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The Catholic Foundation of Alzheimer’s Disease & Related Dementia, TAIWAN

Occupational Therapy f or Families Caring f or People w ith Dementia: Preliminary Effects a nd Relating Factors. The Catholic Foundation of Alzheimer’s Disease & Related Dementia, TAIWAN S - H Tang, O - I Chio, H - C Chou, L - H Chen, H - F Mao Presented by: O - I , Grace Chio.

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The Catholic Foundation of Alzheimer’s Disease & Related Dementia, TAIWAN

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  1. Occupational Therapy for Families Caring for People with Dementia:Preliminary Effects and Relating Factors The Catholic Foundation of Alzheimer’s Disease & Related Dementia, TAIWAN S-H Tang, O-I Chio, H-C Chou, L-H Chen, H-F Mao Presented by: O-I, Grace Chio The Catholic Foundation of Alzheimer’s Disease and Related Dementia

  2. Conflict of Interest Disclosure<CHIO> <OII>, <Master> Has no real or apparent conflicts of interest to report.

  3. Introduction Occupational therapy for client with dementia in community The Home Environmental Skill-building Program ADL/IADL, BPSD, etc. [care recipients] Caring efficacy, emotional wellbeing, etc. [caregivers] (Gitlin, Winter, Corcoran, Dennis, Schonfeld, & Hauch, 2003; Gitlin et al., 2003; 2001) Applicationof OT home program for dementia in Taiwan need cultural modification & evidence building Possible variables affect the effect of intervention Caregiver readiness (CGR) Clinical Dementia Rating (CDR)

  4. Objectives Establish andassess the efficacy of a culturally-appropriated OT home treatment protocol for families caring for people with dementia Explore the possible influence of caregiverreadiness CGR andcare recipient CDR stage on the treatment effect

  5. Participants Sources of case finding Gerontopsychiatry & Neurology clinics in two hospitals in North Taiwan Long-term care centres of Taipei City & New Taipei City Inclusion criteria (individuals with dementia) Community-dwelling elder people aged 65 y/o & above Diagnosized with dementia Non wheelchair- or bed-ridden Fifty-four families caring for people with dementia Simple randomization (lottery drawing) Treatment group: 29 families Control group: 25 families

  6. * p<.05

  7. Assessment - dependent variables Care recipients Cognitive function Mini-mental state examination (MMSE) Activity of daily living (ADL) ADL questionnaire (ADLQ) Behavioral and Psychiatric Symptoms of Dementia (BPSD) Neuropsychiatric Inventory Questionnaire (NPI-Q) Quality of life (QOL) Quality of Life in Alzheimer's Disease (QOL-AD) scale Caregivers Caregiver burden Chinese Zarit Burden Interview (CZBI) Caregiving skill Caregiving Skill Inventory Perceived adequacy of social support Instrumental Social Support Inventory • Source: research assistant (blinded) assessment

  8. Assessment - explanatoryvariables Care recipients Clinical Dementia Rating (CDR) Source: medical record Caregivers Caregiver readiness (CGR) Source: occupational therapist (blinded) evaluation

  9. Caregiver Readiness (CGR) Precontemplation (CRG 1) Loose ideas about dementia (“normal aging”, “deliberate rivalry”, etc.) Not accepting the explanation and suggestions Contemplation (CRG 2) No regard to the possibility in improvement Suspicious attitude towards the suggestions Preparation (CRG 3) Clear understanding to the effect of dementia Readied to accept suggestions to change Action and Maintenance (CRG 4) CG actively involves in or even initiate the problem-solving process. (Gitlin & Corcoran, 2005)

  10. Occupational Therapy Protocol Highlights Targeting at the LIFE/ LIVING of care-recipients and caregivers Starting with the most significant challenge in everyday life Collaboration with caregiver Problem-oriented approach Discussion, implementation, reflection Understanding, communication skills, environmental strategies, etc. 6-12 times home visits in 3 months Trained occupational therapist 4-year clinical experience, 21-hour training course

  11. Occupational Therapy Protocol

  12. Experiment flow chart

  13. Data analysis Generalized estimated equations (GEE) Advantages: missing date management, appropriate working corr. matrix, & robust standard error Structure: independent, α=.05 Successive analyses I. Treatment effect Time (each time point of pretest, intermediate assessment, posttest) Group (treatment group is compared to control group) Covariates: CDR level, CGR level, availability of hired worker II. CGR stages & treatment efficacy Time; CGR level (CGR 3 is compared to CGR 2) III. CDR stages & treatment efficacy Time; CDR level (CDR 1 is compared to CDR 2)

  14. Results – Care recipients • Treatment(group) effect • n = 54 [treatment gp: 29] • Comparison group: Control gp

  15. Results – Caregivers * p<.05

  16. Results – Caregivers * p<.05

  17. Discussion OT home program as an effective treatment Most measures showed positive trend BPSD severity: related to the course of disease and medication BPSD-related distress was relieved to a greater extend in tx group The goals of building up collaboration with and empowering the caregivers were achieved Preliminary results Longer service duration may be needed follow-up & supportive intervention Including more participants in various locations (representation)

  18. Results – Care recipients [CGR] • n = 27 [treatment group] • excluding 2 participants of CGR 1 • 19(CGR2),8 (CGR 3) • Comparison group • CGR 2 (less readied)

  19. Results – Care recipients [CGR]

  20. Results – Caregivers [CGR] * p<.05

  21. Results – Care recipients [CDR] • n = 28 [treatment group] • excluding 1 participant of CDR 3 • 7(CDR1),19 (CDR 2) • Comparison group • CDR 2 (more severe)

  22. Results – Care recipients [CDR]

  23. Results – Caregivers [CDR] * p<.05

  24. Discussion CGR stage andtreatment efficacy Caregivers with higher CGR achieved better results in all care-recipient measures and caregiving skills Caregiving skills Problem preventing & solving (life-style redesign, communication, etc.) Beneficial to both the care-recipients and caregivers Effect of caregiving “The change of quality, not quantity” –quantitative results e.g. Elimination of uncertainty, initiation of alertness & “sense of crisis”

  25. Discussion CDR stage and treatment efficacy Providing effective & appropriate intervention at each CDR stage Early dementia stage Alleviation of caregiving effect, improvement of skills, & introducing resources Maintaining care-recipient cognitive function and QOL (life-style redesign and encouraging activity participation) Further degeneration in function and more symptoms shown ADL problems and BPSD are then addressed & actively solved

  26. Conclusion The effectiveness of the OT home program is supported Caregivers and care-recipients at various stages along the course may be experiencing different challenges and needs Further investigation into such issue may help identifying tailored services for the families caring for people with dementia

  27. References Gitlin, L. N., & Corcoran, M. (2005). Occupational therapy and dementia care: the home environmental skill-building program for individuals and families. AOTA Press: Bethesda Gitlin, L. N., Corcoran, M., Winter, L., Boyce, A., &Hauck,W.W. (2001). A Randomized, controlled trial of a home environmental Intervention: effect on efficacy and upset in caregivers and on daily Function of persons With dementia. The Gerontologist, 41(1), 4–14. Gitlin, L. N.,Hauck,W.,Dennis, M. P, & Winter, L.(2005).Maintenance of effects of the home environmental skill-building program for family caregivers and individuals with Alzheimer’s Disease and related disorders. Journal of Gerontology, 60A(3),368-374. Zeger, S. L., Liang, K. Y., & Albert, P. S. (1988). Models for longitudinal data: a generalized estimated equation approach.Biometrics, 44, 1049-1060.

  28. Thank you for your attention!

  29. Generalized estimated equated (GEE) Superiorities to the ordinary least squares approach correct for clustering in the standard errors (robust standard errors) use all available pairs even when some data are missing various working correlations are available for choosing to better account for the dependency of observations Independent, exchangeable, autoregressive, unstructured, etc.

  30. Occupational Therapy Protocol • Mr. X (care-recipient) & Ms. X (caregiver) • Ms. X mentioned that her husband has declined to read newspaper, one of his most favorite activities • Therapist tried the activities with Mr. X • Strategies: directing Mr. X’s attention to photos & large simple headlines • Encourage Ms. X to try using the strategies

  31. Occupational Therapy Protocol • Acknowledge the effort of Ms. X & allow reflection • Proceed to the next problem (ADLs) • Ms. X mentioned her husband’s difficulties managing the steps of bathing & recognizing his own toothbrush • Therapist discussed with Ms. X • Strategies: (1) memo with pictures & simple written instructions; (2) removal of other toothbrushes

  32. Occupational Therapy Protocol • Identifying the value of simple instruction & environment arrangement • Minimizing the impact of forgetfulness & other symptoms restoring greatest life control • Put everything need to bring with when going out into one single bag • Cabinet with less drawers • Simple memo & day schedule

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