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RESEARCH: Maud J L Graff, Eddy M M Adang, Myrra J M Vernooij-Dassen, Joost Dekker, L Jönsson, Marjolein Thijssen, Willibrord H L Hoefnagels, and Marcel G M Olde Rikkert Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study BMJ 2008; 336: 134-138 [Abstract] [Full text]

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Needs culture based interventions of community occupational therapy for dementia

Om Prakash   (18 January 2008)

Worth considering in UK

Viran Kansagara, Sunita Sayammagaru   (19 January 2008)

Implications of community-based occupational therapy

Kenneth A Hoekstra   (3 June 2008)

Needs culture based interventions of community occupational therapy for dementia 18 January 2008
Om Prakash, Assistant Professor of Psychiatry National Institute of Mental Health And Neurosciences(NIMHANS), Bangalore-29, INDIA Send response to journal: Re: Needs culture based interventions of community occupational therapy for dementia	The research done by Graf and his colleagues (1) is a major step towards dementia management. The research has again reciprocated the role of community interventions in psychiatric disorders. The study will be more fruitful for dementia populations living in developing countries having stable and trustful community participation and having inadequate services of occupational therapist. This will also reduce the caregiver burden to some extent. There is a need to replicate the study findings in other cultures. There is also need to develop culture based intervention models of community occupational therapy that will definitely reduce the costs of informal care giving. References: 1.Maud J L Graff, Eddy M M Adang, Myrra J M Vernooij-Dassen, Joost Dekker, L Jönsson, Marjolein Thijssen, Willibrord H L Hoefnagels, and Marcel G M Olde Rikkert Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study BMJ 2008; 0: bmj.39408.481898.BEv1 Competing interests: None declared
Worth considering in UK 19 January 2008
Viran Kansagara, FTSTA 2 in Old Age Psychiatry University Hospital of North Tees, Hardwick, Stockton - on - Tees, TS19 8PE, Sunita Sayammagaru Send response to journal: Re: Worth considering in UK	The study by Maud et al (1) underlines a few important points. As trainees in Old Age Psychiatry, we deal with patients with dementia. This study is a major step towards managing these people. Community occupational therapy would empower not only the patients, but their carers as well. The majority of patients we see who suffer with mild to moderate dementia go through varying phases of depressive symptoms, which are mainly due to the fact that they are not able to carry on their routine activities of daily living. This creates an additional burden on their carers. Ultimately these patients are put on anti depressants. As a result of this study, we could start looking into this cost effective method of managing dementia patients. This community occupational therapy would improve patients’ sense of competence, leading indirectly to a reduction of their depressive episodes, thus preventing unnecessary treatment with anti depressants or in extreme cases preventing inpatient admissions. This is an area we hope the NHS would give a more serious thought, as it is cost effective, and cost effective strategies are what the NHS desperately needs at the moment. References 1) Maud J L Graff, Eddy M M Adang, Myrra J M Vernooij-Dassen, Joost Dekker, L Jönsson, Marjolein Thijssen, Willibrord H L Hoefnagels, and Marcel G M Olde Rikkert. Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study BMJ 2008; 336: 134-138 Competing interests: None declared
Implications of community-based occupational therapy 3 June 2008
Kenneth A Hoekstra, Vancouver, BC V3W 4M6 Send response to journal: Re: Implications of community-based occupational therapy	In this study by Graff et al (1), the authors describe the cost effectiveness of community occupational therapy for older patients with dementia and the successful impact on their care givers. To further support these findings, an earlier report suggested that community OT for elderly dementia patients improved mood, quality of life and health status while improving the caregivers' patient control (2). Others have also provided insight on community care for the elderly with dementia (3, 4). Conversely, other studies have reported that dementia behavior may be higher in a community-based setting compared to respite care (5). Home caregivers should take into consideration the implications of various services available to the elderly with dementia at residential aged care facilities. 1. Graff MJL, Adang EMM, Vernooij-Dassen MJM, Dekker J, Jönsson L, Thijssen M, Hoefnagels WHL, and Rikkert MGMO. Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study BMJ 2008; 336: 134-138. 2.Graff MJ, Vernooij-Dassen MJ, Thijssen M, Dekker J, Hoefnagels WH, Olderikkert MG. Effects of community occupational therapy on quality of life, mood, and health status in dementia patients and their caregivers: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2007 Sep;62(9):1002-9. 3. Hirsch C. Community based occupational therapy improved daily functioning in older patients with dementia. Evid Based Med. 2007 Apr;12(2):51. 4. Hirsch C. Community-based occupational therapy improved daily functioning in older patients with dementia. ACP J Club. 2007 Mar- Apr;146(2):34. 5. Neville CC, Byrne GJ. Prevalence of disruptive behaviour displayed by older people in community and residential respite care settings. Int J Ment Health Nurs. 2007 Apr;16(2):81-5. Competing interests: None declared