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
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, Lene Thorgrimsen, Bob Woods, & Martin Orrell by Hawker Publications & The Journal for Dementia Care
$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 after 7 weeks

10. Efficacy SLUMS & BIMS utilized to measure baseline cognitive function
PHQ-9 for depression

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%
January 2013 data

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?