Tailored activities to manage neuropsychiatric behaviors in persons with dementia and reduce caregiver burden: a randomized pilot study (original) (raw)
Related papers
International journal of geriatric psychiatry, 2018
To evaluate the efficacy of the tailored activity program-outpatient version (TAP-O) and to reduce neuropsychiatric symptoms (NPS) in patients with dementia and caregiver burden compared with a control group (psychoeducation intervention). Twenty-one persons with dementia and their caregivers were recruited and randomized. The intervention group received TAP-O, designed for outpatients with dementia and their caregivers. TAP-O consisted of eight sessions in which an occupational therapist assessed the patient's abilities and interests; prescribed tailored activities; and educated caregivers about dementia, NPS, and how to implement meaningful activities in the daily routine. The control group received eight sessions of a psychoeducation intervention about dementia and NPS. Compared with controls, patients receiving TAP-O had a significant decrease in hallucination (P = 0.04), agitation (P = 0.03), anxiety (P = 0.02), aggression (P = 0.01), sleep disorder (P = 0.02), aberrant mot...
The Gerontologist, 2009
Objective: To test whether the Tailored Activity Program (TAP) reduces dementia-related neuropsychiatric behaviors, promotes activity engagement, and enhances caregiver wellbeing. 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 eightsession 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. (Am J Geriatr Psychiatry 2008; 16:229 -239)
Contemporary clinical trials, 2016
Among over 5million people in the USA with dementia, neuropsychiatric symptoms (NPS) are almost universal, occurring across disease etiology and stage. If untreated, NPS can lead to significant morbidity and mortality including increased cost, distress, depression, and faster disease progression, as well as heightened burden on families. With few pharmacological solutions, identifying nonpharmacologic strategies is critical. We describe a randomized clinical trial, the Dementia Behavior Study, to test the efficacy of an activity program to reduce significant existing NPS and associated caregiver burden at 3 and 6months compared to a control group intervention. Occupational therapists deliver 8 in-home sessions over 3months to assess capabilities and interests of persons with dementia, home environments, and caregiver knowledge, and readiness from which activities are developed and families trained in their use. Families learn to modify activities for future declines and use strategi...
2018
Cathryn Schaffer and Sonia Nurkse, occupational therapists in an inpatient rehabilitation unit at Good Samaritan of Multicare in Puyallup, WA, proposed a research question: Can occupation-based activities be used to improve quality of life and/or reduce problem behaviors in adults with dementiarelated cognitive impairment? Five databases were searched for articles published from 2007 to 2017, resulting in 23 articles that met search criteria. Interventions that did not take extensive time, training, or resources were included with the intention that they would be easily incorporated into a caregiver or health professional's routine. Multiple interventions were found that address problem behaviors and/or quality of life including social interaction, activity individualization, object interaction, and general occupations. Each of these interventions had moderate to strong evidence that they reduced the occurrence of problem behaviors and limited to mixed evidence supporting their efficacy on improving quality of life, though individualization of activities seemed to have the most evidence as effectively reducing problem behavior occurrences. Results of the critically appraised topic review were summarized into an in-service presentation for inpatient rehabilitation staff of a Multicare hospital. This in-service informed staff regarding the potential to implement these interventions and strategies to educate caregivers of people with dementia about what they can do to reduce occurrence of problem behaviors and increase quality of life of care recipients. A caregiver pamphlet was created with activity ideas and tips to communicate with and engage a person with dementia in activity. The impact of the in-service and pamphlet was assessed with a survey completed by in-service attendees, which yielded positive results: 86% stated they would probably or definitely use the caregiver handout, and 71% said they were somewhat to very comfortable individualizing activities. We recommend future in-services regarding this research in other settings such as long-term care facilities, adult family homes, or to be available as caregiver information sessions. CRITICALLY APPRAISED TOPIC (CAT) PAPER Focused Question: Can occupation-based activities be used to improve quality of life and/or reduce problem behaviors in adults with dementia-related cognitive impairment?
Characteristics of Activities for Persons With Dementia at the Mild, Moderate, and Severe Stages
The Gerontologist, 2016
To understand activity in dementia care, we examine relationships of disease stage with types and characteristics of meaningful activities (cueing needs, help with initiation, and recommended engagement time) provided in a home-based intervention trial designed to reduce behavioral symptoms. Data involved 158 activity prescriptions or written documents detailing prescribed activities, cueing needs, and engagement goals designed by occupational therapists for 56 families. Activities were categorized as arts and crafts, exercise/physical, cognitive, music/entertainment, manipulation/sensory/sorting, family/social/ reminiscence, and domestic/homemaking. Bivariate correlations examined relationships of activity categories and characteristics with disease stage (mild, moderate, or severe). Kruskal-Wallis H tests examined differences among disease stages and frequency of type of activities prescribed, recommended cues, and engagement time. For significant Kruskal-Wallis tests, pairwise co...
Impact of an activities-based adult dementia care program
Neuropsychiatric Disease and Treatment, 2005
The investigators studied over one year the impact of a newly established once-aweek activity-based day care program for dementia patients combined with 17 educational sessions for caregivers held at the same facility. Outcome measures were patient and caregiver quality of life (QOL), patient behavioral disturbance, and use of community-based resources. Of the 37 enrollees, 3 chose not to start the program and 13 dropped out before the end of one year, largely due to health-related issues. Of the initial group, 21 attended for the entire year. The average patient Mini-Mental State Exam (MMSE) score at entry was 16, indicating a moderate level of dementia. Average score on the CERAD Behavior Rating Scale for Dementia (BRSD) was 30.1, indicating a mild level of behavioral disturbance. Attendance at day care was 91%; at the caregiver educational sessions, 74%. Patient and caregiver enthusiasm for the program was high and all wanted to continue attendance beyond the study period despite the fact that patients reported no change in QOL. Caregivers rated patients as having significantly less QOL, and rated their own QOL as unchanged. Symptomatic patient behaviors, as measured by the BRSD, increased significantly over the period of study. Caregivers reported greater use of community resources.
Disability and rehabilitation, 2017
To explore the feasibility of implementing the Tailored Activity Program with a cohort of people with frontotemporal dementia and their carers (dyads). The Tailored Activity Program is an occupational therapy based intervention that involves working collaboratively with family carers and prescribes personalized activities for behavioral management in people with dementia. Twenty dyads randomized into the study (Tailored Activity Program: n = 9; Control: n = 11) were assessed at baseline and 4-months. Qualitative analyzes evaluated feasibility and acceptability of the program for the frontotemporal dementia cohort, and quantitative analyzes (linear mixed model analyzes, Spearman's rho correlations) measured the impact of the program on the dyads. The Tailored Activity Program was an acceptable intervention for the frontotemporal dementia dyads. Qualitative analyses identified five themes: "carer perceived benefits", "carer readiness to change", "strategie...
Dementia Management: An Occupational Therapy Home-Based Intervention for Caregivers
American Journal of Occupational Therapy, 1992
This paper describes an occupational therapy intervention designed for family caregivers of persons with dementia. The intervention, based on the framework of a competence-environmental press model and the principle of collaboration, was implemented during 5 home visits. Each visit was designed to build caregiving skills through collaboration in identifying problem areas, developing and implementing environmental strategies, and modifying management approaches. A case vignette illustrates the therapeutic process and outcomes. The theoretical rationale and structure of the intervention and innovative documentation for evaluation of the theoretic process are also presented.
Targeting Behavioral Symptoms and Functional Decline in Dementia: A Randomized Clinical Trial
Journal of the American Geriatrics Society, 2017
Dementia-related behavioral symptoms and functional dependence result in poor quality of life for persons with dementia and their caregivers. The goal was to determine whether a home-based activity program (Tailored Activity Program; TAP-VA) would reduce behavioral symptoms and functional dependence of veterans with dementia and caregiver burden. Single-blind (interviewer), parallel, randomized, controlled trial (Clinicaltrials.gov: NCT01357564). Veteran's homes. Veterans with dementia and their family caregivers (N = 160 dyads). Dyads in TAP-VA underwent 8 sessions with occupational therapists to customize activities to the interests and abilities of the veterans and educate their caregivers about dementia and use of customized activity. Caregivers assigned to attention control received up to 8 telephone-based dementia education sessions with a research team member. Primary outcomes included number of behaviors and frequency of their occurrence multiplied by severity of occurre...