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GREAT-iP

Maintaining independence in Alzheimer's and related dementias through Goal-oriented cognitive REhAbiliTation: Implementation into Practice

About the project

Cognitive rehabilitation (CR) is a person-centred intervention that helps people with early-stage dementia maintain independence through managing everyday activities better. Several research studies, including the GREAT trial (Clare, Kudlicka, Oyebode et al., 2019), have found positive results. This individualised therapy is conducted in people’s own homes over several sessions with a therapist, who works with the person and the carer to identify realistic and personally-meaningful goals, plan ways of addressing these, and support goal attainment.

CR could form a valuable component of post-diagnostic care pathways and home support packages. In this project we have begun the process of enabling NHS memory services and social care providers, by working with NHS trusts and social care providers to support them to offer CR. At the end of the project, we expect that CR will be in use in at least 15 organisations, and a tried and tested strategy will be available for wider rollout across the UK.

An elderly person with a young girl.

Aims

The aim of this translational study, building on evidence from the GREAT randomised controlled trial, was to develop a foundation for implementing the GREAT Cognitive Rehabilitation intervention in community-based services for people with mild-to-moderate dementia.

Outputs

The study has led to two academic publications:

Morgan-Trimmer, S., Kudlicka, A., Warmoth, K., Leroi, I., Oyebode, J. R., Pool, J., ... & Clare, L. (2021). Implementation processes in a cognitive rehabilitation intervention for people with dementia: a complexity-informed qualitative analysis. BMJ open, 11(10), e051255.

Clare, L., Kudlicka, A., Collins, R., Evans, S., Pool, J., Henderson, C., Knapp, M., Litherland, R., Oyebode, J. and Woods, R., 2023. Implementing a home-based personalised cognitive rehabilitation intervention for people with mild-to-moderate dementia: GREAT into Practice. BMC Geriatrics, 23(1), pp.1-17.

It has also led to a free self-help guide which is available to support people diagnosed with dementia to achieve their goals to enjoy daily activities and independent living. The resource, is called My Life, My Goals. It was funded and supported by the Alzheimer's Society.

Research team 

GREAT-iP was led by Professor Linda Clare, University of Exeter. 

Jan Oyebode, Professor of Dementia Care in the Centre for Applied Dementia Studies, was a regional PI for the GREAT trial. Her role in GREAT-iP, along with Professor Bob Woods, University of Bangor, revolved around the development of resources and materials and liaison with sites to develop and review implementation plans. 

You can see more about the study here: https://sites.google.com/exeter.ac.uk/great-cr/home 

Funding

The project is funded by the Alzheimer’s Society (£399,996.40; 2018-2021).

Acknowledgements

Professor Jan Oyebode was a regional PI for the GREAT trial. Her role in GREAT-iP, along with Professor Bob Woods, University of Bangor, has revolved around the development of resources and materials and liaison with sites to develop and review implementation plans.

Reference: Clare, L., Kudlicka, A., Oyebode, J. R., Jones, R. W., Bayer, A., Leroi, I., ... & Woods, B. (2019). Individual goal‐oriented cognitive rehabilitation to improve everyday functioning for people with early‐stage dementia: A multicentre randomised controlled trial (the GREAT trial). International journal of geriatric psychiatry, 34(5), 709-721.