Tailored activities to manage neuropsychiatric behaviors in persons with dementia and reduce caregiver burden: A randomized pilot study
Tailored activities to manage neuropsychiatric behaviors in persons with dementia and reduce caregiver burden: A randomized pilot study
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DOI：
10.1097/jgp.0b013e318160da72
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发表时间：
2008-03-01
影响因子：
7.2
通讯作者：
Hauck, Walter W.
中科院分区：
文献类型：
--
作者：
Gitlin, Laura N.;Winter, Laraine;Hauck, Walter W.
目的：测试定制活动计划（TAP）是否减少痴呆相关的神经精神行为，促进活动参与，并提高照顾者的幸福感。设计：前瞻性、两组（治疗、等待列表对照）、随机、对照初步研究，以4个月为主要试验终点。在4个月时，对照组接受TAP干预，并在4个月后重新评估。地点：患者家中。参与者：60名痴呆患者和家庭照顾者。干预措施：八届职业治疗干预涉及神经心理和功能测试，选择和定制的活动，以匹配测试中确定的能力，并指导护理人员使用的活动。测量值：痴呆患者的行为发生、活动参与和生活质量;照顾者的客观和主观负担及技能提高。结果如下：在4个月时，与对照组相比，干预护理人员报告问题行为的频率降低，特别是阴影和重复提问，以及更大的活动参与，包括保持忙碌的能力。较少干预护理人员报告躁动或争论。照顾者的好处包括更少的时间做事情和值班，更好的掌握，自我效能和技能提高。干预后的等待名单控制参与者显示出类似的好处，减少行为频率和照顾者为病人做事情的时间和掌握。有抑郁症状的照顾者获得的治疗益处与非抑郁的照顾者相似。结论：根据痴呆症患者的能力量身定制活动，并培训家庭使用活动，为患者和护理人员带来了临床相关的益处。治疗最大限度地减少触发行为的养老院安置和减少客观照顾者的负担。值得注意的是，抑郁的照顾者有效地参与并受益于干预。
Objective: To test whether the Tailored Activity Program (TAP) reduces dementia-related neuropsychiatric behaviors, promotes activity engagement, and enhances caregiver wellbeing. Design: Prospective, two-group (treatment, wait-list control), randomized, controlled pilot study with 4 months as main trial endpoint. At 4 months, controls received the TAP intervention and were reassessed 4 months later. Setting: Patients' homes. Participants: Sixty dementia patients and family caregivers. Intervention: The eight-session occupational therapy intervention involved neuropsychological and functional testing, selection, and customization of activities to match capabilities identified in testing, and instruction to caregivers in use of activities. Measurements: Behavioral occurrences, activity engagement, and quality of life in dementia patients; objective and subjective burden and skill enhancement in caregivers. Results: At 4 months, compared with controls, intervention caregivers reported reduced frequency of problem behaviors, and specifically for shadowing and repetitive questioning, and greater activity engagement including the ability to keep busy. Fewer intervention caregivers reported agitation or argumentation. Caregiver benefits included fewer hours doing things and being on duty, greater mastery, self-efficacy, and skill enhancement. Wait-list control participants following intervention showed similar benefits for reductions in behavioral frequency and caregiver hours doing things for the patient and mastery. Caregivers with depressed symptoms derived treatment benefits similar to nondepressed caregivers. Conclusions: Tailoring activities to the capabilities of dementia patients and training families in activity use resulted in clinically relevant benefits for patients and caregivers. Treatment minimized trigger behaviors for nursing home placement and reduced objective caregiver burden. Noteworthy is that depressed caregivers effectively engaged in and benefited from the intervention.