Reality Orientation (RO) was first described as a technique to improve the quality of life of confused elderly people, although its origins lie in an attempt to rehabilitate severely disturbed war veterans, not in geriatric work. It operates through the presentation of orientation information (eg time, place and person-related) which is thought to provide the person with a greater understanding of their surroundings, possibly resulting in an improved sense of control and self-esteem. There has been criticism of RO in clinical practice, with some fear that it has been applied in a mechanical fashion and has been insensitive to the needs of the individual. There is also a suggestion that constant relearning of material can actually contribute to mood and self-esteem problems. There is often little consistent application of psychological therapies in dementia services, so a systematic review of the available evidence is important in order to identify the effectiveness of the different therapies. Subsequently, guidelines for their use can be made on a sound evidence base.
To assess the evidence of effectiveness for the use of Reality Orientation (RO) as a classroom-based therapy on elderly persons with dementia.
Computerised databases were searched independently by 2 reviewers entering the terms 'Reality Orientation, dementia, control, trial or study'. Relevant web sites were searched and some hand searching was conducted by the reviewer. Specialists in the field were approached for undocumented material, and all publications found were searched for additional references.
All randomized controlled trials (RCTs), and all controlled trials with some degree of concealment, blinding or control for bias (second order evidence) of Reality Orientation as an intervention for dementia were included. The criteria for inclusion/exclusion involved systematic assessment of the quality of study design and the risk of bias, using a standard data extraction form. A measure of cognitive and/or behavioural change was needed.
Data were extracted independently by both reviewers, using a previously tested data extraction form. Authors were contacted for data not provided in the papers. Psychological scales measuring cognitive and behavioural changes were examined.
6 RCTs were entered in the analysis, with a total of 125 subjects (67 in experimental groups, 58 in control groups). Results were divided into 2 subsections: cognition and behaviour. Change in cognitive and behavioural outcomes showed a significant effect in favour of treatment.
There is some evidence that RO has benefits on both cognition and behaviour for dementia sufferers. Further research could examine which features of RO are particularly effective. It is unclear how far the benefits of RO extend after the end of treatment, but and it appears that a continued programme may be needed to sustain potential benefits.
[Show abstract][Hide abstract] ABSTRACT: No randomised controlled trials were found that proved or disproved the efficacy of non-pharmacological interventions for the prevention or management of wandering in the domestic setting. Trials of music therapy, bright light therapy, reality orientation, physical therapy, occupational therapy, and therapeutic touch have been carried out with participants in institutional settings. This review discusses these interventions in the light of their relevance to the domestic setting. Trials of non-pharmacological interventions in the domestic setting are urgently needed.
[Show abstract][Hide abstract] ABSTRACT: Dementia is an age-related progressive neurodegenerative disorder afflicting about 5% of the world's population, and it is expected to grow dramatically in the future keeping in view our ageing society. Currently available medications appear to be able to produce moderate symptomatic benefits but do not to stop disease progression. In this article, the management of the disorder, including the currently available drugs as well as psychosocial strategies, is discussed.
A computerized search on Pubmed from 1980 to 2006 was carried out and all articles evaluated and graded on NICE guidelines.
Currently evaluated and accepted medications only bring about a reduction in the deteriorating course. A combination of pharmacotherapy and psychosocial management is the need of the hour.
American Journal of Alzheimer s Disease and Other Dementias 05/2008; 23(2):150-61. DOI:10.1177/1533317507312957 · 1.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Art therapy has been reported to have effects on mental symptoms in patients with dementia, and its usefulness is expected. We performed a controlled trial to evaluate the usefulness of art therapy compared with calculation training in patients with mild Alzheimer's disease.
Thirty-nine patients with Alzheimer's disease showing slightly decreased cognitive function allowing treatment on an outpatient basis were randomly allocated to art therapy and control (learning therapy using calculation) groups, and intervention was performed once weekly for 12weeks.
Comparison of the results of evaluation between before and after therapy in each group showed significant improvement in the Apathy Scale in the art therapy group (P=0.014) and in the Mini-Mental State Examination score (P=0.015) in the calculation drill group, but no significant differences in the other items between the two groups. Patients showing a 10% or greater improvement were compared between the two groups. Significant improvement in the quality of life (QOL) was observed in the art therapy compared with the calculation training group (P=0.038, odds ratio, 5.54). anova concerning improvement after each method revealed no significant difference in any item.
These results suggested improvement in at least the vitality and the QOL of patients with mild Alzheimer's disease after art therapy compared with calculation, but no marked comprehensive differences between the two methods. In non-pharmacological therapy for dementia, studies attaching importance to the motivation and satisfaction of patients and their family members rather than the superiority of methods may be necessary in the future.
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