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The tailored activity program to reduce behavioral symptoms in individuals with dementia: feasibility, acceptability, and replication potential
- Authors:
- GITLIN Laura N., et al
- Journal article citation:
- Gerontologist, 49(3), June 2009, pp.428-439.
- Publisher:
- Oxford University Press
The Tailored Activity Program (TAP) is a home-based occupational therapy intervention shown to reduce behavioural symptoms and caregiver burden in a randomized trial. This article describes TAP, its assessments, acceptability, and replication potential. TAP involves 8 sessions for a period of 4 months. Interventionists identify preserved capabilities, previous roles, habits, and interests of individuals with dementia; develop activities customized to individual profiles; and train families in activity use. Interventionists documented time spent and ease conducting assessments, and observed receptivity of TAP. For each implemented prescribed activity, caregivers reported the amount of time their relative spent in activity and perceived benefits. The TAP assessment, a combination of neuropsychological tests, standardized performance-based observations, and clinical interviewing, yielded information on capabilities from which to identify and tailor activities. Assessments were easy to administer, taking an average of two 1-hr sessions. Of 170 prescribed activities, 81.5% were used, for an average of 4 times for 23 min by families between treatment sessions for a period of months. Caregivers reported high confidence in using activities, being less upset with behavioral symptoms (86%), and enhanced skills (93%) and personal control (95%). Interventionists observed enhanced engagement (100%) and pleasure (98%) in individuals with dementia during sessions. TAP offers families knowledge of their relative's capabilities and easy-to-use activities. The program was well received by caregivers. Prescribed activities appeared to be pleasurable and engaging to individuals with dementia. TAP merits further evaluation to establish efficacy with larger more diverse populations and consideration as a nonpharmacological approach to manage behavioural symptoms.
Conducting research on home environments: lessons learned and new directions
- Author:
- GITLIN Laura N.
- Journal article citation:
- Gerontologist, 43(5), October 2003, pp.628-637.
- Publisher:
- Oxford University Press
The study of home environments is a research domain within the field of environmental gerontology that addresses issues related to aging in place. Despite the importance of aging at home, there are few recent studies in this area and most are descriptive and lack theoretical direction. This article examines the current state of research on home environments from which methodological challenges and new directions for future research are identified. Three broad research queries are posed: What should we measure and why in home environments? How do older people and their family members use the home environment in health, illness, and caregiving? What are the interrelationships between the home environment, psychological well-being, and daily functioning throughout the aging process? Suggestions for future research on home environments are discussed and the implications for advancing environmental gerontology highlighted. Specifically, the home environment offers a testing ground for generic environmental constructs and their measurement as well as a unique setting from which new understandings and constructs of person -environment fit can emerge.
A randomised, controlled trial of a home environmental intervention: effect on efficacy and upset in caregivers and on daily function of persons with dementia
- Author:
- GITLIN Laura N.
- Journal article citation:
- Gerontologist, 41(1), February 2001, pp.4-14.
- Publisher:
- Oxford University Press
Article examines short-term effects of a home environmental intervention in the U.S. on self-efficacy and upset in caregivers and daily function of dementia patients. Also examines whether treatment effect varied by caregiver gender, race, and relationship to patient. The intervention involved 5 90-min home visits by occupational therapists who provided education and physical and social environmental modifications. Compared with controls, intervention caregivers reported fewer declines in patients' instrumental activities of daily living and less decline in self-care and fewer behaviour problems in patients at 3 months post-test. Also, intervention spouses reported reduced upset, women reported enhanced self-efficacy in managing behaviours, and women and minorities reported enhanced self-efficacy in managing functional dependency. Concludes that 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.
Effects of the Home Environmental Skill-Building Program on the caregiver–care recipient dyad: 6-month outcomes from the Philadelphia REACH initiative
- Authors:
- GITLIN Laura N., et al
- Journal article citation:
- Gerontologist, 43(4), August 2003, pp.532-546.
- Publisher:
- Oxford University Press
The authors examine 6-month effects of the Environmental Skill-Building Program on caregiver well-being and care recipient functioning and whether effects vary by caregiver gender, race (White or non-White), and relationship (spouse or nonspouse). Researchers enrolled 255 family caregivers of community-residing persons with Alzheimer's disease or related disorders, of whom 190 participated in a follow-up interview. Caregivers were randomized to a usual care control group or intervention group that received five home contacts and one telephone contact by occupational therapists, who provided education, problem-solving training, and adaptive equipment. Baseline and 6-month follow-up included self-report measures of caregiver objective and subjective burden, caregiver well-being, and care recipient problem behaviors and physical function. Compared with controls (n = 101), intervention caregivers (n = 89) reported less upset with memory-related behaviors, less need for assistance from others, and better affect. Intervention spouses reported less upset with disruptive behaviors; men reported spending less time in daily oversight; and women reported less need for help from others, better affect, and enhanced management ability, overall well-being, and mastery relative to control group counterparts. Statistically significant treatment differences were not found for hours helping with instrumental activities of daily living, upset with providing assistance with instrumental activities of daily living and activities of daily living, perceived change in somatic symptoms, White versus non-White caregivers, or care recipient outcomes. The Environmental Skill-Building Program reduces burden and enhances caregiver well-being in select domains and has added benefit for women and spouses.