Effects of a multimodal activation program (SimA-P) in residents of nursing homes

Abstract

Is it possible to maintain or even enhance functional and cognitive independence in residents of nursing homes? Little is known about the potentials and limits of therapeutic methods designed to maintain independence in elderly people already in need of residential nursing care. The aim of the "Rehabilitation in Nursing Homes" research project was to determine the practicability and effectiveness of a rehabilitative approach targeting residents of nursing homes. The main objectives of the activation program were to maintain and enhance residents' cognitive and functional autonomy. Data on psychological, functional, and medical variables were obtained from a sample of 294 nursing home residents (age range=70-99 years) at three points of measurement over a 12-month period. The intervention approach draws on the theoretical and practical findings of the SimA Study ("Bedingungen der Erhaltung und Förderung von Selbstständigkeit im höheren Lebensalter," "conditions on maintaining and supporting independent living in old age"; Oswald et al., Z. Gerontopsychol. Psychiatr., 15:61-84, 2002, Z. Gerontopsychol. Psychiatr., 15:13-31, 2002) and incorporates the results of recent therapeutic and rehabilitative studies in the fields of geriatrics and gerontopsychiatry. The intervention involves a combined program of cognitive and physical activation. An alternative program based on biographical information was designed specifically for residents with dementia. Results show that the intervention had significant effects on cognitive and functional parameters. Moreover, transfer effects were observed with respect to activities of daily living and frequency of falls.Keywords Nursing homes . Rehabilitation . Cognitive activation . Fall prevention . Activities of daily living Rehabilitation in nursing homesMost residents of nursing homes are elderly people in need of regular or around-the-clock nursing care [43]. Some 80% of the residents of nursing homes for the elderly have impaired mobility, 80% show cognitive impairment, and 70% experience symptoms of depression. Against this background, rehabilitative approaches to care [12] seek to maintain, enhance, or restore functional ability, or at least to prevent or delay the deterioration or loss of functioning and to help individuals adapt to irreversible losses in functional capacity.Epidemiological studies show that need for care is not determined by physical impairment or illness alone. In fact, it is characterized by multiple factors such as multimorbidity, mobility problems, cognitive impairment, psychological symptoms (primarily depression), and social isolation [25,40, 52]. Accordingly, multimodal intervention programs that target physical exercise and cognitive performance while, at the same time, promoting psychological well-being and social interaction should be most likely to have rehabilitative effects [1].

A mixed methods systematic review of multimodal non-pharmacological interventions to improve cognition for people with dementia

“…Of the 21 group studies, 17 (81%) reported pre–post-test scores using the Mini Mental State Examination (MMSE), the Chinese MMSE or the 7MST (7 Minute Screening Test), and could therefore be included in an effect size (ES) analysis (Figure 2). Oswald et al. (2007) uniquely included a staff survey on residents’ cognitive change.…”

“…Han et al (2017) was the only double-blind or cross-over trial. Three were conducted across multiple centres: Graessel et al (2011) and Oswald, Gunzelmann, and Ackermann (2007) in German nursing homes, and Serda`i Ferrer and del Valle (2014) in Spanish day hospitals. For characteristics of all studies, see Tables 3 to 5.…”

“…Oswald et al (2007) uniquely included a staff survey on residents' cognitive change. In the five case studies only three provided pre-post-test MMSE or similar which hindered comparison of clinical importance (Figure 4).…”

“…Some studies requiring a greater time commitment were less effective. For example, Graessel et al (2011) had the most sessions (288), Oswald et al (2007) had the most weeks (52) and Ibarria et al (2016) had the greatest total time commitment of 979 hours (approximated, see Table 3). Because of the nature of a cross-over trial, the length of wash-out period and the relatively short 32 Dementia 0(0) intervention time of eight weeks in Han et al (2017) they acknowledged that these may have limited the effect of the Multimodal Cognitive Enhancement Therapy (MCET).…”

Potential of Snoezelen room multisensory stimulation to improve balance in individuals with dementia: a feasibility randomized controlled trial

“…3 Some evidence shows that physical training and targeted strength, stamina, suppleness, coordination and cognitive activation have positive effects on falls prevention and balance in individuals with dementia. 23,24 However, these trials were smallscale studies and the effectiveness of falls prevention in individuals with dementia has yet to be determined. 25 Encouraging mobility and exposure to risky situations in less physically able individuals through balance interventions can be counterproductive to falls reduction.…”