Few rigorous clinical trials have investigated the effectiveness of exercise on the physical functioning of patients with Alzheimer disease (AD). Objectives: To investigate the effects of intense and longterm exercise on the physical functioning and mobility of home-dwelling patients with AD and to explore its effects on the use and costs of health and social services. Design: A randomized controlled trial. Setting and Participants: A total of 210 homedwelling patients with AD living with their spousal caregiver. Interventions: The 3 trial arms included (1) groupbased exercise (GE; 4-hour sessions with approximately 1-hour training) and (2) tailored home-based exercise (HE; 1-hour training), both twice a week for 1 year, and (3) a control group (CG) receiving the usual community care. Main Outcome Measures: The Functional Independence Measure (FIM), the Short Physical Performance Battery, and information on the use and costs of social and health care services. Results: All groups deteriorated in functioning during the year after randomization, but deterioration was significantly faster in the CG than in the HE or GE group at 6 (P=.003) and 12 (P=.015) months. The FIM changes at 12 months were Ϫ7.1 (95% CI, Ϫ3.7 to Ϫ10.5), Ϫ10.3 (95% CI, Ϫ6.7 to Ϫ13.9), and Ϫ14.4 (95% CI, Ϫ10.9 to Ϫ18.0) in the HE group, GE group, and CG, respectively. The HE and GE groups had significantly fewer falls than the CG during the follow-up year. The total costs of health and social services for the HE patient-caregiver dyads (in US dollars per dyad per year) were $25

New sensitive measurements of loneliness and social isolation are needed to measure fluctuations in feelings of loneliness and in social isolation.

OBJECTIVES: To determine whether community care of people with dementia can be prolonged with a 2-year multicomponent intervention program and to analyze effects of the intervention on total usage and expenses of social and healthcare services. DESIGN: Randomized controlled trial. SETTING: Community-dwelling couples with one spouse caring for the other spouse with dementia. PARTICIPANTS: Couples with dementia (N 5 125) were allocated at random to the intervention (n 5 63) or control group (n 5 62). INTERVENTION: Intervention couples were provided with a multicomponent intervention program with a family care coordinator, a geriatrician, support groups for caregivers, and individualized services. MEASUREMENTS: Time from enrollment to institutionalization of spouses with dementia and use of services and service expenditure of couples. RESULTS: At 1.6 years, a larger proportion in the control group than in the intervention group was in long-term institutional care (25.8% vs 11.1%, P 5.03). At 2 years, the difference was no longer statistically significant. The 2-year adjusted hazard ratio for the intervention group was 0.53 (95% confidence interval (CI) 5 0.23-1.19, P 5.12). Intervention led to reduction in use of community services and expenditures. The difference for the benefit of intervention group was À 7,985 Euro (95% CI 5 À 16,081 to À 1,499, P 5.03). When the intervention costs were included, the differences between the groups were not significant. CONCLUSION: Although the intervention did not result in a significant difference in the need for institutional care after 2 years, individualizing services in collaboration with families may lead to reduction in use of and expenditures on municipal services.

Regular, long-term, customized HE improved the executive function of community-dwelling older people with memory disorders, but the effects were mild and were not observed in other domains of cognition.

Psychosocial group rehabilitation was associated with lower mortality and less use of health services.

anzctr.org.au Identifier: ACTRN12611001173987.

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