Psychosocial Interventions in Dementia & Carers PDF

**[Psychosocial Interventions in Dementia & Interventions for carers]** **Cognition-Focused Interventions for Dementia** - [Cognitive stimulation]: non-specific cognitive stimulation plus social element. - Origins: Reality Orientation - Evidence: improvements for cognition and...

**[Psychosocial Interventions in Dementia & Interventions for carers]** **Cognition-Focused Interventions for Dementia** - [Cognitive stimulation]: non-specific cognitive stimulation plus social element. - Origins: Reality Orientation - Evidence: improvements for cognition and quality of life in group setting. - NICE guidelines suggest that people with mild/ moderate dementia of all types should be given the opportunity to participate in a structured group cognitive stimulation programme. - [Cognitive training]: guided practice on specific cognitive tasks. - Targets impairment through structured tasks and environments that focus on isolated cognitive abilities and **processes**. - Can be individual or group setting. - Mainly restorative; sometimes combined with psychoeducation and strategy training. - Goal is to improve or maintain ability in specific cognitive domains. - [Cognitive rehabilitation]: individualised approach of setting personally relevant goals via the rehabilitation of cognitive abilities. - Operates on the principle that enriched and enhanced learning environments can promote gains via neuronal plasticity. - A combination of restorative and compensatory approaches combined with psychoeducation and strategy training. - Found to have no changes in cognition and quality of life. **People with Dementia & Their Carers** - In the UK today there are 816,000 people with dementia: - 2/3 women - 2/3 of people with dementia live in the community; 1/3 live in a care home. - 670,000 unpaid carers supporting them; unpaid carers make up of 44% of total costs of caring in the UK. - 70-80% of people with dementia are cared for at home by a relative or friend, saving a considerable amount of public money. **Policy Context** - NICE suggests that psychological therapy for family dementia carers is a key component of high-quality dementia care. - MSNAP suggests that quality standards recommend psychological interventions for family carers as a key dementia care component. **Psychological Needs of Family and Friend Carers** - Use of more **emotion focused and acceptance** based and less **dysfunctional coping strategies** is associated with decreased symptoms of anxiety and depression. - **Problem and solution focused coping strategies** have not been found to help with anxiety and depression. - Caregiver psychosocial factors explained 56% of the variance in BPSD-related distress. **Interventions for Carers** - [CBT Interventions]: - Individual CBT worked better for carers with depression. - Stronger effects for longer interventions & more structured active interventions. - The most effective interventions included an educational and a therapeutic component. - Multi-component interventions can delay entry to residential home. - [iSupport (WHO)]: an online training and skills programme for carers of people with dementia developed by WHO. - It is being developed and translated in different countries. - No evidence of effectiveness, but still an ongoing trial. - [START Project]: - First randomised controlled trial in the UK to test a manual based therapy for dementia carers. - First study worldwide to test the effectiveness of graduates without clinical qualifications in delivering therapy to this group. - Implementation: Management support, skills of the team, resources to deliver intervention, suitability of START, and willingness of individual/ team.