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Randomised controlled trial
Home-based biobehavioural intervention reduces dependence, increases engagement of patients with dementia in the short term and improves care giver well-being and confidence
  1. Debra J Hain
  1. Christine E Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
  1. Correspondence to Debra J Hain
    Christine E Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431, USA; dhain{at}

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A promising care giver intervention

Family caregivers of people with dementia often choose to keep their loved ones at home1 despite the many challenges that may cultivate an environment of stress. Increased caregiver stress may impede the person's ability to effectively manage environmental stimuli as they struggle to meet the needs of the person with dementia frequently neglecting self in the process.2 As the population ages and the number of people with dementia increases, there will be a critical need for more clinical trials aimed at reducing caregiver stress and burden. Gitlin and colleagues reveal the complex nature of caring for someone with dementia and also provide evidence of an intervention that addresses possible strategies to reduce care giver burden while improving the well-being of the person with dementia.

Study design

The researchers tested a non-pharmacological intervention aimed at enhancing the ability of individuals with dementia to engage in daily activities, increasing functionality with an ultimate goal of reducing care giver burden. Care of Persons with Dementia and their Environments (COPE) was a randomised controlled trial in which 237 dyads (care giver and person with dementia) were randomly allocated to one of two groups. Group 1 received a multicomponent intervention that included: (1) psychosocial and physical assessment (patient and caregiver), (2) care giver education (health-related issues) and (3) caregiver training (skills based on expressed needs). The dyads received in-home sessions over 4 months by an occupational therapist, and one face-to-face session and one telephone session by an advance practice nurse. The control group received up to three 20 min telephone calls, and educational material was mailed to the home as needed. Various valid and reliable instruments were used to measure patient and caregiver outcomes. Findings indicate statistically significant differences in outcomes between the two groups at 4 months but not at 9 months. The authors concluded that COPE was beneficial in improving caregivers' ability to manage the person diagnosed with dementia.

Methodological strengths and shortcomings

This was a well-designed and well-conducted study that had an appropriate sample size. The interventionists were trained, and fidelity was monitored by regularly scheduled visits and review of audiotapes. The researchers excluded individuals who had three acute hospitalisations in the past year; this is somewhat concerning because these people may be more vulnerable and in need of this type of intervention. The researchers attempted to follow the long-term effects of the intervention by evaluating the participants at 9 months. Even though it is imperative to show sustainability, 9-month follow-up in this population might not be enough because there may not noticeable changes in this short time frame. A longitudinal study exploring effectiveness of this intervention over time could provide this much needed evidence. The analysis was robust and took into account attrition and missing data. Validity of the study may have been enhanced by using a mixed methods design; integration of two distinct methodologies allows for blending of data from different paradigms offering enhanced insight into the phenomenon of caregiving.3

Implications for practice

The researchers should be applauded for undertaking a study that provides evidence supporting the need for multilevel interventions aimed at improving outcomes for the person with dementia and the caregiver. Once again sustainability becomes an issue, something that becomes increasingly important as healthcare professionals attempt to improve quality of care while reducing costs. It is impressive that cost was part of the analysis, an essential component in determining sustainability; however, identification of payer source could have enhanced real world applicability. As the number of community residing adults with dementia increases, interdisciplinary non-pharmacological interventions are critically needed. Despite having many available resources, caregivers often do not know where to go for advice as they move forward on their caregiving trajectory,4 calling for new and innovative strategies focused on meeting their needs.5 6 The study findings have many practice implications: (1) taking a person-centred approach, (2) interdisciplinary team approaches to care and (3) infusing the unique needs of caregivers and their loved ones in the plan of care.

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  • Competing interests None.

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