O'Sullivan Julie L, Lech Sonia, Gellert Paul, Grittner Ulrike, Voigt-Antons Jan-Niklas, Möller Sebastian, Kuhlmey Adelheid, Nordheim Johanna
Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Institute for Medical Sociology and Rehabilitation Science, Charitéplatz 1, Berlin, Germany.
Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Institute for Biometry and Clinical Epidemiology, Charitéplatz 1, Berlin, Germany.
Int Psychogeriatr. 2022 Feb;34(2):129-141. doi: 10.1017/S1041610221000818. Epub 2021 Jun 29.
To investigate global and momentary effects of a tablet-based non-pharmacological intervention for nursing home residents living with dementia.
Cluster-randomized controlled trial.
Ten nursing homes in Germany were randomly allocated to the tablet-based intervention (TBI, 5 units) or conventional activity sessions (CAS, 5 units).
N = 162 residents with dementia.
Participants received regular TBI (n = 80) with stimulating activities developed to engage people with dementia or CAS (n = 82) for 8 weeks.
Apathy Evaluation Scale (AES-I, primary outcome), Quality of Life in Alzheimer's Disease scale, QUALIDEM scale, Neuropsychiatric Inventory, Geriatric Depression Scale, and psychotropic medication (secondary outcomes). Momentary quality of life was assessed before and after each activity session. Participants and staff were blinded until the collection of baseline data was completed. Data were analyzed with linear mixed-effects models.
Levels of apathy decreased slightly in both groups (mean decrease in AES-I of .61 points, 95% CI -3.54, 2.33 for TBI and .36 points, 95% CI -3.27, 2.55 for CAS). Group difference in change of apathy was not statistically significant (β = .25; 95% CI 3.89, 4.38, p = .91). This corresponds to a standardized effect size (Cohen's d) of .02. A reduction of psychotropic medication was found for TBI compared to CAS. Further analyses revealed a post-intervention improvement in QUALIDEM scores across both groups and short-term improvements of momentary quality of life in the CAS group.
Our findings suggest that interventions involving tailored activities have a beneficial impact on global and momentary quality of life in nursing home residents with dementia. Although we found no clear advantage of TBI compared to CAS, tablet computers can support delivery of non-pharmacological interventions in nursing homes and facilitate regular assessments of fluctuating momentary states.
探讨基于平板电脑的非药物干预对患有痴呆症的养老院居民的整体和即时影响。
整群随机对照试验。
德国的十家养老院被随机分配到基于平板电脑的干预组（TBI，5个单位）或传统活动组（CAS，5个单位）。
N = 162名患有痴呆症的居民。
参与者接受定期的TBI（n = 80），其中包括为痴呆症患者设计的刺激性活动，或接受CAS（n = 82），为期8周。
冷漠评估量表（AES-I，主要结局）、阿尔茨海默病生活质量量表、QUALIDEM量表、神经精神科问卷、老年抑郁量表和精神药物（次要结局）。在每次活动前后评估即时生活质量。在基线数据收集完成之前，参与者和工作人员均处于盲态。数据采用线性混合效应模型进行分析。
两组的冷漠水平均略有下降（TBI组AES-I平均下降0.61分，95%可信区间为-3.54至2.33；CAS组平均下降0.36分，95%可信区间为-3.27至2.55）。冷漠变化的组间差异无统计学意义（β = 0.25；95%可信区间为3.89至4.38，p = 0.91）。这相当于标准化效应量（科恩d值）为0.02。与CAS组相比，TBI组的精神药物用量有所减少。进一步分析显示，两组干预后QUALIDEM评分均有所改善，CAS组的即时生活质量有短期改善。
我们的研究结果表明，涉及量身定制活动的干预措施对患有痴呆症的养老院居民的整体和即时生活质量有有益影响。虽然我们没有发现TBI组与CAS组相比有明显优势，但平板电脑可以支持在养老院提供非药物干预，并有助于定期评估波动的即时状态。
