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?