Authors (including presenting author) :
Choi HY
Affiliation :
Occupational therapy department, Geriatric Day Hospital, TWGHs Wong Tai Sin Hospital
Introduction :
Dementia is a neurodegeneration condition resulting in affecting cognition, functional capacities, level of dependency and relationships with caregiver. With the prolonged care giving, most of the caregivers experience varied level of care burden and become a chronic stress. Research suggests that cognitive stimulation therapy (CST) as a non-pharmacologic and psychological intervention has proven to be effective for people with mild to moderate dementia. Since CST was adapted for Chinese culture, it was widely used as an intervention by community healthcare professionals in Hong Kong. This study explored multidimensional outcomes of mild to moderate cognitive impaired patients and their caregivers in community by comparing the results of CST group and control group.
Objectives :
To investigate the correlations between patient's cognitive performance, communication skills and caregivers' stress in a group of Chinese elderly patients receiving day hospital rehabilitation.
Methodology :
A pilot study was conducted in TWGHs Wong Tai Sin geriatric day hospital (GDH). 17 pairs of patients with mild to moderate cognitive impairment and their main caregivers were recruited and allocated into four groups- 2 CST group and 2 control group. Both CST and control groups’ patients were required to attend twice weekly CST/GDH sessions for 7 weeks. Patients and caregivers were evaluated by an occupational therapist and nurse with baseline and post-intervention assessments. Primary outcomes for participants and caregivers included The Montreal Cognitive Assessment Hong Kong Version (HK-MoCA), Category verbal fluency test (VFT), The Modified Barthel Index (MBI), The Holden Communication Scale (HCS) and the 22-Item Zarit Burden Interview (ZBI-22) scale. Secondary outcome would use the CST observational test including level of interest, communication, level of enjoyment and emotion of CST participants. Post-intervention phone interviews with caregivers were conducted.
Result & Outcome :
In total, 10 pair of patients and caregivers and 7 pair of patients and caregivers were assigned to the CST group and control group respectively. For CST group, patients showed significant change in communication (P=0.008), verbal fluency (P= 0.041), and Activity with Daily Livings (ADL) performance (P=0.042). Result also shows a certain trend towards significance in cognition (P=0.09). It also showed significance change in patients' level of interest (P=0.006), level of enjoyment (P=0.010) and emotion (P=0.014). For control group, patients showed significant change in ADL performance (P=0.027) solely. With pre and post intervention, caregivers in the CST group showed marginal significant difference in care burden (P=0.103), whilst caregivers in control group showed not statistically change in care burden (P=0.498).Our findings confirm that patients with mild to moderate dementia in community are benefits from the CST program, especially in communication and verbal fluency domains. It is also an effective treatment in improving patients’ level of interest, enjoyment, and emotion. With the phone follow-ups, caregivers give positive feedback with CST, yet there is limited evidence in lessening the patients’ caregivers’ burden due to small sample size and recent life event. The results provide an idea for healthcare professionals to identify caregivers who experience difficulties not only related to caregiving to cognitively impaired patients but other stressors. The caregivers who experience high stress level were referred to medical social workers for more supports. Results support a future large-scale trial to investigate if caregivers will be benefit from the CST.
