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Tailored Activities to Manage Neuropsychiatric Behaviors in Persons With Dementia and Reduce Caregiver Burden: A Randomized Pilot Study

https://doi.org/10.1097/01.JGP.0000300629.35408.94Get rights and content

Objective

To test whether the Tailored Activity Program (TAP) reduces dementia-related neuropsychiatric behaviors, promotes activity engagement, and enhances caregiver well-being.

Design

Prospective, two-group (treatment, wait-list control), randomized, controlled pilot study with 4 months as main trial endpoint. At 4 months, controls received the TAP intervention and were reassessed 4 months later.

Setting

Patients' homes.

Participants

Sixty dementia patients and family caregivers.

Intervention

The eight-session occupational therapy intervention involved neuropsychological and functional testing, selection, and customization of activities to match capabilities identified in testing, and instruction to caregivers in use of activities.

Measurements

Behavioral occurrences, activity engagement, and quality of life in dementia patients; objective and subjective burden and skill enhancement in caregivers.

Results

At 4 months, compared with controls, intervention caregivers reported reduced frequency of problem behaviors, and specifically for shadowing and repetitive questioning, and greater activity engagement including the ability to keep busy. Fewer intervention caregivers reported agitation or argumentation. Caregiver benefits included fewer hours doing things and being on duty, greater mastery, self-efficacy, and skill enhancement. Wait-list control participants following intervention showed similar benefits for reductions in behavioral frequency and caregiver hours doing things for the patient and mastery. Caregivers with depressed symptoms derived treatment benefits similar to nondepressed caregivers.

Conclusions

Tailoring activities to the capabilities of dementia patients and training families in activity use resulted in clinically relevant benefits for patients and caregivers. Treatment minimized trigger behaviors for nursing home placement and reduced objective caregiver burden. Noteworthy is that depressed caregivers effectively engaged in and benefited from the intervention.

Section snippets

Study Sample and Procedures

Participants were recruited between 2005 and 2006 through media announcements and social service mailings. Interested caregivers contacted the research office, were explained study procedures, and administered a telephone eligibility screening test. Dementia patients were English-speaking, had a physician diagnosis or Mini-Mental State Examination (MMSE) score <24,22 and were able to feed self and participate in at least two self-care activities (e.g., bathing, dressing). Patients were excluded

RESULTS

Dementia patients were primarily male (57%) and white (77%), with a mean age of 79 years. On average they had a MMSE score of 11.6, were dependent in eight instrumental and five basic activities of living. Caregivers were primarily female (88%), white (77%), high school graduates (56%), and spouses (62%) with a mean age of 65 (Table 1).

CONCLUSIONS

The results of this controlled pilot study suggest positive benefits and large symptom reductions as evidenced by effect sizes for patient and caregiver outcomes. For behaviors, the main outcome, treatment gains were found overall and for frequently occurring behaviors (shadowing, repetitive questioning). Fewer caregivers in intervention reported occurrences of agitation and argumentation, behaviors known to trigger nursing home placement. Additionally, life quality improvements were found with

References (45)

  • AM Landes et al.

    Prevalence of apathy, dysphoria, and depression in relation to dementia severity in Alzheimer's disease

    J Neuropsychiatry Clin Neurosci

    (2005)
  • C Ballard et al.

    Impact of behavioral and psychological symptoms of dementia on caregivers

    Int Psychogeriatr

    (2000)
  • EB Fauth et al.

    Behavioral and psychological symptoms of dementia and caregivers' stress appraisals: intra-individual stability and change over short-term observations

    Aging Ment Health

    (2006)
  • DW Gilley et al.

    Influence of behavioral symptoms on rates on institutionalization for person's with Alzheimer's disease

    Psychol Med

    (2004)
  • C Magai et al.

    Caregiver distress and behavioral symptoms

  • LS Schneider et al.

    Risk of death with atypical antipsychotic drug treatment for Dementia

    J Am Med Assoc

    (2005)
  • LS Schneider et al.

    Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease

    N Engl J Med

    (2006)
  • KM Sink et al.

    Pharmacological treatment of neuropsychiatric symptoms of Dementia: a review of evidence

    J Am Med Assoc

    (2005)
  • LN Gitlin et al.

    A randomized, controlled trial of a home environmental intervention: effect on efficacy and upset in caregivers and on daily function of persons with dementia

    Gerontologist

    (2001)
  • LN Gitlin et al.

    Effects of the home environmental skill-building program on the caregiver–care recipient dyad: 6-month outcomes from the Philadelphia REACH initiative

    Gerontologist

    (2003)
  • SH Belle et al.

    Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: a randomized, controlled trial

    Ann Intern Med

    (2006)
  • MS Mittelman et al.

    Effects of a caregiver intervention on negative caregiver appraisals of behavior problems in patients with Alzheimer's disease: results of a randomized trial

    J Gerontol B Psychol Sci

    (2004)
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    Research reported in this article was supported in part by funds from the National Institute of Mental Health (grant no. R21 MH069425).

    The authors acknowledge the significant contributions of consultants, Dr. Cameron Camp and Ms. Adel Herge, MS, OTR/L, the interventionists Geri Shaw, OTR/L, Tracey Vause-Earland, MS, OTR/L; Michele Rifkin, MS, OTR/L; Catherine Piersol, MS, OTR/L; and Lauren Young Lapin, MS, OTR/L and the interviewing staff. Clinical Trials ID# NCT00259467.

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