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OBJECTIVES: To test the efficacy of a multicomponent intervention to reduce functional difficulties, fear of falling, and home hazards and enhance self‐efficacy and adaptive coping in older adults with chronic conditions. DESIGN: A prospective, two‐group, randomized trial. Participants were randomized to a treatment group or no‐treatment group. SETTING: Urban community‐living older people. PARTICIPANTS: Three hundred nineteen community‐living adults aged 70 and older who reported difficulty with one or more activities of daily living. INTERVENTION: Occupational and physical therapy sessions involving home modifications and training in their use; instruction in strategies of problem‐solving, energy conservation, safe performance, and fall recovery techniques; and balance and muscle strength training. MEASUREMENTS: Outcome measures included self‐rated functional difficulties with ambulation, instrumental activities of daily living, activities of daily living, fear of falling, confidence performing daily tasks, and use of adaptive strategies. Observations of home hazards were also conducted. RESULTS: At 6 months, intervention participants had less difficulty than controls with instrumental activities of daily living (P=.04, 95% confidence interval (CI)=−0.28–0.00) and activities of daily living (P=.03, 95% CI=−0.24 to −0.01), with largest reductions in bathing (P=.02, 95% CI=−0.52 to −0.06) and toileting (P=.049, 95% CI=−0.35–0.00). They also had greater self‐efficacy (P=.03, 95% CI=0.02–0.27), less fear of falling (P=.001, 95% CI=0.26–0.96), fewer home hazards (P=.05, 95% CI=−3.06–0.00), and greater use of adaptive strategies (P=.009, 95% CI=0.03–0.22). Benefits were sustained at 12 months for most outcomes. CONCLUSION: A multicomponent intervention targeting modifiable environmental and behavioral factors results in life quality improvements in community‐dwelling older people who had functional difficulties, with most benefits retained over a year.

Objectives Test effects of an intervention that helps families manage distressful behaviors. Design Two-group randomized trial Setting In-home Participants 272 caregivers and dementia patients Intervention Up to 11 home/telephone contacts over 16-weeks by health professionals who identified potential triggers of patient behaviors including communication, environment, patient undiagnosed medical conditions (by obtaining blood/urine samples), and trained caregivers in strategies to modify triggers and reduce caregiver upset. Between 16–24 weeks, 3 telephone contacts reinforced strategy use. Measurements Primary outcomes included frequency of targeted problem behavior, and caregiver upset with and confidence managing it at 16-weeks. Secondary outcomes included caregiver well-being and management skills at 16 and 24 weeks, and caregiver perceived benefits. Prevalence of medical conditions for intervention patients were also examined. Results At 16 weeks, 67.5% of intervention caregivers reported patient improvement in targeted problem behavior compared to 45.8% of caregivers in a no-treatment control group (p=.002), reduced upset with (p=.028) and enhanced confidence managing (p=.011) the behavior. Additionally, compared to controls, intervention caregivers reported less upset with all problem behaviors (p=.001), negative communication (p=.017), burden (p=.051), and improved well-being (p=.001). Fewer intervention caregivers had depressive symptoms (53.0%) than control group caregivers (67.8%, p=.020). Similar caregiver outcomes occurred at 24-weeks. Compared to controls, intervention caregivers perceived more study benefits (p values <.05) including ability to keep patients home. Blood/urine samples of intervention patients showed 40 (34.1%) had undiagnosed illnesses requiring physician follow-up. Conclusion Targeting behaviors upsetting to caregivers and modifying potential triggers improves patient symptomatology and caregiver well-being and skills.

The Environmental Skill-Building Program reduces burden and enhances caregiver well-being in select domains and has added benefit for women and spouses.

Objective-To test whether the Tailored Activity Program for at-home dementia patients reduces neuropsychiatric behaviors and caregiver burden.Method-A prospective, two-group controlled pilot study with 60 dyads randomized to treatment or wait-list control. Dyads were interviewed at baseline and 4 months (trial endpoint); control participants then received intervention and were reassessed 4 months later. The 8-session occupational therapy intervention involved neuropsychological and functional testing from which activities were customized and instruction in use provided to caregivers. Conclusions-Results suggest clinically-relevant benefits for both dementia patients and caregivers, with treatment minimizing the occurrence of behaviors that commonly trigger nursing home placement. (1) Neuropsychiatric behaviors such as apathy, depressed affect, lability, agitation, and aggressiveness are common occurrences, with most patients manifesting these behaviors over the course of the disease. (2,3,4) Behaviors are the most challenging aspect of caregiving, contributing to caregiver distress, depression, increased care costs, and risk for nursing home placement. (5,6,7,8) There are few tested interventions to minimize behavioral occurrences. Recent research has shown that pharmacological approaches may not be effective and may cause harm (9,10,11). A few caregiver intervention studies report minimal behavioral benefits (12,13,14,15), with most studies not examining patient symptom reduction. Thus, developing and testing nonpharmacological approaches to address behaviors is an important public health priority as articulated in recent position statements by the American Association for Geriatric Psychiatry (16) and Annals of Internal Medicine. (17) One promising approach is activity. Research shows that purposeful activity results in reduced depressive and agitated behaviors. (18,19) However, studies have focused exclusively on nursing home residents, involved small sample sizes, used non-experimental designs, or have not tested systematic approaches to developing activities. Lack of research on communityliving patients is significant given that the home is the primary care setting for this population. Results-At KeywordsThis pilot controlled study evaluates an activity-based intervention, the Tailored Activity Program (TAP) that seeks to reduce behavioral disturbances by identifying patients' preserved capabilities and devising activities that build on them. The trial tested whether tailored activities reduced behavioral occurrences in dementia patients and caregiver burden and enhanced patient engagement, caregiver mastery, self-efficacy, and use of simplification strategies to manage behaviors. Also, because the intervention required caregiver involvement, we evaluated whether caregiver depressive symptoms moderated dementia patient and caregiver outcomes.Using a two-group randomized, parallel design, 60 dyads (dementia patients and their caregivers) were assigned to treatment or wait-list control. Treatment grou...

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.

ADS Plus is cost efficient and is easy to implement within adult day centers. It affords important clinical and public health benefits, including enhanced caregiver well-being, greater adult day service use, and fewer nursing home placements.

An in-home skills training program helps sustain caregiver affect for those enrolled for more than 1 year. More frequent professional contact and ongoing skills training may be necessary to maintain other clinically important outcomes such as reduced upset with behaviors.