Tailored Activities to Manage Neuropsychiatric Behaviors in Persons With Dementia and Reduce Caregiver Burden: A Randomized Pilot Study

Abstract

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...

Effectiveness of Supporting Informal Caregivers of People with Dementia: A Systematic Review of Randomized and Non-Randomized Controlled Trials

“…Caregivers showed a reduction in objective burden. On the other hand no effects were found on depressive symptoms of the dyads, on subjective burden of caregivers, and on quality of life of recipients [92]. Yet another occupational therapy intervention (high methodological quality) of the same first author as the previous studies [93], that contained nine occupational therapy sessions, showed overall positive effects on the primary caregivers' outcomes: upset and confidence in managing target problem behavior as well as in the care-recipient primary outcome: frequency of target problematic behavior.…”

Dyadic interventions for community-dwelling people with dementia and their family caregivers: a systematic review

“…Since it may be important to differentiate between these concepts, developing a new instrument with good psychometric properties may be important. Perceived burden and competence may have different relationships with stressors such as behavior problems (Graff et al, 2007;Gitlin et al, 2008), and perceived competence might be easier to improve because it concerns a skill.…”

“…In the COTiD study [6], Graff et al (2006) show large effect sizes for all outcome measures, including mood, quality of life, daily functioning, and competence, but these effects were not replicated in successive studies of the same program (Voigt-Radloff et al, 2011a). Next, Gitlin et al (2008Gitlin et al ( , 2010a have demonstrated a decrease in behavioral occurrences of the person with dementia in two studies [4a, 5]; however, the Care of Persons with dementia in their Environments (COPE) study [4b], with comparable intervention components, does not show this effect (Gitlin et al, 2010b). Differences in findings in interventions with comparable treatment components might be explained in several ways.…”

Knowing Versus Doing: Education and Training Needs of Staff in a Chronic Care Hospital Unit for Individuals With Dementia

“…However, these approaches require a different method than the method in which staff are traditionally trained; specifically, nonpharmacological approaches include problem solving and tailoring strategies to patient needs, interests, and capabilities. These strategies have been successfully taught to informal caregivers to manage behavioral symptoms (Gitlin et al, 2008;Gitlin, Winter, Dennis, Hodgson, & Hauck, 2010;Teri et al, 2012) and, similarly, could be taught to hospital staff.Regarding care environment, staff members were confident in the care …”