January 4, 2011
A home care program that used nurses and occupational therapists to aid people with Alzheimer’s in their homes brought benefits to patients as well as those caring for a loved one with the disease, researchers report. The benefits of such a program, which does not involve drugs or medications, could have a sizeable effect on the millions of men and women with Alzheimer’s who live at home. It could also help in reducing the stress of family members and others who care for them.
The home care program, known as COPE, for Care of Persons with Dementia in their Environments, was aimed at modifying factors in the home that could reduce the stress of caring for someone with Alzheimer’s. Part of the program involved working with Alzheimer’s patients and caregivers to assist with activities of daily living, such as getting dressed, bathing and eating meals. As the disease progresses, more help is required in carrying out such activities, adding to the care burden.
Designed by medical professionals at Thomas Jefferson University in Philadelphia, the program sought to reduce environmental factors in the home that might be contributing to agitation and poor patient outcomes. Occupational therapists trained caregivers how to handle specific situations, such as getting the patient dressed or fed in the simplest manner possible, with the aim of increasing patient participation. Caregivers were also advised about issues like home safety and stress management, and communicating with a loved one with Alzheimer’s. Nurses looked for any medical conditions, like constipation, dehydration or medication side effects or interactions, that might be causing problems for the patient.
Families received up to 10 in-home sessions with occupational therapists over four months, with an additional face-to-face session and a telephone session with a nurse. A control group got standard care, with three telephone calls from trained research staff members who were not occupational therapists or nurses and educational material.
The researchers found that there were statistically significant improvements in functional dependence for COPE patients at four months compared with control group patients. COPE caregivers also reported improvement in well-being and enhanced confidence, compared to those receiving the standard care.
After nine months, the researchers did not find statistically significant differences between the COPE patients and the control group. However, the caregivers who had received the COPE training reported a “great deal” of improvement in their lives overall, as well as in disease understanding, confidence managing behaviors, ability to care for patients, patients’ quality of life, and ability to keep patients home.
The findings, which were published in the Journal of the American Medical Association, add to a growing body of evidence that non-drug therapies can play an important role in caring for Alzheimer’s patients at home. Other programs, like those developed at the Silberstein Institute at New York University School of Medicine, have shown how a structured program of counseling and support can benefit Alzheimer’s patients and caregivers. (See the ALZinfo.org story, “Counseling and Support Benefits Alzheimer’s Caregivers Worldwide”.)
The results also underline the importance of looking for medical problems that may be contributing to patient discomfort and stress. Undiagnosed but treatable medical problems were identified in close to 40 percent of the dementia patients studied, a finding consistent with other recent studies.
Laura N. Gitlin; Laraine Winter; Marie P. Dennis; Nancy Hodgson; Walter W. Hauck: “A Biobehavioral Home-Based Intervention and the Well-being of Patients With Dementia and Their Caregivers: The COPE Randomized Trial.” Journal of the American Medical Association, Vol. 304 (No. 9). Sept. 1, 2010; pages 983-991.