following treatment were associated with reduced rates of dementia diagnosis up to 8 years later (H...
Background: Research reporting results of clinical trials, psychosocial or technological interven... more Background: Research reporting results of clinical trials, psychosocial or technological interventions frequently omit critical details needed to inform implementation in practice. The aim of this article is to develop an Implementation Readiness (ImpRess) checklist, that includes criteria deemed useful in measuring readiness for implementation and apply it to trials of cognitive stimulation in dementia, providing a systematic review of their readiness for widespread implementation. Methods: Five electronic databases were searched. After initial screening of papers, two reviewers assessed quality and scored the included studies based on the ImpRess checklist specifically developed for this review. Results: Twenty studies met the inclusion criteria. As determined by the ImpRess checklist, scores ranged from 11 to 29 out of 52. According to the checklist the most comprehensive and ready to implement version of cognitive stimulation was Cognitive Stimulation Therapy. Conclusions: Reports of interventions rarely include consideration of implementation in practice. Contrary to the growing number of reporting guidelines, crucial items within the ImpRess checklist have been frequently overlooked. This study was able to show that the ImpRess checklist was feasible in practice and reliable. The checklist may be useful in evaluating readiness for implementation for other manualised interventions.
International Journal of Geriatric Psychiatry, May 10, 2012
New ideas, thought and associations 3 Using orientation, sensitively and implicitly 4 Opinions ra... more New ideas, thought and associations 3 Using orientation, sensitively and implicitly 4 Opinions rather than facts 5 Using reminiscence as an aid to the here-and-now 6 Physical movement 7 Providing triggers and prompts to aid recall and concentration 8 Continuity and consistency between sessions 9 Implicit (rather than explicit) learning Stimulating language Stimulating executive function Person-centred Respect Involvement and inclusion Choice Fun Maximising potential Building / strengthening relationships New ideas, thoughts and associations Opinions rather than facts What is the Research Evidence? • The first trial* included 201 people with dementia living in care homes or attending day centres. • Significant improvements in CST group, compared to 'usual care' control group, demonstrated in: Cognition (ADAS-Cog, p=0.01; MMSE, p=0.04) Both measured memory, language, and executive functioning. Quality of life, as measured by the person themselves and a proxy-rater (QoL-AD, p=0.03) • CST had similar impact on cognition to Galantamine, Rivastigmine and Donepezil**, as well as quality of life benefits.
Approximately 700,000 people in the UK have dementia and it has been estimated that by 2025 there... more Approximately 700,000 people in the UK have dementia and it has been estimated that by 2025 there will be one million people with dementia in the UK rising to 1.7 million by 2051 (Alzheimer's Society, 2007). Around a third of people with dementia are severely affected ...
International Journal of Geriatric Psychiatry, Jan 23, 2017
The CST and maintenance CST programmes are widely used and considered easy to put into practice. ... more The CST and maintenance CST programmes are widely used and considered easy to put into practice. • Outreach support shows no difference in average number of attendees to the programme. • Additional support may assist in sustaining the long term implementation of the maintenance CST programme.
British Journal of Occupational Therapy, Oct 1, 2016
Background. Cognitive Stimulation Therapy (CST) is a well-recognised and evidence based cognitive... more Background. Cognitive Stimulation Therapy (CST) is a well-recognised and evidence based cognitive psychosocial intervention for people with mild to moderate dementia, and recommended in National Institute of Clinical Excellence (NICE) guidelines (2006). Despite increased use of CST in routine care, less is known about its successful implementation in practice, and its effects for people with dementia. Methods. Two CST implementation in practice exercises are reported in this article in order to look at the support required for CST implementation and the effect on positive outcome measures for group members. Study one is a service evaluation of care home staff in greater London who received CST training and ongoing support (set up visit, spot visits, & telephone support) to assist in the setting up and delivery of the CST programme. Study two is an observational study measuring cognition and quality of life CST in practice: service evaluation & observational study_4 06072015 2 of people with dementia in a variety of care settings in receipt of CST as part of usual care. Results. Study one demonstrated a high number of CST and maintenance CST programmes delivered by care home staff. There was also a significant improvement in their approach to dementia and sense of competence over the study timeframe. Study two demonstrated a significant improvement in cognition for people with mild to moderate dementia as rated by the Mini Mental State Examination (MMSE; Folstein, Folstein, & McHugh., 1985), quality of life remained unchanged. Conclusions. There is little research on the implementation and dissemination of psychosocial interventions , described as phase IV in the Medical Research Council (MRC) framework of complex interventions. This article reports promising findings across the CST implementation in practice exercises, with demonstrated benefits for care staff and people with dementia. Both studies strengthen the evidence base supporting its use in routine care. Further research is required to replicate both studies on a larger scale, preferably a randomised controlled trial (RCT) study design.
Programme grants for applied research, Feb 1, 2017
Bob Woods reports that Bangor University has received royalties from the sale of therapy manuals ... more Bob Woods reports that Bangor University has received royalties from the sale of therapy manuals in the UK and the USA. Ian Russell reports that Swansea University has received funds from University College London for lectures and staff mentoring.
Background: Cognitive Stimulation Therapy (CST) is a psychosocial evidence-based group interventi... more Background: Cognitive Stimulation Therapy (CST) is a psychosocial evidence-based group intervention for people with dementia recommended by the UK NICE guidelines. In clinical trials, CST has been shown to improve cognition and quality of life, but little is known about the best way of ensuring implementation of CST in practice settings. A recent pilot study found that a third of people who attend CST training go on to run CST in practice, but staff identified a lack of support as a key reason for the lack of implementation. Methods/design: There are three projects in this study: The first is a pragmatic multi-centre, randomised controlled trial (RCT) of staff training, comparing CST training and outreach support with CST training only; the second, the monitoring and outreach trial, is a phase IV trial that evaluates implementation of CST in practice by staff members who have previously had the CST manual or attended training. Centres will be randomised to receive outreach support. The primary outcome measure for both of these trials is the number of CST sessions run for people with dementia. Secondary outcomes include the number of attenders at sessions, job satisfaction, dementia knowledge and attitudes, competency, barriers to change, approach to learning and a controllability of beliefs and the level of adherence. Focus groups will assess staff members' perceptions of running CST groups and receiving outreach support. The third study involves monitoring centres running groups in their usual practice and looking at basic outcomes of cognition and quality of life for the person with dementia. Discussion: These studies assess the effects of outreach support on putting CST into practice and running groups effectively in a variety of care settings with people with dementia; evaluate the effectiveness of CST in standard clinical practice; and identify key factors promoting or impeding the successful running of groups. Trial registration: Clinical trial ISRCTN28793457.
British Journal of Occupational Therapy, Aug 20, 2016
Background. Cognitive Stimulation Therapy is a well-recognised evidence based cognitive psychosoc... more Background. Cognitive Stimulation Therapy is a well-recognised evidence based cognitive psychosocial intervention for people with mild to moderate dementia. Despite increased use of Cognitive Stimulation Therapy little is known about its implementation in practice. Methods. A service evaluation of care home staff that received CST training and ongoing support by a researcher to deliver the CST and maintenance intervention in practice. Outcome measures including sense of competence, learning transfer, dementia knowledge and approaches to dementia were collected prior to training and at the six month follow up. Attendance by the person with dementia and adherence to the programme was also collected. Results. Ten out of 12 care homes attempted to deliver the Cognitive Stimulation Therapy programme after receiving training and support. Overall, a high number of Cognitive Stimulation Therapy and maintenance Cognitive Stimulation Therapy sessions were delivered. Over the timeframe of the service evaluation staff members 2 demonstrated significant improvements in positive approaches to dementia care and sense of competence. Conclusions. This article reports encouraging findings of training and outreach support with demonstrated improvements in staff outcomes and successful implementation of the Cognitive Stimulation Therapy and maintenance Cognitive Stimulation Therapy programmes run with people with dementia. These results support the current evidence base supporting the use of Cognitive Stimulation Therapy in routine care. This is relevant to Occupational Therapy due to the profession playing a crucial part in the implementation of psychosocial interventions for dementia in practice.
Psychosocial interventions for dementia have often been developed without a sound theoretical, em... more Psychosocial interventions for dementia have often been developed without a sound theoretical, empirical and clinical basis, and most evaluations of these interventions have had serious methodological limitations. This highlights the need to link intervention development with evaluation and design issues during the early stages of phase 1 or development of an intervention. Best practice is to develop interventions systematically, using the best available evidence and appropriate theory. This study focuses on the developmental stage of the Medical Research Council (MRC) guidelines (2008) to develop an evidence-based Maintenance Cognitive Stimulation Therapy (MCST) programme for dementia. The intervention was developed based on a mixed methods approach, using evidence obtained from the Cochrane review of Cognitive Stimulation for dementia followed by a Delphi consultation process with key stake-holders. Four techniques were used: (1) Cochrane review of cognitive stimulation for dementia, (2) a consultation with key stake holders using a Delphi Consensus Process (including an expert consensus conference), (3) focus groups with the target population and (4) a Delphi survey. These techniques were used to complete the theoretical preclinical and phase I modelling of the MRC framework for developing the MCST intervention for dementia.
Background: Depression in dementia is common and associated with negative health outcomes. Mindfu... more Background: Depression in dementia is common and associated with negative health outcomes. Mindfulness-based cognitive therapy is a recommended treatment of choice for recurrent depression, but its use for depression in dementia is yet to be assessed. Objective: This study aimed to investigate the experiences of people with depression and dementia who participated in the mindfulness-based cognitive therapy intervention and those of their carers and facilitators. Methods: This qualitative study was nested within a randomised controlled feasibility study. Semistructured interviews were conducted with 18 people (eight people with dementia and depression, six carers and four course facilitators). Thematic analysis was used to analyse the data. Findings: Several beneficial effects of mindfulness-based cognitive therapy were described. These were a sense of shared suffering among the group, greater present moment focus and awareness, various positive emotional changes, including greater self-compassion, and benefits for carers, such as the reduction of anxiety. Specific aspects of the programme were identified as particularly useful, including facilitator characteristics and certain mindfulness practices. Carer involvement, cognitive difficulties and barriers to home practice influenced engagement with the course. Facilitators described adaptations made to mindfulness-based cognitive therapy and suggested additional modifications for future groups. Conclusion: Results of this process evaluation suggest that mindfulness-based cognitive therapy is a potentially useful intervention for people with depression in dementia, but that further adaptation of the intervention is required to make the programme suitable for this clinical population. Keywords depression, dementia, mindfulness-based cognitive therapy, qualitative, mindfulness '…when you've got someone with memory problems like she's got, by the time she came home from the class she'd forgotten really, what they did there.' (C05)
Background: Depression and dementia are major public health problems in the UK. Depression in ear... more Background: Depression and dementia are major public health problems in the UK. Depression in early-stage dementia is very common and significantly reduces quality of life, speeds cognitive decline and increases functional impairment. Mindfulness-Based Cognitive Therapy (MBCT) is an effective depression prevention programme, and the National Institute for Clinical Excellence (NICE) has suggested that MBCT is a priority for implementation. Alongside this, there is emerging evidence demonstrating promising results in relation to the benefits of adapted mindfulness interventions for people with dementia, suggesting that it could be beneficial in reducing depressive symptoms and in slowing deterioration in cognitive functions such as sustained attention, distraction inhibition and task switching. Methods: The design is a single-blind randomised controlled feasibility trial. Participants with mild to moderate depression and early stages of dementia will be recruited from the participating memory services. Participants will receive either immediate or delayed access to an 8-week MBCT programme. Participants will be assessed by a blind assessor and complete cognitive and mood-related outcome measures before and after the intervention. This feasibility study will test the trial design and assess recruitment, retention, acceptability and adherence, as well as providing preliminary efficacy data. Discussion: This study will inform the design and sample size for a future full randomised controlled trial (RCT), which will be carried out to determine the effectiveness of the intervention in reducing depressive symptoms in people with early stages of dementia.
Background Cognitive stimulation is an intervention for people with dementia which offers a range... more Background Cognitive stimulation is an intervention for people with dementia which offers a range of enjoyable activities providing general stimulation for thinking, concentration and memory usually in a social setting, such as a small group. Its roots can be traced back to Reality Orientation (RO), which was developed in the late 1950s as a response to confusion and disorientation in older patients in hospital units in the USA. RO emphasised the engagement of nursing assistants in a hopeful, therapeutic process but became associated with a rigid, confrontational approach to people with dementia, leading to its use becoming less and less common. Cognitive stimulation is often discussed in normal ageing as well as in dementia. This reflects a general view that lack of cognitive activity hastens cognitive decline. With people with dementia, cognitive stimulation attempts to make use of the positive aspects of RO whilst ensuring that the stimulation is implemented in a sensitive, respectful and person-centred manner.
IntroductionThe prevalence of dementia is almost five times higher in people with intellectual di... more IntroductionThe prevalence of dementia is almost five times higher in people with intellectual disabilities compared with the general population. However, evidence-based treatments for this population are lacking, as most randomised controlled trials for dementia interventions have not included people with intellectual disabilities. Cognitive stimulation therapy (CST) has a robust evidence base in the general dementia population, consistently showing benefits to cognition, quality of life and being cost-effective. We are conducting a mixed-methods feasibility trial of group CST for people with intellectual disabilities and dementia, to determine if a future definitive randomised controlled trial is feasible.Methods and analysisFifty individuals with intellectual disabilities and dementia will be randomised to either the intervention arm (14 sessions of group CST plus treatment as usual) or the control arm (treatment as usual). Randomisation will occur after informed consent has been...
Aims People with depression are up to 72% more at risk to develop cardiovascular disease (CVD) in... more Aims People with depression are up to 72% more at risk to develop cardiovascular disease (CVD) in their lifetime. Evidence-based psychotherapies are first-line interventions for the treatment of depression and are delivered nationally in England through the National Health Service via the Improving Access to Psychological Therapy (IAPT) primary care programme. It is currently unknown whether positive therapy outcomes may be associated with cardiovascular risk reduction. This study aimed to examine the association between psychotherapy outcomes for depression and incident CVD. Methods and results A cohort of 636 955 individuals who have completed a course of psychotherapy was built from linked electronic healthcare record databases of national coverage in England: the national IAPT database, the Hospital Episode Statistics (HES) database, and the HES–ONS (Office of National Statistics) mortality database. Multivariable Cox models adjusting for clinical and demographic covariates were...
Background and Objectives The Covid-19 pandemic reduced access to social activities and routine h... more Background and Objectives The Covid-19 pandemic reduced access to social activities and routine health care that are central to dementia prevention. We developed a group-based, video-call, cognitive well-being intervention; and investigated its acceptability and feasibility; exploring through participants’ accounts how the intervention was experienced and used in the pandemic context. Research Design and Method We recruited adults aged 60+ years with memory concerns (without dementia). Participants completed baseline assessments and qualitative interviews/focus groups before and after the 10-week intervention. Qualitative interview data and facilitator notes were integrated in a thematic analysis. Results 12/17 participants approached completed baseline assessments, attended 100/120 (83.3%) intervention sessions and met 140/170 (82.4%) of goals set. Most had not used video calling before. In the thematic analysis, our overarching theme was social connectedness. Three sub-themes were...
Background & Objectives: The Covid-19 pandemic has revolutionised how we receive services, with a... more Background & Objectives: The Covid-19 pandemic has revolutionised how we receive services, with a huge shift to online delivery. Online health promotion tools could be a costeffective and safe way to improve population health. We used mixed methods to explore user responses to an online cognitive health tool. Methods: 15-28 months after completing an online tool, comprising a cognitive test, lifestyle questionnaire; and dietary and lifestyle behaviour feedback, 4826 participants completed an online survey about their perceptions of it; and questions about their capability, opportunity and motivation for behavioural change developed using the COMB behaviour change model. We reported how responses to the behaviour change questionnaire predicted decisions to make lifestyle and dietary changes. 24 participants attended focus groups to further explore their responses. Results: Most users reported that the tool was useful (88%), with 37% reporting they made lifestyle or dietary changes after using it. More positive responses to questions regarding capability and motivation predicted making changes. Over a third (36%) felt more fearful after completing the tool. In qualitative findings, we identified barriers to engagement across the three COMB domains: a sense that information was "nothing new" (so did not enhance capability); that "experts don't agree" and that the tool may not be credible (influencing motivation), and a lack of support from peers and lower availability of healthy food (reducing opportunities for change). Conclusions: Future e-health tools will be most effective if they have high credibility, demonstrate advice is evidence-based and provide opportunities for support and follow up.
BackgroundDepression is an important, potentially modifiable dementia risk factor. However, it is... more BackgroundDepression is an important, potentially modifiable dementia risk factor. However, it is not known whether effective treatment of depression through psychological therapies is associated with reduced dementia incidence. The aim of this study was to investigate associations between reduction in depressive symptoms following psychological therapy and the subsequent incidence of dementia.MethodsNational psychological therapy data were linked with hospital records of dementia diagnosis for 119808 people aged 65+. Participants received a course of psychological therapy treatment in Improving Access to Psychological Therapies (IAPT) services between 2012 and 2019. Cox proportional hazards models were run to test associations between improvement in depression following psychological therapy and incidence of dementia diagnosis up to eight years later.ResultsImprovements in depression following treatment were associated with reduced rates of dementia diagnosis up to 8 years later (H...
Background: Research reporting results of clinical trials, psychosocial or technological interven... more Background: Research reporting results of clinical trials, psychosocial or technological interventions frequently omit critical details needed to inform implementation in practice. The aim of this article is to develop an Implementation Readiness (ImpRess) checklist, that includes criteria deemed useful in measuring readiness for implementation and apply it to trials of cognitive stimulation in dementia, providing a systematic review of their readiness for widespread implementation. Methods: Five electronic databases were searched. After initial screening of papers, two reviewers assessed quality and scored the included studies based on the ImpRess checklist specifically developed for this review. Results: Twenty studies met the inclusion criteria. As determined by the ImpRess checklist, scores ranged from 11 to 29 out of 52. According to the checklist the most comprehensive and ready to implement version of cognitive stimulation was Cognitive Stimulation Therapy. Conclusions: Reports of interventions rarely include consideration of implementation in practice. Contrary to the growing number of reporting guidelines, crucial items within the ImpRess checklist have been frequently overlooked. This study was able to show that the ImpRess checklist was feasible in practice and reliable. The checklist may be useful in evaluating readiness for implementation for other manualised interventions.
International Journal of Geriatric Psychiatry, May 10, 2012
New ideas, thought and associations 3 Using orientation, sensitively and implicitly 4 Opinions ra... more New ideas, thought and associations 3 Using orientation, sensitively and implicitly 4 Opinions rather than facts 5 Using reminiscence as an aid to the here-and-now 6 Physical movement 7 Providing triggers and prompts to aid recall and concentration 8 Continuity and consistency between sessions 9 Implicit (rather than explicit) learning Stimulating language Stimulating executive function Person-centred Respect Involvement and inclusion Choice Fun Maximising potential Building / strengthening relationships New ideas, thoughts and associations Opinions rather than facts What is the Research Evidence? • The first trial* included 201 people with dementia living in care homes or attending day centres. • Significant improvements in CST group, compared to 'usual care' control group, demonstrated in: Cognition (ADAS-Cog, p=0.01; MMSE, p=0.04) Both measured memory, language, and executive functioning. Quality of life, as measured by the person themselves and a proxy-rater (QoL-AD, p=0.03) • CST had similar impact on cognition to Galantamine, Rivastigmine and Donepezil**, as well as quality of life benefits.
Approximately 700,000 people in the UK have dementia and it has been estimated that by 2025 there... more Approximately 700,000 people in the UK have dementia and it has been estimated that by 2025 there will be one million people with dementia in the UK rising to 1.7 million by 2051 (Alzheimer's Society, 2007). Around a third of people with dementia are severely affected ...
International Journal of Geriatric Psychiatry, Jan 23, 2017
The CST and maintenance CST programmes are widely used and considered easy to put into practice. ... more The CST and maintenance CST programmes are widely used and considered easy to put into practice. • Outreach support shows no difference in average number of attendees to the programme. • Additional support may assist in sustaining the long term implementation of the maintenance CST programme.
British Journal of Occupational Therapy, Oct 1, 2016
Background. Cognitive Stimulation Therapy (CST) is a well-recognised and evidence based cognitive... more Background. Cognitive Stimulation Therapy (CST) is a well-recognised and evidence based cognitive psychosocial intervention for people with mild to moderate dementia, and recommended in National Institute of Clinical Excellence (NICE) guidelines (2006). Despite increased use of CST in routine care, less is known about its successful implementation in practice, and its effects for people with dementia. Methods. Two CST implementation in practice exercises are reported in this article in order to look at the support required for CST implementation and the effect on positive outcome measures for group members. Study one is a service evaluation of care home staff in greater London who received CST training and ongoing support (set up visit, spot visits, & telephone support) to assist in the setting up and delivery of the CST programme. Study two is an observational study measuring cognition and quality of life CST in practice: service evaluation & observational study_4 06072015 2 of people with dementia in a variety of care settings in receipt of CST as part of usual care. Results. Study one demonstrated a high number of CST and maintenance CST programmes delivered by care home staff. There was also a significant improvement in their approach to dementia and sense of competence over the study timeframe. Study two demonstrated a significant improvement in cognition for people with mild to moderate dementia as rated by the Mini Mental State Examination (MMSE; Folstein, Folstein, & McHugh., 1985), quality of life remained unchanged. Conclusions. There is little research on the implementation and dissemination of psychosocial interventions , described as phase IV in the Medical Research Council (MRC) framework of complex interventions. This article reports promising findings across the CST implementation in practice exercises, with demonstrated benefits for care staff and people with dementia. Both studies strengthen the evidence base supporting its use in routine care. Further research is required to replicate both studies on a larger scale, preferably a randomised controlled trial (RCT) study design.
Programme grants for applied research, Feb 1, 2017
Bob Woods reports that Bangor University has received royalties from the sale of therapy manuals ... more Bob Woods reports that Bangor University has received royalties from the sale of therapy manuals in the UK and the USA. Ian Russell reports that Swansea University has received funds from University College London for lectures and staff mentoring.
Background: Cognitive Stimulation Therapy (CST) is a psychosocial evidence-based group interventi... more Background: Cognitive Stimulation Therapy (CST) is a psychosocial evidence-based group intervention for people with dementia recommended by the UK NICE guidelines. In clinical trials, CST has been shown to improve cognition and quality of life, but little is known about the best way of ensuring implementation of CST in practice settings. A recent pilot study found that a third of people who attend CST training go on to run CST in practice, but staff identified a lack of support as a key reason for the lack of implementation. Methods/design: There are three projects in this study: The first is a pragmatic multi-centre, randomised controlled trial (RCT) of staff training, comparing CST training and outreach support with CST training only; the second, the monitoring and outreach trial, is a phase IV trial that evaluates implementation of CST in practice by staff members who have previously had the CST manual or attended training. Centres will be randomised to receive outreach support. The primary outcome measure for both of these trials is the number of CST sessions run for people with dementia. Secondary outcomes include the number of attenders at sessions, job satisfaction, dementia knowledge and attitudes, competency, barriers to change, approach to learning and a controllability of beliefs and the level of adherence. Focus groups will assess staff members' perceptions of running CST groups and receiving outreach support. The third study involves monitoring centres running groups in their usual practice and looking at basic outcomes of cognition and quality of life for the person with dementia. Discussion: These studies assess the effects of outreach support on putting CST into practice and running groups effectively in a variety of care settings with people with dementia; evaluate the effectiveness of CST in standard clinical practice; and identify key factors promoting or impeding the successful running of groups. Trial registration: Clinical trial ISRCTN28793457.
British Journal of Occupational Therapy, Aug 20, 2016
Background. Cognitive Stimulation Therapy is a well-recognised evidence based cognitive psychosoc... more Background. Cognitive Stimulation Therapy is a well-recognised evidence based cognitive psychosocial intervention for people with mild to moderate dementia. Despite increased use of Cognitive Stimulation Therapy little is known about its implementation in practice. Methods. A service evaluation of care home staff that received CST training and ongoing support by a researcher to deliver the CST and maintenance intervention in practice. Outcome measures including sense of competence, learning transfer, dementia knowledge and approaches to dementia were collected prior to training and at the six month follow up. Attendance by the person with dementia and adherence to the programme was also collected. Results. Ten out of 12 care homes attempted to deliver the Cognitive Stimulation Therapy programme after receiving training and support. Overall, a high number of Cognitive Stimulation Therapy and maintenance Cognitive Stimulation Therapy sessions were delivered. Over the timeframe of the service evaluation staff members 2 demonstrated significant improvements in positive approaches to dementia care and sense of competence. Conclusions. This article reports encouraging findings of training and outreach support with demonstrated improvements in staff outcomes and successful implementation of the Cognitive Stimulation Therapy and maintenance Cognitive Stimulation Therapy programmes run with people with dementia. These results support the current evidence base supporting the use of Cognitive Stimulation Therapy in routine care. This is relevant to Occupational Therapy due to the profession playing a crucial part in the implementation of psychosocial interventions for dementia in practice.
Psychosocial interventions for dementia have often been developed without a sound theoretical, em... more Psychosocial interventions for dementia have often been developed without a sound theoretical, empirical and clinical basis, and most evaluations of these interventions have had serious methodological limitations. This highlights the need to link intervention development with evaluation and design issues during the early stages of phase 1 or development of an intervention. Best practice is to develop interventions systematically, using the best available evidence and appropriate theory. This study focuses on the developmental stage of the Medical Research Council (MRC) guidelines (2008) to develop an evidence-based Maintenance Cognitive Stimulation Therapy (MCST) programme for dementia. The intervention was developed based on a mixed methods approach, using evidence obtained from the Cochrane review of Cognitive Stimulation for dementia followed by a Delphi consultation process with key stake-holders. Four techniques were used: (1) Cochrane review of cognitive stimulation for dementia, (2) a consultation with key stake holders using a Delphi Consensus Process (including an expert consensus conference), (3) focus groups with the target population and (4) a Delphi survey. These techniques were used to complete the theoretical preclinical and phase I modelling of the MRC framework for developing the MCST intervention for dementia.
Uploads
Papers by Elisa Aguirre