A Randomized, Controlled Trial of a Home Environmental Intervention

Abstract

The environmental program appears to have a modest effect on dementia patients' IADL dependence. Also, among certain subgroups of caregivers the program improves self-efficacy and reduces upset in specific areas of caregiving.

Design for All Users

“…RCTs have been used for interventions that have introduced specialized designs into the home (e.g., Gitlin et al 2001Gitlin et al , 2006; but when the physical environment is the intervention, most public contexts make it diffi cult to use RCTs and other experimental intervention designs (e.g., randomized/non-randomized, controlled/uncontrolled, pre-/post-). The many practical barriers include the high costs and relative permanence of many physical environmental interventions; the costs, time, and diffi culty of changing intervention, particularly in crossover designs; and the disruption caused by installing or constructing environmental interventions.…”

Feasibility Trial of Tailored Home Modifications: Process Outcomes

“…When delivered by occupational therapy practitioners, home hazard removal programs have been shown to reduce falls by 39% among high-risk fallers in studies conducted in Europe (Nikolaus & Bach, 2003) and Australia (Clemson, Mackenzie, Ballinger, Close, & Cumming, 2008). In addition, home modification programs, which included hazard removal, to improve daily activity performance have demonstrated high acceptability and adherence among older adults in the United States (Gitlin, Corcoran, Winter, Boyce, & Hauck, 2001;Stark, Landsbaum, Palmer, Somerville, & Morris, 2009). However, a recent systematic review revealed that no randomized controlled trials (RCTs) have been conducted in the United States to examine the efficacy of home hazard removal to reduce falls (Stark, Keglovits, Arbesman, & Lieberman, 2017).…”

In-Home Occupational Performance Evaluation for Providing Assistance (I–HOPE Assist): An Assessment for Informal Caregivers

“…Home modification interventions, such as architectural changes, assistive devices, and activity modification, typically target adults with functional limitations but also have the potential to reduce the need for physical care provided by caregivers (Agree & Freedman, 2000;Mortenson et al, 2012). Home modifications can increase functional performance for people with disabilities (Wahl, Fänge, Oswald, Gitlin, & Iwarsson, 2009), improve caregiver self-efficacy, and improve functioning for care recipients with dementia (Gitlin, Corcoran, Winter, Boyce, & Hauck, 2001;Graff et al, 2006). Furthermore, caregivers are receptive to environmental modification strategies; adherence rates for adaptation recommendations have been found to range from 65% (Dooley & Hinojosa, 2004) to 75% (Gitlin et al, 2001).…”

“…Home modifications can increase functional performance for people with disabilities (Wahl, Fänge, Oswald, Gitlin, & Iwarsson, 2009), improve caregiver self-efficacy, and improve functioning for care recipients with dementia (Gitlin, Corcoran, Winter, Boyce, & Hauck, 2001;Graff et al, 2006). Furthermore, caregivers are receptive to environmental modification strategies; adherence rates for adaptation recommendations have been found to range from 65% (Dooley & Hinojosa, 2004) to 75% (Gitlin et al, 2001).…”

“…Although initial findings that home modifications improve caregiver outcomes are promising, research has been hindered by a lack of validated instruments for measuring caregiver self-efficacy and assistance related to daily activities in the home (Gitlin et al, 2001;Glasdam, Timm, & Vittrup, 2010;Graff et al, 2006). The majority of caregiver assessments target perceived caregiver burden, such as the Caregiver Burden Inventory (developmental, physical, social, and emotional burden; Novak & Guest, 1989), the Modified Caregiver Strain Index (strain over time; Thornton & Travis, 2003), and the Caregiver Reaction Assessment (schedule disruptions, lack of family support, health and financial problems, and self-esteem; Given et al, 1992).…”