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

Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University, Philadelphia, Pennsylvania 19130, USA.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 08/2010; 58(8):1465-74. DOI: 10.1111/j.1532-5415.2010.02971.x
Source: PubMed

ABSTRACT To test the effects of an intervention that helps families manage distressing behaviors in family members with dementia.
Two-group randomized trial.
In home.
Two hundred seventy-two caregivers and people with dementia.
Up to 11 home and telephone contacts over 16 weeks by health professionals who identified potential triggers of patient behaviors, including communication and environmental factors and patient undiagnosed medical conditions (by obtaining blood and urine samples) and trained caregivers in strategies to modify triggers and reduce their upset. Between 16 and 24 weeks, three telephone contacts reinforced strategy use.
Primary outcomes were frequency of targeted problem behavior and caregiver upset with and confidence managing it at 16 weeks. Secondary outcomes were 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.
At 16 weeks, 67.5% of intervention caregivers reported improvement in targeted problem behavior, compared with 45.8% of caregivers in a no-treatment control group (P=.002), and reduced upset with (P=.03) and enhanced confidence managing (P=.01) the behavior. Additionally, intervention caregivers reported less upset with all problem behaviors (P=.001), less negative communication (P=.02), less burden (P=.05), and better well-being (P=.001) than controls. Fewer intervention caregivers had depressive symptoms (53.0%) than control group caregivers (67.8%, P=.02). Similar caregiver outcomes occurred at 24 weeks. Intervention caregivers perceived more study benefits (P<.05), including ability to keep family members home, than controls. Blood and urine samples of intervention patients with dementia showed that 40 (34.1%) had undiagnosed illnesses requiring physician follow-up.
Targeting behaviors upsetting to caregivers and modifying potential triggers improves symptomatology in people with dementia and caregiver well-being and skills.

51 Reads
  • Source
    • "105: 55/60 G.I.: intervención estructurada de 8 sesiones de 90 minutos durante 4 meses en los que se incluía información de la enfermedad, manejo conductual del paciente, manejo de pensamientos negativos, mejora de habilidades de comunicación y actividades agradables G.C.: lista de espera Sobrecarga: 22-ZBI Se observan mejoras significativas en el grupo de tratamiento a los 10 meses del inicio del estudio (p<0.01) Gallagher-Thompson et al., 2010 (54) 70: 36/34 G.I.: DVD informativo de 2,5 horas de duración con información sobre la enfermedad y del estrés del cuidador, manejo conductual del paciente, comunicación efectiva, uso de recursos y aspectos legales relacionados con el final de la vida G.C.: DVD con información básica de la enfermedad Depresión: 20- CESD Sin cambios significativos en el grupo intervención Gitlin et al., 2010 (55) 120: 114/106 G.I.: intervención aguda de la intervención con 16 sesiones semanales con un terapeuta ocupacional que elabora un plan de acción personalizado (reducción de estrés, autocuidado, mejora de habilidades del cuidado) y una fase de mantenimiento ( "
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: With the aging of the population, an increasing number of people have dementia, most of whom are receiving home care. Caregivers are exposed to a variety of stressors, which may lead to feeling burdened, or to depression and anxiety. Various programs or structured interventions have been developed to prevent or lessen these negative consequences. The efficacy of these interventions is debated, mainly due to methodological differences between studies. Review studies so far have presented important discrepancies, thus perpetuating a lack of clarity regarding this important geriatric care problem. The effectiveness of interventions designed to prevent or reduce the burden and/or symptoms of anxiety and depression in informal caregivers are reviewed precisely and rigorously. Methods: A systematic review of randomized controlled studies assessing the efficacy of structured interventions on the variables of burden, depression and anxiety in informal caregivers of patients with dementia. Results: The literature search yielded 997 references, of which 35 met the screening criteria. Of these studies, 51.4% had results that were statistically favorable to intervention. The methodology used varied widely between studies. Conclusions: Overall, the available evidence favors the implementation of structured intervention programs, although the results are heterogeneous. Psychoeducational interventions yield better results and can be better adapted to the needs of caregivers.
    Actas espanolas de psiquiatria 11/2014; 42(6-6):300-14. · 1.20 Impact Factor
  • Source
    • "Session helped caregivers identify potential modifying precipitating factors for behaviors targeted as problematic . A range of strategies to manage targeted behaviors (communication techniques and environmental modifications ) were taught to caregivers (Gitlin et al., 2010b). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Nonpharmacologic strategies to manage dementia-related behavioral symptoms depend upon caregiver implementation. Caregivers may vary in readiness to use strategies. We examined characteristics associated with readiness, extent readiness changed during intervention, and predictors of change in readiness. Methods Data came from a randomized trial involving 119 caregivers in a nonpharmacologic intervention for managing behavioral symptoms. Baseline measures included caregiver, patient, and treatment-related factors. At initial (2weeks from baseline) and final (16weeks) intervention sessions, interventionists rated caregiver readiness as pre-action (precontemplation=1; contemplation=2; preparation=3) or action (=4). Ordinal logistic regression identified baseline characteristics associated with initial readiness. Mc Nemar-Bowker test of symmetry described change in readiness; binary logistic regression identified baseline predictors of change in readiness (initial to final sessions). One-way multivariate analysis of variance identified treatment factors (dose/intensity, number of strategies used, perceived benefits, and therapeutic engagement) associated with change in readiness. ResultsAt initial intervention session, 67.2% (N=80) of caregivers were in pre-action and 32.8% (N=39) in action. Initial high readiness was associated with better caregiver mood, less financial difficulty, lower patient cognition, and more behavioral symptoms. By final session, 72% (N=79) were in action and 28% (N=31) in pre-action; caregivers with less financial difficulty improved in readiness (B=-0.70, p=0.017); those in action were more therapeutically engaged (F[2,107]=3.61, p=0.030) and perceived greater intervention benefits (F[2, 88]=6.06, p=0.003). Conclusion Whereas patient and caregiver-related factors were associated with initial readiness, financial stability, therapeutic engagement, and perceived benefits enhanced probability of change. Understanding caregiver readiness and factors associated with its change may be important considerations in nonpharmacologic interventions. Copyright (c) 2013 John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 01/2014; 29(1). DOI:10.1002/gps.3979 · 2.87 Impact Factor
  • Source
    • "Thus, we expect that each dyad’s specific constellations of training and support will vary. The content of the occupational therapy initial assessment includes: Caregiver Assessment of Management Problems (CAMP) [28]; Fear of Falling (FoF); Berg Balance Scale [29]; Functional Independence Measure (FIM) [30]; Allen’s Cognitive Level Screen (ACLS) [31]; and the Mini Nutritional Assessment (MNA) [32]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Given the current lack of disease-modifying therapies, it is important to explore new models of longitudinal care for older adults with dementia that focus on improving quality of life and delaying functional decline. In a previous clinical trial, we demonstrated that collaborative care for Alzheimer's disease reduces patients' neuropsychiatric symptoms as well as caregiver stress. However, these improvements in quality of life were not associated with delays in subjects' functional decline. Trial design Parallel randomized controlled clinical trial with 1:1 allocation. Participants A total of 180 community-dwelling patients aged [greater than or equal to]45 years who are diagnosed with possible or probable Alzheimer's disease; subjects must also have a caregiver willing to participate in the study and be willing to accept home visits. Subjects and their caregivers are enrolled from the primary care and geriatric medicine practices of an urban public health system serving Indianapolis, Indiana, USA. Interventions All patients receive best practices primary care including collaborative care by a dementia care manager over two years; this best practices primary care program represents the local adaptation and implementation of our prior collaborative care intervention in the urban public health system. Intervention patients also receive in-home occupational therapy delivered in twenty-four sessions over two years in addition to best practices primary care. The focus of the occupational therapy intervention is delaying functional decline and helping both subjects and caregivers adapt to functional impairments. The in-home sessions are tailored to the specific needs and goals of each patient-caregiver dyad; these needs are expected to change over the course of the study.Objective To determine whether best practices primary care plus home-based occupational therapy delays functional decline among patients with Alzheimer's disease compared to subjects treated in the control group. Outcomes The primary outcome is the Alzheimer's Disease Cooperative Studies Group Activities of Daily Living Scale; secondary outcome measures are two performance-based measures including the Short Physical Performance Battery and Short Portable Sarcopenia Measure. Outcome assessments for both the caregiver-reported scale and subjects' physical performance scales are completed in the subject's home. Randomization Eligible patient-care giver dyads will be stratified by clinic type and block randomized with a computer developed randomization scheme using a 1:1 allocation ratio. Blinding Single blinded. Research assistants completing the outcome assessments were blinded to the subjects' treatment group. Trial status Ongoing ClinicalTrial.Gov identifier NCT01314950; date of completed registration 10 March 2011; date first patient randomized 9 March 2011.
    Trials 06/2012; 13(1):92. DOI:10.1186/1745-6215-13-92 · 1.73 Impact Factor
Show more