The impact of dignity therapy on depression and anxiety in the patient-caregiver dyad, in the context of mild cognitive impairment and early-stage dementia

Abstract

The phenomenon of ageing has made mental health in older adults a public health priority on an international level. One of the most salient conditions requiring addressing in this demographic is dementia, its behavioural and psychological symptoms and the consequent burden (and psychological sequalae) on their caregivers. Non-pharmacological interventions have been identified as a pivotal component of meaning-centred approach in this patient population. Dignity Therapy (DT), whilst originally devised for use in palliative care populations, has been noted to have potential in neurocognitive disorders (which are noncancer terminal conditions). This study aimed to assess the feasibility and acceptability of DT in dementia, looking at anxiety and depression as outcomes of interest. This study was the first of its kind to adapt DT into a dyadic approach, making the caregiver a direct participant of the intervention, thus emphasising the complex and interdependent nature that exists between a person with dementia (PWD) and their caregiver. The study employed a single-group pretestpostest design. 12 participants (6 dyads) were recruited through the Day Hospital at Karin Grech Hospital. The Hospital Anxiety and Depression Scale (HADS) was used to measure the outcomes of interest at baseline (T0) and 2 weeks post-intervention (T4). The Dignity Therapy Patient Feedback Questionnaire (DTPFQ) was carried out to assess feasibility. In PWD, DT was associated with non-significant reductions in depression (Pre M=3.67, SD=2.94; Post M=3.33, SD=2.94; t(5)=0.47, p=0.33) and anxiety (Pre M=6.00, SD=3.80; Post M=5.33, SD=3.724; t(5)=0.46, p=0.33). In caregivers, DT was associated with near-significant reductions in depression (Pre M=3.00, SD=2.10; Post M=1.67, SD=1.75; t(5)=2.00, p=0.051) and non-significant reductions in anxiety (Pre M=4.33, SD=2.66; Post M=3.50, SD=3.02; t(5)=1.19, p=0.15). DT effect sizes were small in PWD (gav=0.15; 95% CI [-0.57, 0.92]) and small to moderate in caregivers (gav=0.42; 95% CI [-0.12, 1.09]). DTPFQ showed that DT was perceived as tolerable and acceptable in both PWD and caregivers, with no significant differences between the two groups. While this study had limited inferential capacity due to small sample size, it proved useful in establishing a dyadic DT approach is feasible and acceptable in this population. The quantitative findings on anxiety and depression show that whilst not significant, they were promising considering that confidence intervals were weighted towards positive effect (especially on the depression subscale in caregivers). This implies that future dyadic DT research with larger sample sizes has potential to ascertain significant positive outcomes in both PWD and caregivers.