Help for Dementia Patients, Caregivers

Nov. 16, 2006 -- Occupational therapy tailored to individual needs improves the lives of dementia patients and their caregivers, a Dutch study shows.

Patients with mild and moderate dementia lose the ability to perform many of the tasks that earn them pleasure, a sense of accomplishment, and the appreciation of others. This loss of ability frequently frustrates and often exhausts their caretakers.

In-home, individually tailored occupational therapy can help, find Maud J.L. Graff and colleagues at University Medical Center Nijmegen in the Netherlands.

Graff and colleagues developed an occupational therapy strategy that targets dementia patients as well as their caregivers.

The therapists spend time with each patient/caregiver pair. They offer specific education, set feasible goals, and help the patient/caregiver adapt to or change their physical environment.

They also work with the pair to change dysfunctional ways of thinking about the patient's behavior and the caregiver's role.

The process takes time. Treatment consists of 10 one-hour sessions over five weeks.

Does it work? Graff and colleagues tested the program in 135 over-65 patients with mild to moderate dementia and their primary caregivers.

The patient/caregiver pairs were randomly assigned to treatment or no treatment (those in the no-treatment group received treatment at the end of the 12-week study).

Both six weeks and three months after treatment, three-fourths of the patients had improved motor skills. More than four-fifths required less assistance in daily tasks.

And the caregivers felt significantly more competent that those who did not participate in treatment.

This effect is larger than that seen in any drug trial or other psychosocial intervention, Graff and colleagues say.

"We believe that the benefit was sustained because a component of the intervention was to train caregivers in providing the supervision patients needed," Graff and colleagues say.

"The intervention also provided individualized support to caregivers, which earlier studies have also shown to be effective," the researchers say.

Though the therapy is time-consuming, Graff and colleagues suggest it pays off in delayed institutionalization and lower need for health care resources.

The study appears in this week's online edition of BMJ, formerly the British Medical Journal. A case history and detailed description of the therapy appears in the November issue of the journal Dementia.