Abstract
BackgroundPatients living with dementia are severely affected by the development of behavioral and psychologic symptoms (BPSD) which represent a burden for patients and caregivers. The use of psychotropic drugs in the control of BPSD is widely diffused, however the use of a first line non-pharmacologic approach is highly recommended.Here we evaluate the effect of doll therapy (DT) in the management of BPSD, on the reduction of caregiver burden and delirium incidence in nursing home residents by a randomized controlled trial.MethodsWe enrolled fifty-two nursing homes residents living with dementia and BPSD. Subjects were randomized to DT (26) or standard treatment (ST, 26), we measured BPSD, caregiver burden and delirium with standard clinical scales at baseline, after 45 and 90 days.In order to evaluate the presence of BPSD we used Neuropsychiatric Inventory (NPI) scale and the A.Di.CO scale, the caregiver burden was measured by the Greutzner scale and delirium by the Confusion Assessment Method (CAM) scale.ResultsDT was more effective in reducing agitation and aggressiveness as respect to ST. Moreover DT globally reduced the presence of BPSD as dysphoria, wandering and apathy. We observed a significant reduction of the professional caregiver burden and the incidence of delirium was significantly reduced in subjects treated with DT.ConclusionsWe show that DT is more effective that ST in the control of BSPD in patients affected by moderate to severe dementia. Moreover we suggest that DT may effective in reducing the incidence of delirium.Trial registrationRetrospectively registered in ClinicalTrials.gov the 10th June 2, 2021 trial registration number NCT04920591.
Highlights
During the clinical course of dementia, the appearance of behavioural and psychologic symptoms (BPSD) [1,2,3] severely worsen the burden of the disease
The present study evaluate, with a randomized controlled approach, the efficacy of doll therapy (DT) as respect to standard clinical approach in the management of BPSD, in the reduction of caregiver burden and in the reduction of delirium incidence in patients affected by moderate to severe dementia living in nursing homes
Study design This is a randomized controlled trial with two parallel arms, here we assess the effect of DT compared with Standard clinical Treatment (ST) on BPSD and on the caregiver burden in persons with dementia residents in two Italian nursing homes
Summary
During the clinical course of dementia, the appearance of behavioural and psychologic symptoms (BPSD) [1,2,3] severely worsen the burden of the disease. The presence of BPSD often leads to the use of multiple psychotropic drugs, as a consequence patients are exposed to severe adverse events with scarce therapeutic effect [4, 8]. De-prescribing has been proposed in order to reduce severe adverse events within a multicomponent intervention, showing improved health outcomes in old patients affected by cognitive impairment and BPSD [13]. Patients living with dementia are severely affected by the development of behavioral and psychologic symptoms (BPSD) which represent a burden for patients and caregivers. The use of psychotropic drugs in the control of BPSD is widely diffused, the use of a first line non-pharmacologic approach is highly recommended. We evaluate the effect of doll therapy (DT) in the management of BPSD, on the reduction of caregiver burden and delirium incidence in nursing home residents by a randomized controlled trial
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