Extending therapies that work
Cognitive Stimulation Therapy (CST) is a well-established and important tool that improves quality of life and aspects of memory and language skills in people with mild to moderate dementia. Alzheimer’s Disease International recommends that cognitive stimulation should routinely be used with people with early stage dementia, and it continues to be implemented in dementia care across the globe, most recently in Nigeria and Tanzania.
The NHS Institute for Innovation and Improvement (2011) conducted an economic analysis of alternatives to antipsychotic drugs[pdf] for individuals living with dementia, focusing on the cost and benefits of providing CST.
They concluded that by combining health care cost savings and quality of life improvements, behavioural interventions generate a net benefit of nearly £54.9 million a year to the NHS.
However, CST is typically carried out in small groups which can make it difficult or impossible to access for people who are geographically isolated or who have transport or physical health problems that prevent them from joining groups. Also, research showed that some people prefer individualised interventions, and a number of family care-givers requested an approach they could use with the person with dementia at home.
Dr Aimee Spector of University College London and Professor Martin Orrell, now at the University of Nottingham, led a research programme which worked in partnership with family care-givers and people living with dementia to improve the way CST is delivered. They developed ‘Individualised CST’ (iCST) which can be delivered on a one-to-one basis by family care-givers or by paid staff such as community care workers.
A study of 356 people with dementia and their care-givers living across the UK showed that people living with dementia reported an improvement in their relationship with the care-giver after taking part in iCST sessions.
Additional benefits also emerged as care-givers reported an improvement in their own quality of life.
Both people with dementia and family care-givers valued mental stimulation and people with dementia also valued activities that were meaningful and helped them keep in touch with the world around them.
A manual for family care-givers was published with input from people with dementia and care-givers which emphasised the importance of fun and enjoyment. As one participant in the iCST study living with dementia commented:
‘I don’t remember the activities, but I enjoyed what we were doing.’