A retrospective study of a multicomponent rehabilitation programme for community-dwelling persons with dementia and their caregivers

Abstract

Introduction

This study determined whether the multicomponent rehabilitation programme of a memory clinic had positive outcomes on ameliorating everyday functioning, quality of life, mood and behavioural disturbances of persons with dementia and reducing distress and burden of caregivers.

Method

A retrospective pre-test–post-test study without control group was conducted on the first cohort of persons with dementia (n = 30) and their caregivers (n = 30), who participated in a programme lasting for a maximum of 1 year with 25 1-hour counselling sessions. The assessment contained an evaluation of everyday functioning in basic, instrumental and advanced activities of daily living, cognition, mood, emotional and behavioural disturbances, quality of life and caregiver burden.

Results

Eight participants dropped out prematurely. For persons with dementia (n = 22), participating in the programme did not improve everyday functioning and cognition but ameliorated quality of life significantly (Z = –2.7, p = 0.006, 95% CI (.003–.005)) and stabilized mood, emotional and behavioural disturbances for 60% or more of them. For caregivers (n = 22), the mild to moderate burden of care remained stable or got better for 63.6% of the caregivers.

Conclusion

This programme appears to be promising and valuable, and might reduce institutionalization rates. Future explorations are recommended to research how participants evolve and to investigate which participants responded in a positive way.

Keywords

Community-dwelling older persons dementia rehabilitation person-centred care

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References

Alzheimer’s Society UK (2013) Dementia 2013: The hidden voice of loneliness. Available at: www.alzheimers.org.uk/downloads/download/1056/dementia_2013_the_hidden_voice_of_loneliness (accessed 1 February 2017).

Andrieu

Coley

Rolland

et al. (2016) Assessing Alzheimer’s disease patients’ quality of life: Discrepancies between patient and caregiver perspectives. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association 12(4): 427–437.

Aspinal

Glasby

Rostgaard

et al. (2016) Reablement: Supporting older people towards independence. Age and Ageing 45(5): 574–578.

Bahar-Fuchs

Clare

Woods

(2013) Cognitive training and rehabilitation for mild to moderate Alzheimer’s disease and vascular dementia. The Cochrane Database of Systematic Reviews 5(6): CD003260.

Banerjee

Smith

Lamping

et al. (2006) Quality of life in dementia: More than just cognition. An analysis of associations with quality of life in dementia. Journal of Neurology, Neurosurgery, and Psychiatry 77(2): 146–148.

Barca

Engedal

Laks

et al. (2011) Quality of life among elderly patients with dementia in institutions. Dementia and Geriatric Cognitive Disorders 31(6): 435–442.

Brodaty

Arasaratham

(2012) Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. American Journal of Psychiatry 169(9): 946–953.

Brodaty H, Woodward, Boundy K, Ames D, Balshaw R and PRIME Study Group (2014) Prevalence and predictors of burden in caregivers of people with dementia. Am J Geriatr Psychiatry 22(8): 756–765.

Chiao

Hsiao

(2015) Caregiver burden for informal caregivers of patients with dementia: A systematic review. International Nursing Review 62(3): 340–350.

10.

Clare

Linden

Woods

et al. (2010) Goal-oriented cognitive rehabilitation for people with early-stage Alzheimer disease: A single-blind randomized controlled trial of clinical efficacy. The American Journal of Geriatric Psychiatry 18(10): 928–939.

11.

Cochrane A, Furlong M, MCgilloway S, et al. (2016) Time-limited home-care reablement for maintaining and improving the functional independence of older adults (Review). Cochrane Database of Systematic Reviews 10. DOI: 10.1002/14651858.CD010825.pub2.

12.

Cooper

Mukadam

Katona

et al. (2012) Systematic review of the effectiveness of non-pharmacological interventions to improve quality of life of people with dementia. International Psychogeriatrics 24(6): 856–870.

13.

Cummings

Mega

Gray

et al. (1994) The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology 44(12): 2308–2314.

14.

De Vriendt

Gorus

Cornelis

et al. (2013) The advanced activities of daily living: A tool allowing the evaluation of subtle functional decline in mild cognitive impairment. The Journal of Nutrition, Health and Aging 17(1): 64–71.

15.

De Vriendt

Mets

Petrovic

et al. (2015) Discriminative power of the advanced activities of daily living (a-ADL) tool in diagnosis of mild cognitive impairment in an older population. International Psychogeriatrics 27(9): 1419–1427.

16.

Folstein

Mchugh

(1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12(3): 189–198.

17.

Gitlin

Hauck

Dennis

et al. (2005) Maintenance of effects of the home environmental skill-building program for family caregivers and individuals with Alzheimer’s disease and related disorders. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 60(3): 368–374.

18.

Graff

Vernooij-Dassen

Thijsen

et al. (2006) Community based occupational therapy for patients with dementia and their caregivers: Randomised controlled trial. BMJ Geriatrics 9(7580): 1196–1202.

19.

Katz

(1963) Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. Journal of the American Medical Association Sep 21(185): 914–919.

20.

Kurz

Thone-Otto

Cramer

et al. (2012) CORDIAL: Cognitive rehabilitation and cognitive-behavioral treatment for early dementia in Alzheimer disease: A multicenter, randomized, controlled trial. Alzheimer Disease and Associated Disorders 26(3): 246–253.

21.

Lawton

(1994) Quality of life in Alzheimer disease. Alzheimer Disease and Associated Disorders 8(3): 38–50.

22.

Lawton

Brody

(1969) Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist 9(3): 179–186.

23.

Logsdon

McCurry

Teri

(2007) Evidence-based interventions to improve quality of life for individuals with dementia. Alzheimers Care Today 8(4): 309–318.

24.

Mclaren

Lamatia

Callahan

(2013) Systematic review of non-pharmacologic interventions to delay functional decline in community-dwelling patients with dementia. Aging & Mental Health 17(6): 655–666.

25.

Martin-Carrasco

Martin

Valero

et al. (2009) Effectiveness of a psychoeducational intervention program in the reduction of caregiver burden in Alzheimer’s disease patients’ caregivers. International Journal of Geriatric Psychiatry 24(5): 489–499.

26.

Moniz-Cook

Vernooij-Dassen

Woods

et al. (2008) A European consensus on outcome measures for psychosocial intervention research in dementia care. Aging & Mental Health 12(1): 14–29.

27.

Olazaran

Reisberg

Clare

et al. (2010) Nonpharmacological therapies in Alzheimer’s disease: A systematic review of efficacy. Dementia and Geriatric Cognitive Disorders 30(2): 161–178.

28.

Phung

KTT

Waldorff

Buss

et al. (2013) A three-year follow-up on the efficacy of psychosocial interventions for patients with mild dementia and their caregivers: The multicentre, rater-blinded, randomised Danish Alzheimer Intervention Study (DAISY). BMJ Open 3(11): e003584.

29.

Prick

De Lange

Scherder

et al. (2016) The effects of a multicomponent dyadic intervention on the mood, behavior, and physical health of people with dementia: A randomized controlled trial. Clinical Interventions In Aging 11(31): 383–395.

30.

Prince M, Comas-Herrera A, Knapp M, et al. (2016) World Alzheimer Report 2016: Improving healthcare for people living with dementia. Coverage, quality and costs now and in the future. Available at: www.alz.co.uk/research/WorldAlzheimerReport2016.pdf (accessed 1 February 2017).

31.

Reuben

Laliberte

Hiris

et al. (1990) A hierarchical exercise scale to measure function at the Advanced Activities of Daily Living (AADL) level. Journal of The American Geriatrics Society 38(8): 855–861.

32.

Ruiz S and Spafford M (2015) Research prioritization topic brief: Comparative effectiveness of multicomponent management interventions for community-dwelling individuals with dementia. Chicago NORC at the University of Chicago. Available at: www.pcori.org/sites/default/files/PCORI-Topic-Brief-Dementia-CER-of-Multicomponent-Management-Interventions.pdf (accessed 9 June 2017).

33.

Shim

Kang

Kim

et al. (2016) Factors associated with caregiver burden in dementia: 1-Year follow-up study. Psychiatry Investigation 13(1): 43–49.

34.

Sörensen

Pinquart

Duberstein

(2002) How effective are interventions with caregivers? An updated meta-analysis. The Gerontologist 42(3): 356–372.

35.

Sørensen

Waldorff

Waldemar

(2008) Early counselling and support for patients with mild Alzheimer’s disease and their caregivers: A qualitative study on outcome. Aging & Mental Health 12(4): 444–450.

36.

Van’t Leven

Prick

Groenewoud

et al. (2013) Dyadic interventions for community-dwelling people with dementia and their family caregivers: A systematic review. International Psychogeriatrics 25(1): 1581–1603.

37.

Voigt-Radloff

Graff

Leonhart

et al. (2011a) A multicentre RCT on community occupational therapy in Alzheimer’s disease: 10 sessions are not better than one consultation. BMJ Open 1(1): e000096.

38.

Voigt-Radloff

Graff

Leonhart

et al. (2011b) Why did an effective Dutch complex psycho-social intervention for people with dementia not work in the German healthcare context? Lessons learnt from a process evaluation alongside a multicentre RCT. BMJ Open 1(1): e000094.

39.

Wattmo

Wallin

Londos

et al. (2011) Risk factors for nursing home placement in Alzheimer’s disease: A longitudinal study of cognition, ADL, service utilization, and cholinesterase inhibitor treatment. Gerontologist 51(1): 17–28.

40.

Wenborn

Hynes

Moniz-Cook

et al. (2016) Community occupational therapy for people with dementia and family carers (COTiD-UK) versus treatment as usual (Valuing Active Life in Dementia (VALID) programme): Study protocol for a randomised controlled trial. Trials 17(65): 1–10.

41.

Woods

Aguirre

Spector

et al. (2012) Cognitive stimulation to improve cognitive functioning in people with dementia. The Cochrane Database of Systematic Reviews 15(2): CD005562.

42.

Yesavage

Brink

Rose

et al. (1983) Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research 17(1): 37–49.

43.

Zarit

Reever

Bach-Peterson

(1980) Relatives of the impaired elderly: Correlates of feelings of burden. Gerontologist 20(6): 649–655.