Abstract
Background The majority of psychosocial interventions are considered
effective in the treatment of dementia symptoms. However, there are hardly any
evaluated concepts for people with severe dementia. An RCT study of patients
with severe dementia in nursing homes during the Covid-19 pandemic found no
effect of the newly developed multi-component intervention MAKS-s (motor,
activities of daily living, cognitive, social version for persons with severe
dementia) on patients’ quality of life, behavioural and psychological
symptoms.
Material and methods At the end of the controlled phase, 6 months after
beginning of the study, the nursing staff of the control groups were also
trained in MAKS-s. They were then free to decide whether and how often they
wanted to use MAKS-s (open phase). By means of a written follow-up survey,
conducted with trained therapists, after another 6 months, predictors for
positive effects of the intervention on people with severe dementia were to be
identified. The survey also aimed to identify predictors of therapy fidelity.
Data acquisition based on a self-developed questionnaire, assessing the
therapists’ subjective ratings of the three areas of structure, process
and outcome quality of the MAKS-s intervention. Apart from descriptive
evaluations, the predictors of benefit for people with severe dementia were
analysed using a linear regression model and the predictors of therapy fidelity
by using a binary logistic regression model.
Results The more pronounced the normative restrictions due to the
Covid-19 pandemic were, the more frequently manual deviations were observed.
Fewer deviations from the manual were significantly associated with positive
effects on people with severe dementia.
Conclusion The results indicate the importance of therapy fidelity for
the success of MAKS-s intervention. Therapy fidelity is decisive for the extent
of the positive effects of MAKS-s, experienced by the therapists. Furthermore,
the survey results show that activity-restricting pandemic policies in nursing
homes negatively influenced the perceived effectiveness.
Key words
psychosocial intervention - dementia - nursing homes - Treatment adherence and compliance - Covid-19
