Catherine Verrier Piersol

The Tailored Activity Program to Reduce Behavioral Symptoms in Individuals With Dementia: Feasibility, Acceptability, and Replication Potential

PURPOSE The Tailored Activity Program (TAP) is a home-based occupational therapy intervention shown to reduce behavioral symptoms and caregiver burden in a randomized trial. This article describes TAP, its assessments, acceptability, and replication potential. DESIGN AND METHODS 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. RESULTS 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. IMPLICATIONS TAP offers families knowledge of their relatives 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 behavioral symptoms.

Nonpharmacological Interventions to Reduce Behavioral and Psychological Symptoms of Dementia: A Systematic Review.

Introduction. Behavioral and psychological symptoms of dementia (BPSD) are defined as a group of symptoms of disturbed perceptive thought content, mood, or behavior that include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, and wandering. Care of patients with BPSD involves pharmacological and nonpharmacological interventions. We reviewed studies of nonpharmacological interventions published in the last 10 years. Methods. We performed a systematic review in Medline and Embase databases, in the last 10 years, until June 2015. Key words used were (1) non-pharmacological interventions, (2) behavioral symptoms, (3) psychological symptoms, and (4) dementia. Results. We included 20 studies published in this period. Among these studies, program activities were more frequent (five studies) and the symptoms more responsive to the interventions were agitation. Discussion. Studies are heterogeneous in many aspects, including size sample, intervention, and instruments of measures. Conclusion. Nonpharmacological interventions are able to provide positive results in reducing symptoms of BPSD. Most studies have shown that these interventions have important and significant efficacy.

Adaptive Equipment:: A Study of Utilization After Hospital Discharge

This article describes a quality assurance study of patient utilization of adaptive equipment. A major component of occupational therapy practice has been the prescription of equipment to increase independent living. However, little information exists in the literature regarding patients use of equipment. The researchers found an unexpected high rate (85%) of utilization. Reasons for non-utilization are described. Caution is needed in interpreting the results as non-responders (22%) may have been primarily non-users. Based on the findings, the authors suggest establishing a system to retrieve items needed for a short time and individualizing the process of issuing equipment based on environmental and personal needs as opposed to the standard protocol based on a diagnosis.

Reducing neuropsychiatric symptoms in persons with dementia and associated burden in family caregivers using tailored activities: Design and methods of a randomized clinical trial

Among over 5million people in the USA with dementia, neuropsychiatric symptoms (NPS) are almost universal, occurring across disease etiology and stage. If untreated, NPS can lead to significant morbidity and mortality including increased cost, distress, depression, and faster disease progression, as well as heightened burden on families. With few pharmacological solutions, identifying nonpharmacologic strategies is critical. We describe a randomized clinical trial, the Dementia Behavior Study, to test the efficacy of an activity program to reduce significant existing NPS and associated caregiver burden at 3 and 6months compared to a control group intervention. Occupational therapists deliver 8 in-home sessions over 3months to assess capabilities and interests of persons with dementia, home environments, and caregiver knowledge, and readiness from which activities are developed and families trained in their use. Families learn to modify activities for future declines and use strategies to address care challenges. The comparison group controls for time and attention and involves 8 in-home sessions delivered by health educators who provide dementia education, home safety recommendations, and advanced care planning. We are randomizing 250 racially diverse families (person with dementia and primary caregiver dyads) recruited from community-based social services, conferences and media announcements. The primary outcome is change in agitation/aggression at 3 and 6months. Secondary outcomes assess quality of life of persons with dementia, other behaviors, burden and confidence of caregivers, and cost and cost effectiveness. If benefits are supported, this activity intervention will provide a clinically meaningful approach to prevent, reduce, and manage NPS.

Efficacy and acceptability of a home-based, family-inclusive intervention for veterans with TBI: A randomized controlled trial

Abstract Objective: Traumatic brain injury (TBI) often undermines community re-integration, impairs functioning and produces other symptoms. This study tested an innovative programme for veterans with TBI, the Veterans’ In-home Programme (VIP), delivered in veterans’ homes, involving a family member and targeting the environment (social and physical) to promote community re-integration, mitigate difficulty with the most troubling TBI symptoms and facilitate daily functioning. Setting: Interviews and intervention sessions were conducted in homes or by telephone. Participants: Eighty-one veterans with TBI at a VA polytrauma programme and a key family member. Design: This was a 2-group randomized controlled trial. Control-group participants received usual-care enhanced by two attention-control telephone calls. Follow-up interviews occurred up to 4 months after baseline interview. Main measures: VIP’s efficacy was evaluated using measures of community re-integration, target outcomes reflecting veterans’ self-identified problems and self-rated functional competence. Results: At follow-up, VIP participants had significantly higher community re-integration scores and less difficulty managing targeted outcomes, compared to controls. Self-rated functional competence did not differ between groups. In addition, VIP’s acceptability was high. Conclusion: A home-based, family-inclusive service for veterans with TBI shows promise for improving meaningful outcomes and warrants further research and clinical application.

Exploration of individual and family factors related to community reintegration in veterans with traumatic brain injury

BACKGROUND: Community reintegration (CR) poses a major problem for military veterans who have experienced a traumatic brain injury (TBI). Factors contributing to CR after TBI are poorly understood. OBJECTIVE: To address the gap in knowledge, an ecological framework was used to explore individual and family factors related to CR. DESIGN: Baseline data from an intervention study with 83 veterans with primarily mild to moderate TBI were analyzed. Instruments measured CR, depressive symptoms, physical health, quality of the relationship with the family member, and sociodemographics. Posttraumatic stress disorder and TBI characteristics were determined through record review. RESULTS: Five variables that exhibited significant bivariate relationships with CR (veteran rating of quality of relationship, physical functioning, bodily pain, posttraumatic stress disorder diagnosis, and depressive symptoms) were entered into hierarchical regression analysis. In the final analysis, the five variables together accounted for 35% of the variance, but only depression was a significant predictor of CR, with more depressed veterans exhibiting lower CR. CONCLUSIONS: Efforts to support CR of Veterans with TBI should carefully assess and target depression, a modifiable factor.

The Let's Go Program for Community Participation: A Feasibility Study

ABSTRACT Community participation positively influences health and wellness. As individuals age, chronic disease and changes in physical and cognitive capacities may influence community participation in older adults resulting in social isolation, depression, and decreased health. Aims: The aim of this study was to evaluate the feasibility of implementing Lets Go, a four-week multimodal community mobility program designed to prevent decline in community participation in older adults (≥60 years old) living in an urban area who self-identified as having difficulty with community mobility. Methods: Using a pre–post measure design, participants’ (N = 7) knowledge, confidence, and participation in community mobility were evaluated. Results: All participants increased their knowledge of alternative transportation options and their confidence in community mobility. The majority of participants maintained or increased their autonomy outdoors and social participation (85.71%) and increased the frequency of community trips (85.71%). Conclusions: A multimodal community mobility program can increase community participation in older adults who report community mobility deficits. Additional studies are needed to support these findings.

Targeting Behavioral Symptoms and Functional Decline in Dementia: A Randomized Clinical Trial

Dementia‐related behavioral symptoms and functional dependence result in poor quality of life for persons with dementia and their caregivers. The goal was to determine whether a home‐based activity program (Tailored Activity Program; TAP‐VA) would reduce behavioral symptoms and functional dependence of veterans with dementia and caregiver burden.

Effectiveness of Interventions for Caregivers of People With Alzheimer’s Disease and Related Major Neurocognitive Disorders: A Systematic Review

OBJECTIVE. The goal of the evidence review was to evaluate the effectiveness of interventions for caregivers of people with Alzheimer’s disease and related major neurocognitive disorders that facilitate the ability to maintain participation in the caregiver role. METHOD. Scientific literature published in English between January 2006 and April 2014 was reviewed. Databases included MEDLINE, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews. RESULTS. Of 2,476 records screened, 43 studies met inclusion criteria. Strong evidence shows that multicomponent psychoeducational interventions improve caregiver quality of life (QOL), confidence, and self-efficacy and reduce burden; cognitive reframing reduces caregiver anxiety, depression, and stress; communication skills training improves caregiver skill and QOL in persons with dementia; mindfulness-based training improves caregiver mental health and reduces stress and burden; and professionally led support groups enhance caregiver QOL. CONCLUSION. Strong evidence exists for a spectrum of caregiver interventions. Translation of effective interventions into practice and evaluation of sustainability is necessary.

THE BRAZILIAN VERSION OF TAILORED ACTIVITY PROGRAM (TAP-BR) TO MANAGE NEUROPSYCHIATRIC BEHAVIORS IN PERSONS WITH DEMENTIA AND REDUCE CAREGIVER BURDEN IN BRAZIL: A RANDOMIZED PILOT STUDY

P3-362 THE BRAZILIAN VERSION OF TAILORED ACTIVITY PROGRAM (TAP-BR) TO MANAGE NEUROPSYCHIATRIC BEHAVIORS IN PERSONS WITH DEMENTIA AND REDUCE CAREGIVER BURDEN IN BRAZIL: A RANDOMIZED PILOT STUDY Marcia Maria Pires Camargo Novelli, Styfany Corrêa Machado, Gabriela Balestra de Lima, Lais Cantatore, Barbara Pereira de Sena, Renata Savino Rodrigues, Camyla Izys, Mariana Boaro Fernandez Canon, Ricardo Nitrini, Laura N. Gitlin, Catherine V. Piersol, Mônica Sanches Yassuda and Inter Professional Nucleus of Aging Research and Attendance (NIPAE), Federal University of S~ao Paulo, Santos, Brazil; University of S~ao Paulo Medical School, S~ao Paulo, Brazil; 3 Johns Hopkins University School of Nursing, Baltimore, MD, USA; 4 Thomas Jefferson University College of Health Professions, Philadelphia, PA, USA; University of S~ao Paulo, S~ao Paulo, Brazil. Contact e-mail: mnovelli@uol.com.br