Alzheimer's Disease, Dementia
Conditions
Keywords
Alzheimer's disease, Dementia, Safety, Home Care Services
Brief summary
The purpose of this study was to test the effectiveness of a new multimodal educational intervention to improve home safety for persons with dementia of the Alzheimer's type and their home caregivers.
Detailed description
Objectives: The purpose of this research study was to test the effectiveness of a new multimodal educational intervention to improve caregiver competence to create a safer home environment, and decrease risk and accidents to veterans with dementia living in the community. Objective 1: To determine the effect of the Home Safety Toolkit intervention on caregiver self-efficacy, caregiver adherence to home safety recommendations, and caregiver strain. Objective 2: To determine the effect of the Home Safety Toolkit intervention on the frequency of risky behaviors and accidents among care recipients with dementia of the Alzheimer's type living in the community. Research Design: This study was a single-blinded clinical trial with random assignment of subjects to either the intervention group that receives the Home Safety Toolkit Intervention or the control group which receives customary care. Methodology: The sample consisted of primary family caregivers of a person with dementia of the Alzheimer's type (DAT) receiving care at the Bedford VAMC Dementia Outpatient Clinic, the VA Boston HCS, and the Boston University Alzheimer's Disease Center. Subjects were dyads of primary caregivers and persons with a progressive DAT who live in the community, are willing to have home visits for home safety education, and who read and speak English. Inclusion criteria for care recipients were: diagnosis of DAT, score of 24 or less on the Mini-Mental State Exam (MMSE), is expected to continue living in the community for the next 6 months, and has the ability to ambulate without help from the caregiver. Inclusion criteria for the primary informal caregiver were: lives in the home with the care-recipient, provides a minimum of 4 hours of care-giving or supervision per day, and has no known cognitive impairment as judged by the primary care provider who refers the subject dyad for study recruitment. Exclusion criteria were: care-recipient MMSE score of 25 or greater; a previous home safety visit; and admission to a long-term care facility. Persons with DAT who are living alone will be excluded because their safety issues are more complex and there is no primary informal caregiver who can make consistent observations about risky behaviors and accidents. Time 1 and Time 2 data collection was conducted at home visits and interim data collection was done biweekly by phone. A total of 108 subject dyads completed the study, randomly assigned to the control group (N-48 dyads) and intervention group (60 dydads). The length of participation for each caregiver-care recipient dyad was 3 months after which the control group was offered the Home Safety Toolkit. Data analysis used Multivariate Analysis of Covariance (MANCOVA) to test hypotheses for significant group differences with the following outcome variables: adherence to recommendations; post-intervention caregiver self-efficacy and post-intervention caregiver strain; care-recipient risky behaviors and accidents. Covariates will include: baseline measures of caregiver self-efficacy and caregiver strain, caregiver years of formal education and use of social support resources.
Interventions
BEHAVIORALHome Safety Toolkit
Health literacy-verified booklet and home safety items to promote competence to make home safety modifications.
Sponsors
Boston Medical Center
US Department of Veterans Affairs
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Subjects are dyads of primary caregivers and persons with a progressive DAT who live in the community, are willing to have home visits for home safety education, and who read and speak English. * Inclusion criteria for care recipients are: diagnosis of DAT, score of 24 or less on the Mini-Mental State Exam (MMSE), is expected to continue living in the community for the next 6 months, and has the ability to ambulate without help from the caregiver. * Inclusion criteria for the primary informal caregiver are: lives in the home with the care-recipient, provides a minimum of 4 hours of care-giving or supervision per day, and has no known cognitive impairment as judged by the primary care provider who refers the subject dyad for study recruitment.
Exclusion criteria
* Care-recipient MMSE score of 25 or greater. * A previous home safety visit. * Admission to a long-term care facility. - Persons with DAT who are living alone will be excluded because their safety issues are more complex and there is no primary informal caregiver who can make consistent observations about risky behaviors and accidents.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Caregiver Self-efficacy | 3 months after baseline | Caregiver self-efficacy was measured by the Revised Checklist for Caregiving Self-Efficacy; the scale consists of 17 items which are rated from 0 - 100% confidence. The total score is summed from these percentages and ranges from 0 - 1700 where higher scores indicate a higher level of confidence. |
| Caregiver Strain | 3 months after baseline | Caregiver Strain was measured by the MBRC Caregiver Strain Index; scores ranged from 0 - 15 with higher scores indicating more strain. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Care Recipient Risky Behaviors and Accidents | 3 months after baseline | The Risky Behavior Checklist listed common risky behaviors and accidents exhibited by care recipients with dementia based on previous research. Potential scores ranged from 0 - undetermined. The maximum score is undetermined because the measure represents the caregiver count of the number of times an incident occurred. In this study, sum scores ranged from 0 - 180. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Home Safety Toolkit Intervention group receives home safety tool-kit with education and self-efficacy materials to promote competence to make home safety modifications.
Home Safety Toolkit: Health literacy-verified booklet and home safety items to promote competence to make home safety modifications. | 120 |
| Checklist Received conventional home safety checklist | 96 |
| Total | 216 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Subject no longer met inc criteria | 20 | 18 |
Baseline characteristics
| Characteristic | Home Safety Toolkit | Checklist | Total |
|---|---|---|---|
| Age, Continuous caregiver | 70.6 years STANDARD_DEVIATION 11.4 | 69.4 years STANDARD_DEVIATION 12.9 | NA years |
| Age, Continuous care-recipient | 80.4 years STANDARD_DEVIATION 6.7 | 80.9 years STANDARD_DEVIATION 7.2 | NA years |
| Functional Activities Questionnaire | 25.8 Units on a scale STANDARD_DEVIATION 4.1 | 26.4 Units on a scale STANDARD_DEVIATION 3.1 | NA Units on a scale |
| Gender Female | 8 participants | 6 participants | 14 participants |
| Gender Male | 11 participants | 10 participants | 21 participants |
| Mini Mental State Exam | 12.4 Units on a scale STANDARD_DEVIATION 6.6 | 13.0 Units on a scale STANDARD_DEVIATION 6.9 | NA Units on a scale |
| Physical Self Maintenance Scale | 14.6 Units on a scale STANDARD_DEVIATION 4.3 | 15.1 Units on a scale STANDARD_DEVIATION 4 | NA Units on a scale |
| Region of Enrollment United States | 120 participants | 96 participants | 216 participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 8 / 70 | 8 / 57 | 0 / 70 | 1 / 57 |
| serious Total, serious adverse events | 2 / 70 | 0 / 57 | 0 / 70 | 0 / 57 |
Outcome results
Primary
Caregiver Self-efficacy
Caregiver self-efficacy was measured by the Revised Checklist for Caregiving Self-Efficacy; the scale consists of 17 items which are rated from 0 - 100% confidence. The total score is summed from these percentages and ranges from 0 - 1700 where higher scores indicate a higher level of confidence.
Time frame: 3 months after baseline
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Home Safety Toolkit | Caregiver Self-efficacy | 1350.30 units on a scale | Standard Deviation 197.18 |
| Checklist | Caregiver Self-efficacy | 1305.65 units on a scale | Standard Deviation 203.36 |
p-value: 0.002MANCOVA
Primary
Caregiver Strain
Caregiver Strain was measured by the MBRC Caregiver Strain Index; scores ranged from 0 - 15 with higher scores indicating more strain.
Time frame: 3 months after baseline
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Home Safety Toolkit | Caregiver Strain | 5.95 units on a scale | Standard Deviation 3.17 |
| Checklist | Caregiver Strain | 6.96 units on a scale | Standard Deviation 3.86 |
p-value: <0.0001MANCOVA
Secondary
Care Recipient Risky Behaviors and Accidents
The Risky Behavior Checklist listed common risky behaviors and accidents exhibited by care recipients with dementia based on previous research. Potential scores ranged from 0 - undetermined. The maximum score is undetermined because the measure represents the caregiver count of the number of times an incident occurred. In this study, sum scores ranged from 0 - 180.
Time frame: 3 months after baseline
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Home Safety Toolkit | Care Recipient Risky Behaviors and Accidents | 33.95 number of risky behaviors and accidents | Standard Deviation 32.57 |
| Checklist | Care Recipient Risky Behaviors and Accidents | 37.44 number of risky behaviors and accidents | Standard Deviation 37.04 |
p-value: <0.0001MANCOVA