title: Prognostic factors for a favourable long-term outcome from an integrative psychotherapeutic nursing home programme.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Psychiatric-Skilled Nursing Home DrieMaasStede, Argos Zorggroep, Schiedam, The Netherlands. t.bakker@argoszorggroep.nl
authors.forename: Ton J E M
authors.initials: TJ
authors.lastname: Bakker
authors.forename: Hugo J
authors.initials: HJ
authors.lastname: Duivenvoorden
authors.forename: Jacqueline
authors.initials: J
authors.lastname: van der Lee
authors.forename: Marcel G M
authors.initials: MG
authors.lastname: Olde Rikkert
authors.forename: Aartjan T F
authors.initials: AT
authors.lastname: Beekman
authors.forename: Miel W
authors.initials: MW
authors.lastname: Ribbe
mesh_terms: D000203:Activities of Daily Living / Q000145:classification / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D000647:Amnesia / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D015897:Comorbidity; D003299:Cooperative Behavior; D003704:Dementia / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006707:Homes for the Aged; D006801:Humans; D055048:Integrative Medicine / Q000379:methods*; D033183:Interdisciplinary Communication; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D008609:Mental Status Schedule / Q000706:statistics & numerical data; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D009735:Nursing Homes; D010348:Patient Care Team; D011379:Prognosis; D011594:Psychometrics; D011613:Psychotherapy / Q000379:methods*