Implementation of Cognitive Stimulation Therapy in Long Term Care

Abstract

Problem and Purpose: Individuals with dementia are often treated with psychotropic medications despite harmful side effects. Cognitive Stimulation Therapy (CST) has been shown to improve cognitive functioning and quality of life (QOL) in individuals with dementia and reduce adverse behaviors. The aim of this quality improvement (QI) project was to implement a CST program in a long term care facility for residents with dementia to decrease the number of adverse behaviors, reduce the use of psychotropic medications and improve cognition and quality of life. Methods: This quality improvement project was implemented in a 200 bed long term care facility in Baltimore City. Nine residents were selected to participate in a sevenweek CST program. A DNP student performed the CST sessions twice a week for 45 minutes. Content was based on activities outlined in the CST program manual, with a different theme for each session that incorporated cognitive stimulation, reality orientation, reminiscence therapy, and validation therapy. Outcome measures included the St. Louis University Mental Status (SLUMS) Exam and the Quality of Life in Alzheimer’s Disease (QOL-AD) Scale. Assessments were completed pre- and post-implementation. Psychotropic medication use and the frequency of adverse behaviors were monitored through chart audits performed bi-weekly. Results: Eight residents completed the full seven-week CST program. All participants attended at least half of the sessions. There was an overall average increase in SLUMS scores of 19% with a mean pre-implementation score of 16.75 and mean post implementation score of 20. QOL scores improved an overall average of 12% for six of the eight participants, and an average decrease of 20% for two participants. Deficiencies existed which prohibited the ability to accurately evaluate behavioral charting completed by the staff. There was no change in the use of psychotropic medications for residents enrolled in CST. An important secondary outcome was the observation of increased sustained socialization of residents when not participating in CST. Conclusion: CST improves cognitive functioning and may be correlated with the improving QOL of some residents. Additional research is needed to further investigate the effect CST has on increasing or sustaining socialization for long term care residents.