A pilot study exploring factors influencing delivery of individual cognitive stimulation therapy in the Indian context

Abstract

Abstract Background Elderly with dementia in India is expected to increase to 7.6 million by 2030, however, availability of therapeutic services like Individual Cognitive Stimulation Therapy (iCST) remain limited. In order to bridge this gap, we culturally adapted the iCST modules for use with dementia patients in India and report preliminary findings from a pilot study exploring factors influencing session delivery. Method Modules were reviewed by two experienced geriatric care specialists and modified to include culturally appropriate content, images and activities such as music, cinema, games, food and festivals. To ensure appropriateness of content, inputs were taken from senior citizens. Sessions were piloted with 4 older adults who had a diagnosis of dementia by a neurologist/psychiatrist and corroborated with the Hindi Mental Status Examination (range of scores between 14 to 21 indicating initial and moderate stage of dementia). A trained care‐specialist delivered the sessions at home (3 participants) or clinic setting (1 participant). Participants were assessed on a 5‐point Likert scale for interest, mood, enjoyment, communication and anxiety for each session. Session notes were maintained to document observations and feedback was obtained from family members that was qualitatively analyzed for acceptability and feasibility. Result Participants were between 60‐85 years of age, with postgraduate education, retired from private or government jobs. Qualitative data from session notes and family feedback was analyzed using thematic analysis. Feedback indicated the following benefits: setting up a meaningful daily routine, improving socialization and providing respite for primary caregivers during sessions. Clients showed improvements in learning new information, self‐confidence and self‐motivation. Modules on food, faces/scenes and number games were most enjoyable. Participant interest in sessions fluctuated according to changes in medication and mood of the client, (usually impacted by day‐to‐day on goings within the family), which the specialist had to factor into session delivery. Two participants discontinued iCST, one due to development of aphasia and another due to denial of the illness by spouse and refusal to continue sessions. Conclusion Although iCST has several benefits, several contextual factors influence delivery of sessions, highlighting the importance of increasing public awareness for better delivery.