- Email: [email protected]
EFFICACY OF GROUP PSYCHOTHERAPY FOR CAREGIVERS OF DEMENTIA PATIENTS
P1558
P4-541
Poster Presentations: Wednesday, July 19, 2017
EFFICACY OF GROUP PSYCHOTHERAPY FOR CAREGIVERS OF DEMENTIA PATIENTS
Hideki Sugiyama1, Koji Kasanuki2, Mayumi Yamagata1, Noriko Sato1, Yosuke Ichimiya1, 1Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan; 2Mayo Clinic, Jacksonville, FL, USA. Contact e-mail: [email protected] Background: In the field of dementia, growing evidence of non-phar-
macologic therapy for the patients has been emerged; however, studies focusing on supporting their caregiver’s mental stress are limited. Group psychotherapy has originally developed among psychology/ psychiatry field, aiming the patients’ mutual interaction and communication, together with clinical psychologists and practitioners. It is unclear whether the applicability and the efficacy of this type of psychotherapy for caregivers of dementia patients. Therefore, we had started up the group psychotherapy team in 2007 including psychiatrist, nurse and clinical psychologist, and have continued to provide this therapy for a decade. The scheme of our group psychotherapy consists of mixture of counseling, psychoeducation and family association. The purpose of this study was to examine the efficacy of group psychotherapy. Methods: We recruited the caregivers of dementia patients who agreed with the informed consent with respect to the concept of this therapy and the purpose of this study. All individuals had been aware that they had some stresses in daily care of the patients at the enrollment. Our group psychotherapy was registration-based, biweekly 60 minutes five sessions. To assess the efficacy, the endpoint was determined as the score change between the initial and the last assessment of the series of psychological tests using Japanese version of Profile of Mood States-Brief (POMS), Self-rating Depression Scale (SDS) and Zarit Caregiver Burden Interview (ZBI). Results: 142 caregivers (126 female (89%), mean age 60.7611.5 years) were included in this study. In POMS, the tension-anxiety and fatigue were tend to be higher. For POMS and SDS, score change from the initial and the last assessment were not significantly different. By contrast, ZBI score decreased significantly (p <0.01) after five sessions. Regarding gender difference, there was no male dominancy among POMS, SDS and ZBI scores, although the sample size was small. Conclusions: The present study indicates that our present group psychotherapy could specifically ease the care burden of dementia caregivers. To compensate the potential problem such as hesitation for attending seen among males, the scheme should be updated continuously.
P4-542
USING TECHNOLOGY TO IMPLEMENT THE HEALTH QUALITY ONTARIO QUALITY STANDARDS FOR BEHAVIOURAL SYMPTOMS OF DEMENTIA
Ilan Fischler, Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada. Contact e-mail: [email protected] Project description: In 2016, Health Quality Ontario released the first
Provincial quality standards for the assessment and treatment of the Behavioural Symptoms of Dementia. The standard is composed of fourteen statements, each accompanied by a definition and indicators to allow health care organizations to measure adherence. Ontario Shores Centre for Mental Health Sciences, a tertiary-care mental health hospital in Whitby, Ontario, systematically implemented the standard as of
March 31, 2017. This paper will describe the electronic templates and automated clinical rules that were created in support of redesigned workflows to promote adherence to the standard. Roles and responsibilities of clinical staff were re-evaluated and education was provided to support the provision of recommended evidence-based interventions. A business intelligence strategy was implemented to share adherence to the quality statements across the organization. Initial reports demonstrated that in the month of March 2017, appropriate evidence-based nonpharmacologic interventions were provided to 50 % of patients, psychotropic medications were appropriately monitored using standardized scales and regular interprofessional review in 71% of patients, and ineffective/inappropriate psychotropic medications were appropriately switched in 100% of patients. 27 interventions comprised a comprehensive interprofessional assessment which was to be completed within 21 days of admission. This timeline was never met as of March 2017, and a focus for 2017-18 will be to implement quality improvement cycles to improve adherence to the quality standard.
P4-543
COGNITIVE FUNCTION AS A PROXY OF FINANCIAL DECISION MAKING IN OLDER PRIMARY CARE ADULTS
Anthony Weiner1, Christopher Heye2, Lee Baer1, Maurizio Fava1, Janet C. Sherman1, 1Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 2 Cogniscient, Belmont, MA, USA. Contact e-mail: chris.heye@ cognisc.com Background: Adults over 54 in the United States own about 2/3 of all wealth in the country. However, many older adults appear to make sub-optimal financial decisions, leaving them at high risk for Table l Cognitive Tests by Domain Domain Intellectual Cognitive Screen Attention/Working Memory Processing Speed
Test(s)
Test of Premorbid Functioning (TOPF) Mini Mental Status Exam (MMSE) WAIS-IV Digit Span Forward WAIS-IV Arithmetic DKEFS Color Naming DKEFS Word Reading Trail Making Test, Part A Executive Functions (EF) – Inhibitory Control DKEFS Color Word Interference (response time, errors) – Cognitive Trail Making Test, Part B Flexibility DKEFS Color Word Interference (DKEFS CWS) Wisconsin Card Sorting Test, percent error score – Organization Rey Copy Fragmentation Clock drawing Visuospatial Rey Copy Presence and Accuracy Functions Verbal Memory HVLT-R Total Recall HVLT-R Delayed Recall HVLT-R Retention Visual Memory Rey Immediate retention Rey Immediate Presence and Accuracy Rey Delayed Retention Rey Delayed Presence and Accuracy Definitions: WAIS ¼ Wechsler Adult Intelligence Scale, DKEFS ¼ Delis-Kaplan Executive Function System, HVLT-R ¼ Hopkins Verbal Learning Test-Revised, Rey ¼ Rey-Osterrieth.
P4-541
Poster Presentations: Wednesday, July 19, 2017
EFFICACY OF GROUP PSYCHOTHERAPY FOR CAREGIVERS OF DEMENTIA PATIENTS
Hideki Sugiyama1, Koji Kasanuki2, Mayumi Yamagata1, Noriko Sato1, Yosuke Ichimiya1, 1Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan; 2Mayo Clinic, Jacksonville, FL, USA. Contact e-mail: [email protected] Background: In the field of dementia, growing evidence of non-phar-
macologic therapy for the patients has been emerged; however, studies focusing on supporting their caregiver’s mental stress are limited. Group psychotherapy has originally developed among psychology/ psychiatry field, aiming the patients’ mutual interaction and communication, together with clinical psychologists and practitioners. It is unclear whether the applicability and the efficacy of this type of psychotherapy for caregivers of dementia patients. Therefore, we had started up the group psychotherapy team in 2007 including psychiatrist, nurse and clinical psychologist, and have continued to provide this therapy for a decade. The scheme of our group psychotherapy consists of mixture of counseling, psychoeducation and family association. The purpose of this study was to examine the efficacy of group psychotherapy. Methods: We recruited the caregivers of dementia patients who agreed with the informed consent with respect to the concept of this therapy and the purpose of this study. All individuals had been aware that they had some stresses in daily care of the patients at the enrollment. Our group psychotherapy was registration-based, biweekly 60 minutes five sessions. To assess the efficacy, the endpoint was determined as the score change between the initial and the last assessment of the series of psychological tests using Japanese version of Profile of Mood States-Brief (POMS), Self-rating Depression Scale (SDS) and Zarit Caregiver Burden Interview (ZBI). Results: 142 caregivers (126 female (89%), mean age 60.7611.5 years) were included in this study. In POMS, the tension-anxiety and fatigue were tend to be higher. For POMS and SDS, score change from the initial and the last assessment were not significantly different. By contrast, ZBI score decreased significantly (p <0.01) after five sessions. Regarding gender difference, there was no male dominancy among POMS, SDS and ZBI scores, although the sample size was small. Conclusions: The present study indicates that our present group psychotherapy could specifically ease the care burden of dementia caregivers. To compensate the potential problem such as hesitation for attending seen among males, the scheme should be updated continuously.
P4-542
USING TECHNOLOGY TO IMPLEMENT THE HEALTH QUALITY ONTARIO QUALITY STANDARDS FOR BEHAVIOURAL SYMPTOMS OF DEMENTIA
Ilan Fischler, Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada. Contact e-mail: [email protected] Project description: In 2016, Health Quality Ontario released the first
Provincial quality standards for the assessment and treatment of the Behavioural Symptoms of Dementia. The standard is composed of fourteen statements, each accompanied by a definition and indicators to allow health care organizations to measure adherence. Ontario Shores Centre for Mental Health Sciences, a tertiary-care mental health hospital in Whitby, Ontario, systematically implemented the standard as of
March 31, 2017. This paper will describe the electronic templates and automated clinical rules that were created in support of redesigned workflows to promote adherence to the standard. Roles and responsibilities of clinical staff were re-evaluated and education was provided to support the provision of recommended evidence-based interventions. A business intelligence strategy was implemented to share adherence to the quality statements across the organization. Initial reports demonstrated that in the month of March 2017, appropriate evidence-based nonpharmacologic interventions were provided to 50 % of patients, psychotropic medications were appropriately monitored using standardized scales and regular interprofessional review in 71% of patients, and ineffective/inappropriate psychotropic medications were appropriately switched in 100% of patients. 27 interventions comprised a comprehensive interprofessional assessment which was to be completed within 21 days of admission. This timeline was never met as of March 2017, and a focus for 2017-18 will be to implement quality improvement cycles to improve adherence to the quality standard.
P4-543
COGNITIVE FUNCTION AS A PROXY OF FINANCIAL DECISION MAKING IN OLDER PRIMARY CARE ADULTS
Anthony Weiner1, Christopher Heye2, Lee Baer1, Maurizio Fava1, Janet C. Sherman1, 1Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 2 Cogniscient, Belmont, MA, USA. Contact e-mail: chris.heye@ cognisc.com Background: Adults over 54 in the United States own about 2/3 of all wealth in the country. However, many older adults appear to make sub-optimal financial decisions, leaving them at high risk for Table l Cognitive Tests by Domain Domain Intellectual Cognitive Screen Attention/Working Memory Processing Speed
Test(s)
Test of Premorbid Functioning (TOPF) Mini Mental Status Exam (MMSE) WAIS-IV Digit Span Forward WAIS-IV Arithmetic DKEFS Color Naming DKEFS Word Reading Trail Making Test, Part A Executive Functions (EF) – Inhibitory Control DKEFS Color Word Interference (response time, errors) – Cognitive Trail Making Test, Part B Flexibility DKEFS Color Word Interference (DKEFS CWS) Wisconsin Card Sorting Test, percent error score – Organization Rey Copy Fragmentation Clock drawing Visuospatial Rey Copy Presence and Accuracy Functions Verbal Memory HVLT-R Total Recall HVLT-R Delayed Recall HVLT-R Retention Visual Memory Rey Immediate retention Rey Immediate Presence and Accuracy Rey Delayed Retention Rey Delayed Presence and Accuracy Definitions: WAIS ¼ Wechsler Adult Intelligence Scale, DKEFS ¼ Delis-Kaplan Executive Function System, HVLT-R ¼ Hopkins Verbal Learning Test-Revised, Rey ¼ Rey-Osterrieth.