Abstract
Purpose: Dementia is the major cause for disability and dependence in older people and associated with considerable psychological burden. The aim of this study was to determine the feasibility, acceptability and preliminary efficacy of Dignity Therapy, a brief psychotherapeutic intervention to enhance dignity and reduce psychological burden, in patients with early stage dementia and in their families or close friends.Materials and methods: In this randomized, waitinglist-controlled clinical trial a total of 54 patients with new diagnosis of early stage dementia and 54 study partners (spouses: n = 37; relatives: n = 14; close friends: n = 3) were randomly assigned to immediate treatment (n = 28) or delayed treatment (n = 26) after 3 months waiting. The main outcomes were feasibility: proportion of screened and invited patients who consented participation; Acceptability: number of drop-outs, and satisfaction with treatment; Efficacy: psychological burden (Hospital Anxiety and Depression Scale—HADS), quality of life (WHOQOL-Bref), and sense of dignity (Patient Dignity Inventory—PDI).Results: In total 38.6% of all eligible patients (n = 140) consented and were enrolled. Along the study six participants (11.1%) dropped out. Patients' satisfaction with the treatment was high and with no significant difference between the groups. HADS scores were significantly lower in both groups at the 3-months follow-up (immediate group: mean difference = −2.69, SE = 0.85, P = 0.003; delayed group: mean difference = −1.97, SE = 0.89, P = 0.031). There was no significant group by time interaction effect (F = 0.71; df = 2, 70.3; P = 0.50). PDI scores only decreased significantly (i.e., improvement of dignity) in the immediate group (mean difference = −6.56, SE = 1.63, P < 0.001; delayed group: mean difference = −3.01, SE = 1.69, P = 0.081), but the group by time interaction effect was not statistically significant (F = 2.29; df = 1, 46.8; P = 0.14). Quality of life improved in some respects by the treatment, but the immediate and the delayed group did not differ significantly over time. After pooling patients' data of both groups, Dignity Therapy resulted in significant improvements in almost all outcome measures. Patients' family members/close friends reported high satisfaction with the intervention.Conclusions: Our findings suggest that Dignity Therapy is feasible and highly accepted in patients with early stage dementia. Patients reported significant improvements, however, there was no significant effect of the intervention in the immediate treatment group compared to the delayed group.
Highlights
Dementia is considered a global health concern, affecting over 50 million people worldwide and is estimated to increase to 131.5 million by 2050 [1]
Because this study primarily focussed on feasibility and acceptability of Dignity Therapy in patients with early stage dementia, we chose a randomized, waiting list controlled design to achieve a large group of participants who received the intervention
Feasibility was defined by the number of participants who signed informed consent (IC) in proportion to the number of eligible subjects who were invited to participate in the study. Because this was the first time to apply this intervention in this specific clinical population, we considered Dignity Therapy as feasible if at least 40% of all eligible subjects consented
Summary
Dementia is considered a global health concern, affecting over 50 million people worldwide and is estimated to increase to 131.5 million by 2050 [1]. The cognitive deficits associated with dementia can interfere profoundly with daily activities and the management of everyday life, resulting in functional and social restrictions and a need for support in the completion of every day routine [2]. Dementia is one of the major causes for disability and dependence in older people [4]. In the absence of effective treatments, the diagnosis of dementia is frequently associated with considerable psychological burden in affected subjects as well as their family members. Dependence of care, physical and psychological impairments render individuals suffering from dementia vulnerable. Identifying methods that foster and retain the experience of dignity in patients living with dementia is of crucial importance
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