Reality Orientation for Dementia

Spector, Aimee; Davies, Stephen; Woods, Bob; Orrell, Martin

doi:10.1093/geront/40.2.206

Cited by 141 publications

(42 citation statements)

References 19 publications

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“…Our group CST study 6 had an effect size of 0.32. Our Cochrane review of RO 26 found a standardised mean difference (SMD) of 0.58, whereas the individual RO/CST study 12 found a SMD of 0.41. Taking a conservative approach, we estimated the SMD relative to TAU to be 0.35.…”

Section: Exclusionmentioning

confidence: 85%

Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial

Orgeta

Leung

Yates

et al. 2015

Health Technol Assess

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BackgroundGroup cognitive stimulation therapy programmes can benefit cognition and quality of life for people with dementia. Evidence for home-based, carer-led cognitive stimulation interventions is limited.ObjectivesTo evaluate the clinical effectiveness and cost-effectiveness of carer-delivered individual cognitive stimulation therapy (iCST) for people with dementia and their family carers, compared with treatment as usual (TAU).DesignA multicentre, single-blind, randomised controlled trial assessing clinical effectiveness and cost-effectiveness. Assessments were at baseline, 13 weeks and 26 weeks (primary end point).SettingParticipants were recruited through Memory Clinics and Community Mental Health Teams for older people.ParticipantsA total of 356 caregiving dyads were recruited and 273 completed the trial.InterventioniCST consisted of structured cognitive stimulation sessions for people with dementia, completed up to three times weekly over 25 weeks. Family carers were supported to deliver the sessions at home.Main outcome measuresPrimary outcomes for the person with dementia were cognition and quality of life. Secondary outcomes included behavioural and psychological symptoms, activities of daily living, depressive symptoms and relationship quality. The primary outcome for the family carers was mental/physical health (Short Form questionnaire-12 items). Health-related quality of life (European Quality of Life-5 Dimensions), mood symptoms, resilience and relationship quality comprised the secondary outcomes. Costs were estimated from health and social care and societal perspectives.ResultsThere were no differences in any of the primary outcomes for people with dementia between intervention and TAU [cognition: mean difference –0.55, 95% confidence interval (CI) –2.00 to 0.90;p-value = 0.45; self-reported quality of life: mean difference –0.02, 95% CI –1.22 to 0.82;p-value = 0.97 at the 6-month follow-up]. iCST did not improve mental/physical health for carers. People with dementia in the iCST group experienced better relationship quality with their carer, but there was no evidence that iCST improved their activities of daily living, depression or behavioural and psychological symptoms. iCST seemed to improve health-related quality of life for carers but did not benefit carers’ resilience or their relationship quality with their relative. Carers conducting more sessions had fewer depressive symptoms. Qualitative data suggested that people with dementia and their carers experienced better communication owing to iCST. Adjusted mean costs were not significantly different between the groups. From the societal perspective, both health gains and cost savings were observed.ConclusionsiCST did not improve cognition or quality of life for people with dementia, or carers’ physical and mental health. Costs of the intervention were offset by some reductions in social care and other services. Although there was some evidence of improvement in terms of the caregiving relationship and carers’ health-related quality of life, iCST does not appear to deliver clinical benefits for cognition and quality of life for people with dementia. Most people received fewer than the recommended number of iCST sessions. Further research is needed to ascertain the clinical effectiveness of carer-led cognitive stimulation interventions for people with dementia.Trial registrationCurrent Controlled Trials ISRCTN65945963.FundingThis project was funded by the National Institute of Health Research (NIHR) Health Technology Assessment (HTA) programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 64. See the NIHR Journals Library website for further information.

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Section: Exclusionmentioning

confidence: 85%

Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial

Orgeta

Leung

Yates

et al. 2015

Health Technol Assess

Self Cite

160

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“…A meta-analysis [29] on the efficacy of reality orientation in individuals suffering from dementia, which included 6 RCTs, concluded that this intervention has a positive effect on both cognitive and behavioural aspects. In the present review, we identified 9 reality orientation RCTs, including all those trials identified for the meta-analysis by Spector et al [29].…”

Section: Discussionmentioning

confidence: 99%

“…In the present review, we identified 9 reality orientation RCTs, including all those trials identified for the meta-analysis by Spector et al [29]. All trials described cognitive improvements (as measured by the MMSE or similar tests) independently of sample size, which varied from 15 resident patients in a home of elderly people [19] to 197 patients assisted in different centres [11].…”

Section: Discussionmentioning

confidence: 99%

Cognitive Psychosocial Intervention in Dementia: A Systematic Review

Carrión

Aymerich²,

Baillès³

et al. 2013

Dement Geriatr Cogn Disord

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Background: The evolution of dementia depends on the underlying pathology, early diagnosis and the availability of effective treatment for some of the symptoms that interfere with the patients' or caregivers' quality of life. Even though there is no specific treatment to reverse dementia, some interventions such as reality orientation and skills training can retard cognitive impairment. Aim: To review existing scientific evidence regarding the efficacy of therapies included in the category of cognition-oriented approaches for people suffering from dementia. Methods: Papers were retrieved from several bibliographic databases (last publication date: 2009) with pre-specified selection criteria, data extraction and methodological quality assessment. Results: Nine reality orientation and 8 skills training trials were identified as meeting the inclusion criteria. Conclusions: Stimulation of cognitive functions, especially by means of reality orientation, improves overall cognitive function in patients suffering from dementia.

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“…L'analyse du comportement du patient apporte en général des indications quant aux mesures à mettre en oeuvre. Ces mesures dépendent donc directement du « savoir-faire » et du « savoir être » du personnel, mais aussi de l'environnement au sens plus large [92][93][94][95].…”

Section: Formationunclassified