Psychiatric-Skilled Nursing Home DrieMaasStede, Argos Zorggroep, Schiedam, The Netherlands.
Dement Geriatr Cogn Disord. 2011;32(5):318-31. doi: 10.1159/000334969. Epub 2012 Jan 25.
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.
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).
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.
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.
背景/目的：精神老年患者中存在多种精神症状（MPS）的比例约为 80%。MPS 对照顾者有负面影响；70-80%的照顾者负担较重。我们测试了一种针对 MPS 以及照顾者负担的综合心理治疗方案（IRR）。为了制定指示 IRR 的决策规则，确定了诊断和功能基线变量对 IRR 有利结果的预测潜力。
采用 DSM-IV 痴呆、遗忘障碍或其他认知障碍分类的患者，在一项随机对照试验中进行随访，比较 IRR（n=81）与常规疗养院护理（n=87）。在 T1（入院）和 T2（6 个月随访）进行评估。
在综合预后模型中，阿尔茨海默病对 NPI 总分严重程度（OR 3.01）、IRR 对一般负担和照顾者能力（OR 2.29 和 3.34）的改善具有显著的预后质量。认知功能的预后价值较低。
对 MPS 严重程度和照顾者负担的积极变化进行预后建模是可行的。应用三个决策规则，均导致 IRR 作为指示干预。对于患有广泛认知功能障碍的精神老年患者，特别是患有阿尔茨海默病型痴呆的患者，将其转介至 IRR 方案是合理的。
