Marie P. Dennis

A Randomized Trial of a Multicomponent Home Intervention to Reduce Functional Difficulties in Older Adults

OBJECTIVES: To test the efficacy of a multicomponent intervention to reduce functional difficulties, fear of falling, and home hazards and enhance self‐efficacy and adaptive coping in older adults with chronic conditions.

A Biobehavioral Home-Based Intervention and the Well-being of Patients With Dementia and Their Caregivers: The COPE Randomized Trial

CONTEXT Optimal treatment to postpone functional decline in patients with dementia is not established. OBJECTIVE To test a nonpharmacologic intervention realigning environmental demands with patient capabilities. DESIGN, SETTING, AND PARTICIPANTS Prospective 2-group randomized trial (Care of Persons with Dementia in their Environments [COPE]) involving patients with dementia and family caregivers (community-living dyads) recruited from March 2006 through June 2008 in Pennsylvania. INTERVENTIONS Up to 12 home or telephone contacts over 4 months by health professionals who assessed patient capabilities and deficits; obtained blood and urine samples; and trained families in home safety, simplifying tasks, and stress reduction. Control group caregivers received 3 telephone calls and educational materials. MAIN OUTCOME MEASURES Functional dependence, quality of life, frequency of agitated behaviors, and engagement for patients and well-being, confidence using activities, and perceived benefits for caregivers at 4 months. RESULTS Of 284 dyads screened, 270 (95%) were eligible and 237 (88%) randomized. Data were collected from 209 dyads (88%) at 4 months and 173 (73%) at 9 months. At 4 months, compared with controls, COPE patients had less functional dependence (adjusted mean difference, 0.24; 95% CI, 0.03-0.44; P = .02; Cohen d = 0.21) and less dependence in instrumental activities of daily living (adjusted mean difference, 0.32; 95% CI, 0.09-0.55; P = .007; Cohen d = 0.43), measured by a 15-item scale modeled after the Functional Independence Measure; COPE patients also had improved engagement (adjusted mean difference, 0.12; 95% CI, 0.07-0.22; P = .03; Cohen d = 0.26), measured by a 5-item scale. COPE caregivers improved in their well-being (adjusted mean difference in Perceived Change Index, 0.22; 95% CI, 0.08-0.36; P = .002; Cohen d = 0.30) and confidence using activities (adjusted mean difference, 0.81; 95% CI, 0.30-1.32; P = .002; Cohen d = 0.54), measured by a 5-item scale. By 4 months, 64 COPE dyads (62.7%) vs 48 control group dyads (44.9%) eliminated 1 or more caregiver-identified problems (chi(2/1) = 6.72, P = . 01). CONCLUSION Among community-living dyads, a nonpharmacologic biobehavioral environmental intervention compared with control resulted in better outcomes for COPE dyads at 4 months. Although no group differences were observed at 9 months for patients, COPE caregivers perceived greater benefits. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00259454.

Targeting and managing behavioral symptoms in individuals with dementia: a randomized trial of a nonpharmacological intervention.

OBJECTIVES: To test the effects of an intervention that helps families manage distressing behaviors in family members with dementia.

Effect of an In-Home Occupational and Physical Therapy Intervention on Reducing Mortality in Functionally Vulnerable Older People: Preliminary Findings

OBJECTIVES: To evaluate the effect of a multicomponent intervention on mortality and the role of control‐oriented strategy use as the change mechanism.

Long-term effect on mortality of a home intervention that reduces functional difficulties in older adults: results from a randomized trial.

OBJECTIVES: To evaluate the long‐term mortality effect of a home‐based intervention previously shown to reduce functional difficulties and whether survivorship benefits differ according to initial mortality risk level.

A non-pharmacological intervention to manage behavioral and psychological symptoms of dementia and reduce caregiver distress: Design and methods of project ACT3

Project ACT is a randomized controlled trial designed to test the effectiveness of a non-pharmacological home-based intervention to reduce behavioral and psychological symptoms of dementia (BPSD) and caregiver distress. The study targets 272 stressed racially diverse family caregivers providing in-home care to persons with moderate stage dementia with one or more behavioral disturbances. All participants are interviewed at baseline, 4-months (main trial endpoint), and 6-months (maintenance). The four-month intervention involves up to 13 visits from an occupational therapist who works with families to problem-solve potential triggers (communication style, environmental clutter) contributing to behaviors, and instruct in strategies to reduce caregiver stress and manage targeted behaviors. To rule out infection or other potential medical contributors to behaviors, a nurse obtains blood and urine samples from the dementia patient, and conducts a medication review. Participants in the no-treatment control group are offered the nurse arm and one in-home session following trial completion at 6-months. This paper describes the research methods, theoretical and clinical aspects of this multi-component, targeted psycho-social treatment approach, and the measures used to evaluate quality of life improvements for persons with dementia and their families.

Depressive Symptoms in Older African-American and White Adults with Functional Difficulties: The Role of Control Strategies

OBJECTIVES: To examine whether control‐oriented strategies buffer effects of functional difficulties on depressive symptoms over time in older African‐American and white adults with disability.

Assessing Perceived Change in the Well-being of Family Caregivers: Psychometric Properties of the Perceived Change Index and Response Patterns

The purpose of this study was to evaluate the psychometric properties of the Perceived Change Index (PCI), a 13-item scale that measures caregiver appraisals of self-improvement or decline in distinct areas of well-being, and to examine demographic differences in responses. The scale was administered to 255 care-givers participating at the Philadelphia site of the National Institute of Aging-funded Resources for Enhancing Alzheimer’s Caregiver Health initiative. Principal axis analysis with one half of the sample was used to evaluate factor structure. Evidence of convergent and divergent validity was examined using the second half of the sample. Differential response patterns by caregiver characteristics were also examined using regression analysis. Using one half of the sample, 3 underlying factors were found (affect, α = .85; somatic, α = .80; management, α = .76), accounting for 63% of the variance. The overall index was internally consistent (Cronbach’s α = .90). Using the second half of the sample, Pearson correlational analyses of the overall index and its subscales revealed that perceived improvement was significantly associated with fewer depressive symptoms, higher scores on perceived positive aspects of caregiving, and more participation in social activities. As expected, it was not associated with the care recipient’s Mini-Mental Status Examination scores or functional status. Perceived improvement scores for specific areas of well-being were associated with being African American, male, and a spouse. The PCI is a brief, easily administered, and valid self-report measure that can serve as an indicator of caregiver appraisal of well-being in research and clinical practice.

Cost Effectiveness of a Home-Based Intervention That Helps Functionally Vulnerable Older Adults Age in Place at Home

Evaluating cost effectiveness of interventions for aging in place is essential for adoption in service settings. We present the cost effectiveness of Advancing Better Living for Elders (ABLE), previously shown in a randomized trial to reduce functional difficulties and mortality in 319 community-dwelling elders. ABLE involved occupational and physical therapy sessions and home modifications to address client-identified functional difficulties, performance goals, and home safety. Incremental cost-effectiveness ratio (ICER), expressed as additional cost to bring about one additional year of life, was calculated. Two models were then developed to account for potential cost differences in implementing ABLE. Probabilistic sensitivity analyses were conducted to account for variations in model parameters. By two years, there were 30 deaths (9: ABLE; 21: control). Additional costs for 1 additional year of life was

Identification of and beliefs about depressive symptoms and preferred treatment approaches among community-living older African Americans.

13,179 for Model 1 and