Effects of rehabilitation program focused on improving real-life daily activities of patients with mild cognitive impairments or dementia and their caregivers

Authors

  • Yohei Otaka Department of Rehabilitation Medicine I, School of Medicine, Aichi, Japan
  • Shin Kitamura Department of Rehabilitation Medicine I, School of Medicine, Aichi, Japan; Faculty of Rehabilitation, School of Health Sciences, Aichi, Japan https://orcid.org/0000-0002-4442-0854
  • Megumi Suzuki Faculty of Rehabilitation, School of Health Sciences, Aichi, Japan
  • Akiko Maeda Faculty of Rehabilitation, School of Health Sciences, Aichi, Japan
  • Chinami Kato Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
  • Rena Ito Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
  • Asuka Hirano Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
  • Yuki Okochi Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
  • Koji Mizutani Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
  • Hiroshi Yoshino Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Aichi, Japan
  • Hajime Takechi Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Aichi, Japan

DOI:

https://doi.org/10.2340/jrmcc.v6.12293

Keywords:

Alzheimer Disease, Behavior Therapy, Caregivers, Dementia, Rehabilitation

Abstract

Objective: To evaluate the effectiveness of a dyadic outpatient rehabilitation program focused on improving the real-life daily activities of patients with mild cognitive impairments or dementia and their caregivers.

Design: Retrospective study.

Subjects: Eight patients with mild cognitive impairments or dementia and their caregivers.

Methods: The rehabilitation program comprised eight 1-hour sessions by occupational therapists with patients and his/her caregivers. Patients were assessed for motor function, cognitive function, and quality of life, and their caregivers were assessed for depression and caregiver burden. Participants were assessed at pre-program and post-program, and 3-month follow-up.

Results: The scores of caregiver-assessed Quality of life in Alzheimer’s disease scale in patients significantly improved at post-program (median [interquartile range], 30.0 [7.0]) compared with pre-program (27.0 [2.8], effect size = 0.77, p = 0.029). In caregivers, the Zarit Caregiver Burden Interview scores decreased significantly at post-program (16.5 [13.0]) compared with pre-program (22.0 [17.5], effect size = 0.72, p = 0.042). There were no significant differences in other assessments.

Conclusions: The rehabilitation program focused on real daily activities and demonstrated to improve patients’ quality of life and caregivers’ depression and caring burden through patient-caregiver interaction. Future enhanced follow-up systems are warranted.

Downloads

Download data is not yet available.

References

World Health Organization. Fact sheets. Dementia 2022. [cited 2023 Feb 5]. Available from: https://www.who.int/news-room/fact-sheets/detail/dementia

World Health Organization, Resource Library. Countries with the oldest populations in the world. [cited 2023 Feb 5]. Available from: https://www.prb.org/resources/countries-with-the-oldest-populations-in-the-world/

Ministry of Health Labour and Welfare, Comprehensive survey of living conditions 2016. 2017. [cited 2023 Feb 5]. Available from: https://www.mhlw.go.jp/toukei/saikin/hw/k-tyosa/k-tyosa16/dl/05.pdf

Ministry of Health Labour and Welfare, Comprehensive survey of living conditions 2019. 2020. [cited 2023 Feb 5]. Available from: https://www.mhlw.go.jp/toukei/saikin/hw/k-tyosa/k-tyosa19/dl/05.pdf

Vitaliano PP, Zhang J, Scanlan JM. Is caregiving hazardous to one’s physical health? A meta-analysis. Psychol Bull 2003; 129: 946–972.

https://doi.org/10.1037/0033-2909.129.6.946 DOI: https://doi.org/10.1037/0033-2909.129.6.946

Jönsson L, Jönhagen ME, Kilander L, Soininen H, Hallikainen M, Waldemar G, et al. Determinants of costs of care for patients with Alzheimer’s disease. Int J Geriatr Psych 2006; 21: 449–459.

https://doi.org/10.1002/gps.1489 DOI: https://doi.org/10.1002/gps.1489

Chiao CY, Wu HS, Hsiao CY. Caregiver burden for informal caregivers of patients with dementia: a systematic review. Int Nurs Rev 2015; 62: 340–350.

https://doi.org/10.1111/inr.12194 DOI: https://doi.org/10.1111/inr.12194

Luijpen MW, Scherder EJ, Van Someren EJ, Swaab DF, Sergeant JA. Non-pharmacological interventions in cognitively impaired and demented patients – a comparison with cholinesterase inhibitors. Rev Neurosci 2003; 14: 343–368.

https://doi.org/10.1515/revneuro.2003.14.4.343 DOI: https://doi.org/10.1515/REVNEURO.2003.14.4.343

Bahar-Fuchs A, Clare L, Woods B. Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer’s disease and vascular dementia. Cochrane Database Syst Rev 2013; 2013: CD003260.

https://doi.org/10.1002/14651858.CD003260.pub2 DOI: https://doi.org/10.1002/14651858.CD003260.pub2

Forbes D, Forbes SC, Blake CM, Thiessen EJ, Forbes S. Exercise programs for people with dementia. Cochrane Database Syst Rev 2015; 2015: CD006489.

https://doi.org/10.1002/14651858.CD006489.pub4 DOI: https://doi.org/10.1002/14651858.CD006489.pub4

Orgeta V, Qazi A, Spector AE, Orrell M. Psychological treatments for depression and anxiety in dementia and mild cognitive im-pairment. Cochrane Database Syst Rev 2014; 2014: CD009125.

https://doi.org/10.1002/14651858.CD009125.pub2 DOI: https://doi.org/10.1002/14651858.CD009125.pub2

Reilly S, Miranda-Castillo C, Malouf R, Hoe J, Toot S, Challis D, et al. Case management approaches to home support for people with dementia. Cochrane Database Syst Rev 2015; 1: CD008345.

https://doi.org/10.1002/14651858.CD008345.pub2 DOI: https://doi.org/10.1002/14651858.CD008345.pub2

van der Steen JT, van Soest-Poortvliet MC, van der Wouden JC, Bruinsma MS, Scholten RJ, Vink AC. Music-based therapeutic inter-ventions for people with dementia. Cochrane Database Syst Rev 2017; 5: CD003477.

https://doi.org/10.1002/14651858.CD003477.pub3 DOI: https://doi.org/10.1002/14651858.CD003477.pub3

Woods B, Aguirre E, Spector AE, Orrell M. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Syst Rev 2012; 2: CD005562.

https://doi.org/10.1002/14651858.CD005562.pub2 DOI: https://doi.org/10.1002/14651858.CD005562.pub2

Kim SK, Park M. Effectiveness of person-centered care on people with dementia: a systematic review and meta-analysis. Clin Interv Aging 2017; 12: 381–397.

https://doi.org/10.2147/cia.s117637 DOI: https://doi.org/10.2147/CIA.S117637

Dinapoli EA, Scogin F, Bryant AN, Sebastian S, Mundy MJ. Effect of individualized social activities on quality of life among older adults with mild to moderate cognitive impairment in a geriatric psychiatry facility. Aging Ment Health 2016; 20: 262–270.

https://doi.org/10.1080/13607863.2015.1008990 DOI: https://doi.org/10.1080/13607863.2015.1008990

Cohen-Mansfield J, Thein K, Marx MS, Dakheel-Ali M, Freedman L. Efficacy of nonpharmacologic interventions for agitation in ad-vanced dementia: a randomized, placebo-controlled trial. J Clin Psychiatry 2012; 73: 1255–1261.

https://doi.org/10.4088/JCP.12m07918 DOI: https://doi.org/10.4088/JCP.12m07918

Cohen-Mansfield J, Libin A, Marx MS. Nonpharmacological treatment of agitation: a controlled trial of systematic individualized intervention. J Gerontol A Biol Sci Med Sci 2007; 62: 908–916.

https://doi.org/10.1093/gerona/62.8.908 DOI: https://doi.org/10.1093/gerona/62.8.908

Brown Wilson C, Arendt L, Nguyen M, Scott TL, Neville CC, Pachana NA. Nonpharmacological interventions for anxiety and dementia in nursing homes: a systematic review. Gerontologist 2019; 59: e731–e742.

https://doi.org/10.1093/geront/gnz020 DOI: https://doi.org/10.1093/geront/gnz020

Clare L, Linden DE, Woods RT, Whitaker R, Evans SJ, Parkinson CH, et al. Goal-oriented cognitive rehabilitation for people with early-stage Alzheimer disease: a single-blind randomized controlled trial of clinical efficacy. Am J Geriatr Psychiatry 2010; 18: 928–939.

https://doi.org/10.1097/JGP.0b013e3181d5792a DOI: https://doi.org/10.1097/JGP.0b013e3181d5792a

Graff MJ, Vernooij-Dassen MJ, Thijssen M, Dekker J, Hoefnagels WH, Olderikkert MG. Effects of community occupational therapy on quality of life, mood, and health status in dementia patients and their caregivers: a randomized controlled trial. J Gerontol A Biol Sci Med Sci 2007; 62: 1002–1009.

https://doi.org/10.1093/gerona/62.9.1002 DOI: https://doi.org/10.1093/gerona/62.9.1002

Graff MJ, Vernooij-Dassen MJ, Thijssen M, Dekker J, Hoefnagels WH, Rikkert MG. Community based occupational therapy for pati-ents with dementia and their care givers: randomised controlled trial. BMJ 2006; 333: 1196.

https://doi.org/10.1136/bmj.39001.688843.BE DOI: https://doi.org/10.1136/bmj.39001.688843.BE

Voigt-Radloff S, Graff M, Leonhart R, Schornstein K, Jessen F, Bohlken J, et al. A multicentre RCT on community occupational therapy in Alzheimer’s disease: 10 sessions are not better than one consultation. BMJ Open 2011; 1: e000096.

https://doi.org/10.1136/bmjopen-2011-000096 DOI: https://doi.org/10.1136/bmjopen-2011-000096

McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR, Kawas CH, et al. The diagnosis of dementia due to Alzheimer’s dise-ase: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement 2011; 7: 263–269.

https://doi.org/10.1016/j.jalz.2011.03.005 DOI: https://doi.org/10.1016/j.jalz.2011.03.005

Albert MS, Dekosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, et al. The diagnosis of mild cognitive impairment due to Alzhei-mer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guide-lines for Alzheimer’s disease. Alzheimers Dement 2011; 7: 270–279.

https://doi.org/10.1016/j.jalz.2011.03.008 DOI: https://doi.org/10.1016/j.jalz.2011.03.008

Neary D, Snowden JS, Gustafson L, Passant U, Stuss D, Black S, et al. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology 1998; 51: 1546–1554.

https://doi.org/10.1212/wnl.51.6.1546 DOI: https://doi.org/10.1212/WNL.51.6.1546

Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39: 142–148.

https://doi.org/10.1111/j.1532-5415.1991.tb01616.x DOI: https://doi.org/10.1111/j.1532-5415.1991.tb01616.x

Ries JD, Echternach JL, Nof L, Gagnon Blodgett M. Test-retest reliability and minimal detectable change scores for the timed “up & go” test, the six-minute walk test, and gait speed in people with Alzheimer disease. Phys Ther 2009; 89: 569–579.

https://doi.org/10.2522/ptj.20080258 DOI: https://doi.org/10.2522/ptj.20080258

Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53: 695–699.

https://doi.org/10.1111/j.1532-5415.2005.53221.x DOI: https://doi.org/10.1111/j.1532-5415.2005.53221.x

Roalf DR, Moberg PJ, Xie SX, Wolk DA, Moelter ST, Arnold SE. Comparative accuracies of two common screening instruments for classification of Alzheimer’s disease, mild cognitive impairment, and healthy aging. Alzheimers Dement 2013; 9: 529–537.

https://doi.org/10.1016/j.jalz.2012.10.001 DOI: https://doi.org/10.1016/j.jalz.2012.10.001

Logsdon RG, Gibbons LE, McCurry SM, Teri L. Assessing quality of life in older adults with cognitive impairment. Psychosom Med 2002; 64: 510–519.

https://doi.org/10.1097/00006842-200205000-00016 DOI: https://doi.org/10.1097/00006842-200205000-00016

Torisson G, Stavenow L, Minthon L, Londos E. Reliability, validity and clinical correlates of the Quality of Life in Alzheimer’s disease (QoL-AD) scale in medical inpatients. Health Qual Life Outcomes 2016; 14: 90.

https://doi.org/10.1186/s12955-016-0493-8 DOI: https://doi.org/10.1186/s12955-016-0493-8

Matsui T, Nakaaki S, Murata Y, Sato J, Shinagawa Y, Tatsumi H, et al. Determinants of the quality of life in Alzheimer’s disease patients as assessed by the Japanese version of the Quality of Life-Alzheimer’s disease scale. Dement Geriatr Cogn Disord. 2006; 21: 182–191.

https://doi.org/10.1159/000090744 DOI: https://doi.org/10.1159/000090744

Radloff LS. The CES-D Scale. Appl Psychol Meas 1977; 1: 385–401.

https://doi.org/10.1177/014662167700100306 DOI: https://doi.org/10.1177/014662167700100306

Clark CH, Mahoney JS, Clark DJ, Eriksen LR. Screening for depression in a hepatitis C population: the reliability and validity of the Center for Epidemiologic Studies Depression Scale (CES-D). J Adv Nurs 2002; 40: 361–369.

https://doi.org/10.1046/j.1365-2648.2002.02378.x DOI: https://doi.org/10.1046/j.1365-2648.2002.02378.x

Whitlatch CJ, Zarit SH, von Eye A. Efficacy of interventions with caregivers: a reanalysis. Gerontologist 1991; 31: 9–14.

https://doi.org/10.1093/geront/31.1.9 DOI: https://doi.org/10.1093/geront/31.1.9

Wang G, Cheng Q, Wang Y, Deng YL, Ren RJ, Xu W, et al. The metric properties of Zarit caregiver burden scale: validation study of a Chinese version. Alzheimer Dis Assoc Disord 2008; 22: 321–326.

https://doi.org/10.1097/WAD.0b013e3181902334 DOI: https://doi.org/10.1097/WAD.0b013e3181902334

Cohen J. Statistical power analysis for the behavioral science. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.

International Psychogeriatric Association. IPA Complete Guides to Behavioral and Psychological Symptoms of Dementia-Specialists Guide; 2015.

Pinquart M, Sörensen S. Helping caregivers of persons with dementia: which interventions work and how large are their effects? Int Psychogeriatr 2006; 18: 577–595.

https://doi.org/10.1017/s1041610206003462 DOI: https://doi.org/10.1017/S1041610206003462

Parker D, Mills S, Abbey J. Effectiveness of interventions that assist caregivers to support people with dementia living in the com-munity: a systematic review. Int J Evid Based Healthc 2008; 6: 137–172.

https://doi.org/10.1111/j.1744-1609.2008.00090.x DOI: https://doi.org/10.1111/j.1744-1609.2008.00090.x

Marim CM, Silva V, Taminato M, Barbosa DA. Effectiveness of educational programs on reducing the burden of caregivers of elderly individuals with dementia: a systematic review. Rev Lat Am Enfermagem 2013; 21: 267–275.

https://doi.org/10.1590/s0104-11692013000700033 DOI: https://doi.org/10.1590/S0104-11692013000700033

Kishita N, Hammond L, Dietrich CM, Mioshi E. Which interventions work for dementia family carers?: an updated systematic review of randomized controlled trials of carer interventions. Int Psychogeriatr 2018; 30: 1679–1696.

https://doi.org/10.1017/s1041610218000947 DOI: https://doi.org/10.1017/S1041610218000947

Spector A, Orrell M, Charlesworth G, Marston L. Factors influencing the person-carer relationship in people with anxiety and demen-tia. Aging Ment Health 2016; 20: 1055–1062.

https://doi.org/10.1080/13607863.2015.1063104 DOI: https://doi.org/10.1080/13607863.2015.1063104

Teri L, Gibbons LE, McCurry SM, Logsdon RG, Buchner DM, Barlow WE, et al. Exercise plus behavioral management in patients with Alzheimer disease. JAMA 2003; 290: 2015–2022.

https://doi.org/10.1001/jama.290.15.2015 DOI: https://doi.org/10.1001/jama.290.15.2015

McCurry SM, Gibbons LE, Logsdon RG, Vitiello MV, Teri L. Nighttime insomnia treatment and education for Alzheimer’s disease: a randomized, controlled trial. J Am Geriatr Soc 2005; 53: 793–802.

https://doi.org/10.1111/j.1532-5415.2005.53252.x DOI: https://doi.org/10.1111/j.1532-5415.2005.53252.x

Gitlin LN, Winter L, Burke J, Chernett N, Dennis MP, Hauck WW. Tailored activities to manage neuropsychiatric behaviors in persons with dementia and reduce caregiver burden: a randomized pilot study. Am J Geriatr Psychiatry 2008; 16: 229–239. DOI: https://doi.org/10.1097/01.JGP.0000300629.35408.94

https://doi.org/10.1097/JGP.0b013e318160da72 DOI: https://doi.org/10.1097/JGP.0b013e318160da72

Chien WT, Lee IYM. Randomized controlled trial of a dementia care programme for families of home-resided older people with dementia. J Adv Nurs 2011; 67: 774–787.

https://doi.org/10.1111/j.1365-2648.2010.05537.x DOI: https://doi.org/10.1111/j.1365-2648.2010.05537.x

Published

2023-10-05

How to Cite

Otaka, Y., Kitamura, S., Suzuki, M., Maeda, A., Kato, C., Ito, R., … Takechi, H. (2023). Effects of rehabilitation program focused on improving real-life daily activities of patients with mild cognitive impairments or dementia and their caregivers. Journal of Rehabilitation Medicine - Clinical Communications, 6, jrmcc12293. https://doi.org/10.2340/jrmcc.v6.12293

Issue

Section

Original Report

Categories