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 in: International psychogeriatrics Vol. 25; no. 1; pp. 34 - 46
• 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: Cambridge, UK Cambridge University Press 01.01.2013
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Caregivers; Caregivers - statistics & numerical data; Cost of Illness; Female; Follow-Up Studies; Geriatric Assessment; Geriatric psychology; Geriatrics; Humans; Integrative Medicine - methods; Intervention; Male; Medical sciences; Mental Disorders - rehabilitation; Mental Disorders - therapy; Neuropsychological Tests; Nursing Homes; Precision Medicine - methods; Psychiatric Status Rating Scales; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Rehabilitation; Treatment Outcome; cognitive impairment; psychotherapy; behavioural and psychological symptoms of dementia (BPSD); psychogeriatrics; nursing homes; Human; Nursing home for the aged; Cognitive disorder; Psychotherapy; Controlled therapeutic trial; Caregiver burden; Stress; Behavioral disorder; Symptomatology; Treatment; Follow up study; Mental disorder; Degenerative disease; Homes for the aged; Behavioural and psychological symptoms of dementia; Elderly; Dementia
• ISSN: 1041-6102; 1741-203X
• DOI: 10.1017/S1041610212001305

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.