Use of non-pharmacological interventions in patients with cognitive impairment: a comparison of residential and nursing homes in Poland

INTRODUCTION: Availability of non-pharmacological interventions (NPIs) to manage neuropsychiatric symptoms is important for reduction of psychotropics use in residents with dementia in long-term care facilities (LTCFs). OBJECTIVES: The aim was to assess prevalence of NPIs in residents with cognitive impairment (CI) in LTCFs, and to find factors associated with their participation in cognitive therapy (CT). PATIENTS AND METHODS: A cross-sectional analysis of a country-representative sample of 23 LTCFs in Poland was conducted between 2015-2016. We used the InterRAI-LTCF tool to collect data from 455 residents with CI. RESULTS: Most of the residents were involved in occupational therapy activities (OT,73.4%), and medical rehabilitation (MR,67.2%); however, less than half participated in CT (44.8%), and physical activity group (41.2%), whilst only 24.2% of individuals received psychological therapy (PT) and only 22.7% residents were being encouraged to enhance their ability with activities of daily living (ADL). We found a positive correlation between participation in enhancing ADL and CT (rho = 0.677; P <0.001), and a considerable variation between the LTCFs in prevalence of PT, CT and encouraging maintaining ADL. The chance of participating in CT was higher among female patients (OR, 1.87; 95% CI, 1.15-3.04), residents of nursing homes (OR, 2.79; 95% CI, 1.69-4.60), of larger facilities (OR, 4.09; 95% CI, 2.45-6.81), and among residents having moderate CI (OR, 2.27; 95% CI, 1.27-4.08), delusions symptoms (OR, 2.31; 95% CI, 1.34-3.98), diagnosis of depression (OR, 5.07; 95% CI, 2.31-11.14), or Alzheimer's disease accompanied by behavioral disorders (OR for interaction, 5.25; 95% CI, 1.28-21.58). CONCLUSIONS: We found a relatively high use of MR and OT and significant diversity between facilities in use of CT, PT and maintaining/enhancing ADL.