Home-Based Intervention Seems to Provide Some
Benefit to Dementia Patients, Caregivers
But, did not find statistically significant
differences for any outcome measure between COPE group and control group
at 9 months
Aug.
31, 2010 A program designed to improve the quality of life for
home-bound dementia patients and their caregivers found some success,
although caregivers perceived the greater benefits, according to a study
in the September 1 issue of the Journal of the American Medical
Association (JAMA).
Among the more than 5 million persons in the United
States with dementia, most live at home, and are cared for by family
members. With disease progression, families increasingly provide
hands-on physical assistance with activities of daily living (ADL), with
this often resulting in heightened caregiver distress.
"Trials of anti-dementia medications show few if
any benefits for physical function or caregiver burden and have
substantial adverse effects," the authors write. "Optimal treatment to
postpone functional decline in patients with dementia is not
established."
Most of today's primary care physicians are not
adequately trained to provide the complex care needed by older adults
with multiple chronic conditions
Older
population needing long-term care is large and growing. An estimated 10
million have enough trouble performing acts of daily living - like
bathing, dressing and eating - that they require assistance
The Care of Persons with Dementia in their
Environments (COPE) trial was designed by Laura N. Gitlin, Ph.D., of
Thomas Jefferson University, Philadelphia, and colleagues to test a
non-pharmacologic, bio-behavioral approach to support physical function
and quality of life for patients with dementia and the well-being of
their caregivers.
"The COPE program targeted modifiable environmental
stressors to decrease sensorial, physical, and cognitive demands and
align with patient capabilities and also ruled out underlying medical
conditions that could lead to reduced patient functioning. The
intervention sought to re-engage patients in daily activities and
increase functionality, thereby alleviating caregiver burden," the
researchers write.
The trial included patients with dementia and
family caregivers (community-living dyads [two individuals regarded as a
pair, such as a husband and wife]) who were recruited from March 2006
through June 2008. Of 284 couples screened, 270 (95 percent) were
eligible and 237 (88 percent) randomized.
Data were collected from 209 couples (88 percent)
at 4 months and 173 (73 percent) at 9 months.
The intervention consisted of up to 12 home or
telephone contacts over 4 months by health professionals who assessed
patient capabilities and deficits; obtained blood and urine samples; and
trained families in home safety, simplifying tasks and stress reduction.
Control group caregivers received 3 telephone calls and educational
materials.
The researchers found that there were statistically
significant improvements in functional dependence for COPE patients at 4
months compared with control group patients. Improvement occurred mostly
for instrumental activities of daily living (IADLs), and COPE patients
improved slightly more in ADL functioning than controls, but this was
not statistically significant. There were also small but statistically
significant improvements in engagement for COPE compared with control
patients.
COPE caregivers, compared with control group
caregivers, reported improvement in well-being and enhanced confidence
using activities. Of 112 caregivers (53.8 percent) reporting 1 or more
caregiver-identified problems eliminated by 4 months, 64 (62.7 percent)
were COPE caregivers and 48 (44.9 percent) were control group
caregivers.
The researchers did not find statistically
significant differences between the COPE group and the control group
participants at 9 months for any outcome measure.
"However, COPE compared with control caregivers
reported a 'great deal' of improvement in their lives overall, disease
understanding, confidence managing behaviors, made life easier, ability
to care for patients, patients' quality of life, and ability to keep
patients home."
"Because most patients live at home with functional
decline, a nonpharmacologic, biopsychosocial-environmental intervention
may positively contribute to disease management. Future research needs
to examine effects of underlying medical conditions, ways to boost
treatment effects, cost-effectiveness, COPE in combination with
pharmacologic treatments, and translational potential," the authors
conclude.
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Aug.
31, 2010 A program designed to improve the quality of life for
home-bound dementia patients and their caregivers found some success,
although caregivers perceived the greater benefits, according to a study
in the September 1 issue of the Journal of the American Medical
Association (JAMA). 
