Prognostic Factors for a Favourable Long-Term Outcome from an Integrative Psychotherapeutic Nursing Home Programme

• Published in: Dementia and geriatric cognitive disorders Vol. 32; no. 5; pp. 318 - 331
• Main Authors: Bakker, Ton J.E.M., Duivenvoorden, Hugo J., van der Lee, Jacqueline, Olde Rikkert, Marcel G.M., Beekman, Aartjan T.F., Ribbe, Miel W.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland Karger 01.01.2011; S. Karger AG
• Subjects: Activities of Daily Living - classification; Activities of Daily Living - psychology; Aged; Aged, 80 and over; Alzheimer Disease - diagnosis; Alzheimer Disease - psychology; Alzheimer Disease - therapy; Amnesia - diagnosis; Amnesia - psychology; Amnesia - therapy; Biological and medical sciences; Comorbidity; Cooperative Behavior; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Dementia - diagnosis; Dementia - psychology; Dementia - therapy; Disease Progression; Double-Blind Method; Female; Follow-Up Studies; Homes for the Aged; Humans; Integrative Medicine - methods; Interdisciplinary Communication; Male; Medical sciences; Mental Disorders - diagnosis; Mental Disorders - psychology; Mental Disorders - therapy; Mental Status Schedule - statistics & numerical data; Neurology; Neuropsychological Tests - statistics & numerical data; Nursing Homes; Original Research Article; Patient Care Team; Prognosis; Psychometrics; Psychotherapy - methods; Vascular diseases and vascular malformations of the nervous system; Neuropsychiatric symptoms; Psychotherapy; Behavioural and psychological symptoms of dementia; Psychiatry; Nursing home; Prognostics; Cognitive impairment; Nervous system diseases; Prognosis; Cognitive disorder; Prognostic; Behavioral disorder; Mental disorder; Degenerative disease; Dementia; Nurse
• ISSN: 1420-8008; 1421-9824
• DOI: 10.1159/000334969

Background/Aims: The prevalence of multiple psychiatric symptoms (MPS) in psychogeriatric patients is about 80%. MPS have negative effects on caregivers; 70–80% of caregivers are moderately to heavily burdened. We tested an integrative psychotherapeutic programme (IRR) focused on MPS as well as caregiver burden. To develop decision rules in indicating IRR, prognostic potentialities of diagnostic and functional baseline variables for a favourable outcome of IRR were identified. Methods: Patients with a DSM-IV classification of dementia, amnestic disorders or other cognitive disorders were followed in a randomised controlled trial, comparing IRR (n = 81) with usual nursing home care (n = 87). Assessments at T1 (intake) and T2 (6 months’ follow-up). Results: In the combined prognostic models Alzheimer dementia showed significant prognostic qualities for improvement on NPI sum severity (OR 3.01), IRR on general burden and competence of caregiver (OR 2.29 and 3.34). Cognitive functions had low prognostic value. Conclusion: Prognostic modelling of positive change on severity of MPS and caregiver burden was feasible. Applying three decision rules, all resulted in IRR as indicated intervention. It seems justified to refer psychogeriatric patients suffering from a broad range of cognitive function disorders, specifically patients with dementia of the Alzheimer type, to the IRR programme.