Home visiting intervention with Psychologist and OT (Nobili)

 “Structured intervention on caregivers of patients with dementia and problem behaviors”

Principal Investigator(s): Alessandro Nobili1, MD; Emma Riva1, MD, PhD; Gabriella Salvini Porro1, MS.

Institutional Affiliation: 1. Istituto di Ricerche Farmacologiche “Mario Negri”, via Eritrea 62; 20157 Milan, Italy. 2. Federazione Alzheimer Italia, via Marino 7; 20121 Milan, Italy

Caregiver Intervention Description

1. Summary of Intervention

Our intervention consisted of separate home visit by a psychologist and an occupational therapist. Each visit lasted an average of 60-90 minutes. The psychologist discussed with the family the dynamic among relatives, the caregiver stress and its psychological consequences, verbal and nonverbal communication between caregiver and patient, changes in the patient’s personality, and how the caregiver managed problem behavior. The occupational therapist gave practical advice on strategies to prevent and manage problem behavior, to maintain and/or improve the patient’s residual functional abilities, to modify home barriers, to limit dangerous situations, and to adapt the environment to meet the patient’s needs.

The effect of the structured intervention was seen mostly on the reduction of the frequency of behavioral problem, particularly psychic agitation and delusion, and to a lesser extent on time spent for caring. Another positive effect was the reduction of caregivers’ stress.

Key search terms:

Psychological and occupational therapy advices and support to caregivers (structured intervention).

2. Intervention Materials

Description of materials used in the intervention:

The Italian version of the “Information manual for caregivers” prepared by the Alzheimer Europe Association; a list of physicians and/or clinical centers dealing with AD patients to contact in case of needs.

Contact information for further information, materials, and training:

Alessandro Nobili (nobili@marionegri.it)
Emma Riva (riva@marionegri.it)

3. Implementing the Intervention

Training qualifications and guidelines for those delivering the intervention:

Training ad-hoc (to the persons that answered telephone calls; Occupational therapists; Psychologists.

Estimated costs of implementing the intervention:

US Dollars: 15.000/year (personnel salaries not included).

Caveats/ limitations on the implementation of this intervention:

To obtain written informed consent; to organize home visits.

Other useful information for implementing the intervention:

More frequent visits (e.g., monthly) by psychologists, occupational therapists should be done, both for support and periodical assessment. The involvement of the referent physician or clinical center is also advised.

4. For more information

Nobili A, Riva E, Tettamanti M, et al. The effect of a structured intervention on caregivers of patients with dementia and problem behaviors. A randomized controlled pilot study. Alzheimer Dis. Assoc Disoerd 2004;18:75-82.