Therapy that helps people with dementia maintain lifestyles rolled out

The University of Exeter is leading a programme to train carers in goal-orientated cognitive rehabilitation. It entails practitioners working with people with dementia and their carers to establish goals that are most important to helping people maintain their lifestyle. These differ depending on the individual, ranging from cooking food without burning it to remembering the names of loved ones. The practitioner works with the person and the carer to put in place strategies to help them achieve these goals.

The technique has been found to be successful. The GREAT trial was a large-scale randomised controlled trial, in which half of the participants received the therapy and half did not. It involved 475 people across eight sites in the UK. Half of this group received ten cognitive rehabilitation sessions over three months, and then took part in four ‘top-up’ sessions over six months. The other half continued with their lives as usual, allowing the research team to measure any benefits from the therapy.

The study, funded by the National Institute for Health Research (NIHR) and supported by Alzheimer’s Society, found that those who took part in the therapy showed significant improvement in the areas they had identified, after both the ten week and 'top-up' sessions. Family carers agreed that their performance had improved. Both participants and carers were happier with the participants’ abilities in the areas identified.

Now, University researchers are implementing the technique by offering training to staff in NHS Trusts and social care organisations providing care to people with dementia. Alzheimer’s Society is funding a new study, called GREAT into Practice, to see if this approach can be incorporated into routine practice so that people with dementia can benefit.

Already, 13 organisations are signed up, including NHS trusts, local authorities, private and third sector home care providers, and care homes. The researchers are recruiting even more to come on board.

Dr Krystal Warmoth, of the University of Exeter, is Project Manager for GREAT into Practice. She said: “Our research has shown that cognitive rehabilitation can help people achieve the goals that matter most to them. This is essential in demonstrating that dementia is not an inevitable decline in all areas, and in providing people with the simple tools to live as well as possible with the condition. We’re excited to roll this out so more people can benefit.”

The goals participants choose vary, as dementia affects people in a wide range of ways. Some participants want to find ways of staying independent, for example, by learning or re-learning how to use household appliances or mobile phones. Some want to manage daily tasks better, perhaps by developing reminders to remember their keys and purse when they go shopping. Others want to stay socially connected, and focused on improving their ability to engage in conversation. Sometimes staying safe is important, so strategies focus on practical challenges like withdrawing money safely from a cashpoint. 

Professor Linda Clare, of the University of Exeter, leads the research programme. She said: “Our work focuses around supporting people to live as well as possible with dementia. There’s plenty that we can do, and exactly what strategy we put in place depends on individual need. Helping people to maintain their lifestyles is really important to retaining independence, functional ability and overall quality of life.”

Colm Owens, Clinical Director for Older People’s Mental Health Services at Devon Partnership NHS Trust, said: “It’s so important to support the 850,000 people who are living with dementia in the UK to maintain their lifestyles. It can help maintain independence and support people to live the way they want to. We’re delighted to be involved in rolling out this technique to improve ability in the areas that matter most to people with dementia.”

Mark McGlade, Managing Director of Home Instead Senior Care - Exeter & East Devon said: “It is a privilege to support people living with dementia to live life their way and to help them achieve their own goals. As the UK’s leading quality care provider in supporting older people to maintain independence in their own homes, Cognitive Rehabilitation is a perfect fit for Home Instead to take into the local community so that we can support more people with dementia to live well in their own homes. In supporting people to regain confidence and improve their ability to perform the daily tasks that matter most to them as individuals, they may be able to stay in their own homes for longer.”

Dr Doug Brown, Chief Policy and Research Officer at Alzheimer’s Society, said: “It’s great to see these researchers challenging misconceptions by showing that, with the right support, you can live well with dementia. Of the top ten killers dementia is the only one we can’t cure, prevent or even slow down, so learning to live well is crucial for the UK’s 850,000 people with dementia and their carers.

“This research shows people with early-stage dementia can learn new skills to help them maintain their independence, social lives and personal safety. The personalised nature of this therapy highlights that everyone with dementia is different, so setting individual goals and tailoring care to each person had clear benefits.

“Alzheimer’s Society has supported the researchers throughout this work to ensure that the therapy could be smoothly used in real life by the NHS and social care so we’re thrilled that 13 organisations have already signed up to bring this vital support closer to the people who need it and hope many more will follow.”

For more information on the implementation study, contact Krystal Warmoth on k.warmoth@exeter.ac.uk.