WASHINGTON, DC—A simple $76 toolkit with items typically found at any neighborhood hardware store has shown promise in increasing home safety for Alzheimer’s disease patients and reducing the strain on overburdened caregivers.
It could be solution to one of the greatest difficulties faced by VA physicians who treat Alzheimer’s: Instructing caregivers—usually a family member—in how to be constantly vigilant about the patient without overwhelming the caregivers with clinical data.
The goal of Scott Trudeau, PhD, an occupational therapist working through VA’s New England Geriatric Research, Education and Clinical Center, was to find an intervention that gave caregivers more control over the patient without increasing stress. The result was simple and inexpensive set of tools designed to decrease accidents and risky behavior in the home, and to help combat the wandering behavior specific to Alzheimer’s and other forms of dementia.
“We needed to target outcomes for both the caregiver and care receiver,” Trudeau said, describing his work at the annual VA Health Services R&D conference. “If we could increase adherence to home safety recommendations and increase self-efficacy and lower caregiver strain, that could have an impact on the safety and care environment for the care receiver.”
The first step was providing caregivers with easy-to-read worksheets designed to keep a person with memory loss safe at home. The worksheets described changes that, according to previous research, families are comfortable making. The information was presented in bite-size steps with abundant illustrations to increase usability for the caregiver.
For example, in a section on kitchen safety, one instruction is simply: “Remove scissors and knives from counters and drawers.”
Caregivers are also provided with a toolkit filled with items available at any home maintenance store. Inside the toolkit, caregivers find a motion sensor, slide bolt lock, grab bars, colored duct tape, stove knob covers, rubber tub mat, tub transfer bench, and nightlights. Instructions for how these materials are installed and used, and why they are important, are included.
Trudeau tested the intervention with 160 families. Alzheimer’s patients were on average 80 years old with a mini mental state exam (MMSR) score of less than 24. Both those families using the intervention and those without received biweekly telephone calls from study personnel—usually Trudeau—to track risky behavior and offer support.
“I would ask about how many times they tried to get out, not just how many times they succeeded,” Trudeau said. “And I would often ask the question: How many times did you find yourself having to look for him, that he wasn’t where you thought he was?”
The initial results from this pilot project are positive. The study found that caregivers in the intervention group showed higher home safety, higher caregiver self-efficacy, and lower caregiver strain. Alzheimer’s patients had significantly lower accidents and risky behavior. In addition, the cost-effective, practical intervention goes well with VA’s Patient-Aligned Care Team (PACT) model. At the HSR&D conference, the research sparked interest among physicians looking for new ways to support caregivers.
“The house of cards that many people are living in when they’re caring for someone with AD at home can be pretty unstable,” Trudeau said. “An ounce of prevention can go a long way to supporting folks in keeping their loved ones at home.”
The Phone Call Variable
A concern raised at the conference was how the biweekly phone calls may have skewed the study’s findings. A call from a physician of Trudeau’s expertise and stature every two weeks could, by itself, improve the morale and vigilance of a caregiver.
The calls were necessary, Trudeau said, because researchers found that caregivers could not always be relied upon to keep an accurate written log. However, he stressed that any support and coaching that occurred during the calls was driven by the caregivers.
“I never initiated,” Trudeau said. “I would ask my questions and ask if they had any questions.” While it was not tracked, Trudeau estimates that less than 30% of the calls included any substantial support.
He also noted that the cost of his time in making the calls increased the total cost of the intervention significantly, but that if the program were expanded, lower-cost VA employees could make the telephone calls instead.
Trudeau and his colleagues are applying for funding from VA’s Quality Enhancement Research Initiative to proceed with implementation of the intervention on a larger scale.
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