Research
Mina Swaminathan Research Fellowship
On the 2nd anniversary of the T.S. Santhanam Center for Elderly Care, Dr. Soumya Swaminathan, the chair of the M.S Swaminathan Research Foundation, launched the Mrs. Mina Swaminathan Dementia Research Fellowship at DEMCARES. It’s a one year research program for health care professionals who work with people with dementia. The selected candidate will conduct clinical empirical research on topics related to dementia care.
The fellowship was launched in 2023. The research that year focused on exploring pragmatic approaches to managing behavioural and psychological symptoms of dementia and the results were presented at international conferences.
This year, the fellowship is focusing on developing palliative care models for people with advanced dementia.
Please contact our research fellows Ms. Shreenila (2023) and Ms. Sudharshini (2024) for more information on the fellowships and their research.
The Azim Premji Foundation (APF) Project
The Azim Premji Foundation (APF) is a not-for-profit organization committed to creating a just, equitable, and sustainable society, with a strong emphasis on education and social development in India. This mission aligns seamlessly with the vision of DEMCARES, as both organizations strive to enhance societal well-being. Through this collaboration, DEMCARES extends geriatric mental health services to rural communities, ensuring accessibility to individuals across all socioeconomic strata.
Rural Geriatric Mental Health Project
Objective: To deliver comprehensive geriatric mental health services in rural India through a network of trained community health workers (CHWs). This pilot project operates in five selected blocks within the Chengalpattu district, leveraging a dedicated and multidisciplinary team to bring mental health care to the doorstep of rural communities.
Team Composition:
- Field Coordinators: Two social workers from major taluks oversee the activities of CHWs.
- Community Health Workers: Twenty CHWs and two nurses serve as frontline workers delivering mental health services.
- Volunteers: Seventy-five volunteers from local communities assist CHWs in building rapport, identifying clients, and raising awareness.
- Specialists: A team of three psychologists and two psychiatrists provides expert support for diagnostic and therapeutic interventions.
Training and Capacity Building
Training sessions for CHWs and volunteers are conducted by experienced psychiatrists and psychologists. These sessions use customized training manuals developed to suit the varying expertise and knowledge levels of the trainees.
Preparation Phase
The groundwork involves mapping resources and villages within the selected blocks. Field coordinators engage with local stakeholders to secure permissions, while CHWs liaise with panchayat presidents to ensure smooth implementation of awareness programs and screenings.
Screening Process
CHWs conduct door-to-door screenings of all individuals aged 60 and above using standardized psychiatric screening tools. Priority is given to individuals flagged by volunteers or identified through snowball sampling. Those with positive screening results are invited to the Mobile Rural (MoRu) Clinics for further evaluation.
Diagnosis and Care
At the MoRu Clinics, psychiatrists and psychologists use advanced psychiatric assessment tools to confirm diagnoses. For bedridden individuals or those unable to visit the clinic, home assessments are conducted by the specialists.
Treatment Approaches
- Pharmacological Interventions: Medications prescribed by psychiatrists are delivered by CHWs. Clients living alone or exhibiting suicidal tendencies are closely monitored by volunteers, with family members kept informed.
- Non-Pharmacological Interventions: All diagnosed clients and their caregivers receive psychoeducation about the condition. Psychosocial interventions, including activities of daily living (ADL) training, cognitive stimulation therapy (CST), and behavioral and psychological symptoms of dementia (BPSD) management, are provided by CHWs under the supervision of psychologists. For clients with depression, information leaflets and customized interventions are also introduced.
Follow-up and Teleconsultations
CHWs conduct follow-up visits to clients’ homes, facilitating teleconsultations with psychiatrists via video calls. Treatment plans are adjusted based on client and caregiver feedback.
Additional Services
- Referral of clients with physical health issues to government hospitals or primary health centers (PHCs).
- Informing individuals with vision impairments about free ophthalmology camps.
MOBILE URBAN (MoUr) CLINIC
A Geriatric Urban Camp is designed to address mental health issues among elderly residents in institutional care. This initiative involves a multidisciplinary team including psychiatrists, psychologists, and social workers, focusing on comprehensive mental health screening and care for older adults over an extended period.
Objective:
To address mental health issues among elderly residents in institutional care through a multidisciplinary approach.
Key Features:
- Multidisciplinary Team: The initiative involves psychiatrists, psychologists, and social workers working collaboratively to provide holistic and tailored mental health care.
- Camp Duration: Spanning multiple weeks, the camp begins with detailed psychological assessments and progresses to psychiatrist consultations.
- Psychological Assessments: Assessments evaluate residents’ mental well-being and guide discussions on potential modifications and activities to enhance their quality of life. Every resident is screened to ensure comprehensive care.
- Data Management: Screening data is systematically recorded using tools like the online database RedCap for efficient tracking and follow-up.
- Standardized Instruments:
- Vellore Screening Instrument for Dementia (VSID)
- Generalized Anxiety Disorder Scale (GAD-7)
- Patient Health Questionnaire (PHQ-9)
- Other tools for cognitive impairment, anxiety, depression, and psychosis
- Free Medications: Medications are provided free of charge to residents based on their needs.
- Follow-Up Care: Teleconsultations ensure continuity of care and ongoing mental health support for participants.
Mobile Rural (MoRu) Clinics
MoRu Clinics serve as a cornerstone of the project, ensuring accessibility and comprehensive care for rural populations. These clinics operate twice a week in different villages and are staffed by a team of two psychiatrists, two psychologists, and a nurse.
Services Offered:
- Diagnostic evaluations for individuals who screen positive.
- Home visits for clients unable to attend the clinic.
- Referral to local resources for physical health concerns.
- Prescription of pharmacological and non-pharmacological therapies.
- Linkage to social welfare programs.
Current Research Projects
SCARF Cohort of Psychosis in Elderly – Chennai (SCOPE – C)
This project aims to establish a cohort of elderly with psychosis and to follow them up for a period of one year, observe the nature, course, and outcomes of the psychotic symptoms at the end of the study period and to identify associated cognitive, functional and sensory impairments and to observe their course over time. This project is ongoing with the recruitment process currently underway.
Palliative care Model for advanced Dementia
Sudharshini B, Sridhar Vaitheswaran
This project aims to develop a palliative care model for persons with advanced dementia in the Indian context. It’s a one year research project, is for the betterment of people with advanced dementia and their caregivers.
Barriers to Mental Health Care and Treatment Adherence Among Older Adults in Rural Settings
Jeyasree Elangovan*, Nivedhitha Srinivasan, Jama Sebastian, Rohith Khanna Deivasigamani, Anusha Kumaravelu, Sridhar Vaitheswaran
This project aims to identify the barriers that older adults face in accessing mental health services and the factors contributing to non-adherence to treatment in rural communities. The researchers anticipate that the findings will inform essential strategies to enhance the rates of individuals accessing mental health services and to reduce dropout rates within the ongoing rural project.
Rural Adaptation of Cognitive Stimulation Therapy (rCST)
The current study focuses on adapting the individual CST intervention for the rural population in Tamil Nadu, India. The aim is to culturally adapt Individual Cognitive Stimulation Therapy (CST) for the rural setting in Chengalpet district, Tamil Nadu, test the feasibility of the adapted intervention by assessing recruitment, acceptability, fidelity, preliminary efficacy, and suitability of outcome measures, and modify the intervention based on both qualitative and quantitative findings.
Past Research Projects
STrategies for RelaTives (START)
START is a psychosocial intervention developed in the UK targeting caregivers of people with dementia (PwD). It is a manualized intervention containing weekly one-hour sessions delivered for eight weeks. It aims to reduce burden from caregiving, anxiety and depression among caregivers of people with dementia. The main focus of the intervention includes psychoeducation about dementia, behavioural management, thought analysis, communication skills, planning for the future and behaviour activation including relaxation. In this project, START was culturally and linguistically adapted to suit the Indian population. Furthermore, a feasibility test was done to obtain evidence for further implementation. START is now fully available in Tamil and English for use in clinical settings.
Cognitive Stimulation Therapy (CST) International
Cognitive Stimulation Therapy is an established, evidence-based group intervention shown to improve quality of life and slow down cognitive deterioration in persons with dementia. DEMCARES, with the support of the developers of Cognitive Stimulation Therapy – International, has adapted the intervention for use in urban settings within Tamil Nadu. It has also assessed the acceptability and feasibility of the intervention.
This project further aimed to investigate the likely barriers and facilitators of implementation using a series of meetings and qualitative interviews with stakeholders, including clinicians, policy makers, academics and people with dementia and their families. Develop an implementation strategy, with both generic and shared themes (related to CST) and unique considerations for each setting. And, test this strategy through looking at feasibility (including adherence, attendance, acceptability and attrition), agreed parameters of success (including numbers of trained facilitators, numbers of groups run), outcomes (cognition, quality of life, activities of daily living) and costs / affordability of models.
Robotics in Dementia Care
Robotics in Dementia Care is a study conducted in collaboration with Imperial College London. Dementia is a major cause for disability and dependency in elderly and the care needs increase with progression of the illness. In low and middle income countries such as India, the family takes the role of providing care. The WHO predicts that the availability of informal caregivers may reduce in the future. To maximize the availability of interventions, Social Robots are being employed in developed countries to provide engagement for persons with dementia. The use of robots to provide engagement to persons with dementia is being explored for the first time in India. A Hybrid Face Robot capable of emotive responses will be used to engage persons with dementia. This preliminary study of feasibility and acceptance was conducted at DEMCARES, SCARF and the study is now published.
Selected Academic Publications – DEMCARES
- Fisher, E., Venkatesan, S., Benevides, P., Bertrand, E., Brum, P. S., El Baou, C., … & Spector, A. (2024). Online cognitive stimulation therapy for dementia in Brazil and India: acceptability, feasibility, and lessons for implementation. JMIR Aging, 7, e55557.
- Kumar CT, Varghese M, Duddu V, Vaitheswaran S, Srivastava S, Shaji KS, et al. Indian Psychiatric Society multicentre study: Diagnostic patterns, comorbidity and prescription practices for patients with Dementia. Indian J Psychiatry 2023;65:52-60.
- Sridhar Vaitheswaran, Anusha Kumar, & Subashini Sargunan (2022). Rating scales in Geriatric Psychiatry, In: Rajshekar Bipeta & Vikas Menon (eds) Indian Psychiatric Update – Rating scales and Assessment Schedules in Mental Health, Indian Psychiatric Society, South Zonal Branch, Vol 5.
- Perkins L, Fisher E, Felstead C, Rooney C, Wong GHY, Dai R, Vaitheswaran S, Natarajan N, Mograbi DC, Ferri CP, Stott J, Spector A. Delivering Cognitive Stimulation Therapy (CST) Virtually: Developing and Field-Testing a New Framework. Clin Interv Aging. 2022;17:97-116. https://doi.org/10.2147/CIA.S348906
- Stoner CR, Lakshminarayanan M, Mograbi DC, Vaitheswaran S, et al. Development and acceptability of a brief, evidence-based Dementia Awareness for Caregivers course in low- and middle-income countries. Dementia. 2022;21(2):598-617. doi: 10.1177/14713012211055316
- Naylor R., Vaitheswaran S., Nyame S., Boateng D., Mograbi D.C. (2021) Dementia in Sub-Saharan Africa, Asia and Latin America. In: Selin H. (eds) Aging Across Cultures. Science Across Cultures: The History of Non-Western Science, vol 10. Springer, Cham. https://doi.org/10.1007/978-3-030-76501-9_24
- Sridhar Vaitheswaran, Graeme Currie, Vijaya Raghavan Dhandapani, Greeshma Mohan, Thara Rangaswamy, Swaran Preet Singh. Implementation of first episode psychosis intervention in India – A case study in a low-and middle-income country, SSM – Mental Health, Volume 1, 2021, 100018, ISSN 2666-5603. https://doi.org/10.1016/j.ssmmh.2021.100018
- Vaitheswaran S, Balasubramanian S, Natarajan N, et al. Ethical Issues in Delivering Psychological Therapies in Geriatric Psychiatry in India. Indian Journal of Psychological Medicine. July 2021. doi: 10.1177/02537176211026970
- Leroi I, Vaitheswaran S, Sheikh S, Chaudhry N, Goswami S P, Miah J, Sakel M, Tofique S, Husain N. Capacity & capability building for applied dementia research in low- & middle-income countries: Two exemplars from South Asia. Indian J Med Res 2020;152:614-25. https://www.ijmr.org.in/text.asp?2020/152/6/614/318246
- Natarajan, N., Vaitheswaran, S., Lima, M.R., Wairagkar, M. & Vaidyanathan, R (2021). Acceptability of Social Robots and Adaptation of Hybrid-Face Robot for Dementia Care in India: A Qualitative Study. The American Journal of Geriatric Psychiatry. Published online. https://doi.org/10.1016/j.jagp.2021.05.003
- Lima MR, Wairagkar M, Natarajan N, Vaitheswaran S and Vaidyanathan R (2021) Robotic Telemedicine for Mental Health: A Multimodal Approach to Improve Human-Robot Engagement. Front. Robot. AI 8:618866. https://doi.org/10.3389/frobt.2021.618866
- Monisha Lakshminarayanan, Sridhar Vaitheswaran, Nivedhitha Srinivasan, Gayathri Nagarajan, Ahalya Ganesh, Kunnukatil S. Shaji, Mina Chandra, Murali Krishna & Aimee Spector (2021) Cultural adaptation of Alzheimer’s disease assessment scale–cognitive subscale for use in India and validation of the Tamil version for South Indian population, Aging & Mental Health. DOI: 10.1080/13607863.2021.1875192
- Du B, Lakshminarayanan M, Krishna M, Vaitheswaran S, Chandra M, Kunnukattil Sivaraman S, Goswami SP, Rangaswamy T, Spector A, Stoner.
- Currie G, Gulati K, Spyridonidis D, Vaitheswaran S. Distributing leadership for scaling up evidence-based innovation in LMICs: a case for leadership development in India. BMJ Leader Published Online First: 25 March 2021. doi: 10.1136/leader-2020-000230
- Lamech N, Lakshminarayanan M, Vaitheswaran S, John S, Rangaswamy T. Support groups for family caregivers of persons with dementia in India (innovative practice). Dementia. October 2020. doi:10.1177/1471301220969302
- Stoner Charlotte R., Chandra Mina, Bertrand Elodie, DU Bharath, Durgante Helen, Klaptocz Joanna, Krishna Murali, Lakshminarayanan Monisha, Mkenda Sarah, Mograbi Daniel C., Orrell Martin, Paddick Stella-Maria, Vaitheswaran Sridhar, Spector Aimee. A New Approach for Developing “Implementation Plans” for Cognitive Stimulation Therapy (CST) in Low and Middle-Income Countries: Results From the CST-International Study. Frontiers in Public Health, 8, 2020, 342 (https://www.frontiersin.org/article/10.3389/fpubh.2020.00342) DOI=10.3389/fpubh.2020.00342. ISSN=2296-2565
- Sridhar Vaitheswaran, Monisha Lakshminarayanan, Vaishnavi Ramanujam, Subashini Sargunan, Shreenila Venkatesan. Experiences and Needs of Caregivers of Persons With Dementia in India During the COVID-19 Pandemic—A Qualitative Study. The American Journal of Geriatric Psychiatry, 2020, ISSN 1064-7481, https://doi.org/10.1016/j.jagp.2020.06.026
- Spector A, Stoner CR, Chandra M, Vaitheswaran S, Du B, Comas-Herrera A, Dotchin C, Ferri C, Knapp M, Krishna M et al. Mixed methods implementation research of cognitive stimulation therapy (CST) for dementia in low and middle-income countries: study protocol for Brazil, India and Tanzania (CST-International). BMJ Open. 2019 20;9(8):e030933.
- Lamech N, Raghuraman S, Vaitheswaran S. and Rangaswamy T. The Support Needs of Family Caregivers of Persons with Dementia in India: Implications for Health Services. Dementia. 2019 Aug;18(6):2230-2243. doi: 10.1177/1471301217744613
- Cognitive Stimulation Therapy – An international perspective – India: Sridhar Vaitheswaran, Monisha Lakshminarayanan and Shruti Raguraman; in Cognitive Stimulation Therapy for Dementia: History, Evolution and Internationalism (Aging and Mental Health Research). Routledge 2018; Editors: Lauren A. Yates, Jen Yates, Aimee Spector, Martin Orrel, Bob Woods
- Raghuraman S, Lakshminarayanan M, Vaitheswaran S and Rangaswamy T. Cognitive Stimulation Therapy for dementia: Pilot studies of acceptability and feasibility of cultural adaptation for India. Am J Geriatr Psychiatry 2017; 25(9): 1029-1032.
- Telemental health – Video conferencing in mental health services: Sridhar Vaitheswaran, Philip Crocket, Sam Wilson and Harry Millar; Advances in psychiatric treatment (2012), vol. 18, 392–398