Home-based activity program helps older veterans with dementia maintain function

November 29, 2017

People with dementia often have behavioral symptoms. These include problems with memory, language, and decision-making abilities. People with dementia can also experience changes in mood, such as increased irritability, depression, and anxiety. They often need assistance with their daily activities, such as feeding, dressing, using the toilet, and bathing themselves. These symptoms are often troubling for people with dementia, as well as for their caregivers.

These dementia symptoms can reduce quality of life for people as they age. This can make them dependent on other people, which can lead to caregivers feeling distressed. It may also lead to people with dementia being hospitalized or placed in a nursing home, even if it is not what they would prefer for their care.

There are no effective drug treatments for dementia or its symptoms. Therefore, researchers have been exploring treatment options to improve symptoms that don't involve using medication. A team of researchers studied one of those programs, called the Tailored Activity Program (TAP). TAP matches activities to the interests and abilities of people with dementia. Then it teaches caregivers how to use those activities daily.

The researchers initially reported positive results in a small study of 60 . They then studied TAP in a larger group of veterans living with dementia. They reported their results in the Journal of the American Geriatrics Society.

The researchers studied 160 veterans diagnosed with dementia and whose average age was 80. The study also included 160 of the veterans' caregivers, who were mostly women around 72-years-old.

TAP included up to eight in-home sessions led by occupational therapists ( who focus on helping us participate in the activities of everyday life). During the first two sessions, these health professionals evaluated the veterans' risk for falls, their daily routines and habits, and their previous and current interests. They also examined the veterans' , including lighting, seating, clutter, and noise. They looked as well at the interests and abilities of the veterans' caregivers. Based on the assessment, the therapists provided an "assessment report" and offered three " prescriptions."

The therapists showed the veterans and caregivers how to set up the activities and use them every day. They also provided written instructions for the caregivers. The instructions covered activity goals for the individual veteran and communication strategies for the . They also instructed caregivers on ways that they could modify the home environment to help the veteran participate in the activity. The therapists worked with the veterans to show the caregivers how to use activities. They had caregivers practice recommended . They also provided on-going education to help caregivers understand dementia and its behavioral symptoms.

During the last two sessions, caregivers learned how to simplify activities as the veterans' abilities declined. They also learned strategies to make care challenges like bathing easier.

A control group of caregivers received eight telephone sessions with a trained research team member who offered caregiver education about home safety and dementia. The researchers did not offer information about activities or to this group.

After four months, nearly 70 percent of the veterans in the TAP group either eliminated or reduced the frequency and severity of their -related behaviors. This is compared to 46 percent of the veterans in the control group. Also, caregivers in the TAP group reported that the veterans were less dependent on them as they performed their . Caregivers in the TAP group reported less distress due to the veterans' behaviors, too.

The researchers concluded that TAP offers immediate benefits to the veterans and their caregivers.

Explore further: Effects of at-home cognitive stimulation therapy on dementia patients and caregivers

More information: Laura N. Gitlin et al, Targeting Behavioral Symptoms and Functional Decline in Dementia: A Randomized Clinical Trial, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.15194

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