title: Benefit of an integrative psychotherapeutic nursing home program to reduce multiple psychiatric symptoms of psychogeriatric patients and caregiver burden after six months of follow-up: a re-analysis of a randomized controlled trial.
abstract: BACKGROUND
  In this paper, we aim to test the long-term benefit of an integrative reactivation and rehabilitation (IRR) program compared to usual care in terms of improved psychogeriatric patients on multiple psychiatric symptoms (MPS) and of caregivers on burden and competence. Improvement was defined as >30% improvement (≥ a half standard deviation) compared to baseline.
  
  
  METHODS
  We used the following outcome variables: difference in the number of improved patients on MPS (Neuropsychiatric Inventory, NPI) and improved caregivers on burden (Caregiver Burden, CB) and competence (Caregiver Competence List, CCL). Assessments were taken after intake (T1) and after six months of follow-up (T3). Risk ratios (RR), number needed to treat (NNT), and odds ratios (ORs) were calculated.
  
  
  RESULTS
  IRR had a significant positive effect on NPI-cluster hyperactivity (RR 2.64; 95% CI: 1.26-5.53; NNT 4.07). In the complete cases analysis, IRR showed significant ORs of 2.80 on the number of NPI symptoms and 3.46 on the NPI-sum-severity; up to 76% improved patients. For caregivers, competence was a significant beneficiary in IRR (RR 2.23; 95% CI: 1.07-4.62; NNT 5.07). In the complete cases analysis, the ORs were significantly in favor of IRR on general burden and competence (ORs range: 2.40-4.18), with up to 71% improved caregivers.
  
  
  CONCLUSIONS
  IRR showed a significantly higher probability of improvement with a small NNT of four on multiple psychiatric symptoms in psychogeriatric patients. The same applies to the higher probability to improve general burden and competence of the caregiver with an NNT of five. The results were even more pronounced for those who fully completed the IRR program. (Inter)national psychogeriatric nursing home care and ambulant care programs have to incorporate integrative psychotherapeutic interventions.
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: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000706:statistics & numerical data*; D017281:Cost of Illness; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D055048:Integrative Medicine / Q000379:methods; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation* / Q000628:therapy; D009483:Neuropsychological Tests; D009735:Nursing Homes; D057285:Precision Medicine / Q000379:methods; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome