Community based occupational therapy for patients with dementia and their care givers: randomised controlled trial. Randomized controlled trial of a dementia care programme for families of home-resided older people with dementia. Primary vs subspecialty care: a structured follow-up of dementia patients and their caregivers. Goal-oriented cognitive rehabilitation for people with early-stage Alzheimer disease: a single-blind randomized controlled trial of clinical efficacy. A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers: the COPE randomized trial. Reality orientation therapy combined with cholinesterase inhibitors in Alzheimer's disease: randomised controlled trial. A randomized, controlled trial of a home environmental intervention: effect on efficacy and upset in caregivers and on daily function of persons with dementia. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial. Tailored activities to manage neuropsychiatric behaviors in persons with dementia and reduce caregiver burden: a randomized pilot study. Effectiveness of case management among older adults with early symptoms of dementia and their primary informal caregivers: a randomized clinical trial. Effects of the Medicare Alzheimer's Disease Demonstration on nursing home entry. Early-stage memory loss support groups: outcomes from a randomized controlled clinical trial. The Effectiveness of a Home Care Program for Supporting Caregivers of Persons with Dementia in Developing Countries: A Randomised Controlled Trial from Goa, India Family care as collaboration: effectiveness of a multicomponent support program for elderly couples with dementia. Randomized controlled intervention study. Anger and depression management: psychoeducational skill training interventions for women caregivers of a relative with dementia. Behavioral treatment of depression in dementia patients: a controlled clinical trial. Effect of a training programme to reduce stress in carers of patients with dementia. Caregiver Supports: Outcomes From the Medicare Alzheimer's Disease Demonstration Process evaluation to explore internal and external validity of the "Act in Case of Depression" care program in nursing homes. A randomized, controlled study of an Alzheimer's caregiver skills training program Targeting and managing behavioral symptoms in individuals with dementia: a randomized trial of a nonpharmacological intervention. Effects of community occupational therapy on quality of life, mood, and health status in dementia patients and their caregivers: a randomized controlled trial. Increasing walking and bright light exposure to improve sleep in community-dwelling persons with Alzheimer's disease: results of a randomized, controlled trial. Integrative psychotherapeutic nursing home program to reduce multiple psychiatric symptoms of cognitively impaired patients and caregiver burden: randomized controlled trial. Do memory clinics improve the quality of life of carers? A randomized pilot trial. Effects of the home environmental skill-building program on the caregiver-care recipient dyad: 6-month outcomes from the Philadelphia REACH Initiative. Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial. Effects of the Medicare Alzheimer's Disease Demonstration on caregiver burden and depression. Nighttime insomnia treatment and education for Alzheimer's disease: a randomized, controlled trial. The Prince Henry Hospital dementia caregivers' training programme. Effects of supporting community-living demented patients and their caregivers: a randomized trial. Reducing caregiver burden: a randomized psychoeducational intervention for caregivers of persons with dementia. A multicentre RCT on community occupational therapy in Alzheimer's disease: 10 sessions are not better than one consultation Why did an effective Dutch complex psycho-social intervention for people with dementia not work in the German healthcare context? Lessons learnt from a process evaluation alongside a multicentre RCT
OBJECTIVE To determine the effectiveness of community based occupational therapy on daily functioning of patients with dementia and the sense of competence of their care givers . DESIGN Single blind r and omised controlled trial . Assessors were blinded for treatment allocation . SETTING Memory clinic and day clinic of a geriatrics department and participants ' homes . PARTICIPANTS 135 patients aged > or = 65 with mild to moderate dementia living in the community and their primary care givers . INTERVENTIONS 10 sessions of occupational therapy over five weeks , including cognitive and behavioural interventions , to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision . MAIN OUTCOME MEASURES Patients ' daily functioning assessed with the assessment of motor and process skills ( AMPS ) and the performance scale of the interview of deterioration in daily activities in dementia ( IDDD ) . Care giver burden assessed with the sense of competence question naire ( SCQ ) . Participants were evaluated at baseline , six weeks , and three months . RESULTS Scores improved significantly relative to baseline in patients and care givers in the intervention group compared with the controls ( differences were 1.5 ( 95 % confidence interval 1.3 to 1.7 ) for the process scale ; -11.7 ( -13.6 to -9.7 ) for the performance scale ; and ( 11.0 ; 9.2 to 12.8 ) for the competence scale ) . This improvement was still significant at three months . The number needed to treat to reach a clinical ly relevant improvement in motor and process skills score was 1.3 ( 1.2 to 1.4 ) at six weeks . Effect sizes were 2.5 , 2.3 , and 1.2 , respectively , at six weeks and 2.7 , 2.4 , and 0.8 , respectively , at 12 weeks . CONCLUSIONS Occupational therapy improved patients '  daily functioning and reduced the burden on the care giver , despite the patients ' limited learning ability . Effects were still present at 12 weeks , which justifies implementation of this intervention . TRIAL REGISTRATION Clinical Trials NCT00295152 [ Clinical Trials.gov ] AIM This paper reports a study to examine the effectiveness of a 6-month dementia care programme for Chinese families living with and caring for a relative with dementia , compared with routine family support services in Hong Kong . BACKGROUND Recognizing the adverse psychosocial health effects inherent in dementia care , different psychosocial interventions provided preliminary evidence of their effectiveness in improving family members ' knowledge and skills in caregiving and delaying dementia sufferers ' illness deterioration and institutionalization . Little is known about the effects of such interventions for family caregivers ' psychosocial health conditions , particularly in non-Western population s. METHODS A r and omized controlled trial was conducted with 92 Chinese families of a relative with dementia in two dementia care centres in Hong Kong . They were r and omly selected from a dementia client list and then r and omly assigned to receive either the dementia family care programme ( n=46 ) , or routine care only ( n=46 ) . Clients ' symptoms and institutionalization , and caregivers ' quality of life , burden and social support at recruitment , 1 week , and 12 and 18 months following intervention were measured and compared between the study groups using repeated measures MANOVAS followed by Helmert 's contrast tests . Data was collected over a period of 24 months , between September 2007 and August 2009 . RESULTS Results of the MANOVAS and contrast tests indicated that at 18-month follow-up , participants in the family programme reported significantly greater improvements in clients ' symptoms and institutionalization rates , and caregivers ' quality of life and burden , when compared with their counterparts in the routine care group . CONCLUSION These findings provide evidence that the dementia care family programme can improve the psychosocial functioning of both clients with dementia and their family caregivers in a Chinese population . Further research is recommended to investigate whether this intervention can also apply to families with different socio-economic background s and across cultures All dementia patients and their caregivers who had received a University-based comprehensive evaluation and a diagnosis of Alzheimer 's disease during 1997 ( N = 80 ) were surveyed 1 year after their initial assessment . Of the original cohort , 72.5 % were contacted , and two subgroups were defined : 31 patients were being seen only by their primary care physicians ( MED ) , and 27 patients were being treated in addition by a geriatric psychiatry faculty member ( GERO ) . There were statistically significant differences between the two groups ( MED vs. GERO , respectively ) at follow-up in terms of : 1 ) hospitalization ( 39 % vs. 15 % ; P < O.05 ) ; 2 ) cognitive status ( P < O.05 ) ; and 3 ) prescription of donepezil  at follow-up ( 35 % vs. 64 % ; P < O. 005 ) . These differences need to be assessed in a larger-scale prospect i ve study OBJECTIVES To provide evidence regarding the clinical efficacy of cognitive rehabilitation ( CR ) in early-stage Alzheimer disease ( AD ) . DESIGN Single-blind r and omized controlled trial comparing CR with relaxation therapy and no treatment . SETTING Outpatient , community-based setting . PARTICIPANTS Sixty-nine individuals ( 41 women , 28 men ; mean age 77.78 years , st and ard deviation 6.32 , range = 56 - 89 ) with a diagnosis of AD or mixed AD and vascular dementia and a Mini-Mental State Examination score of 18 or above , and receiving a stable dose of acetylcholinesterase-inhibiting medication . Forty-four family carers also contributed . INTERVENTION Eight weekly individual sessions of CR consisting of personalized interventions to address individually relevant goals supported by components addressing practical aids and strategies , techniques for learning new information , practice in maintaining attention and concentration , and techniques for stress management . MEASUREMENTS The primary outcomes were goal performance and satisfaction , assessed using the Canadian Occupational Performance Measure . Question naires assessing mood , quality of life and career strain , and a brief neuropsychological test battery were also administered . A subset of participants underwent functional magnetic resonance imaging ( fMRI ) . RESULTS CR produced significant improvement in ratings of goal performance and satisfaction , whereas scores in the other two groups did not change . Behavioral changes in the CR group were supported by fMRI data for a subset of participants . CONCLUSIONS The findings support the clinical efficacy of CR in early-stage AD . CR offers a means of assisting people with early-stage AD and their families in managing the effects of the condition CONTEXT Optimal treatment to postpone functional decline in patients with dementia is not established . OBJECTIVE To test a nonpharmacologic intervention realigning environmental dem and s with patient capabilities . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve 2-group r and omized trial ( Care of Persons with Dementia in their Environments [ COPE ] ) involving patients with dementia and family caregivers ( community-living dyads ) recruited from March 2006 through June 2008 in Pennsylvania . INTERVENTIONS Up to 12 home or telephone contacts over 4 months by health professionals who assessed patient capabilities and deficits ; obtained blood and urine sample s ; and trained families in home safety , simplifying tasks , and stress reduction . Control group caregivers received 3 telephone calls and educational material s. MAIN OUTCOME MEASURES Functional dependence , quality of life , frequency of agitated behaviors , and engagement for patients and well-being , confidence using activities , and perceived benefits for caregivers at 4 months . RESULTS Of 284 dyads screened , 270 ( 95 % ) were eligible and 237 ( 88 % ) r and omized . Data were collected from 209 dyads ( 88 % ) at 4 months and 173 ( 73 % ) at 9 months . At 4 months , compared with controls , COPE patients had less functional dependence ( adjusted mean difference , 0.24 ; 95 % CI , 0.03 - 0.44 ; P = .02 ; Cohen d = 0.21 ) and less dependence in instrumental activities of daily living ( adjusted mean difference , 0.32 ; 95 % CI , 0.09 - 0.55 ; P = .007 ; Cohen d = 0.43 ) , measured by a 15-item scale modeled after the Functional Independence Measure ; COPE patients also had improved engagement ( adjusted mean difference , 0.12 ; 95 % CI , 0.07 - 0.22 ; P = .03 ; Cohen d = 0.26 ) , measured by a 5-item scale . COPE caregivers improved in their well-being ( adjusted mean difference in Perceived Change Index , 0.22 ; 95 % CI , 0.08 - 0.36 ; P = .002 ; Cohen d = 0.30 ) and confidence using activities ( adjusted mean difference , 0.81 ; 95 % CI , 0.30 - 1.32 ; P = .002 ; Cohen d = 0.54 ) , measured by a 5-item scale . By 4 months , 64 COPE dyads ( 62.7 % ) vs 48 control group dyads ( 44.9 % ) eliminated 1 or more caregiver-identified problems ( chi(2/1 ) = 6.72 , P = . 01 ) . CONCLUSION Among community-living dyads , a nonpharmacologic biobehavioral environmental intervention compared with control result ed in better outcomes for COPE dyads at 4 months . Although no group differences were observed at 9 months for patients , COPE caregivers perceived greater benefits . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00259454 BACKGROUND Reality orientation therapy combined with cholinesterase inhibitors has not been evaluated in patients with Alzheimer 's disease . AIMS To perform such an evaluation . METHOD We r and omly assigned 79 of 156 patients treated with donepezil  to receive a reality orientation programme . Caregivers of the treatment group were trained to offer the programme at home 3 days a week , 30 min/day , for 25 consecutive weeks , and were invited to stimulate and involve patients in reality-based communication . RESULTS The treatment group showed a slight improvement in Mini-Mental State Examination ( MMSE ) scores ( mean change + 0.2 , s.e.=0.4 ) compared with a decline in the control group ( mean change -1.1 , s.e.=0.4 ; P=0.02 ) . Similarly for the Alzheimer 's Disease Assessment Scale -- Cognition ( treatment group mean change + 0.4 , s.e.=0.8 ; control group -2.5 , s.e.=0.8 ; P=0.01 ) . The intervention had an equal effect on cognition in those with mild ( MMSE score > or = 20 ) and moderate ( score < 20 ) dementia . No significant effect was observed for behavioural and functional outcomes . CONCLUSIONS Reality orientation enhances the effects of donepezil on cognition in Alzheimer 's disease PURPOSE OF STUDY The authors determined short-term effects of a home environmental intervention on self-efficacy and upset in caregivers and daily function of dementia patients . They also determined if treatment effect varied by caregiver gender , race , and relationship to patient . DESIGN AND METHODS Families ( N = 171 ) of dementia patients were r and omized to intervention or usual care control group .  The intervention involved 5 90-min home visits by occupational therapists who provided education and physical and social environmental modifications . RESULTS Compared with controls , intervention caregivers reported fewer declines in patients ' instrumental activities of daily living ( p = .030 ) and less decline in self-care and fewer behavior problems in patients at 3 months post-test . Also , intervention spouses reported reduced upset ( p = .049 ) , women reported enhanced self-efficacy in managing behaviors ( p = .038 ) , and women ( p = .049 ) and minorities ( p = .037 ) reported enhanced self-efficacy in managing functional dependency . IMPLICATION S The environmental program appears to have a modest effect on dementia patients ' IADL dependence . Also , among certain subgroups of caregivers the program improves self-efficacy and reduces upset in specific areas of caregiving CONTEXT Most older adults with dementia will be cared for by primary care physicians , but the primary care practice environment presents important challenges to providing quality care . OBJECTIVE To test the effectiveness of a collaborative care model to improve the quality of care for patients with Alzheimer disease . DESIGN , SETTING , AND PATIENTS Controlled clinical trial of 153 older adults with Alzheimer disease and their caregivers who were r and omized by physician to receive collaborative care management ( n = 84 ) or augmented usual care ( n = 69 ) at primary care practice s within 2 US university-affiliated health care systems from January 2002 through August 2004 . Eligible patients ( identified via screening or medical record ) met diagnostic criteria for Alzheimer disease and had a self-identified caregiver . INTERVENTION Intervention patients received 1 year of care management by an interdisciplinary team led by an advanced practice nurse working with the patient 's family caregiver and integrated within primary care . The team used st and ard protocol s to initiate treatment and identify , monitor , and treat behavioral and psychological symptoms of dementia , stressing nonpharmacological management . MAIN OUTCOME MEASURES Neuropsychiatric Inventory ( NPI ) administered at baseline and at 6 , 12 , and 18 months . Secondary outcomes included the Cornell Scale for Depression in Dementia ( CSDD ) , cognition , activities of daily living , re source use , and caregiver 's depression severity . RESULTS Initiated by caregivers ' reports , 89 % of intervention patients triggered at least 1 protocol for behavioral and psychological symptoms of dementia with a mean of 4 per patient from a total of 8 possible protocol s. Intervention patients were more likely to receive  cholinesterase inhibitors  ( 79.8 % vs 55.1 % ; P = .002 ) and  antidepressants  ( 45.2 % vs 27.5 % ; P = .03 ) . Intervention patients had significantly fewer behavioral and psychological symptoms of dementia as measured by the total NPI score at 12 months ( mean difference , -5.6 ; P = .01 ) and at 18 months ( mean difference , -5.4 ; P = .01 ) . Intervention caregivers also reported significant improvements in distress as measured by the caregiver NPI at 12 months ; at 18 months , caregivers showed improvement in depression as measured by the Patient Health Question naire-9 . No group differences were found on the CSDD , cognition , activities of daily living , or on rates of hospitalization , nursing home placement , or death . CONCLUSIONS Collaborative care for the treatment of Alzheimer disease result ed in significant improvement in the quality of care and in behavioral and psychological symptoms of dementia among primary care patients and their caregivers . These improvements were achieved without significantly increasing the use of antipsychotics or sedative-hypnotics . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00246896 OBJECTIVE To test whether the Tailored Activity Program ( TAP ) reduces dementia-related neuropsychiatric behaviors , promotes activity engagement , and enhances caregiver well-being . DESIGN Prospect i ve , two-group ( treatment , wait-list control ) , r and omized , 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 question ing , 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 result ed in clinical ly 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 BACKGROUND It is believed that timely recognition and diagnosis of dementia is a pre-condition for improving care for both older adults with dementia and their informal caregivers . However , diagnosing dementia often occurs late in the disease . This means that a significant number of patients with early symptoms of dementia and their informal caregivers may lack appropriate care . OBJECTIVES To compare the effects of case management and usual care among community-dwelling older adults with early symptoms of dementia and their primary informal caregivers . DESIGN R and omized controlled trial with measurements at baseline and after 6 and 12 months . SETTING Primary care in West-Friesl and , the Netherl and s. PARTICIPANTS 99 pairs of community-dwelling older adults with dementia symptoms ( defined as abnormal screening for symptoms of dementia ) and their primary informal caregivers . INTERVENTION 12 months of case management by district nurses for both older adults and informal caregivers versus usual care . MEASUREMENTS PRIMARY OUTCOME informal caregiver 's sense of competence . SECONDARY OUTCOMES caregiver 's quality of life , depressive symptoms , and burden , and patient 's quality of life . Process measurements : intervention fidelity and caregiver 's satisfaction with the quality of case management . RESULTS Linear mixed model analyses showed no statistically significant and clinical ly relevant differences over time between the two groups . The process evaluation revealed that intervention fidelity could have been better . Meanwhile , informal caregivers were satisfied with the quality of case management . CONCLUSION This study shows no benefits of case management for older adults with dementia symptoms and their primary informal caregivers . One possible explanation is that case management , which has been recommended among diagnosed dementia patients , may not be beneficial if offered too early . However , on the other h and , it is possible that : ( 1 ) case management will be effective in this group if more fully implemented and adapted or aim ed at informal caregivers who experience more severe distress and problems ; ( 2 ) case management is beneficial but that it is not seen in the timeframe studied ; ( 3 ) case management might have undetected small benefits . This has to be established . Trial registration ISCRTN83135728 STUDY QUESTION Did the  Medicare Alzheimer 's Disease Demonstration , with its goal of improving caregiver outcomes through case management and subsidized community services , affect the nursing home entry rate of treatments with dementia compared to controls ? DATA SOURCES Interviews conducted at baseline and six months thereafter . Measures include date of nursing home entry , client and caregiver health , and income . STUDY DESIGN The demonstration r and omly assigned voluntary applicants into treatment and control groups . Treatment group cases were eligible for case management and for an 80 percent discount on community care benefits , up to about $ 600 per month . DATA COLLECTION All cases received baseline and semi-annual assessment interviews for up to three years after enrollment . Analyses are among cases that remained in the demonstration for more than 30 days after enrollment ( n = 8,095 ) . PRINCIPAL FINDINGS The intervention of case management and subsidized community service had no effect on nursing home entry rates for treatments overall , compared to those of controls , and few effects on treatment subgroups , with the exception of one site where it may have increased nursing home entry rates . CONCLUSIONS Providing case management and subsidized community services with the goal of improving caregiver outcomes may have little effect on nursing home entry rates for people with dementia OBJECTIVES This article describes results of a r and omized controlled trial comparing a time-limited  early-stage memory loss ( ESML )  support group program conducted by a local Alzheimer 's Association chapter to a wait-list ( WL ) control condition . METHODS One hundred and forty-two dyads were r and omized in blocks to ESML ( n = 96 ) or WL ( n = 46 ) . Mean age of participants was 74.9 years , and mean Mini-Mental State Examination was 23.4 . The primary outcome was participant 's quality of life ; secondary outcomes included mood , family communication , and perceived stress . RESULTS On the intent-to-treat ( ITT ) pre-post analysis , significant differences were seen in participant quality of life ( p < .001 ) , depression ( p < .01 ) , and family communication ( p < .05 ) . Within the care partner groups , there was no significant difference between ESML and WL in the ITT analysis . A post hoc exploratory examination of changes that were associated with improved quality of life in ESML participants revealed significant reductions of depressive symptoms and behavior problems ( p < .05 ) , improved family communication ( p < .05 ) , self-efficacy ( p < .01 ) , Medical Outcomes Study short form ( SF-36 ) role-emotional ( p < .05 ) , SF-36 social functioning ( p < .05 ) , and SF-36 mental health components ( p < .01 ) in improvers . DISCUSSION These results support the efficacy of ESML support groups for individuals with dementia Objectives To develop and evaluate the effectiveness of a home based intervention in reducing caregiver burden , promoting caregiver mental health and reducing behavioural problems in elderly persons with dementia . Methodology and Principal Findings This was a r and omised controlled trial in which the person with dementia-caregiver dyad was r and omly allocated either to receive the intervention immediately or to a waiting list group which received the intervention after 6 months . It was carried out in communities based in two talukas ( administrative blocks ) in Goa , India . Mild to moderate cases with dementia ( diagnosed using the DSM IV criteria and grade d using the Clinical Dementia Rating scale ) and their caregivers were included in the trial . Community based intervention provided by a team consisting of Home Care Advisors who were supervised by a counselor and a psychiatrist , focusing on supporting the caregiver through information on dementia , guidance on behaviour management , a single psychiatric assessment and psychotropic medication if needed . We measured caregiver mental health ( General Health Question naire ) , caregiver burden ( Zarit Burden Score ) , distress due to behavioural disturbances ( NPI-D ) , behavioural problems in the subject ( NPI-S ) and activities of daily living in the elder with dementia ( EASI ) . Outcome evaluations were masked to the allocation status . We analysed each outcome with a mixed effects model . 81 families enrolled in the trial ; 41 were r and omly allocated to the intervention . 59 completed the trial and 18 died during the trial . The intervention led to a significant reduction of GHQ ( −1.12 , 95 % CI −2.07 to −0.17 ) and NPI-D scores ( −1.96 , 95%CI −3.51 to −0.41 ) and non-significant reductions in the ZBS , EASI and NPI-S scores . We also observed a non-significant reduction in the total number of deaths in people with dementia in the intervention arm ( OR 0.34 , 95 % CI 0.01 to 1.03 ) . Conclusion Home based support for caregivers of persons with dementia , which emphasizes the use of locally available , low-cost human re sources , is feasible , acceptable and leads to significant improvements in caregiver mental health and burden of caring . Clinical Trials.gov OBJECTIVES To determine whether community care of people with dementia can be prolonged with a 2-year multicomponent intervention program and to analyze effects of the intervention on total usage and expenses of social and healthcare services . DESIGN R and omized controlled trial . SETTING Community-dwelling couples with one spouse caring for the other spouse with dementia . PARTICIPANTS Couples with dementia ( N=125 ) were allocated at r and om to the intervention ( n=63 ) or control group ( n=62 ) . INTERVENTION Intervention couples were provided with a multicomponent intervention program with a family care coordinator , a geriatrician , support groups for caregivers , and individualized services . MEASUREMENTS Time from enrollment to institutionalization of spouses with dementia and use of services and service expenditure of couples . RESULTS At 1.6 years , a larger proportion in the control group than in the intervention group was in long-term institutional care ( 25.8 % vs 11.1 % , P=.03 ) . At 2 years , the difference was no longer statistically significant . The 2-year adjusted hazard ratio for the intervention group was 0.53 ( 95 % confidence interval (CI)=0.23 - 1.19 , P=.12 ) . Intervention led to reduction in use of community services and expenditures . The difference for the benefit of intervention group was -7,985 Euro ( 95 % CI=-16,081 to -1,499 , P=.03 ) . When the intervention costs were included , the differences between the groups were not significant . CONCLUSION Although the intervention did not result in a significant difference in the need for institutional care after 2 years , individualizing services in collaboration with families may lead to reduction in use of and expenditures on municipal services PURPOSE This study examines the short-term impact of two theoretically based psychoeducational small group interventions with distressed caregivers , and it also examines the role of specific moderator and mediator variables on caregiver outcomes . DESIGN AND METHODS Female participants ( N = 169 ) aged 50 and older who were caring for a community-dwelling relative with a dementing illness were r and omly assigned to one of three treatment interventions : anger management , depression management , or a wait-list control group . These interventions took place over a 3- to 4-month period . The primary outcomes examined were anger or hostile mood , depressed mood , frequency of use of positive and negative coping strategies , and perceived caregiving self-efficacy . RESULTS Significant main effects in the expected direction were found for changes in most of these measures . Participants in both anger management and depression management groups had significant reductions in their levels of anger or hostility and depression from Time 1 to Time 2 in comparison to participants in the wait-list control group . Use of positive cognitive coping strategies increased in the anger management group only . Self-efficacy significantly increased for participants in both intervention groups , and it was also demonstrated to function as a mediator of intervention effects . Pretreatment levels of depressive symptoms and anger expression style ( Anger Expression-Out ) moderated the relative effects of the two interventions on mood and coping . IMPLICATION S These data are consistent with a growing body of evidence supporting the effectiveness of skills training , in small groups , to improve both the affective states and the type of coping strategies used by caregivers . In addition , this study underscores the need to evaluate key pretreatment variables in order to determine which form of treatment may be more compatible with caregiver characteristics and thus more likely to be beneficial to individuals The current study is a controlled clinical investigation of two nonpharmacological treatments of depression in patients with Alzheimer 's disease .  Two active behavioral treatments , one emphasizing patient pleasant events and one emphasizing caregiver problem solving , were compared to an equal- duration typical care condition and a wait list control .  Seventy-two patient-caregiver dyads were r and omly assigned to one of four conditions and assessed pre- , post- , and at 6-months follow-up . Patients in both behavioral treatment conditions showed significant improvement in depression symptoms and diagnosis as compared with the two other conditions . These gains were maintained at 6-month follow-up . Caregivers in each behavioral condition also showed significant improvement in their own depressive symptoms , while caregivers in the two other conditions did not . Results indicate that behavioral interventions for depression are important and effective strategies for treating demented patients and their caregivers OBJECTIVE --To reduce the psychological stress and improve the skills in coping of people who care for relatives with dementia . DESIGN -- Assessment and suitability of carers by question naire ; assessment of patients and carers in a hospital outpatient clinic ; allocation to groups according to date of application to study . Linkage of groups of four carers and programme coordinator by telephone conference calls over 12 months after programmes . Re assessment at three , six , 12 , and , for those in the " wait list " group , 18 months . SETTING --The programmes were conducted in the psychiatry unit of a Sydney teaching hospital . SUBJECTS -- Eligible patients were less than 80 years old , had mild to moderate dementia , and lived at home with their carer . Of the 96 patient-carer pairs in the study , 33 were in the dementia carers ' programme group  , 31 were in the memory retraining group , and 32 were in the wait list group . INTERVENTIONS --Carers in the dementia carers ' programme received training in coping with the difficulties of looking after patients with dementia while the patients had sessions in subjects such as memory retraining . In the memory retraining programme  patients were admitted and received the patient component of the carers ' programme while their carers had 10 days ' respite . In the wait list group carers waited six months before undertaking the carers ' programme . MAIN OUTCOME MEASURES --Effect of the programmes on carers ' general health question naire scores and the rate of placement of patients in institutions . RESULTS --At 12 months ' follow up the carers ' programme had result ed in significantly lower psychological stress among carers than the memory retraining programme ( mean ( SD ) general health question naire scores at 0 months were 6.31 ( 6.23 ) and 3.60 ( 6.25 ) respectively , and at 12 months were 4.69 ( 5.58 ) and 7.40 ( 9.39 ) ; p less than 0.05 . ) In the wait list group distress scores remained stable , even after the carers and patients had undertaken the carers ' programme . Patients deteriorated over 12 months regardless of group allocation , but at 30 months , allowing for patients who died and could not be included in the analysis , 65 % of patients in the carers ' programme group were still living at home compared with 26 % in the memory retraining programme group . CONCLUSION --The intensive intervention programme described for carers of patients with dementia can reduce the psychological morbidity of the carer and delay the placement of the patient in an institution without increasing the use of health services by either patient or carer A r and omized 3-year study assessed the effect of exp and ed community-based services and case management on 5,254 caregivers of dementia clients . A tested policy concern was whether the financing of formal care would result in a reduction of informal assistance . Unmet needs task assistance for the demonstration 's treatment group caregivers decreased by 30 percent within 6 months and by about 20 percent over 36 months relative to controls . While treatment group members used slightly more formal care over time , there were no differences between treatment and control groups in primary caregiver hours after 36 months , or in the number of tasks in which primary or secondary caregivers provided assistance BACKGROUND A multidisciplinary , evidence -based care program to improve the management of depression in nursing home residents was implemented and tested using a stepped-wedge design in 23 nursing homes ( NHs ) : "  Act in case of Depression " ( AiD ) . OBJECTIVE Before effect analyses , to evaluate AiD process data on sampling quality ( recruitment and r and omization , reach ) and intervention quality ( relevance and feasibility , extent to which AiD was performed ) , which can be used for underst and ing internal and external validity . In this article , a model is presented that divides process evaluation data into first- and second-order process data . METHODS Qualitative and quantitative data based on personal files of residents , interviews of nursing home professionals , and a research data base were analyzed according to the following process evaluation components : sampling quality and intervention quality . SETTING Nursing home . RESULTS The pattern of residents ' informed consent rates differed for dementia special care units and somatic units during the study . The nursing home staff was satisfied with the AiD program and reported that the program was feasible and relevant . With the exception of the first screening step ( nursing staff members using a short observer-based depression scale ) , AiD components were not performed fully by NH staff as prescribed in the AiD protocol . CONCLUSION Although NH staff found the program relevant and feasible and was satisfied with the program content , individual AiD components may have different feasibility . The results on sampling quality implied that statistical analyses of AiD effectiveness should account for the type of unit , whereas the findings on intervention quality implied that , next to the type of unit , analyses should account for the extent to which individual AiD program components were performed . In general , our first-order process data evaluation confirmed internal and external validity of the AiD trial , and this evaluation enabled further statistical fine tuning . The importance of evaluating the first-order process data before executing statistical effect analyses is thus underlined This study was an attempt to improve the quality of the relationship between dementia caregivers and their loved ones by decreasing the gap between caregivers ' expectations and patients ' actual functional abilities and by teaching supportive skills . Although a group of 49 caregiver-patient dyads were recruited , the outcome measures of only those dyads ( 47 ) that completed the week seven session were used for analysis . Half of the dyads were r and omized to an intervention group and the other half to a waiting list . The intervention group ( N = 24 ) completed a four-session caregiver training program in which caregivers first watched investigators administering to their loved ones the Texas Functional Living Scale and later progressed to helping their loved ones by appropriate cueing to perform the tasks involved . Comparisons were made between baseline scores , scores at seven weeks , and scores at the end of 17 weeks on the congruence between caregiver estimates and patients ' actual performance on the Independent Living Scale and measures of cognition , function , preillness quality of relationship , caregiver mood , feeling of self-efficacy , and several other measures . We were not able to increase the congruence between caregiver estimates and patients ' actual performance and found no change in any other measure . We did find the expected relationship between depression and caregiver sense of self-efficacy OBJECTIVES To test the effects of an intervention that helps families manage  distressing behaviors in family members with dementia . DESIGN Two-group r and omized trial . SETTING In home . PARTICIPANTS Two hundred seventy-two caregivers and people with dementia . INTERVENTION Up to 11 home and telephone contacts over 16 weeks by health professionals who identified potential triggers of patient behaviors , including communication and environmental factors and patient undiagnosed medical conditions ( by obtaining blood and urine sample s ) and trained caregivers in strategies to modify triggers and reduce their upset . Between 16 and 24 weeks , three telephone contacts reinforced strategy use . MEASUREMENTS Primary outcomes were frequency of targeted problem behavior and caregiver upset with and confidence managing it at 16 weeks . Secondary outcomes were caregiver well-being and management skills at 16 and 24 weeks and caregiver perceived benefits . Prevalence of medical conditions for intervention patients were also examined . RESULTS At 16 weeks , 67.5 % of intervention caregivers reported improvement in targeted problem behavior , compared with 45.8 % of caregivers in a no-treatment control group ( P=.002 ) , and reduced upset with ( P=.03 ) and enhanced confidence managing ( P=.01 ) the behavior . Additionally , intervention caregivers reported less upset with all problem behaviors ( P=.001 ) , less negative communication ( P=.02 ) , less burden ( P=.05 ) , and better well-being ( P=.001 ) than controls . Fewer intervention caregivers had depressive symptoms ( 53.0 % ) than control group caregivers ( 67.8 % , P=.02 ) . Similar caregiver outcomes occurred at 24 weeks . Intervention caregivers perceived more study benefits ( P<.05 ) , including ability to keep family members home , than controls . Blood and urine sample s of intervention patients with dementia showed that 40 ( 34.1 % ) had undiagnosed illnesses requiring physician follow-up . CONCLUSION Targeting behaviors up setting to caregivers and modifying potential triggers improves symptomatology in people with dementia and caregiver well-being and skills BACKGROUND Cure of dementia is not possible , but quality of life of patients and caregivers can be improved . Our aim is to investigate effects of community occupational therapy on dementia patients ' and caregivers '  quality of life , mood , and health status and caregivers ' sense of control over life . METHODS Community-dwelling patients aged 65 years or older , with mild-to-moderate dementia , and their informal caregivers ( n = 135 couples of patients with their caregivers ) were r and omly assigned to 10 sessions of occupational therapy over 5 weeks or no intervention . Cognitive and behavioral interventions were used to train patients in the use of aids to compensate for cognitive decline and caregivers in coping behaviors and supervision . Outcomes , measured at baseline , 6 weeks , and 12 weeks , were patients ' and caregivers ' quality of life ( Dementia Quality of Life Instrument , Dqol ) , patients ' mood ( Cornell Scale for Depression , CSD ) , caregivers ' mood ( Center for Epidemiologic Studies Depression Scale , CES-D ) , patients ' and caregivers ' health status ( General Health Question naire , GHQ-12 ) , and caregivers ' sense of control over life ( Mastery Scale ) . RESULTS Improvement on patients ' Dqol overall ( 0.8 ; 95 % confidence interval [ CI ] , 0.6-.1 , effect size 1.3 ) and caregivers ' Dqol overall ( 0.7 ; 95 % CI , 0.5-.9 , effect size 1.2 ) was significantly better in the intervention group as compared to controls . Scores on other outcome measures also improved significantly . This improvement was still significant at 12 weeks . CONCLUSION Community occupational therapy should be advocated both for dementia patients and their caregivers , because it improves their mood , quality of life , and health status and caregivers ' sense of control over life . Effects were still present at follow-up OBJECTIVES To test the effects of walking , light exposure , and a combination intervention ( walking , light , and sleep education ) on the sleep of persons with Alzheimer 's disease ( AD ) . DESIGN R and omized , controlled trial with blinded assessors . SETTING Independent community living . PARTICIPANTS One hundred thirty-two people with AD and their in-home caregivers . INTERVENTIONS Participants were r and omly assigned to one of three active treatments ( walking , light , combination treatment ) or contact control and received three or six in-home visits . MEASUREMENTS Primary outcomes were participant total wake time based on wrist actigraphy and caregiver ratings of participant sleep quality on the Sleep Disorders Inventory ( SDI ) . Secondary sleep outcomes included additional actigraphic measurements of sleep percentage , number of awakenings , and total sleep time . RESULTS Participants in walking ( P=.05 ) , light ( P=.04 ) , and combination treatment ( P=.01 ) had significantly greater improvements in total wake time at posttest ( effect size 0.51 - 0.63 ) than controls but no significant improvement on the SDI . Moderate effect size improvements in actigraphic sleep percentage were also observed in active treatment participants . There were no significant differences between the active treatment groups and no group differences for any sleep outcomes at 6 months . Participants with better adherence ( 4 d/wk ) to walking and light exposure recommendations had significantly less total wake time ( P=.006 ) and better sleep efficiency ( P=.005 ) at posttest than those with poorer adherence . CONCLUSION Walking , light exposure , and their combination are potentially effective treatments for improving sleep in community-dwelling persons with AD , but consistent adherence to treatment recommendations is required OBJECTIVE To test the effectiveness of an integrative psychotherapeutic nursing home program ( integrative reactivation and rehabilitation [ IRR ] ) to reduce multiple neuropsychiatry symptoms ( MNPS ) of cognitively impaired patients and caregiver burden ( CB ) . DESIGN R and omized controlled trial . SETTING Psychiatric-skilled nursing home ( IRR ) and usual care ( UC ) , consisting of different types of nursing home care at home or in an institution . PARTICIPANTS N = 168 ( 81 IRR and 87 UC ) . Patients had to meet classification of the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition for dementia , amnestic disorders , or other cognitive disorders . Further inclusion criteria : Neuropsychiatric Inventory ( NPI ) ≥3 ; Mini-Mental State Examination ≥18 and ≤27 ; and Barthel Index ( BI ) ≥5 and ≤19 . INTERVENTION IRR consisted of a person-oriented integrative psychotherapeutic nursing home program to reduce MNPS of the patient and CB . UC consisted of different types of nursing home care at home or in an institution , mostly emotion oriented . MEASUREMENTS Primary outcome variable was MNPS ( number and sum-severity of NPI ) . Furthermore , burden and competence of caregiver were also measured . ASSESSMENT S T1 ( inclusion ) , T2 ( end of treatment ) , T3 ( after 6 months of follow-up ) . Cohen 's d ( Cd ) was calculated for mean differences ( intention to treat ) . For confounding , repeated measurement modeling ( r and om regression modeling [ RRM ] ) was applied . RESULTS In the short term from the perspective of the caregiver , IRR showed up to 34 % surplus effects on MNPS of the patients ; NPI symptoms : 1.31 lower ( Cd , -0.53 ) ; and NPI sum- severity : 11.16 lower ( Cd , -0.53 ) . In follow-up , the effects were sustained . However , from the perspective of the nursing team , these effects were insignificant , although the trend was in the same direction and correlated significantly with the caregiver results over time ( at T3 : r = 0.48 ) . In addition , IRR showed surplus effects ( up to 36 % ) on burden and competence of caregiver : NPI emotional distress : 3.78 ( Cd , -0.44 ) ; CB : 17.69 ( Cd , -0.63 ) lower ; and Competence : 6.26 ( Cd , 0.61 ) higher . In follow-up , the effects increased up to 50 % . RRM demonstrated that the effects were stable . CONCLUSION From the perspective of the caregiver , IRR was significantly more effective than UC to reduce MNPS in cognitively impaired patients and CB . In follow-up , the effect on CB even increased . However , from the perspective of the nursing team , the effects on MNPS were statistically insignificant . Nevertheless , the trend was in the same direction and correlated significantly with the caregiver results over time . Further research is needed , preferably using a blinded r and omized controlled trial OBJECTIVE To determine the effects of attendance at a memory clinic on the psychosocial health of carers .  DESIGN R and omized control trial . PARTICIPANTS Fifty community dwelling subjects with mild to moderate dementia and their carers . MAIN OUTCOME MEASURES Carer burden , psychological morbidity and psychosocial health related quality of life at 6 and 12 months post intervention . MAIN RESULTS There was significant improvement in psychosocial health related quality of life of carers as measured by the psychosocial domain of the Functional Limitation Profile ( FLP ) at 6 months ( p < 0.01 ) , including improvement in the subgroups of alertness behaviour ( p < 0.05 ) and social interaction ( p < 0.01 ) , after adjustment for age of subject and baseline scores . The improvement in social interaction was maintained at 12 months ( p < 0.05 ) . There was no significant difference in carer psychological morbidity ( General Health Question naire ) , carer burden ( Zarit family interview ) or carer knowledge of dementia ( Dementia Knowledge Test ) at 6 or 12 months , between groups . CONCLUSIONS These results demonstrate improved psychosocial health related quality of life for carers of those with mild to moderate cognitive impairment attending a memory clinic .  Further research in this area is indicated , comparing memory clinic intervention with alternative support PURPOSE We examine 6-month effects of the Environmental Skill-Building Program on  caregiver well-being and care recipient functioning  and whether effects vary by caregiver gender , race ( White or non-White ) , and relationship ( spouse or nonspouse ) . DESIGN AND METHODS We enrolled 255 family caregivers of community-residing persons with Alzheimer 's disease or related disorders , of whom 190 participated in a follow-up interview . Caregivers were r and omized to a usual care control group or intervention group that received five home contacts and one telephone contact by occupational therapists , who provided education , problem-solving training , and adaptive equipment . Baseline and 6-month follow-up included self-report measures of caregiver objective and subjective burden , caregiver well-being , and care recipient problem behaviors and physical function . RESULTS Compared with controls ( n = 101 ) , intervention caregivers ( n = 89 ) reported less upset with memory-related behaviors , less need for assistance from others , and better affect . Intervention spouses reported less upset with disruptive behaviors ; men reported spending less time in daily oversight ; and women reported less need for help from others , better affect , and enhanced management ability , overall well-being , and mastery relative to control group counterparts . Statistically significant treatment differences were not found for hours helping with instrumental activities of daily living , upset with providing assistance with instrumental activities of daily living and activities of daily living , perceived change in somatic symptoms , White versus non-White caregivers , or care recipient outcomes . IMPLICATION S The Environmental Skill-Building Program reduces burden and enhances caregiver well-being in select domains and has added benefit for women and spouses CONTEXT Exercise training for patients with Alzheimer disease combined with teaching caregivers how to manage behavioral problems may help decrease the frailty and behavioral impairment that are often prevalent in patients with Alzheimer disease . OBJECTIVE To determine whether a home-based exercise program combined with caregiver training in behavioral management techniques would reduce functional dependence and delay institutionalization among patients with Alzheimer disease . DESIGN , SETTING , AND PATIENTS R and omized controlled trial of 153 community-dwelling patients meeting National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer Disease and Related Disorders Association criteria for Alzheimer disease , conducted between June 1994 and April 1999 . INTERVENTIONS Patient-caregiver dyads were r and omly assigned to the combined exercise and caregiver training program , Reducing Disability in Alzheimer Disease ( RDAD ) , or to routine medical care ( RMC ) . The RDAD program was conducted in the patients ' home over 3 months . MAIN OUTCOME MEASURES Physical health and function ( 36-item Short-Form Health Survey 's [ SF-36 ] physical functioning and physical role functioning subscales and Sickness Impact Profile 's Mobility subscale ) , and affective status ( Hamilton Depression Rating Scale and Cornell Depression Scale for Depression in Dementia ) . RESULTS At 3 months , in comparison with the routine care patients , more patients in the RDAD group exercised at least 60 min/wk ( odds ratio [ OR ] , 2.82 ; 95 % confidence interval [ CI ] , 1.25 - 6.39 ; P = .01 ) and had fewer days of restricted activity ( OR , 3.10 ; 95 % CI , 1.08 - 8.95 ; P<.001 ) . Patients in the RDAD group also had improved scores for physical role functioning compared with worse scores for patients in the RMC group ( mean difference , 19.29 ; 95 % CI , 8.75 - 29.83 ; P<.001 ) . Patients in the RDAD group had improved Cornell Depression Scale for Depression in Dementia scores while the patients in the RMC group had worse scores ( mean difference , -1.03 ; 95 % CI , -0.17 to -1.91 ; P = .02 ) . At 2 years , the RDAD patients continued to have better physical role functioning scores than the RMC patients ( mean difference , 10.89 ; 95 % CI , 3.62 - 18.16 ; P = .003 ) and showed a trend ( 19 % vs 50 % ) for less institutionalization due to behavioral disturbance . For patients with higher depression scores at baseline , those in the RDAD group improved significantly more at 3 months on the Hamilton Depression Rating Scale ( mean difference , 2.21 ; 95 % CI , 0.22 - 4.20 ; P = .04 ) and maintained that improvement at 24 months ( mean difference , 2.14 ; 95 % CI , 0.14 - 4.17 ; P = .04 ) . CONCLUSION Exercise training combined with teaching caregivers behavioral management techniques  improved physical health and depression in patients with Alzheimer disease STUDY QUESTION Does improved access to community-based care reduce perceived burden and reported levels of depression among primary caregivers of people with dementia ? DATA SOURCES Baseline and periodic caregiver interviews with participants in the Medicare Alzheimer 's Disease Demonstration . Client and caregiver attributes and caregiver outcomes such as depression and burden scores were among the measures . STUDY DESIGN Applicants to the demonstration ( all voluntary ) were r and omly assigned into treatment and control groups . Treatment group cases were eligible for case management and for up to $ 699 per month in community care benefits . ( The actual monthly entitlement varied among the eight demonstration communities due to regional cost differences and inflation adjustments over the four-year demonstration period . ) DATA COLLECTION A total of 5,307 eligible individuals received a baseline assessment at the time of application to the demonstration and at least one semi-annual re assessment . Clients and their caregivers were periodically reassessed producing a total of 20,707 observations . PRINCIPAL FINDINGS Persons in the treatment group had a high exposure to case management and a greater likelihood of community service use relative to those in the control group . Treatment group membership was associated with statistically significant , but very small reductions in caregiver burden ( in four of eight sites ) and depression ( three of eight sites ) over a 36-month tracking period . These findings are not sustained with all cases combined , or among a higher-re source demonstration model considered separately . CONCLUSIONS Both the fact that these programmatic differences did not translate into substantial treatment group reductions in caregiver burden or depression , and the consistency of these findings with those of prior case management evaluations suggest the need to reformulate this programmatic intervention into areas not previously tested : 24-hour care , crisis intervention , coordination with primary care , or chronic disease management OBJECTIVES To evaluate whether a comprehensive sleep education program ( Nighttime Insomnia Treatment and Education for Alzheimer 's Disease ( NITE-AD ) ) could improve sleep in dementia patients living at home with their family caregivers . DESIGN A r and omized , controlled trial . PARTICIPANTS Thirty-six community-dwelling patients with Alzheimer 's disease ( AD ) and their family caregivers . INTERVENTION All participants received written material s describing age- and dementia-related changes in sleep and st and ard principles of good sleep hygiene . Caregivers in active treatment ( n=17 ) received specific recommendations about setting up and implementing a sleep hygiene program for the dementia patient and training in behavior management skills . Patients in active treatment were also instructed to walk daily and increase daytime light exposure with the use of a light box . Control subjects ( n=19 ) received general dementia education and caregiver support . MEASUREMENTS Primary sleep outcomes were derived for patients and caregivers from 1 week of sleep-wake activity measured at baseline , posttest ( 2 months ) , and 6-month follow-up using an Actillume wrist-movement recorder . Secondary patient outcomes included the Epworth Sleepiness Scale , the Cornell Depression Scale , and the Revised Memory and Behavior Problem Checklist . Caregiver self-reports included the Pittsburgh Sleep Quality Index and the Center for Epidemiological Study of Depression Scale . RESULTS Patients participating in NITE-AD showed significantly greater ( P<.05 ) posttest reductions in number of nighttime awakenings , total time awake at night , and depression , and increases in weekly exercise days than control subjects . At 6-month follow-up , treatment gains were maintained , and additional significant improvements in duration of night awakenings emerged . When cognitive level was controlled , NITE-AD patients had lower longitudinal ratings of daytime sleepiness than controls . There was a trend for control subjects to spend more time in bed at 6 months than NITE-AD patients . CONCLUSION This study provides the first evidence that patients with AD who are experiencing sleep problems can benefit from behavioral techniques ( specifically , sleep hygiene education , daily walking , and increased light exposure ) that are known to improve sleep in nondemented , institutionalized older adults OBJECTIVE To describe the theory , elements and practice of a successful caregiver training programme ; and report the 8-year outcome . DESIGN Prospect i ve , r and omized control trial and longitudinal follow-up over approximately 8 years . SETTING Psychiatry unit , general teaching hospital , Sydney , Australia . PARTICIPANTS 96 persons less than 80 years old with mild to moderate dementia and their cohabiting caregivers . INTERVENTIONS All patients received a 10-day structured memory retraining and activity programme . Caregivers in the immediate and wait-list caregiver training groups received a structured , residential , intensive 10-day training programme , boosted by follow-ups and telephone conferences over 12 months . Those in the wait-list group entered the programme after waiting 6 months . The third group of caregivers received 10 days ' respite ( while patients underwent their memory retraining programme ) and 12 months booster sessions as for the other groups . MAIN OUTCOME MEASURES Nursing home admission ; time until patient death . MAIN RESULTS 64 % of patients whose caregivers were in the immediate training group , 53 % of wait-list group patients and 70 % of memory retraining patients had died . Nursing home admission had occurred in 79 % of the immediate training , 83 % of the delayed and 90 % of the memory retraining group . Eight-year survival analysis indicated that patients whose caregivers received training stayed at home significantly longer ( p = 0.037 ) and tended to live longer ( p = 0.08 ) . CONCLUSIONS Caregiver training programmes demonstrably can delay institutionalization of people with dementia OBJECTIVES To determine whether community care of demented patients can be prolonged by means of a 2-year support program based on nurse case management . DESIGN R and omized controlled intervention study with 2-year follow-up . SETTING Demented patients entitled to payments from the Social Insurance Institution for community care , in five municipalities in eastern Finl and . PARTICIPANTS One hundred demented patients , age 65 and older , living at home with the primary support of informal caregivers , allocated at r and om to the intervention ( n = 53 ) or control group ( n = 47 ) . INTERVENTION Intervention patients and their caregivers were provided with a 2-year intervention program of systematic , comprehensive support by a dementia family care coordinator . MEASUREMENTS Time to institutionalization ( period in community care ) from enrollment of patients in the study to their placement in long-term institutional care . RESULTS During the first months , the rate of institutionalization was significantly lower in the intervention group than in the control group ( P = .042 ) , but the benefit of the intervention decreased with time ( P = .028 ) . Estimated probability of staying in community care up to 6 , 12 , and 24 months was 0.98 , 0.92 , and 0.63 in the intervention group and 0.91 , 0.81 , and 0.68 in the control group , respectively . Results also suggest that the intervention used in the study might be especially beneficial to patients with severe dementia and those with problems threatening the continuity of community care . CONCLUSIONS The placement of demented patients in long-term institutional care can be deferred with the support of a dementia family care coordinator . However , by the end of the 2-year intervention , the number of patients institutionalized was similar in the intervention and control group . It seems to be beneficial to direct this type of intensive support at severely demented patients and their caregivers . On the basis of our experiences , we suggest that intervention by a dementia family care coordinator should be targeted especially at patients with problems threatening the continuity of community care This 3-year r and omized clinical trial tested the effectiveness of an interdisciplinary psychoeducational family group intervention in decreasing the caregivers ' perceptions of the frequency and severity of behavioral problems in persons with dementia and their reactions to those problems , and in decreasing caregiver burden and depression . The intervention consisted of seven weekly , 2-hour multimedia training sessions that included education , family support , and skills training for 94 primary caregivers and their families . Repeated measures ANOVA was used to test for significant differences between the intervention and waiting list control groups over a 5-month period . The intervention was successful in reducing caregivers ' negative reactions to disruptive behaviors and in reducing caregiver burden over time Objective To compare the benefits and harms of a Dutch 10-session Community Occupational Therapy programme for patients with Alzheimer 's disease with the impact of a one session consultation at home in German routine healthcare . Design A seven-centre , parallel group , active controlled r and omised controlled trial . Patients and carers were not masked . Assessors were fully blind for treatment allocation for one of two primary - outcome measurements . Setting Patients ' homes . Participants Patients with mild to moderate Alzheimer 's disease ( Mini-Mental State Examination 14–24 ) , living in the community with primary carer available and without severe depression or behavioural symptoms , were eligible . Interventions Experimental 10 home visits within 5 weeks by an occupational therapist , educating patients in the performance of simplified daily activities and in the use of aids to compensate for cognitive decline ; and educating carers in coping with behaviour of the patient and in giving supervision to the patient . Control one home visit including individual counselling of patient and carer and explanation of a leaflet on coping with dementia in daily life . Outcome measures The primary outcome was the patient 's daily functioning measured with the Interview of Deterioration in Daily activities in Dementia and the Perceive , Recall , Plan and Perform System of Task Analysis . Assessment s were at baseline , 6 , 16 and 26 weeks , with a postal assessment at 52 weeks . Results 141 patients were 1:1 r and omised to the experimental ( N=71 ) and control group ( N=70 ) . Data for 54 and 50 participants were analysed . Patients ' daily functioning did not differ significantly between the experimental and control group at week 6 , 16 , 26 or 52 and remained stable over 26 weeks in both groups . No adverse events were associated with the interventions . Conclusions In German healthcare , a Dutch 10-session community occupational therapy was not better than a one-session consultation for the daily functioning of patients with Alzheimer 's disease . Further research on the transfer of complex psychosocial is needed . International Clinical Trials Registry Platform DRKS00000053 ; Funded by the German Federal Ministry of Health Background The positive effects of the Dutch Community Occupational Therapy in Dementia programme on patients ' daily functioning were not found in a multicentre r and omised controlled trial ( RCT ) in Germany . Objectives To evaluate possible effect modification on the primary outcome within the German RCT with regard to ( 1 ) participant characteristics , ( 2 ) treatment performance and ( 3 ) healthcare service utilisation ; and ( 4 ) to compare the design and primary outcome between the German and the original Dutch study . Methods ( 1 ) The impact of participant baseline data on the primary outcome was analysed in exploratory ANCOVA and regression analyses . ( 2 ) Therapists completed question naires on context and performance problems . The main problems were identified by a qualitative content analysis and focus-group discussion . Associations of the primary outcome with scores of participant adherence and treatment performance were evaluated by regression analysis . ( 3 ) Utilisation rates of healthcare services were controlled for significant group differences . ( 4 ) Differences in the Dutch and German study design were identified , and the primary outcome was contrasted at the item level . Results ( 1 ) Participant characteristics could not explain more than 5 % of outcome variance . ( 2 ) The treatment performance of some active intervention components was poor but not significantly associated with the primary outcome . ( 3 ) There were no significant group differences in the utilisation of healthcare re sources . ( 4 ) In contrast to the Dutch waiting-control group , the active intervention in the German control group may have reduced group differences in the current RCT . The German patients demonstrated a higher independence at baseline and less improvement in instrumental activities of daily living . Conclusion The differences in outcome may be explained by a more active control treatment , partially poor experimental treatment and less room for improvement in the German sample . Future cross-national transfers should be prepared by pilot studies assessing the applicability of the intervention and patient needs specific to the target country . Trial registration International Clinical Trials Registry Platform , DRKS00000053
BACKGROUND In this review , we study the effects of dyadic psychosocial interventions focused on community-dwelling people with dementia and their family caregivers , and the relationship of the effects with intervention components of programs .
Effects of combined intervention programs for people with dementia living at home and their caregivers : a systematic review .