Optimizing care for nursing home residents with dementia
More than half of the 1.4 million nursing home (NH) residents have a diagnosis of Alzheimer’s disease or dementia. Disruptions in daily routine, difficulty communicating needs, and environmental overstimulation or sensory deprivation in the NH setting often result in neuropsychiatric symptoms (NPS). If untreated, NPS, such as aggression and agitation, can result in adverse events (e.g., accidental falls), which increases the risk of hospitalization, death, and other negative outcomes. Nationally, 33% of NH residents with dementia are administered off-label psychotropic medications to address NPS. This comparative effectiveness study represents the first-ever evaluation of two non-pharmacologic approaches that address neuropsychiatric symptoms in residents with dementia: the transdisciplinary approach that builds a common language among providers to deliver integrated dementia care and the multidisciplinary approach that capitalizes on each provider’s specific expertise to deliver problem-based dementia care, across multiple nursing home settings and geographic regions. Dr. Piersol is working with a team of researchers and key stakeholders to transform the quality of dementia care to achieve the Center for Medicaid and Medicare’s goal of reducing off-label psychotropic use, a high priority for residents and their caregivers. Specifically, this study has the potential to address a critical clinical dilemma that leaves providers and families ill-equipped to reduce the use of off-label medications and sustain non-pharmacologic approaches. Driven by the clinical community, this study will be conducted within the clinical setting, and thus, aims to address the evidence gaps, which frontline staff has described and prioritized to enhance the likelihood of widespread adoption.
Non-pharmacologic interventions for people with dementia and their caregivers:
The prevalence of Alzheimer’s disease continues to rise in the United States with 70 percent of people with dementia cared for at home by family caregivers who play a vital role in the safety and well-being of the person with dementia. Behavioral symptoms are common and often upsetting and challenging for both the person with dementia and the caregiver. This on-going work involves testing the efficacy of ecologically driven (person-environment fit) non-pharmacologic interventions designed to reduce behavioral symptoms and dependency and promote activity engagement in the person with dementia, and reduce burden and increase the quality of life in the caregiver.
Translation of evidence in dementia interventions to real world settings
The translation, implementation, and evaluation of the effectiveness of evidence-based interventions for older adults and caregivers are critical elements to knowledge translation. This work within Jefferson Elder Care, established to bridge the gap between social-behavioral research and clinical practice, focuses on developing and implementing evidence-based clinical services to improve the daily lives of older adults and their families. Dr. Piersol leads training in Skills2Care® an evidence-based program for family caregivers that is delivered by an occupational therapist in a variety of practice settings.
Supporting adults with intellectual disability and dementia and their caregivers
Adults with intellectual disability (ID) are living longer and experiencing the same age-related changes as other older populations. Studies indicate the prevalence of dementia in persons with ID is about 5%, similar to the typical population. The evidence clearly identifies supervision, support, and training as important factors to mitigate staff stress that is experienced as part of performing the job responsibilities, especially when dealing with changing environmental demands and the specific needs of adults with ID and dementia. Dr. Piersol is collaborating with Dr. E. Adel Herge to advance evidence-based interventions for caregivers (informal and formal) who support the rising population of individuals with intellectual disability and dementia.
Community based Interventions for Veterans with Traumatic Brain Injury
Traumatic brain injury (TBI), the signature injury of the Iraq and Afghanistan wars, causes a broad range of cognitive and physical symptoms that inhibit community participation and compromise quality of life for Veterans and their families. Veterans In-home Program (VIP) is a community-based, family-inclusive rehabilitation intervention designed to support community integration and reduce depression and family member burden. Findings show that VIP with an occupational therapy based intervention had a positive impact on veteran performance and satisfaction with daily activities. On-going work with collaborators is focused on testing this model with civilians and in other types of settings.
Improving medication adherence and diabetes self-management in older adults
Diabetes is an epidemic. According to the Centers for Disease Control and Prevention (CDC), diabetes affects 9.3% of the population of the United States and the estimated total cost of diabetes in the United States in 2012 was $245 billion. Management of diabetes is a societal need, as much of the human and financial cost of diabetes is associated with unmanaged diabetes and the complications and sequelae of uncontrolled blood glucose. Occupational therapy brings a distinct contribution to inter-professional Diabetes Self-Management (DSM) efforts with its focus on everyday performance and adapting tasks and environments to an individual’s capacities and habits in order to optimize performance. Effective, sustained DSM depends on integrating DSM behaviors into daily routines and individualizing DSM demands to the capacities and habits of the individual. This emerging work with collaborators seeks to advance the evidence that promotes medication adherence, daily performance, and efficacy in individuals with diabetes.
Jefferson Elder Care Lab
The mission of Jefferson Elder Care is to improve the lives of older adults and caregivers through knowledge translation and best practices grounded in evidence and real-world experience. Researchers, educators, and practitioners of Jefferson Elder Care collaborate with community partners and professional organizations to deliver clinical services, training, and consultation, and engage in scholarship and research activities that optimize performance and participation of people as they age and build skills of caregivers. Link to lab’s website: www.jefferson.edu/eldercare