Targeting and Managing Behavioral Symptoms in Individuals with Dementia: A Randomized Trial of a Nonpharmacological Intervention

Abstract

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.

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

“…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. Additionally, there was less caregiver upset with all problem behaviors, less negative communication, depression and burden decreased, and well-being improved (secondary outcomes).…”

Reporting of harms in randomized controlled trials of psychological interventions for mental and behavioral disorders: A review of current practice

“…However, only three of these reports included information about the proportion of participants that deteriorated [39,40,44]. Two trials evaluated an intervention for patients with dementia and their caregivers [46,47], and assessed change in caregivers on a scale ranging from 1 (got much worse) to 5 (improved a lot). Clinically significant change in the patients was defined as a change of 0.5 standard deviations or more in one of these trials [46].…”

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

“…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.…”