Jefferson’s Center for Applied Research on Aging and Health (CARAH) Finds
Tailored Activity Program (TAP) Minimizes Disruptive Behaviors
In Dementia Patients Living at Home and Caregiver Burden

Encouraging homebound dementia patients to engage in customized activities reduces disruptive neuropsychiatric behaviors and caregiver burden, researchers at Thomas Jefferson University’s Center for Applied Research on Aging and Health (CARAH) report. The study, led by Laura N. Gitlin, PhD, Director of CARAH, appears in this month’s American Journal of Geriatric Psychiatry.

The study, “Tailored activities to Manage Neuropsychiatric Behaviors in Persons with Dementia and Reduce Caregiver Burden: A Randomized Pilot Study,” was conducted by the research team of Dr. Gitlin, Laraine Winter, Janice Burke, Nancy Chernett, Marie P. Dennis, and Walter W. Hauck.  It furthers previous findings that purposeful activity is a safe, healthy alternative to pharmacological approaches in minimizing disruptive behavioral occurrences associated with dementia, such as agitation and aggressiveness. According to CARAH, these behaviors are the most challenging aspects of caregiving and contribute to caregiver stress, depression, increased care costs, and risk for nursing home placement. CARAH’s most recent study, supported by the National Institute of Mental Health, focused on community-living patients cared for at home by relatives whereas previous studies using activity therapy has focused exclusively on nursing home residents. 

CARAH’s Tailored Activity Program (TAP) involves eight sessions, six home visits, and two telephone contacts by occupational therapists over four months. Contacts were spaced to allow caregivers to practice using the activities independently. In the first two home sessions, interventionists met with caregivers, introduced intervention goals, discerned daily routines, and identified previous and current activity interests of persons with dementia. Based on the assessment, interventionists developed written activity plans, or Activity Prescriptions, which specified patient capabilities, a specific activity, an activity goal, and specific implementation strategies.  Interventionists instructed caregivers on how to introduce activities and support activity engagement. Caregivers were provided specific skills such as how to communicate, use cueing and redirection as well as using stress-reducing techniques for themselves to help establish a calm emotional tone. OTs also taught caregivers how to downgrade the complexity of activities and prepare for future declines in capability.

 The Tailored Activity Program is based on the environmental vulnerability/reduced stress threshold model, which asserts that with disease progression, dementia patients become increasingly vulnerable to their environment and experience lower thresholds for tolerating stimuli, which can result n behavioral disturbances. The intervention addressed this vulnerability by matching activities to cognitive and functional capabilities, as well as the previous roles, habits, and interests of the patient.

Patient and caregiver outcomes were measured after four months of participation in TAP. Patient outcomes included a reduction in the occurrence of negative behaviors such as agitation and argumentativeness. Caregivers also reported greater activity engagement and a trend toward overall improved life quality. Caregivers also benefited from participation in the study; many reported fewer hours doing things for patients and greater mastery and enhanced self-efficacy using activities and simplification techniques.  

The overall results of the TAP study conducted by CARAH suggest positive benefits and very large symptom reductions as demonstrated in patient and caregiver outcomes. Treatments gains were found for the most frequently occurring behaviors, such as shadowing and repetitive questioning, and for agitation and argumentative behaviors, which research suggests trigger nursing home placement. Additionally, life quality improvements were found such that caregivers reported enhanced ability of their relative to derive pleasure and engage in activities. 

Founded by Dr. Laura Gitlin, the Center for Applied Research on Aging and Health (CARAH), in the College of Health Professions of Thomas Jefferson University, seeks to improve the lives of older adults through research, training of health professionals and implementation of evidence-based clinical services. CARAH is committed to enhancing the quality of life for older adults and family caregivers by developing, testing and disseminating innovative community and home-based health and human services. CARAH explores opportunities for academic-community partnerships and facilitates interdisciplinary approaches to problems of public health importance covering the topics of physical frailty, health disparities, dementia care, end of life comfort care, healthy aging, aging at home in place and quality of life issues. Learn more about CARAH’s research at http://www.jefferson.edu/jchp/carah/

Contact:
Jacqueline Paquet
215-503-1918
Jacqueline.Paquet@jefferson.edu

Published: March 3, 2008