Feasibility of Telehealth Occupational Therapy for Behavioral Symptoms of Adults With Dementia: Randomized Controlled Trial

Abstract

Importance: Supporting community residency of adults with Alzheimer’s disease (AD) is a critical public health initiative. Occupational therapy can contribute to this goal. Objective: To assess the feasibility of a novel telehealth intervention to support occupational engagement in community-residing people with AD. Design: Single-blind, three-arm, parallel, randomized controlled trial. Setting: Occupational therapy delivered through telehealth in participants’ homes. Participants: People with AD who reside in the community with behavioral symptoms and their care partners (dyads). Interventions: (1) HARMONY (Helping older Adults cReate & Manage OccupatioNs successfully), a telehealth intervention that applies principles of individualized guided discovery with environmental cueing for caregivers of persons with AD to promote activity participation and manage behavioral symptoms; (2) standardized training regarding the use of a sensory-based approach in dementia care; and (3) a control, including home safety education and weekly monitoring of behaviors. Outcomes and Measures: Feasibility was assessed as the primary outcome measured by completion of at least 75% of the telehealth sessions. Secondary outcomes included change in functional activity performance and neuropsychiatric behavioral symptoms. Results: Twenty-eight dyads participated. The intervention was feasible, with high adherence to weekly visits (M number of visits = 5.4 for HARMONY, 4.9 for standardized training, and 4.6 for control), with high participant retention in the intervention arms. HARMONY demonstrated promise in improving patient performance and behavioral symptoms. Conclusions and Relevance: HARMONY is feasibly delivered through telehealth service and has a positive effect on occupational performance and behavioral symptoms of AD. Additional studies are needed to explore effectiveness in a broader population. What This Article Adds: Use of HARMONY for community-residing adults with AD is feasible and has promise for improving functional activity performance and behavioral symptoms, as well as caregiver satisfaction.

Rehabilitation Services for Young-Onset Dementia: Examples from High- and Low–Middle-Income Countries

“…Telehealth assists in overcoming barriers of geographical distance, an absence of local specialised services (a frequent limitation given the low prevalence of YOD), and travel arrangements to attend frequent clinical appointments (e.g., carers having to take time off). For people with dementia, telehealth has been shown to be a feasible mode of delivery of cognitive rehabilitation [ 107 ], occupational therapy [ 108 ], and speech and language therapy [ 73 , 109 , 110 , 111 ]. Moreover, remote delivery of cognitive rehabilitation reduces time and the travel costs of staff, making rehabilitation cheaper and more sustainable [ 112 ].…”