Cognitive and Physical Stimulation Therapy Kelsey Firsick, BSW Mitchel P. Kohnen, BS Kinesiology Jeff Loraine RN,DON NHC Healthcare of Maryland Heights

Learning Objectives To allow for alternative programing to help reduce need for antipsychotic medications To assist care givers in developing therapeutic techniques to manage difficult behaviors To promote strategies to assist with improving cognition and decreasing depression To facilitate programs to maintain or improve functionality in dementia patients with behaviors

Program Development Initial program started to increase quality of life in dementia patients with behaviors Later developed to comply with CMS initiative to reduce antipsychotic usage in dementia patients with behaviors Aimed at reducing difficult behaviors Enhanced programing to combine cognitive stimulation and physical exercise

Cognitive Stimulation Therapy www.cstdementia.com Cochrane Database concluded: “CST programs benefit cognition in persons with mild to moderate dementia as much as cholinesterase inhibitors” “Shown to improve quality of life and be cost effective Professor Martin Orrell, University College of London Performed training for our center and region

Cognitive Stimulus Training(cont.) Two Comprehensive training manuals, “Making A Difference” &”Making A Difference” volume 2. Manual for group leaders by Aimee Spector, Lene Thorgrimsen, Bob Woods, & Martin Orrell by Hawker Publications & The Journal for Dementia Care www.caseinfo.org/books $30 each

Cognitive Stimulus Training

Program Development Cognitive Stimulation Therapy Physical Stimulation Therapy Small groups (6-10) people Groups meet twice a week 3 groups formed Consist of a set warm up followed by a predetermined topic of interest All residents get involved Multiple visual and tactile aids Walking and exercise program performed before each meeting Residents walk an average of 10 minutes and perform 6-8 repetitions of resistance exercises

Program Development Appointed 2 “Memory Care Liaisons” Assist with memory care unit and operations as well as program development for Cognitive and Physical Stimulation Different focus for each Exercise Activity Work in conjunction and combine specialties to enhance programing

Efficacy Participants where assessed for baseline cognition and depression before program began and after 7 weeks

Efficacy SLUMS & BIMS utilized to measure baseline cognitive function PHQ-9 for depression http://medschool.slu.edu/agingsuccessfully/pdfsurveys/slumsexam_05.pdf

Resistance Therapy

Dosage Reduction Program participants reviewed for potential reduction Anti-psychotic utilization reviewed by Medical Director, Consultant Pharmacist, & Primary Physician Decrease in psychotropics done gradually

Dosage Reduction Occupancy NHC MH – 93% MO – 67.9% Nat’l Avg. – 82.2% Psychiatric DX. NHC MH- 61.9% MO- 59.8% Nat’l Avg. – 55.4% Antipsychotic Usage NHC MH – 14.9% MO – 28.4% Nat’l Avg. – 25.2% January 2013 data

Conclusion Enhanced the quality of life of the cognitively impaired Programming has allowed for increased resident and family satisfaction Allowed healthcare center to diversify it’s services and provided additional referral source Decreased hospital readmission rates Staff acquisition of new skill sets to assist with caring for the cognitively impaired

Questions?