Dementia Care

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Vol 5 No 5 October/November 2016 Australian Journal of Dementia Care 43
can evoke unpleasant memories”.
CST program facilitators should use the
resources as prompts for participants to
share opinions and experiences that
stimulate new thoughts, ideas and
associations.
CST pilot success
We developed theAustralian guidebook
following our 2014 research study of an
Australian adaptation of the CST program.
Study participants were outpatients
attendingACPS, aged 60 years and over
with mild to moderate DSM-IV dementia.
Details of that pilot study have been
previously reported in this journal
(Kanareck et al 2015).
The study proved it to be an effective
Australian adaptation of the CSTmaterial,
which was shown to be easily transferable
to anAustralian setting. It demonstrated
that the inclusion of Australian content
encouraged participants to interact and
bond over shared experiences.
IncorporatingAustralian content also
enabled facilitators to use their own
knowledge and experiences and provided
a familiar environment for participants.
Participants reported the material used
was suitable for Australians. They were
responsive to global concepts and
universal knowledge. There was a benefit
in including local content, which facilitated
reminiscence and discussion about
participants’ own life experiences.
The pilot project was trialled in a
DCRC SPEC I AL I SSUE : THE B I G P I CTURE I N DEMENT I A RESEARCH
Key principles of CST
• Mental stimulation
• New ideas, thoughts and associations
• Using orientation sensitively and
implicitly
• Opinions, rather than facts
• Using reminiscence as an aid to the
here-and-now
• Providing triggers to aid recall
• Continuity and consistency between
sessions
• Implicit (rather than explicit) learning
• Stimulating language
• Stimulating executive function
• Person-centred
• Respect
• Involvement
• Inclusion
• Choice
• Fun
• Maximising potential
• Building/strengthening relationships.
Chat, Stories & Tea
Following a successful CST trial, The Whiddon Group is now
introducing its own version of the program, called Chat,
Stories & Tea. Karn Nelson reports
In 2015 The Whiddon Group, a not-for-profit Australian aged care
provider, successfully tested the CST program in eight of our
residential and community care settings, finding it to be an effective
and enjoyable therapy for people with mild to moderate dementia.
Based on the success of that trial, we will be offering our version of the program, called Chat,
Stories & Tea, in all our care services by the end of 2016. It’s based on CST therapy and
maintains the therapy’s principles and group structure, but has been tailored to suit Whiddon’s
aged care environment, residents and community care clients.
Our CST program is aimed at peoplewith short-termmemory loss or mild tomoderate cognitive
impairment. Each program runs for four months and involves small social groups of up to eight
people, facilitated by one or two CST-trained Whiddon leisure or nursing staff. In the first six
weeks the groups meet twice a week, and then once a week for the remaining 10 weeks.
The groups are structured, but involve conversation and interaction around different themes
using multi-sensory stimulus. Conversation and group activities draw on opinions, creative
expression, imagination and life experience. The themes include travel, history, celebrities,
gardening, music, food, art and craft activities.
Although well established in the UK and used widely in both residential and community care
settings across the aged care sector there, CST is not well researched in Australia. At the time
of our trial, we knew of only one other provider in South Australia offering a CST program, and
one research trial run by the Aged Care Psychiatry Service (ACPS) in Sydney (see main article).
Whiddon’s CST trial aimed to assess the level of benefit to residents and clients and pilot the
program before implementing it in all our services.
We tested CST across six residential and two community care services in regional, rural and
remote NSW. One combined group of residential and community care clients was run at our
metropolitan service at Glenfield. Forty-five residents and clients, in groups of between four and
eight, participated over six months. Most had mild to moderate dementia, and some more
advanced dementia. The trial program comprised an intensive stage of eight weeks, with 45-
minute groups run twice aweek, and amaintenance stage of 18weekswith groups once aweek.
We used a mixed methods approach to measure changes in cognitive impairment, quality of
life and effectiveness of the program structure. Cognitive impairment was measured using the
Psychogeriatric Assessment Scale (PAS) and quality of life was measured through the Quality
of Life – Alzheimer’s (QoL-AD) scale.
In addition semi structured interviews were conducted with staff running the groups to gain
further insights into the effectiveness and sustainability of the therapy and program.
The results
The CST program, as applied in the Whiddon trial, proved to be relatively easy to run in both
residential and community care settings. It had a positive effect on the cognitive status of
participants, with 52% showing improved PAS scores from baseline to the end of the
program. Effect on quality of life was harder to measure. Community care clients showed
improved scores across the duration of the trial, whereas those for residential care clients
improved following the intensive stage, but tailed off after the maintenance stage.
While findings were less pronounced in quantitative analyses, the qualitative research revealed
significant benefits to clients and staff. Staff, family members and clients reported cognitive
improvements, an increase in confidence and self-esteem (improved interpersonal skills and
interactions), and psychological benefits for clients. Staff reported increased job satisfaction
and greater knowledge and understanding of clients and skills in engaging with people with
dementia.
CST gives participants the opportunity to widen their social networks in an enjoyable and
highly supportive environment. It would seem to be a valuable program underpinning
relationship-centred care and positive ageing approaches.
Acknowledgment
Support and training for the Whiddon trial was provided by Daniella Kanareck, Natalie Narunsky and
Professor Brian Draper from the ACPS, Eastern Suburbs Mental Health Services, Sydney.
Karn Nelson is Whiddon Group’s Executive General Manager, Strategic Policy and Research.
Contact her at: