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


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.

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    • "Occupational therapists met with caregivers over nine in-home sessions to identify behavioral symptoms most distressing to families and potential modifying precipitating factors, and instruct caregivers in nonpharmacological strategies to address targeted behavioral symptoms. Strategies might include having caregivers simplify communications, tasks and the home environment and introducing and using activities of meaning to persons with dementia (Gitlin et al., 2010).] ) were examined . "
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    ABSTRACT: Previous research shows that nonpharmacological strategies may effectively manage behavioral symptoms (agitation, wandering) in persons with dementia and improve caregiver wellbeing. However, strategies depend upon caregivers for their implementation. We examine the impact of caregiver readiness to use nonpharmacological strategies on treatment outcomes. Data were from a randomized trial involving 110 family caregivers in the treatment group which received nonpharmacologic strategies for managing behavioral symptoms. Interventionists rated caregiver readiness to use nonpharmacologic strategies as pre-action (precontemplation, contemplation, preparation) or action at treatment initiation and conclusion. Caregivers in pre-action and action stages by treatment conclusion (16 weeks) were compared on proximal (frequency of, and caregiver upset and confidence with targeted behaviors) and more distal (caregiver burden and wellbeing) outcomes at 16 and 24-week follow-ups. By treatment conclusion, 28.2% (n = 31) and 71.8% (n = 79) of caregivers were rated at pre-action and action respectively. Means for proximal outcomes differed between the groups at 16 and 24 weeks; those at action showed greater improvement on all proximal and distal outcomes. Hierarchical regressions showed significant relationships of readiness to targeted outcomes. By 24 weeks, caregiver readiness predicted lower frequency estimates of targeted behaviors (β = −.180, p = .041) and higher confidence (β = .27, p = .009). Readiness was not a significant predictor of caregiver burden and wellbeing at 16 or 24 weeks. By treatment conclusion, >25% of participants were not activated to use nonpharmacologic strategies. Activated caregivers reported greater decline in distressing behavioral symptoms, and more confidence than non-activated participants. Activation is needed to impact behavioral management but not other caregiver outcomes. Copyright
    No preview · Article · Feb 2016 · International Journal of Geriatric Psychiatry
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    • "Caregiver approaches and skill sets are essential to effective use of PCC, and rely on caregivers' understanding of the intrinsic qualities of personhood, such as the person's history, prior occupations, interests, and values. Gitlin et al. (2010) highlighted the influence of the care environment, along with the caregiver-client relationship, on the ability of community-dwelling older adults with ADRD to perform in a goaldirected manner and to engage in occupations. In addition, a study by McKeown, Clarke, Ingleton, "

    Preview · Article · Jan 2015
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    • "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 ( "
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    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.
    Full-text · Article · Nov 2014 · Actas espanolas de psiquiatria
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