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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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