kelsey firsick, bsw mitchel p. kohnen, bs kinesiology jeff loraine rn,don nhc healthcare of maryland...
TRANSCRIPT
Cognitive and Physical Stimulation Therapy
Kelsey Firsick, BSWMitchel P. Kohnen, BS Kinesiology
Jeff Loraine RN,DON
NHC Healthcare of Maryland Heights
Learning ObjectivesTo allow for alternative programing to help
reduce need for antipsychotic medicationsTo assist care givers in developing therapeutic
techniques to manage difficult behaviorsTo promote strategies to assist with improving
cognition and decreasing depressionTo 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 behaviorsLater developed to comply with CMS
initiative to reduce antipsychotic usage in dementia patients with behaviors
Aimed at reducing difficult behaviorsEnhanced programing to combine cognitive
stimulation and physical exercise
Cognitive Stimulation Therapywww.cstdementia.comCochrane Database concluded:
1. “CST programs benefit cognition in persons with mild to moderate dementia as much as cholinesterase inhibitors”
2. “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 DevelopmentCognitive Stimulation Therapy
Physical Stimulation Therapy
Small groups (6-10) peopleGroups meet twice a week3 groups formedConsist of a set warm up
followed by a predetermined topic of interest
All residents get involvedMultiple 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 DevelopmentAppointed 2 “Memory Care Liaisons”Assist with memory care unit and operations
as well as program development for Cognitive and Physical Stimulation
Different focus for eachExerciseActivity
Work in conjunction and combine specialties to enhance programing
EfficacyParticipants where
assessed for baseline cognition and depression before program began and after 7 weeks 0
510152025303540
PostPre
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 ReductionProgram 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%
NHC MH MO US
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Census Psychiatric DxAntipsychotic
ConclusionEnhanced the quality of life of the cognitively
impairedProgramming has allowed for increased
resident and family satisfactionAllowed healthcare center to diversify it’s
services and provided additional referral source
Decreased hospital readmission ratesStaff acquisition of new skill sets to assist
with caring for the cognitively impaired
Questions?