Focus and effectiveness of psychosocial interventions for people with dementia in institutional care settings from the perspective of coping with the disease

Introduction: The care for persons with dementia with chronic diseases has changed much in the past decades. This counts for the care for people with dementia as well. The care presently offered is not merely aimed at improving or stabilizing the medicalcondition of the person, but also at improving their quality of life by supporting the person in accepting his disease and coping with the consequences of it. Based on this perspective, many psychosocial interventions were developed in the past decades. The aim of this study was to get insight in the effectiveness of these interventions in thedifferent adaptation areas.Method: Several literature reviews into psychosocial interventions offered in institutional care to people with dementia were analysed. The reviews covered the period from 1970 until 2007. The interventions were categorised according to their aim tosupport people in coping with one or more adaptive tasks, as described in the Adaptationcoping model (Dröes, 1991; Finnema et al., 2000).Results: Most of the investigated psychosocial interventions were aimed atsupporting people with dementia in Maintaining an emotional balance and Coping with disabilities. Regarding Maintaining an emotional balance psychomotor therapy, music therapy, adapting the living environment, validation, snoezelen en pet therapy are most frequently investigated and have shown to be able to positively influence behaviour symptoms, such as: agression, apathy, restlessness, depressive and anxious behavior. In the area of Coping with own disabilities interventions such as reality orientation, activity groups, normalising living pattern and structuring daily activities have shown to be effective in improving cognitive functioning and conducting daily activities. Alsorelatively many studies are conducted into Maintaining social relationships and Coping with the care environment (e.g. homely environment with enough privacy and normal living pattern). Few studies investigated interventions to help people Develop an adequate care relationship with professional carers and to Preserve a positive selfimage. No studies were found into interventions to help people Cope with an uncertain future. The most broad effects were found with pet therapy, snoezelen, psychomotortherapy, normal living pattern and creating a homely environment. Conclusion: Psychosocial interventions can be utilised for adaptation problems in several areas. For each area several interventions are available. Choices for individual treatment need to be based on the individual needs, personal characteristics, preferences and goal behaviour of the person with dementia. Future research should focus on better designed studies (RCT's) and predictors of effective psychosocial interventions for the treatment of different adaptation problems.