Occupational therapy, specifically designed to improve an individual patient's daily functioning and reduce the burden on the primary caregiver, has been shown to produce improvement lasting at least 3 months in patients with mild to moderate dementia.

Occupational therapy in dementia

Summary

Occupational therapy - specifically designed to improve patients' daily functioning and reduce the burden on caregivers - was found to produce a sustained improvement (at least 3 months) in patients with mild to moderate dementia.

Introduction

The use of drugs to treat dementia is not as efficient, say, as the use of an antibiotic for a bacterial infection. In the management of some diseases, non-pharmacological measures can be just as effective, or even more effective, than medication. A report in the British Medical Journal is therefore timely. It describes a clinical trial in which occupational therapy (OT) was studied for its effectiveness in helping both dementia patients and their caregivers. This article summarizes what was done and how the study came out.

What was done

The focus of occupational therapy is to improve a patient's activities of daily living, thus promoting independence and involvement in social activities. This should substantially decrease the burden on the caregiver, too. Such an outcome may be considered equal to, or even more relevant, than improving the patient's cognitive ability.

The memory and geriatric clinics at Nijmegen University, Netherlands, provided 135 patients for this study. They had to be over 65, have mild to moderate dementia, be living in the community, and have a primary caregiver on at least one day a week. They were randomly allocated to OT (ten sessions at home over five weeks), or no OT. The trial was single-blind; this meant the patients and caregivers knew which treatment they were getting (obviously), but the assessors did not know.

The OT was delivered by experienced occupational therapists who had received additional training in OT for dementia patients. Both the patient and their primary caregiver received the therapy. All patients in the study were assessed at baseline, after 6 weeks (to measure the effect), and after 12 weeks (follow-up measurement). Assessors scored the patients using two recognized measures: the assessment of motor and process skills (AMPS), and deterioration in daily activities in dementia (IDDD). Caregivers were assessed with the sense of competence questionnaire (SCQ).

Information was collected on age, gender, and educational level (in both patients and caregivers), other existing illnesses, depressive mood, cognitive abilities, and behavior (in patients only), and depression in caregivers.

What was found

The patients averaged 78 and their caregivers 64 years of age; 44% of the patients were male. Caregivers were mostly the partner (60%) or a daughter (32%).

After six weeks, at the end of the active treatment period, 84% of the OT patients had clinically relevant process skills improvements, compared with 9% of those not receiving OT (the controls). The OT group also had more frequent clinical improvement in performance of daily living activities - 78% versus 12%. For all 3 outcomes together, 47% in the OT group and 2% in the control group achieved a clinically relevant difference.

Among the caregivers, 58% in the OT group versus 18% in the controls had a relevant improvement in their sense of competence.

After 12 weeks, 37% of the OT group still had a clinically relevant difference from baseline in all 3 measures, compared to 2% of the controls.

What this means

The findings in this study are quite clear. Occupational therapy specifically directed at dementia patients was clearly effective in improving important aspects of their disease, and improving caregiver's feelings of competence to handle the situation. A similar positive effect of OT has been reported for stroke patients, and there may be other conditions that would respond to such an approach. An important question, therefore, concerns the expense of specific training for the therapists (it averaged 80 hours for each therapist); moreover, the 10 one-hour sessions involved an average of 18 hours therapist time per patient and caregiver (travel time, analysis of results, multidisciplinary briefings, etc.).

The study investigators believe the benefits of OT in patients were sustained because the caregivers were trained to provide the supervision the patients needed for sustained efforts. They are confident the approach would prove cost-effective in clinical practice. So the next step should be trials to demonstrate cost-effectiveness to the usually-skeptical health providers.

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