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A Randomized Controlled Trial of a Home Environmental Intervention: Effect on Efficacy and upset in Caregivers and on Daily Function of Persons with Dementia.

Caregiver Intervention Description

The intervention involved 5, 90 minute home visits by an occupational therapist who evaluates the home environment, observes performance of the person with dementia and the caregiving and communication style of the caregiver. Based on this assessment and in-depth interview with the caregiver regarding their specific daily issues, concerns and challenges, the interventionist provides basic education about dementia and the stressors of caregiving, and trains in specific strategies to help caregivers cope with daily care challenges. Strategies that are provided reflect simple modifications to the physical environment (e.g., removal of hazardous objects, use of a memory board or daily calendar) and social environment (e.g., communication techniques, cueing and approaches to simplifying everyday tasks), as well as basic problem solving and stress management techniques.

Since this intervention has been tested, we have since expanded it to a 6 home visit and included a physical therapy component. This intervention component involves one, one hour physical therapy home visit involving instruction to caregivers in proper body mechanics when assisting in bathing, dressing, ambulation, in helping a person recover from a fall, and in learning how to fall safely. (See Gitlin et al., 2003 in The Gerontologis; and Cornman-Levy, D., Gitlin, L. N., Corcoran, M., & Schinfeld, S. (2001). Caregiver aches and pains: The role of physical therapy in helping families provide daily care. Alzheimer’s Care Quarterly, 2, 47-55).

2. Intervention Materials

Interventionists provide caregivers a list of strategies specific to their care challenges.

Caregivers are also provided education materials from the Alzheimer’s Association and/or Mace and Rabins, 36 Hour Day, when appropriate.

Contact Information:

Laura N. Gitlin, Ph.D.
Director, Center for Applied Research on Aging and Health
Jefferson College of Health Professions
130 S. 9th Street, Suite 513
Philadelphia, PA 19107

Tele: 215 503-2896
Fax: 215 923-2475

3. Implementing the Intervention

Given the observation of performance of both caregiver and person with dementia required for this intervention, it represents a skilled level of service delivered by occupational therapists. Occupational therapists with home care or dementia care experience are eligible for training in the delivery of the intervention. Training requires 35 hours of readings, didactic and experiential learning in the elements of the intervention. In training, interventionists learn: 1) how to effectively collaborate with the caregiver, 2) how to understand the cultural tenets of the caregiver-patient dyad that structure and inform caregiving in the home environment, 3) how to develop strategies that are tailored to individual problems and which resonate with cultural values of the dyad, 4) how to validate caregiver efforts and reinforce use of strategies, and 5) a range of strategies for specific problem areas. Likewise for the physical therapist, critical to their training is learning how to work collaboratively with the caregiver in providing training.

Availability of Training: We are currently seeking funding to establish a training institute in which this and the related interventions we have tested can be provided systematically. We are in the process of refining certification procedures, training slides and materials.

Costs of implementation: We are currently in the process of establishing costs.

Categories of Costs of implementation include the following:

1. 35 hour training (includes readings, didactic and experiential components)

4. Access to our web page (under construction) to obtain specific proven strategies and action plans

5. Development of action plans (written 2-3 page documents that outline specific strategies to address a targeted problem area).

4. For more information

Gitlin, L. N. & Corcoran, M. (2005). Occupational therapy and dementia care: The home environment skill-building program for individuals and families. American Occupational Therapy Association.

Gitlin, L. N. & Gywther, L. P. (2003). In-home interventions: Helping caregivers where they live. In D. Coon, D. Gallagher-Thompson, D., Thompson, L. (Eds.) Innovative interventions to reduce caregiver distress: A clinical guide (pp. 139-160). New York: Springer Publications.

Gitlin, L. N., Winter, L., Corcoran, M., Dennis, M., Schinfeld, S., & Hauck, W. (2003). Effects of the Home Environmental Skill-building Program on the Caregiver-Care Recipient Dyad: Six-month Outcomes from the Philadelphia REACH Initiative. The Gerontologist, 43(4), 532-546.

Gitlin, L. N., Schinfeld, S., Winter, L., Corcoran, M., & Hauck, W. (2002). Evaluating home environments of person with dementia: Interrater reliability and validity of the home environmental assessment protocol (HEAP). Disability and Rehabilitation, 24, 59-71.

Gitlin, L. N. Winter, L., Dennis, M., Corcoran, M, Schinfeld, S., & Hauck, W. (2002). Strategies used by families to simplify tasks for individuals with Alzheimer's disease and related disorders: Psychometric analysis of the task management strategy index (TMSI). The Gerontologist, 42, 61-69.

Corcoran, M., & Gitlin, L. N. (2001). Family caregiver acceptance and use of environmental strategies in occupational therapy intervention. Physical & Occupational Therapy in Geriatrics, 19(1), 1-20.

Cornman-Levy, D., Gitlin, L. N., Corcoran, M., & Schinfeld, S. (2001). Caregiver aches and pains: The role of physical therapy in helping families provide daily care. Alzheimer’s Care Quarterly, 2, 47-55.

Toth-Cohen, S., Gitlin, L. N., Corcoran, M., Eckhardt, S., Johns, P., & Lipsett, R. (2001). Providing services to family caregivers at home: Challenges and recommendations for health and human service professions. Alzheimer’s Care Quarterly, 2, 23-32.

Gitlin, L. N., Corcoran, M. (2000). Making homes safer: Environmental adaptations for people with dementia. Alzheimer’s Care Quarterly, 1, 50-58.

Gitlin, L. N., Corcoran, M., Winter, L., Boyce, A., & Marcus, S. (1999). Predicting participation and adherence to a home environmental intervention among family caregivers of dementia patients. Family Relations, 48, 363-372.