Jun 14, 2010

Tailored Activity Program (TAP) Minimizes Disruptive Behaviors In Dementia Patients Living at Home and Caregiver Burden

The study furthers previous findings that purposeful activity is a safe, healthy alternative to pharmacological approaches in minimizing disruptive behavioral occurrences associated with dementia, such as agitation and aggressiveness.....
By Bob DeMarco
Alzheimer's Reading Room

This is interesting research that I intend to look into in more detail. The findings seem to indicate that this approach could be an alternative to placing Alzheimer's patients into nursing homes or other types of Alzheimer's care facilities.

I am particularly interested in any approach that is an alternative to "drugging up" Alzheimer's patients that evidence aggressive, mean, or unruly behavior.

One of the questions being raised is whether or not Alzheimer's caregivers would be willing to pay for this service. If it turns out that it would cost less then "institutionalization" the answer could be yes. Perhaps the Federal government could run additional studies to determine if this kind of education is a cost effective solution for Medicare and Medicaid. Both Medicare and Medicaid will be forced, sooner or later, to start discovering effective solution that keep Alzheimer's patients home. They will need to start following the model that is available in states like Vermont.

I suppose this methodolgy is very close to the successful methods that Judy Berry is using at the Lakeview Ranch. Perhaps we can get her to write on this topic.

There are additional findings since the study described below was completed.

Would you be willing to pay for a caregiver training program that helped you deal with agitation, aggressiveness, repetitiveness, and taught you how to communicate more effectively with someone suffering from Alzheimer's disease?

Jefferson’s Center for Applied Research on Aging and Health (CARAH) Finds Tailored Activity Program (TAP) Minimizes Disruptive Behaviors In Dementia Patients Living at Home and Caregiver Burden

Encouraging homebound dementia patients to engage in customized activities reduces disruptive neuropsychiatric behaviors and caregiver burden, researchers at Thomas Jefferson University’s Center for Applied Research on Aging and Health (CARAH) report. The study, led by Laura N. Gitlin, PhD, Director of CARAH, appears in this month’s American Journal of Geriatric Psychiatry.

The study, “Tailored activities to Manage Neuropsychiatric Behaviors in Persons with Dementia and Reduce Caregiver Burden: A Randomized Pilot Study,” was conducted by the research team of Dr. Gitlin, Laraine Winter, Janice Burke, Nancy Chernett, Marie P. Dennis, and Walter W. Hauck.

The study furthers previous findings that purposeful activity is a safe, healthy alternative to pharmacological approaches in minimizing disruptive behavioral occurrences associated with dementia, such as agitation and aggressiveness.

According to CARAH, these behaviors are the most challenging aspects of caregiving and contribute to caregiver stress, depression, increased care costs, and risk for nursing home placement.

CARAH’s most recent study, supported by the National Institute of Mental Health, focused on community-living patients cared for at home by relatives whereas previous studies using activity therapy has focused exclusively on nursing home residents.

CARAH’s Tailored Activity Program (TAP) involves eight sessions, six home visits, and two telephone contacts by occupational therapists over four months. Contacts were spaced to allow caregivers to practice using the activities independently. I

In the first two home sessions, interventionists met with caregivers, introduced intervention goals, discerned daily routines, and identified previous and current activity interests of persons with dementia. Based on the assessment, interventionists developed written activity plans, or Activity Prescriptions, which specified patient capabilities, a specific activity, an activity goal, and specific implementation strategies.

Interventionists instructed caregivers on how to introduce activities and support activity engagement. Caregivers were provided specific skills such as how to communicate, use cueing and redirection as well as using stress-reducing techniques for themselves to help establish a calm emotional tone. OTs also taught caregivers how to downgrade the complexity of activities and prepare for future declines in capability.

The Tailored Activity Program is based on the environmental vulnerability/reduced stress threshold model, which asserts that with disease progression, dementia patients become increasingly vulnerable to their environment and experience lower thresholds for tolerating stimuli, which can result n behavioral disturbances. The intervention addressed this vulnerability by matching activities to cognitive and functional capabilities, as well as the previous roles, habits, and interests of the patient.

Patient and caregiver outcomes were measured after four months of participation in TAP. Patient outcomes included a reduction in the occurrence of negative behaviors such as agitation and argumentativeness. Caregivers also reported greater activity engagement and a trend toward overall improved life quality. Caregivers also benefited from participation in the study; many reported fewer hours doing things for patients and greater mastery and enhanced self-efficacy using activities and simplification techniques.

The overall results of the TAP study conducted by CARAH suggest positive benefits and very large symptom reductions as demonstrated in patient and caregiver outcomes. Treatments gains were found for the most frequently occurring behaviors, such as shadowing and repetitive questioning, and for agitation and argumentative behaviors, which research suggests trigger nursing home placement. Additionally, life quality improvements were found such that caregivers reported enhanced ability of their relative to derive pleasure and engage in activities.

Founded by Dr. Laura Gitlin, the Center for Applied Research on Aging and Health (CARAH), in the College of Health Professions of Thomas Jefferson University, seeks to improve the lives of older adults through research, training of health professionals and implementation of evidence-based clinical services.

CARAH is committed to enhancing the quality of life for older adults and family caregivers by developing, testing and disseminating innovative community and home-based health and human services. CARAH explores opportunities for academic-community partnerships and facilitates interdisciplinary approaches to problems of public health importance covering the topics of physical frailty, health disparities, dementia care, end of life comfort care, healthy aging, aging at home in place and quality of life issues.

Jacqueline Paquet

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Bob DeMarco is the editor of the Alzheimer's Reading Room and an Alzheimer's caregiver. Bob resides in Delray Beach, FL.

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