Psycho-social Approaches

A psycho social approach is an approach that is designed to support a person with dementia that does not involve the use of medication. You can expect to find papers here that discuss a variety of different approaches including, but not limited to reminiscence therapy, spirituality, arts based approaches and cognitive stimulation therapy.

Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series.

Abraha, I., Rimland, J.M., Trotta, F.M., Dell’Aquila, G., Cruz-Jentoft, A., Petrovic, M., Gudmundsson, A., Soiza, R., O’Mahony, D., Guaita, A. and Cherubini, A.
BMJ Open
During the course of their illness, many people with dementia develop behavioural and psychological symptoms of dementia (BPSD) including agitation, delusions, hallucinations and depression.
Both pharmacological and non-pharmacological therapies have been developed as options for responding to BPSD. The former however are problematic and adverse side effects are common and although the latter are considered to be a preferable option, there is conflicting evidence on their efficacy and practicality. This paper by Abraha et al. (2017) assesses the evidence supporting non-pharmacological interventions, by updating a previous systematic review from 2011, with the aim of providing a working compendium for the non-drug management of dementia, as part of the Optimal Evidence-Based Non-Drug Therapies in Older People project. Some 38 reviews were included, from which 142 primary studies were identified providing details on non-pharmacological interventions for BPSD. The interventions were classified into sensory stimulation interventions of which there were nine different types, e.g. massage therapy and light therapy, cognitive/emotion-oriented interventions of which there were four different types e.g. cognitive stimulation therapy and validation therapy, behavioural management techniques, multi-component interventions and other interventions including exercise therapy and animal-assisted therapy. Under each classification, the evidence for each type of intervention was reviewed. Among sensory simulation interventions, music therapy was found to the only convincingly effective intervention for reducing behavioural symptoms. Some behavioural management techniques were also found to be promising. However, the authors conclude that overall there is limited evidence supporting the efficacy of non-pharmacological interventions due to the sample size, methodological quality and variations of interventions and outcomes assessed.

An evaluation of community based cognitve stimualtion therapy: a pilot study with an Irish population of people with dementia

Kelly, M.E., Finan, S., Lawless, M., Scully, N., Fitzpatrick, J., Quigley, M., Tyrrell, F., O’Regan, A. and Devane, A.
Irish Journal of Psychological Medicine
Despite evidence of its’ benefits cognitive stimulation therapy (CST) is not routinely available in Ireland, post diagnosis. This study aimed to assess the benefits of a 14 week community based CST programme for people with dementia, their carers and facilitators.
Overall the study showed that CST delivered once weekly over 14 weeks had a positive impact on the person with dementia, their families and staff. Significant improvements were evidenced in participants’ subjective cognitive performance and in satisfaction with their performance. Significant improvements were also seen in facilitators’ ratings of participant engagement and confidence. The findings suggest a relationship between carer and participant wellbeing, and between carer wellbeing and their rating of participant cognitive function. The authors argue that it is time for the government to support the provision of CST across Ireland.

Narratives of health and illness: Arts-based research capturing the lived experience of dementia.

Moss, H. and O’Neill, D.
This paper by Moss and O’Neill (2017) has two main purposes. It presents the residencies of three artists in a geriatric medicine unit in a hospital in Dublin, ROI.
These residencies were initiated to create new artistic work that would promote greater understanding of the lived experience of persons with dementia and their experience of using services. Arts-based research methodologies were adopted and this approach is presented and the benefits explored. In each of the three residencies, the artists engaged with eight people with dementia, their family carers and hospital staff and the format that the residencies took is described. The paper summarises the results of the residencies under three headings: creation of original art works of high artistic quality; opportunities for increasing understanding and public awareness of dementia; creation of artworks that have an ongoing role as a tool for students to learn about dementia. The authors discuss the challenges and issues that arise when artists are brought into a medical setting, and also the contribution that arts-based research can make.

The experience of spirituality from the perspective of people living with dementia: A systematic review and meta-synthesis.

Daly, L., Fahey-McCarthy, E. and Timmins, F.
In this systematic review and meta synthesis Daly et al. (2016) found that while it may not be explicitly named as such, spirituality was a significant part of the lives of people with dementia, with some studies suggesting that a sense of spirituality may in fact be heightened in dementia.
For some spirituality is associated with religion and a connection with God while for others it is connected with nature, art and music. Spirituality in dementia was also found to be embodied through relationship with others, fostering an ongoing sense of connection and occupation. However the person experiences their spirituality the literature indicates it is something that sustains the person in the face of dementia. The authors discuss the importance of both acknowledging and meeting spiritual needs for people with dementia while urging that no assumptions are made. Rather they argue these needs must be addressed at a personal level and as such they draw our attention to the importance of life story work. They also argue that the findings confirm the need for spiritual competency among health and social care practitioners.

Song writing with clients who have dementia: A case study.

Ahessy, B.
The Arts in Psychotherapy
Ahessy (2017) provides an overview of the role of music therapy in dementia care and then discusses a single case study to highlight the potential of song writing as music therapy. The study involves a 94yr old woman who received individual music therapy over a period of 18months.
Margaret began with improvised playing of the piano with the therapist but this developed over time to where she was able to co-compose songs with the therapist. There were improvements in Margaret's focus and attention and she took great joy in recognising herself and her story in the songs. Even when Margaret forgot she had written the songs, she could remember the words. Ahessy describes how after a cardiac arrest, Margaret became more subdued but the sessions continued to provide a way for her to emotionally connect with her evident fear of dying. He concludes that Margaret was supported in songwriting to connect with and express her emotions. She was able to sing, to improvise and to compose in collaboration. He suggests music therapy allowed her to experience herself in new ways and to strengthen her sense of self. Acknowledging the difficulties in quantifying the impact of therapies such as music therapy, Ahessy quotes Chavin (2002) who argues that "music is not a frill. It is something that we should simply consider adding into a dementia programme. It is essential to life."

Feasiblity of the Namaste Care Programme to enhance care for those with advanced dementia

Magee, M., McCorkell, G., Guille, S. and Coates, V.
International journal of palliative nursing
This paper reports on a small study introducing the Namaste Care Programme to a nursing home in Northern Ireland. The Namaste programme aims to enhance quality of life for people with dementia by taking a holistic approach to meeting individual needs. In this instance Magee et al.
(2017) wanted to investigate whether it was feasible to introduce the programme to usual care and to explore its impact on residents, families and staff. Acknowledging the limitations of the study which involved a very small number of participants, the authors suggest the study still offers valuable information both on the barriers such as additional demands on staff and the benefits; a measured improvement in behaviour and a perceived improvement in relationships between families and staff. They conclude that the programme can improve quality of care and that ideally resources would be made available to offer the programme to residents with dementia.

Psychosocial intervention use in long-stay dementia care: A classic grounded theory.

Hunter, A., Keady, J., Casey, D., Grealish, A. and Murphy, K.
Qualitative health research
Hunter et al. (2016) set out to develop a grounded theory of staff use of psychosocial interventions with people with dementia in long stay care. The theory explains staff motivation to use psycho social interventions, and the interaction between institutional and personal factors.
The core category to emerge was “becoming a person again”. Key to this is the understanding of psychosocial intervention as a mutual experience for staff and residents with dementia. Four conceptual stages are theorised around this category; balancing the influences; individualising status, striving to make the most of time; interpreting care. The authors suggest the theory offers new knowledge on how the use of a psychosocial intervention arises from a balancing of needs of residents with dementia and staff and that this model can support psychosocial intervention training and embedding in practice.

Factors that affect quality of life from the perspective of people with dementia: a metasynthesis.

O'Rourke, H.M., Duggleby, W., Fraser, K.D. and Jerke, L.
Journal of the American Geriatrics Society
O’Rourke et al. (2015) identified and synthesised qualitative research findings of factors affecting quality of life from the perspective of people with dementia. 7 Countries, including Ireland are represented.
They identified four key factors related to quality of life (QOL): relationships, agency in life today, wellness perspective and sense of place. Within these factors it was the sense of connectedness or disconnectedness which influenced QOL. Further, where there was a sense of connection this related to happiness and a sense of disconnection related to sadness. The authors conclude that these findings offer the potential for further studies to identify ways to improve QOL for people with dementia, even in the face of cognitive decline.

Therapeutic use of dolls for people living with dementia: A critical review of the literature.

Mitchell, G., McCormack, B. and McCance
Mitchell et al. (2016) document a critical review of the literature on doll therapy for people with dementia. A total of 11 studies are included; most are observational of people with dementia engaged in doll therapy.
Four examine perceptions of healthcare professions and one is a retrospective analysis of case notes pre and post doll therapy. The literature suggests that some people with dementia may benefit from the use of dolls with improvements shown in communication, interaction with others, dietary intake and general wellbeing. However it remains controversial with healthcare professionals’ attitudes identified as a barrier.

Developing an educational dvd on the use of hand massage in the care of people with dementia: An innovation.

Tuohy, D., Graham, M.M., Johnson, K., Tuohy, T. and Burke, K.pp.299-303.
Nurse education in practice
Tuohy et al. (2015) describe the process of developing an educational DVD on the use of hand massage in the care of people with dementia. The authors refer to evidence that hand massage can provide physiological benefits for people with dementia.
They describe the collaborative nature of the project which took 10 months to complete. The DVD provides an overview of hand massage and a demonstration. The authors argue that the DVD responds to new developments in learning and to the time pressures on professionals and carers, particularly in attending face to face training. Since its launch in 2012, hand massage has been introduced to residential settings for people with dementia and a number of workshops provided for health professionals and carers.

The value of life story work for staff, people with dementia and family members.

McKinney, A.
Nursing Older People
The author of this article combines his personal experience of being involved in life story work of a relative with recent literature on the topic.
He highlights the value of such work for healthcare staff and relatives, as it allows them to view the person with dementia as more than their current diagnosis. For people with dementia it offers the opportunity to tell their story and can contribute to feelings of safety. McKinney (2017) concludes that any such work should begin early and that to be successful, must be embedded in a supportive culture.

Person-centred dementia care: a reality check in two nursing homes in Ireland

Colomer, J. and de Vries, J.
Person centred approaches to care (PCC) in Ireland are widely accepted at policy and management level. This study aimed to examine the reality of its practice.
Colomer & De Vries (2016) took a phenomenological approach to identify the perceptions and experiences of care workers in two nursing homes with a PCC policy. They found that most participants had not received training or education in PCC. They were vague and confused on questions examining their knowledge of PCC. Participants placed high value on training in practice, identifying team work as essential and highlighting the pressures of time and staffing constraints. The study found evidence of implicit knowledge of PCC but participants continued to describe aspects of good care within a task orientated framework. The authors acknowledge that the study is limited by size and recruitment from only 2 homes. However care assistant training in Ireland is standardised so they suggest it reflects issues across Ireland and a need to assess and most likely improve training.

Developing a structured education reminiscence-based programme for staff in long-stay care facilities in Ireland

Journal of Clinical Nursing

Cooney et al. (2013) describe the development and piloting of a structured education reminiscence programme for staff in long stay care settings.

 The programme was structured around a four-phase model: problem definition, accumulation of building blocks for intervention design, intervention design and validation.  The authors acknowledge that taking such a comprehensive approach is time consuming and labour intensive but argue that the nature of the programme gave staff ownership and enabled them to effectively use reminiscence in daily practice, improving their knowledge and ability to meet the psychosocial needs of residents.

Efficacy of a cognitive stimulation therapy programme for people with dementia

Irish Journal of Psychological Medicine

This study by Coen et al. (2011) aimed to replicate previous research by Spector et al.

(2003) which found that Cognitive Stimulation Therapy (CST) produced improvements in cognition and quality of life for people with dementia that compared favourably with trials of cholinesterase inhibitors. While this study used a smaller sample and a control group engaged in routine activities, findings reflected those of Spector et al. that CST has beneficial effects for people with dementia, evidenced by improved MMSE AND QoL-AD scores that fell just short of statistical significance. The authors acknowledge the limitations of the small sample size and also that the changes in MMSE and QoL-AD were not reflected in the ADAScog. 

Life story work in practice: aiming for enduring change

Journal of Dementia Care

Gibson and Carson (2010) report on a Northern Ireland Trust Project to establish life story work for people with dementia in residential and day care settings.

 They document the initial enthusiasm that many creative projects are greeted with, only to fall in the face of obstacles such as a newer ‘fad’ promising better, cheaper results. They document the work to engage management and staff with a view to establishing a more durable project.  Staff reported positively on the programme but the single greatest obstacle was lack of time, as already reported in Cooney et al.’s study (2014). The authors suggest the project has highlighted the complexity of establishing enduring creative projects, even where they are regarded positively. 

The effects of music therapy for older people with dementia

British Journal of Nursing

Wall and Duffy (2010) review the literature on the effects of music therapy for older people with dementia.

 They found that music therapy had a positive impact on the behaviour of people with dementia but that there were methodological limitations in all thirteen studies reviewed.  Most of the studies were quantitative and the authors recommend larger sample sizes to allow for generalisation of results. They also suggest there is a need for more qualitative studies.

The participative arts for people living with a dementia: A critical review

International Journal of Ageing and Later Life

Zeilig et al. (2014) completed a review of the literature to address the question: What is the value of arts and culture for people living with dementia? The authors acknowledge that this field is in its infancy and much of the research has methodological limitations.

 However, the literature suggests that participative arts can make a positive contribution to those affected by dementia. They conclude the evidence must be strengthened but that studies should take account of the wider context, should be theoretically informed, include the views of people with dementia and incorporate economic analysis.

The impact of reminiscence on the quality of life of residents with dementia in long-stay care

International journal of geriatric psychiatry

In the context of increasing recognition of the potential value of reminiscence in maintaining or improving quality of life, O’Shea et al.

(2014) evaluated the effectiveness of a structured education-based reminiscence programme for people with dementia in long stay residential care settings in ROI. Effectiveness was measured in a two-group, single-blind clustered randomised trial, using self-rated quality of life as the primary outcome. The results on the effects of the intervention suggest that there was a positive but clinically non-significant improvement in the mean quality of life of the residents in the intervention group compared with the control group. However, the results of per-protocol analysis, which includes only units that followed protocol, indicates that there was a clinically and statistically significant effect of the intervention on quality of life of residents with those in the intervention groups experiencing a better improvement in quality of life compared to those in the control group.  

‘Seeing me through my memories': a grounded theory study on using reminiscence with people with dementia living in long-term care

Journal of Clinical Nursing

Cooney et al. (2014) examined the perceptions of reminiscence and its impact among relatives, staff and people with dementia participating in the study.

Staff felt that reminiscence allowed them to “see and know” the person behind the dementia and felt that it also allowed the person with dementia to view them as individuals, while residents perceived staff to be more interested in them as individuals.  The authors suggest this ‘revealing’ is not necessarily a result of the reminiscence but rather due to the resulting interaction and the shared bond that is created.  Family members welcomed staff getting to know their relative as an individual and the study also found that positive effects impacted on the wider group of residents.  Lack of time was the most significant barrier.

Reminiscence in dementia: A concept analysis


Dempsey et al. (2014) analyse the concept of reminiscence in dementia.  They identify a range of definitions and the use of surrogate terms, and that reminiscence is a process that takes place in stages in the context of interaction with others.

 They conclude that reminiscence is an effective psychosocial intervention and that developing the concept further would benefit from an operational definition.

Effectiveness of a structured education reminiscence-based programme for staff on the quality of life of residents with dementia in long-stay units: a study protocol for a cluster randomised trial


O’Shea et al. (2011) outline the study protocol for the trial referred to above. This study aimed to address the scarcity of trials on reminiscence as an intervention for people with dementia and the methodological issues associated with existing evidence.

 The protocol outlines a two-group, single blind cluster randomised trial conducted in long stay care settings.  The primary outcome is quality of life for residents, with secondary outcomes of agitation levels and depression in residents, and staff care burden.