Independence in dementia’s early stages

A new program is being developed through a national research collaboration to help people with mild cognitive impairment maintain their independence for longer.

Above: Professor Gill Lewin.

By Stephen Easton

West Australian community nursing organisation Silver Chain is developing a new program to help people in the early stages of dementia regain or maintain independence, through their partnership with Curtin University.

Silver Chain’s research director, Professor Gill Lewin from Curtin University’s Centre for Research on Ageing, is leading the project to develop a new version of the non-profit community care provider’s successful Home Independence Program (HIP), in collaboration with Alzheimer’s Australia WA.

Professor Lewin said there was mounting evidence indicating that personalised early interventions could successfully help people with mild cognitive impairment maintain their independence for longer.

Anecdotal reports from Silver Chain staff had also revealed that clients with mild memory loss were already receiving beneficial interventions through the original HIP, which excludes those with a dementia diagnosis.

“There have been a number of research studies indicating that people with early dementia benefit from an activity program in terms of both lifting mood and increasing mobility – their general functioning and quality of life is improved,” Professor Lewin said.

“In terms of cognitive strategies there is, again, increasing research showing that if you train somebody in a task they get better at it … but there is not necessarily generalisation [across all cognitive tasks].

“It’s very individual. Lots has been gathered from people who have been working with or caring for people with dementia, about what worked well. … Strategies like labelling things or leaving them in the same spot.”

The researchers hope that HIP-D, the new program specifically targeted at people with dementia, will repeat the success of HIP, which has seen about two thirds of participants able to go without any ongoing care and support services, and a reduction in the services needed by the other third, according to Prof Lewin.

For many older people, assistance with a few tasks around the house begins a downward slide, as the physical benefits of mundane everyday activities are lost. 

“Physical activity has been shown to have enormous benefits across the board in terms of health and the ability to function on a day to day basis,” she said.

“People are inadvertently putting themselves at higher risk by not exerting themselves to mop the floor or do the laundry.”

A large randomised controlled trial of the HIP model was completed last year, with the results to be published soon, and it has contributed to the development of other wellness and ‘reablement’ programs around the country.

Like the original HIP, HIP-D will be developed in such a way that other organisations can adapt and integrate the same principles into their own work processes, with the Silver Chain deployment used as an example.

The HIP-D research team, funded by the Dementia Collaborative Research Centre – Carers and Consumers, will first develop the modified and extended service model before running a small pilot within Silver Chain.

The West Australian Department of Health have also pledged financial support to fund the pilot and, if it is successful, a larger rollout across Silver Chain’s metropolitan services in October next year.

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