Integratief reactiverings- en rehabilitatieprogramma voor psychogeriatrische patiënten

Objective

To test the effectiveness of an integrative reactivation and rehabilitation programme (IRR) for reducing multiple neuropsychiatric symptoms of psychogeriatric patients and caregiver burden.

Design

Open RCT.

Method

Of the 168 participants, 81 were in the IRR and 87 received standard care. The inclusion criteria were a) dementia, an amnestic disorder or other cognitive disorder (DSM-IV); b) Neuropsychiatric Inventory (NPI) score of ≥ 3; c) Mini-mental state examination score ≥ 18 and ≤ 27; d) Barthel Index ≥ 5 and ≤ 19. Primary outcome variables were the number and severity of multiple neuropsychiatric symptoms, measured by NPI. Furthermore, caregiver burden and competence were measured.

Measurements took place at inclusion (T1), at the end of treatment (T2), and six months thereafter (T3). Cohen’s-d (Cd) was calculated for mean differences; random regression modelling (RRM) was applied.

Results

At the end of treatment (T1-T2), IRR showed significantly more reduction in number (difference in NPI-scores: 1.31; Cd -0.53), as well as severity of symptoms ( 11.16; Cd -0.53). In the IRR group, general caregiver burden and emotional distress were statistically significantly lower and competence was increased. Six months after the end of treatment (T1-T3), effects on the patients were still measurable but after correction no longer statistically significant; caregiver competence had further increased. This was confirmed by RRM.

Conclusion

IRR was more effective than standard emotion-oriented care in reducing multiple neuropsychiatric symptoms as well as caregiver burden. Caregiver competence in the IRR group had significantly more increased. We recommend that usual nursing home care incorporates integrative psychotherapeutic treatment strategies.

Conflict of interest: none declared. Financial support: financial support was received from ZonMW (The Netherlands Organisation for Health Research and Development) for this study.