Cognitive and Physical Stimulation Therapy

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

2. 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

3. 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

4. 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

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

6. Cognitive Stimulus Training

7. 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

8. 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

9. Efficacy • Participants where assessed for baseline cognition and depression before program began and after7weeks

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

11. Resistance Therapy

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

13. 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%

14. 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

15. Questions?