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Benefit of an integrative psychotherapeutic nursing home program to reduce multiple psychiatric symptoms of psychogeriatric patients and caregiver burden after six months of follow-up: a re-analysis of a randomized controlled trial

Published online by Cambridge University Press:  09 August 2012

Ton J. E. M. Bakker ,
Hugo J. Duivenvoorden ,
Jacqueline van der Lee ,
Marcel G. M. Olde Rikkert ,
Aartjan T. F. Beekman  and
Miel W. Ribbe
Ton J. E. M. Bakker*
Affiliation:
Psychiatric-Skilled Nursing Home “DrieMaasStede,” Argos Zorggroep, Schiedam, the Netherlands VU Department of Nursing Home Medicine, EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands VU University Medical Center, Amsterdam, the Netherlands
Hugo J. Duivenvoorden
Affiliation:
Psychiatric-Skilled Nursing Home “DrieMaasStede,” Argos Zorggroep, Schiedam, the Netherlands
Jacqueline van der Lee
Affiliation:
Psychiatric-Skilled Nursing Home “DrieMaasStede,” Argos Zorggroep, Schiedam, the Netherlands
Marcel G. M. Olde Rikkert
Affiliation:
Department of Geriatrics, Radboud University Medical Centre, Nijmegen, the Netherlands
Aartjan T. F. Beekman
Affiliation:
VU University Medical Center, Amsterdam, the Netherlands GGZ Buitenamstel and Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
Miel W. Ribbe
Affiliation:
VU Department of Nursing Home Medicine, EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands VU University Medical Center, Amsterdam, the Netherlands
*
Correspondence should be addressed to: Ton J. E. M. Bakker, MD, PhD, Psychiatric-Skilled Nursing Home “DrieMaasStede,” Argos Zorggroep, Schiedam/VU Department of Nursing Home Medicine, EMGO Institute for Health and Care Research VU University Amsterdam/VU University Medical Center, Amsterdam, the Netherlands. Phone: +3110-4278163; Fax: +3110-4719379. Email: t.bakker@argoszorggroep.nl.
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Abstract

Background: In this paper, we aim to test the long-term benefit of an integrative reactivation and rehabilitation (IRR) program compared to usual care in terms of improved psychogeriatric patients on multiple psychiatric symptoms (MPS) and of caregivers on burden and competence. Improvement was defined as >30% improvement (≥ a half standard deviation) compared to baseline.

Methods: We used the following outcome variables: difference in the number of improved patients on MPS (Neuropsychiatric Inventory, NPI) and improved caregivers on burden (Caregiver Burden, CB) and competence (Caregiver Competence List, CCL). Assessments were taken after intake (T1) and after six months of follow-up (T3). Risk ratios (RR), number needed to treat (NNT), and odds ratios (ORs) were calculated.

Results: IRR had a significant positive effect on NPI-cluster hyperactivity (RR 2.64; 95% CI: 1.26–5.53; NNT 4.07). In the complete cases analysis, IRR showed significant ORs of 2.80 on the number of NPI symptoms and 3.46 on the NPI-sum-severity; up to 76% improved patients. For caregivers, competence was a significant beneficiary in IRR (RR 2.23; 95% CI: 1.07–4.62; NNT 5.07). In the complete cases analysis, the ORs were significantly in favor of IRR on general burden and competence (ORs range: 2.40–4.18), with up to 71% improved caregivers.

Conclusion: IRR showed a significantly higher probability of improvement with a small NNT of four on multiple psychiatric symptoms in psychogeriatric patients. The same applies to the higher probability to improve general burden and competence of the caregiver with an NNT of five. The results were even more pronounced for those who fully completed the IRR program. (Inter)national psychogeriatric nursing home care and ambulant care programs have to incorporate integrative psychotherapeutic interventions.

Keywords

cognitive impairmentbehavioural and psychological symptoms of dementia (BPSD)nursing homespsychogeriatricspsychotherapy
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 1 , January 2013 , pp. 34 - 46
Copyright
Copyright © International Psychogeriatric Association 2012

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References

Aalten, P., Vugt, E., de Jaspers, N., Jolles, J. and Verhey, F. R. J. (2005). The course of neuropsychiatric symptoms in dementia. Part II: relationships among behavioural sub-syndromes and the influence of clinical variables. International Journal of Geriatric Psychiatry, 20, 531–36. doi: 10.1002/gps.1317.CrossRefGoogle ScholarPubMed
Bakker, T. J. E. M. (2000). Palliative care in chronic psycho-geriatrics: a case study. Patient Education and Counseling, 41, 107–113.CrossRefGoogle ScholarPubMed
Bakker, T. J. E. M., Duivenvoorden, H. J. and Schudel, W. J. (2001). Psycho-geriatric reactivation in a psychiatric-skilled nursing home: a clinical–empirical exploration. International Journal of Geriatric Psychiatry, 16, 1–6.3.0.CO;2-5>CrossRefGoogle Scholar
Bakker, T. J. E. M., Duivenvoorden, H. J., van der Lee, J. and Trijsburg, R. W. (2005). Prevalence of psychiatric function disorders in psychogeriatric patients at referral to nursing home care: the relation to cognition, activities of daily living and general details. Dementia and Geriatric Cognitive Disorders, 20, 215–224. doi:10.1159/000087298.CrossRefGoogle ScholarPubMed
Bakker, T. J. E. M., Duivenvoorden, H. J., van der Lee, J., Olde Rikkert, M., Beekman, A. T. F. and Ribbe, M. W. (2011), Integrative psychotherapeutic nursing home programme to reduce multiple psychiatric symptoms of psychogeriatric patients and caregiver burden: a randomized controlled trial. American Journal of Geriatric Psychiatry, 19, 507–520.CrossRefGoogle Scholar
Black, W. and Almeida, O. P. (2004). A systematic review of the association between the behavioral and psychological symptoms of dementia and burden of care. International Psychogeriatrics, 16: 295–315. doi:/10.1017/S1041610204000468.CrossRefGoogle ScholarPubMed
Burrows, A. B., Satlin, A. and Salzman, C. (1995). Depression in a long-term care facility: clinical features and discordance between nursing assessment and patient interviews. Journal of the American Geriatrics Society, 43, 1118–1122.CrossRefGoogle Scholar
Callahan, C. M., Hendrie, H. C., Dittus, R. S., Brater, C. C., Hui, S. L. and Tierney, W. M. (1994). Improving treatment of late life depression in primary care: a randomized clinical trial. Journal of the American Geriatrics Society, 42, 839–846.CrossRefGoogle ScholarPubMed
Cummings, J. L., Mega, M., Gray, K. and Rosenberg-Thompson, S. (1994) The neuropsychiatric Inventory, comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
Cummings, J. L., Koumaras, B., Chen, M. and Mirski, D.(Rivastigmine Nursing Home Study Team) (2005). Effects of rivastigmine treatment on the neuropsychiatric and behavioral disturbances of nursing home residents with moderate to severe probable Alzheimer's disease: a 26-week, multicenter, open-label study. American Journal of Geriatric Pharmacotherapy, 3, 137–148.CrossRefGoogle ScholarPubMed
Davison, T. E., Hudgson, C., McCabe, M. P., George, K. and Buchanan, G. (2007). An individualized psychosocial approach for “treatment resistant” behavioral symptoms of dementia among aged care residents. International Psychogeriatrics, 19, 859–873. doi:10.1017/S1041610206004224.CrossRefGoogle ScholarPubMed
Exel, N. J. van, Scholte op Reimer, W. J. M., Brouwer, W. B. F., van den Berg, B., Koopmanschap, M. A. and van den Bos, G. A. M. (2004). Instruments for assessing the burden of informal caregiving for stroke patients in clinical practice: a comparison of CSI, CRA, SCQ and self-rated burden. Clinical Rehabilitation, 18, 203–214. doi:0.1191/0269215504cr723oa.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle Scholar
Haan, R. de, Liburg, M., Schuling, J., Broeshart, J., Jonkers, L. and Zuylen, P. van. (1993). Clinimetric evaluation of the Barthel Index, a measure of limitations in daily activities. [Klinimetrische evaluatie van de Barthel-index, een maat voor beperkingen in het dagelijks functioneren.] (in Dutch). Nederlands Tijdschrift voor Geneeskunde, 18, 917–921.Google Scholar
Hinchliffe, A. C., Hyman, I. L., Blizard, B. and Livingston, G. (1995). Behavioural complications of dementia: can they be treated? International Journal of Geriatric Psychiatry, 10, 839–847. doi:10.1002/gps.930101005.CrossRefGoogle Scholar
Katona, C., Livingston, G., Cooper, C., Ames, D., Brodaty, H. and Chiu, E. (2007). International Psychogeriatric Association consensus statement on defining and measuring treatment benefits in dementia. International Psychogeriatrics, 19, 345–354. doi:10.1017/S1041610207005145.CrossRefGoogle ScholarPubMed
Livingston, G. and Katona, C. (2004). The place of memantine in the treatment of Alzheimer's disease: a number needed to treat analysis. International Journal of Geriatric Psychiatry, 19, 919–925. doi:10.1002/gps.1166.CrossRefGoogle ScholarPubMed
Livingston, G., Johnston, K., Katona, C., Paton, J. and Lyketsos, C. G. (2005). Old Age Task Force of the World Federation of Biological Psychiatry: systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia. American Journal of Psychiatry, 162, 1996–2021.CrossRefGoogle Scholar
Muskens, J. B., Noy, J. and Verburg, M. (1992). Progression of dementia and admission: an explorative longitudinal study. (Progressie van dementie en opname: Een exploratief longitudinaal onderzoek) (in Dutch). Huisarts en Wetenschap, 35, 490–497.Google Scholar
Norman, G. R., Sloan, J. A. and Wyrwich, K. W. (2003). Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Medical Care, 41, 582–592.CrossRefGoogle ScholarPubMed
Peeters, J. M., Van Beek, A. P. A., Meerveld, J. H. C. M., Spreeuwenberg, P. M. M. and Francke, A. L. (2010). Informal caregivers of persons with dementia, their use and needs for specific professional support: a survey of the National Dementia Programme. BMC Nursing, 9, 9. doi:10.1186/1472-6955-9-9.CrossRefGoogle ScholarPubMed
Pot, A. M., Deeg, D. J. H. and Knipscheer, C. P. M. (2001). Institutionalization of demented elderly: the role of caregiver characteristics. International Journal of Geriatric Psychiatry, 16, 273–280. doi:10.1002/gps.331.CrossRefGoogle ScholarPubMed
Reisberg, B., Ferris, S. H., de Leon, M. J. and Crook, T. (1982). The global deterioration scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 1136–1139.Google ScholarPubMed
Rockwood, K., Joyce, B. and Stolee, P. (1997). Use of goal attainment scaling in measuring clinical important change in cognitive rehabilitation patients. Journal of Clinical Epidemiology, 50, 581–588. doi:10.1016/s0895-4356(97)00014-0.CrossRefGoogle ScholarPubMed
Schneeweiss, S., Setoguchi, S., Brookhart, A., Dormuth, C. and Wang, P. S. (2007). Risk of death associated with the use of conventional versus atypical antipsychotic drugs among elderly patients. Canadian Medical Association Journal, 176, 627–632. doi:10.1503/cmaj.061250.CrossRefGoogle ScholarPubMed
Scholey, K. E. and Woods, B. T. (2003). A series of brief cognitive therapy interventions with people experiencing both dementia and depression: a description of techniques and common themes. Clinical Psychology and Psychotherapy, 10, 175–185. doi:10.1002/cpp.368.CrossRefGoogle Scholar
Selbaek, G., Kirkevold, Ø. and Engedal, K. (2008). The course of psychiatric and behavioral symptoms and the use of psychotropic medication in patients with dementia in Norwegian nursing homes-a 12 month follow-up study. American Journal of Geriatric Psychiatry, 16, 528–536.CrossRefGoogle ScholarPubMed
Teri, L. and Gallagher-Thompson, D. (1991). Cognitive–behavioral interventions for treatment of depression in Alzheimer patients. The Gerontologist, 31, 413–416. doi:10.1093/geront/31.3.413.CrossRefGoogle Scholar
Teunisse, S. (1997). Clinimetrics in Dementia. Dissertation, University of Amsterdam.Google Scholar
Watson, L. C., Zimmerman, S., Cohen, L. W. and Dominik, R. (2009). Practical depression screening in residential care/assisted living: five methods compared with gold standard diagnoses. American Journal of Geriatric Psychiatry, 17, 556–564. doi:10.1097/JGP.0b013e31819b891c.CrossRefGoogle ScholarPubMed